Complete Answers BUNDLE | Latest | Emergency Medicine - TEST BANK, COMAT, Genitourinary, Trauma, EOR, Neurology Guide, Practice, Pretest exam, Procedures | Exam 1 - 9 | 100% Correct Answers Guaranteed in TB with All-New Q&A - A !

(Answered 2023) Emergency Medicine COMAT Exam
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TIMI score
Answer: a prognostic tool for patients with unstabe angina or NSTEMI
Categorizes patient’s risk of death and ischemic events & helps clinicians with
therapeutic decision-making.
A point of one for each of the following:
1) apsirin use in the last seven days
2) ST changes of at least 0.5 mm on EKG
3) Elevated serum cardiac biomarkers
4) Age greater than 65
5) known CAD (coronary stenosis greater than or equal to equal to 50%)
6) At least two angina episodes within the last 24 hours
7) At least three risk factors for CAD such as: HTN, DM, current cigarette
smoker, family hx of premature CAD (CAD in male first-degree relative or father less than55, or female first-degree relative or mother less than 65)
most common complication associated with giving pediatric patientssuccinylcholine
Answer: Rhabdomyolysis with associated hyperkalemia
Tx – copious IV Fluid hydration
Contraindications to succinylcholine
Answer: burns, crush injuries, renal failure, im-mobilization for >48 hours,
narrow angle glaucoma & malignant hyperthermia.
What cases is hyperkalemia a huge concern?
Answer: Severe burns, crush injuries,& renal failure.
Glasgow Coma Scale:
What to do with a patient with a GCS of 8?
Answer: Intubation
Thoracic injuries secondary to blunt chest
Answer: The plain CXR remains thestandard initial diagnostic remains the
standard initial diagnostic study for theevaluation of chest trauma in a
hemodynamically stable patient.
CXR in blunt trauma patients are usually taken in the supine position initially
until unstable spinal fractures have been ruled out.Then, it is important to get a
PA viewto appropriately evaluate for small hemothorax, pneumothorax o
diaphragm injury.
What is first line in supraventricular tachycardia?
Answer: Vagal maneuvers
Compartment syndrome

Answer: Associated with five P’s – pain, paraesthesia, pallor,pulselessness, &
poikilothermia
Critical level = Btwn 10 mmHg & 35
mmHgPoor outcomes = >30 mmHg
Fasciotomy is the definitive treatment

Normal compartment pressure
Answer: <10 mmHg
Interstitial cystitis
Answer: also known as bladder pain syndrome
Is a chronic condition diagnosed in patients with symptoms of dysuria,
frequency,urgency with no other causes of such symptoms.
Tx’ment of DKA (steps)
Answer:
1) Volume expansion with IVF (0.45% NACl or 0.9%NaCl at 250-500
ml/hour)
–Bolus anywhere from 2-4 liters of fluid prior to starting IV insulin
2) Check potassium levels is checked and replace as needed
3) An insulin drip will need to be started at 0.1 unit/kg/hour
–after serum glucose
4) Check serum pH level to determine if bicarbonate is needed in the fluids
5) When serum glucose is at a reasonable level 200 mg/dL), the fluids should
bechanged to D5 0.45% NaCl & the insulin drip is weaned.
Influenza Treatment

(Answered 2023) Emergency Medicine Genitourinary ExamAll New Qs & As for A++ Exam – Pass Guaranteed!

