CRITICAL RESPONSE MANUAL FINAL SCRIPT
COMPREHENSIVE ANSWERS VERIFIED
◉ A 22-year-old African American male presents to the emergency
department with shortness of breath, which started 2 hours prior to
arrival. He does not have a history of pulmonary disease that he is
aware of, and he states that in the past at random events he has had
similar episodes. He does nothing to get the episodes to stop, and he
also states that he feels his chest pounding at the same time of the
shortness of breath. He has no medical history that he is aware of,
and he takes no medications or any illicit drugs. On examination he
is alert, awake, and oriented. His vital signs show T 99.0, P 142, R 18,
and BP 132/82. His chest x-ray is negative for any acute
cardiopulmonary disease, and his electrocardiogram has an
irregularly irregular rate of 142 with visible delta waves.
Given the clinical situation above, what is the best medication for
managing this patient's condition with a long-term approach?
A Amiodar. Answer: *The Correct Answer is: D
This patient has Wolff-Parkinson-White (WPW) syndrome along
with atrial fibrillation and a rapid ventricular response. Of the
choices given in managing this patient's tachycardia, oral flecainide*
(D) will serve to slow the process within the accessory pathway and
prolong the refractory period. Amiodarone (A) has been shown to
not be effective in managing the patient's tachycardia with respect to
WPW, and the other medications (B, C, and E) would not have an
,effect on the condition and may actually worsen the patient's
symptoms.
◉ An 80-year-old male nursing home patient is brought to the
emergency department with abdominal distension. A plain film of
the abdomen is pictured below. Which of the following is the most
likely diagnosis?
A Small bowel obstruction
B Cecal volvulus
C Sigmoid volvulus
D Toxic megacolon. Answer: *The Correct Answer is: C
A volvulus is an obstruction of the colon due to a loop of bowel that
has rotated more than 180 degrees on its axis with the mesentery.
The most common site for a volvulus is the sigmoid colon (65%). A
sigmoid volvulus is associated with abdominal pain and distension.
Plain films of the abdomen would show a characteristic "bent inner
tube" appearance. Sigmoidoscopy can be used to decompress the
bowel by gently releasing the area of obstruction.* Following
decompression, a rectal tube is inserted to act as a stent to prevent
the bowel from twisting upon itself again.
◉ What is the most common blood gas abnormality in patients with
a pulmonary embolism?
A Respiratory alkalosis
,B Metabolic acidosis
C Metabolic alkalosis
D Respiratory acidosis
E Compensated respiratory acidosis. Answer: The Correct Answer is:
A
Respiratory alkalosis occurs as a *result of the hyperventilation.*
◉ A 14-year-old boy presents to the emergency department with
acute scrotal pain and vomiting for the past 2 hours. His left testicle
is in extreme pain and he states the pain started while playing
basketball in gym class. On physical exam of the affected testicle,
which of the following findings would suggest testicular torsion?
A Transillumination
B Positive Prehn's sign
C Positive cremasteric reflex
D Abnormal transverse lie
E Mass of enlarged veins palpated. Answer: *The Correct Answer is:
D
Testicular torsion is most common between ages 12-18 with the
classic presentation of abrupt and severe onset of pain with
nausea/vomiting. The testicle on physical examination is painful,
swollen, high-riding, tender, and has an abnormal transverse lie
(D).*
Transillumination (A) is when light is placed behind the scrotum and
fluid is illuminated in cases of hydroceles. Prehn's sign (B) is pain
, relief with elevating the scrotum and is positive in cases of
epididymitis.
The cremasteric reflex (C) is a normal finding that causes elevation
of the testis on the ipsilateral side when the inner aspect of the inner
thigh is stroked. The absence of cremasteric reflex on the affected
side is often found in acute torsion. A mass of enlarged veins (E), or
"bag of worms," is a finding associated with a varicocele.
◉ A 29-year-old female who is only taking oral contraceptives
presents to the emergency department with a 1-day history of
worsening shortness of breath. On examination, the patient is
afebrile, her pulse rate is 105, respiratory rate is 24, and blood
pressure is 122/78. She has wheezing to all lung fields and appears
to be in mild to moderate distress. There is no swelling or edema to
the lower extremities. Based on these findings, what is the best test
to order to determine the diagnosis in this patient?
