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EM Midterm Questions

Terms in this set (101)

Sudden onset dyspnea and dull, pleuritic unilateral chest pain explains pneumothorax. t/f
False
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Which of the following conditions does a plural effusion happen secondary to?
All of These
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Microscopic hematuria is defined as greater than 3 RBC per field?
True
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T/F. You're MI pt. isn't doing too great and after consulting with Cardiology the plan is to prepare them for CABG. They can stay on their current meds: ASA, Clopidogrel, LWMH.
False
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The monitor is showing SVT! What 3 treatments would you try in a STABLE patient?
Valsalva, Adenosine, if refractory then procainamide
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A 57 y/o patient comes into the ED with cardiogenic shock. While prepping the patient for a CABG, what two drugs should still be continued?
UFH
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While doing an EKG on your asymptomatic patient, you find notching with appropriate discordance. It is notched with ST depression and T-wave inversion in leads V1-3 with ST elevation in the lateral leads. What do you suspect?
RBBB
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57-year-old male presents to the ER with fever, productive cough, and SOB. PMHx includes DM2 and hypertension. Physical exam indicates pneumonia. Which of the following is the best treatment for this patient?
Azithromycin 500 mg PO x 1 day then 250 QD x 4 days + Augmentin 875/125 mg PO BID
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A 60 y/o diabetic patient that had a recent MI comes to your ED, and you discover an ABI of 0.8. You know the gold standard is an arteriogram, but it is currently not available for use. What imaging modality will you use?
US w/ doppler
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18-month-old female presents with wheezing and copious rhinorrhea. Which of the following is NOT an appropriate method of treatment for this patient?
Nasal saline drops and Albuterol
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Patient presents to the ER with bradycardia and slight AMS. Vitals are stable except a HR of 45. Physical exam reveals diminished reflexes and pretibial edema. Patient is lucid enough to tell you she has never had this happen before. PMHx includes Afib, which is typically well-controlled. Multiple labs are ordered, including CBC, CMP, and TSH. Which of the following is the most likely cause of her presentation?
Amiodarone
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You have a patient who presents to the ER with fruity breath, Kussmaul breathing, nausea and vomiting, and weakness. Upon obtaining labs, your patient has a glucose of 512, pH of 5.5, anion gap of 20, potassium of 5.2, and ketones in the urine. How would you treat this patient?
Give IV isotonic fluids, insulin and potassium at the same time
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A 25 year old male presents to your ED with weight gain, depression, complaining of being cold all the time, and macroglossia. Your patient reports they began taking Amiodarone about 1 month. What is the most important thing to treat and save this patient based on their presentation?
Give Levothyroxine 200 mcg IV
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A patient presents to the ER with chest pain and SOB. You obtain an EKG and see the following (see picture below). What do you need to give this patient to avoid further complications?
Magnesium sulfate 2g over one minute
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Which of the following are not symptoms of hypocalcemia?
Abdominal pain
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EN is a confused 26-year-old female who presents to the ED via EMS with complaints of diarrhea/vomiting and "chest pain". Upon further questioning you find that the patient is having heart palpitations and was recently involved in a MVC. Her vitals are as follows: HR 155, RR 20, BP 135/90, Temp 101.4, O2 sat 96% on room air. Physical exam demonstrates hyperreflexia. How would you treat this patient?
PTU and a non-selective Beta-Blocker
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Which of the following statements is true regarding third degree heart block?
These patients require a permanent pacemaker
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Which of the following is NOT a sign of an emergent condition?
Infant male with phimosis
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Select the correct statement regarding acute kidney injury (AKI)
Volume loss via diuresis, diarrhea, dehydration, or hemorrhage can lead to pre-renal AKI
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All of the following are signs of HYPOvolemia, EXCEPT
Hypertension
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Your patient has a blood glucose of 620. Which of the following is the most important factor to secure the diagnosis of Hyperosmolar hyperglycemia syndrome?
Altered Mental Status
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Hypernatremia is almost always caused by:
Relative loss of water
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Your patient's UA comes back + for blood, but microscopy does not show RBCs. What would you expect the pt history to include?
Crush Injury
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Which of the following is a BUN:Creatinine ratio of >20:1 most specific for?
Pre-renal AKI
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A patient presents with sharp, stabbing chest pain that she reports is slightly better when she leans forward. She states that, "this pain has been going on for about a month or so." When auscultating for lung sounds, you hear a friction rub in the left lower sternal border. You decide to obtain an EKG. Which findings would you expect to see?
Normal EKG
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In working up your patient with chest pain, you notice a soft, high-pitched murmur that you believe to be acute aortic regurgitation. Which of the following should you be most concerned for?
