emergency medicine rosh mock exam with
| | | | | |
correct answers |
A |32-year-old |woman |presents |with |persistent |nausea |over |the |last |two |weeks. |She |is |approximately |
10 |weeks |pregnant. |She |has |been |able |to |tolerate |fluids, |but |has |had |decreased |food |intake. |She |
denies |any |abdominal |or |pelvic |pain |or |vaginal |bleeding. |What |medication |is |considered |first-line |
treatment |for |this |patient? |- |VERIFIED |ANSWER✔✔-*Pyridoxine*:1st |line |tx |for |NAUSEA |in |pregnancy!
-doesn't |help |w/vomiting
-Pyridoxine |is |a |water-soluble |B |complex |vitamin |that |is |necessary |in |the |metabolism |of |lipids, |amino |
acids, |and |carbohydrates
#2:add |antihistamine(benadryl) |or |5HT3 |antagonist(zofran:category |B); |also |meclizine(category |B), |
dimendydrinate
#3: |methylprednisolone |or |chlorpromazine
-Prochlorperazine: |category |C
What |electrolyte |abnormalities |can |be |seen |in |patients |with |hyperemesis |gravidarum? |- |VERIFIED |
ANSWER✔✔-hypokalemia |w/hypochloremic |metabolic |alkalosis
A |39-year-old |man |presents |to |the |Emergency |Department |with |left |hand |pain. |He |denies |recent |
trauma, |genital |or |oral |lesions, |or |fever. |His |medical |history |is |significant |for |diabetes |mellitus |and |
tobacco |abuse. |His |examination |is |shown |above. |Which |of |the |following |is |the |most |appropriate |
initial |therapy |for |this |patient? |- |VERIFIED |ANSWER✔✔-*I&D*
DX: |felon=pyogenic |infection |or |ABSCESS |of |the |digital |subcutaneous |tissue |and |pulp
-caused |by |*Staph |aureus*
-.If |left |untreated, |the |infection |may |spread |to |the |flexor |tendon |sheath |leading |to |flexor |
tenosynovitis, |or |to |the |bone |leading |to |osteomyelitis
True |or |false: |Incision |and |drainage |should |be |avoided |in |cases |of |herpetic |whitlow. |- |VERIFIED |
ANSWER✔✔-True, |as |this |can |lead |to |secondary |bacterial |infection
,An |18-year-old |man |is |brought |in |by |EMS |following |a |motor |vehicle |collision |with |prolonged |
extrication. |His |vitals |on |arrival |are |HR |110, |BP |100/60, |RR |20. |He |is |noted |to |have |*periorbital |
ecchymosis |with |tarsal |plate |sparing("raccoon |eyes")* |on |physical |examination. |Which |of |the |
following |is |the |most |likely |diagnosis? |- |VERIFIED |ANSWER✔✔-*Basilar |skull |fracture*
-PE: |mastoid |ecchymosis |(Battle |sign), |hemotympanum, |CSF |leaks |(presenting |as |otorrhea |or |
rhinorrhea), |& |periorbital |ecchymosis |with |tarsal |plate |sparing |("raccoon |eyes")
-Any |patient |with |a |suspected |basilar |skull |fracture |should |undergo |*a |head |CT* |to |look |for |extra-
axial |hematoma |formation |as |well |as |cerebral |damage, |which |is |common
-Extra-axial |hematomas |associated |with |a |basilar |skull |fracture |are |a |*neurosurgical |emergency*
-CSF |leaks |in |the |setting |of |basilar |skull |fractures |are |typically |self |limited
Orbital |floor |fractures |- |VERIFIED |ANSWER✔✔-"blowout |fractures," |most |often |occur |due |to |direct |
trauma |to |the |eye
-Periorbital |ecchymosis |in |this |setting |will |also |not |show |tarsal |plate |sparing |as |seen |with |basilar |skull |
fractures
-teardrop |sign: |herniated |tissue |and |muscle
globe |rupture |- |VERIFIED |ANSWER✔✔-=full |thickness |injury |to |sclera |
-traumatic |vision-threatening |emergency |that |can |present |with |corneal |or |scleral |lacerations, |bullous |
subconjunctival |hemorrhage, |iris |abnormalities |("teardrop |pupil"), |or |uveal |prolapse
-positive |seidel |test: |aqueous |flow |on |fluorescein |testing
-tx: |eye |shield, |avoid |tonometry, |elevate |head |of |bed, |NPO, |antiemetics, |analgesia, |antibiotics, |
emergent |ophthalmology |consult
