Emergency Medicine EOR Practice
+ Drop Arm Test = ? - ANS-Rotator Cuff Tear
*(specific?)*
23 year old pregnant female presents with high blood pressure and protein in her urine. as you
speak to her she begins having a seizure. what do you do - ANS-give magnesium and
immediate delivery
32 year old male presents with an open laceration from a shovel he was using to garden. he
states that he has not received a tetanus vaccine in the past. based on his answer, what should
you do? - ANS-give Tdap *AND* the immunoglobulin for coverage of the dirty wound
5 H's: - ANS--*H*ypovolemia
-*H*ypoxia
-*H*ydrogen ion (acidosis)
-*H*ypo-/*H*yper*kalemia*
-*H*ypothermia
5 T's: - ANS--*T*ension pneumothorax
-*T*amponade (cardiac)
-*T*oxins
-*T*hrombosis (pulmonary)
-*T*hrombosis (coronary)
A 21-year-old college student is brought to the ED by her roommate who states that the patient
has been very sleepy today. She has a history of diabetes and has not refilled her medication in
over a week. Her BP is 95/61 mm Hg, HR is 132 beats per minute, temperature is 99.7°F, and
RR is 20 breaths per minute. Her fingerstick glucose is 530 mg/dL. Which of the following
choices most closely matches what you would expect to find on her arterial blood gas with
electrolytes and urinalysis?
a. pH 7.38, anion gap 5, normal urinalysis
b. pH 7.57, anion gap 21, presence of glucose and leukocytes in urine
c. pH 7.47, anion gap 12, presence of glucose and ketones in urine
d. pH 7.26, anion gap 12, presence of glucose and ketones in urine
e. pH 7.26, anion gap 21, presence of glucose and ketones in urine - ANS-E This patient
presents with an anion gap metabolic acidosis, glucosuria, and ketonuria, which is consistent
with diabetic ketoacidosis (DKA). DKA is an acute, life-threatening disorder occurring in patients
with insulin insufficiency. It results in hyperglycemia, ketosis, and osmotic diuresis and clinically
presents with gastrointestinal
, (GI) distress, polyuria, fatigue, dehydration, mental confusion, lethargy, or coma. When the
diagnosis of DKA is clinically suspected and hyperglycemia is confirmed by elevated fingerstick
glucose, the results of a blood gas and
urinalysis confirm the diagnosis. In DKA, the liver metabolizes free fatty acids into ketone bodies
for alternative fuel in the setting of cellular glucose underutilization. The result is ketonuria and
anion gap metabolic acidosis (pH < 7.4 and HCO3 < 24). Glucosuria, the result of
hyperglycemiarelated osmotic diuresis, is another manifestation of DKA. The anion gap is
calculated by subtracting Cl− and HCO3 − from Na. A normal anion gap is 8 to 12 mEq/L. An
elevated gap is a result of an
increased concentration of unmeasured anions. In DKA, the elevated anion gap is caused by
the production of ketones.
*pCO2 is not part of the diagnostic criteria
a 34 year old female presents with RUQ pain, n/v. on exam you feel a palpable gallbladder. -
ANS-put in NG tube with continuous suction. npo. iv fluids
A 45-year-old man is brought into the ED after a head-on motor vehicle collision. His BP is
85/45 mm Hg and HR is 130 beats per minute. He is speaking coherently. His breath sounds
are equal bilaterally. After 2 L of fluid resuscitation, his BP is 80/40 mm Hg. A FAST examination
reveals fluid in Morison pouch. Which of the following organs is most likely to be injured in blunt
abdominal trauma? *what would you administer first?*
a. Liver
b. Spleen
c. Kidney
d. Small bowel
e. Bladder - ANS-B Blunt trauma is the most common mechanism of injury seen in the United
States. The forces exerted on the abdomen put all of the organs at risk for injury. Motor vehicle
collisions with another vehicle or with pedestrians are the major causes of blunt abdominal
trauma. The spleen is the organ most often injured, and in approximately 66% of these cases, it
is the only damaged intraperitoneal organ.
*administer IV fluids since the patient is hypOtensive*
A 77-year-old female has been treated for the last two weeks for a community-acquired
pneumonia. While on oral azithromycin, the patient continues to develop fevers, some as high
as 1030F. Her oral intake has decreased, and her effort to breathe continues to be labored. On
examination, the patient continues to have rhonchi and some mild rales that are best
appreciated in the anterior right lung region. A follow-up chest x-ray reveals a consolidated
infiltrate of the right middle lobe. A CT of the chest reveals a loculated, fluid-filled area of the
right middle lobe with no evidence of a foreign body. Based on these new findings, what is the
most likely pathogen causing this ongoing infection?
