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EMERGENCY MEDICINE EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS
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EMERGENCY MEDICINE EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS
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EMERGENCY MEDICINE EXAM 2024/2025 WITH 100%ACCURATE SOLUTIONS
A 68-year-old female presents to the emergency department with signs
and symptoms of an acute ischemic stroke. The initial CT scan is
normal. Her blood pressure is 164/105. What is the most appropriate
treatment for the blood pressure of this patient?
A Atenolol PO
B Clonidine PO
C Close monitoring
D Labetolol IV
E Nicardipine IV - Precise Answer ✔✔*The Correct Answer is: C
Aggressively lowering blood pressure may decrease blood flow to the
ischemic tissue, thus decreasing the chances of recovery or increasing
the risk of further infarction. In the setting of an acute ischemic stroke,
blood pressure elevation should be monitored closely, with some
elevation expected.* This elevation is expected to decline without
medication in the first few hours to days, but if elevation continues to a
systolic blood pressure greater than 220mmHg, or mean arterial pressure
greater than 120mmHg, medication is advised. Medications may include
intravenous labetolol or nicardipine, with close monitoring of the
patient. After the acute phase following a stroke, appropriate oral
medications may be considered for outpatient hypertension
management.
You are evaluating a 67-year-old male with known cirrhosis of the liver
secondary to alcoholic liver disease, although he has been sober for the
,past year. He is brought in to the emergency department by his daughter,
who notes that for the past few days he has seemed to be more confused.
On examination you note the patient to be mildly confused but alert to
person and place. He has noticeable asterixis. He is not currently taking
any medications and his blood alcohol level is undetectable. What is the
treatment of choice in this case based on your physical examination
findings?
A amoxicillin
B prednisone
C lactulose
D folic acid
E thiamine - Precise Answer ✔✔*The correct answer is (C). *
This patient most likely has hepatic encephalopathy due to end-stage
liver disease. *Asterixis indicates an increase in serum ammonia. The
treatment of choice is lactulose. Both folic acid and thiamine are used in
the treatment of alcoholic liver disease, but do not treat elevated
ammonia levels.* Antibiotics may be used secondarily in patients
nonresponsive to lactulose, but amoxicillin is not preferred. Prednisone
is not a treatment for hepatic encephalopathy.
A 76-year-old man, is brought to the emergency department by his niece
after she found him wandering around his yard in the cold wearing only
a tee shirt and jeans. When she set up his pill container about 36 hours
earlier, he seemed his usual self but, in retrospect, possibly a little more
confused than usual. The niece says that he has "high blood," treated
with a "white fluid pill," "sugar diabetes," treated with an oral
medication, and early "old timer's" dementia treated with "a memory
pill." Vital signs include an oral temperature of 100.8F, pulse 100 beats
per minute, respirations 24 and somewhat shallow, and blood pressure of
,88/52. Initial examination reveals a slightly dehydrated, stuporous man
appearing older than his stated age, who smells strongly of urine. He has
no lateralizing signs. What is the most likely cause of the mental status
changes?
A hyperglycemic hyperosmolar state
B lactic acidosis
C st - Precise Answer ✔✔*The Correct Answer is: A
The combination of confusion and dehydration in a patient with diabetes
type 2 who is taking a diuretic strongly suggest hyperosmolar state.*
Patients with lactic acidosis (B) have marked hyperventilation and,
usually, signs and symptoms of a serious illness. The lack of lateralizing
signs makes a stroke (C) less likely. Urinary tract infection (D) could
certainly cause confusion and incontinence in an elderly man and should
be investigated. Alzheimer dementia (E) progresses slowly; sudden
decompensation is usually due to delirium.
A 66-year-old man with a history of HTN and diabetes mellitus, type 2,
presents to the emergency department with complaints of palpitations for
over 2 weeks, tachypnea, and chest pain. He denies history of CAD,
stroke, TIA, or congestive heart failure. He is afebrile, with vital signs as
follows: BP 145/98, HR 138, and RR 22. His EKG is shown (Figure 1).
Troponins are negative X 3. Which of the following choices is the most
appropriate next diagnostic study for this patient?
A Transthoracic echocardiogram
B Cardiac catheterization
C Nuclear stress test
D Holter monitor
, E Event recorder - Precise Answer ✔✔*The Correct Answer is: A
Choice A, transthoracic echocardiogram, is correct, as it can
demonstrate the presence of valvular heart disease. The presence of
valvular heart disease can change the recommendations for embolism
prophylaxis.* Choice B, cardiac catheterization, is useful in patients
suspected to have unstable angina, or who have sustained a myocardial
infarction. Choice C, nuclear stress test, is useful in patients suspected to
have angina pectoris, and may be a useful diagnostic study in this patient
with cardiac risk factors (once the issue of atrial fibrillation has been
treated). Choices D and E would be useful tests if the EKG had not
established a diagnosis for this patient, with the Holter monitor indicated
in patients experiencing symptoms on a daily basis, and the event
recorder indicated in patients demonstrating more sporadic symptoms.
What absolute tissue pressure generally is used as a guideline for
diagnosing compartment syndrome?
A 10 mm Hg
B 20 mm Hg
C 30 mm Hg
D 40 mm Hg
E 50 mm Hg - Precise Answer ✔✔*The Correct Answer is: C
Many trauma surgery services use an absolute tissue pressure of
approximately 30 mm Hg as the threshold for diagnosing compartment
syndrome.* Based on the entire clinical picture, patients with numbers in
that range or higher will likely require surgical decompression with a
fasciotomy, while lower numbers will probably be managed with a more
conservative approach.
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