What |bone |is |most |commonly |involved |in |basilar |skull |fractures? |- |VERIFIED |ANSWER✔✔-temporal |
bone
What |basic |metabolic |panel |abnormality |is |associated |with |upper |GI |bleeding? |- |VERIFIED |
ANSWER✔✔-Elevated |BUN/Creatinine |ratio
A |77-year-old |woman |presents |with |an |acute |change |in |mental |status. |She |has |a |history |of |diabetes |
mellitus, |hypertension, |and |prior |ischemic |stroke. |Home |medications |include |aspirin, |clopidogrel, |
lisinopril, |and |glyburide. |She |was |found |by |family |to |be |confused |and |diaphoretic. |Her |blood |sugar |
was |32 |mg/dL. |She |was |given |50 |grams |of |intravenous |dextrose |by |emergency |personnel |with |a |
, return |to |her |baseline |mental |status. |On |arrival |to |the |emergency |department, |her |blood |sugar |is |185
|mg/dL. |When |asked, |she |thinks |she |may |have |accidentally |taken |an |extra |dose |of |her |glyburide |this |
morning. |She |is |currently |asymptomatic |and |asking |when |she |can |go |home. |Which |of |the |following |is |
the |most |appropriate |management |of |this |patient? |- |VERIFIED |ANSWER✔✔-*Admission |for |24-hour |
observation*
-b/c |the |hypoglycemic |effect |of |*sulfonylureas* |lasts |up |to |24 |hours |allowing |for |once-daily |dosing
-work |by |promoting |endogenous |insulin |secretion |by |the |pancreas
What |is |trench |foot? |- |VERIFIED |ANSWER✔✔-Prolonged |wet |and |cold |(but |nonfreezing) |exposure |
causing |reversible |neurovascular |injury
What |medication |is |indicated |in |cases |of |recurrent |hypoglycemia |associated |with |sulfonylurea |
overdose? |- |VERIFIED |ANSWER✔✔-Octreotide, |a |somatostatin |analogue |that |inhibits |release |of |insulin
|from |the |pancreatic |beta-islet |cells
A |27-month-old |girl |presents |to |the |ED |with |parents |after |one |episode |of |generalized |convulsions. |
Parents |note |she |has |was |initially |lethargic |but |then |cleared |to |baseline. |Temperature |in |the |ED |is |
102.9°F. |As |you |move |to |examine |her, |she |has |another |generalized |tonic |clonic |seizure. |It |rapidly |
terminates |without |intervention |and |she |returns |to |baseline. |Which |of |the |following |is |the |next |most |
important |step |in |this |child's |workup? |- |VERIFIED |ANSWER✔✔-*Observation |& |Reassurance* |if |
patient |remains |at |mental |baseline |and |don't |continually |have |seizures |requiring |intervention
DX: |COMPLEX |Febrile |seizure
-any |event |not |meeting |the |criteria |for |a |simple |febrile |seizure
-should |raise |suspicion |for |serious |disease |such |as |meningitis, |intracranial |hemorrhage, |or |intracranial |
mass
- |should |prompt |providers |to |consider |further |workup |with |laboratory |testing, |lumbar |puncture, |EEG, |
and |neuroimaging; |*however, |if |the |patient |returns |to |baseline |despite |repeat |seizures |(2-3), |then |
this |testing |is |not |required*
What |would |you |expect |to |find |on |the |cerebrospinal |fluid |analysis |of |a |patient |with |bacterial |
meningitis? |- |VERIFIED |ANSWER✔✔-Elevated |white |blood |cell |count, |elevated |protein, |low |glucose, |
organisms |on |gram |stain
simple |febrile |seizure |- |VERIFIED |ANSWER✔✔-(1) |generalized |tonic-clonic |seizure
(2) |occurring |in |the |appropriate |age |group |of |age |6 |months |to |5 |years
| | | | | |
correct answers |
A |32-year-old |woman |presents |with |persistent |nausea |over |the |last |two |weeks. |She |is |approximately |
10 |weeks |pregnant. |She |has |been |able |to |tolerate |fluids, |but |has |had |decreased |food |intake. |She |
denies |any |abdominal |or |pelvic |pain |or |vaginal |bleeding. |What |medication |is |considered |first-line |
treatment |for |this |patient? |- |VERIFIED |ANSWER✔✔-*Pyridoxine*:1st |line |tx |for |NAUSEA |in |pregnancy!