A. Staphylococcal aureus
B. Pseudomonas aeurginosa
+ Drop Arm Test = ? - ANS-Rotator Cuff Tear
*(specific?)*
23 year old pregnant female presents with high blood pressure and protein in her urine. as you
speak to her she begins having a seizure. what do you do - ANS-give magnesium and
immediate delivery
32 year old male presents with an open laceration from a shovel he was using to garden. he
states that he has not received a tetanus vaccine in the past. based on his answer, what should
you do? - ANS-give Tdap *AND* the immunoglobulin for coverage of the dirty wound
5 H's: - ANS--*H*ypovolemia
-*H*ypoxia
-*H*ydrogen ion (acidosis)
-*H*ypo-/*H*yper*kalemia*
-*H*ypothermia
5 T's: - ANS--*T*ension pneumothorax
-*T*amponade (cardiac)
-*T*oxins
-*T*hrombosis (pulmonary)
-*T*hrombosis (coronary)
A 21-year-old college student is brought to the ED by her roommate who states that the patient
has been very sleepy today. She has a history of diabetes and has not refilled her medication in
over a week. Her BP is 95/61 mm Hg, HR is 132 beats per minute, temperature is 99.7°F, and
RR is 20 breaths per minute. Her fingerstick glucose is 530 mg/dL. Which of the following
choices most closely matches what you would expect to find on her arterial blood gas with
electrolytes and urinalysis?
a. pH 7.38, anion gap 5, normal urinalysis
b. pH 7.57, anion gap 21, presence of glucose and leukocytes in urine
c. pH 7.47, anion gap 12, presence of glucose and ketones in urine
d. pH 7.26, anion gap 12, presence of glucose and ketones in urine
e. pH 7.26, anion gap 21, presence of glucose and ketones in urine - ANS-E This patient
presents with an anion gap metabolic acidosis, glucosuria, and ketonuria, which is consistent
with diabetic ketoacidosis (DKA). DKA is an acute, life-threatening disorder occurring in patients
with insulin insufficiency. It results in hyperglycemia, ketosis, and osmotic diuresis and clinically
presents with gastrointestinal
, (GI) distress, polyuria, fatigue, dehydration, mental confusion, lethargy, or coma. When the
diagnosis of DKA is clinically suspected and hyperglycemia is confirmed by elevated fingerstick
glucose, the results of a blood gas and
urinalysis confirm the diagnosis. In DKA, the liver metabolizes free fatty acids into ketone bodies
for alternative fuel in the setting of cellular glucose underutilization. The result is ketonuria and
anion gap metabolic acidosis (pH < 7.4 and HCO3 < 24). Glucosuria, the result of
hyperglycemiarelated osmotic diuresis, is another manifestation of DKA. The anion gap is
calculated by subtracting Cl− and HCO3 − from Na. A normal anion gap is 8 to 12 mEq/L. An
elevated gap is a result of an
increased concentration of unmeasured anions. In DKA, the elevated anion gap is caused by
the production of ketones.
*pCO2 is not part of the diagnostic criteria
a 34 year old female presents with RUQ pain, n/v. on exam you feel a palpable gallbladder. -
ANS-put in NG tube with continuous suction. npo. iv fluids
A 45-year-old man is brought into the ED after a head-on motor vehicle collision. His BP is
85/45 mm Hg and HR is 130 beats per minute. He is speaking coherently. His breath sounds
are equal bilaterally. After 2 L of fluid resuscitation, his BP is 80/40 mm Hg. A FAST examination
reveals fluid in Morison pouch. Which of the following organs is most likely to be injured in blunt
abdominal trauma? *what would you administer first?*
a. Liver
b. Spleen
c. Kidney
d. Small bowel
e. Bladder - ANS-B Blunt trauma is the most common mechanism of injury seen in the United
States. The forces exerted on the abdomen put all of the organs at risk for injury. Motor vehicle
collisions with another vehicle or with pedestrians are the major causes of blunt abdominal
trauma. The spleen is the organ most often injured, and in approximately 66% of these cases, it
is the only damaged intraperitoneal organ.
*administer IV fluids since the patient is hypOtensive*
A 77-year-old female has been treated for the last two weeks for a community-acquired
pneumonia. While on oral azithromycin, the patient continues to develop fevers, some as high
as 1030F. Her oral intake has decreased, and her effort to breathe continues to be labored. On
examination, the patient continues to have rhonchi and some mild rales that are best
appreciated in the anterior right lung region. A follow-up chest x-ray reveals a consolidated
infiltrate of the right middle lobe. A CT of the chest reveals a loculated, fluid-filled area of the
right middle lobe with no evidence of a foreign body. Based on these new findings, what is the
most likely pathogen causing this ongoing infection?
A. Staphylococcal aureus
B. Pseudomonas aeurginosa
