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71 Cards in this Set
- Front
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A 25 year old presents hours after eating sushi. She complains of abdominal pain, vomiting, and diarrhea. She has the sensation of pins and needles over her body in a non-dermatomal distribution. She noticed that her ice cold feet felt paradoxically burning hot in her hand. What is the most likely etiology?
a. ciguatoxin b. scombroid c. monosodium glutamate d. hepatitis A e. campylobacter |
a. this scenario is classic for ciguatoxin. scombroid more commonly presents with histaminergic symtpoms. hepatitis A presents with hepatitis (duh) and campylobacter presents with bloody diarrhea and vomiting.
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A 68yo man presents with gradual onset 4 hours ago of diffuse, constant, severe abdominal pain. He appears extremely uncomfortable, but vital signs and abdominal exam are normal. Rectal exam reveals brown stool with occult b lood. EKG, CXR, and KUB are normal. WBC is 18.5, urinalysis, lytes, and amylase are normal, BUN is 41, and creatinine is 1.6. His past history includes hypertension, CHF, diverticulosis, and ruptured appendix. The most likely cause of his pain is which of the following?
a. diverticulitis b. incomplete small bowel obstruction c. mesenteric ischemia d. myocardial infarction |
c. mesenteric ischemia
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A 64 yo man presents to the ED with a history of a 20 lb weight loss over several months followed by the development of abdominal pain and jaundice over the last few days. There is a palpable right upper quadrant mass on exam. What is the most likely diagnosis?
a. hepatic carcinoma b. acute cholecystitis c. chronic portal vein thrombosis d. ascending cholangitis e. pancreatic carcinoma |
e. pancreatic carcinoma
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EMTALA requires hospitals to provide the following:
a. emergency care to all patients even if they do not receive Medicare funding b. interpreters for all patients in a timely fashion c. screening exam, competent ED physicians and appropriate stabilization d. screening exam, stabilization process, and appropriate transfer process |
d. screening exam, stabilization, and transfer. EMTALA does not involve itself with physician competency, time to treatment, time to interpreters, or funding source, nor does it discuss "care," merely "stabilization."
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A 25yo man presents with a pulmonary embolus and BP 80 systolic. What would be definitive therapy in this patient?
a. embolectomy b. thrombolytic therapy c. intravenous fluids d. vasopressor therapy e. LMW heparin |
b. thrombolytics have been shown to reduce mortality in PE with hypotension
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A 30yo woman presents with acute onset of chest pain. an EKG is done whie she has pain and shows ST segment elevation in the lateral leads. The pain subsides and a repeat EKG reveals resolution of the ST segment elevation. What is the most likely correct diagnosis?
a. mitral valve prolapse b. pericarditis c. subendocardial infarction d. variant angina e. benign early repolarization |
d. variant angina
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A 75yo man presents with severe upper lumbar pain for 5 days. Exam of the spine is unremarkable. The abdomen is nontender, has normal bowel sounds and a pulsatile mid abdomen. Vital signs are: 145/70, pulse 80, RR 16, T 98.6. The most appropriate diagnostic test would be
a. ultrasound b. lumbar spine x-rays c. aortogram d. IV pyelogram e. abdominal CT |
e. abdominal CT. ultrasound is a good choice in looking for rupture, particularly in the unstable patient. this patient is stable, and a CT would help delineate his vascular anatomy preoperatively.
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A 35yo man presents with a 7 hour history of acute substernal chest pain. An EKG reveals ST elevation in leads I, II, III, aVL, aVF, and V2-V6. Administration of thrombolytics in this patient will likely cause which of the following?
a. cardiac tamponade b. dysrhythmias c. extension of his aortic dissection d. resolution of his symptoms |
a. cardiac tamponade. the patient's EKG has signs of pericarditis, not ischemia, and lysis may cause bleeding.