Aortic Dissection
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Bronchitis is almost always bacterial
False
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Patient has Cushings. They are most likely going to present as
Hypervolemia hypernatremia
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A sexually actively woman comes into ER with abdominal pain and cervical tenderness and no cause can be found, what should you do?
Give ceftriaxone, doxycycline, and metronidazole
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A patient presents to the ED with complaints of chest pain radiating to their left arm. Upon evaluation, an EKG with troponins is ordered. Results of the EKG show indications of a right-sided STEMI and troponins are appropriately positive. What is the first step in your treatment process?
give chewable 325 ASA
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Which of the following is not a potential extrapulmonary effect associated with SARS Cov-2?
Hypothermia resulting in shortened ability to withstand cold temperatures
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What are some indications on a physical exam that would lead you towards considering a patient that would require Natural Saline or Lactated Ringers as a part of the treatment regimen?
Dry mucous membranes & decreased cap refill
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The "nutcracker effect" is typically seen with which diagnosis and which vessel is compressed?
Varicocele/renal vein
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A 16-year-old male presents to the ED with complaints of severe testicular pain that started 3 hours ago. On examination you note "bell clapper deformity" of the testis. What is the diagnosis and how much time is left to treat?
Testicular Torsion/3 hours
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A football player presents to the ED after the first day of summer two-a-days. He notes that he has never played football before and spent his entire break inside playing Call of Duty. What lab result would cinch the diagnosis of rhabdomyolysis?
CK > 5 times ULN
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A 27 YO female presents to the ER with abdominal pain and some nausea with the pain. When asked where it hurt most, she couldn't determine a side, but said lower abdomen. Pt reports her only medication is an oral contraceptive pill, which she says she is "pretty good at taking regularly". Pt reports she is sexually active and thinks she had an STI some years ago. What is the most concerning differential and how is it generally ruled out?
Ectopic Pregnancy, r/o with US and beta-HCG
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A potential COVID patient presents to the ED with mild SOB. Pt is a 27 yo F, T 99.8, HR 75, BP 125/87, RR 19, O2 sat 94% on room air, BMI 32. What are your next steps?
Have patient walk down the hall and measure O2 sat a second time to see if it dropped.
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A hydrocele is appreciated on the L testicle of a 20 yo M. It was confirmed via transillumination and does not cause any pain at the current moment. What is the treatment?
Leave it alone and have the patient return if and when it produces significant pain or pressure.
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What should you check first in an altered patient with salt abnormality?
Point of care glucose
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Replenishing potassium will not be effective in a hypokalemic patient with _____________ deficiency.
Magnesum
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Which of the following are the TWO life-threatening conditions treated with magnesium?
Torsades de points and Eclampsia
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____________ is a base that your kidneys make.
Bicarb
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A ________________ patient in renal crisis is a life-threatening emergency and treatment cannot be delayed for testing.
Hypotensive
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Tension pneumothorax should be diagnosed clinically and immediately treated with...
Needle decompression
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_____________: Nonretractable foreskin secondary to distal scarring.
Phimosis
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A 24 y/o patient comes into your ER c/o N/V. On exam you note that she has fruity breath and dry oral mucosa. She is alert and oriented despite obvious distress. You order labs, and note the following: BGl is 550, pH is 7.1, serum ketones are positive, Na is 130, and K is 6.0. You hang lactated ringers. What do you do next?
Given insulin at 0.1 U/k/hr
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A 28 y/o patient comes into your ER complaining of a cough and SOB. On exam they are febrile and in distress. You put them on nasal cannula and have them sit upright. The patient's test comes back positive for Covid; the patient gets aggravated and tells you covid is fake and the vaccine kills people. You decide to admit the patient as their vitals worsen, and eventually place them on a nonrebreather. However, their O2 sats continue to drop. What should you do next?
Consider awake proning
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A patient comes to your ER and is diagnosed with rhabdomyolysis. You counsel him on the causes of rhabdo, so he can avoid it in the future. What TWO things do you warn him about?
Methamphetamine use; Extreme exertion
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Your patient experiences a chest pain for 25 minutes that is persists even when resting. What diagnosis do you suspect?
Unstable Angina
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Your patient comes into your ER with an erection that has lasted in excess of 4 hours, what should you do?
Get him an emergent urology consult
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A 58 y/o male patient presents to your ER with 30 minutes of squeezing chest pressure that radiates to the left arm, diaphoresis, and slight dyspnea. You administer oxygen, nitroglycerine, and aspirin as an MI is on your differential. The patient has relief of chest pressure with nitroglycerine. What are your next steps?
Obtain a 12 lead ECG and troponins to determine if this is an ischemic event
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Which medication should you NOT give to a patient in thyroid storm?
