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問題一覧
1
What is the medication of choice in the initial treatment of acute aortic dissection without shock?
esmolol
2
Which of the following is true regarding concussions?
Neurologic exam is typically normal
3
You are evaluating a 45 year old woman with a severe headache. As part of your history taking, you ask about risk factors. Which of the following is a known risk for subarachnoid hemorrhage?
Sibling with a history of ruptured cerebral aneurysm.
4
Which of the following are true regarding post-lumbar puncture headaches?
Symptoms begin typically within 48 hours.
5
Regarding CSF analysis, which of the following is most abnormal?
>1 polymorphonuclear neutrophils (PMN)
6
Which of the following are is NOT typically found in patients with Wernicke’s encephalopathy?
Tremor
7
A 32 year old woman presents with gradual onset headache. After 4 days of suffering, she has a seizure for the first time. Her husband brings her to the ER where a CT scan shows intracerebral hemorrhage. CT angiogram and venograms are performed and patient is diagnosed with cerebral venous thrombosis with an intracerebral hemorrhage. Which of the following is the most appropriate next step?
Start low-molecular weight heparin
8
Which of the following is NOT a risk factor for pelvic inflammatory disease?
Advanced Age
9
A 30 year old woman presents with a left sided abdominal pain and vaginal bleeding. You suspect a diagnosis of ectopic pregnancy. Which of the following is true?
None of these are true.
10
All of the following are true regarding the diagnosis of ectopic pregnancy except:
all of these are true
11
Which of the following is true regarding ectopic pregnancy?
The ideal patient for non-surgical management has an hCG < 5000 and ectopic size of < 4cm
12
Which of the following does not increase a woman’s risk for pre-eclampsia?
All of these are risk factors
13
Which of the following lab findings would be expected in a patient with HELLP syndrome?
low hemoglobin
14
Which of the following is true regarding appendicitis in pregnancy?
Appendicitis is the most common surgical emergency of pregnancy.
15
Which of the following is true regarding cardiac arrest in children?
cardiac arrest in children is more often due to respiratory causes than cardiac causes
16
Which of the following is a difference between paediatric and adult airways?
Infants’ vocal cords are angled differently leading to difficult nasal intubations.
17
A 6 year old male presents with fever, cough, night sweats, generalized malaise for 3 days. Which of the following is the most likely diagnosis? CXR shown.
Round Pneumonia
18
Which of the following is the LEAST appropriate method of maintaining an airway in a child with epiglottis?
Supraglottic airway
19
A ten day old infant presents with swelling around his umbilicus that started today. There is a small amount of erythema and drainage but no fluctulance noted, and the child is afebrile. What is the best next step in management?
Consult a paediatric surgeon for management.
20
Which of the following is true regarding the positive and negative symptoms of schizophrenia?
Paranoid delusions and neologisms are positive symptoms
21
A first year emergency medicine intern has just finished his internal medicine rotation. He remembers being bitten by a scorpion several years ago and after taking care of several patients with pancreatitis he is now convinced that he has it. He has checked himself into the ED three separate times and has had negative blood tests, negative CT scan and three normal rectal exams. He presents again today asking for more tests and possibly another two rectal exams. Which of the following might this intern have?
Hypochondriasis
22
A 40 year old female comes to the ED with abdominal pain. She had an explorative laparotomy done one week ago that was unremarkable. Today she has a fever and the wound appears infected. One of the nurses notices her picking at the wound and putting her feces into it. Which of the following is the most likely diagnosis?
Factitious Disorder
23
Which of the following is NOT a criteria for septic shock?
Initial presenting systolic BP <90
24
Which of the following lab findings is most suggestive of a transudate on thoracenteis for a pleural effusion?
Low pleural fluid protein: serum protein ratio
25
Which of the following is an indication for digibond in an adult patient with acute digoxin overdose?
Serum potassium 5.8
26
Which of the following is true regarding ingestion of mushrooms?
Amanita mushrooms are associated with hepatotoxicity.
27
Which of the following is an indication for dialysis in a case of salicyclate overdose?
pulmonary edema
28
Which of the following is considered acceptable pre oxygenation before intubation?
8 breaths with maximum inhalation and exhalation.
29
What is the paralytic of choice in patients with high risk of desaturation?
Rocuronium
30
Which of the following is the preferred site of access for the peripheral vein cutdown?
Basilic vein
31
A two year old child is involved in an MVA. He arrives to ED with a BP of 60/p and a HR of 150. You suspect that he may be going into shock and will require fluid resuscitation. Paramedics have not been able to place an IV line after 3 attempts. What should be done next?
insert an IO
32
Paramedics call to inform you they’re bringing a pregnant woman who says she 8 months pregnant and was in a motor vehicle accident. He is hypotensive with a BP of 70/p. They have her immobilized and flat on a spine board. how should you respond?