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A 62 yo female presents to the ED with an acute MI. After stabilization, you transfer her to your hospital's cardiac cath lab. You get a call from the cardiologist telling you that the patient had a total occlusion of the circumflex artery. In what EKG leads would this patient have shown ST-T wave changes?
a. V3-V4 b. II, III, aVF c. I, aVL, V5, V6 d. aVR, aVL, and aVF E. V1-V3 |
c. I, aVL v5, v6
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Large R waves and ST depression in V1 and V2 imply an acute myocardial infarction localized to which area of the heart?
a. inferior wall b. lateral left ventricle c. posterior wall d. right ventricle e. anterior wall of the left ventricle |
c. posterior wall
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All of the following are contraindicators to alteplase except
a. acute pericarditis b. previous MI c. recent surgery d. blood pressure of 200/130 e. active diabetic retinopathy |
b. previous MI
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If a patient is using a beta agonist inhaler more than 4 times a day, which of the following should be considered?
a. addition of theophylline b. addition of steroid therapy c. addition of atrovent inhaler d. addition of cromalyn sodium inhaler |
b. addition of steroid therapy
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Anticholinergics are efficacious in treating COPD for all of the following reasons except
a. they cause bronchodilation b. they block bronchoconstriction caused by airway irritants c. they have a faster onset of action than beta agonists d. they have a longer half-life than beta agonists. |
c. they have a faster onset of action than beta agonists.
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A 5 yo girl presents with complaints of scalp itching and patchy hair loss. The most appropriate treatment regimen is
a. topical lubricants to decrease scaling b. oral griseofulvin for 6 weeks c. senenium sulfide shampoo twice weekly as a sole agent d. antihistamines and oral steroid therapy e. urgent referral to a dermatologist as oral antifungal therapy should not be prescribed by non-dermatologists. |
b. griseofulvin for 6 weeks. child should be followed up for monitoring, as some children may bump their LFTs
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A 50 year old male binge drinker is found at 4am by his son. He appears intoxicated and is complaining of not being able to see. In the ED, he is found to have a measured serum asmolality of 422. The rest of his electrolytes are as follows: Na 138, K 6.1 Cl 97, HCO3 4.4, BUN 20, Creatinine 1.7, Glucose 338. The serum ethanol is 0. What is the calculated osmolar gap?
a. 110 b. 120 c. 130 d. 140 e. 150 |
b. 120 (2xNa) + (glucose/18) + (BUN/2.8) is calculated osms. subtract from measured.
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All of the following are appropriate treatments for hypercalcemia, except
a. steroids b. intravenous normal saline c. thiazinde diuretics d. calcitonin e. bisphosphonates |
c. thiazide diuretics. these increase Ca resorption in the kidney
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Of the signs and symptoms of acute angle closure glaucoma, which one of the following is most consistently seen?
a. pupillary constriction b. intraocular pressure of 30-60 mmHg c. lens opacity d. monocular blindness e. painless loss of vision |
b. intraocular pressure of 30-60
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Of the following, which is the most important initial diagnostic test in the evaluation of a retropharyngeal abscess?
a. CT scan of the neck b. Direct laryngoscopy c. indirect laryngoscopy d. soft tissue lateral x ray |
soft tissue lateral neck xray
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A 24yo girl presents with heavy vaginal bleeding. She gives a h/o frequent heavy menses and easy bruising. Her CBC, platelet count, PT, and PTT are all normal. These findings suggest
a. TTP b. hemophilia A carrier c. autoimmune hemolytic anemia d. Von Willebrand disease e. no coagulopathy |
d. von willebrand's disease
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A 19yo male hemophiliac sustains a blow to the head with a blunt object. There was no loss of consciousness. His family brings him to the ED an hour later stating that he is acting different. His exam is remarkable for mild confusion and a hematoma to the right side of the skull. What is the best method to correct his hemophilia before sending him for a head CT?
a. DDAVP b. 10 units cryoprecipitate c. 20 units cryoprecipitate d. 25 units/kg factor VIII concentrate e. 50 units/kg factor VIII concentrate |
e. 50 units factor VIII
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The diagnosis of acute rheumatic fever can be made on finding which of the following set of signs or symptoms:
a. prolonged PR interval, fever, and positive throat culture for group A strep b. carditis, chorea, and fever c. subcutaneous nodules, fever, and positive ASO titer d. Elevated ESR, fever, and positive throat culture e. Prolonged PR interval, fever, elevated ESR and positive ASO titer |
b. carditis, chorea, and fever. this is 2 major and 1 minor criteria for the diagnosis.
