ER Questions
What are absolute contraindication to thrombolytic therapy in a patient with an acute ST segment elevation myocardial infarction?
A previous hemorrhagic stroke, a stroke within one year, a known intracranial neoplasm, active internal bleeding, and a suspected aortic dissection. Severe, but controlled hypertension, use of anticoagulation, and active peptic ulcer disease are relative contraindications in which the risk/benefit ratio must be weighed in each patient.
A 78 year-old patient who is in acute distress with near-syncope and lightheadedness is being examined. The patient's pulse is 40/min and blood pressure is 90/56 mm Hg. Examination of the patient at 45 degrees of elevation reveals cannon "a" waves. Which of the following is the most likely explanation for these abnormal waves? A) AV dissociation B) Aortic stenosis C) Systolic HTN D) LVH
A) AV dissociation The patient is in a third-degree heart block with the atria contracting against a closed atrioventricular valve, which would be the scenario in a patient who has an escape rate of 40. Elderly patients are at risk for heart conduction problems such as complete heart block.
A 25-year-old male presents to the emergency department for evaluation of a wound on his hand. He cut his hand while tearing down a chicken coop. On examination of his right hand you note a dirty 3 cm jagged laceration. The patient is unaware of his tetanus immunization status. Besides cleaning and debriding the wound, what is the recommended clinical intervention in this patient? A) Administer tetanus-diptheria toxoid (Td) and tetanus immune globulin (TIG) B) Administer diphtheria, tetanus, and pertussis vaccine (DTP) C) Administer tetanus toxoid vaccine (TT) and tetanus immune globulin (TIG) D)No tetanus immunization or tetanus immune globulin is necessary in this patien
A) Administer tetanus-diptheria toxoid (Td) and tetanus immune globulin (TIG)
Early clues to impending delirium tremens include A) Agitation and decreased cognition B) Visual hallucinations and diaphoresis C) Autonomic hyperactivity and dehydration D) Mental confusion and sensory hyperacuity
A) Agitation and decreased cognition
A 45 year-old female presents to the emergency department with generalized, hot, erythema of the skin. Physical exam reveals an oral temperature of 102 degrees Fahrenheit, purulent conjunctivitis, and mucosal erosions. Her skin is painful and separates from the dermis with touch. Which of the following is the most likely cause for this condition? A) Ampicillin B) Prednisolone C) Aspirin D) HCTZ
A) Ampicillin Medications are most frequently implicated in toxic epidermal necrolysis. These usually include, analgesics (NSAIDs), antibiotics (Ampicillin) and anticonvulsants (Carbamazepine).
A 45 year-old male presents to the Emergency Department complaining of sudden onset of tearing chest pain radiating to his back. On examination the patient is hypertensive and his peripheral pulses are diminished. Electrocardiogram shows no acute ST-T wave changes. Which of the following is the diagnostic study of choice in this patient? A) CT scan B) TEE C) MRI D) Cardiac cath
A) CT scan This patient has signs and symptoms of acute aortic dissection for which CT scan is the diagnostic study of choice.
An 80-year-old female presents with pain in her vertebral column. Radiography reveals compression fracture of T12 that is consistent with an osteoporotic compression fracture. Which of the following treatment modalities has the potential to cause analgesia of the fracture site with its use? A) Calcitonin nasal spray B) Alendronate C) Raloxifene D) Combined estrogen and progesterone therapy
A) Calcitonin nasal spray Calcitonin has the ability to cause analgesia when used for acute compression fracture of the vertebral body.
A 26 year-old gravida 0 sexually active female presents to the emergency room complaining of colicky pain in her lower abdomen for the past 12 hours. She passed out earlier in the day while trying to have a bowel movement. Her last menstrual period was 6 weeks ago. She has noted vaginal spotting over the last 24 hours. Vital signs show Temp 37 degrees C, BP 96/60mmHg, P 110, R 16, Oxygen Sat. 98%. Abdominal exam is positive for distension and tenderness. Bowel sounds are decreased. Pelvic exam shows cervical motion and adnexal tenderness. Which of the following is the most likely diagnosis? A) Ectopic pregnancy B) Appendicitis C) Crohn's Disease D) PID
A) Ectopic pregnancy High suspicion for ectopic pregnancy should be maintained when any possible pregnant woman presents with vaginal bleeding or abdominal pain. Hint: In pelvic inflammatory disease the temperature is usually above 38 degrees C and pelvic pain usually follows onset of cessation of menses.
