PART TWO EM ROSH

aplastic anemia

This list includes cytotoxic agents, antibacterials, antiseizure medications, antithyroid drugs, nonsteroidal anti-inflammatory drugs, gold, and arsenic compounds.

aplastic anemia - what drugs cause this

This list includes cytotoxic agents, antibacterials, antiseizure medications, antithyroid drugs, nonsteroidal anti-inflammatory drugs, gold, and arsenic compounds.

eelctrolyte imabalcne in SIADH

HYPONATREMIA NORMAL POTASSIUM LOW SERUM OSMOLALITY

The gold standard for diagnosing pneumonia ?

in most cases- a chest radiograph is used, however, chest computed tomography is a more sensitive study. NOT A SPUTUM CULTURE

The reduction of serum human chorionic gonadotropin greater than ___% over 48 hours in the presence of vaginal bleeding is highly suggestive of pregnancy loss.

25

t scores and how often to monitor

-1.50 to -1.99 should be retested every three to five years -1.01 to -1.49can be monitored every 10 to 15 years. Patients with T-scores between -2.00 to -2.49 = every two years

helpful- what is the tx for outpt inpatient diverticulitis

. Some patients with acute diverticulitis require hospitalization. These include patients with complicated diverticulitis and uncomplicated diverticulitis with one or more of the following features: sepsis, microperforation, immunosuppression, high fever (> 102.5° F), severe abdominal pain, advanced age, significant comorbidities, intolerance of oral intake, and failing outpatient therapy. Immunosuppression includes use of immunosuppressive agents, chronic high-dose use of corticosteroids, advanced HIV infection, and poorly controlled diabetes mellitus. The outpatient management consists of oral antibiotics for 7 to 10 days, and patients should be reassessed after two or three days of treatment. The outpatient regimen used to treat acute diverticulitis is typically one of the following: ciprofloxacin and metronidazole, levofloxacin and metronidazole, or amoxicillin-clavulanic acid. There is no evidence for dietary restriction in patients with uncomplicated diverticulitis. However, some clinicians recommend a clear liquid diet for two to three days prior to reassessment. The inpatient management for uncomplicated diverticulitis consists of intravenous antibiotics, intravenous fluids, and pain management. Patients can be made nil per os or be offered a clear liquid diet. The recommended antibiotic regimen for patients who are admitted is either piperacillin-tazobactam or one of the following combinations: ciprofloxacin and metronidazole, levofloxacin and metronidazole, or ceftriaxone and metronidazole

A 60-year-old man presents to the emergency department with confusion, disorientation, delirium, and muscle weakness. His urine is very concentrated, and he is diagnosed with syndrome of inappropriate antidiuretic hormone secretion. WHAT IS THE TX?

. The mainstay of treatment for chronic patients is fluid restriction. Urea is a solute excreted by the kidneys that can also be used as a treatment for chronic patients long-term to increase urine volume but is used with caution in patients with kidney disease. Additional treatments include loop diuretics (e.g., furosemide) with increased salt intake, mannitol, and demeclocycline

s/s chronic pancreatitis- Pain is most frequently present in the epigastric and left upper quadrantand anorexia, nausea, vomiting, constipation, flatulence, and weight loss are common presenting complaints. Acute attacks can vary in duration from a few hours to two weeks. Bulky, foul-smelling, fatty stools define steatorrhea and do not often present until 90% of pancreatic function is lost. A ___ is the gold standard diagnostic test but is not as practical given the duration of the test and the time taken to analyze results.

72-hour fecal fat quantitative analysis - elastase A 54-year-old man with a history of smoking and alcohol use disorder reports to the emergency department complaining of six days of abdominal pain. He describes the pain as episodic, epigastric pain that radiates to the back. It is partially relieved by leaning forward and worsens 20 minutes after eating. He also reports nausea and vomiting with loose, greasy, foul-smelling stools. Which of the following laboratory results is most likely abnormal and aids in the diagnosis of this patient?

