Intern Year: Bonus Questions From Peer Vii

Front 1

Which of the following abnormal test results is the earliest indicator of biological damage from whole-body penetrating irradiation?

A
Anemia B
Eosinophilia C
Leukopenia D
Lymphopenia E
Thrombocytopenia

Back 1

Lymphopenia

Front 2

A 24-year-old woman presents complaining of dysuria, urgency, and frequency. She denies fever, vomiting, and back pain. She has no significant past medical history or medication allergies, and a urine pregnancy test is negative. A bedside dip urinalysis reveals 3+ blood, (+) nitrite, and 1+ leukocyte esterase.

What is the most appropriate course of action?

A
Order a urine culture and treat with an appropriate antibiotic for 3 days B
Order a urine culture and treat with an appropriate antibiotic for 7 days C
Treat with an appropriate antibiotic for 3 days D
Treat with an appropriate antibiotic for 7 days E
Wait for a microscopic analysis of the urine before deciding whether to order a urine culture

Back 2

Treat with an appropriate antibiotic for 3 days

Bactrim

Front 3

In immunocompetent patients, which of the following is most common in the prodromal phase of shingles?

A
Ataxia B
Dysuria C
Fever D
Headache E
Vomiting

Back 3

Headache

Front 4

A 60-year-old man presents by ambulance from a private physician's office. He had become short of breath during an outpatient bronchoscopy. Vital signs are blood pressure 120/70, pulse rate 120, respiratory rate 30, and temperature 36.7°C (98°F); oxygen saturation as measured by peripheral pulse oximetry is 86% on 100% oxygen by nonrebreather mask. The patient is cyanotic; breath sounds are clear and symmetrical bilaterally, and the remainder of the physical examination is normal. Arterial blood gas analysis reveals the following: pH, 7.30; PCO2, 30 mm Hg; PO2, 180 mm Hg.

Which of the following statements related to his condition is correct?

A
Immediate needle decompression is indicated B
No treatment is required C
Oxygen saturation curve is shifted to the left D
Sodium nitrite administration will be the most effective E
Thrombolytics should be considered

Back 4

Oxygen saturation curve is shifted to the left

Front 5

A 65-year-old man presents after being stung by a bee. He complains of wheezing, shortness of breath, and tightness in his throat. His medical history includes hypertension treated with atenolol.

Aside from epinephrine and steroids, what medication should be considered?

A
Cetirizine B
Cimetidine C
Glucagon D
Insulin and D50W E
Metoprolol

Back 5

Glucagon

Front 6

A 48-year-old disabled physician presents with severe lower back pain, screaming obscenities and uncooperative. After administration of hydromorphone 8 mg IV, he is more cooperative with the examination but still screaming. Vital signs are blood pressure 190/110, pulse rate 120 (sinus rhythm on monitor), respiratory rate 22, and temperature 38.5°C (101.3°F); oxygen saturation is 100% on room air. Physical examination reveals a disheveled, obese man who looks older than his stated age. There are no external signs of trauma, and the examination is normal except for midline lumbar spine tenderness. He has intact strength in all extremities and no sensory deficits. Plain films of the lumbar-sacral spine show moderate degenerative joint disease. CBC, chem 7, and urinalysis are all normal.

The most appropriate next step in management is:

A
Admission for pain management B
CT scan C
Discharge to skilled nursing facility D
MRI E
Psychiatry consultation

Back 6

MRI

Front 7

A 17-year-old boy with Type 1 diabetes mellitus presents with diabetic ketoacidosis. A venous blood gas analysis is conducted, and the pH is 7.09.

Treating this patient with bicarbonate could result in which of the following complications?

A
CSF alkalosis B
Hypokalemia C
Hypotonicity D
Increased work of breathing E
Rightward shift of the oxyhemoglobin dissociation curve

Back 7

Hypokalemia

probably because you decrease acid in blood and drive potassium intracellularly

Front 8

A 20-year-old-woman presents with a painful right ear. She has no history of ear problems but swims several times a week. Examination reveals erythema of the external auditory canal with some purulent discharge and a perforation in the tympanic membrane.

The treatment option most likely to damage her ear is:

A
Ciprofloxacin otic and hydrocortisone otic suspension B
Hydrocortisone and acetic acid otic solution C
Neomycin/polymyxin/hydrocortisone otic suspension D
Ofloxacin otic solution E
Penicillinase-resistant penicillin

Back 8

Hydrocortisone and acetic acid otic solution

Front 9

Which of the following tick-borne diseases is caused by a spirochete organism?

A
Babesiosis B
Colorado tick fever C
Ehrlichiosis D
Relapsing fever E
Tick paralysis

Back 9

Relapsing fever

Rickettsia and Borrelia species

Front 10

A 22-year-old woman who is 1 week postpartum and breastfeeding presents complaining of vaginal bleeding more than expected that started 2 days earlier. She says that the previous lochia has not been malodorous and has been light red in color, and that she has had no fever or vomiting. Vital signs are normal except for a mild tachycardia. She has minimal abdominal pain. Pelvic examination reveals normal vagina and cervix, with no cervical motion tenderness. There is bleeding noted from the os. Bimanual examination is normal, and a firm globular uterus is noted.