A 14 year-old patient, who fell on his outstretched hand, complains of pain along his entire arm. There is point tenderness and swelling over the midshaft of the radius. There is significant pain with limited flexion of the elbow joint. An x-ray will most likely show which of the following fractures? A) Galeazzi's B) Scaphoid C) Colles' D) Smiths
A) Galeazzi's Hint: A Smith's fracture is the reverse of a Colles' fracture, with volar angulation of the distal radius, but does not involve the elbow joint.
What is the recommendation for primary prevention of stroke in a patient under sixty years of age with atrial fibrillation? A) No therapy is needed B) Aspirin C) Warfarin D) Maze procedure
A) No therapy is needed
A 2 month-old infant has had a single, generalized tonic-clonic convulsion lasting 4 to 5 minutes. There is no history of trauma and the infant had been well previously. Physical findings include a temperature of 39.6 degrees C (103.2 degrees F), a bulging tympanic membrane on the right, and an inflamed pharynx. The next most appropriate step is to A) Perform lumbar puncture B) Order Skull XR C) Obtain EEG D) Send home with Abs and anticonvulsants
A) Perform lumbar puncture Febrile convulsions are uncommon under the age of 3 months. The physical findings suggest the possibility of meningitis, so lumbar puncture with CSF analysis is indicated.
Which of the following is the first-line treatment for symptomatic bradyarrhythmias due to sick sinus syndrome (SSS)? A) Permanent pacemaker B) Radiofrequency ablation C) Antiarrhythmics D) Anticoagulation therapy
A) Permanent pacemaker
A 35 year-old male presents with fever, perineal pain, and dysuria. On physical examination, the patient is toxic-appearing, febrile, and his prostate is very tender to palpation. Laboratory testing reveals leukocytosis, pyuria, and bacteriuria. Which of the following is the treatment of choice for this patient? A) ampicillin and gentamicin B) ceftriaxone and doxycycline C) Bactrim D)Nitrofurantoin
A) ampicillin and gentamicin Acute prostatitis is best treated acutely with parenteral antibiotics, such as ampicillin and gentamicin.
You are examining a patient with right-sided extremity weakness and left-sided weakness of the face. Where is the lesion? A) brainstem B) cerebral hemisphere C) cerebellum D) basal ganglia
A) brainstem Hint: Patients with cerebral hemisphere lesions may present with motor, sensory, visual or auditory findings depending on the lesion. Hint: Patients with basal ganglia lesions present with bradykinesia, akinesia, and loss of postural reflexes.
Which of the following medications used in the treatment of supraventricular tachycardia is able to cause sinus arrest and asystole for a few seconds while it breaks the paroxysmal supraventricular tachycardia? A) Digoxin B) Adenosine C) Verapamil D) Quinidine
B) Adenosine
An elderly patient with poorly-controlled Type 2 diabetes and renal disease develops a fever of 102°F orally, productive cough, and dyspnea. Physical examination demonstrates a respiratory rate of 32/min, labored breathing, and rales at the left base. Pulse oximetry is 90%. Which of the following is the next appropriate step in the management of this patient? A) Administer nebulized cortiosteroids B) Admit to the hospital C) Oral antimicrobial therapy D) Endotracheal intubation
B) Admit to the hospital Community acquired pneumonia is the most deadly infectious disease in the U.S. Important risk factors for increased morbidity and mortality include advanced age, alcoholism, comorbid medical conditions, altered mental status, respiratory rate greater than 30 breaths/min, hypotension, and a BUN greater than 30.
A 56 year-old male with a known history of polycythemia suddenly complains of pain and paresthesia in the left leg. Physical examination reveals the left leg to be cool to the touch and the toes to be cyanotic. The popliteal pulse is absent by palpation and Doppler. The femoral pulse is absent by palpation but weak with Doppler. The right leg and upper extremities have 2+/4+ pulses throughout. Given these findings what is the most likely diagnosis? A) Venous thrombosis B) Arterial thrombosis C) Thromboangitis obliterans D) Thrombophlebitis
B) Arterial thrombosis Arterial thrombosis has occurred and is evidenced by the loss of the popliteal and dorsalis pedis pulse. This is a surgical emergency. Venous occlusion and thrombophlebitis do not result in loss of arterial pulse.
