Intern Year: Peer Viii Emergent

Front 1

in a pt with DKA how do you calculate for corrected sodium

Back 1

+1.2 increase for every 100 over 100

Front 2

Which of the following clinical features is associated with vasovagal or neurocardiogenic syncope?

Absent prodrome

Confusion

Nausea

Orthostatic hypotension

Back 2

Nausea

Front 3

Which of the following tests is the most specific for making the diagnosis of alcoholic ketoacidosis?

Beta-hydroxybutyrate

Formic acid

Lactate

Oxalic acid

Back 3

Beta-hydroxybutyrate

Front 4

Which of the following is an early sign of superior vena cava syndrome?

Cyanosis

Facial plethora

Facial swelling

Upper extremity edema

Back 4

Facial swelling

Facial swelling that is prominent early in the morning and resolves over the first few hours the patient is up is an early sign of superior vena cava (SVC) syndrome. The patient might also have early morning periorbital edema, nasal congestion, and conjunctival suffusion.

Front 5

Which of the following forms of hepatitis is transmitted by the fecal-oral route?

A
Autoimmune hepatitis B
Hepatitis C C
Hepatitis delta virus D
Hepatitis E

Back 5

Hepatitis E

Coinfection with hepatitis B and D is most commonly associated with fulminant disease

Front 6

__________/________ jaundice is usually caused by an increased rate of red blood cell destruction

Back 6

Unconjugated/indirect jaundice is usually caused by an increased rate of red blood cell destruction (as in hemolytic anemia, sickle cell disease, absorption of hematoma) or, less commonly, by decreased hepatic uptake (sepsis, some drugs) or abnormal conjugation that can be congenital (Gilbert syndrome) or acquired (advanced hepatocellular disease).

Front 7

In ____________/_________, hyperbilirubinemia results from impaired excretion by the hepatocyte of conjugated bilirubin into the bile cannaliculi or from obstructed bile flow into the intrahepatic or extrahepatic ducts

Back 7

In conjugated/direct jaundice, hyperbilirubinemia results from impaired excretion by the hepatocyte of conjugated bilirubin into the bile cannaliculi or from obstructed bile flow into the intrahepatic or extrahepatic ducts. Impaired hepatocyte excretion or intrahepatic obstruction (cholestasis) can be congenital or acquired. Extrahepatic obstruction can also be classified as intrinsic or extrinsic depending on the anatomic location of the obstruction.

Front 8

when trying to determine the amount of factor to give to a bleeding hemophilia pt, the equation is?

Back 8

patient’s weight (kg) × 0.5 × percentage change in factor

so the amount of factor needed to reach 40% in a 80kg pt would be:
so the calculation is 80 kg × 0.5 × 40% = 1,600 U

Front 9

A 45-year-old man presents with headache, vertigo, and blurred vision of 3 days' duration. He is a smoker and says that he has been bruising easily lately. Physical examination is remarkable for swelling in the right leg and engorgement of the skin. Laboratory test results include: WBCs, 15,000/mcL; Hgb, 20 g/dL; Hct, 62%; and platelets, 450,000/mcL.

Which of the following interventions should be completed in the emergency department?

1-L normal saline bolus


Aspirin 81 mg


Phlebotomize 1 L blood


Warfarin therapy

Back 9

Aspirin 81 mg

Complications of polycythemia are related to hyperviscosity, especially noted when the Hct is greater than 60%. Aside from thrombosis, hemorrhage and reduced blood flow to the tissues are also complications. Treatment is phlebotomy and volume replacement with saline, with a goal of reducing the Hct level to less than 55%. This should be done slowly, 1 to 1.5 L over 24 hours, although in the case of emergencies such as a thrombotic stroke, up to 500 mL can be phlebotomized rapidly in otherwise healthy patients. Low-dose aspirin should also be started.

Front 10

Which of the following scuba divers is most likely to have decompression sickness?

