BOARD REVIEW QUESTIONS
February 2017 | Volume 17 Issue 2
Challenging ABEM style questions for enhanced learning and deeper understanding of the EMRAP program
www.emrap.org
Editor-in-Chief: Mel Herbert, MD Executive Editor: Stuart Swadron, MD Associate Editor: Dan Joseph, MD
Question #1 A 5-year old female presents to the Emergency Department for “constipation.” The parents report the child has not had a bowel movement in 5 days. She has a long history of constipation, typically has one bowel movement per week, and has occasional episodes of fecal incontinence. She is tolerating orals but reports some intermittent abdominal discomfort. Vital signs are: HR 110, RR 20, T 98.6ºF (37ºC). Exam reveals a soft, mildly distended abdomen. Which of the following is the most appropriate next step in management? 1. 2. 3. 4.
Abdominal x-ray Abdominal ultrasound Abdominal CT Reassurance and supportive care
Question #2 According to this month’s EMRAP with Al Sacchetti, which of the following is the sensitivity of parents for identifying a serious bacterial illness when they report there is something wrong with their child? 1. 10% 2. 23.5% 3. 74.6% 4. 96.8% Question #3 A 25-year old male is brought in by the police for medical clearance after allegedly ingesting a bag of cocaine. Which of the following imaging modalities CANNOT be used to detect the foreign body ingestion? 1. CT scan 2. Ultrasound 3. Xray 4. All of the above are effective Question #4 What percentage of patients will experience hypotension during intubation? 1. 1% 2. 10% 3. 25% 4. 75%
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BOARD REVIEW QUESTIONS
Question #5 A 68-year old female presents to the ER with shortness of breath and fever. Vital signs are: HR 130, RR 40, BP 80/50, T 102.2ºF (40ºC). Physical exam is remarkable for a tachypneic and confused female with rhonchi throughout the right lung. The decision is made to intubate. According to this month’s segment with Haney Mallemat, which of the following is the most appropriate induction agent? 1. Etomidate 2. Ketamine 3. Midazolam 4. Propofol Question #6 Which of the following symptom is LEAST likely to be present in a child presenting with bipolar disorder? 1. Depression 2. Elation 3. Irritability 4. Inability to sleep Question #7 A 55-year old female with known congenital long QT syndrome presents with significant nausea and vomiting. Which of the following is the safest anti-emetic to give this patient? 1. Diphenhydramine 2. Haloperidol 3. Metoclopramide 4. Ondansetron Question #8 Which of the following pelvic fractures is most concerning for bleeding risk? 1. 2. 3. 4.
Iliac wing fracture Inferior pubic ramus Superior pubic ramus Posterior ring fractures
Question #9 Which of the following is true of pelvic binders? 1. 2. 3. 4.
Decreased length of hospitalization Decreased mortality Decreased transfusion requirement None of the above
Question #10 Which of the following injuries is least likely to be detected by FAST exam? 1. 2. 3. 4.
Bladder rupture causing bleeding Liver laceration causing bleeding Retroperitoneal bleeding from pelvic fractures Splenic laceration causing bleeding
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BOARD REVIEW QUESTIONS
Question #11 Which of the following features is most concerning for acute coronary syndrome? 1. 2. 3. 4.
Chest pain similar to a prior MI Chest pain with diaphoresis Chest pain with radiation to bilateral arms Chest pain with vomiting
Question #12 A 55-year old male with diabetes presents with intermittent substernal chest pain over the past 2 days. EKG shows no signs of ischemia. Which of the following reflects Amal Mattu’s approach to this patient’s biomarker testing? 1. 2. 3. 4.
Troponin-I assay at time zero and 2 hour Troponin-I assay at time zero and 3 hour Troponin-I assay at time zero and 4 hour Troponin-I assay at time zero and 6 hour
Question #13 A 28-year old male presents with a severe headache associated with nausea and vomiting. He reports the headache started 2 hours prior while he was sitting and has gradually worsened since that time. He denies any trauma, fever, or infectious symptoms. He had no loss of consciousness and has experienced no neck pain According to this month’s EMRAP segment, which of the following is the most appropriate workup to rule out subarachnoid in this patient? 1. 2. 3. 4.
CT angiography CT non-contrast CT non-contrast followed by lumbar puncture No testing is required
Question #14 Which of the following reflects the false-positive rate of lumbar punctures to detect subarachnoid hemorrhage in patients with a negative head CT within 6 hours of headache onset? 1. 1% 2. 5% 3. 75% 4. 99.5% Question #15 According to ACOG, which of the following Rh negative patients may NOT require RhoGam? 1. 2. 3. 4.
Patient with confirmed 10 week IUP presenting with vaginal bleeding Patient with confirmed 14 week pregnancy with intrauterine fetal demise undergoing dilation and curettage Patient with confirmed 36 week IUP presenting with cramping and bloody show All of the above should receive RhoGam
Question #16 A 24-year old G2P1 at 10 weeks presents with vaginal bleeding. Vital signs are: HR 80, RR 20, BP 100/80, T 98.6ºF (37ºC). Physical exam reveals scant vaginal bleeding and a closed cervical os. Bedside ultrasound reveals the presence of an intrauterine pregnancy. The patient has a point of care hemoglobin of 12 mg/dL and is Rh positive. According to this month’s EMRAP segment, which of the following is the most appropriate next step in management? 1. 2. 3. 4.
Discharge with OB-GYN follow-up Formal ultrasound in radiology RhoGam administration Serum beta HCG testing
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BOARD REVIEW QUESTIONS
Question #17 A 55-year old male is brought in by EMS in cardiac arrest. He had a witnessed collapse, bystander CPR, and was found to be in ventricular fibrillation by EMS. He has received 3 shocks without successful cardioversion. In the ED the patient is given amiodarone and an additional attempt at defibrillation is unsuccessful. Which of the following is the most appropriate next step in management? 1. Digoxin 2. Esmolol 3. Procainamide 4. Termination of resuscitation Question #18 A 65-year old male presents with headache and vomiting as well as right-sided weakness. The patient is taken immediately to CT scan which reveals a left sided hemorrhagic stroke. According to this month’s Paper Chase segment, which of the following is the desired systolic blood pressure goal for this patient? 1. 110-139 mmHg 2. 140-179mmHg 3. No difference was found between the above blood pressure goals Question #19 According to the article by Ray et al, Association between MRI exposure during pregnancy and fetal and childhood outcomes, which of the following is associated with fetal harm? 1. Gadolinium administration 2. MRI without contrast 3. Ultrasound 4. All of the above were associated with fetal harm Question #20 A 33-year old male presents to the ER after a possible overdose. EMS found the patient unresponsive and apneic. They administered 4 mg intranasal naloxone after which the patient began breathing but remained comatose. Urine toxicology screening is negative in the ED. According to this month’s EMRAP segment, which of the following is the most likely agent? 1. Counterfeit Xanax (fentanyl and etizolam) 2. Heroin 3. Hydromorphone 4. Midazolam Question #21 A 23-year old female spontaneously delivers a term neonate in your resuscitation bay. Initial examination of the child reveals a crying neonate who is appropriately responsive and has good tone. Pulse oxygenation is 60% one minute after delivery. Which of the following is the most appropriate next step in management? 1. 2. 3. 4.
Bag valve mask ventilation Endotracheal intubation Supplemental oxygenation Give the baby to mother
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