The Long

1. The Long Sirous Partovi, MD

2. And the Short of It Randy Goldstein, MD

3. A patient with acute adrenal insufficiency is best treated with hydrocortisone and • A. NS • B. D5 NS • C. NS + Ca • D. NS + K • E. Makes no difference

4. A 45 year old WF with history of breast CA presents with constipation and abdominal pain. ED evaluation and treatment include: • A. Positive Chvostek’s sign • B. Increase fluid and dietary fiber • C. IVF and lasix • D. Referral to oncologist • E. Obtain Barium enema

5. Treatment of acute asthma attack in patients in 2nd trimester pregnancy includes all except: • A. Prednisone • B. Beta agonists • C. SQ epinephrine • D. IV fluids

6. A mom that delivered her baby yesterday develops chicken pox. Who must receive VZIG? • A. Mom • B. Mom and infant • C. Mom, infant and 2 year old sibling • D. Infant and 2 year old sibling • E. Infant alone

7. Post Exposure Treatment- VZIG • Pts on high dose steroids • Immunocompromised without a history of CP • Pregnant women • Newborns exposed 5 days prior to birth and 2 days after delivery • Neonates born to nonimmune mothers • Hospitalized premature infants < 28 weeks’ gestation

8. A pt on chronic dialysis has been taking magnesium containing antacids. He presents with hypotension and areflexia. ED treatment includes: • A. Bicarb • B. Pacing • C. IV Calcium • D. Terbutaline • E. IV fluids

9. An elderly patient c/o bilateral buttock and posterior upper thigh pain on ambulation. Diagnostic modality: • A. LS spine x-rays • B. CT of L- spine • C. MRI of back • D. MRA of back • E. Angiography of BLE Leriche’s Syndrome

10. A 55 yo male presents with facial swelling over one week in conjunction with SOB, JVD and dilated thoracic veins. Most likely diagnosis is: • A. Ascites with anasarca • B. Mediastinitis • C. Pulmonary embolism • D. Bronchogenic CA • E. Pneumonia

11. Most common cause of sudden death in athletes • Hypertrophic Cardiomyopathy

12. Earliest complaint of a patient with tetanus • Locked jaw

13. A patient 2 wks post anterior MI presents with stroke. ED workup should include: • A. Carotid doppler • B. Brain MRA • C. Echocardiogram • D. Cardiac enzymes • E. Four vessel angiogram

14. Kids with cyanotic heart disease presenting with syncope should be placed in: • A. Trendelenberg position • B. Reverse Trendelenberg position • C. Knee-chest position • D. Upside down position • E. Left decubitus position

15. 22-year-old man presents with a one day history of increasing bilateral leg weakness and paresthesias. He has not been ill otherwise and his vital signs are normal. Physical exam is normal except for symmetric lower extremity weakness and decreased deep tendon reflexes. Sensation is normal. What is the most likely diagnosis? • Guillain-Barré syndrome • poliomyelitis • tick paralysis • transverse myelitis • viral hepatitis

16. Guillain-Barré syndrome • Autoimmune etiology • Distal weakness is more common • The ascending paralysis is characteristically symmetric or nearly symmetric • The facial and other cranial nerves are involved in 25%-50% of the patients. • Motor deficits predominate • DTRs arealmost always absent in the affected extremities • Recent bacterial infection, preceding Campylobacter jejuni infection, and influenza vaccination have all been associated

17. Guillain-Barré syndrome • Diagnosis is based on the patient’s clinical presentation • Analysis of CSF: Albuminocytologic dissociation, in which the CSF has a protein content of greater than 400 mg/L and a cell count of less than 10/ml • Heavy metal poisoning, volatile hydrocarbon abuse, acute intermittent porphyria are all on the diff dx

18. 35 year old female with hx of multifocal neuro deficit. The best way to make the diagnosis is: • A comprehensive psychiatric evaluation • CT of the head • Lumbar puncture • MRI of the head • EMG and NCS

19. A 2 year old male presents after being struck by a car

20. Assuming the patient is stable, the next step would be to • A) obtain a CT of the abdomen and pelvis • B) insert a foley catheter • C) perform a retrograde urethrogram • D) perform a diagnostic peritoneal lavage • E) obtain an intravenous pyelogram

21. 59 yom with acute chest pain and weakness to left arm. ECG shows ST elevation in anterior leads. Treatment should include all of the above, except: • Nitrates • Beta blockers • Thrombolytics • ASA • Ca channel blockers

22. Where is the most common site of bursitis in the body? Olecranon

23. The most frequent cause of fetal death following blunt abdominal trauma during pregnancy is Placental abruption

24. The antihypertensive most likely responsible for this finding is a(n) • ACE inhibitor • Beta blocker • Calcium channel blocker • Diuretic • Nitrate