The most likely diagnosis is:

A
Lower genital tract laceration B
Normal menses C
Retained placenta D
Uterine atony E
Uterine rupture

Back 10

Retained placenta

Front 11

Which of the following statements regarding the management of acute severe asthma is most accurate?

A
Corticosteroids should be administered after completion of bronchodilator therapy B
Intravenous beta-agonists are more effective than nebulized beta-agonists C
Magnesium administration results in an improvement of approximately 10% of predicted FEV1 D
Patients require high-dose corticosteroid therapy E
Response to corticosteroids is age related

Back 11

Magnesium administration results in an improvement of approximately 10% of predicted FEV1

Front 12

Regarding submersion injuries, which of the following statements is correct?

A
Complete recovery in 48 hours is typical of submersion victims who never required CPR B
Electrolyte measurement should be routine C
Prolonged attempts at resuscitation of asystolic pediatric patients after warm-water submersion should be pursued D
Prophylactic antibiotics are usually indicated E
The Heimlich maneuver is of proven efficacy in removing aspirated fluid

Back 12

Complete recovery in 48 hours is typical of submersion victims who never required CPR

Front 13

Which of the following conditions is an unlikely complication of sinusitis?

A
Cavernous sinus thrombosis B
Dental abscess C
Periorbital cellulitis D
Pott\'s puffy tumor E
Subdural empyema
Which of the following conditions is an unlikely complication of sinusitis?

Back 13

Dental abscess

Front 14

Which of the following infectious agents is thought to be the most common cause of Bell palsy in the developed world?

A
Borrelia burgdorferi B
Epstein-Barr virus C
Herpes simplex virus D
Mycobacterium tuberculosis E
Varicella-zoster virus

Back 14

Herpes simplex virus

Front 15

Which of the following is the least likely risk factor for postpartum endometritis?

A
Cesarean delivery B
Chorioamnionitis C
Many vaginal examinations during labor D
Time since rupture of membranes E
Urinary tract infection

Back 15

Urinary tract infection

Front 16

In a patient exhibiting psychosis, which of the following factors is more likely to indicate an organic cause rather than a functional cause?

A
Age of onset younger than 40 years B
Auditory hallucinations C
Normal orientation D
Normal vital signs E
Sudden onset

Back 16

Sudden onset

Front 17

A 23-year-old woman presents after a motor vehicle crash. She is 22 weeks pregnant and complaining of abdominal pain. Vital signs include blood pressure 110/78, pulse rate 124, and respiratory rate 28.

Which of the following statements regarding her vital signs is correct?

A
Cardiac output is increased in pregnancy, which means that she can tolerate larger blood losses than a nonpregnant trauma patient can B
Elevation of the diaphragm and reduced functional residual capacity are causing the elevated respiratory rate C
Heart rate increases in the second trimester, which means that the tachycardia is caused by pregnancy, not hypovolemia D
Hypotension might not develop until 35% of her blood volume is lost due to relative hypervolemia of pregnancy E
Systolic and diastolic blood pressure decrease in the second trimester, which means that the blood pressure indicates she is not hypovolemic

Back 17

Hypotension might not develop until 35% of her blood volume is lost due to relative hypervolemia of pregnancy

Front 18

A 58-year-old man presents with the complaint of stomach discomfort off and on for several months. For the past 2 weeks he has had a gnawing, burning sensation between meals and at night.

Which of the following recommendations will have the greatest impact on his condition?

A
Avoid alcohol B
Avoid NSAIDs C
Begin taking a proton pump inhibitor D
Begin treatment for Helicobacter pylori infection E
Stop smoking cigarettes

Back 18

Begin treatment for Helicobacter pylori infection

Front 19

Infection with which of the following helminths is known to cause a fatal hyperinfection in immunocompromised patients?

A
Ascaris lumbricoides B
Enterobius vermicularis C
Necator americanus D
Strongyloides stercoralis E
Trichuris trichiura

Back 19

Strongyloides stercoralis

neamatode round worm

Front 20

An 83-year-old man with a history of hypertension, COPD, and Type 2 diabetes mellitus presents with left hemiparesis and left-sided hemisensory changes and left-sided neglect. His GCS score is 15. His symptoms started 1 hour before presentation. Thirty minutes after arrival in the emergency department, his mental status deteriorates and his GCS score falls to 11.

The most likely etiology of these symptoms is:

A
Anterior cerebral artery embolism B
Internal capsule intracerebral hemorrhage C
Posterior cerebral artery aneurysm rupture D
Posterior cerebral artery thrombosis E
Vertebral artery occlusion

Back 20

Internal capsule intracerebral hemorrhage

blood supply to the MCA

Front 21

A 27-year-old woman treated with peritoneal dialysis for renal failure presents complaining of abdominal pain and fever for 2 days. She has noticed cloudy dialysate, and she gave a sample to the nurse at the triage desk. Her abdomen appears normal on inspection but is tender to palpation diffusely with rebound.