Which of the following represents appropriate health maintenance counseling for a patient with hepatic insufficiency and several previous episodes of hepatic encephalopathy? ADaily oral probiotics BLow-protein diet CTwo or three large meals daily with no snacking DZinc supplementation

ADaily oral probioticS

A patient presents to the emergency department with a hyperglycemic crisis. Which of the following clinical findings is more common in diabetic ketoacidosis than hyperosmolar hyperglycemic state? AAbdominal pain BFocal neurologic deficits CObtundation DPolyuria

AAbdominal pain

A 54-year-old man with a history of smoking and alcohol use disorder reports to the emergency department complaining of six days of abdominal pain. He describes the pain as episodic, epigastric pain that radiates to the back. It is partially relieved by leaning forward and worsens 20 minutes after eating. He also reports nausea and vomiting with loose, greasy, foul-smelling stools. Which of the following laboratory results is most likely abnormal and aids in the diagnosis of this patient? AFecal elastase BFecal fat evaluation with Sudan staining CSerum amylase DSerum lipase

AFecal elastase

A 10-year-old boy presents to the emergency department complaining of right eye redness, pain, photophobia, and decreased visual acuity after being struck in the face with a baseball. Physical exam reveals blood pooling in the inferior portion of the anterior chamber, obscuring the inferior one-third of the iris and inferior portion of the pupil. The visible portion of the pupil is round and reactive to light. Swinging light test is negative for afferent pupillary defect on the right. Extraocular muscle range of motion is normal bilaterally. X-ray of the skull is negative for orbital fracture. Fluorescein staining is negative for corneal abrasion. Which of the following is the most likely diagnosis? AHyphema BOpen-globe rupture CSubconjunctival hemorrhage DTraumatic iritis

AHyphema

A 24-year-old nurse sustains a needlestick injury while working in the hospital. He has not completed his hepatitis B vaccination series. The source patient agrees to a hepatitis B serology panel, which reveals positive hepatitis B surface antigen, negative hepatitis B surface antibody, positive hepatitis B core antibody, and positive immunoglobulin M hepatitis B core antibody. Which of the following is the appropriate treatment for the exposed nurse? ANo prophylaxis is needed BOne dose each of hepatitis B immunoglobulin and hepatitis B vaccine COne dose of hepatitis B immunoglobulin with a second dose in one month DOne dose of hepatitis B vaccine

ANo prophylaxis is needed BOne dose each of hepatitis B immunoglobulin and hepatitis B vaccineCorrect Answer COne dose of hepatitis B immunoglobulin with a second dose in one month DOne dose of hepatitis B vaccine Health care providers with an adequate vaccine response do not require post-exposure prophylaxis. Those with low titer levels and exposure to an infectious patient require one dose of hepatitis B immunoglobulin and a dose of the hepatitis B vaccine. If the source patient is not infectious, providers with low titer levels should receive a single dose of the vaccine with repeat antibody testing in one to two months.

A patient is brought to the emergency room with acute onset of dyspnea and tachypnea. He has a long history of alcoholism and was involved in a motor vehicle accident two days ago. He is hypoxic with crackles auscultated bilaterally. Chest radiography reveals diffuse bilateral infiltrates which spare the costophrenic angle and air bronchograms, there was no cardiomegaly or pleural effusion noted. Oxygen saturation is 70%. Which of the following is the most important initial treatment?-- dx??!

ARDS- TRACHEAL INTUBATE

A 42-year-old woman is being evaluated for acute cholecystitis. Which of the following diagnostic studies is most accurate for detecting cholelithiasis?

Abdominal US

first line tx for aspiration pneumo

Ampicillin-sulbactam is the first-line antimicrobial therapy for patients with suspected anaerobic pulmonary infection. Alternatives include amoxicillin-clavulanate or metronidazole plus either amoxicillin or penicillin G. Patients with an anaphylactic allergic response to penicillins may be treated with clindamycin. Patients who acquire aspiration pneumonia in a hospital setting should be treated with agents that target aerobic gram-negative bacilli in addition to anaerobic pathogens. Choices of therapy in these patients include imipenem, meropenem, and piperacillin-tazobactam. Vancomycin or linezolid should be added if there is clinical suspicion for methicillin-resistant S. aureus.

s/s aplastic anemia

Aplastic anemia is defined as failure of the bone marrow resulting in pancytopenia. Signs and symptoms of aplastic anemia include pallor, jaundice (if hemolysis is present), ecchymosis, bleeding, tachycardia, fatigue, peripheral edema (or other signs of heart failure), and increased incidence of bacterial or fungal infection. Patients may also present with a history of recent exposure to toxic substances, new drugs, or viral pathogens, or they may present with short stature, skin or nail changes, or other signs of a genetic disorder Laboratory testing will reveal pancytopenia, which may vary from mild to severe, as well as a decreased reticulocyte count

crohns disease- complications

Arthritis, arthropathy, episcleritis, anterior uveitis, primary sclerosing cholangitis, kidney stones, vitamin B12 deficiency, and pulmonary conditions (e.g., chronic bronchitis, interstitial lung disease) characterize the extraintestinal manifestations of disease

what loobes are common in aspiration pneumo

Aspiration leads to infection in dependent lung zones, usually the posterior segments of the upper lobes and the superior and basilar segments of the lower lobes.

