ER

fracture involving the maxilla at the level of the nasal fossa

1. (Le Fort I facial fracture)

*acute inferior wall* myocardial injury

2 mm ST-segment elevations in leads II, III, and aVF

Which is the most appropriate indication for IV thrombolytic therapy in a patient with *acute coronary syndrome*?

2 mm of ST-segment elevation in the anterior/lateral wall

fracture involves several facial bones, including the maxilla, the nasal bones, and the medial aspects of the orbits.

2. (Le Fort II fracture)

Troponin I and CK-MB levels elevate in __to__ hrs after onset of MI

3 to 12

fracture includes aspects of the maxilla, zygoma, nasal bones, ethmoids, vomer, and lesser bones of the cranial base. It can also be described as a craniofacial dysfunction.

3. (Le Fort III)

Hypokalemia is associated with serum K+ levels of less than

3.5 mEq/L

Hyperkalemia relates to serum K+ levels of more than

5.5 mEq/L

A beta natriuretic peptide below what level rules out CHF?

< 100

A 40-year-old man presents to the ED with acute blunt chest and abdominal trauma following motor vehicle crash. The patient presented with jugular venous distention, decreased BP, and muffled heart tones. Which of the following is the most likely diagnosis? (A) pericardial tamponade (B) tension pneumothorax (C) myocardial rupture (D) aortic rupture (E) myocardial contusion

A

A patient presents to the ED after being bitten by an unknown "insect" while camping. The pain began as a pinprick sensation at the bite site and spread quickly to include the entire bitten extremity. The bite wound became erythematous 45 minutes after the bite. The bite evolved into *target lesion* and the patient complains of muscle cramp-like spasms in the large muscle groups. Which of the following is the most likely cause? (A) black widow spider (B) hobo spider (C) brown recluse spider (D) tarantula (E) scorpion

A

The differential diagnosis of a patient with an ECG demonstrating prominent U waves includes (A) potassium depletion (B) calcium depletion (C) digitalis toxicity (D) hypothermia

A

Which of the following PE findings is most likely present in a patient with extraocular muscle entrapment following facial trauma? (A) Binocular double vision (B) Binocular loss of vision (C) Monocular double vision (D) Monocular loss of vision (E) Tear drop-shaped pupil

A

A patient presents to the ER with tearing chest pain radiating to his back. What is the most likely diagnosis?

Aortic dissection

What is the frst line medical treatment for pericarditis

Aspirin and NSAIDS

most common primary cardiac tumor overall.

Atrial myxoma

Spontaneous esophageal rupture following forceful vomiting after overindulging in food and alcohol is known: (A) bezoar (B) Boerhaave syndrome (C) Burger sign (D) Brudzinski sign

B

Which of the following regions best describes the location of a Le Fort fracture? (A) Mandible (B) Midfacial (C) Occipital (D) Temporal (E) Zygoma

B

Rare life-threatening problem characterized by a full-thickness tear of the esophageal wall. Spontaneous esophageal rupture following forceful vomiting after overindulging in food and alcohol is known as: (A) bezoar (B) Boerhaave syndrome (C) Burger sign (D) Brudzinski sign

B (Boerhaave syndrome, postemetic rupture, and spontaneous esophageal rupture are synonymous terms. The most common site of injury is the distal esophagus, which demonstrates a longitudinal tear occurring in the left posterolateral aspect. Most cases occur in middle-aged men after they have overindulged in food and alcohol.)

Following a myocardial infarction, what medication should you be using to treat hypertension?

