GroundED in EM Pre-Test
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A 48-year-old male with history of congestive heart failure presents to the emergency department with severe chest pain that began 2 hours ago after snorting cocaine. His vital signs are significant for a blood pressure of 210/100 and a heart rate of 160. On physical exam, the patient appears diaphoretic with dilated pupils. The initial ECG shows a regular narrow complex tachycardia with unclear P waves but no ST-T segment changes. The labs are within normal limits, including a troponin. You administer IV diazepam with little effect on the heart rate or blood pressure. What is the next most appropriate agent for the management of this patient's hemodynamic abnormalities? *
1 point
A 2-month-old child comes into the emergency department with ongoing fussiness and crying for the past 3 hours. Mom reports that he has been otherwise healthy and denies fever, cough, congestion, rhinorrhea, vomiting, or rash. She reports that he has not been eating as well over the last 2 days. You attach the patient to a cardiac monitor and see the heart rate at 280 bpm with a BP of 82/44. The ECG shows a regular, narrow complex tachycardia. What is your next step in treatment? *
1 point
A 45-year-old woman presents with dyspnea for the past several days. Her vital signs are: BP 120/80, HR 115, RR 22 with oxygen saturation of 98% on room air, and T 98.8 F. She was recently diagnosed with breast cancer and had a recent mastectomy 3 weeks ago. Which of the following is true regarding evaluation for pulmonary embolism (PE) in this patient? *
1 point
What is the primary physiologic goal of cardiopulmonary resuscitation (CPR) and epinephrine in cardiac arrest? *
1 point
Paramedics arrive at the site of a factory explosion. On site they come across a patient who has a piece of machinery fragment stuck in his right thigh. The bleeding is controlled, and the patient’s right lower extremity has normal pulses, strength, and sensation. His injury is an example of what type of blast injury? *
1 point
What is the most common finding in patients with an aortic dissection? *
1 point
A 13-year-old male presents to the emergency department with acute testicular pain for the last two hours. The patient awoke from sleep with sudden intense pain localized to the left testicle. He reports associated lower abdominal pain, acute testicular swelling, nausea, and vomiting. On genitourinary exam, the patient has a diffusely tender, edematous, high-riding left testicle. Pain is relieved by elevation of the left testicle. After providing appropriate analgesia, what is the next best step in this patient’s management? *
1 point
What is the best initial therapy to reduce blood pressure and shearing forces in a patient with acute aortic dissection? *
1 point
All of the following sonographic findings support a diagnosis of acute cholecystitis EXCEPT: *
1 point
A 76-year-old man with a history of hypertension, atrial fibrillation on warfarin, and smoking presents to the emergency department with diffuse abdominal pain. His vital signs are as follows: blood pressure 76/42, heart rate 82, respiratory rate 20, oxygen saturation 99% on room air. He appears uncomfortable on exam with a mildly distended abdomen that is diffusely tender. Which of the following diagnostic tests is the most appropriate? *
1 point
A 57-year-old male presents to the emergency department feeling lightheaded with associated palpitations and nausea. His vital signs are as follows: Temperature 98.9F, blood pressure 67/29, and heart rate 145 beats/minute. The monitor displays a regular wide complex tachycardic rhythm. What is the next most appropriate treatment? *
1 point
A 40-year-old male with no past medical history presents with two days of coffee-ground emesis. The patient denies alcohol abuse. Which of the following is most likely to be the cause of his symptoms? *
1 point
A 72 year-old woman is brought in by ambulance for confusion, a left-sided facial droop, and left arm weakness that began 45 minutes prior arrival at the emergency department. She has a history of hypertension and diabetes mellitus. She is afebrile with a heart rate of 73 bpm, blood pressure of 154/96, respiratory rate of 12, and oxygen saturation of 98% on room air. What is the next best step in her care? *
1 point
A 77-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents in cardiac arrest. Emergency medical services was dispatched for respiratory distress. His presenting rhythm is pulseless electrical activity (PEA). In addition to establishing an airway, continuous cardiopulmonary resuscitation (CPR), and intravenous epinephrine, which of the following should be performed next? *
1 point
Which of the following is not an absolute contraindication to the administration of tissue plasminogen activator (tPA) in acute ischemic stroke? *
1 point
Which of the following is true regarding the diagnosis of ectopic pregnancy? *
1 point
A 31-year-old healthy female presents with sudden-onset nausea, vomiting, and dizziness, which she describes as the sensation that the room is spinning. The dizziness is severe, lasts for a couple minutes, and then resolves. She denies any tinnitus, chest pain, palpitations, visual changes, or syncope. She is sitting still because she notes that any movement of her head makes her symptoms worse. On exam, her gait is normal, but she keeps her head still while walking. What will the physical exam be most likely to show? *
1 point
Which of the following patients is at greatest risk for exertional heat stroke? *
1 point
A 34-year-old male with no past medical history is brought in by his spouse after sustaining an electrical shock at home one hour ago. The patient reports that he was plugging a toaster into a wall socket when he immediately saw a spark. This was followed by an electric sensation running through his right arm and inability to let go of the cord for a few seconds. The incident was witnessed by his spouse, who states that he never lost consciousness. On arrival to the ED, the patient denies any symptoms. His physical exam is unremarkable. The initial ECG is normal. What is the appropriate disposition for this patient? *
1 point
A 19-year-old male presents with altered mental status. His vitals are as follows: Temperature 106.70F, heart rate 168, blood pressure 112/78, respiratory rate 18, oxygen saturation 99%. His ECG shows atrial fibrillation with rapid ventricular response. What treatment should be initiated immediately? *
1 point
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