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A 62 yo woman presents complaining of lightheadedness after eating in a restaurant. She has a history of a fish allergy and is certain that her meal was contaminated because she got a burning sensation around her mouth prior to the onset of lightheadedness. On arrival to the ED she is pale, diaphoretic, with an urticarial rash on her arms and legs. Her vital signs are BP 70/palp, pulse 115, RR 36, T 98.6 and she fails to respond to a 500cc bolus of normal saline. Which of the following is the best course of action for this patient?
a. methylprednisolone 125 mg infusion alone b. glucagon 1mg IV c. MAST trousers, Trendelenburg position, and 1L normal saline bolus d. 0.1 cc of 1:1000 solution in 10 cc of normal saline epinephrine IV e. benedryl 50 mg |
d. this patient has anaphylaxis, and requires epinephrine
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The most common cardiac manifestation of Lyme disease is
a. pericarditis b. LV dysfunction c. atrioventricular block d. RV dysfunction e. myocarditis |
c. AV block
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An otherwise healthy 42 yo female presents with cough and fever. She says she feels awful and hurts everywhere. You diagnose influenza. All of the following are true except
a. influenza viruses are orthomyxoviruses of 3 antigenic types (A, B, and C) b. influenza is characterized by the sudden onset of fever, frequently with chills or rigors, headache, malaise, diffuse myalgias, and a nonproductive cough c. because of its low side-effect profile, emporic therapy with amantadine is a cost-effective approach to suspected influenza d. vaccination is recommended yearly for immunosuppressed patients or those with chronic illnesses, people older than 65, and women in the second or third trimester of pregnancy e. influenza A has been the predominant virus in 90% of the flu seasons between 1990-1999 |
c. empiric therapy with amantadine is NOT cost effective
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Toxic Shock Syndrome and Kawasaki disease may be distinguished based on the presence of
a. fever b. desquamation of skin c. leukocytosis d. renal failure |
d. renal failure
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Which of the following statements regarding diphtheria is incorrect?
a. the average incubation period of respiratory tract diphtheria is 20-30 days b. fever and sore throat are the most frequent patient complaints c. cervical adenopathy is present in <50% of patients d. cough and SOB are generally present in < 25% of patients e. a diphtheric membrane is present in >50% of patients |
a. the average incubation period of respiratory tract diphtheria is 20-30 days
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In patients with faucial diphtheria, the extent of the membrane usually parallels the clinical toxicity.
a. true b. false |
a. true
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Which of the following is generally not recognized as a serious complication of diphtheria?
a. congestive heart failure b. muscle paralysis c. airway obstruction d. glomerulonephritis d. cardiac conduction disturbances |
d. glomerulonephritis
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Although serum diphtheria antitoxin is the mainstay of therapy, antibiotics are beneficial in preventing growth and spread of the organism. Which of the following antibiotics would be the most appropriate treatment?
a. clindamycin b. erythromycin d. doxycyline d. ciprofloxacin e. metronidazole |
b. erythromycin
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Which of the following statements regarding pertussis is incorrect?
a. a synonym for this illness is whooping cough b. it is a respiratoy illness transmitted by aerosolized droplets c. prior infection with pertussis will provide lifetime immunity d. since 1980, there has been an increase of reported cases in the U.S. e. pertussis is predominantly a pediatric disease. |
c. prior infection with pertussis will NOT provide lifetime immunity
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All of the following statements regarding pertussis are correct except
a. the catarrhal phase harbors the greatest infectivity stage due to the presence of nondescript symptoms b. the paroxysmal phase begins as fever subsides and cough increases c. the convalescent phase has a residual cough that may last from weeks to months d. the major complications are superinfections e. the presence of petechiae above the nipple line suggests an acute coagulopathy |
e. the petechiae are usually from forceful coughing, not from coagulopathy
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Which of the following statements regarding tetanus is incorrect?
a. the global incidence of tetanus is estimated to be near one million cases/year b. although rare in the US, inadequate primary immunization and waning immunity are the primary risk factors c. the spors of Clostridium tetani are highly susceptible to heat and their survival rate is short lasting d. the neurotoxin tetanospasm is produced at the entry site and causes autonomic nervous system dysfunction e. the symptom of trismus (caused by masseter spasm) is generally present in > 50% of patients |
c. the spores of C. tetani are NOT highly susceptible to heart, and they live for a long time
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In managing a patient with tetanus, which of the following statements is incorrect?