Beta blocker

A 55-year-old man presents to the ED with chest pain that started 30 minutes ago, diaphoresis, and nausea. An ECG shows ST elevation in I, aVL, and V2 through V6. What is the diagnosis? (A) inferior infarction (B) lateral infarction (C) anterior infarction (D) posterior infarction

C

A 16-year-old girl is brought to the emergency department by ambulance after reportedly ingesting "a bottle of aspirin." Vital signs are temperature 37.8°C oral; pulse 94/min; respirations 30/min; blood pressure 100/68 mm Hg. What would you expect the blood gases to show that would confirm she had swallowed the aspirin? A anion gap metabolic acidosis with respiratory acidosis B nonanion gap metabolic acidosis with respiratory alkalosis C anion gap metabolic acidosis with respiratory alkalosis D nonanion gap metabolic acidosis with respiratory acidosis

C. (An acute salicylate overdose (greater than 150 mg/kg) will produce symptoms of salicylate intoxication. Chronic salicylate intoxication occurs with ingestion of greater than 100 mg/kg/day for at least 2 days. Salicylates affect most organ systems, leading to various metabolic abnormalities. Because salicylates are a gastric irritant, symptoms of vomiting and diarrhea occur soon after the overdose, which may contribute to the development of dehydration. Salicylates stimulate the respiratory center leading to hyperventilation and hyperpnea resulting in respiratory alkalosis and compensatory alkaluria. A characteristic feature of salicylate intoxication is the coexistence of a respiratory alkalosis with a widened anion gap metabolic acidosis.)

An 89-year-old female patient from a nursing home presents to the ED with abdominal pain and distention. The abdominal radiograph demonstrates multiple air-fluid levels and dilated large bowel loops consistent with a large bowel obstruction (LBO). What is the most likely cause of the obstruction? (A) diverticulitis (B) abdominal wall hernias (C) carcinoma (D) sigmoid volvulus (E) adhesions

C. (Carcinoma of the colon is the most common cause of LBOs in adults. Diverticulitis can also cause LBOs, and patients often give a history of intermittent left lower quadrant pain. Sigmoid volvulus is a less common cause of LBO. It is seen most often in the elderly with poor bowel habits and chronic constipation. )

A pathologic S3 is most commonly associated with what diagnosis?

CHF

Bat wing vessels or Kerley B lines on a CXR should make you think of what diagnosis?

CHF

Paroxysmal nocturnal dyspnea should make you think of what diagnosis?

CHF

What imaging needs to be done before taking a patient to the OR with an aortic aneurysm

CT (echo may be used as initial study, but CT is need for surgery)

Gold standard to diagnose Coronary artery disease

Cardiac Catheterization

What is the gold standard for diagnosing coronary artery disease?

Cardiac catheterization

classically described by the triad of JVD, arterial hypotension, and muffled heart sounds

Cardiac tamponade

He was hypotensive and tachycardic. The neck veins were distended and heart sounds were muffled. Dx? Tx?

Cardiac tamponade/Pericardiocentesis

Tissue hypoperfusion d/t acute MI or end-stage heart failur

Cardiogenic shock

A 55-year-old woman with a history of mitral stenosis, secondary to rheumatic heart disease, presents to the emergency department with increasing dyspnea while walking up one flight of stairs. She denies chest pain and discomfort, but states that recently she has also noticed palpitations. She also admits to lower extremity edema, which is new within the last week. Which of the following tachyarrhythmias is she most likely to demonstrate on EKG? A Ventricular tachycardia B Atrial flutter C Ventricular fibrillation D Ventricular bigeminy E Torsades de pointes

Choice B is correct. As patients with mitral stenosis age, and their mitral stenosis progresses to moderate or moderately severe mitral stenosis (most commonly after their fourth decade), the incidence of atrial arrhythmias—including premature atrial contractions, paroxysmal tachycardia, atrial flutter, and atrial fibrillation—increases. Choices A, C, D, and E are less likely, given that they are ventricular arrhythmias

Avulsion of the spinous process of C6 or C7, NOT associated with neurological deficits

Clay shovelers

What is the most common cause of CHF?