What is the most appropriate treatment?

A
CT scan with contrast to evaluate the cause of pain B
Intraperitoneal first-generation cephalosporin or vancomycin C
Intravenous first-generation cephalosporin or vancomycin D
Laparotomy for removal of the Tenckhoff catheter E
Placement of a Hickman catheter and emergent hemodialysis

Back 21

Intraperitoneal first-generation cephalosporin or vancomycin

Front 22

Contraindications to nasotracheal intubation in a trauma patient include:

A
Apnea B
Cervical spine fracture C
Depressed mental status D
Hypotension E
Pneumothorax

Back 22

Apnea

Front 23

Urticaria is differentiated from erythema multiforme by:

Age at onset of symptom

Appearance of the rash

Patient's sex

Relief with antihistamines

Response to epinephrine

Back 23

Response to epinephrine

Front 24

A 26-year-old man with known hemophilia A presents after being hit in the head with a baseball. Physical examination reveals an abrasion on his forehead and a normal neurologic examination. Brain scan results are normal.

What is the most appropriate management?

A
Administer DDAVP, and discharge patient home B
Administer factor replacement, and admit C
Admit the patient for observation D
Check factor IX levels, and discharge the patient home if they are adequate E
Discharge the patient home with followup

Back 24

Administer factor replacement, and admit

Front 25

Which of the following is an AIDS-defining condition?

A
Idiopathic thrombocytopenic purpura B
Oral candidiasis C
Peripheral neuropathy D
Recurrent bacterial pneumonia E
Seborrheic dermatitis

Back 25

Recurrent bacterial pneumonia

Front 26

A 44-year-old man presents following a witnessed seizure that lasted 2 minutes. On arrival his mental status is intact, and he has no focal neurologic deficits. He has no history of a seizure disorder and has otherwise been in his usual state of health. Thirty minutes later he has another seizure that begins in the right arm and progresses to 1 minute of jerking of the extremities followed by postictal confusion.
This event is most accurately classified as:

Absence seizure

Complex partial seizure

Grand mal seizure

Psychomotor seizure

Temporal lobe seizure

Back 26

Complex partial seizure

Front 27

Which of the following statements regarding calcium and phosphorous metabolism in patients with end-stage renal failure is correct?

A
A low calcium-phosphate product indicates a high risk for systemic calcification B
Prevention of systemic calcification includes oral calcium-binding gels and high-phosphate dialysate C
Symptoms of systemic calcification include painful, swollen joints due to pseudogout D
Systemic calcification affects only the small vessels of the extremities E
These patients have reduced phosphate absorption and lower serum phosphate levels

Back 27

Symptoms of systemic calcification include painful, swollen joints due to pseudogout

Front 28

An 86-year-old woman presents with a 6-month history of fatigue and lethargy, increasing confusion, constipation, poor appetite, slowed speech, and dyspnea. Vital signs include blood pressure 105/60, pulse rate 55, and temperature 33.5°C (92.3°F); oxygen saturation is 91% on room air. Physical examination reveals a lethargic, obese woman who is oriented only to place and person. She has evidence of bilateral pleural effusions and has nonpitting peripheral edema.

Potential iatrogenic causes of this condition include:

A
Amiodarone B
Digoxin C
Diltiazem D
Flecainide E
Procainamide

Back 28

Amiodarone

Front 29

Which of the following conditions is most likely to be a precipitating factor for pneumothorax?

A
Chronic obstructive pulmonary disease B
Cigarette smoking C
Marfan syndrome D
Physical exertion E
Pneumocystis carinii pneumonia

Back 29

Cigarette smoking

Front 30

What percentage spontaneous pneumo can be discharged?

how long will it take to resolve

Back 30

up to 20%

note: small pneumos (20 and above) require about 1 week (up to 2) to spontaneously resolve

1.8% per day

Front 31

With regard to salicylate poisoning, which of the following is correct?

A
A negative plain radiograph excludes the presence of enteric-coated or sustained-release aspirin in the gastrointestinal tract B
Ensuring hypoventilation after intubation is critical in management C
Reversible sensorineuronal hearing loss correlates with serum salicylate levels D
The Done nomogram is essential in guiding therapy E
Urinary pH is a determinant of mortality

Back 31

Reversible sensorineuronal hearing loss correlates with serum salicylate levels

Front 32

how do you calculte serum osmolarity

Back 32

(2 * (Na) + (BUN / 2.8) + (glucose / 18) + (ethanol/4.6)

Front 33

A 20-year-old man presents with left eye irritation. He was walking in a park and accidentally ran into a tree branch. The impact knocked his glasses off, and he believes the branch scratched his eye. Examination reveals a corneal abrasion.