A CT chest
B Chest x-ray
C Ventilation to perfusion scan
D Pulmonary arteriography
E MRI chest. Answer: *The Correct Answer is: D
This patient presents with a history and physical exam that is
consistent with an acute pulmonary embolus (PE). The prognosis for
this type of illness can be serious, and in some cases death can
result. The test that is still the gold standard for determination of a
PE is the pulmonary arteriogram.* CT of the chest with contrast
COMPREHENSIVE ANSWERS VERIFIED
◉ A 22-year-old African American male presents to the emergency
department with shortness of breath, which started 2 hours prior to
arrival. He does not have a history of pulmonary disease that he is
aware of, and he states that in the past at random events he has had
similar episodes. He does nothing to get the episodes to stop, and he
also states that he feels his chest pounding at the same time of the
shortness of breath. He has no medical history that he is aware of,
and he takes no medications or any illicit drugs. On examination he
is alert, awake, and oriented. His vital signs show T 99.0, P 142, R 18,
and BP 132/82. His chest x-ray is negative for any acute
cardiopulmonary disease, and his electrocardiogram has an
irregularly irregular rate of 142 with visible delta waves.
Given the clinical situation above, what is the best medication for
managing this patient's condition with a long-term approach?
A Amiodar. Answer: *The Correct Answer is: D
This patient has Wolff-Parkinson-White (WPW) syndrome along
with atrial fibrillation and a rapid ventricular response. Of the
choices given in managing this patient's tachycardia, oral flecainide*
(D) will serve to slow the process within the accessory pathway and
prolong the refractory period. Amiodarone (A) has been shown to
not be effective in managing the patient's tachycardia with respect to
WPW, and the other medications (B, C, and E) would not have an
,effect on the condition and may actually worsen the patient's
symptoms.
◉ An 80-year-old male nursing home patient is brought to the
emergency department with abdominal distension. A plain film of
the abdomen is pictured below. Which of the following is the most
likely diagnosis?
A Small bowel obstruction
B Cecal volvulus
C Sigmoid volvulus
D Toxic megacolon. Answer: *The Correct Answer is: C
A volvulus is an obstruction of the colon due to a loop of bowel that
has rotated more than 180 degrees on its axis with the mesentery.
The most common site for a volvulus is the sigmoid colon (65%). A
sigmoid volvulus is associated with abdominal pain and distension.
Plain films of the abdomen would show a characteristic "bent inner
tube" appearance. Sigmoidoscopy can be used to decompress the
bowel by gently releasing the area of obstruction.* Following
decompression, a rectal tube is inserted to act as a stent to prevent
the bowel from twisting upon itself again.
◉ What is the most common blood gas abnormality in patients with
a pulmonary embolism?
A Respiratory alkalosis
,B Metabolic acidosis
C Metabolic alkalosis
D Respiratory acidosis
E Compensated respiratory acidosis. Answer: The Correct Answer is:
A
Respiratory alkalosis occurs as a *result of the hyperventilation.*
◉ A 14-year-old boy presents to the emergency department with
acute scrotal pain and vomiting for the past 2 hours. His left testicle
is in extreme pain and he states the pain started while playing
basketball in gym class. On physical exam of the affected testicle,
which of the following findings would suggest testicular torsion?
A Transillumination
B Positive Prehn's sign
C Positive cremasteric reflex
D Abnormal transverse lie
E Mass of enlarged veins palpated. Answer: *The Correct Answer is:
D
Testicular torsion is most common between ages 12-18 with the
classic presentation of abrupt and severe onset of pain with
nausea/vomiting. The testicle on physical examination is painful,
swollen, high-riding, tender, and has an abnormal transverse lie
(D).*
Transillumination (A) is when light is placed behind the scrotum and
fluid is illuminated in cases of hydroceles. Prehn's sign (B) is pain
, relief with elevating the scrotum and is positive in cases of
epididymitis.
The cremasteric reflex (C) is a normal finding that causes elevation
of the testis on the ipsilateral side when the inner aspect of the inner
thigh is stroked. The absence of cremasteric reflex on the affected
side is often found in acute torsion. A mass of enlarged veins (E), or
"bag of worms," is a finding associated with a varicocele.
◉ A 29-year-old female who is only taking oral contraceptives
presents to the emergency department with a 1-day history of
worsening shortness of breath. On examination, the patient is
afebrile, her pulse rate is 105, respiratory rate is 24, and blood
pressure is 122/78. She has wheezing to all lung fields and appears
to be in mild to moderate distress. There is no swelling or edema to
the lower extremities. Based on these findings, what is the best test
to order to determine the diagnosis in this patient?
A CT chest
B Chest x-ray
C Ventilation to perfusion scan
D Pulmonary arteriography
E MRI chest. Answer: *The Correct Answer is: D
This patient presents with a history and physical exam that is
consistent with an acute pulmonary embolus (PE). The prognosis for
this type of illness can be serious, and in some cases death can
result. The test that is still the gold standard for determination of a
PE is the pulmonary arteriogram.* CT of the chest with contrast
