RoshCast EM Board Review

“As to diseases, make a habit of two things — to help, or at least, to do no harm.”   ― Hippocrates Welcome back to episode 6! Last week’s episode included a new intro Rapid Review…let us know what you think of it. Should we continue it? Keep sending your thoughts to feedback@roshreview.com. This podcast is fluid, and we are open to making changes that would best suit our listeners’ learning styles. Let’s get started * Prophylaxis for Neisseria meningitidis should be offered to household members, school contacts in the prior 7 days, and those with direct exposure to the patient. The preferred antibiotic regimen is rifampin BID for two days. * The most common cause of a bilateral Bell’s palsy is Lyme disease. * The most common cause of maternal mortality during delivery is maternal hemorrhage, which can be caused by uterine atony, genital trauma, retained products, or, DIC. * The most serious adverse reaction to ketamine is laryngospasm, which is treated with bag-valve-mask ventilation. Tthe most common adverse reaction is an emergence reaction. Now to this week’s podcast Question 1 Which of the following antidotes is paired with the correct poisoning? A. Bupivacaine – Intralipid B. Hydrofluoric acid – Sodium bicarbonate C. Lorazepam – Fomepizole D. Metformin – Octreotide Teaching image Question 2 A 3-year-old girl presents to the ED with altered mental status. She was in her usual state of health until one day prior to presentation when she developed abdominal pain, vomiting, and bloody diarrhea after she was found with a bottle of vitamins from the family’s medicine cabinet. She transiently improved for a few hours then became increasingly lethargic. On arrival, she responds only to painful stimulus. Her blood pressure is 65/40 mm Hg and her heart rate is 160 beats per minute. She appears profoundly dehydrated. Her arterial blood gas demonstrates a metabolic acidosis. What is the most definitive therapy for this patient? A. Activated charcoal B. Deferoxamine C. Sodium bicarbonate D. Whole-bowel irrigation Teaching image Question 3 You are the physician for a patient who is diagnosed with pancreatic adenocarcinoma. The oncologist makes a note of a positive Trousseau’s syndrome in the documentation. Which of the following is she referring to? A. Nontender palpable gallbladder B. Palpable left supraclavicular lymph node C. Popliteal pain with abrupt ankle dorsiflexion D. Tender migratory thrombophlebitis Teaching image Question 4: A 27-year-old woman presents with a painful rash on both of her legs. What is the most common cause of this condition? A. Allergy B. Drug hypersensitivity reaction C. Herpes virus D. Streptococcal infection Question 5 A 15-year-old G1P0 woman at 23 weeks presents with sharp, left lower quadrant abdominal pain for 1 hour. She has had an ultrasound confirming the presence of a single intrauterine pregnancy. The pain is severe and associated with nausea. Pelvic examination reveals tenderness of the left adnexa. The patient’s urinalysis is unremarkable. What test should be ordered to diagnose the patient? A. Abdominal X-ray B.

“The young physician starts life with 20 drugs for each disease, and the old physician ends life with one drug for 20 diseases.”   -Osler  Welcome back to another episode of Roshcast. This week are are adding a new level of spaced repetition by doing a brief review of previous week’s key take away points before diving into the new material.     * The most common causes of small bowel obstructions are (1) adhesions and then (2) cancer. In comparison, large bowel obstructions are caused most frequently by (1) cancer and then (2) volvulus. * Nursemaid’s elbow is treated by either supination followed by elbow flexion or hyperpronation. * Nitrates reduce both preload and afterload by dilating vascular smooth muscle. * Lithium toxicity can cause bradycardia, t wave flattening and QTc prolongation. * The most common finding in aortic dissection is hypertension. Let us know how you feel about this feature by sending feedback to feedback@roshreview.com. And please leave us comments. We want to hear from you.  Let’s get going with the new material from Episode 5. Question 1 Which of the following requires chemoprophylaxis for meningitis exposure? A. Breastfeeding mother of an infant with E. coli meningitis B. Classmates of a 7-year-old with S. pneumoniae meningitis C. Respiratory therapist for a 10-year-old with H. influenzae meningitis D. Roommate of a 19-year-old with N. meningitides Teaching image Question 2 What is the most likely cause of a patient presenting with bilateral facial nerve palsy? A. Borrelia burgdorferi B. Herpes simplex virus C. Leukemia D. Mycoplasma pneumonia Teaching image 1 Teaching image 2 Question 3 Which of the following is the most common cause of maternal mortality during delivery? A. Hemorrhage B. Infection C. Preeclampsia D. Pulmonary embolism Teaching image Question 4 A 4-year old boy presents with a facial laceration. He has been ill with an upper respiratory infection. Procedural sedation with ketamine is planned for his wound repair. Which of the following is a potential serious adverse reaction? A. Elevated intracranial pressure B. Laryngospasm C. Myoclonus D. Seizure Teaching image Question 5 Which of these statistical terms describes the risk of committing a Type I error? A. Alpha B. Beta C. p value D. Power Question 6 A 22-year-old man presents after encountering a Portuguese man-of-war in the ocean. He reports significant stinging to his leg with some paresthesias. Which of the following has been shown to be most effective to neutralize additional nematocysts? A. Cold fresh water B. Hydrogen peroxide C. Salt water D. Vinegar Teaching image Question 7 A 33-year-old woman, with chronic persistent asthma, presents with palpitations. Her vital signs are HR 210,

