Emergency Med NBME Form 1

Emergency Med NBME Form 1 52 yo man - 6 hrs after onset of severe, epigastric abd pain > began at cocktail party > was there for 4 hrs - 3 martinis, lot of food PMHx: HLD (statin) 100.4F 104/min 150/92 mmHg PE: diffuse tenderness over upper quadrants BL - esp epigastrium; no guarding/rebound labs: WBC WNL, BR 3 (direct 2.4), alk phos 210, AST 325, ALT 360, amylase 1200, lipase 600 most likely cause of symptoms? - CORRECT ANSWER common bile duct obstruction choledocholithiasis = stone in CBD lipase high so think pancreatitis 2 MC causes: alcohol and gallstones if alcoholic cause - the AST should be higher than ALT (A Scotch and Tonic) abd pain that started right after eating a lot of food > think gallstones he also has PMHx of HLD - another RF for pancreatitis 42 yo man - 30 min after onset of gen weakness, SOB, severe abd cramps, sweating > began while gardening 99.2F 52/min RR: 24/min 98/60 mmHg POx: 98% RA PE: diaphoresis, excessive lacrimation, 2 mm pupils reactive to light; diffuse wheezes; abd - no tenderness; muscle strength 4/5 in ext - muscle fasciculations; DTRs 2+; no Babinski; intact sens after decontamination - most app tx to immediately relieve current symptoms? - CORRECT ANSWER administration of atropine homeboy was gardening - exposure to spray insecticides (aka organophosphates - AChE inhibitors) > these can cause acute cholinergic toxicity = DUMBBELLS (diarrhea, urination, miosis/muscle weakness, bradycardia/bronchorrhea, emesis, lacrimation, sweating/salivation) pralidoxime regenerates AChE at musc/nic receptors - only peripheral > useless once aging of bonded complex has occurred atropine reverse peripheral and central musc toxicity