a. benzodiazepines are the mainstay of symptomatic treatment b. infusions of magnesium sulfate are effective in spasm control c. metronidazole is the antibiotic of choice in treating C tetani d. succinylcholine should never be considered for neuromuscular blockade e. TIG is not contraindicated in pregnancy |
d. succinylcholine MAY be considered for neuromuscular blockade
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All of the following statements regarding boltulism are correct except
a. infant botulism is the most common form of the illness in the US b. the typical onset of symptoms (in all forms) begins 18-36 hours after ingestion of the toxin c. neurologic symptoms occur as a symmetric ascending muscular weakness d. the major cause of death is respiratory failure e. the patient is usually alert and afebrile unless secondary infection is present. |
c. neurologic symptoms occur as a symmetric ascending muscular weakness
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Which of the following patients would not be a candidate for the 23-valent pneumococcal vaccine?
a. 48 yo male with a history of chronic alcoholism b. 6 year old female with asymptomatic HIV infection c. 53yo female with multiple myeloma d. 36 yo male with sickle cell disease e. 1yo male with sickle cell disease |
e. 1 yo with sickle cell disease, because still have a functional spleen
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Which of the following statements regarding meningococcemia is not correct?
a. petechiae are present in >50% of patients and generally first appear on the torso b. Waterhouse-Friderichsen syndrome may be a fatal complication c. poor prognostic indicators include seizures upon ED presentation d. if meningitis is present, the CSF protein will be increased and the CSF glucose will be decreased e. the tentative diagnosis is based on clinical signs and symtpoms |
actually, this is a poorly worded question. 80% of people develop the rash. all the other ones are really true. e. would be the least true, but it's still true.
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All of the following statements regarding Kawasaki disease are correct except
a. it is primarily a disease of children with peak incidence occuring in children < 5 years b. seasonal variation is present with late winter and early spring being predominant c. it is the most common cause of acquired pediatric heart disease in the US d. coronary artery aneurysm is considered the most feared complication e. aspirin should not be given due to the possibility of an existing Reye's syndrome |
e. aspirin should be given to these patients
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Toxic shock syndrome has a classical rash associated with the syndrome. The rash is generally diffuse and is comprised of non-pruritic vesicular lesions.
a. true b. false |
b. false
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All of the following statements regarding varicella/zoster are correct except:
a. zoster is often preceded by tingling or hypesthesia b. the rash of varicella is initially maculopapular and then transforms into a vesiculated lesion c. adults have increased morbidity and mortality from varicella d. the use of steroids to decrease post-herbetic neuralgia is highly recommended e. disseminated zoster or complicated zoster should be treated with IV acyclovir |
d. the use of steroids is advocated by many, but studies are mixed, and the evidence is weak.
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Which of the following statements regarding viral infections are incorrect?
a. roseola is the most common exanthum in children <2 years of age b. erythema infectiosum is a mild febrile disease of childhood c. the slapped cheek appearance is typical of erythema infectiosum d. rotavirus typically infects children between the ages of 6 months to 2 years e. black vomit is associated with yellow fever |
b. erythema infectiosum has a very high fever
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Which of the following statements regarding viral illnesses is correct?
a. RSV infections are most commonly diagnosed in children between the ages of 3 and 5 b. suppurative parotid swelling is the hallmark of mumps c. Koplik's spots found on the lateral buccal mucosa are considered pathohnomonic for rubella d. the rash of measles begins on the head and progresses downward e. all patients with SARS require hospitalization |
d. the rash of measles begins on the head and works down
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Which of the following is the most common cause of the common cold?
a. astrovirus b. coxsackie B virus c. rhinovirus d. picornavirus e. enterovirus |
c. rhinovirus
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In a study published in 2003, which of the following states has NOT been associated with identification of rabid bats?
a. Texas b. New Mexico C. Maine D. Utah E. North Dakota |
E. North Dakota. there are no people there to identify bats
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Which of the following sequences is correct when initiating rabies vaccine immunoprophylaxis?