A 53 year-old female with sudden onset "of the worst headache she has ever had" presents to the emergency department. She has a history of migraines but states that the current headache is not like her usual headaches. Results of her physical examination are unremarkable. Which of the following is the next best step in the evaluation of this patient? A) Angiogram B) CT scan C) Transcranial doppler D) MRI
B) CT scan This patient's history is highly suggestive of subarachnoid hemorrhage. CT is best to screen for intracranial hemorrhage. It is faster than MRI and more sensitive in the first 24 hours.
A 19 year-old college student has a severe sore throat and a temperature of 102° F. On examination, there are vesicles on the soft palate with some erythema. The tonsils are not enlarged. There is mild cervical lymph node enlargement. Which of the following is the most likely diagnosis? A) EBV B) Coxsackie virus group A C) Strep pyogenes D) Mycoplasma PNA
B) Coxsackie virus group A Hint: Epstein-Barr is accompanied by generalized lymphadenopathy. Exudative pharyngitis and tonsillitis may also occur. Hint: Streptococcus pyogenes produces an exudative pharyngitis
A 23-month-old male presents to the office with his father who reports the patient has had an acute onset of severe pharyngitis, fever of 103.5 degrees F and what sounds like harsh, high-pitched breath sounds. His dad states the child has started drooling and seems to be worsening. The child is not presently crying but has muffled voice sounds. The child has not been immunized due to religious reasons. What is the most appropriate next step? A) Administer Ceftriaxone B) Emergent transfer C) Administer racemic epi D) Obtain IV access
B) Emergent transfer Epiglottitis requires endotracheal intubation to maintain the airway but should be performed only in the operating room or emergency room with a competent physician prepared to place an endotracheal tube or less often to perform a tracheostomy.
A 52 year-old male presents with a severely painful, swollen right great toe. He denies recent trauma, but reports several similar episodes of toe pain and swelling over the past two to three years. He has a history of alcohol abuse and hypertension, for which he "takes medication" of unknown type. Examination reveals bright erythema and edema associated with the right first MCP joint. Which of the patient's antihypertensive medications may be contributing to this condition? A) Diltiazem B) HCTZ C) Lisinopril D) Metoprolol
B) HCTZ
A 17 year-old male is accidentally struck in the right eye while playing football and is immediately transported to the hospital. In the emergency room, he complains of severe pain behind the eye as well as double vision. On examination, he has exophthalmos, cannot move his right eye upward and blood is noted in the anterior chamber. Which of the following is the most appropriate course of action at this time? A) Apply ice packs and cold compress B) Immediately refer the patient to an ophthalmologist C) Attempt to keep the patient calm and order skull XR D) Administer a dose of IM broad spectrum Abx
B) Immediately refer the patient to an ophthalmologist This scenario describes a "blow-out" fracture of the orbit with hyphema and, because of the signs and symptoms presented, warrants an immediate consult by an ophthalmologist.
A 25-year-old female, G2 P1001, presents to your office at 11-weeks gestation with vaginal bleeding, mild lower abdominal cramping, and bilateral lower pelvic discomfort. On examination, blood is noted at the dilated cervical os. No tissue is protruding from the cervical os. The uterus by palpation is 8-9 weeks gestation. No other abnormalities are found. Which of the following is the most likely diagnosis? A) Threatened abortion B) Inevitable abortion C) Incomplete abortion D) Complete abortion
B) Inevitable abortion
A patient's EKG reveals widened P waves in lead II and large negative deflection of the P wave in lead V1. Which of the following is the most likely underlying cause for this? A) Right atrial enlargement B) Left atrial enlargement C) Right ventricular hypertrophy D) Left ventricular hypertrophy
B) Left atrial enlargement Hint: Right atrial enlargement is found on EKG with peaked P waves in lead II and a large positive deflection on the initial P wave in lead V1.
Bony and cartilaginous enlargement of distal interphalangeal joints is commonly seen in which of the following medical conditions? A) RA B) OA C) Psoriatic OA D) Gouty arthritis
B) OA
An immunocompromised patient presents with signs and symptoms consistent with Legionella pneumophila who has not responded to initial antibiotic therapy with a macrolide. Which of the following should be added? A) Clarithromycin B) Rifampin C) Levofloxacin D) Augmentin
B) Rifampin
Which of the following is the most common cause for acute myocardial infarction? A) Occlusion caused by coronary microemboli B) Thrombus development at a site of vascular injury C) Congenital abnormalities D) Severe coronary a. spasm
B) Thrombus development at a site of vascular injury
A 30-year-old female presents to the emergency department with a syncopal episode. She has a history of irregular menstrual cycles and infertility. She has scanty, persistent vaginal bleeding and sharp pelvic pain. A left adnexal mass is palpated. The most likely diagnosis is A) placenta abruption B) ectopic pregnancy C) pelvic inflammatory disease D) ruptured ovarian cyst
B) ectopic pregnancy Pelvic inflammatory disease typically presents with fever, abdominal pain, purulent vaginal discharge, and cervical motion tenderness. Acute pelvic pain may occur secondary to bleeding from the rupture of a hemorrhagic ovarian cyst, but no adnexal mass would be palpable on pelvic examination.