A 65-year-old man presents with flank pain that has progressively worsened over the last two days. He reports a weak urinary stream, increased frequency, and hematuria. Physical examination reveals a palpable kidney, costovertebral angle tenderness, and a hypertrophic prostate. Laboratory studies show elevated creatinine and blood urea nitrogen but are otherwise normal. Bedside renal ultrasound reveals a dilated renal pelvis. Which of the following is the most appropriate next step in management? AAntibiotic therapy BBladder catheterization CPercutaneous nephrostomy DUreteral stent placement

BBladder catheterization

A 46-year-old man presents to the clinic for a routine physical. He has a medical history of coronary artery disease, hypertension, hyperlipidemia, and a previous myocardial infarction. His vitals reveal HR 75 bpm, RR 15/min, BP 148/87 mm Hg, T 98.7°F, and SpO2 99% on room air. His most recent lipid panel reveals low-density lipoprotein cholesterol of 92 mg/dL, high-density lipoprotein cholesterol of 41 mg/dL, triglyceride level of 394 mg/dL, and total cholesterol of 212 mmol/L. Which of the following should be the primary goal in reducing this patient's risk for acute coronary syndrome? ADecreasing blood pressure using amlodipine BDecreasing low-density lipoprotein levels using atorvastatin CDecreasing triglyceride levels using gemfibrozil DIncreasing high-density lipoprotein levels using niacin

BDecreasing low-density lipoprotein levels using atorvastatin

A 25-year-old man presents to the clinic with muscle weakness, headache, polyuria, and polydipsia. His medical history includes hypertension, for which he takes hydrochlorothiazide, amlodipine, and enalapril. Vitals show HR 82 bpm, RR 16/min, T 98.3°F, BP 152/103 mm Hg, and SpO2 99% on room air. Review of past visits reveals similar blood pressure values. A basic metabolic panel reveals a serum potassium of 2.9 mmol/L and a serum bicarbonate of 25 mmol/L. Which of the following tests confirms this patient's underlying disorder? AHypertonic saline infusion test BOral sodium loading test CSerum aldosterone DSerum bicarbonate

BOral sodium loading test Hypertension is an elevation of systemic blood pressure evidenced by a systolic value above 140 mm Hg or a diastolic value above 90 mm Hg. The most common form of hypertension is essential or primary hypertension. Secondary hypertension occurs as a result of another underlying condition, which is most commonly renovascular disease. Primary aldosteronism, also called hyperaldosteronism, is the most common cause of refractory hypertension in youth and middle-aged adults and occurs due to an inappropriately high aldosterone secretion that does not suppress with sodium loading, which results in sodium retention and suppression of plasma renin. Hyperaldosteronism is caused by a unilateral adrenal adenoma or hyperplasia or by bilateral adrenal hyperplasia. Hypertension is usually moderate in patients with this condition but may be severe. Diastolic hypertension may be the only clinical manifestation, and edema is rarely associated. Hypokalemia can result in muscle weakness, paresthesias with frank tetany, headache, polyuria, and polydipsia. Routine laboratory findings commonly include hypokalemia and elevated serum bicarbonate. Specific testing is indicated in patients with sustained hypertension above 150/100 mm Hg on three separate days, hypertension resistant to three conventional antihypertensive medications (including a diuretic), controlled blood pressure requiring four or more drugs, hypokalemia, a personal or family history of early-onset hypertension or cerebrovascular accident at age 40 or younger, a first-degree relative with the condition, presence of an adrenal mass, or low plasma renin activity. An oral sodium loading test involves two weeks of a high-sodium diet and removal of certain medications (i.e., diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, clonidine, nonsteroidal anti-inflammatory drugs, oral estrogens, and oral contraceptives). The plasma renin activity or a direct renin assay are then drawn using a specific protocol. Plasma renin activity levels of < 0.65 ng/mL/h or direct renin assay < 0.36 ng/mL is diagnostic of primary aldosteronism while a serum aldosterone to plasma renin activity ratio < 24 excludes the diagnosis. A ratio greater than 67 can also be used to support the suspected diagnosis as it is highly suggestive. Further confirmation of the diagnosis is acquired via a 24-hour urine collection in an acidified container, which is tested for aldosterone, cortisol, and creatinine. Urinary aldosterone levels greater than 20 mcg/24 h confirms primary aldosteronism. All patients with confirmed diagnosis should undergo genetic testing and a thin-section CT scan of the adrenals. Primary aldosteronism that is caused by a unilateral aldosteronoma can be cured with surgical resection. Those with disease secondary to bilateral hyperplasia are instead treated medically with a potassium-sparing diuretic, particularly eplerenone, spironolactone, or amiloride. Other antihypertensive medications such as amlodipine, angiotensin-converting enzyme inhibitors (enalapril, captopril), or angiotensin receptor blockers (losartan) may be required for adequate blood pressure control. Hypertension is reversible in two-thirds of patients. Cardiovascular complications such as stroke occur more commonly in patients with primary hyperaldosteronism than essential hypertension

