Medicine (Acute Care/Preventive)

Question 1

causative agent of chancroid, painful papule or pustule with irregular, deep, and demarcated borders

Answer 1

Haemophilus ducreyi

Question 2

Syphilis is caused by

Answer 2

Treponema pallidum (spirochete)

Question 3

presents with painless ulcer called chancre

Answer 3

Syphilis

Question 4

maculopapular rash + condylomata lata + low grade fever + malaise + headache + generalized lymphadenopathy

Answer 4

Syphilis - Secondary stage (4-8 wks after chancre)

Question 5

presents with multiple painful vesicles accompanied by vulvar pain and pruritus

Answer 5

Herpes simplex

Question 6

most common bacterial STD

Answer 6

Chlamydia trachomatis

Question 7

STD often asymptomatic, but may present with urethritis, mucopurulent cervicitis, or PID

Answer 7

Chlamydia trachomatis

Question 8

causes granuloma inguinale (donovanosis)

Answer 8

Klebsiella granulomatis

Question 9

lesion characterized by beefy red ulcer with a rolled edge of granulation tissue

Answer 9

granuloma inguinale / donovanosis

Question 10

seizure treatment or prophylaxis for head trauma px at ER

Answer 10

phenytoin or levetiracetam

Question 11

signs of increased ICP

Answer 11

deteriorating LOC
deteriorating resp pattern
cushing reflex
lateralizing CNS signs (cranial nerve palsies, hemiparesis)
seizures
papilledema (occurs late)
n/v and h/a

Question 12

response to increased ICP presenting as high BP, low HR and irregular respirations

Answer 12

Cushing reflex

Question 13

signs of basal skull fracture

Answer 13

raccoon’s eyes
hemotympanum
battle’s sign
csf rhinorrhea or otorrhea

Question 14

meds to administer at least 2 mins prior to RSI in suspected raised ICP

Answer 14

fentanyl or lidocaine

Question 15

goals for head trauma cases in ED

Answer 15

avoid secondary injuries:
ischemia
dec CPP
hypoxia
seizures

Question 16

vitamin K-dependent clotting factors

Answer 16

factors 279,10
receptor proteins C&S

Question 17

When may gastric lavage be useful?

Answer 17

Gastric lavage may occasionally be useful in the first hour of ingestion.

Question 18

In what situations is gastric lavage dangerous?

Answer 18

Gastric lavage is dangerous in:
1. Caustic ingestion
2. Altered mental status

Question 19

Why is gastric lavage dangerous in caustic ingestion?

Answer 19

It causes burning of the esophagus and oropharynx.

Question 20

Why is gastric lavage dangerous in altered mental status?

Answer 20

It may cause aspiration.

Question 21

What are the most common causes of death by overdose?

Answer 21

Acetaminophen and Aspirin

They are, by far, the most common cause of death by overdose.

Question 22

benign and should be given to anyone with a pill overdose; superior to lavage and ipecac

Answer 22

Activated charcoal (SDAC / MDAC)

Question 23

acetaminophen ingestion causes toxicity at how many grams (and # of 500mg tabs)?

Answer 23

> 8g or > 16 tabs

Question 24

acetaminophen ingestion causes fatality at how many grams (and # of 500mg tabs)?

Answer 24

> 12 g or > 24 tabs

Question 25

aspirin overdose treatment

Answer 25

urinary alkalinization with sodium bicarbonate

Question 26

What condition is characterized by crushing, substernal chest pain with ST elevations in V1, V2, V3, short breath, crackles, and LE edema?

Answer 26

STEMI

Question 27

What condition is indicated by an unrestrained passenger in a motor vehicle accident presenting with unilateral diminished breath sounds and dullness to percussion?

Answer 27

Hemothorax

Question 28

What condition is seen in a young person with unilateral upper extremity swelling, pain, and erythema following vigorous exercise?

Answer 28

Deep venous thrombosis

Question 29

What condition is presented by an older man with a recent history of abdominal surgery, severe abdominal pain, constipation, and an irreducible mass in the left lower quadrant?

Answer 29

Incarcerated inguinal hernia

Question 30

What condition occurs immediately after completing a marathon when a runner collapses without loss of consciousness and has minimally elevated temperature?