Which of the following clinical findings would be seen in a patient with food poisoning caused by Staphylococcus aureus? A) Ingestion of mayo based salads 48 hours earlier B) Bloody diarrhea with mucus for one week C) Abdominal cramps and vomiting for 48 hours D) High fever for 1 week
C) Abdominal cramps and vomiting for 48 hours
A 30-year-old female presents to the emergency room having passed out at home 30 minutes prior to arrival. Her last menstrual period was 6 weeks ago and pregnancy test was reported positive 5 days ago. She started having vaginal bleeding last night. Vital signs are BP 70/40 mmHg, P 140 bpm, R 22. She is pale and diaphoretic. The next step in the evaluation of this patient's condition should be which of the following? A) Abdominal US B) Culdocentesis C) Laparotomy D) MRI
C) Laparotomy Laparotomy is indicated with presumptive diagnosis of ectopic pregnancy in an unstable patient
A 22 year-old patient complains of sudden onset of chest pain accompanied by shortness of breath. The patient appears dyspneic. On examination, the trachea is deviated to the left, breath sounds are faint on the right, and the right chest is hyperresonant to percussion. The preferable treatment for this patient would be A) A trach B) Insertion of a chest tube with underwater seal, left 2nd intercostal space C) Needle thoracotomy right 2nd intercostal space D) A ling scan for PE and begin Heparin therapt
C) Needle thoracotomy right 2nd intercostal space Decreased breath sounds and hyperresonance are noted on the side of the pneumothorax; tracheal deviation to the opposite side indicates development of a tension pneumothorax. Treatment consists of inserting a chest tube on the side of the pneumothorax and connecting to an underwater seal.
Which of the following views on plain films is preferred to identify spondylolysis? A) Anterior B) Posterior C) Oblique D) Lateral
C) Oblique
A 34-year-old man comes to the urgent care with fever of 102 degrees F, chills, and perineal pain for the past 2 days. In addition, he has difficulty voiding, dysuria, frequency, urgency, and nocturia. Which of the following physical examination findings are consistent with this history? A) Mild suprapubic tenderness B) Scrotal swelling and tenderness C) Prostate tender, warm, and swollen D) CVA tenderness
C) Prostate tender, warm, and swollen The diagnosis of acute prostatitis is supported by fever, irritative voiding symptoms, perineal pain and exquisite tenderness of the prostate on rectal exam.
A football player complains of burning pain, numbness, and tingling extending from the left shoulder down into the hand after he tackled a player. These symptoms resolved spontaneously in minutes. Following resolution of the symptoms, he has full strength and normal sensation in the left arm. What is the most likely etiology of his symptoms? A) Acute muscle strain B) Mild concussion C) Stretching of nerve roots and brachial plexus D) Thoracic outlet obstruction
C) Stretching of nerve roots and brachial plexus Brachial plexus neurapraxia, commonly called "stinger" injuries, results from stretching of the cervical nerve roots and brachial plexus by a mechanism such as that described in this question. Hint: Thoracic outlet syndrome is most commonly caused by cervical rib and is usually only symptomatic when the arm is elevated.
A 48 year-old alcoholic, whose last drink was 6 days ago, presents to the clinic complaining of palpitations and intermittent abdominal pain. On physical examination, blood pressure is 170/110 mm Hg, pulse 124/min, respirations 22/min, and temperature 100.4 degrees F. The patient is agitated and excitable. Cardiovascular examination reveals tachycardia without murmurs, gallops, or rubs, and is otherwise normal. Which of the following is the most appropriate intervention? A) Start antihypertensive medication B) begin a cardiac workup for angina C) admit to hospital for alcohol withdrawal D) consul social services for appropriate disposition
C) admit to hospital for alcohol withdrawal This patient is exhibiting the signs and symptoms of alcoholic withdrawal characterized by delirium, autonomic hyperactivity, perceptual distortions, and fluctuating levels of psychomotor activity. Seizures are a common occurrence prior to DTs, but the delirium may occur without preceding seizures. This is a medical emergency, and if untreated, it has a mortality rate of 20%.