A 19-year-old man presents to the ED with pain along his penile shaft forthe
past 7 days. He reports a low-grade fever and myalgias and was sexuallyactive
with a new partner 10 days ago. He denies any penile discharge or dysuria.
There is no inguinal adenopathy palpated on exam, but he hastenderpenile
lesions, revealed in the image seen above. Which of the following is most
likely to be an effective treatment?
Acyclovir PO
Ceftriaxone IM
Doxycycline PO
Penicillin G IM
Answer: ( A )
Explanation:
Thisis a patient with a primary herpesinfection, characterized by a low-grade
fever;myalgias; and multiple painful, shallow, tender, genital lesions. These
typically follow a 2-7-day incubation period. Patients often do not have
adenopathy until the 2nd or 3rd week of illness. Lesions last for 2-4 weeks.
Treatment is acyclovir toreduce the duration of symptoms and viral shedding.
Ceftriaxone (B) is one of several treatment regimens for chancroid. Although
chancroid also presents with painful genital ulcers, 50% of patients also
develop a large unilateral, fluctuant lymph node (bubo) 1 week after the ulcers
appear. It is often difficult to differentiate herpes from chancroid on exam.
However, herpesis orders of magnitude more common in the United States;
most cases of chan- croid occur in developing countries. There are usually
fewer than 100 cases of chancroid reported to the CDC annually. Therefore, in
patients such as this one, herpes should be of primary consideration, and
acyclovir is more likely to be an effective treatment. Doxycycline (C) is used to treat lymphogranuloma venereum.However, lesions are painless and often go

unnoticed. Patients often present in thesecondary stage following the
disappearance of genital lesions, when they developpainful lymphadenitis.
Penicillin (D) would be the appropriate treatment for syphilis.However, the
incubation period is typically longer and primary lesions (chancres)are painless with raised edges.

One Step Further
Question:What is the utility of a Tzanck test?
Answer: Tzanck tests are nolonger recommended due to poor sensitivity.
A 48-year-old man presents with fever and an acutely painful scrotum. Hehas significant pain during testicular palpation. A cremasteric reflex is pre-sent and
Doppler ultrasonography shows an enlarged, thickened epididymis with
increased blood flow to the left testicle. There is no discharge from the urinary
meatus. Which of the following is the most appropriate antibiotic for this condition?
Ceftriaxone plus doxycycline
Doxycycline alone
Levofloxacin
Penicillin
Answer: ( C )
Explanation:
Epididymitis occurs most commonly in men between the ages of 14 and 35
years.However, it can occur in any age group. It occurs from an ascending
infection from the urethra, prostate, or bladder, and occasionally by
hematogenous spread.Epididymitis is characterized by gradually increasing
dull, unilateral scrotal pain, fever, and dysuria. Examination usually reveals
localized epididymal edema and tenderness (posterior aspect of scrotum),
possible testicular tenderness, and a normal cremasteric reflex. Pain may be
relieved with testicular elevation (positive Prehn sign). Scrotal pain should be

initially evaluated with a color Doppler ultra- sound test, and in the case of
epididymitis, the typical findings are an enlarged, thickened epididymis with
increased blood flow. The most common organisms re-sponsible for
epididymitisin those 14 to 35 years-of-age are Neisseria gonorrhoeaeand
Chlamydia trachomatis. In older individuals (traditionally >35 years of age)
and nonsexually active individuals, the Gram-negative rod bacteria
(Escherichia, Klebsiella, Enterobacter and Citrobacter species) are most
common. Trimetho- prim-sulfamethoxazole or a fluoroquinolone such as
levofloxacin or ciprofloxacin is the recommended treatment in this age group.
Ceftriaxone plus doxycycline (A) is the treatment of choice for suspected
orchitis or epididymitisin men between the ages of 14 and 35 years.
Doxycycline alone (B)is not recommend as the sole antibiotic for orchitis in
any age group. Penicillin (D)is more appropriate for streptococcal or
staphylococcal infections, both of which are not common etiologies of orchitis
or epididymitis.

One Step Further
Question: Doesthe presence of Prehn’s sign rule out testicular torsion?
Answer: No.
Which of the following is one of the most helpful signsto rule out testicular
torsion?
Presence of a bell-clapper deformity
Presence of Prehn’s sign (relief of scrotal pain upon elevation of scrotum)
Presence of the cremasteric reflex
Vertical lie of testicle
Answer: ( C )
Explanation:
The cremasteric reflex is a superficial reflex elicited by lightly stroking the
superior and medial (inner) thigh in a male. The normal response is an
immediate contrac- tion of the cremaster muscle that pulls up the testis (>0.5