Coronary artery disease

A patient presents to the ED with ST elevation in leads II, III, and aVF. The patient is hemodynamically stable. What measure should you use to limit the size of infarction in this patient? (A) nonsteroidal anti-inflammatory medication (B) glucocorticoids (C) calcium channel blockers (D) fibrinolytic agents

D

Increase in which factor is most likely to increase preload? (A) arterial vascular tone (B) stroke volume (C) heart rate (D) intravascular volume

D

Cardiac tamponade is potentially life-threatening. What is the mechanism by which the effusion impedes stroke volume? (A) direct compression increases end-diastolic volume (B) increased pressure in pericardium decreases coronary blood flow (C) increased pressure decreases sinus rhythm (D) compression of inferior vena cava decreases preload

D. (Compression caused by cardiac tamponade decreases the preload, which is an important component of stroke volume.)

A 42-year-old man presents to the ED with a right-sided facial injury after an assault with a wooden club. The patient complains of *diplopia and pain to right side of the face*. The examination reveals *enophthalmos, impaired ocular motility, and infraorbital hypoesthesias (numbness).* What is the most likely diagnosis? (A) maxilla fracture involving the superior orbital ridge (B) orbital blowout fracture with herniation of contents into the frontal sinus (C) maxillary blowout fracture with herniation into the soft palate (D) orbital blowout fracture with herniation of contents into the maxillary sinus (E) orbital blowout fracture without herniation

D. (Direct and compressive forces to the eye may cause a blowout fracture to the orbital floor with herniation of the contents into the maxillary sinus. Blowout fractures may produce enophthalmos, diplopia, impaired ocular motility, and infraorbital hypoesthesias. Many orbital floor fractures resolve spontaneously and require only close follow-up with consultants. A decision to operate may be delayed 10 to 14 days, depending on persistent diplopia or enophthalmos)

Calf pain should always make you think of what diagnosis?

DVT

What is the name of the syndrome that involves pericarditis several days after a myocardial infarction?

Dressler syndrome

Pulmonary Embolism EKG

EKG: sinus tachycardia (S1Q3T3), Hampton hump

A 68-year-old woman with a history of hypertension and diabetes mellitus type 2 comes to the emergency department with her son, who noticed that while decorating for Christmas she seemed more dyspneic than normal, and had to sit down frequently. In addition, he noticed that she was pale and diaphoretic, and insisted on driving her to the emergency department. On questioning, she denies chest pain, but admits to being more fatigued than usual, with frequent jaw discomfort during activity. Activities such as vacuuming her house cause dyspnea, and she now has to stop several times while carrying laundry up from the basement. On physical examination, the patient's blood pressure is 90/50, pulse 99 bpm, respirations 22, and she is afebrile. Auscultation of the chest demonstrates a new systolic murmur. An EKG demonstrates normal sinus rhythm with nonspecific ST and T wave changes. Serial troponin elevations above the 99 th percentile of normal are noted. Which of the following would be the most appropriate next step in the management of this patient? A Clopidogrel, heparin, and aspirin, followed by cardiac catheterization B Nuclear stress test C Treadmill stress test D Thiazide diuretics and loop diuretics E Dobutamine stress echocardiogram

Explanation The Correct Answer is: A In patients with non-ST-segment myocardial infarction, such as this patient with ischemic symptoms and serial troponin elevation above the 99 th percentile of normal, clopidogrel, aspirin, and heparin prior to cardiac catheterization are recommended, with the intention of percutaneous coronary intervention. In addition, morphine, oxygen, nitrates, beta blockade, ACE inhibitors, statin therapy, and glycoprotein IIb/IIa inhibitors should be considered, depending on the patient's blood pressure, heart rate, and hemodynamic stability. Choice D would be useful in the treatment of patients with hypertension and lower extremity edema. Choices B, C, and E, are all forms of stress testing, which should be performed in patients with symptoms of angina pectoris, but not for patients with acute myocardial infarction. (Fauci et al., 2008, Chapter 238)