The best treatment option is:

A
Erythromycin ophthalmic ointment, no patch B
Erythromycin ophthalmic ointment, patch C
Homatropine, no patch D
Homatropine, patch E
Topical anesthetic

Back 33

Erythromycin ophthalmic ointment, no patch

Front 34

A 68-year-old man with a history of Type 2 diabetes mellitus and hypertension presents with cellulitis of his arm following a scratch from his cat. He has noticed bilateral progressive leg edema for several weeks. He denies nausea, vomiting, diarrhea, chest pain, shortness of breath, headache, and confusion. Vital signs are blood pressure 165/89, pulse rate 78, respiratory rate 18, and temperature 38.5°C (101.3°F). Physical examination reveals an obese man with erythema, swelling, and warmth of the right upper extremity with lymphangitis. Additionally, the patient has symmetrical bilateral lower extremity edema. Laboratory test results are as follows: sodium, 125 mEq/L; potassium, 4.5 mEq/L; chlorine, 95 mEq/L; HCO3, 24 mEq/L; BUN, 18 mg/dL; creatinine, 1.4 mg/dL; and glucose, 135 mg/dL.

In addition to intravenous antibiotics, management should include:

A
Dexamethasone 8 mg IV B
Hypertonic saline 400 mL C
Normal saline 1,300 mL D
Saline 0.45% 400 mL E
Water restriction

Back 34

Water restriction

Front 35

Which of the following pathogens causes the most commonly reported sexually transmitted infection in the United States?

A
Chlamydia trachomatis B
Hepatitis B virus C
Human papilloma virus D
Neisseria gonorrhoeae E
Trichomonas

Back 35

Chlamydia trachomatis

Front 36

With regard to the presentation of early appendicitis, which of these symptoms has the lowest sensitivity?

A
Abdominal pain B
Anorexia C
Fever D
Migration of pain E
Vomiting

Back 36

Fever

Front 37

Which of the following statements regarding laboratory values in diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar nonketotic syndrome (HHNS) is correct?

A
Arterial pH is more likely to be below 7.2 in HHNS B
Glucose is more likely to be significantly elevated in DKA C
In HHNS, the serum sodium value is more likely to be elevated D
Initial potassium level is likely to be very low in both DKA and HHNS E
Serum ketones are more likely to be present in HHNS

Back 37

In HHNS, the serum sodium value is more likely to be elevated

Front 38

Which of the following conditions can result in pseudocyanosis?

A
Cold exposure B
Hemochromatosis C
Methemoglobinemia D
Pulmonary embolism E
Sulfhemoglobinemia

Back 38

Hemochromatosis

Front 39

For children undergoing treatment for diabetic ketoacidosis, which of the following has been shown to be most strongly associated with the development of clinically significant cerebral edema?

A
Administration of an insulin bolus prior to a continuous drip B
Degree of hyponatremia on presentation C
Elevated BUN on presentation D
Height of the serum glucose concentration on presentation E
Known history of diabetes with a record of poor compliance

Back 39

Elevated BUN on presentation

Front 40

Which of the following statements regarding blunt traumatic placental abruption is correct?

A
In pregnant women with blunt trauma, less than 40% of fetal losses result from placental abruption B
More than half of women with placental abruption can present with no vaginal bleeding C
Position of the placenta affects the incidence of traumatic placental abruption D
Ultrasonography is the best method for identifying traumatic placental abruption E
Women with traumatic placental abruption are less likely to have a coagulopathy than are those without traumatic placental abruption

Back 40

In pregnant women with blunt trauma, less than 40% of fetal losses result from placental abruption

Front 41

In needle aspiration of a peritonsillar abscess, aspiration of only the superior pole of the tonsil will:

A
Avoid possible vascular injury B
Be sufficient if it is negative C
Be sufficient if it is positive D
Miss 30% of abscesses E
Require incision and drainage if positive

Back 41

Miss 30% of abscesses

Front 42

Which of the following is the most common ECG abnormality associated with mitral valve prolapse?

A
Paroxysmal supraventricular tachycardia B
QT prolongation C
Rapid atrial fibrillation D
ST-segment depression in leads II, III, and aVF E
Ventricular tachycardia

Back 42

Paroxysmal supraventricular tachycardia

Front 43

A 17-year-old girl attended a pool party where alcohol was being served. She dove head first into the shallow end of the pool and landed directly on her head. In the emergency department, she has severe neck pain and minimal movement below the level of the shoulders.
Which of the following is the most likely injury?

Burst fracture

Flexion-distraction fracture

Spinous process fracture

Transverse process fracture

Wedge fracture

Back 43

Burst fracture

vertebra breaks from a high-energy axial load (e.g., car accidents or falls from a great height or high speed, and some kinds of seizures), with shards of vertebra penetrating surrounding tissues and sometimes the spinal canal

Front 44

Which of the following pretreatment patient characteristics has been associated with an increased risk of intracerebral hemorrhage following treatment with tPA for acute ischemic stroke?

A
Advanced age B
Increased stroke severity C
Isolated global aphasia D
Major surgery within 14 days E
Rapid improvement in neurologic signs

Back 44

Increased stroke severity

Front 45

Which of the following is a characteristic of the HELLP syndrome?