cm) on the side stroked. The presence of a cremasteric reflex appears to be one of the most helpful signsin ruling out testicular torsion. The cremasteric reflex may be absent in conditions such as testicular torsion, upper and lower motor
neuron disorders, spinal injury of L1-L2, and iatrogenic transection of the
ilioinguinal nerve during surgery for hernia repair. Despite being one of the most helpful signs, it is important to note that
the presence of a cremasteric reflex cannot rule out testicular torsion with
100%certainty.
The bell-clapper deformity (A) is an entity in which the tunica vaginalis
completelyencircles the epididymis, distal spermatic cord, and the testis rather
than attachingto the posterolateral aspect of the testis. This causes the testicle to hang free within the tunica vaginalis, in a horizontal fashion. This anatomic
abnormality predisposes to spermatic cord torsion. Relief of pain with
elevation of a painful testicle represents a positive Prehn’s sign (B) and points
toward a diagnosis of epididymitis rather than testicular torsion. It is thought
that by elevating the painfultesticle, the pain of epididymitis improves because
the elevation takes the weightof the testis off the epididymal suspension but
does not affect the testicle in casesof testicular torsion. However, Prehn’s sign
is unreliable and should not be used to rule out testicular torsion. Although a
vertical lie (D) of the testicle is normal, it does not rule out testicular torsion

One Step Further
Question: What age is testicular torsion most likely to occur?
Answer: Bi-modal distribution with peak incidence in the neonate within
first few days of lifeand in preadolescence
Which of the following is associated with an increased likelihood of testicular torsion?
Age greater than 50 years
Epididymitis

(Answered 2023) Emergency Medicine Trauma Exam
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A 16-year-old girl presents with right thumb pain after a fall while skiing.
Physical examination reveals pain and swelling of the right thumb. X-ray ofthe
thumb is negative. Valgus stress at the metacarpophalangeal joint results in
increased pain and deviation of 40 degrees.What treatment is indicated?
CT scan of the thumb
Sugar tong splint and urgent referral for surgical management
Thumb spica and urgent referral for surgical management
Thumb spica for 4 weeks and primary care follow up
Answer: ( C )
Explanation:
The patient presents with rupture of the ulnar collateral ligament (UCL) and
requires immobilization and urgent surgical management. Injury to the UCL
was initially described in Scottish gamekeepers (hence Gamekeeper’s thumb).
The injury was developed through the repetitive motion of twisting the necks of
rabbits.
Today, the injury is most commonly seen in skiers who receive the injury
during a fall while holding a ski pole.The mechanism of injury is forced
abduction of thethumb resulting in a tear of the UCL near its insertion at the
proximal phalanx.
Physical examination reveals swelling and tenderness along the ulnar surface
of the thumb and difficulty with making a pinching motion. Valgus stress of the UCL can differentiate a partial tear from a complete rupture of the ligament.
Stress should be applied to the metacarpophalangeal (MCP) joint in full
extension and at30 degrees of flexion.If there is more than 35 degrees of joint
laxity or 15 degrees oflaxity beyond the unaffected thumb, a complete UCL
rupture should be suspected.Both partial tears and complete ruptures should be
placed in a thumb spica splint.Partial tearstypically will recover completely with
immobilization whereas completeruptures invariably need surgical repair.

A CT scan of the thumb (A) is not necessary for the diagnosis of a UCL
rupture. Sugar tong splinting (B) does not immobilize the first MCP or first IP
joints. A thumbspica and follow up with primary care (D) is appropriate for a
partial tear but not for a complete rupture.

