Emergency Medicine EOR
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1. Bedside echocardiography: A 76-year-old man presents to the emergency
department with shortness of breath and lightheadedness. Vital signs include
blood pressure 70/56 mm Hg, heart rate 124 beats/minute, respiratory rate 22
breaths/minute, and temperature 37.6°C. He has distended neck veins and occa-
sional dropped radial beats. His lungs are clear to auscultation, but his heart sounds
are distant. He has some fullness to palpation of the right upper quadrant of his
abdomen. Which of the following is the most appropriate diagnostic test?
2. Hypertrophic cardiomyopathy: A 23-year-old professional soccer player col-
lapses during a match. He is pulseless, and cardiopulmonary resuscitation is initiat-
ed. Which of the following is the most common cause of sudden death in competitive
athletes?
3. Acetazolamide IV, topical apraclonidine, topical timolol: A 34-year-old woman
presents to the ED with severe right eye pain. The pain began after she entered
a dark movie theatre. On physical exam, you note a mid-dilated pupil (4 mm) and
corneal edema. Which of the following is the correct combination of medications in
the treatment for this process?
4. Discharge home with prednisone and eye lubricant and patch at night: A
46-year-old woman without significant past medical history presents with drooping
of the left side of her face which she noticed this morning when she looked into the
mirror. She is unable to completely close her left eye and cannot raise her eyebrows
on the left side. Her vision is intact. When asked to puff out her cheeks, air leaks out
the left side. The rest of her neurologic exam is normal. Which of the following is the
most appropriate initial management?
5. Subarachnoid hemorrhage: A 35-year-old woman with a history of migraines
and polycystic kidney disease presents to the Emergency Department with a severe,
diffuse headache. The onset was abrupt approximately one hour prior to arrival.
Her vital signs are within normal limits. She has photophobia and phonophobia, as
well as pain with extraocular movements. Which of the following is the most likely
diagnosis?
6. Paronychia: A 55-year-old woman presents with right finger pain. She reports she
habitually bites her nails. On examination, the lateral nail fold and cuticle of the right
ring finger is erythematous, fluctuant and tender to palpation. Which of the following
is the most likely diagnosis?
7. Schizophrenia: A 25-year-old man is brought to the emergency department by
police for bizarre behavior. His family arrives and states that his behavior changed
about eight months ago. He does not abuse drugs or alcohol. On examination, he
has a flat affect and appears to be responding to internal stimuli. His speech is
disorganized and he says, "I've been running from the Russians who are trying to
, Emergency Medicine EOR
Study online at https://quizlet.com/_9ngqae
steal my thoughts." His laboratory and urine studies are unremarkable. What is the
most likely diagnosis?
8. Inspiratory arrest with right upper quadrant palpation: A 44-year-old woman
presents to the emergency department with one week of crampy abdominal pain
that is worse after she eats. She denies alcohol consumption or tobacco abuse. On
physical examination, she is overweight and has epigastric and right upper quadrant
abdominal tenderness to palpation. Which of the following examination findings is
most consistent with cholecystitis?
9. Atropine: A 50-year-old woman presents to the emergency department following
a syncopal episode. On physical exam she is diaphoretic. She is alert and oriented.
Her blood pressure is 90/50 mm Hg and respirations are 12 per minute. Her rhythm
strip is shown above. What is the most appropriate pharmacologic treatment for this
patient's condition?
10. Permethrin: A 14-year-old boy presents complaining of intense pruritus in his
groin, axillae, and between his fingers after returning home from 4-week summer
camp one week ago. He reports several other campers had similar symptoms. On
exam, you note excoriations in the inguinal region and axillae, surrounding scattered
erythematous papules. Which of the following is the most appropriate treatment?
11. Urinary retention: Which of the following is the most sensitive finding in cauda
equina syndrome?
12. Central retinal artery occlusion: A 77-year-old woman presents to the ED with
acute painless vision loss. On funduscopic exam, you note the above. Which of the
following is the most likely diagnosis?
13. Aspirin: A 56-year-old woman with a history of hypertension, diabetes mellitus,
and hypercholesterolemia presents with acute substernal chest pain that is worse
with exertion and associated with nausea and shortness of breath. Her sister and
her mother both had "heart attacks" before age 55 years. Which of the following
offers a proven mortality benefit in acute coronary syndrome?
14. Sigmoid volvulus: A 75-year-old man with a long-standing history of consti-
pation presents complaining of abdominal pain for the last two days. He is now
experiencing abdominal distention, constipation, and inability to pass gas for the last
12 hours. On examination, his abdomen is distended and tympanitic to percussion.
You obtain an upright abdominal X-ray as seen above. What is the most likely
diagnosis?
15. Hypercalcemia: A 65-year-old man presents to the ED with diffuse bone pain,
abdominal cramping, and severe constipation. He is currently undergoing dialysis
for end-stage renal disease but has not been to dialysis this week. Physical exam
reveals a lethargic man with diffuse abdominal tenderness without rebound or
guarding. Which of the following is the most likely etiology for his symptoms?