Displace the uterus
33
A patient presents to the ED after being punched in the face. he is having difficult seeing out of his left eye where he has it. What is the next step in treatment?
Perform lateral canthotomy
34
Which of the following is the diagnostic modality of choice in hemodynamically unstable patients with blunt abdominal trauma?
ultrasound
35
A 45 year old with a history of lupus presents to the ED for vomiting, diarrhea, and muscle aches. Her only medication is prednisone. She remembers being bitten by a cat two weeks ago. Which of the following organisms should be suspected?
Capnocytophaga
36
Paramedics are performing chest compressions on an unresponsive patient. They were unable to establish an OV but have an endotracheal tube in place. Which of the following medications can safely be given to the patient while alternative plans are being made for IV access?
Naloxone
37
A patient presents with a laceration to the left lower extremity that crosses the knee joint. Presence of which of the following warrants operative evaluation?
Expanding hematoma
38
A young man is involved in a. motorcycle crash. Blood is found at the urethral meatus. Which test is needed prior to placing a Foley catheter?
Urethrogram
39
Two men get into a fight over which pony they think is the cutest and one of them gets punched in the face. He presents with a sunken eye and decreased sensation on his upper cheek. While checking extraocular movements, you ask him to look up and he reports double vision. Which of the following muscles is most likely involved?
Inferior Rectus
40
A 50 year old lady complains of pain and swelling along her lower jaw. The pain worsens while eating. She constantly has a dry mouth despite drinking plenty of fluids. Which treatment is most likely to provide relief?
Sialogogues
41
Which of the following statements is true regarding compartment syndrome in a patient with a tibia fracture?
Compartment syndrome can occur at lower pressures in hypotensive patients
42
Which of the following is true regarding rhabdomyolysis?
Excessive fluid resuscitation may result in compartment syndrome
43
A newborn has a heart rate of 126/min with irregular respirations. He has flexion of all four extremities and resists extension. He grimaces in response to stimulation but does not cry or pull away. Hands and feet are cyanotic but otherwise he is pink in color. What is this newborns APGAR score?
7
44
A new type of Rapid HIV test is being developed. In a sample of 100 patients, 70 are known to be HIV positive and 30 are known to be negative. 60 of the patients with HIV tested positive using this new tool and the other 10 tested negative. 15 patients who do not have HIV tested positive. What is the specificity of this new rapid HIV test?
0.5
45
A child was playing outside when his neighbors dog bit him on the leg. He had a 1cm laceration to his lower Meg. The dog is up to date on the rabies vaccination. What is the best course of action?
Wash the wound with soap and water
46
A 30 year old male is stabbed in the chest. Which of the following is true regarding diaphragmatic rupture?
Penetrating trauma leading to rupture may present years later.
47
Which of the following statements is true regarding inpatient treatment of community acquired pneumonia ?
Pneumonia mortality rates have not changed significantly since penicillin became readily available
48
A 65 year old disheveled man presents with fractures in different stages of healing. He confirms that his family abuses him but he wishes to return home with them. In addition to notifying protection services, what should be done?
Discharge home with family
49
A 70 year old male presents with foot pain. on exam his foot is cold and pulseless. what is the Most likely cause?
Thromboembolism
50
which of the following represents the correct order of sequence for appearance of sonographic findings of an intrauterine pregnancy ?
Gestational sac, double decidual sign, yolk sac, fetal pole, fetal heart activity
51
Which of the following statements is true regarding Tularemia?
The ulceroglandular variant of tularemia is most common
52
Ultrasound is more sensitive than plain films for which type of fracture ?
Rib
53
You are planning to perform procedural sedation for a child with a laceration. The patient last meal was two hours ago. How much additional time should you wait to perform the sedation?
No amount of time is necessary
54
which of the following is true regarding brown recluse spider envenomations?
Dapsone may be beneficial in preventing local effects of the venom
55
Which of the following contributes to the development of hepatic encephalopathy in a patient with cirrhosis ?
Hypokalemia
56
Which of the following statements is true regarding treatment of COPD ?
administering steroids, intravenously has been shown to increase hospital length stages without reducing morbidity or mortality .
57
A 16 year old girl dislocated her patella while playing volleyball. Which of the following is true?
She is at high risk to have recurrent dislocation
58
Which of the following statements is true regarding airway management of an obese patient?
Ideal positioning is to elevate the head 25°
59
A pregnant female is being treated for eclampsia with IV magnesium sulfate. She becomes bradypneic and less responsive. Which of the following should be administered?
Calcium gluconate
60
which of the following is an indication for admission in patients with hepatitis ?
All of the above
61
A patient presents with abdominal pain. KUB is shown below. Which of the following statements is true regarding this finding?
This patient has a higher risk of appendiceal perforation.
