Emergency Medicine Shelf Q&A
Scored A
What are the burn characterizations if it is from child abuse? - ANSWER -sharp lines of
demarcation, uniform depth, lack of splash marks, spared flexural creases
How does hyperthyroidism trigger atrial fibrillation? - ANSWER -increases atrial conduction
automaticity
descending motor paralysis, begins with cranial nerves, can lead to hypoventilation and
respiratory acidosis due to diaphragmatic paralysis - ANSWER -botulinum toxicity (impaired
neuromucular transmission)
What can help prevent CPAP-associated epistaxis? - ANSWER -humidification
hyperdense biconvex lesion that does not cross suture lines, brief loss of consciousness followed
by lucid interval - ANSWER -epidural hematoma
What should be done of symptomatic patients with an epidural hematoma? - ANSWER -
emergent neurosurgical hematoma evacuation
altered level of consciousness, ataxia, slurred speech, are arousable and have normal vital signs -
ANSWER -isolated overdose of benzodiazepines
altered mental status, ataxia, slurred speech, vital sign derangements, respiratory depression -
ANSWER -co-ingestion of sedative-hypnotic (alcohol and benzodiazepines)
Where do epirudal hematomas commonly occur? - ANSWER -pterion region (junction of
frontal, parietal, temporal, and sphenoid bones)
,What are ECG signs that suggest an arrhythmia as the cause of syncope? - ANSWER -sinus
bradycardia, sinus pauses, atrioventricular block, and prolonged QTc interval
mononucleosis-like syndrome (fever, night sweats, lymphadenopathy, arthralgias, and diarrhea),
oral ulcerations, transient rash (oval, red, macular lesions), GI symptoms - ANSWER -acute HIV
infection
What should be used for moderate to severe pain in patients with opioid use disorder? -
ANSWER -intravenous short-acting opioids
How may the imaging of an immunosuppressed patient look for community-acquired
pneumonia? - ANSWER -normal chest x-ray despite signs and symptoms, should undergo high-
resolution CT scan of chest to identify pulmonary infiltrate
loss of motor and sensory function, loss of rectal tone, urinary retention - ANSWER -acute spinal
cord compression
What is the management for acute spinal cord compression? - ANSWER -emergency surgical
consultation, neuroimaging, possible IV glucocorticoids
What should be done immediately following the diagnosis of a perforated peptic ulcer? -
ANSWER -surgical consultation, IV PPIs and antibiotics, fluid resuscitation and nasogastric
suction
contralateral hemiparesis (facial > upper > lower), hemisensory loss, dysarthria, hemineglect -
ANSWER -middle cerebral artery infarct
What can improve neurologic outcomes in patients with ischemic stroke when given within 4.5
hours of symptom onset? - ANSWER -thrombolytic therapy (IV alteplase)
,sudden onset, severe abdominal pain and anion-gap metabolic acidosis - ANSWER -acute
mesenteric ischemia
How is diagnosis of acute mesenteric ischemia made? - ANSWER -CT mesenteric angiography
What is the first step in management of a patient who ingested a single, potentially toxic dose
(>7.5 g) of acetaminophen? - ANSWER -gastric decontamination (charcoal) and measurement of
serum acetaminophen levels
acute drop in hemoglobin, reticulocyte count <1%, no splenomegaly, parvovirus B19 is the most
common cause - ANSWER -aplastic crisis
What should be given for cardiac toxicity from TCA overdose? (prolonged QRS duration >100
msec, ventricular arrhythmias) - ANSWER -sodium bicarbonate
short PR interval (<120 msec), slurred upstroke of QRS complex (delta wave), QRS interval
widening - ANSWER -Wolff-Parkinson-White (created by an accessory atrioventricular
pathway)
How is hypertension treated during a hemorrhagic stroke? - ANSWER -intravenous nicardipine
What does the diagnostic paracentesis show for ascites from cirrhosis? - ANSWER -yellow or
straw-colored fluid, low total protein, high serum-ascites albumin gradient
What is the management for ascites from cirrhosis? - ANSWER -sodium restriction, alcohol
abstinence, spironolactone, and furosemide
excruciating anorectal pain exacerbated by sitting, bluish bulge at anal verge - ANSWER -
thrombosis of external hemorrhoid
, life-threatening complication of blood product transfusion marked by the massive release of
cytokines, reactive oxygen species, and inflammatory mediators from neutrophils in the
pulmonary vasculature - ANSWER -transfusion-related acute lung injury
acute dyspnea, diffuse bilateral infiltrate, JVD, crackles, decreased ejection fraction, elevated
BNP - ANSWER -transfusion-associated circulatory overload
neurologic deficits disseminated in time and space, lumbar puncture for CSF analysis shows
oligoclonal bands - ANSWER -multiple sclerosis
fever, dysuria, leukocytosis, tender/swollen prostate - ANSWER -acute bacterial prostatitis
What is the treatment for acute bacterial prostatitis? - ANSWER -6 weeks of therapy with TMP-
SMX or fluoroquinolone
hypotension, muffle heart sounds, jugular venous distention - ANSWER -cardiac tamponade
What is associated with an increased risk of arrhythmias or seizures in TCA overdose? -
ANSWER -QRS duration >100 msec (treat with sodium bicarbonate)
What is the next step in management after a needle-stick exposure to HIV? - ANSWER -draw
blood for HIV serology and start antiretroviral therapy with 3 drugs immediately
How is respiratory failure managed in acute decompensated heart failure? - ANSWER -
noninvasive positive pressure ventilation (followed by intubation if needed)
How is the diagnosis of carbon monoxide poisoning made? - ANSWER -co-oximetry of arterial
blood gas (shows elevated carboxyhemoglobin level)