One Step Further
Question:What is Stener’s lesion?
Answer: Soft tissue interposition from theadductor aponeurosis associated with
a ulnar collateral ligament rupture.
A 13-year-old boy with no past medical history presents to urgent care with
a headache three days after a closed head injury.The patient states thathe stood
up from kneeling and hit the top of his head on a wood cabinet. There was no
loss of consciousness or seizure activity. In addition to the headache, he
complains of difficulty concentrating at school and dizziness.His physical
examination is unremarkable.What management is indicated?
CT scan of the head with contrast CT
scan of the head without contrastMRI
of the brain
Referral to primary care physician
Answer: ( D )
Explanation:
The patient presents with minor head trauma and complaints consistent with a
concussion and should have follow-up arranged with their primary care
provideror concussion specialist. A concussion is a minor traumatic brain
injury (TBI) that is often seen in MVCs and collision sports (football,
hockey). It is typically caused by a rotational injury or an accelerationdeceleration injury. Patients will
present with a number of non-specific symptoms including headaches,
dizziness,confusion, amnesia, difficulty concentrating, and blurry vision but do

not have focalneurologic findings. Despite the absence of severe intracranial
injury, patients canhave chronic and debilitating symptoms from concussions.
Neurology referral is recommended, as patients should have functional testing
and tracking of their symptoms for resolution. It is vital to council patients to
avoid contact sports or activities that increase the risk of recurrent injury as
these patients are at risk for more severe injury with a second impact.
In the absence of focal neurologic findings, absence of antiplatelet or
anticoagulantuse, and minor trauma, imaging is not needed (A, B, C).

One Step Further
Question: What imaging modality can show abnormalities in patients with
concussion in the acute setting?
Answer: Positron emission tomography (PET)scan.
A 55-year-old construction worker presents to the ED after a fall from 20
feet while at work. Per EMS, the patient was confused when they found him
with a large hematoma over the right temporal area, swelling of the right
maxilla, and deformities to the right shoulder and knee. Appropriate spinal
precautions were initiated prehospital. On arrival at the ED, his GCS score is
eight with a blood pressure of 162/96, heart rate of 72, and oxygen saturationof
100% on a non-rebreather mask. Which of the following statements is correct
regarding the management of this patient’s airway?
Attempt rapid sequence intubation with etomidate and succinylcholine Cervical
spine radiographs should be obtained prior to establishing a defin-itive airway
since the patient’s oxygen saturation is 100%
Continue oxygenation via non-rebreather face mask and immediately obtaina
CT scan of the brain followed by neurosurgical consultation
Lidocaine administration is contraindicated due to a paradoxical elevation in
intracranial pressure
Nasotracheal intubation is an appropriate alternative to orotracheal airwayAnswer: ( A )

Explanation:
Trauma patients with a GCS score less than or equal to eight require
immediateairway management. It is suspected that even a single episode of
hypoxia in thepatient with severe head trauma leads to a poorer prognosis.
This patient shouldbe endotracheally intubated using etomidate and
succinylcholine. Etomidate is an ideal induction agent in the head-trauma
patient. Etomidate has been shownto decrease cerebral oxygen consumption,
cerebral blood flow, and intracranial pressure but appears to have minimal
effects on cerebral perfusion pressure.
Airway management takes priority in this scenario. Given the patient’s GCS
scoreof eight in the setting of polytrauma, it is recommended to establish a
definitive airway. During endotracheal intubation, the patient’s cervical spine
should be immobilized to prevent any further injury to the spinal cord. As long
as proper cervicalspine precautions are taken, cervical radiographs(B) can be
obtained afterthe patient is stabilized. Achieving this, however, can occur with
in-line traction anddoes not require immobilization using a hard collar.
Although epidural hematomais a strong consideration, it is unsafe to take the
patient to head CT (C) without firstsecuring the airway.Consulting neurosurgery
for patients with severe head traumais prudent and can occur prior to the return of
CT scan results.But the initial priorityin such patientsis establishment of a
definitive airway.There is a reflexive responseto laryngoscopy and intubation
that increases intracranial pressure, although the precise mechanism is poorly
understood. Intravenous lidocaine (D) is thought to reduce intracranial pressure and blunt the response to laryngoscopy and intuba- tion. Although recent
reports have questioned the clinical benefit, administration of lidocaine during
the pretreatment phase of rapid sequence induction for head injury patients
remains a component of current ATLS guidelines.The nasotrachealairway (E)
should not be attempted in patients with midface trauma or potential basilar
skull fracture because the tube may inadvertently penetrate the intracranial
space.