-doesn't |help |w/vomiting
-Pyridoxine |is |a |water-soluble |B |complex |vitamin |that |is |necessary |in |the |metabolism |of |lipids, |amino |
acids, |and |carbohydrates
#2:add |antihistamine(benadryl) |or |5HT3 |antagonist(zofran:category |B); |also |meclizine(category |B), |
dimendydrinate
#3: |methylprednisolone |or |chlorpromazine
-Prochlorperazine: |category |C
What |electrolyte |abnormalities |can |be |seen |in |patients |with |hyperemesis |gravidarum? |- |VERIFIED |
ANSWER✔✔-hypokalemia |w/hypochloremic |metabolic |alkalosis
A |39-year-old |man |presents |to |the |Emergency |Department |with |left |hand |pain. |He |denies |recent |
trauma, |genital |or |oral |lesions, |or |fever. |His |medical |history |is |significant |for |diabetes |mellitus |and |
tobacco |abuse. |His |examination |is |shown |above. |Which |of |the |following |is |the |most |appropriate |
initial |therapy |for |this |patient? |- |VERIFIED |ANSWER✔✔-*I&D*
DX: |felon=pyogenic |infection |or |ABSCESS |of |the |digital |subcutaneous |tissue |and |pulp
-caused |by |*Staph |aureus*
-.If |left |untreated, |the |infection |may |spread |to |the |flexor |tendon |sheath |leading |to |flexor |
tenosynovitis, |or |to |the |bone |leading |to |osteomyelitis
True |or |false: |Incision |and |drainage |should |be |avoided |in |cases |of |herpetic |whitlow. |- |VERIFIED |
ANSWER✔✔-True, |as |this |can |lead |to |secondary |bacterial |infection
,An |18-year-old |man |is |brought |in |by |EMS |following |a |motor |vehicle |collision |with |prolonged |
extrication. |His |vitals |on |arrival |are |HR |110, |BP |100/60, |RR |20. |He |is |noted |to |have |*periorbital |
ecchymosis |with |tarsal |plate |sparing("raccoon |eyes")* |on |physical |examination. |Which |of |the |
following |is |the |most |likely |diagnosis? |- |VERIFIED |ANSWER✔✔-*Basilar |skull |fracture*
-PE: |mastoid |ecchymosis |(Battle |sign), |hemotympanum, |CSF |leaks |(presenting |as |otorrhea |or |
rhinorrhea), |& |periorbital |ecchymosis |with |tarsal |plate |sparing |("raccoon |eyes")
-Any |patient |with |a |suspected |basilar |skull |fracture |should |undergo |*a |head |CT* |to |look |for |extra-
axial |hematoma |formation |as |well |as |cerebral |damage, |which |is |common
-Extra-axial |hematomas |associated |with |a |basilar |skull |fracture |are |a |*neurosurgical |emergency*
-CSF |leaks |in |the |setting |of |basilar |skull |fractures |are |typically |self |limited
Orbital |floor |fractures |- |VERIFIED |ANSWER✔✔-"blowout |fractures," |most |often |occur |due |to |direct |
trauma |to |the |eye
-Periorbital |ecchymosis |in |this |setting |will |also |not |show |tarsal |plate |sparing |as |seen |with |basilar |skull |
fractures
-teardrop |sign: |herniated |tissue |and |muscle
globe |rupture |- |VERIFIED |ANSWER✔✔-=full |thickness |injury |to |sclera |
-traumatic |vision-threatening |emergency |that |can |present |with |corneal |or |scleral |lacerations, |bullous |
subconjunctival |hemorrhage, |iris |abnormalities |("teardrop |pupil"), |or |uveal |prolapse
-positive |seidel |test: |aqueous |flow |on |fluorescein |testing
-tx: |eye |shield, |avoid |tonometry, |elevate |head |of |bed, |NPO, |antiemetics, |analgesia, |antibiotics, |
emergent |ophthalmology |consult