What joint is responsible for the primary motion involved in the pathogenesis of an ankle sprain? ADistal tibiofibular joint BSubtalar joint CTalofibular joint DTibiotalar joint

BSubtalar joint

definitive dx of aplastic anemia

Bone marrow biopsy

Which of the following is most likely to confirm the diagnosis of active Mycobacterium tuberculosis? AChest radiograph BFluorochrome staining CNucleic acid amplification testing DTuberculin skin testing

CNucleic acid amplification testing

A 69-year-old woman presents to the emergency department with a headache that is worse in the early morning for two days. She has no significant medical history. She reports a pulsatile machine-like sound in her ears. Bilateral funduscopic exam is performed, and retinal findings are shown above. Visual field and visual acuity testing are normal. Which of the following is the most likely diagnosis? AAnterior ischemic optic neuropathy BCentral retinal vein occlusion CPapilledema DPapillitis

CPapilledema

A 12-year-old girl presents to the emergency department after injuring her left knee earlier today. She is a gymnast and landed awkwardly from a vault. She states that her knee "collapsed" when she landed, and she heard and felt a "pop" in the knee as she fell. The knee was very painful, and she was unable to extend it or put weight on the leg. An athletic trainer who witnessed the injury had the patient lay on her back on the mat and was able to bring her knee into extension. As he did so, the patient felt another "pop" in the knee and immediately had less pain. She was helped off the mat but still had difficulty putting weight on the knee. On physical examination, she has a large effusion in the knee. Range of motion of the knee is 0° of extension compared with +15° of hyperextension on the right and 120° of flexion compared with 150° on the right. She has diffuse tenderness to palpation over the knee and a positive apprehension sign. She has no laxity to varus or valgus stress, Lachman, or drawer testing but is guarding. X-rays of the knee show a joint effusion but no bony abnormalities. Her physes are open but beginning to fuse. Which of the following is the most likely diagnosis? AAnterior cruciate ligament tear BDistal femoral physeal injury CPatellar dislocation DPatellar tendon rupture

CPatellar dislocation

A 52-year-old man with a history of cystic fibrosis presents to the emergency department with fever, cough, and shortness of breath. Physical examination shows bronchial breath sounds, egophony, and increased tactile fremitus. Chest radiograph shows lobar consolidation in the left lower lung lobe. In addition to being admitted to the intensive care unit, which of the following is the most appropriate therapy? AAmoxicillin and azithromycin BAzithromycin and doxycycline CPiperacillin-tazobactam and ciprofloxacin DVancomycin and levofloxacin

CPiperacillin-tazobactam and ciprofloxacinCorrect Answer

An 18 year-old male who was struck in the left eye with a baseball presents with ocular pain, periorbital ecchymosis, and restricted upward gaze. Which of the following is the diagnostic study of choice in this patient?

CT scan of the orbit

A 25-year-old, right-handed man presents to the emergency department after he was involved in an altercation. He complains of pain in his left forearm. Physical examination shows ecchymoses, moderate swelling, and tenderness to palpation over the mid-forearm on the ulnar side. Distal neurovascular examination is intact, and he has full range of motion of his fingers. X-rays of the forearm show a nondisplaced, transverse fracture at the junction of the proximal and middle thirds of the ulna and an intact radius. Which of the following is the most important next step in determining the appropriate treatment for this injury? AMagnetic resonance imaging of the forearm BMeasurement of compartment pressures in the forearm CX-rays of the elbow and wrist DX-rays of the humerus

CX-rays of the elbow and wrist

Osteomyelitis can be prevented by implementing prompt debridement and surgical fixation and with the administration of prophylactic antibiotics. Patients with type I or II fractures should be prescribed antibiotics with gram-positive organism coverage. ___ is the most commonly used agent in these patients. Agents used to treat type III fractures should additionally target gram-negative organisms with regimens commonly consisting of(3 options) A patient with a type III fracture who has had potential exposure to contaminated waterrequires agents that treat Pseudomonas species, such as ceftazidime or cefepime.

