Rosh Review PANCE Practice Exam Study Material Questions and Answers 2024
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Rosh
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five-year-old boy presents to the emergency department with nasal bleeding lasting greater than two hours. In the emergency department, the nurse applied pressure for 20 minutes without successful resolution. The patient appears well and has a normal heart rate and blood pressure. The patient's mot...
Rosh Review PANCE Practice Exam
Study Material Questions and Answers
2024
possiblea
possiblea 8/7/24 .
,five-year-old boy presents to the A 32-year-old woman presents to the
emergency department with nasal clinic with acute vertigo that began 12
bleeding lasting greater than two hours ago and has been constant. She
hours. In the emergency department, complains of nausea, vomiting and
the nurse applied pressure for 20 difficulty ambulating but denies
minutes without successful resolution. tinnitus or change in hearing. Past
The patient appears well and has a medical history is significant for a
normal heart rate and blood pressure. recent viral illness. Physical exam
The patient's mother reports that the reveals horizontal nystagmus and a
child's father has a bleeding disorder negative Dix-Hallpike maneuver.
for which he occasionally uses a nasal Which of the following is the most
spray. The patient has never had likely diagnosis?
testing, and this is his first physician
encounter for bleeding. Which lab
abnormality would you expect to find A Benign paroxysmal positional
for the child's inherited condition? - vertigo
*increased bleeding time* B Ménière's diseaseYour Answer
C Vestibular migraine
Pt has Von Willebrand disease D Vestibular neuronitis - D
(VWD). It is the most common
hereditary bleeding disorder.
A 58-year-old woman with a history
of previous cerebrovascular accident
vWF = causes the platelets to stick presents to the emergency department
together, contributes to fibrin clot by ambulance due to concern for
formation (carries factor viii) possible overdose. According to her
husband, at home she was vomiting
and complaining of nausea and
will have normal platelets, normal
ringing in her ears. The patient is
PT/INR, aPTT (unless very deficient
confused and unable to answer
in factor 8 than can be prolonged)
questions upon arrival. Her blood
pressure is 90/57 mm Hg, heart rate is
112 beats/minute, respiratory rate is
tx with desmopressin
28 breaths/minute, and temperature is
103.1°F. Which of the following
, interventions should be avoided if overdose. Salicylate removal can be
possible? improved with the use of
hemodialysis (D). Indications for
hemodialysis include altered mental
A Administration of intravenous status, renal insufficiency, cerebral or
fluids pulmonary edema, serum salicylate
B Arterial blood gas analysis concentration > 100 mg/dL (in acute
overdose) and > 50 mg/dL (in chronic
C Endotracheal intubation overdose), and clinical deterioration
D Hemodialysis - C despite aggressive resuscitation.
Providers need to be aware that
airway management can worsen the Rifampin known s/e - Rifampin is an
condition of patients with aspirin integral drug in standard combination
overdose. The brief moment of apnea treatment of active M. tuberculosis
that occurs in preparation for disease and can be used as an
intubation can cause acute and alternative to isoniazid (INH) in the
significant worsening of the patient's treatment of latent tuberculosis
respiratory alkalosis. Intubation of infection in children who cannot
patients exhibiting tachypnea in tolerate INH. All rifamycins including
aspirin overdose has resulted in death rifampin can turn urine and other
and should be reserved for patients secretions (e.g., tears, saliva, stool,
with hypoventilation and severe sputum) orange. The rifamycins
respiratory distress. inhibit the DNA-dependent RNA
polymerase of mycobacteria, resulting
in decreased RNA synthesis.
aspirin overdose includes aggressive
volume resuscitation with intravenous
fluids (A), especially in those who are clinical presentation for anterior vs
hypotensive due to fluid loss and posterior hip dislocations - posterior =
inappropriate systemic vasodilation. leg will be shortened, adducted,
Frequent laboratory testing is done to INTERNALLY ROTATED
assess clinical status and response to
treatment. Arterial blood gas analysis
(B) is critical and should be drawn anterior = markedly abducted,
every 1-2 hours to monitor acid-base EXTERNALLY rotated
status in patients with a salicylate
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