What |bone |is |most |commonly |involved |in |basilar |skull |fractures? |- |VERIFIED |ANSWER✔✔-temporal |
bone
What |basic |metabolic |panel |abnormality |is |associated |with |upper |GI |bleeding? |- |VERIFIED |
ANSWER✔✔-Elevated |BUN/Creatinine |ratio
A |77-year-old |woman |presents |with |an |acute |change |in |mental |status. |She |has |a |history |of |diabetes |
mellitus, |hypertension, |and |prior |ischemic |stroke. |Home |medications |include |aspirin, |clopidogrel, |
lisinopril, |and |glyburide. |She |was |found |by |family |to |be |confused |and |diaphoretic. |Her |blood |sugar |
was |32 |mg/dL. |She |was |given |50 |grams |of |intravenous |dextrose |by |emergency |personnel |with |a |
, return |to |her |baseline |mental |status. |On |arrival |to |the |emergency |department, |her |blood |sugar |is |185
|mg/dL. |When |asked, |she |thinks |she |may |have |accidentally |taken |an |extra |dose |of |her |glyburide |this |
morning. |She |is |currently |asymptomatic |and |asking |when |she |can |go |home. |Which |of |the |following |is |
the |most |appropriate |management |of |this |patient? |- |VERIFIED |ANSWER✔✔-*Admission |for |24-hour |
observation*
-b/c |the |hypoglycemic |effect |of |*sulfonylureas* |lasts |up |to |24 |hours |allowing |for |once-daily |dosing
-work |by |promoting |endogenous |insulin |secretion |by |the |pancreas
What |is |trench |foot? |- |VERIFIED |ANSWER✔✔-Prolonged |wet |and |cold |(but |nonfreezing) |exposure |
causing |reversible |neurovascular |injury
What |medication |is |indicated |in |cases |of |recurrent |hypoglycemia |associated |with |sulfonylurea |
overdose? |- |VERIFIED |ANSWER✔✔-Octreotide, |a |somatostatin |analogue |that |inhibits |release |of |insulin
|from |the |pancreatic |beta-islet |cells
A |27-month-old |girl |presents |to |the |ED |with |parents |after |one |episode |of |generalized |convulsions. |
Parents |note |she |has |was |initially |lethargic |but |then |cleared |to |baseline. |Temperature |in |the |ED |is |
102.9°F. |As |you |move |to |examine |her, |she |has |another |generalized |tonic |clonic |seizure. |It |rapidly |
terminates |without |intervention |and |she |returns |to |baseline. |Which |of |the |following |is |the |next |most |
important |step |in |this |child's |workup? |- |VERIFIED |ANSWER✔✔-*Observation |& |Reassurance* |if |
patient |remains |at |mental |baseline |and |don't |continually |have |seizures |requiring |intervention
DX: |COMPLEX |Febrile |seizure
-any |event |not |meeting |the |criteria |for |a |simple |febrile |seizure
-should |raise |suspicion |for |serious |disease |such |as |meningitis, |intracranial |hemorrhage, |or |intracranial |
mass
- |should |prompt |providers |to |consider |further |workup |with |laboratory |testing, |lumbar |puncture, |EEG, |
and |neuroimaging; |*however, |if |the |patient |returns |to |baseline |despite |repeat |seizures |(2-3), |then |
this |testing |is |not |required*
What |would |you |expect |to |find |on |the |cerebrospinal |fluid |analysis |of |a |patient |with |bacterial |
meningitis? |- |VERIFIED |ANSWER✔✔-Elevated |white |blood |cell |count, |elevated |protein, |low |glucose, |
organisms |on |gram |stain
simple |febrile |seizure |- |VERIFIED |ANSWER✔✔-(1) |generalized |tonic-clonic |seizure
(2) |occurring |in |the |appropriate |age |group |of |age |6 |months |to |5 |years