“Live as if you were to die tomorrow. Learn as if you were to live forever.”  –Mahatma Gandhi Welcome back! Despite using randomly generating questions, a lot of the question in this episode involved mnemonics. We also review many core concepts in emergency medicine. Enjoy. You can find our previous episodes here in case you missed them. Please, please, please send us feedback. Lets get started Question 1 A 55-year-old woman with a history of gallstones presents to the ED with right upper quadrant abdominal pain. Her blood pressure is 98/64 mmHg, heart rate is 110 beats per minute, respiratory rate is 22 breaths per minute, and temperature is 39.8°C. She has scleral icterus and appears jaundiced. She is also mildly confused. She is tender in the RUQ with guarding. What is the most likely diagnosis? A. Acute cholangitis B. Acute cholecystitis C. Acute pancreatitis D. Spontaneous bacterial peritonitis Teaching image Question 2 Which of the following is true regarding cervical spine injuries due to trauma? A. A focused neurological exam with active range of motion of the cervical spine is essential to clearing the cervical spine B. A technically adequate 3-view cervical spine x-ray will pick up all cervical spine fractures C. Odontoid fractures in the elderly are easily identified on plain films D. The NEXUS and Canadian cervical spine decision rules have very high specificity Teaching image 1 Teacing image 2 Teaching image 3 Teaching image 4 Question 3 A 5-year-old girl presents to the ED with a rash that started on her face and spread to her neck, axillae, and groin. Mom states that the patient had an upper respiratory infection one week prior. On examination, the patient’s rash is tender to the touch. Which of the following statements regarding the diagnosis of this patient’s condition is correct? A. Deep layers of the dermis are involved B. It often leaves the patient disfigured from scarring C. Mucous membrane involvement is common D. The disease is caused by an exotoxin-producing bacterium Teaching image  Question 4: A 21-year-old man presents with a headache. What feature should raise the concern for a subarachnoid hemorrhage? A. Age <40 B. Fever C. History of intravenous drug use D. Sudden onset of headache Teaching image  Question 5 A 20-year-old woman with a history of depression and previous overdose presents with altered mental status. The patient is disoriented with mumbling speech. Her vitals are: T 101.2°F, HR 122, BP 130/82; RR 16. Physical examination is notable for dilated pupils, dry mucous membranes and flushed skin. On ECG, her QRS interval is 60 ms. Which ingested medication is most likely? A.