A
Increased LDH B
Neurologic symptoms C
Normal antithrombin III D
Occurs early in pregnancy E
Renal symptoms

Back 45

Increased LDH

Lactate dehydrogenase is a marker of hemolysis and is elevated (> 600 U/liter

Front 46

Regarding treatment of heart failure in patients with diastolic rather than systolic dysfunction:

A
Aggressive therapy with diuretics is more effective B
Beta-blocking agents might improve cardiac output C
Both are associated with impaired cardiac contractility D
Most patients with CHF have diastolic dysfunction E
Ventricular filling pressures are higher in systolic dysfunction than in diastolic dysfunction

Back 46

Beta-blocking agents might improve cardiac output

Front 47

Which of the following statements regarding lung abscess is correct?

A
A cancerous etiology is more likely if the abscess develops in the posterior portion of the lung B
Anaerobic bacteria are more commonly found in immunocompromised patients than in immunocompetent patients C
In most cases, the abscess cavity communicates with a bronchiole D
Infectious lung abscesses commonly occur in the superior segments of the lower lobes E
Surgical intervention is commonly necessary

Back 47

In most cases, the abscess cavity communicates with a bronchiole

Front 48

Which of the following findings in a patient with hepatic abscess is most suggestive of pyogenic rather than amebic disease?

A
Elevated aminotransferases B
High fever, chills, abdominal pain, nausea, vomiting C
Hyperbilirubinemia D
Leukocytosis E
Right pleural effusion on chest x-ray

Back 48

Hyperbilirubinemia

Front 49

The most common unilateral neck mass in an older adult is:

A
Lymphoma B
Mononucleosis C
Parotiditis D
Squamous cell carcinoma E
Thyroid disorder

Back 49

Squamous cell carcinoma

Front 50

Which of the following biological warfare agents requires respiratory and contact isolation for suspected cases?

A
Anthrax B
Botulinum toxin C
Pneumonic plague D
Ricin toxin E
Smallpox

Back 50

Smallpox

Front 51

Which of the following statements best describes the role of neuroimaging in a patient presenting with acute stroke symptoms?

A
CT and MRI are equivalent for detecting hemorrhagic transformation of an acute ischemic stroke B
CT is superior to MRI for detecting chronic hemorrhage C
MRI and noncontrast CT are equivalent for identifying acute hemorrhage D
MRI is superior to noncontrast CT for detecting acute hemorrhage E
Unenhanced CT remains superior to MRI for detecting acute hemorrhage

Back 51

MRI and noncontrast CT are equivalent for identifying acute hemorrhage

Front 52

In an asthmatic patient who requires intubation:

A
Inspiratory-to-expiratory ratio should be kept at 1:2 B
Ketamine is the preferred paralytic agent C
Nasotracheal intubation is preferred over orotracheal D
Propofol can be used as a sedating agent E
Tidal volume should be kept at 10 cc/kg ideal body weight

Back 52

Propofol can be used as a sedating agent

Front 53

A 67-year-old woman is brought to the emergency department from a skilled nursing facility for evaluation of fever and right-sided neck swelling. CT scan of the neck shows inflammatory changes in the right parotid consistent with parotitis.

Which of the following antibiotic choices is most appropriate?

A
Amoxicillin-clavulanate B
Ampicillin-sulbactam C
Cephalexin and metronidazole D
Clindamycin E
Vancomycin and metronidazole

Back 53

Vancomycin and metronidazole

Front 54

A 42-year-old woman presents to a Level I trauma facility after a high-speed motor vehicle crash. She has significant chest trauma but is hemodynamically stable. After initial films are obtained, she undergoes high-resolution CT scanning of the chest, which reveals a traumatic rupture of the aorta.
Which of the following findings is most indicative of this entity on the patient's initial chest x-ray?

Deviation of the esophagus 1 to 2 cm to the right

First and second rib fractures

Left clavicle fracture

Pulmonary contusion

Upward displacement of the left mainstem bronchus 40 degrees

Back 54

Deviation of the esophagus 1 to 2 cm to the right

Front 55

What effect will placing a magnet on the skin over a patient's pacemaker have on pacemaker function?

A
Cause the pacemaker to deliver a shock to the endocardium B
Double the current output of the pacemaker C
Double the rate output of the pacemaker D
Turn the pacemaker off E
Turn the pacemaker on at a fixed rate

Back 55

Turn the pacemaker on at a fixed rate

Front 56

In which of the following presentations is placement of a thoracostomy tube indicated?

19-year-old woman with spontaneous pneumothorax of 20%3.7%

25-year-old woman with large blebs and recurrent pneumothorax of 20%

30-year-old woman with a loculated pleural effusion

35-year-old man with asthma, intubated, with pneumothorax of 3%

57-year-old man with hepatic coagulopathy with pneumothorax of 25%

Back 56

35-year-old man with asthma, intubated, with pneumothorax of 3%


pts on mechanical ventilation can have expansion of the pneumo and lead to tension

Front 57

A 60-year-old woman with a history of end-stage renal disease on hemodialysis presents unresponsive with only a weak carotid pulse. Cardiac monitoring is started (Figure 41), and CPR is initiated. Intravenous access is established, and the patient is intubated.