Cefazolin cefoxitin, cefotetan, or ampicillin-sulbactam. idk why this is different in the other slideshow

most sensitive vs specific test for hypocalcemia

Chvostek sign = more sensitive test than =Trousseau signthe most specific for hypocalcemia.

tx trigger finger

Conservative treatment of trigger finger initially includes activity modification, splinting, and short-term nonsteroidal anti-inflammatory drugs. Splints should keep the metacarpophalangeal joint in slight flexion and use should be dictated by patient preference. The splint should be used for three to six weeks.

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?

Coxsackie virus

Which of the following mechanisms is the most common cause of acute urinary retention? AAnticholinergic medications BInefficient detrusor muscle CInfections DOutflow obstruction

DOutflow obstruction

A 33-year-old woman presents with recent-onset fever, abdominal cramps, and diarrhea. She describes frequent, small-volume, bloody diarrhea and reports no recent antibiotic use or history of gastrointestinal disorders. Vitals reveal HR 105 bpm, RR 19/min, BP 138/78 mm Hg, T 103.9°F, and SpO2 98% on room air. Which one of the following suspected organisms requires empiric antibiotic therapy? AClostridium perfringens BSalmonella CShiga-toxin-producing Escherichia coli DShigella

DShigella

A 21-year-old baseball pitcher reports to the orthopaedic clinic complaining of anterior shoulder pain in his throwing arm that has progressed over the past three weeks. He states his pain is worse in the cocked throwing position, and he reports clicking, popping, and a catching sensation with throwing. He has a history of glenohumeral subluxation in this shoulder. Which of the following is the most likely diagnosis? ABiceps tendinitis BMultidirectional shoulder instability CRotator cuff tear DSuperior labrum anterior posterior tear

DSuperior labrum anterior posterior tear

An 88-year-old woman has a past medical history of osteoarthritis, hypertension, and hyperthyroidism. Her medications include meloxicam, enalapril, and hydrochlorothiazide. She is 61 inches tall and weighs 183 pounds. She denies smoking, alcohol consumption, or prior fracture. In addition to her advanced age, which of the following increases her risk of sustaining a fracture secondary to osteoporosis? AHigh body mass index BNonsteroidal anti-inflammatory drug use COsteoarthritis DUntreated hyperthyroidism

DUntreated hyperthyroidism Independent risk factors for fracture secondary to osteoporosis include advancing age, prior fracture, glucocorticoid therapy, parental history of hip fracture, low body weight, current cigarette smoking, excessive alcohol consumption, rheumatoid arthritis, and secondary osteoporosis (e.g., untreated hyperthyroidism, inflammatory bowel disease, hypogonadism, premature menopause).

A 65-year-old woman with a history of multiple abdominal surgeries presents with paroxysms of crampy abdominal pain, vomiting, and abdominal distention. Abdominal plain film shows dilated loops of bowel with air-fluid levels. Which of the following is recommended in the nonoperative management of this condition? ABroad-spectrum antibiotics BCorticosteroids CMaintaining a normal diet DVolume resuscitation

DVolume resuscitation

A 12-year-old boy presents to the emergency department after being hit in the right eye by a baseball. The patient complains of pain with eye movement and diplopia. On physical exam, the right eye is lower in the horizontal plane than the left eye, and enophthalmos is noted on the right. When asked to gaze upward, the left eye responds but the right eye remains stationary. Which of the following physical exam findings best correlates with this patient's probable injury? Decreased sensation along the right cheek, upper lip, and gingiva BDecreased sensation at the tip of the nose CRight-sided facial droop with muscle weakness including the forehead DWidened intercanthal distance

Decreased sensation along the right cheek, upper lip, and gingiva

Question: What medication increases the risk of vertebral fracture after cessation?

Denosumab

causes of brain abscess A 63-year-old man with poorly controlled diabetes presents to the emergency department with altered mental status, fever, and frontal headache. He has been taking analgesics regularly without any improvement in his pain. He is febrile on examination. He appears lethargic and is noted to have right-sided hemiparesis. He is rushed to CT for STAT imaging of the head where he has a grand mal seizure. Postcontrast imaging reveals a large ring-enhancing lesion in the left frontal lobe with surrounding cerebral edema. What would you expect to learn from his history based on the likely diagnosis?