NSAIDs
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A patient shows up to the ER breathing fast, N/V, and fruity smelling breath. You do a work-up for DKA, labs show potassium is 2.5. How do you proceed?
Give potassium then insulin
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A patient presents with tachycardia, dyspnea, hemoptysis, and unilateral leg swelling. Which of the following is not one of the preferred interventions for the primary diagnosis on your differential?
Aspirin
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Which of the following can lead to falsely low sodium results or pseudohyponatremia? Select all that apply.
Hyperlipidemia, Hyperglycemia, Hyperprotenemia
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Hypoxemia is PaO2 of ______
<60 mmHg
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A patient presents to your ER with fever and flank pain, which type of cast would you except to see on a UA to help aid you in your diagnosis of pyelonephritis?
White blood cell cast
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Patients CK levels are 5 times the UNL, what electrolyte is most important to correct during treatment?
Hyperkalemia
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One of the most common causes of pre-renal AKI is from cirrhosis, what pathological process has caused this issue from cirrhosis?
Loss of albumin
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Patient presents to your ER with abdominal pain, blood glucose of 300, and a PH of 7.12. As you are doing your workup for DKA what medications might the patient be on that would have caused the DKA?
Steroids
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While treating a patient for DKA you have been giving IV insulin, the blood sugar is now down below 250. What is the next best step?
Recheck the ion gap
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Patient comes to your ER with hypoglycemia, you admitted them and gave them glucose. While reviewing the patients' medications you noticed the patient takes sulfonylureas. In addition to administering glucose what over medication must be given?
Octreotide 50mc IV
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A patient presents with an BS of 774 and is in DKA. The potassium is 5.7. The patient needs to be treated with potassium and insulin.
False
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What three things should be done initially for a patient who presents to the ER with unstable angina?
All of these
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A 24 yo female patient presents with right sided abdominal pain and nausea. She missed her period last week. What test would you order to confirm your suspicions of what could be going on with the patient?
Hcg
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Mr. S comes into the ED with c/o "heart racing". He receives a standard 12-lead ECG. You notice Delta waves with shortened and narrow PR intervals, what do you suspect is the most likely cause and what initial 1st line treatment of choice would you provide?
Orthodromic WPW/Adenosine
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What is the 1st line treatment in an outpt setting for a pt with PID?
Ceftriaxone 250 mg IM once + Doxycycline 100 mg PO BID x 14 days
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Which imaging do you use to dx kidney stones?
CT without contrast
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Which of the following must be present in a patient to diagnose Hyperosmolar Hyperglycemic Syndrome?
Mental status changes
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26 year-old male presents to the ER with constant severe pain on his right side that radiates to his back. CT without contrast shows a 6 mm kidney stone. What is the best next step?
Admit the patient and urology consult
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Which of the following symptoms is most concerning in a patient with COPD or asthma?
Decreased breath sounds
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A 39-year-old man presents to the ED with a 2-day hx of LT testicular pain and swelling as well as "pain in my butt". Pt reports being in a monogamous heterosexual relationship and denies participating in anal intercourse. PE reveals a red swollen LT testicle that is moderately tender to palpation. Vitals are WNL and labs are negative. Based on the Patient's hx and PE findings, what is the likely dx and what would be the appropriate Tx plan?
Epididymitis. Levofloxacin 500mg PO x10 days
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Chronic atrophic dermatitis (looks like lichen sclerosis), is a complication associated with which GU pathology/dz?
Phimosis
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67 year old female reports to the ED with a 5 day hx of dysuria, frequency, and suprapubic pain. Pt denies fever, nausea, vomiting, or hematuria. Pt reports a hx of sulfa and PCN allergies. Physical exam is benign other than some mild suprapubic tenderness. Vitals are wnl, Labs normal except CrCl is 25 and UA is positive for leukocyte esterase and nitrites. Pt is dx with an uncomplicated UTI and prescribed ABX. Which abx would be appropriate to prescribe for this dx and patient hx?
Levofloxacin or Ciprofloxacin
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What is the first line treatment for most cases of acute bronchitis?
Nothing, it's usually viral and self-limiting
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Upon determining a patient has the flu, you want to prescribe Oseltamivir, which should be fine because their symptoms began about 3 days ago.
False
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When comparing ABGs and VBGs you need to make a correction. How much would you change the VBG pH to compensate and obtain a more accurate ABG?
+ 0.03 to pH
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44yo female presents to the ED with RUQ pain that occurs after eating and radiates to the right shoulder blade. Your CMP comes back with elevated LFTs but the RUQ US comes back normal. What is the next step?