, Emergency Medicine EOR
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16. Pulmonary contusion: Which of the following is the most common injury seen
in a child with severe blunt chest trauma such as being struck by a motor vehicle?
17. Chronic obstructive pulmonary disease: A 79-year-old man presents to the
ED complaining of dyspnea. His rhythm strip is shown above. What is the most likely
underlying process?
18. Presence of the cremasteric reflex: Which of the following is one of the most
helpful signs to rule out testicular torsion?
19. Hyphema: A 72-year-old man presents to the emergency department with left
eye pain. Earlier this evening he was involved in a fistfight. He reports getting
punched in the eye with no loss of consciousness. He now has eye pain and blurry
vision. On physical exam his visual acuity is 20/50 in the left eye and 20/20 in the
right eye. His intraocular pressure is 14 on the left. His left eye is shown above. What
is the most likely diagnosis?
20. Glucose of 313: A 42-year-old man with a history of alcohol abuse presents with
severe abdominal pain and vomiting following an alcohol binge. Lab values are as
follows: WBC 14,000, Hgb 10, platelets 98, lipase 9000, AST 200, ALT 107, T. bill
1.6, Na 134, K 5.1, Cr. 3.1, and glucose 313. Which of the following lab values is
associated with increased mortality?
21. Fever: A 38-year-old man presents to the emergency department with low back
pain that began this morning when he rolled over in bed. Throughout the day, he
tried ibuprofen and acetaminophen without relief, which prompted him to come to
the Emergency Department for further evaluation. Which of the following historical
findings is an indication for further investigation?
22. Subglottic narrowing: An 18-month-old boy presents with his father for a cough
and difficulty breathing. The father states that the child has had nasal congestion and
coryza for the last two days. On exam, he has a barking cough, inspiratory stridor,
and a prolonged inspiratory phase. Which of the following would you expect to see
on radiographic evaluation?
23. High output heart failure: A 42-year-old man presents to the ED with racing
heart rate and difficulty breathing. On physical exam, you note bilateral ocular propto-
sis and 3+ non-pitting edema of the bilateral lower extremities. His electrocardiogram
is shown above. Which of the following complications of this disease is this patient
most likely experiencing?
24. Hypotension: A 55-year-old man presents with fever and right upper quadrant
pain. On examination, you note that the patient is jaundiced and slightly altered.
Clinically you make the diagnosis of cholangitis. Which of the following is the final
component of Reynold's pentad?
25. Nitroglycerin: A 58-year-old man presents with chest pain. His electrocardio-
gram is shown above. A right-sided electrocardiogram is also performed and shows
Study online at https://quizlet.com/_9ngqae
1. Bedside echocardiography: A 76-year-old man presents to the emergency
department with shortness of breath and lightheadedness. Vital signs include
blood pressure 70/56 mm Hg, heart rate 124 beats/minute, respiratory rate 22
breaths/minute, and temperature 37.6°C. He has distended neck veins and occa-
sional dropped radial beats. His lungs are clear to auscultation, but his heart sounds
are distant. He has some fullness to palpation of the right upper quadrant of his
abdomen. Which of the following is the most appropriate diagnostic test?
2. Hypertrophic cardiomyopathy: A 23-year-old professional soccer player col-
lapses during a match. He is pulseless, and cardiopulmonary resuscitation is initiat-
ed. Which of the following is the most common cause of sudden death in competitive
athletes?
3. Acetazolamide IV, topical apraclonidine, topical timolol: A 34-year-old woman
presents to the ED with severe right eye pain. The pain began after she entered
a dark movie theatre. On physical exam, you note a mid-dilated pupil (4 mm) and
corneal edema. Which of the following is the correct combination of medications in
the treatment for this process?
4. Discharge home with prednisone and eye lubricant and patch at night: A
46-year-old woman without significant past medical history presents with drooping
of the left side of her face which she noticed this morning when she looked into the
mirror. She is unable to completely close her left eye and cannot raise her eyebrows
on the left side. Her vision is intact. When asked to puff out her cheeks, air leaks out
the left side. The rest of her neurologic exam is normal. Which of the following is the
most appropriate initial management?
5. Subarachnoid hemorrhage: A 35-year-old woman with a history of migraines
and polycystic kidney disease presents to the Emergency Department with a severe,
diffuse headache. The onset was abrupt approximately one hour prior to arrival.
Her vital signs are within normal limits. She has photophobia and phonophobia, as
well as pain with extraocular movements. Which of the following is the most likely
diagnosis?
6. Paronychia: A 55-year-old woman presents with right finger pain. She reports she
habitually bites her nails. On examination, the lateral nail fold and cuticle of the right
ring finger is erythematous, fluctuant and tender to palpation. Which of the following
is the most likely diagnosis?
7. Schizophrenia: A 25-year-old man is brought to the emergency department by
police for bizarre behavior. His family arrives and states that his behavior changed
about eight months ago. He does not abuse drugs or alcohol. On examination, he
has a flat affect and appears to be responding to internal stimuli. His speech is
disorganized and he says, "I've been running from the Russians who are trying to
, Emergency Medicine EOR
Study online at https://quizlet.com/_9ngqae
steal my thoughts." His laboratory and urine studies are unremarkable. What is the
most likely diagnosis?