A 50-year-old woman with a history of hypertension complains of chest tightness and dyspnea while walking up one flight of stairs. She recently experienced an episode of near-syncope while walking her dog. She denies a history of rheumatic fever. On auscultation, a crescendo-decrescendo systolic ejection murmur is heard at the upper right sternal border radiating to the carotids bilaterally. Troponin levels are negative at 0, 3, and 6 hours. Her EKG demonstrates evidence of left ventricular hypertrophy. A transthoracic echocardiogram reveals significant aortic stenosis secondary to congenital bicuspid aortic valve, left ventricular hypertrophy, and normal left ventricular systolic function. Which of the following is the most appropriate next step in management? A Cardiac catheterization followed by aortic valve replacement B Monitoring via repeat transthoracic echocardiogram in 6 months C Monitoring via transesophageal echocardiogram in 6 months D Treadmill exercise stress test E Automatic internal cardiac defibrillator placement

Explanation The Correct Answer is: A In symptomatic patients demonstrating significant aortic stenosis, aortic valve replacement after cardiac catheterization, to evaluate for coronary artery disease and possible concomitant coronary artery bypass surgery with aortic valve replacement, is indicated. As the patient is demonstrating the classic symptoms of severe aortic stenosis, choice A is the most appropriate next step in management. Choices B and C are thus inappropriate, as the patient is already symptomatic. If the patient were not symptomatic, choice B would be a viable choice compared to choice C, because it is less invasive than transesophageal echocardiogram. Choice D would be inappropriate, as strenuous physical activity should be avoided in patients with severe aortic stenosis. Choice E is appropriate therapy for patients at risk for ventricular tachycardia/fibrillation. (McPhee et al., 2011, Chapter 10)

fracture involves a hyperextension injury in which the anterior longitudinal ligament avulses the inferior portion of the anterior vertebral body at its insertion. The second cervical vertebra is the most common location for an extension teardrop fracture

Extension teardrop

Clay-shovelers fracture

Fx of C6 or C7

Which of the following is the most common cause of erosive esophagitis?

GERD

Causes of Pancreatitis

Gallstones, alcohol, meds, trauma, HLD, Elevated Triglyceri

What best defines peripheral wedge-shaped consolidation on pleural surface observed in pnt with a PE?

Hampton hump

6-yo boy presents to ED with abdominal pain, blood in the stools, and arthritis. PE reveals *multiple dark erythematous lesions on his legs and buttocks*. These findings are characteristic of which disease?

Henoch-Schonlein purpura

Do loop diuretics cause hyperkalemia or hypokalemia?

Hypokalemia

What are the three inferior leads?

II, III and aVF

What is represented by ST segment depressions greater than 1mm on EKG?

Ischemia

A blockage of which artery causes a lateral wall MI?

Left circumflex artery

What is the initial treatment for a myocardial infarction?

MONA - morphine, oxygen,nitroglycerin and aspirin

Most common tumor responsible for metastasis to heart.

Malignant melanoma

Which fnding requires immediate attention: left bundle branch block or right bundle branch block?

New left bundle branch block is a STEMI equivalent. Right bundle branch block is usually not a problem.

characterized by warmth, redness, swelling, and tenderness over the affected eye, along with conjunctival injection, eyelid swelling, chemosis, fever, ocular pain and limitation of eye movement.

Orbital cellulitis

List three catastrophic complications of a myocardial infarction.

Papillary muscle rupture, myocardial wall rupture and left ventricular aneurysm

What is the defnitive treatment for cardiac tamponade?

Pericardiocentesis

A patient presents to the ER with chest pain. An EKG shows diffuse ST elevations in almost all of the leads. What is the most likely diagnosis?

Pericarditis

patient complains of severe pleuritic chest pain that is relieved with sitting and leaning forward. What is the most likely diagnosis?

Pericarditis

ECG shows low-voltage QRS complexes and CXR demonstrates normal lung fields and cardiac silhouette. What test should be ordered next in this patient?

Pericarditis is dx-ed using Doppler echocardiography

characterized by warmth, redness, swelling, and tenderness over the affected eye, along with conjunctival injection, eyelid swelling, chemosis, and fever.

Periorbital cellulits

pain and swelling to the midshaft humeral region. The physical examination reveals a wrist drop on the injured side. Which nerve is most likely injured?