a. day 0, 3, 7, 14, 28 b. day 0, 3, 10, 17, 24 c. day 0, 2, 4, 6, 16 d. 0, 4, 8, 16, 24 e. 0, 3, 7, 21, 35 |
a. day 0, 3, 7, 14, 28
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After a potential rabies exposure, patients who have had pre-exposure prophylaxis require HRIG and rabies vaccine on days 0 and 3
a. true b. false |
b. false
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all of the following structures are contained in the anterior compartment of the upper arm except
a. ulnar nerve b. radial nerve c. brachial artery d. median nerve e. biceps brachii |
a. ulnar nerve. this is posterior
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A 78 yo female falls and injures her right upper arm. Upon review of the x-rays, you see a fracture of the humeral mid-shaft. Which structure would have the highest probability of being damaged?
a. median nerve b. ulnar nerve c. musculocutaneous nerve d. radial nerve e. brachial artery |
e. brachial artery
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You suspect a compartment syndrome developing in an injured patient. Which of the following is the only dependable early sign?
a. pain b. pallor c. paresthesias d. paralysis e. pulsenessness |
a. pain
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Of the following ossification centers, which will be the last to close?
a. trochlea b. capitellum c. external epicondyle d. radial head e. olecranon |
c. external, or lateral epicondyle
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After viewing the x-ray of a 7yo female who fell at the park, you diagnose a supracondylar fracture. Which of the following statements is incorrect?
a. this diagnosis rarely occurs after the age of 15 b. extension type injuries account for the vast majority of this pathology c. if there is angulation of the proximal fragment into the antecubital fossa, there can be damage to the median nerve d. ED reduction is only necessary when the displaced fracture is associated with vascular compromise e. this fracture is the second leading cause of elbow fractures in children |
e. this fracture is the most COMMON pediatric elbow fracture. in general, the ED physician should not reduce these unless necessary, as every attempt increases the risk of ischemic contractures. reduction is better done by ortho.
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In an anterior elbow dislocation the lateral view of the radiograph will snow the humerus posterior to the ulna.
a. true b. false |
a. true
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All of the following statements regarding radial head subluxation are correct except
a. the annular ligament slips between the capitellum and radial head, thereby decreasing supination of the arm b. with a characteristic history of the child's arm being pulled while in pronation, x-rays are not needed prior to reduction c. 24 hour immobilization is often required after successful reduction d. the recurrence rate for children is 20% e. a "click" does not have to be heard to indicate successful reduction |
c. immobilization is not required
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Which of the following statements is incorrect regarding clavicular pathology?
a. the clavicle is the most common fracture in children b. fractures of the middle third are most common c. immobilization with a simple sling is often the only necessary stabilizing treatment d. greenstick fractures of the mid clavicle are rare in children e. most fractures of the clavicle can be followed by the family physician |
d. greenstick fractures of the midclavicle are common
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The most common complication of proximal humeral fracture is adhesive capsulitis.
a. true b. false |
a. true
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All of the statements regarding sternoclavicular dislocations are correct except
a. it is the least commonly dislocated major joint in the body b. anterior dislocations are more common c. posterior dislocations may be associated with life-threatening injuries d. posterior dislocations are true orthopedic emergencies with emergent reductions necessary e. plain radiographs will usually be sufficient to establish the diagnosis |
e. it is not uncommon to require CT scans to evaluate these injuries
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Which of the following statements regarding anterior shoulder dislocations is not correct?
a. the shoulder is the most commonly dislocated major joint in the body b. the subcoracoid is the most common type c. there is a higher incidence of potential damage to the median nerve d. the stimson technique is a safe but potentially time consuming reduction technique e. bankart fracture is a corresponding fracture of the anterior glenoid rim |
c. there is not a high incidence of median nerve damage
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Which of the following statements regarding posterior dislocation of the shoulder is incorrect?
a. epilepsy and electric shock therapy are common etiologies b. posterior dislocations can often be missed on initial exam c. the AP view on xray may show the light bulb sign d. the most common misdiagnosis associated with posterior dislocations is adhesive capsulitis e. neurovascular injuries are very common with this dislocation |
e. neurovascular injuries are rare with this dislocation
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Which of the following statments regardign luxatio erecta is not correct?
