Continuous Core Content BOARD REVIEW QUESTIONS
January 2017 | Volume 17 Issue 1
Continuous Core Content Challenging ABEM style questions for enhanced learning and deeper understanding of the EM:RAP program
www.emrap.org
Editor-in-Chief: Mel Herbert, MD Executive Editor: Stuart Swadron, MD Associate Editor: Dan Joseph, MD
Question #1 A 70-year old male presents to the Emergency Department by ambulance after a syncopal episode. He reports feeling severe abdominal pain and then losing consciousness. Vital signs are: HR 120, RR 20, BP 96/66, O2 sat 98%, T 98.6ºF (37ºC). Physical exam reveals a pale male patient with diffuse abdominal discomfort. Which of the following is the most appropriate initial diagnostic test? 1. 2. 3. 4.
Abdominal X-ray series CT abdomen and pelvis Point-of-care ultrasound Upright chest radiograph
Question #2 A 65-year old female presents with severe diffuse abdominal pain. She reports that over the past 2 months she has experienced similar but less severe diffuse pain after meals, however starting this morning the pain became constant and severe. Vital signs are: HR 110, RR 20, BP 116/76, O2 sat 98%, T 98.6ºF (37ºC). Which of the following is the most appropriate initial diagnostic test in this patient? 1. 2. 3. 4.
Abdominal X-ray series CT abdomen and pelvis with contrast CT angiography abdomen and pelvis Upright chest radiograph
Question #3 A 78-year old male presents with epigastric abdominal pain and vomiting. He reports the pain began earlier this afternoon after lunch. Vital signs are: HR 90, BP 155/90, RR 20, O2 sat 96%, T 98.6ºF (37ºC). Physical examination reveals an uncomfortable appearing male in moderate distress. Point-of-care ultrasound is negative for abdominal aortic aneurysm or free fluid, and reveals a normal gallbladder without stones. Which of the following is the most appropriate next step in evaluation of this patient? 1. CT abdomen and pelvis with contrast 2. CT angiography abdomen and pelvis 3. Electrocardiogram 4. Serum lactate
EM:RAP Board Review Questions: January 2017
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BOARD REVIEW QUESTIONS
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Question #4 An 80-year old male is transferred from a nursing facility for abdominal distension. He has a history of dementia and is unable to provide further history. X-ray is shown. Which of the following is the most appropriate next step in management? Source: https://web.stanford.edu/dept/radiology/radiologysite/site271.html 1. Barium enema 2. Exploratory laparotomy 3. Sigmoidoscopy 4. Promotility agents and IV fluids
Question #5 A 65-year old male presents to the Emergency Department with diffuse abdominal pain over the past 3 hours. He has a history of diabetes, hypertension and peptic ulcer disease. Vital signs are: HR 110, RR 20, BP 94/72, O2 sat 98%, T 98.6ºF (37ºC). Physical examination reveals a distended abdomen with rebound tenderness. Which of the following is the most appropriate next step in management? 1. 2. 3. 4.
Abdominal X-ray CT abdomen and pelvis with contrast Exploratory laparotomy Serum lactate
EM:RAP Board Review Questions: January 2017
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