EKG is sinusoidal. tx?

Back 57

Calcium chloride (10%) 1 amp IV, regular insulin 10 units IV, and glucose 25 g IV

Front 58

Which of the following statements regarding Rocky Mountain spotted fever in children is correct?

A
CSF pleocytosis is commonly present B
Intravenous clindamycin is the treatment of choice C
Most cases are diagnosed in the western United States D
Most commonly seen in adolescents E
Rash is initially petechial and becomes purpuric

Back 58

CSF pleocytosis is commonly present

Front 59

What is the proper treatment for tooth fracture?

A
Apply calcium hydroxide paste to the subluxed tooth and refer for urgent dental evaluation B
Keep the tooth fragment in milk until dental consultation is available for immediate reimplantation of the fragment C
Place the tooth fragment in Hanks solution until dental consultation is available for immediate reimplantation of the fragment D
Place the tooth fragment in the patient\'s mouth until dental consultation is available for immediate reimplantation of the fragment E
Splint the remaining subluxed tooth using periodontal dressing and refer for urgent dental evaluation

Back 59

Apply calcium hydroxide paste to the subluxed tooth and refer for urgent dental evaluation

Front 60

Which of the following statements regarding universal precautions is correct?

A
Approximately 50% of documented occupational exposure cases have resulted from hollow-bore needlestick injuries B
Droplet precautions are required in the care of patients with pertussis, mumps, rubella, diphtheria, and Neisseria meningitides and Streptococcus pneumoniae infection C
Postexposure prophylaxis of a health care worker following an occupational exposure should be delayed until the patient has consented to testing D
The likelihood of contracting AIDS after a mucocutaneous exposure is higher than the risk of contracting AIDS after a parenteral exposure E
Universal precautions, including sterile gloves, should always be used for emergency department procedures, including suturing and cutaneous abscess drainage

Back 60

Droplet precautions are required in the care of patients with pertussis, mumps, rubella, diphtheria, and Neisseria meningitides and Streptococcus pneumoniae infection

Front 61

The most common cause of arterial embolism is:

A
Aortic stenosis B
Atherosclerotic plaque C
MI D
Rheumatic heart disease E
Vasculitis

Back 61

MI

Front 62

central cord syndrome presents as a weakness in upper extremities more than lower...what is the general cause?

Back 62

hyper extension injury in old folk

Front 63

Which of the following statements correctly describes the significance of a normal initial ECG in a patient presenting with chest pain who subsequently rules in for acute MI?

A
Almost 20% of these patients will die or develop a significant complication B
Lack of chest pain at the time of presentation in an older patient is associated with decreased mortality C
Less than 3% of patients who have an acute MI present with a normal ECG D
The risk of in-hospital death is 25% that of patients who present with diagnostic ECGs E
These patients do not require initial treatment with aspirin, beta-blockers, or heparin

Back 63

Almost 20% of these patients will die or develop a significant complication

Front 64

In a patient with acute anterior wall MI, which of the following findings is an indication for placement of a temporary pacemaker?

A
Acute left bundle-branch block B
Heart rate of 50 C
Mobitz second-degree heart block, type I D
New right bundle-branch block with left anterior fascicular block E
QT prolongation

Back 64

New right bundle-branch block with left anterior fascicular block

Front 65

Which of the following statements regarding lung cancer is correct?

Cavitation is commonly seen in small cell cancers8.17%

Extrathoracic metastases are rarely seen with small cell lung cancer

Large cell cancers of the lung tend to present as peripheral masses

Small cell neoplasms are not a common cause of superior vena cava obstruction

Squamous cell carcinoma is the most common type of lung cancer in the United States

Back 65

Large cell cancers of the lung tend to present as peripheral masses


(adenocarcinoma is most common)

Front 66

what common OTC for URI can cause urinary retention

Back 66

pseudoephedrine

Front 67

What size foreign body cannot be passed in kids

Back 67

Longer than 5cm, wider than 2cm still in the esophagous

Front 68

A mother brings her 14-month-old son to the emergency department. For the past 4 to 5 days she has seen mucus in his diapers, and that morning she noted a red mass protruding from his rectum.
Regarding this condition, which of the following is correct?

Affects girls more often than boys

Is associated with cystic fibrosis and malnutrition

Requires excision of the lesion in the emergency department

Requires proctosigmoidoscopy

Requires referral for surgical correction

Back 68

Is associated with cystic fibrosis and malnutrition


this is rectal prolapse

reducible in ED

Front 69

Which of the following statements regarding bronchiectasis is correct?

Hemoptysis occurs in a minority of cases

It involves small-sized airways, often at the level of alveoli

Staphylococcus aureus lower respiratory tract infection is an important cause

The associated cough is most often dry

Viruses have not been shown to be associated with its development

Back 69

Staphylococcus aureus lower respiratory tract infection is an important cause

Front 70

Which of the following statements regarding complex eyelid lacerations is correct?