Which of the following is a major risk factor for an ectopic pregnancy? A) alcohol intake B) young maternal age C) history of salpingitis D) low dose OCP
C) history of salpingitis A previous history of salpingitis is a major risk factor for ectopic pregnancy since damage to the fallopian tube prevents the fertilized ovum from reaching the uterus prior to implantation.
Which of the following is an indication for hospitalization in a patient who has acute bronchiolitis? A) Pulse ox of 94% on RA B) child between 4-6 months of age C) moderate tachypnea and feeding difficulties D) hyperinflation and interstitial infiltrates on CXR
C) moderate tachypnea and feeding difficulties
A 22 year-old male presents several hours after sustaining a hand injury when he punched a wall. X-rays of the hand demonstrate fracture of the fifth metacarpal neck with 65 degrees dorsal angulation and a claw hand. What is the most appropriate intervention? A) Antibiotic treatment and ulnar gutter splint immobilization B) Closed reduction and ulnar gutter splint immobilization C)Open reduction and ulnar gutter splint immobilization D) Ulnar gutter splint immobilization only
C)Open reduction and ulnar gutter splint immobilization Hint: Reduction followed by splinting is recommended for fifth metatarsal fractures with angulation of 15-40 degrees.
A 22 month-old male infant presents with one day of barking cough preceded by three days of cold symptoms. On physical examination, his axillary temperature is 100.4°F and he has no stridor at rest. Inspiratory stridor is evident when he becomes agitated during the examination. There are no signs of respiratory distress or cyanosis. Which of the following is the most appropriate treatment for this patient? A) Nebulized albuterol B) Nebulized epi C) Oral amoxicillin D) Oral dexamethason
Corticosteroids are beneficial in the treatment of croup. Intramuscular administration has shown no benefit over oral administration. Viral croup is an upper airway disease and there is no role for bronchodilator therapy. Nebulized racemic epinephrine is only indicated in the treatment of croup in cases of moderate to severe rest stridor, respiratory distress, or hypoxia.
How to treat Hemophilia A?
Cryoprecipitate
A patient presents to the office following a syncopal episode. The patient claims that the syncope occurs when he changes position such as rolling over in bed or when he bends over to tie his shoes. Which of the following is the most likely explanation for this presentation? A) Carotid sinus hypersensitivity B) Vasovagal episode C) Subclavian steal syndrome D) Atrial myxoma
D) Atrial myxoma Atrial myxoma most commonly presents with sudden onset of symptoms that are typically positional in nature due to the effect that gravity has on the tumor. Myxomas are the most common type of primary cardiac tumor in all age groups and are most commonly found in the atria. Hint: Carotid sinus hypersensitivity may present with syncope but is usually related to tight collars or when excessively turning the head. Vasovagal episodes may occur with syncope as its manifestation but it is not caused by changes in position. Subclavian steal syndrome may present with syncope that is related to exercise of the affected arm which results in a decreased pulse when the Adson maneuver is performed.
A 2-year-old presents with sudden onset of cough and stridor. On examination the child is afebrile and appears nontoxic with a respiratory rate of 42 breaths per minute. What is the next step in the evaluation of this patient? A) Lateral soft tissue XR of neck B) Indirect laryngoscopy C) Finger sweep D) CXR
D) CXR
A 3 year-old child playing in an abandoned shed is bitten by a black widow spider. The mother rushes the child to the emergency department within 20 minutes of the incident. Which of the following if the best initial intervention? A) IM steroids B) Administration of antivenom C) Immediate immersion in a cold bath D) Hospital admission for sx care
D) Hospital admission for sx care Hospital admission for symptomatic care should be considered in children, pregnant women, and patients with preexisting cardiovascular disease. Administration of antivenin should be administered to patients with severe envenomation manifested as seizures, respiratory failure, or hypertension.
A 16-year-old nulliparous acutely ill female presents with bilateral lower abdominal pain. She has a temperature of 100.4 degrees F and on examination has a tender, enlarged left adnexa. Cervical culture is positive for Chlamydia. Ultrasound reveals a complex tubular structure in the left adnexal area. What is the recommended treatment? A) Outpatient with IM ceftriaxone and oral doxy B) Oral doxy C) IM procaine penicillin D) Hospitalization with parenteral cefoxitin and doxy
D) Hospitalization with parenteral cefoxitin and doxy
A 35 year-old pregnant patient presents with fever, chills, and left-sided flank pain. On physical examination left-sided CVA tenderness is noted. Urinalysis reveals numerous white blood cells and white blood cell casts. Which of the following is the most appropriate treatment? A) Oral cipro B) Oral bactrim C) IV Gentamicin D) IV ceftriaxone
D) IV ceftriaxone IV cephalosporins are first line treatment of pyelonephritis in a pregnant patient, followed by oral step-down therapy.