Radial

CHF PE findings

S3 (LV dysfunction) gallop, JVD >8 cm, Rales, Tachycardia, Displaced PMI

*Posterior wall infarction* will likely show

ST depressions and then elevations in V1 to V3

*Lateral wall infarction* will likely show

ST depressions in leads I, AVL, and V5 to V6.

Which EKG leads are used to diagnose an anterior wall MI?

ST elevation in I, aVL, V2-V6.

*Anterior wall infarction* will likely show

ST elevation in leads I, AVL, and V2 - V6.

*Inferior wall infarction* will likely show

ST elevation in leads II, III, and AVF.

Clot busting drugs should be used within 3 hours of which two cardiac events

STEMI and new left bundle branch block

The radiographs demonstrate multiple loops of dilated small bowel, airfluid levels, and a string of pearls sign. What is the most likely cause ?

Small bowel obstruction (SBO) is most often due to adhesions following surgery.

most commonly affects tall, thin men, between the ages of 20 and 40 years, who are heavy cigarette smokers. The pain is usually pleuritic and localizes to the affected side. Most patients have decreased breath sounds on the affected side, but few have a significant tachypnea or tachycardia

Spontaneous pneumothorax

List the components of Virchow's triad.

Stasis, vascular injury, hypercoagulability

indication for lumbar puncture

Subarachnoid hemarrage/cerebral aneurism

Serum K+ levels in 6.5 to 7.5 mEq/L typically result in

Tall peaked T waves and short QT interval.

During a hospitalization for acute exacerbation of COPD, troponin levels are drawn on a 62-year-old man with a history of hypertension, hyperlipidemia, and chronic tobacco use, and found to be elevated above the 99 th percentile of normal. Which of the following choices would qualify this patient for the most recent ACC/AHA consensus guideline's definition of myocardial infarction? A Ischemic symptoms B New right bundle branch-block on EKG C J wave on EKG D Pulmonary vascular congestion on CXR E Elevated WBC count

The Correct Answer is: A Choice A is the most appropriate choice, as troponin elevation may occur in the setting of patients who do not suffer from acute coronary syndrome. Therefore, the 2007 consensus guidelines recommended that the definition of myocardial infarction be applied to those patients who not only had troponin elevation above the 99 th percentile, but also met one of the following criteria: "ischemic symptoms, new left bundle branch block (not right bundle branch-block as in choice B), new ST and T-wave changes, new Q waves, or imaging evidence of a new loss of viable myocardium or new regional wall-motion abnormality." Choice C, J wave, is characteristic of patients with hypothermia. Choice D, pulmonary vascular congestion, is frequently noted on CXR of patients with congestive heart failure. Choice E, an elevated WBC count, is indicative of an infectious process.

A 70-year-old man with a history of pulmonary hypertension and obstructive sleep apnea presents with complaints of increasing dyspnea while walking his dog. He has also recently noted increased lower extremity edema. On physical examination, jugular venous distension is noted. Auscultation of the chest demonstrates a high-pitched blowing diastolic murmur. With inspiration, the murmur increases in intensity and is heard over the second and third left intercostal spaces. An S 3 is appreciated. Palpation of the precordium reveals a hyperdynamic right ventricle, and both a systolic and diastolic thrill. The abdominal exam reveals hepatomegaly and splenomegaly. Based on this patient's history and physical exam findings, which of the following is the most likely finding on echocardiogram? A Tricuspid regurgitation B Aortic stenosis C Atrial septal defect D Pulmonic regurgitation/insufficiency E Mitral stenosis

The Correct Answer is: D This patient is demonstrating signs and symptoms of right heart failure, and with a history of pulmonary hypertension and a high-pitched diastolic blowing murmur (Graham Steell murmur), Choice D is the most likely of the choices offered. A blowing holosystolic murmur at the left lower sternal border is characteristic for tricuspid regurgitation, Choice A. Choice B, aortic stenosis, presents with a systolic ejection murmur. An atrial septal defect, Choice C, if large, could present with similar symptoms of exertional dyspnea secondary to a large shunt, but auscultation would reveal a moderately loud systolic ejection murmur that is heard best in the second and third interspaces. This is secondary to increased pulmonary arterial flow. Choice E, mitral stenosis, presents with a diastolic murmur heard best in the left lateral decubitus position, with the bell of the stethoscope at the apex.

