Emergency medicine rosh mock exam 2023 practice questions and answers
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Emergency medicine rosh
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Emergency Medicine Rosh
Emergency medicine rosh mock exam 2023 practice questions and answers
A 32-year-old woman presents with persistent nausea over the last two weeks. She is approximately 10 weeks pregnant. She has been able to tolerate fluids, but has had decreased food intake. She denies any abdominal or pelvic p...
emergency medicine rosh mock exam 2023 practice questions and answers a 32 year old woman presents with persistent nausea over the last two weeks she is approximately 10 weeks pregnant she has been
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Emergency medicine rosh mock exam 2023 practice
questions and answers
A 32-year-old woman presents with persistent nausea over the last two weeks. She is
approximately 10 weeks pregnant. She has been able to tolerate fluids, but has had
decreased food intake. She denies any abdominal or pelvic pain or vaginal bleeding.
What medication is considered first-line treatment for this patient?
Pyridoxine:1st line tx for NAUSEA in pregnancy!
-doesn't help w/vomiting
-Pyridoxine is a water-soluble B complex vitamin that is necessary in the metabolism of
lipids, amino acids, and carbohydrates
#2:add antihistamine(benadryl) or 5HT3 antagonist(zofran:category B); also
meclizine(category B), dimendydrinate
#3: methylprednisolone or chlorpromazine
-Prochlorperazine: category C
What electrolyte abnormalities can be seen in patients with hyperemesis gravidarum?
hypokalemia w/hypochloremic metabolic alkalosis
A 39-year-old man presents to the Emergency Department with left hand pain. He
denies recent trauma, genital or oral lesions, or fever. His medical history is significant
for diabetes mellitus and tobacco abuse. His examination is shown above. Which of the
following is the most appropriate initial therapy for this patient?
I&D
DX: felon=pyogenic infection or ABSCESS of the digital subcutaneous tissue and pulp
-caused by Staph aureus
-.If left untreated, the infection may spread to the flexor tendon sheath leading to flexor
tenosynovitis, or to the bone leading to osteomyelitis
True or false: Incision and drainage should be avoided in cases of herpetic whitlow.
True, as this can lead to secondary bacterial infection
An 18-year-old man is brought in by EMS following a motor vehicle collision with
prolonged extrication. His vitals on arrival are HR 110, BP 100/60, RR 20. He is noted to
have periorbital ecchymosis with tarsal plate sparing("raccoon eyes") on physical
examination. Which of the following is the most likely diagnosis?
Basilar skull fracture
-PE: mastoid ecchymosis (Battle sign), hemotympanum, CSF leaks (presenting as
otorrhea or rhinorrhea), & periorbital ecchymosis with tarsal plate sparing ("raccoon
eyes")
-Any patient with a suspected basilar skull fracture should undergo a head CT to look
for extra-axial hematoma formation as well as cerebral damage, which is common
-Extra-axial hematomas associated with a basilar skull fracture are a neurosurgical
emergency
-CSF leaks in the setting of basilar skull fractures are typically self limited
Orbital floor fractures
"blowout fractures," most often occur due to direct trauma to the eye
-Periorbital ecchymosis in this setting will also not show tarsal plate sparing as seen
,with basilar skull fractures
-teardrop sign: herniated tissue and muscle
globe rupture
=full thickness injury to sclera
-traumatic vision-threatening emergency that can present with corneal or scleral
lacerations, bullous subconjunctival hemorrhage, iris abnormalities ("teardrop pupil"), or
uveal prolapse
-positive seidel test: aqueous flow on fluorescein testing
-tx: eye shield, avoid tonometry, elevate head of bed, NPO, antiemetics, analgesia,
antibiotics, emergent ophthalmology consult
What bone is most commonly involved in basilar skull fractures?
temporal bone
What basic metabolic panel abnormality is associated with upper GI bleeding?
Elevated BUN/Creatinine ratio
A 77-year-old woman presents with an acute change in mental status. She has a history
of diabetes mellitus, hypertension, and prior ischemic stroke. Home medications include
aspirin, clopidogrel, lisinopril, and glyburide. She was found by family to be confused
and diaphoretic. Her blood sugar was 32 mg/dL. She was given 50 grams of
intravenous dextrose by emergency personnel with a return to her baseline mental
status. On arrival to the emergency department, her blood sugar is 185 mg/dL. When
asked, she thinks she may have accidentally taken an extra dose of her glyburide this
morning. She is currently asymptomatic and asking when she can go home. Which of
the following is the most appropriate management of this patient?