8. Inspiratory arrest with right upper quadrant palpation: A 44-year-old woman
presents to the emergency department with one week of crampy abdominal pain
that is worse after she eats. She denies alcohol consumption or tobacco abuse. On
physical examination, she is overweight and has epigastric and right upper quadrant
abdominal tenderness to palpation. Which of the following examination findings is
most consistent with cholecystitis?
9. Atropine: A 50-year-old woman presents to the emergency department following
a syncopal episode. On physical exam she is diaphoretic. She is alert and oriented.
Her blood pressure is 90/50 mm Hg and respirations are 12 per minute. Her rhythm
strip is shown above. What is the most appropriate pharmacologic treatment for this
patient's condition?
10. Permethrin: A 14-year-old boy presents complaining of intense pruritus in his
groin, axillae, and between his fingers after returning home from 4-week summer
camp one week ago. He reports several other campers had similar symptoms. On
exam, you note excoriations in the inguinal region and axillae, surrounding scattered
erythematous papules. Which of the following is the most appropriate treatment?
11. Urinary retention: Which of the following is the most sensitive finding in cauda
equina syndrome?
12. Central retinal artery occlusion: A 77-year-old woman presents to the ED with
acute painless vision loss. On funduscopic exam, you note the above. Which of the
following is the most likely diagnosis?
13. Aspirin: A 56-year-old woman with a history of hypertension, diabetes mellitus,
and hypercholesterolemia presents with acute substernal chest pain that is worse
with exertion and associated with nausea and shortness of breath. Her sister and
her mother both had "heart attacks" before age 55 years. Which of the following
offers a proven mortality benefit in acute coronary syndrome?
14. Sigmoid volvulus: A 75-year-old man with a long-standing history of consti-
pation presents complaining of abdominal pain for the last two days. He is now
experiencing abdominal distention, constipation, and inability to pass gas for the last
12 hours. On examination, his abdomen is distended and tympanitic to percussion.
You obtain an upright abdominal X-ray as seen above. What is the most likely
diagnosis?
15. Hypercalcemia: A 65-year-old man presents to the ED with diffuse bone pain,
abdominal cramping, and severe constipation. He is currently undergoing dialysis
for end-stage renal disease but has not been to dialysis this week. Physical exam
reveals a lethargic man with diffuse abdominal tenderness without rebound or
guarding. Which of the following is the most likely etiology for his symptoms?
, Emergency Medicine EOR
Study online at https://quizlet.com/_9ngqae
16. Pulmonary contusion: Which of the following is the most common injury seen
in a child with severe blunt chest trauma such as being struck by a motor vehicle?
17. Chronic obstructive pulmonary disease: A 79-year-old man presents to the
ED complaining of dyspnea. His rhythm strip is shown above. What is the most likely
underlying process?
18. Presence of the cremasteric reflex: Which of the following is one of the most
helpful signs to rule out testicular torsion?
19. Hyphema: A 72-year-old man presents to the emergency department with left
eye pain. Earlier this evening he was involved in a fistfight. He reports getting
punched in the eye with no loss of consciousness. He now has eye pain and blurry
vision. On physical exam his visual acuity is 20/50 in the left eye and 20/20 in the
right eye. His intraocular pressure is 14 on the left. His left eye is shown above. What
is the most likely diagnosis?
20. Glucose of 313: A 42-year-old man with a history of alcohol abuse presents with
severe abdominal pain and vomiting following an alcohol binge. Lab values are as
follows: WBC 14,000, Hgb 10, platelets 98, lipase 9000, AST 200, ALT 107, T. bill
1.6, Na 134, K 5.1, Cr. 3.1, and glucose 313. Which of the following lab values is
associated with increased mortality?
21. Fever: A 38-year-old man presents to the emergency department with low back
pain that began this morning when he rolled over in bed. Throughout the day, he
tried ibuprofen and acetaminophen without relief, which prompted him to come to
the Emergency Department for further evaluation. Which of the following historical
findings is an indication for further investigation?
22. Subglottic narrowing: An 18-month-old boy presents with his father for a cough
and difficulty breathing. The father states that the child has had nasal congestion and
coryza for the last two days. On exam, he has a barking cough, inspiratory stridor,
and a prolonged inspiratory phase. Which of the following would you expect to see
on radiographic evaluation?
23. High output heart failure: A 42-year-old man presents to the ED with racing
heart rate and difficulty breathing. On physical exam, you note bilateral ocular propto-
sis and 3+ non-pitting edema of the bilateral lower extremities. His electrocardiogram
is shown above. Which of the following complications of this disease is this patient
most likely experiencing?
24. Hypotension: A 55-year-old man presents with fever and right upper quadrant
pain. On examination, you note that the patient is jaundiced and slightly altered.
Clinically you make the diagnosis of cholangitis. Which of the following is the final
component of Reynold's pentad?
25. Nitroglycerin: A 58-year-old man presents with chest pain. His electrocardio-
gram is shown above. A right-sided electrocardiogram is also performed and shows