A
Emergent ophthalmologic consultation is required with all lacerations involving the lid margin B
Even very small lacerations of the lid margin (<1 mm) require suturing to avoid notching of the eyelid and improper eyelid closure C
Full-thickness lid repair is impossible in the emergency department setting and requires surgical repair to avoid a poor cosmetic outcome D
Lacerations medial to the punctum involving the lacrimal system require stenting E
Repair of a canalicular laceration can be performed by a skilled emergency physician

Back 70

Lacerations medial to the punctum involving the lacrimal system require stenting

Front 71

Which of the following statements regarding cardiac serum markers is correct?

A
BNP level has little correlation with recurrent acute coronary syndromes B
CPK appears within 1 to 2 hours after an acute MI and is gone within 24 hours C
Myoglobin appears within 1 to 2 hours after an acute MI and peaks at 5 to 7 hours D
Total CPK is more specific for acute cardiac ischemia than the CK-MB fraction E
Troponins appear in the first 4 hours after an acute MI and are gone by 24 to 36 hours

Back 71

Myoglobin appears within 1 to 2 hours after an acute MI and peaks at 5 to 7 hours

note: trops will peak in about 24 hours, can last a week

Front 72

For a previously healthy toddler with mild croup, the administration of oral dexamethasone:

A
Is indicated only for moderate-to-severe croup, because mild croup is self-limited B
Is indicated only if the parents are unable to provide cool mist at home C
Is precluded by an unacceptably high rate of uncontrollable vomiting after administration D
Leads to mild hyperactivity that interferes with normal sleep patterns E
Leads to quicker resolution of symptoms when compared with observation

Back 72

Leads to quicker resolution of symptoms when compared with observation

Front 73

Which of the following best describes the cough associated with pertussis in infants?

A
Paroxysmal, staccato cough associated with posttussive emesis B
Productive cough associated with fever and respiratory failure C
Repetitive cough followed by a loud and distinct whooping sound D
Seal-like barking cough associated with inspiratory stridor at rest E
Weak cough with pooled secretions and very poor air exchange

Back 73

Paroxysmal, staccato cough associated with posttussive emesis

Front 74

Which of the following is the most common cause of conjugated hyperbilirubinemia in school-aged children?

A
Amanita toxin B
Bacterial sepsis C
Biliary atresia D
Familial nonhemolytic jaundice E
Hepatitis A

Back 74

Hepatitis A

Front 75

A 58-year-old man presents with a finger amputation that he sustained while cleaning out a lawnmower. His right index finger is completely amputated at the level of the middle phalanx. Physical examination reveals normal vital signs and active arterial bleeding from the amputation site. The amputated finger was placed in a plastic bag in a cooler filled with ice. Gross dirt and organic debris are on both the proximal amputation site and the amputated part. The patient is right-handed and has no significant medical history.

What is the next step to improve the chance for successful replantation?

A
Gently wash both the amputated digit and the proximal site with povidone-iodine solution or hydrogen peroxide, then replace the digit in the ice B
Leave the amputated digit in the cooler C
Remove the amputated part from the cooler, wrap it in saline-soaked gauze, then refrigerate it in a plastic bag D
Send the amputated part to pathology E
Warm the amputated part to room temperature, then rinse it with saline and wrap it in gauze

Back 75

Remove the amputated part from the cooler, wrap it in saline-soaked gauze, then refrigerate it in a plastic bag

Front 76

When evaluating a patient for hypovolemia, the most reliable clinical finding is:

A
Capillary refill time of 3 seconds or more B
Diminished skin turgor C
Inability to stand secondary to postural dizziness D
Orthostatic blood pressure decrease of 20 mm Hg E
Resting supine heart rate greater than 100 beats/min

Back 76

Inability to stand secondary to postural dizziness

Front 77

Which of the following statements regarding the use of ketamine for procedural sedation and analgesia is correct?

Advantages include the maintenance of protective airway reflexes and the absence of cardiovascular effects


Concurrent use of benzodiazepines to prevent emergence reactions does not significantly prolong clinical recovery time


Development of intense myoclonic jerking movements indicates the presence of a latent seizure disorder and should be treated with a benzodiazepine


Induces dissociation between the cortical and limbic systems, resulting in amnesia, sedation, and analgesia


Laryngospasm is rare, but when it occurs an emergent surgical rescue airway is often needed

Back 77

Induces dissociation between the cortical and limbic systems, resulting in amnesia, sedation, and analgesia


note: ketamine causes increased bp and tachycardia

Front 78

Which of the following statements regarding infants who present with a chief complaint of excessive crying is correct?

A bulging fontanel during crying episodes suggests meningitis


Infants with corneal abrasions have symptoms clearly referable to the eyes


Intussusception is the most common cause


Severe weight loss is a common physical examination finding


Supraventricular tachycardia is a known cause

Back 78

Supraventricular tachycardia is a known cause

Front 79

A 60-year-old man presents with an acute MI. He has had pain for 45 minutes. He is hemodynamically stable and has no contraindications to medical or interventional therapies for STEMI. A PCI-capable referral center is 1 hour away.