25. Abrupt shaking chills, rusty sputum, lobar consolidation Strep pneumo ETOH abuse, current jelly sputum, lobar infiltrate with bulging fissure • Klebsiella HA, malaise, nonproductive cough,interstitial infiltrates • Mycoplasma Old smoker, high fever, dry cough, toxic appearance, patchy infiltrate, pleural effusion • Legionella

26. 53 year old man involved in an MVA and suffered a neck injury. The most likely injury is: • Dissection of carotid artery • jugular vein • Injury to C7-T2 • Epidural hematoma • C1-C2 fracture

27. Horner’s Syndrome • Unilateral facial ptosis, miosis, and anhydrosis • Damage to the cervical sympathetic plexus • Cluster headaches may show Horner’s • Horner’s syndrome may also result from • Aortic dissection • Advanced malignancy • Occlusion of the PICA (Wallenberg syndrome) • Posterior pharynx abscesses

28. What is the most common cause of painful hip in children? Transient synovitis

29. This 16 year old female who presented with heart palpitations

30. Most likely suffers from • A) hyperkalemia • B) hyperthyroidism • C) supraventricular tachycardia • D) cocaine abuse • E) idiopathic palpitations

31. Delta waves – WPW syndrome

33. True statements about this condition includes: • Often atraumatic or associated with a relatively minor injury • Most commonly occurs in boys 10 to 17 years of age with obesity and underdeveloped genitalia • Salter and Harris type I variety • Internal fixation is the treatment • All of the above

34. Slipped Femoral Capital Epiphysis • Often atraumatic, boys 10-17 years (obese) • Left more common than right • Insidious onset • Stiffness in the hip • An abduction and external rotational deformity is characteristic • CT scan, an MRI scan, or a bone scan should be considered if a fracture is clinically suggested but remains radiographically occult after plain radiographs. • Treatment is Internal fixation

35. What is Beck’s triad? Muffled heart tones Hypotension Increased JVD

36. 6 year old presents with fever, sore throat and a rash

37. The following are true of this disease • A) Penicillin is the treatment of choice • B) It’s natural history is to resolve spontaneously without sequelae • C) The most common etiology is Strep pneumoniae • D) It is contagious only before the rash erupts • E) It is most common in children less than 3 years of age

38. This 2 year old child presents with drooling. He is otherwise in no distress. The next step should be: • Rapid intubation • Ipecac administration • Barium swallow study • Call the friendly GI doc • Meat tenderizer

39. Esophageal Foreign Bodies Esophagus has three normal anatomic sites of narrowing where impactions are most common: • The cricopharyngeus muscle • The crossing point of the aorta • Lower esophageal sphincter

40. What are the most common causes of acute mitral regurgitation? Acute MI Bacterial endocarditis Trauma

41. This child’s lesion is a • Left CN VI palsy • Right CN VI palsy • Left CN III palsy • Right CN III palsy • A great party trick

42. What are the most common signs of pulmonary embolism? Dyspnea Tachypnea What are the most common ECG findings in a patient with pulmonary embolism? • Sinus tachycardia • Non specific ST-T changes

43. 38 year old patient with HIV presents with fever, shortness of breath and dry cough for 1 week. ABG shows PO2 of 59. The treatment should include all except: • Oxygen therapy • Intubation if in distress • Bactrim IV • Triple med regimen for TB • Steroids

44. PCP • PCP is the most common opportunistic infection in AIDS • Uncommon in patients with CD4 >200/mm3 • Nonproductive cough, fever, shortness of breath, diffuse interstitial infiltrates on chest radiograph, and arterial hypoxemia • Bilateral interstitial infiltrates that begin in the perihilar region- can vary considerably, ranging from a normal appearance to dense consolidation • Prednisone is indicated for moderate-to-severe PCP who have a PaO2 less than 70 mm Hg or an A-a gradient greater than 35 mm Hg.

45. 8-week-old boy presents with cough and low-grade fever and conjunctivitis Chlamydia

46. The following etiologies are associated with the condition shown on this radiograph, except: • Collagen vascular diseases • Previous hip dislocation • Prolonged corticosteroid use • Sickle cell anemia • Thallasemia minor

47. This 6 year old presents after being treated at his PCP clinic for 3 days of vomiting

48. A reasonable next step would be to • A) Obtain a CT of the head • B) Perform a lumbar puncture • C) Obtain a cervical spine series • D) Administer diphenhydramine • E) Sneak up on the child’s left side and yell “BOO” to see if he’s faking this and will turn his head

49. Testicular torsion has two peaks: Infancy Adolescence

50. This patient cannot recall how he was injured. True statement concerning this injury include all except: • Associated with high incidence of infectious complications • The most common aerobic organisms include Strep/Staph • Eikenella corrodens is found in about one third of anaerobic cultures • ED management includes copious wash out and closure • Complications could include amputation of the fingers-hand