Admission for 24-hour observation
-b/c the hypoglycemic effect of sulfonylureas lasts up to 24 hours allowing for once-
daily dosing
-work by promoting endogenous insulin secretion by the pancreas
What is trench foot?
Prolonged wet and cold (but nonfreezing) exposure causing reversible neurovascular
injury
What medication is indicated in cases of recurrent hypoglycemia associated with
sulfonylurea overdose?
Octreotide, a somatostatin analogue that inhibits release of insulin from the pancreatic
beta-islet cells
A 27-month-old girl presents to the ED with parents after one episode of generalized
convulsions. Parents note she has was initially lethargic but then cleared to baseline.
Temperature in the ED is 102.9°F. As you move to examine her, she has another
generalized tonic clonic seizure. It rapidly terminates without intervention and she
returns to baseline. Which of the following is the next most important step in this child's
workup?
Observation & Reassurance if patient remains at mental baseline and don't continually
have seizures requiring intervention
DX: COMPLEX Febrile seizure
-any event not meeting the criteria for a simple febrile seizure
-should raise suspicion for serious disease such as meningitis, intracranial hemorrhage,
or intracranial mass
, - should prompt providers to consider further workup with laboratory testing, lumbar
puncture, EEG, and neuroimaging; however, if the patient returns to baseline
despite repeat seizures (2-3), then this testing is not required
What would you expect to find on the cerebrospinal fluid analysis of a patient with
bacterial meningitis?
Elevated white blood cell count, elevated protein, low glucose, organisms on gram stain
simple febrile seizure
(1) generalized tonic-clonic seizure
(2) occurring in the appropriate age group of age 6 months to 5 years
(3) seizure is less than 15 minutes in duration
(4) the child has a nonfocal neurologic exam
(5) there is no recurrence of seizures within 24 hours
A 39-year-old woman presents to the ED with fever and altered mental status after an
intentional overdose. On physical exam, you note lower extremity hyperreflexia and
myoclonus. Vital signs are BP 170/110 mm Hg, HR 126 beats per minute, RR 24
breaths per minute, and T 101.2°F. Which of the following is the classic antidote to this
toxicologic process?
cyproheptadineor benzodiazepines, hydration/cooling
DX: serotonin syndrome
Bromocriptine is for neuroleptic malignant syndrome like dantrolene
What is the youngest age someone may receive tPA for acute stroke?
18 yo
A 64 year-old woman presents to the emergency department complaining of facial pain.
She was at a major league baseball game and was struck in the face with a foul ball.
She is awake and alert and able to provide you with the history. On physical exam she
has extensive swelling and ecchymosis to the nasal bridge and upper lip region. Upon
grasping her upper teeth, the nasal complex and maxilla move together as a unit. A CT
of the facial bones reveals a fracture extending from the maxilla superiorly to the nasal
bridge in a pyramidal shape. What is the most likely diagnosis?
Le Fort II fracture
-fracture extends from the maxilla superiorly to the nasal bridge, including the lacrimal
bones, orbital floor and rim.
-physical exam: nasal complex moves with the maxilla when the upper teeth are
grasped and rocked
-CT of the facial bones will confirm the diagnosis
-Management: pain control and facial trauma consultation for operative repair
Evaluation of extraocular movement on physical exam in patients with facial trauma is
utilized to rule out what complication of orbital trauma?
Orbital fracture with associated muscle entrapment
A 42-year-old man presents with pain in his foot after falling while descending the stairs.
He is unable to bear weight on the foot. Pulses and sensation are intact. He has pain
with palpation of the midfoot and a small area of ecchymosis on the plantar surface of
the foot. His X-ray is shown above. What is the likely diagnosis?
Lisfranc injury (tarsometatarsal joint complex)
-comprised of the articulations of the bases of the first three metatarsals with the
cuneiforms and the fourth and fifth metatarsals with the cuboid, joined together with
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