Selected Topics in Emergency Medicine

Question 1

Class of drugs that may cause syndrome of muscle rigidity, hyperthermia, autonomic instability, and extrapyramidal symptoms

Answer 1

Antipsychotics (neuroleptic malignant syndrome)

Question 2

Side effects of corticosteroids

Answer 2

Acute mania, immunosuppression, thin skin, osteoporosis, easy bruising, myopathies

Question 3

Treatment for DTs

Answer 3

Benzodiazepenes

Question 4

Treatment for acetaminophen overdose

Answer 4

N-acetylcysteine

Question 5

Treatment for opioid overdose

Answer 5

Naloxone

Question 6

Treatment for benzodiazepene overdose

Answer 6

Flumazenil (monitor for withdrawal and seizure)

Question 7

Treatment for neuroleptic malignant syndrome and malignant hyperthermia

Answer 7

Dantrolene

Question 8

Treatment for malignant hypertension

Answer 8

Nitroprusside

Question 9

Treatment of atrial fibrillation.

Answer 9

Rate control, rhythm conversion, and anticoagulation

Question 10

Treatment for supraventricular tachycardia

Answer 10

If stable, rate control with carotid massage or other vagal stimulation; if unsuccessful, consider adenosine

Question 11

Causes of drug-induced SLE

Answer 11

Isoniazid, penicillamine, hydralazine, procainamide, chlorpromazine, methyldopa, quinidine

Question 12

Macrocytic, megaloblastic anemia with neurologic symptoms

Answer 12

B12 deficiency

Question 13

Macrocytic megaloblastic anemia without neurologic symptoms

Answer 13

Folate deficiency

Question 14

A burn patient presents with cherry-red, flushed skin and coma. SaO2 is normal, but carboxyhemoglobin is elevated. Treatment?

Answer 14

Treat CO poisoning with 100% oxygen or with hyperbaric oxygen if poisoning is severe or the patient is pregnant

Question 15

Blood in the urethral meatus or high-riding prostate

Answer 15

Urethral injury or bladder rupture

Question 16

Test to rule out urethral injury

Answer 16

Retrograde cystourethrogram

Question 17

Radiographic evidence of aortic dissection

Answer 17

Widened mediastinum (>8 cm), loss of aortic knob, pleural cap, tracheal deviation to the right, depression of left main stem bronchus

Question 18

Radiographic indications for surgery in patients with acute abdomen

Answer 18

Free air under the diaphragm
Extravasation of contrast
Severe bowel distension
Space-occupying lesion on CT
Mesenteric occlusion (angiography)

Question 19

The most common organism in burn-related infections

Answer 19

Pseudomonas

Question 20

Method of calculating fluid replacement in burn patients

Answer 20

Parkland formula: 24-hour fluids = 4 x wt (kg) x % body surface area affected

Question 21

Acceptable urine output in a trauma patient

Answer 21

50 cc/hr

Question 22

Acceptable urine output in a stable patient

Answer 22

30 cc/hr

Question 23

Signs of neurogenic shock

Answer 23

Hypotension and bradycardia

Question 24

Signs of increased ICP

Answer 24

Hypertension, bradycardia, and abnormal respirations (Cushing triad)

Question 25

Shock with decreased CO, decreased PCWP, increased peripheral vascular resistance

Answer 25

Hypovolemic shock

Question 26

Shock with decreased CO, increased PCWP, increased peripheral vascular resistance

Answer 26

Cardiogenic (or obstructive) shock

Question 27

Shock with increased CO, decreased PCWP, decreased PVR

Answer 27

Distributive (e.g. septic or anaphylactic) shock

Question 28

Treatment of septic shock

Answer 28

Fluids and antibiotics

Question 29

Treatment of cardiogenic shock

Answer 29

Identify cause; inotropes (e.g. dopamine)

Question 30

Treatment of hypovolemic shop

Answer 30

Identify cause; fluid and blood repletion

Question 31

Treatment of anaphylactic shock

Answer 31

Epinephrine 1:1000 and diphenhydramine

Question 32

Supportive treatment for ARDS

Answer 32

Low tidal volume ventilation

Question 33

Signs of air embolism

Answer 33

A patient with chest trauma who was previously stable suddenly dies

Question 34

Signs of cardiac tamponade

Answer 34

Distended neck veins, hypotension, diminished heart sounds (Beck triad). Pulsus paradoxis

Question 35

Absent breath sounds, dullness to percussion, shock, flat neck veins

Answer 35

Massive hemothorax

Question 36

Absent breath sounds, tracheal deviation, shock, distended neck veins

Answer 36

Tension pneumothorax

Question 37

Treatment for blunt or penetrating abdominal trauma in hemodynamically unstable patients

Answer 37

Immediate exploratory laparotomy

Question 38

Elevated ICP in alcoholics or the elderly following head trauma. Can be acute or chronic, crescent shape on CT.

Answer 38

Subdural hematoma

Question 39

Head trauma with immediate loss of consciousness followed by a lucid interval and then rapid deterioration. Convex shape on CT.

Answer 39

Epidural hematoma