Scored A
What are the burn characterizations if it is from child abuse? - ANSWER -sharp lines of
demarcation, uniform depth, lack of splash marks, spared flexural creases
How does hyperthyroidism trigger atrial fibrillation? - ANSWER -increases atrial conduction
automaticity
descending motor paralysis, begins with cranial nerves, can lead to hypoventilation and
respiratory acidosis due to diaphragmatic paralysis - ANSWER -botulinum toxicity (impaired
neuromucular transmission)
What can help prevent CPAP-associated epistaxis? - ANSWER -humidification
hyperdense biconvex lesion that does not cross suture lines, brief loss of consciousness followed
by lucid interval - ANSWER -epidural hematoma
What should be done of symptomatic patients with an epidural hematoma? - ANSWER -
emergent neurosurgical hematoma evacuation
altered level of consciousness, ataxia, slurred speech, are arousable and have normal vital signs -
ANSWER -isolated overdose of benzodiazepines
altered mental status, ataxia, slurred speech, vital sign derangements, respiratory depression -
ANSWER -co-ingestion of sedative-hypnotic (alcohol and benzodiazepines)
Where do epirudal hematomas commonly occur? - ANSWER -pterion region (junction of
frontal, parietal, temporal, and sphenoid bones)
,What are ECG signs that suggest an arrhythmia as the cause of syncope? - ANSWER -sinus
bradycardia, sinus pauses, atrioventricular block, and prolonged QTc interval
mononucleosis-like syndrome (fever, night sweats, lymphadenopathy, arthralgias, and diarrhea),
oral ulcerations, transient rash (oval, red, macular lesions), GI symptoms - ANSWER -acute HIV
infection
What should be used for moderate to severe pain in patients with opioid use disorder? -
ANSWER -intravenous short-acting opioids
How may the imaging of an immunosuppressed patient look for community-acquired
pneumonia? - ANSWER -normal chest x-ray despite signs and symptoms, should undergo high-
resolution CT scan of chest to identify pulmonary infiltrate
loss of motor and sensory function, loss of rectal tone, urinary retention - ANSWER -acute spinal
cord compression
What is the management for acute spinal cord compression? - ANSWER -emergency surgical
consultation, neuroimaging, possible IV glucocorticoids
What should be done immediately following the diagnosis of a perforated peptic ulcer? -
ANSWER -surgical consultation, IV PPIs and antibiotics, fluid resuscitation and nasogastric
suction
contralateral hemiparesis (facial > upper > lower), hemisensory loss, dysarthria, hemineglect -
ANSWER -middle cerebral artery infarct
What can improve neurologic outcomes in patients with ischemic stroke when given within 4.5
hours of symptom onset? - ANSWER -thrombolytic therapy (IV alteplase)
,sudden onset, severe abdominal pain and anion-gap metabolic acidosis - ANSWER -acute
mesenteric ischemia
How is diagnosis of acute mesenteric ischemia made? - ANSWER -CT mesenteric angiography
What is the first step in management of a patient who ingested a single, potentially toxic dose
(>7.5 g) of acetaminophen? - ANSWER -gastric decontamination (charcoal) and measurement of
serum acetaminophen levels
acute drop in hemoglobin, reticulocyte count <1%, no splenomegaly, parvovirus B19 is the most
common cause - ANSWER -aplastic crisis
What should be given for cardiac toxicity from TCA overdose? (prolonged QRS duration >100
msec, ventricular arrhythmias) - ANSWER -sodium bicarbonate
short PR interval (<120 msec), slurred upstroke of QRS complex (delta wave), QRS interval
widening - ANSWER -Wolff-Parkinson-White (created by an accessory atrioventricular
pathway)
How is hypertension treated during a hemorrhagic stroke? - ANSWER -intravenous nicardipine
What does the diagnostic paracentesis show for ascites from cirrhosis? - ANSWER -yellow or
straw-colored fluid, low total protein, high serum-ascites albumin gradient
What is the management for ascites from cirrhosis? - ANSWER -sodium restriction, alcohol
abstinence, spironolactone, and furosemide
excruciating anorectal pain exacerbated by sitting, bluish bulge at anal verge - ANSWER -
thrombosis of external hemorrhoid
, life-threatening complication of blood product transfusion marked by the massive release of
cytokines, reactive oxygen species, and inflammatory mediators from neutrophils in the
pulmonary vasculature - ANSWER -transfusion-related acute lung injury
acute dyspnea, diffuse bilateral infiltrate, JVD, crackles, decreased ejection fraction, elevated
BNP - ANSWER -transfusion-associated circulatory overload
neurologic deficits disseminated in time and space, lumbar puncture for CSF analysis shows
oligoclonal bands - ANSWER -multiple sclerosis
fever, dysuria, leukocytosis, tender/swollen prostate - ANSWER -acute bacterial prostatitis
What is the treatment for acute bacterial prostatitis? - ANSWER -6 weeks of therapy with TMP-
SMX or fluoroquinolone
hypotension, muffle heart sounds, jugular venous distention - ANSWER -cardiac tamponade
What is associated with an increased risk of arrhythmias or seizures in TCA overdose? -
ANSWER -QRS duration >100 msec (treat with sodium bicarbonate)
What is the next step in management after a needle-stick exposure to HIV? - ANSWER -draw
blood for HIV serology and start antiretroviral therapy with 3 drugs immediately
How is respiratory failure managed in acute decompensated heart failure? - ANSWER -
noninvasive positive pressure ventilation (followed by intubation if needed)
How is the diagnosis of carbon monoxide poisoning made? - ANSWER -co-oximetry of arterial
blood gas (shows elevated carboxyhemoglobin level)