Direct spread can include infections such as otitis media, mastoiditis, frontal sinusitis, ethmoid sinusitis, and dental infections.

A 24-year-old woman presents to the emergency department with low-grade fever, flu-like symptoms, petechiae, and a new-onset murmur. She also has weakness of the left side of her body and slurred speech. She does not have any history of intravenous drug use or prosthetic heart valve replacement. Which of the following is the most likely explanation of her neurologic findings?

Embolic stroke from septic heart valve vegetations

___ is the most sensitive imaging study for chronic pancreatitis and affords clinicians the opportunity to intervene during diagnostic imaging.

Endoscopic retrograde cholangiopancreatography

In a patient with metabolic acidosis due to ingestion of methanol, which substance below is considered therapeutic?

Ethanol, along with hemodialysis and supportive measures, is indicated for metabolic acidosis caused by methanol ingestion.

Severity of subarachnoid hemorrhage is graded based on the __ and __ grading system

Hunt and Hess

A patient states that he has been camping in the mountains of North Carolina for the past two weeks. He presents to the clinic complaining of "flu-like" symptoms for the past 10-14 days however he notes that he started to develop a slight rash on his wrist and ankles about seven days ago. Which of the following tests would provide a confirmatory diagnosis? Immunofluorescent assay B C-reactive protein C Heterophile agglutination D Anti-streptolysin O titer

Immunofluorescent assay

aplastic anemia - tx

In the absence of an identified, modifiable, causative insult, first-line therapy for severe aplastic anemia is with hematopoietic cell transplantation (depending on donor availability). If a donor is not available, immunosuppressive therapy may be life-saving.

A 17-year-old boy presents to the emergency department after suffering a neck injury while performing a tackle during a football game. He has been placed in a cervical collar. He is complaining of pain in his neck and is unable to move his extremities. On physical examination, he is found to be bradycardic and hypotensive. Imaging demonstrates a C5 cervical cord injury due to a C5-C6 fracture-dislocation. In addition to flaccid paralysis, what would you expect to find on initial examination?

In the acute stage, a patient with a complete cord injury will present with absent reflexes, flaccid muscle tone, priapism, and no response to plantarstimulation. As time goes on, patients develop spasticity and hyperreflexia as well as urinary retention and bladder distention.

A 27-year-old female presents to the emergency department with complaints of progressively worsening vision in her right eye over the past week. She reports right eye pain that is worse with eye movement. Her color vision is affected. She has been having flashes of light triggered by eye movement. Her physical examination demonstrates poor central visual acuity: OS 20/15, OD 20/60. Fundoscopic examination is unremarkable. Magnetic resonance imaging of the brain and orbits with gadolinium is obtained, which reveals inflammation of the optic nerve and numerous periventricular ovoid white matter lesions > 3 mm in size. Based on the imaging of the brain, what is the most likely diagnosis?

MS

MENIERES- DEFINITIVE DX

POST MORTEM

A 45-year-old man is brought to the emergency department after being found unresponsive in an alley. Emergency personnel administered naloxone, and he regained consciousness. He is alert and complains of severe pain in his left lower leg. He has mild swelling of the calf, and it feels more firm than the right. You are concerned about acute compartment syndrome. Which of the following physical examination findings is most sensitive for the diagnosis of acute compartment syndrome?

Pain with passive extension of the toes

s/s of asthma (mild vs mod vs severe- include peak expir. flow)

Patients experiencing mild asthma exacerbation may be short of breath while walking, talk in phrases, and be agitated. They may also have increased respiratory rate, moderate wheezing, and absent pulsus paradoxus. Moderate asthma exacerbation is characterized by dyspnea at rest, agitation, increased respiratory rate, loud wheezing, and present pulsus paradoxus (10-25 mm Hg). Individuals who are in severe asthma exacerbation are tachypneic, wheeze loudly, are tachycardic, and have pulsus paradoxus (> 25 mm Hg). Patients experiencing respiratory arrest are mute at rest, drowsy or confused, tachypneic, bradycardic, and have paradoxical thoracoabdominal movement. Peak expiratory flow rates (or forced expiratory volume in one second, or percent personal best) that are commonly seen in mild, moderate, severe, and respiratory arrest include ≥ 70%, 40-69%, < 40%, and < 25%, respectively.

An electrocardiogram (ECG) shows a sinus rhythm with varying T wave heights, axis changes every other beat and a wandering baseline. Which of the following is most likely the diagnosis?

