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ROSH REVIEW Emergency Medicine Questions and Answers | Already Passed
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ROSH REVIEW Emergency Medicine Questions and Answers | Already Passed
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©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AMROSH REVIEW Emergency Medicine
Questions and Answers | Already Passed
A 14-year-old boy presents complaining of intense pruritus in his groin, axillae, and between his
fingers after returning home from summer camp 1 week ago. He reports several other campers
had similar symptoms. On exam, you note excoriations in the inguinal region and axillae
surrounding scattered, erythematous papules. Which of the following is the most appropriate
treatment?
Ketoconazole
Lindane
Permethrin
Prednisone - ✔️✔️Correct Answer ( C )
Explanation:
This patient has scabies; a pruritic dermatitis caused by cutaneous infection with the mite
Sarcoptes scabei, var hominis. Scabies is spread by skin-to-skin contact and should be
considered in patients with generalized pruritus, especially when exposure to others with similar
symptoms is reported. The rash of scabies involves papules, which are often excoriated. Burrows
are pathognomonic but not uniformly present. Unless previously infected, pruritus generally
takes 3-6 weeks to develop because symptoms are due to delayed (Type IV) sensitivity reaction.
The pruritus is classically worse at night and affects the web spaces of the fingers, flexor aspect
of the wrists, axillae, groin, nipples, and the periumbilical region. Except in cases involving an
immunocompromised host, the scalp and face are generally spared. Diagnosis is clinical but can
be confirmed by placing scrapings collected with a #15 blade scalpel in mineral oil for
microscopic examination. The treatment of choice for primary scabies infection is the application
of topical scabicidal agents, with repeat application in 7 days. The treatment of choice is
permethrin 5% lotion. Individuals affected by scabies should avoid skin-to-skin contact with
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,©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AM
others. Patients with typical scabies may return to school or work 24 hours after the first
treatment.
Should family members of an infected individual also be treated for scabies? - ✔️✔️Yes, family
members and sexual contacts.
Scabies - ✔️✔️Sarcoptes scabiei
Pruritic rash worse at night
Linear burrows
Interdigital spaces of hands/feet, penis, breasts
Permethrin (first line)
Ivermectin
**head and back are sparred
(head involved in children)
An 18-month-old boy presents to the emergency department with worsening shortness of breath.
The parents report he has had a cough, runny nose, and fussiness for the past five days. On exam,
the patient demonstrates subcostal retractions, tachypnea, and diffuse wheezing. The patient is
given an albuterol nebulizer treatment without any improvement of his wheezing. Chest X-ray
does not show any abnormality. Which of the following organisms is the most likely cause of his
symptoms?
Bordetella pertussis
Haemophilus influenzae
Parainfluenza virus
Respiratory syncytial virus - ✔️✔️Correct Answer ( D )
Explanation:
The patient has bronchiolitis, which is the most common lower respiratory tract infection in
patients less than two years of age. It remains the leading cause for hospitalization in infants
under one year of age. Bronchiolitis is most commonly caused by respiratory syncytial virus
(RSV), but may be caused by other viral agents. Bronchiolitis is inflammation of the lower
respiratory tract, which involves edema, epithelial cell necrosis, bronchospasm, and increased
mucus production. The resultant lower airway obstruction causes increased work of breathing
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,©PREP4EXAMS@2024 [REAL EXAM DUMPS] Friday, July 19, 2024 6:13 AM
and wheezing. Bronchiolitis is a clinical diagnosis based on age under two years old, rhinorrhea,
tachypnea, and wheezing. Unlike asthma or reactive airway disease, there is often no significant
improvement with albuterol. There is often a history of several days of upper respiratory
symptoms, such as rhinorrhea, mild cough, and mild fever. Rapid antigen tests, blood work, and
radiographs are not usually needed. Radiographs may demonstrate hyperinflation and atelectasis,
but do not show any focal infiltrates like with pneumonia. Bronchiolitis is usually self-limited,
with respiratory status typically improving over 2-5 days. Management involves supportive care.
Bronchiolitis - ✔️✔️
What months of the year contain the peak incidence of RSV in North America? - ✔️✔️November
to March.
A 76-year-old man presents to the emergency department with shortness of breath and
lightheadedness. Vital signs include blood pressure 70/56 mm Hg, heart rate 124 beats/minute,
respiratory rate 22 breaths/minute, and temperature 37.6°C. He has distended neck veins and
occasional dropped radial beats. His lungs are clear to auscultation, but his heart sounds are
distant. He has some fullness to palpation of the right upper quadrant of his abdomen. Which of
the following is the most appropriate diagnostic test?
Bedside echocardiography
Chest radiograph
Computed tomography angiogram of the chest
Electrocardiogram - ✔️✔️Correct Answer ( A )
Explanation:
This patient presents with a clinical picture consistent with obstructive shock. His distended neck
veins, full right upper quadrant, muffled heart sounds, and hypotension are all consistent with
pericardial tamponade. A pericardial sac slowly accumulating fluid can stretch without
obstructing cardiac function. Tamponade occurs when rapid fluid accumulation results in
elevated pressures that inhibit venous return. This is a dynamic process over the course of the
cardiac cycle, therefore bedside echocardiography is the diagnostic test of choice. Fluid around
the heart with evidence of right atrial compression and right ventricular diastolic collapse are
diagnostic of pericardial tamponade.
Pericardial Effusion - ✔️✔️
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What is the emergent treatment of pericardial tamponade? - ✔️✔️Pericardiocentesis.
An 8-year-old African-American girl with a history of sickle cell anemia presents with diffuse
pain consistent with an acute sickle cell pain crisis. While in the emergency department, she
develops acute onset headache, right sided facial droop and right arm weakness. A CT scan
confirms the diagnosis. Which of the following is the next best step in management?
Alteplase
Exchange transfusion
MRI brain
Tranexamic acid - ✔️✔️Correct Answer ( B )
Explanation:
Cerebrovascular events are a potential complication of sickle cell disease. This patient developed
symptoms concerning for acute ischemic stroke. For pediatric patients with acute ischemic stroke
in the setting of sickle cell disease, exchange transfusion is the treatment of choice. Transfusion
goals include decreasing hemoglobin S levels to less than 30% and obtaining a total hemoglobin
level of 10 g/dL. For adults with acute ischemic stroke in the setting of sickle cell disease,
consider tissue plasminogen activator (tPA). tPA is not indicated or approved for use in pediatric
patients
Tranexamic acid (D) is an antifibrinolytic agent used in the management of hemorrhage.
Indications include acute traumatic hemorrhage, intraoperative blood loss, and obstetric
hemorrhage. Tranexamic acid is not used for ischemic events
Manage Sickle Cell - ✔️✔️
What is the most common bacterial cause of acute chest syndrome in adults with sickle cell
disease? - ✔️✔️Atypical bacteria such as Chlamydia pneumoniae, Mycoplasma pneumoniae,
Mycoplasma hominis.
Correct Answer ( B )
Explanation:
The patient has atrial fibrillation with rapid ventricular response. Atrial fibrillation results when
multiple areas of the atrial myocardium simultaneously depolarize and contract. As a result, the
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