19-year-old man with vague chest pain, full neck, and Hamman crunch

21-year-old woman with pain at the front of her head, facial edema, and petechial hemorrhages


33-year-old woman with vision changes, headache, and dizziness


45-year-old man with inability to urinate

Back 10

45-year-old man with inability to urinate

Decompression sickness (DCS) results from the formation of small bubbles of nitrogen gas that accumulate in the blood and tissues during ascent. Nitrogen is highly fat soluble with a proclivity for the white matter of the CNS

Front 11

Which of the following statements regarding myxedema coma is correct?
AActive rewarming can precipitate hypotension
BHyperglycemia is common
CHypernatremia is common
DIntravenous T4 administration has been associated with sudden death

Back 11

Active rewarming can precipitate hypotension

Active rewarming measures such as electric blankets in the setting of myxedema coma can in fact precipitate hypotension. This can occur as a result of reversal of peripheral vasoconstriction that coexists with both significant volume depletion and diminished cardiac output. For this reason, at least initially, passive rewarming is favored. Myxedema coma is a life-threatening manifestation of longstanding hypothyroidism that requires early diagnosis and appropriate management to prevent death. Despite the name, patients can present with neither myxedema (nonpitting edema due to accumulation of mucopolysaccharides from decreased metabolism) nor coma. A depressed level of consciousness, rather than agitation, is common

Front 12

A patient known to have advanced HIV infection presents following a seizure. He has had headache, fever, and altered mental status for 2 weeks. A contrast-enhanced head CT scan shows multiple ring-enhancing lesions.

Which of the following therapies is most likely indicated?
AFour-drug antituberculosis therapy
BIntravenous gancyclovir
CLiposomal amphotericin B
DPyrimethamine and sulfadiazine plus folinic acid

Back 12

Pyrimethamine and sulfadiazine plus folinic acid

Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, is the most common ring-enhancing lesion in the CNS of patients with AIDS.

STOP SAYING CMV

Front 13

at how many weeks are steroids indicated for pre-mature birth

Back 13

before 34

Front 14

A patient who recently had an upper respiratory viral syndrome now presents with pneumonia and a cavitary lesion on chest radiograph.

Which of the following antibiotic choices provides adequate coverage for the likely organisms?
AAmpicillin and gentamicin
BCeftriaxone and azithromycin
CIsoniazid, rifampicin, and ethambutol
DVancomycin and levofloxacin

Back 14

DVancomycin and levofloxacin

The classic presentation of Staphylococcus aureus pneumonia is post-viral pneumonia that progresses to formation of a lung abscess that creates a cavitary lesion (pneumatoceles) on chest radiograph leading to bronchopleural fistulas and empyema. S. aureus is also associated with intravenous drug use and cystic fibrosis.

Front 15

A 35-year-old man presents after his wife says that he passed out while watching television. He has no past medical history and is currently asymptomatic. Vital signs are within normal limits, and physical examination findings are completely normal

EKG shows Brugada syndrome. What should be done?

Back 15

Admit the patient for cardiac monitoring and consultation for defibrillator placement

Typically, the resulting cardiac effects of Brugada syndrome (syncope or cardiac arrest) manifest in the third and fourth decades of life. Sudden cardiac death is caused by rapid polymorphic ventricular tachycardia or fibrillation

here are three recognized patterns of Brugada syndrome, distinguished by their precordial ST-segment and T-wave morphologies. Characteristically, there is an incomplete right bundle-branch block pattern and J-point segment and ST-segment elevation in leads V1 through V3

Front 16

What is the only situation in which corticosteroids should be used in patients with intracranial abscesses?

Back 16

When signs of herniation are present,

as evident by obtundation, sluggish pupils, bradycardia, bradypnea, and hypertension, aggressive treatment to decrease the intracerebral pressure should be undertaken. This can include hyperventilation, administration of mannitol, and use of corticosteroids to decrease swelling