62
an elderly male patient presents with weakness. He recently recently started chemotherapy for Squamous cell lung cancer. Labs show acute renal failure, and hyperkalemia. which of the following is also most likely present?
Hypocalcemia
63
A six day old infant presents to the ER with watery eye drainage, which of the following is the best course of action ?
treat with topical erythromycin, 0.5% ointment and oral erythromycin .
64
A 45 year old male presents with thoracic back pain and symmetric weakness in both legs. The following image is obtained. Which of the following is true?
Most patients can be managed with supportive care
65
Which of the following illnesses does not require strict airborne precautions?
Anthrax
66
What is the most likely diagnosis in a father and son, who present together with abdominal pain, flushing, and pruritus after eating at a restaurant?
Scromboid poisoning
67
A 48 year old man dislocates his hip while dancing along to his favorite Irish rock band. Which of the following is true regarding hip dislocations?
Anterior dislocation leads to shortening and external rotation
68
Which of the following statements is true regarding infection and solid organ, transplant recipients?
CMV can cause invasive disease that produces fever and neutropenia .
69
which of the following statements is true regarding ultrasound findings of foreign bodies ?
Wooden foreign bodies, have a characteristic acoustic shadow similar to a gallstone.
70
which of the following statements is true regarding Gammahydroxybutraye (GHB) intoxication?
Periods of agitation, alternating with periods of depressed level of consciousness is characteristic
71
Which of the following statements is true regarding burn management?
All of the above are true
72
How should a child with rocky mountain spotted fever be treated
Doxycycline
73
Routine treatments of rhabdomyolysis, should include which of the following?
IV. Fluid resuscitation.
74
In what setting is allopurinol contraindicated for treatment of gout ?
Monotherapy during an acute flare
75
which of the following can be used as treatment for haemophilus duccreyi?
Azithromycin, 1 g PO
76
which of the following statements is correct regarding patients with eye pain ?
Patients with iritis may have a Mishappen pupil
77
which of the following statements is true regarding intracranial bleeds ?
Subdural hemorrhage has a higher rate of mortality than epidural hemorrhage
78
What is the earliest EKG finding of acute myocardial ischemia?
Peaked T waves
79
which of the following statements is true Regarding pertussis?
Antibiotics may be of benefit even after four weeks of symptoms
80
How many adjacent ribs must be broken to make a diagnosis of flail chest?
3
81
What is the most common cause of acute chest syndrome in patients with sickle cell disease?
M. Pnemoniae
82
In an unstable patient with cardiac tamponade, which of the following chambers is being compressed during diastole?
Right ventricle
83
A 60 year old male who works as a crop duster is brought to the ER with weakness and muscle fasciculations . On exam, you notice myosis, bradycardia and wheezing bilaterally. treatment for the patient’s weakness and fasciculations includes which of the following?
pralidoxime
84
A 32 year old woman is involved in a motor vehicle accident. She winces and withdraws in response to pain, but does not open her eyes. She is making sounds but you cannot make out distinct words. What is her Glasgow coma scale?
7
85
Which of the following statements is true regarding aspiration pneumonia?
Corticosteroids are of no benefit
86
Which of the following is the primary Ketone body responsible for acidosis in alcoholic keto acidosis
beta- hydroxybutyrate
87
A 65 year old diabetic patient presents with toe pain. On exam he has an ulcer at the base of his first metatarsal. x-rays are done. What is the next best step?
IV antibiotics and emergent surgical consultation
88
which of the following statements is true regarding moderate sedation ?
Airway protective reflexes are maintained
89
Fetal cardiac activity can first be detected by transVaginal ultrasound at what gestational age?
Six weeks
90
What is the most common cause of pneumonia in patients with HIV ?
S Pneumoniae
91
A patient slips and cut himself on a metal fence post two weeks later the wound is low to heal. He has difficulty swallowing and muscle spasms. Tetanus is suspected what is the preferred antibiotic to be initiated ?
Metronidazole
92
What is the expected urine output of a patient with severe hypothermia?
Increased
93
which of the following animal bites is associated with hypersensitivity and localized numbness ?
Scorpion
94
What is the most common complication of infective endocarditis?
Congestive heart failure
95
Which of the following is true regarding Osborne waves in hypothermia?
Osborne waves are typically more prominent in the precordial leads
96
What is the standard of care for diagnosis of subarachnoid hemorrhage?
CT head without contrast and lumbar puncture
97
which of the following are expected findings in patients With myxedema coma?
Hypercholesterolemia
98
Which of the following statements is true regarding Trendelenburg position?
It has no role in the placement of a femoral, central venous line
99
Risk of Thrombo embolism is greatest at what stage of pregnancy
Immediate postpartum
100
Which of the following statements about the difference between C Perfringens and S aureus Food poisoning is correct?
symptoms for c perfringins Typically start after six hours