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EM Comat TEST |Q&A’s Latest Update| Verified
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EM Comat TEST |Q&A’s Latest Update| Verified
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EM Comat TEST |Q&A’s Latest Update|Verified
What type of injury causes upper extremity hypertension with LE hypotension +/- hoarseness? -
✔✔Blunt Thoracic Aortic Injury
BTAI can occur as a complication of rapid deceleration (fall from height). While complete
rupture results in rapid exsanguination and death, incomplete rupture can have a variety of
clinical manifestations including UE hypertension with LE
Dx- CT angio
TEE
Cannot use TTE (does not fully visualize the thoracic aorta)
Management- surgery
What causes episodic symptoms (hypertension, diaphoresis, tachycardia), tremor in a patient
with family history (thyroid cancer, nephrolithiasis)? - ✔✔Pheochromocytoma
Multiple Endocrine Neoplasia Type 2A (MEN 2A)
Pheochromocytoma is the most common tumor of the adrenal medulla in adults and is
associated with catecholamine production.
MEN 2A and 2B due to RET proto-oncogene mutations, VHL, NF1
Derived from chromaffin cells (neural crest)
,other findings= tremor and polycythemia
Management= alpha antagonists (penoxybenzamine) followed by beta blockers prior to surgery
What is a common cause of stroke in young patients following minor trauma or chiropractic
manipulation of the neck? Patients typically present with acute-onset, unilateral head and neck
pain, ipsilateral partial Horner syndrome (ptosis and miosis without anhidrosis), and signs of
cerebral ischemia - ✔✔Internal Carotid Artery Dissection
ICA is a common cause of stroke in young patients. These often occur spontaneously in patients
with specific risk factors (connective tissue disease, HTN, OCP use)
Partial Horner due to disruption of sympathetic fibers that travel along the ICA
DX: CT or MR Angio
Tx: Thrombolysis for patients that presents <4.5 hours after symptom onset
What are the lung sounds in COPD exacerbation? - ✔✔Distant/ muffled heart sounds
borderline elevated BP
hyperinflation and a narrow cardiac silhouette on CXR
What is the treatment for a hemothorax? - ✔✔Tube Thoracostomy
Hemothorax can occur as a complication of penetrating chest trauma and can present with
decreased breath sounds, dullness to percussion, hypotension, and flat neck veins.
, Initial management involves placement of tube thoracostomy. For patients with severe
bleeding (>1500 mL immediate bloody output) or persistent hemorrhage, emergent
thoracotomy should be performed)
Clinical Features- dullness to percussion, diminished breath sounds, hypotension and flat neck
veins
+/- hypovolemic shock
FAST Scan- intrathoracic free fluid
CXR- blunting of costodiaphragmatic angle; opacification of the affected area
How do you evaluate for CSF rhinorrhea? - ✔✔Testing for CSF- specific proteins (B-2
transferrin), endoscopic nasal examination to locate the defect
Presentation- unilateral watery rhinorrhea, increased rhinorrhea with maneuvers that increase
ICP (coughing, bowel movements)
Management- hospitalization for inpatient management. Bed rest and head of bed elevation;
avoid maneuvers that increase ICP
+/- lumbar drain placement, surgical repair
complication- meningitis
X-ray findings for pulmonary embolism - ✔✔Enlargement of the pulmonary artery (fleischner
sign)
Wedge- shaped lung opacity representing an area of infarction (Hampton Hump)
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