Get a CT scan
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56yo male with hx of alcoholism presents to the ED with LUQ pain that is burning and radiates to the back. He has been nauseous and vomiting for the past 3 hours. Lipase comes back 3x UNL. What is your treatment?
Zofran, NPO, 1-2 NS, manage pain
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In a patient presenting with aortic dissection think chest pain and which of the following?
All of the above
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TWO of the following are indicators of poor prognosis in someone who presents to your ED with ischemic limb
Paralysis, Paresthesia
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Hypoxia is PaO2
<60mmhg
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65y/o male patient presents to your ED with an exacerbation of COPD. You order a VBG to look at CO2 and pH. You need to add ____ to your ___ if you draw a venous sample.
0.03, pH
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Patient presents to your ED with AMS. On your differential is HHS. Assessing vitals, you note the patient's HR is 45 and RR is 8. On physical exam you note prolonged reflexes and nonpitting edema. What treatment for this patient do you proceed with?
Levothyroxine
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Patient presents to your ED with signs of weakness and malaise along with a history of diarrhea. You decide to draw labs and note when assessing their electrolytes that K+ is high at 6.5. You order a STAT EKG. In order to stabilize the cardiac membrane, you give Calcium gluconate 2g IV. You know your next action is to shift K into the cell. The following THREE should be given to do so.
Insulin with D50, Sodium bicarbonate, Albuterol
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45 y/o F p/w AMS and weakness via EMS for unknown period. According to chart review, pt has a history of homelessness, SUD, HLD, GERD, and hypothyroidism. Upon interviewing the patient, she denies recent drug use and reports noncompliance with all medications 2/2 to financial issues.
Patient's vitals are as follows: HR: 43, BP: 95/60, RR: 12/min, 98% on RA. Afebrile. Due to her AMS, you decide to include a neurological exam which shows she is only AxO to self and marked hyporeflexia throughout. What MUST be ordered for this patient?
CT head
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Which of the following is not a gut pain you should be overly concerned about?
All of the above
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True or False, a child with bronchiolitis is likely to also have a history of asthma?
False
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An overweight female patient presents to the ER with RUQ pain that radiated to her right upper shoulder. In which of the following situations should you order a CT?
Elevated liver function test
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25y/o M presents to the ED with fever, malaise, nausea vomiting and RUQ pain. His total bilirubin is high and upon exam you note hepatomegaly. Based on your leading differential, what would be the next phase of this patient's disease state?
Sudden onset of jaundice
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55y/o F presents to the ED with the complaint of black tarry stools. What finding would decrease your suspicion for something ominous?
Recent iron supplementation rx from her PCP
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60 y/o pt presents with persistent cough with sputum, fever, chest discomfort and confusion. He has no history of comorbidities. Vitals: BP 80/60, RR 35, HR 70, T 101.1 F. On physical exam you note bronchial breath sounds and inspiratory crackles. Labs show uremia but are otherwise are unremarkable. Pt denies any hospital admission in the past year or any antibiotic use. Based on CURB-65 criteria, where should this patient be treated?
ICU
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A recently collected kidney stone from a patient eludes you to suspect multiple myeloma. Which additional labs do you request to further inquire this diagnosis?
SPEP, paraprotein gap
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Which of the below findings DOES NOT fit the CURB-65 requirements?
RR: 28
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In which of the following correctly pairs a physical exam finding with that of an electrolyte imbalance?
Muscle weakness of hyperkalemia
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Joe,68, presents to you with a long-standing history of dyspnea, sputum production, and chronic cough that just won't go away. He has smoked half a pack of cigarettes since he was 19 years old. He now presents to you with increasing dyspnea, especially on exertion, a RR of 23. What would best describe his current state?
Hypercapnic due to alveolar hypoventilation
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Beyonce, 39, presents to you with a lingering productive cough that has been going on for two weeks post an upper respiratory infection. Physical exam does not alert you to much concern. What question would you ask the patient to rule out any alarming features related to this patient's condition?
Any leg tenderness, swelling?
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Which patient would raise the most concern with a systemic viral infection caused by Influenza A?
65yo patient that looks ill
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22-month child presents to you with a highly concerned mother. Mother states that child has been wheezing throughout the day and night and has copious amounts of rhinorrhea. On PE & interview, you note some nasal flaring, a temp of 102.2F, and some coughing. What testing would you like to complete on this patient?
No testing needed, counsel & provide education to mom
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Patient presents post hysterectomy with concerns of hematuria. What is on the top differential of life-threating urinary bleeds related to this patient?
All of these
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On CT of the abdomen/pelvis, it is noted that patient A, who presents with concerns relating to an acute kidney injury, has indications of hydronephrosis. Which process are most leaning towards as a differential?
Postrenal AKI caused by a neurogenic bladder
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