Pericardial effusion

Risk factors for subarachnoid hemorrhage include

hypertension, cigarette smoking, family history of subarachnoid hemorrhage, cocaine use, polycystic kidney disease, and Ehlers-Danlos syndrome.

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?

Question 51 Explanation: 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.

What is the most common causative organism of subacute bacterial endocarditis?

S. VIRIDANS

vtach- stable/uunstable/pulseless - tx?!

Stable patients may be treated with intravenous or intraosseous adenosine, and if adenosine is ineffective, procainamide or amiodarone should be used. Unstable patients with monomorphic VT should be immediately treated with synchronized direct current cardioversion, whereas unstable polymorphic VT is treated with immediate defibrillation.

____ is also called trigger finger and is caused by a disparity in size between the flexor tendon and the surrounding pulley system at the first ___ pulley that overlies the metacarpophalangeal joint. This size disparity causes the flexor tendon to catchas it attempts to glide through the stenotic sheath with flexion and extension of the finger. A 43-year-old man reports to the orthopaedic clinic for evaluation of his right third finger. He states that this finger gets stuck when he makes a fist, and he has to manually extend it. Which of the following is likely found in this patient's medical history?

Stenosing flexor tenosynovitis, annular (A1)

An x-ray taken on a patient complaining of wrist pain after being hit by a baseball reveals a non-displaced mid-shaft ulnar fracture. Which of the following splints is most appropriate for treatment?

Sugar tong

___ is the most common symptom in acute PE

Tachypnea/dyspnea?

A 32-year-old multiparous woman presents to the emergency department with vaginal bleeding after giving birth one hour earlier at home. She describes a prolonged labor and brings the intact placenta with her. On physical exam, she is mildly hypotensive and tachycardic, with a boggy uterus on palpation. Copious active uterine bleeding is noted, with total blood loss since arrival estimated at 500 mL. Bimanual uterine compression, oxygen administration, and an oxytocin drip with lactated Ringer solution are initiated while blood is drawn for labs, including blood typing. Which of the following is the best next step in management of this emergency?

Tranexamic acid 1 g IV

Question: What is the etiology of pityriasis rosea?

Viral

Prophylactic therapy in these patients consists of oral administration of ___ one hour prior to the procedure. Patients with penicillin allergies should receive oral formulations of (3)

amoxicillin, cephalexin, azithromycin, or clarithromycin.

A 63-year-old woman with a past medical history of hypertension, stroke and advanced dementia is brought to the emergency department from a skilled nursing facility after a four day course of productive cough with foul-smelling purulent sputum. Vital signs include HR 95 bpm, RR 19/min, BP 139/87 mm Hg, T 102.4°F, and SpO2 97% on room air. Physical examination reveals a thin, frail-appearing, elderly woman with poor dentition. Chest auscultation reveals diffuse wheezes and rhonchi with increased tactile fremitus and egophony. Plain film radiography of the chest demonstrates the findings shown above. What is the dx and Which of the following pathogens is the most likely responsible organism?

aspiration pneumo The predominant pathogens responsible for infection are anaerobic organisms such as Prevotella melaninogenica, Peptostreptococcus, Fusobacterium nucleatum, Fusobacterium necrophorum, and Bacteroides species. depressed consciousness secondary to drug or alcohol use, seizures, general anesthesia, or central nervous system disease (e.g., stroke, Parkinson disease, advanced dementia) are at an increased risk for developing aspiration pneumonia. Dentition is often poor, and cough demonstrates expectoration of foul-smelling purulent sputum.

Most common cause of lung abscess

aspiration pneumonia

A 43-year-old man reports to the orthopaedic clinic for evaluation of his right third finger. He states that this finger gets stuck when he makes a fist, and he has to manually extend it. Which of the following is likely found in this patient's medical history?

atients with diabetes mellitus, rheumatoid arthritis, or deposition disorders (e.g., amyloidosis) have an increased risk of developing trigger finger.

The bite from which of the following is associated with fever, lacrimation, rhinorrhea, bradycardia, hypertension, and tachyarrhythmias? A Brown recluse spider B Black widow spider C Black flies D Bedbugs

black widow

A patient with a unilateral sensory or weakness finding on one side of the body and contralateral finding of weakness or sensory loss of the face has a __ lesion.

brainstem

Surgical intervention (classic discectomy with limited laminotomy) is only indicated for (back pain)

cauda equina syndrome or unequivocal disc herniation and one of the following: muscular weakness, progressive neurological deficits, and intractable pain that interferes with job or personal life in an emotionally stable patient who has failed conservative treatment.