A 49-year-old female with a known history of hypertension presents to the emergency department with a generalized headache that is throbbing. She states she had run out of her normal blood pressure medication about a week ago and since then she has noticed that her headache came about and has been getting worse. She denies any nausea, vomiting, visual changes, chest pain, or other symptoms. On exam the patient has a BP 227/120, P 78, R 18. Her HEENT exam is essentially normal, lungs are clear to auscultation, and heart is a regular rhythm without murmur or gallop. Given this clinical situation, which medication would be the most appropriate to address the patients condition? A IV nitroprusside B Oral furosemide C Spironolactone D IV labetalol E Oral hydralazine

The Correct Answer is: D This patient's clinical situation is one of a hypertensive emergency. In this situation the goal is to bring down the systolic pressure to prevent end organ damage. Given the possible choices, the best choice would be intravenous labetalol (D) due to its effective quick onset, and its ability to be tolerated with most patients. While oral furosemide (B) and hydralazine (E) can both be effective in managing hypertension, the IV dosing of labetalol would be the better choice. Nitroprusside (A) is no longer a treatment option. Spironolactone (C) would not have strong enough effects to appropriately lower the blood pressure in an efficient manner.

A 65-year-old recent alcoholic comes to the emergency department with recent onset of dyspnea, with exertion, 3 pillow orthopnea, lower extremity edema, and palpitations, in which he describes his heart as racing. Which of the following is most likely to be the cause of his high-output congestive heart failure? A Mitral regurgitation B Aortic stenosis C Uncontrolled hypertension D Ruptured chordae tendinae E Beriberi

The Correct Answer is: E Choice E, beriberi, also known as thiamine deficiency, is common among alcoholics, and the only high-output cause of congestive heart failure among the choices offered. Other causes include severe anemia, thyrotoxicosis, and arteriovenouis shunting (for example, in hemodialysis patients). Choice A, mitral regurgitation, is a cause of excessive preload, leading to heart failure. Choice D, ruptured chordate tendinae associated with mitral regurgitation, would also be a cause of excessive preload, leading to heart failure. Choices B and C, aortic stenosis and uncontrolled hypertension, are causes in which too much afterload leads to heart failure.

A 50-year-old woman with a history of hypertension complains of chest tightness and dyspnea while walking up one flight of stairs. She recently experienced an episode of near-syncope while walking her dog. She denies a history of rheumatic fever. On auscultation, a crescendo-decrescendo systolic ejection murmur is heard at the upper right sternal border, radiating to the carotids bilaterally. Troponin levels are negative at 0, 3, and 6 hours. Her EKG demonstrates evidence of left ventricular hypertrophy. Given the patient's physical exam findings and recent symptoms, which of the following is the most appropriate next diagnostic study? A Chest X-ray B Transesophageal echocardiogram C Holter monitor D Treadmill exercise stress test E Transthoracic echocardiogram

The Correct Answer is: E Choice E, transthoracic echocardiogram, is a simple, sensitive, and non-invasive diagnostic tool which can evaluate for the presence of valvulopathy in a patient in this age group, who is likely demonstrating severe aortic stenosis secondary to a congenital bicuspid valve. Patients with a congenital bicuspid aortic valve typically develop symptoms once the valve leaflets have become calcified and thickened, secondary to the undue stress over many years on a structurally abnormal aortic valve. Choice A might be able to give evidence of cardiomegaly or calcification of heart valves, but would not be sensitive enough to detect the degree of valvulopathy, if present. Choice B, transesophageal echocardiogram, would give information regarding valvulopathy, but is a more invasive test; therefore, choice E is more appropriate. Choice C is a useful diagnostic tool for evaluation of patients complaining of palpitations, but incorrect for this patient, who has no symptoms of palpitations. Choice D, although a useful diagnostic tool for the evaluation of exercise tolerance and in patients complaining of chest pain, does not allow direct visualization of the heart valves to evaluate the degree of aortic stenosis; as the patient is likely demonstrating severe aortic stenosis, cardiac catheterization to evaluate for coronary artery disease prior to surgery will need to be performed.