Which of the following is the best treatment option?
AAdminister routine medical therapy for STEMI, including thrombolytics, and admit to the CCU
BAdminister routine medical therapy for STEMI, including thrombolytics, and admit to the CCU with planned transfer to the referral center in 24 to 36 hours
CAdminister thrombolytics and transfer for rescue angioplasty if needed
DGive a half-dose thrombolytic and a glycoprotein IIb/IIIa inhibitor and then transfer
EInitiate direct transfer to the referral center for primary angioplasty

Back 79

Initiate direct transfer to the referral center for primary angioplasty

Goal is 90 minutes if you have PCI capability

f your hospital does not have a PCI program, the next best option may be rapid transfer to a nearby medical center that is experienced and prepared to use PCI to treat heart attack. The goal in this case is to open the artery within 2 hours of the patient first receiving care by emergency medical worker

Front 80

Which of the following is the most common cause of severe diastolic hypertension in young children?
AAcute cocaine ingestion
BCoarctation of the aorta
CHyperthyroidism
DInactivity and obesity
EPheochromocytoma

Back 80

coarctation of the aorta

Front 81

Which of the following statements regarding the management of acute traumatic brain injury is correct?
AAggressive fluid resuscitation has been shown to increase intracranial pressure and worsen outcomes
BCorticosteroids have no role in treatment
CHyperventilation to a PaCO2 of 25 to 28 mm Hg reduces intracranial pressure and improves outcomes
DIn a large meta-analysis, hypoxia was not found to worsen outcomes
EPermissive hypotension (SBP 85-90 mm Hg) has demonstrated improved neurologic outcomes

Back 81

Corticosteroids have no role in treatment

Front 82

In children, which of the following is most strongly associated with congenital prolonged QT interval on ECG?
AAmbiguous genitalia and a webbed neck
BFamily history of exercise-induced syncope
CMaternal history of recurrent miscarriages
DProfound bradycardia on prenatal ultrasonography
ESyncope after initiating antifungal therapy

Back 82

Family history of exercise-induced syncope

Front 83

A 65-year-old woman presents for evaluation of weakness. Her daughter says that she is a serious alcoholic and has become unable to remember things correctly. Physical examination is significant for ataxia, slurred speech, nystagmus, and paralysis of the extraocular muscles with significant deficit when looking laterally.

What is the most likely diagnosis?
AAlcohol withdrawal delirium
BAlcoholic psychosis
CCentral pontine myelinolysis
DKorsakoff syndrome
EWernicke syndrome

Back 83

EWernicke syndrome

Front 84

what is the difference btw a Jones and Lisfranc fx?

Back 84

Jones: 5th base metatarsal

Lisfranc::Base (or head) of 2-4, usually crush injury

Front 85

Which of the following statements regarding early warning signs of acute coronary syndrome in women is correct?
A20% of women have at least one of them prior to an acute MI
BFatigue is a common symptom
CThey are never attributed to psychiatric conditions
DWomen are more likely than men to seek care for them
EWomen commonly present at a younger age than do men

Back 85

Fatigue is a common symptom

Front 86

For a previously healthy infant who sustains an apparently minor, isolated blunt head injury and presents awake, alert, and neurologically intact, which of the following is the best single predictor of identifying a traumatic abnormality on a head CT scan?
AAge
BHeadache
CLoss of consciousness
DSeizure
EVomiting

Back 86

AAge

Front 87

A 68-year-old man presents with a 1-week history of low back pain after doing some yard work. He denies specific injury, falls, and fever. Past medical history is remarkable for hypertension. On physical examination, he has tenderness to palpation in the right lumbar region. On ipsilateral straight leg raise, he has pain into the hamstring region. Deep tendon reflexes and motor strength are normal.

Which of the following statements concerning the evaluation and management of this presentation is correct?
AA positive crossed straight leg raise test will be of little value in determining whether he has a herniated disc
BAbnormal findings on CT or MRI are highly specific and will correlate well with his symptoms
CEarly radiographic imaging is indicated because of his age
DRequires MRI of the lumbar spine within 24 hours
EShould be treated with NSAIDs and muscle relaxants, bed rest for 48 to 72 hours, and physical therapy within 3 to 4 days

Back 87

Early radiographic imaging is indicated because of his age

Front 88

A 23-year-old man presents complaining of abdominal pain and headache. He appears quite knowledgeable about the differential diagnosis of his symptoms and tells the triage nurse that he must be admitted immediately. Physical examination reveals pain out of proportion to the findings. Results of diagnostic testing are unremarkable. Although his pain subsides after medications, he tells the nurse that he is not well enough to go home yet. He says that he has undergone a battery of tests for the same problem in the past, but he is vague about the results.

What is the most likely diagnosis?
AConversion disorder
BHypochondriasis
CMalingering
DMunchausen syndrome
ESomatization disorder

Back 88

Munchausen syndrome