Answer 30

Exercise-associated postural hypotension

Question 31

What condition is indicated by a young patient with moderate chest pain worsened by palpation?

Answer 31

Costochondritis

Question 32

Miner present with Ataxia, irritability, gingival inflammation, and excess salivation

Answer 32

Mercury poisoning

Question 33

What condition is suggested by a sudden-onset, severe headache in an elderly patient?

Answer 33

Subarachnoid hemorrhage

Question 34

What type of headache is characterized by sudden-onset, severe, unilateral, periorbital headache with tearing and conjunctival injection?

Answer 34

Cluster headache

Question 35

What condition is indicated by an elderly patient with an extensive smoking history presenting with fatigue, malaise, bilateral upper extremity edema, and headache worse with supine positioning?

Answer 35

SVC syndrome (Pancoast tumor)

Question 36

What injury is indicated by a fall onto an outstretched hand with arm in adduction and internal rotation, showing widening of the glenohumeral joint space?

Answer 36

Posterior shoulder dislocation

Question 37

What condition is characterized by repeated bilateral lower extremity pain and swelling after strenuous exercise with spontaneous resolution?

Answer 37

Chronic exertional compartment syndrome

Question 38

What condition presents in a young patient with no past medical history, showing encephalopathy, anion gap metabolic acidosis, and hyperglycemia?

Answer 38

Diabetic ketoacidosis

Question 39

What injury is indicated by a fall from a roof with spinal tenderness and spinal X-ray showing decreased vertebral body height at T8?

Answer 39

Vertebral compression fracture

Question 40

What injury is associated with a recent bar fight and severe tenderness of the medial hand at the 5th metacarpal?

Answer 40

Boxer's fracture

Question 41

associated injury in head-on collision

Answer 41

head/facial, thoracic (aortic), lower extremity

Question 42

associated injuries in lateral/T-bone collision

Answer 42

head, c-spine, thoracic, abdominal, pelvic, and LE

Question 43

associated injuries in rear-end collision

Answer 43

hyperextension of C-spine (whiplash injury)

Question 44

head trauma with a gcs score of 8 or less, + cushing's response

Answer 44

A: intubate B: hyperventilate (100% O2) C: maintain adequate bp (sBP >90) administer fentanyl or lidocaine (2mins prior to RSI) sedate elevate head to 20 ° seizure prophylaxis mannitol 1g/kg rapidly infused or 3% saline 3ml/kg remove cervical collar if possible

Question 45

treatment of TCA overdose

Answer 45

sodium bicarbonate

Question 46

most accurate test for carbon monoxide poisoning

Answer 46

level of carboxyhemoglobin

Question 47

very high carbon monoxide will lead to ph?, pCO2?, HCO3?

Answer 47

low ph low pCO2 low HCO3

Question 48

decreases the half life of methemoglobin

Answer 48

methylene blue

Question 49

shortens half life of carboxyhemoglobin

Answer 49

hyperbaric oxygen

Question 50

first step in managing organophosphate poisoning / nerve gas at ER

Answer 50

administer Atropine

Question 51

dangerous mechanisms requiring c-spine radiography (Canadian C-Spine Rule)

Answer 51

Fall from 1m or more / 5 stairs axial load to head (e.g. diving) MVC high speed (>100km/hr), rollover, ejection motorized recreational vehicles bicycle collision

Question 52

GCS15, alert and stable trauma patients requiring c-spine radiograph

Answer 52

age 65 or older, OR dangerous mechanism paresthesias in extremities

Question 53

next step after confirming there is no high-risk factor that mandates c-spine radiography for gcs15, alert and stable patient? (Canadian C-Spine Rule)

Answer 53

assess any low-risk factor that allows safe assessment of ROM - Simple rear-end MCV , OR - Sitting position in ED, OR - Ambulatory at anytime, OR - Delayed (not immediate) onset of neck pain, OR - absence of midline C-spine tenderness

Question 54

mechanisms excluded in simple rear-end MVC

Answer 54

hit by truck/bus hit by high-speed vehicle rollover pushed into oncoming traffic

Question 55

mgmt for patient with SCI and in shock

Answer 55

IVF vasopressors maintain normothermia maintain euglycemia

Question 56

High urine pH increases the risk of developing this stone

Answer 56

struvite stones (magnesium ammonium phosphate)