A 66-year-old male with a history of hypertension, diabetes mellitus, and hypercholesterolemia presents by emergency medical services (EMS) to the emergency department complaining of severe chest pain with radiation into his back. The patient states that he was feeling well in the morning, but while performing some light activity he felt a "ripping" sensation in his back, which he initially thought was a pulled muscle. The pain continued and the patient started to have chest pain, shortness of breath, and lightheadedness. On initial examination the patient is still in pain, pale, diaphoretic, and has a blood pressure of 85/40. His chest is clear to auscultation, and he has a 3/6 diastolic murmur best appreciated at the base of the heart. Given this clinical scenario, what is the best test to definitively diagnose this medical problem? A Chest x-ray B Transthoracic echocardiography C Transesophageal echocardiography D Cardiac catheterization E Computed tomography

The Correct Answer is: E This patient is exhibiting a history and physical examination that is consistent with a thoracic aneurysm. The patient's history of hypertension, along with the "ripping" sensation in his back and hypotension give a clinical presentation that is suggestive of a thoracic aneurysm dissection. Given this clinical situation, the best test to evaluate for a potential dissection is by computed tomography (E). This test is sensitive enough to determine if there is a luminal irregularity. While echocardiography (B and C) may be able to show evidence of an aneurysm, it is not specific enough to show all the areas of an aneurysm. In this situation a chest x-ray (A) would not give enough specificity to appropriately diagnose an aneurysm, as well as a cardiac catheterization (D).

Which of the following conventional or plain radiographic views of the face is most beneficial for evaluating trauma of the midface?

The Waters view is useful in evaluation of the presence of orbital rim fractures and air-fluid levels in the maxillary sinuses.

The bite lesion is usually mildly erythematous and may become firm and heal with little scarring over several days to weeks. Occasionally, the lesion may become necrotic over 3 to 4 days with subsequent eschar formation.

The brown recluse spider bites are difficult to identify.

A 66-year-old female with a history of nephrotic syndrome presents to the emergency department complaining of a non-productive cough and dyspnea on exertion following a recent vacation to Orlando. She is currently taking prednisone. What diagnosis is highly suspected in this patient due to her history of nephrotic syndrome? A.pneumonia B.pulmonary embolism C.chronic obstructive pulmonary disease (COPD) exacerbation D.Cushing's syndrome E.asthma exacerbation

The correct answer is (B). Patient's with nephrotic syndrome commonly have a hypercoagulable state and are at risk for deep venous thrombosis (DVT) with resultant PE. Patients on chronic prednisone may have a risk of developing Cushing's syndrome, but this is not consistent with the patient's history. Pneumonia is possible due to chronic prednisone use but not directly caused by her history of nephrotic syndrome. COPD and asthma are not linked to nephrotic syndrome.

useful in the diagnosis of acute coronary syndrome because this amino acid does not exist in skeletal muscle.

Troponin levels

Dx of PE:

V/Q scan: Uses radioactive material to compare ventilation & perfusion

Which EKG leads are used to diagnose an anterolateral MI?