a. <1% of shoulder dislocations fall into this category b. in the AP view on xray, the humeral shaft lies parallel to the spine of the scapula c. neuropraxic pathology of the brachial plexus is uncommon d. tears of the rotator cuff are common with this injury e. adhesive capsulitis is a common long-term complication |
c. neuropraxic pathology of the brachial plexus IS common
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All of the following statements regarding injection therapy of joints are correct except
a. concurrent use of a local anesthetic is a common practice b. site specific complications include subcutaneous atrophy and articular cartilage damage c. corticosteroids inhibit all phases of the inflammatory response: leukocyte migration, edema formation, mediator release, vascular permeability, collagen deposition, and fibroblast proliferation d. hydrocortisone acetate is a more potent agent than triamcinolone diacetate e. systemic complications are rare |
d. hydrocortisone is more potent
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All of the following statements regarding low back pain are correct except
a. 85% of patients with low back pain have the etiology in the soft tissues b. cauda equina syndrome is considered to be caused by a massive central disk herniation c. spondylolisthesis usually causes excess pain even if the slippage is <10% d. primary bone tumors are less frequent than metastatic disease e. although rare, disk herniation in children will have similar presentations as adults |
c. spondylolisthesis usually does not cause excessive pain
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Which of the following is the most consistent finding in cauda equina syndrome?
a. saddle anesthesia b. urinary retention c. decreased sensation to the upper posterior thighs d. decreased sensation to the buttocks e. decreased sphincter tone |
b. urinary retention
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All of the following statements regarding low back pain are correct excepts
a. spinal infections may have a normal WBC count b. plain radiogrpahs are considered as a standard in working up a patient with suspected spinal infections c. metastatic disease can present as either lytic or blastic lesions d. a + supine straight leg raise test with a negative sitting straight leg test suggests a nonphysiologic cause for low back pain e. lumbar punctures are relatively contraindicated when entertaining a diagnosis of spinal infection |
b. plain radiographs are unhelpful in assessing for spinal infection
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In treating a 36yo male construction worker with uncomplicated low back pain, which of the following treatments would be least beneficial?
a. antiinflammatory medications b. short term opiods c. strick bed rest for 2-3 days d. physiotherapy e. soft tissue manipulation |
c. strict bedrest is not beneficial
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All of the following statements regarding upper back pain are correct except
a. the incidence of metastatic disease is less in the thoracic spine than in the lumbar area b. the majority of times the rason for thoracic back pain is musculoskeletal c. thoracic spine herniations are rare d. when considering thoracic disk herniation, one must also consider other etiologies of the pain such as aortic dissection e. spinal cord compression from disk herniation is more likely in the thoracic spine than the lumbar spine |
a. is not correct
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Which of the following is the most common wrist fracture in adults?
a. Colles b. Smiths c. Nightstick d. Bartons e. Galeazzi |
a. colles
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The term valgus denotes a deformity in which the described part is angulated away from the midline of the body
a. true b. false |
a. true
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When describing a fracture, displacement is defined by the position of the distal fragment relative to the proximal bone
a. true b. false |
a. true
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Which of the following statements regarding Salter-Harris fractures in children is incorrect?
a. a type I injury will often haev a negative xray for fracture b. type V injuries are most commonly a result of a crush injury c. type III injuries may have a disruption of growth to that site because the germinal layer is affected d. growth disturbance do not typically occur in types 1 and III e. type V fractures are very common |
e. type V fractures are rare
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Which of the following statements regarding compartment syndrome is false?
a. pain on passive stretching is an important finding b. the anterior compartment of the lower leg is the most common site c. normal compartment pressure is 0 mmHg d. relative ischemia begins when tissue pressure within a closeed compartment increases to within 15 mmHg of a patient's diastolic BP e. hyperkalemia, rhabdomyolysis, and myoglobinuria may occur and can lead to renal failure |
d. a compartment pressure greater than 30 warrants intervention
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Now many bones are in the hand and wrist?
a. 27 b. 28 c. 29 d. 26 e. a gazillion |
a. 27
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Which of the following is not one of Kanavel's signs for flexor tenosynovitis?
a. flexed posture of the digit b. tenderness over the synovial sheath c. pain on passive digit extension d. swollen, erythemetous digit e. inability for complete flexion |
e. flexion is not part of Kanavel's signs
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