Which of the following can be used to treat chronic bacterial prostatitis? A) Penicillin B) Cephalexin C) Nitrofurantoin D) Levofloxacin
D) Levofloxacin
A patient with advanced AIDS complicated by toxoplasmosis presents with altered mental status, recent onset of seizures, and focal neurologic deficits. Which of the following diagnostic studies is most helpful? A) Toxoplasma gondii antibody titers B) CT scan of brain C) Lumbar puncture D) MRI of brain
D) MRI of brain An MRI showing multiple isodense or hypodense ring-enhancing mass lesions is the most useful test for such a patient. Hint: Lumbar puncture is contraindicated secondary to possible mass effect.
A 53-year-old male with history of hypertension presents complaining of recent 4/10 left-sided chest pain with exertion that is relieved with rest. He states the pain usually lasts approximately 4 minutes and is relieved with rest. Heart examination reveals regular rate and rhythm with no S3, S4, or murmur. Lungs are clear to auscultation bilaterally. Electrocardiogram reveals no acute changes. Which of the following is the most appropriate initial step in the evaluation of this patient? A) Cardiac catherization B) CT angio C) Echo D) Nuclear stress test
D) Nuclear stress test Nuclear stress testing is the most appropriate initial diagnostic study in the evaluation of a patient with signs and symptoms consistent with stable angina.
A 47 year-old perimenopausal female with vasomotor symptoms complains of vulvar itching and copious vaginal discharge with a rancid odor. Physical examination reveals erythema of the vulva and petechiae on the cervix. The pH of the vaginal discharge is five. Which of the following is the recommended treatment for this patient? A) Topical Metro B) Oral fluconazole C) Topical Estrodiol D) Oral Metro
D) Oral Metro This is a classic description of trichomonas vulvovaginitis. This condition must be treated with oral metronidazole or tinidazole.
A 25 year-old female presents to the emergency department after an episode of substernal chest pain with radiation to the middle of her back that came on suddenly and lasted for about four minutes this morning while in bed. She denies previous episodes. Examination is unremarkable, but she appears jittery. Toxicology screen is positive for cocaine. Which of the following medications is contraindicated in this patient? A) Lorazepam (Ativan) B) Diltiazem C) Nitroglycerin D) Propanolol
D) Propanolol Pure Beta blockers, such as propranol, can cause a paradoxical hypertension because of unopposed alpha-adrenergic effects.
A 29-year-old patient with idiopathic thrombocytopenia purpura (ITP) is treated with prednisone therapy. Despite therapy, platelet counts remain consistently below 20,000/microliter over the course of 6 weeks. Which of the following is the most appropriate intervention for this patient? A) Aspirin B) IVIG C) Danazol D) Splenectomy
D) Splenectomy Persistently low platelet counts (less than 20,000) require effective long-term treatment, and splenectomy is the treatment of choice. Intravenous immunoglobulin can be utilized for short-term treatment, but the platelet count is likely to return to baseline within a month. Danazol is typically reserved for ITP that fails to respond to splenectomy.
An 8 year-old child is brought in by his mother with a two day history of spreading, non-pruritic red rash. The rash was preceded by moderate fever, sore throat and rhinorrhea. Examination reveals a moderately ill appearing child with a fine, macular-papular rash on an erythematous base spread diffusely over the trunk with some accentuation in the skin folds. The face is flush with perioral pallor. There is palpable anterior cervical lymphadenopathy. Which of the following is the most appropriate diagnostic study to establish the diagnosis? A) Shave biopsy B) Epstein Barr virus IgG C) CBC D) Throat culture
D) Throat culture
In the treatment of alcohol-related hypoglycemia, thiamine is administered before glucose to prevent which of the following?
Wernicke's encephalopathy Alcoholics are typically deficient in thiamine. If glucose alone is given to treat hypoglycemia, Wernicke's encephalopathy can be precipitated since thiamine is not available for nutritional purposes when glucose is replaced. Therefore, thiamine is always given prior to glucose until a satisfactory diet can be given in order to prevent Wernicke's encephalopathy.