V5 and V6

What will a CXR show for a patient with an aortic dissection

Widened mediastinum

Le Fort I fracture

a fracture involving the maxilla at the level of the nasal fossa

Signs and symptoms best describes the presentation of a dissecting thoracic aortic aneurysm?

abrupt and severe pain in chest or between the scapulae

The typical physical examination findings reveal a red eye with fixed, mid-dilated pupil, corneal clouding (hazy cornea), and a shallow anterior chamber.

acute narrow-angle glaucoma

What is the mechanism of injury for Posterior shoulder dislocation?

arm held internal rotation & external rotation painful

Describe cauda equina

bilateral leg pain, saddle anesthesia, urinary incontinence, and fecal incontinence

Which is the most compelling indication for thrombolytic therapy in a patient with acute pulmonary embolism?

circulatory collapse and refractory hypoxemia

avulsion fracture of the spinous process of the lower cervical vertebrae. This oblique fracture of the base of the spinous process, classically C7.

clay-shoveler fracture

What is the best test for diagnosing CHF?

echo

Tx for Cardiac Tamponade

echocardiograph-guided pericardiocentesis

ECG findings is most likely associated with hypokalemia?

flattened T waves

The ECG findings of hypokalemia include:

flattened T waves, U waves, and ST-segment depressions.

A patient is involved in a motor vehicle accident and suffered a fractured neck. The fracture lines extend through the pedicles of C2. Which of the following describes this unstable hyperextension fracture to the cervical spine?

hangman fracture

A 1-year-old boy is brought to the emergency department by his parents, who state that the child refuses to walk or crawl and begins crying when they stand him. He seems calm while lying on the examination table. Vitals are as follows: Temp: 38°C, HR: 70, RR: 15. Bruising is noted in several places. His parents deny trauma, but have noticed that he bruises easily. What other physical finding would you expect? A Conjunctival hemorrhages secondary to shaken baby syndrome B Pain response over the wrists secondary to passive range of motion C Pain response with passive range of motion to the hip secondary to slipped epiphysis D Pharyngitis and sand paper rash secondary to a staph infection E Swelling and warmth over the knee secondary to hemarthroses

he Correct Answer is: E This patient has hemophilia A. Hemarthroses usually occur when an affected child begins to walk. Due to his hemophilia, easy bruising can occur. Hemarthroses can cause low-grade fevers without infection being present, so choice D is incorrect. Wrist joints are less involved then knees, ankles, and elbows.

Which of the following disorders may present with a patient experiencing anxiety, tremors, palpitations, fatigue, and hemiplegia?

hypoglycemia

Causes of non-traumatic cardiac tamponade?

metastatic malignancy

ST segment depression and T wave changes are indicative of ___

myocardial ischemia.

Which calcium channel blocker is used to treat subarachnoid hemorrhages by preventing posthemorrhagic vasospasms?

nimodipine

Which drug is beneficial in lowering increased intracranial pressure (ICP) associated with subarachnoid hemorrhage?

nimodipine

Cardiac enzymes in a patient with a 2-hr hx of chest pain 2ry to acute MI would commonly demonstrate findings?

normal creatine kinase (CK-MB) and troponin I levels

Immediate management priority in pnt with septic shock is:

oxygenation and ventilation

What ECG change may be noted when a patient has a potassium level of 6.0 mEq/L?

peaked T waves

Which is the most common etiology of upper GI bleeding?

peptic ulcer disease

Acute Pericarditis

pericardial friction rub & serial electrocardiographic abnormalities, leaning forward may give relief

Which signs and symptoms is most likely to be indicative of acute myocardial ischemia or infarction?

retrosternal chest discomfort

What is the mechanism of injury for an anterior shoulder dislocation?

shoulder external rotation with abduction; Falls onto an outstretched hand as mechanism of injury is more common in older patients.

The definitive treatment of aortic dissection that involves the ascending aorta (type A) should include

surgery

A child falls on an outstretched hand. Complains of pain and swelling to the wrist. X-ray demonstrates a buckling of the cortex to the distal radius. What is your diagnosis?

torus fracture

one would expect to see WHAT with tension pneumothorax that leads to shock?

tracheal deviation

What is considered the most specific myocardial injury enzyme marker?

troponin I

clinical findings differentiates periorbital from orbital cellulitis?

worsening pain with eye movements