“The secret of getting ahead is getting started.”   -Mark Twain Hope you enjoyed ACEP as much as we did. Now it is time to get back to work. For current residents, the 2017 In-training Exam  is scheduled for February 22nd. Do not forget to subscribe to Roshcast on your favorite podcast player, so new episodes will automatically be downloaded after release. Regular review and spaced repetition are the keys to success.  You can find our previous episodes here in case you missed them.  Remember, we appreciate any feedback you can provide. Please send it to feedback@roshreview.com  Lets get started… Question 1 A 15-year old boy presents to the ED after falling two stories down an elevator shaft. He complains of severe bilateral heel and back pain. On exam, he is alert with normal vital signs. His dorsalis pedis, popliteal, and femoral pulses are strong; no other deformity is recognized. Radiographs of the bilateral heels reveal calcaneal fractures. What additional test should be considered in this patient? A.  Compartment pressures B.  Complete radiographs of the spine C,  CT angiography D.  Retrograde urethrogram Teaching card to supplement answer Teaching card to supplement answer Question 2 An 18-year-old man presents to the ED via the police because of altered mental status and violent behavior. The patient reportedly had been on a drug binge, using amphetamines and cocaine for the last two days. On arrival, he is afebrile, his heart rate is 140 beats per minute, blood pressure is 180/110 mm Hg, and he is respiring at 22 breaths per minute. He is agitated and combative, but there is no evidence of traumatic injury. His pupils are dilated, and he is diaphoretic. Which of the following statements is true regarding the treatment of amphetamine and cocaine toxicity? A.  Antipsychotics are the preferred initial therapy for agitation and psychosis B.  Beta-adrenergic blockers are safe for managing tachycardia and dysrhythmias C.  Body packers with leaking packets should receive whole-bowel irrigation D.  Vasodilators are first-line therapy for treating amphetamine-induced hypertension E.  Wide-complex tachydysrhythmias should be treated initially with sodium bicarbonate Teaching card to supplement answer Teaching card to supplement answer Question 3 A 19-year-old man is brought in from a house fire. He has severe burns over a significant portion of his body. His right thigh has circumferential full-thickness burns and no palpable pulse in the foot. Where should an escharotomy be performed? A.  Anterior midline thigh B.  Circumferentially in the mid thigh C.  Medial and lateral thigh D.  Posterior midline thigh Teaching card to supplement answer Teaching card to supplement answer Question 4 Which of the following test results has the highest sensitivity for excluding pulmonary embolism?

Welcome back to Roshcast Emergency Medicine Board Review Episode 2.  Similar to how ED physicians have no control over the next patient who rolls through the door, we are going to, once again, answer questions as they are randomly generated by the question bank. In case you missed episode one.  Remember, we need your feedback. Please send it to feedback@roshreview.com  Lets get started… Question 1 Nitrate therapy works by which of the following mechanisms? A. Reducing afterload B. Reducing both preload and afterload C. Reducing cardiac contractility D. Reducing preload Teaching card to supplement answer Question 2 What is the most common exam finding reported in patients with acute aortic dissection? A.  Aortic insufficiency B.  Hypertension C.  Hypotension D.  Pulse deficit Teaching card to supplement answer Question 3 A 32-year-old woman, who is at 20 weeks gestational age, presents to the ED after a seizure. Her vital signs are BP 115/70, HR 105, RR 16, T 37.5°C, and pulse oximetry 98% on room air. On exam, you note some confusion, but otherwise there are no focal deficits. Lab results reveal a hemoglobin of 7 g/dL and platelets of 12,000/µL. A peripheral blood smear reveals schistocytes. Which of the following is the most appropriate treatment for her condition? A.  Delivery of fetus B.  Magnesium sulfate C.  Plasmapheresis D.  Platelet transfusion Teaching card to supplement answer Question 4 A 72-year-old man presents for evaluation of palpitations. He has a regular, wide complex tachycardia at a rate of 140. Which of the following supports a diagnosis of ventricular tachycardia? A.  Discordance of the QRS axis in the precordial leads B.  Fusion beats C.  Leftward axis D.  ST elevation greater than 5 mm Teaching card to supplement answer Question 5 A 3-year-old girl presents to the ED with her mom and grandmother for evaluation of vaginal spotting. The child has no other complaints and specifically denies sexual abuse or trauma when questioned alone. After watching a news special on sexual abuse, mom is concerned that her daughter may have been sexually assaulted, despite no specific concern. The child is acting appropriately and there are no external lesions or signs of trauma. Internal pelvic exam is difficult due to the patient’s age. Which of the following statements is true? A.  Obtain a pelvic x-ray prior to attempting a physical exam B.  She is the victim of abuse; do no further evaluation without a trained nurse present and contacting authorities C.  She may have a vaginal foreign body; consider a nasal speculum to attempt visualization and removal D.  Vaginitis is an unusual diagnosis in this age group Question 6  A 27-year-old woman currently breast-feeding presents to the ED with an inflamed and painful right breast. Her vital signs are BP 125/70 mm Hg, HR 105, RR 16, and T 38.3°C. On exam, you note extensive cellulitis of the right breast that begins at the nipple.