Urticaria may be treated with antihistamines, such as diphenhydramine. Additionally, prednisone (C) is incorrect because drug-induced hypersensitivity reaction is absent, which is associated with s/s

constitutional symptoms (fever and chills) and abnormal lab findings (eosinophilia, elevated liver enzymes, and atypical lymphocytosis). E

pyoderma gangrenosum and erythema nodosum - dx for crohns

crohns

. Direct inguinal hernia protrudes mediallyto the inferior epigastric vessels within the Hesselbach triangle through the ___ ring

external Indirect inguinal hernia, the most common type of inguinal hernia, protrudes at the internal inguinal ring, a site where the spermatic cord (in males) and the round ligament (in females) exit the abdomen.

sodium and potassium (high/low) in DKA

low sodium high potassium

The most common underlying cause for cardiac tamp

malignancy

On performing a mental status examination you notice that the patient tends to repeat words and phrases out of context to your questions. This type of thought disorder is defined as which of the following?

perservation

A 42-year-old woman with no significant past medical history is rushed to the emergency department with complaints of left-sided weakness and visual disturbance in her left eye for the past two days. There is no carotid bruit on exam. An MRI of the brain reveals multiple foci of acute infarcts in right subcortical areas and old infarcts noted in the left. In addition to cardiac monitoring, what other diagnostic study should be considered to identify an underlying embolic cause? Posterior/Anterior circulation strokes are commonly embolic.

posterior

. Other patients who require DENTAL prophylaxis include patients who have (??)

sustained prior endocarditis infection, received a cardiac transplantation and subsequently developed valvulopathy, and those who have unrepaired cyanotic congenital heart disease, a repaired congenital heart defect that utilizes prosthetic materials, or a repaired congenital heart defect with residual defects.

Broad-spectrum antibiotics are not recommended for most patients with an uncomplicated small bowel obstruction t/f

t!

A 28 year-old male presents with burns sustained from hot grease splashed on his left hand earlier this afternoon. The burn extends from his palm to the volar aspect of his wrist and has an erythematous base, covered by an intact blister. There are a few small scattered blisters over the dorsum of the left hand. Which of the following is the initial intervention of choice?

tetanus

A 25-year-old man in South Florida presents during the summer with hypopigmented lesions on his upper back and proximal arms. The lesions do not itch or hurt, but he is bothered by the appearance of the lesions. What is the most likely diagnosis and

tinea versicolor- topical fungals

Delay of surgical management (> six hours) may result in infarction of the testis with liquefaction requiring orchiectomy. If surgery is not available within __ hours of presentation, manual detorsion should be attempted.

two A 14-year-old boy presents to a rural urgent care clinic with limited resources complaining of sudden-onset scrotal pain associated with nausea and vomiting for three hours. The closest hospital is four hours away. Physical examination reveals bell-clapper deformity. Cremasteric reflex and Prehn sign are negative. Which of the following is the next best step?

A 42-year-old man presents to the emergency department complaining of unbearable, diffuse abdominal pain that radiates to his right shoulder and began one hour ago. His medication list includes hydrochlorothiazide 25 mg daily for essential hypertension, aspirin 81 mg daily for coronary artery disease, and ibuprofen 800 mg daily for the past three weeks for an ankle sprain. Vital signs demonstrate HR 105 bpm, RR 19/min, T 95.2°F, BP 131/87 mm Hg, and SpO299% on room air. Physical exam reveals a weak radial pulse with cool distal extremities and abdominal rigidity. Which of the following is the most appropriate initial diagnostic study?

upright chest xray

In a patient with subarachnoid hemorrhage, what develops as a result of lysis of the subarachnoid blood clots and release of nitrous oxide and endothelin approximately three days after onset of symptoms?

vasospasm!!!- Vasospasm is treated with calcium channel blockers, primarily nimodipine.

talking abuot parotitis: Therefore, this patient should be treated with ?????? . Some risk factors for methicillin-resistant Staphylococcus aureus include intravenous drug use, recent hospitalization, renal insufficiency, diabetes mellitus, and hemodialysis.

vvancomycin and either cefepime and metronidazole or piperacillin-tazobactam Intravenous ampicillin-sulbactam (A) is a beta-lactam antibiotic with a beta-lactamase inhibitor. It is the recommended treatment for community-acquired acute bacterial parotitis in patients who are immunocompetent. Intravenous cefuroxime and metronidazole (B) is an alternative antibiotic regimen for patients with community-acquired acute bacterial parotitis in patients who are immunocompetent.