One Step Further
Question: How much does succinylcholine elevate serum potassium concentration?

Complete Answers Emergency Medicine EOR Exam ( Latest 2023)
TEST BANK
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Dilated Cardiomyopathy: most common cause is . Others?
Answer: alcohol; may also be idiopathic, myocarditis, or drugs (doxorubicin) –

1 in 3 cases of heartfailure are caused by dilated cardiomyopathy

What PE and EKG changes are seen with dilated cardiomyopathy?
Answer: PE: S3,JVD, crackles – possible mitral regurg
EKG: nonspecific ST and T wave changes, LBBB
Hypertrophic cardiomyopathy: is due to hypertrophy of the . PE reveals mitral regurgitation, a heart sound, and prominent left ventricular
impulse. EKG reveals LVH
Answer: cardiac septum; S4
Restrictive cardiomyopathy: often caused by a process, or post-radiation or post open-heart surgery.What is the most common first symptom?-
Answer: –infiltrative process- amyloidosis,sarcoidosis, and hemochromatosis
— changesin myocardium
–most common first symptom is exertion intolerance and fluid retention, signs
ofright heart failure
Atrial fibrillation – regularly irregular – the most common sustained arrhythmia in adults – what three treatments are used?

Answer:

rate control w BB, CCB, ordigoxin
Anticoagulation w heparin & warfarin
rhythm control w amiodarone or cardioversion
Atrial flutter – sawtooth pattern in II, III, aVF – what three treatments areused?
Answer:
cardioversion if no contraindications
acute rate control tx w BB, CCB – amiodarone,sotalol, quinidine, or
procainamide
If site of reentrant is known, catheter ablation
Multifocal atrial tachycardia – noted in patients with COPD or severe
systemic illness – EKG shows multiple shaped P waves and differing PR
intervals. are agents of choice?
Answer: CCB
BLOCKS
=prolonged PR interval
=progressive increase in PR until Pwave is blocked.3.
=sudden block in P wave w no change in PR
=atrial and ventricular rhythm are independent of each other.: First
degree; Wenckebach Mobitz type I; Mobitz type II, Third degree block
A may develop after acute MI, PE, aortic stenosis and is due to a
conduction delay in the right or left bundles.: Bundle branch block
Paroxysmal supraventricular tachycardia is a reentry tachycardia, commonly noted in elderly patients with underlying heart disease. What treatment may be helpful before using adenosine ie. the drug of choice?

Answer: vagalmaneuvers or antianxiety medication

What are some drugs associated with Torsades de pointes?
Answer: tricyclic an-tidepressants, erythromycin, ketoconazole, haloperidol,
cisapride, disopyramide,pentamidine, sotalol, class I anti-arrhythmics
CHF – Systolic dysfunction means a problem with the .What drug is
contraindicated?
Answer: pump; CCB!
CHF – Diastolic dysfunction means a problem with the .
Answer: complianceor relaxation of the heart during ventricular filling
The principle means that as preload increases, the ventricle is
stretched during diastole filling and the ejection fraction is increased.
Answer: -Frank-Starling principle
is released from cardiac ventricles in response to increased wall
tension.
Answer: BNP – B-type natriuretic peptide
What is the pharmacologic therapy for heart failure?
Answer:
diuretics for fluidretention
ACEi
vasodilators (hydralazine & nitrates)
BB for LV dysfunction
digitalis to increase cardiac contractility
Functional Classification of Heart Failure:
-No cardiac symptoms with ordinary activity.
-Cardiac symptoms w MARKED activity but asymptomatic at rest
-Cardiac symptoms w MILD activity but asymptomatic at rest
-Cardiac symptoms at rest.
Answer: Class I, Class II, Class III, Class IV
Stage 1 Hypertension is defined as greater than . Stage 2 Hypertension is defined as greater than .
Answer: 140/90; 160/100
Hypertension Drug of Choice for
Answer:
angina
diabetes
hyperlipidemia
CHF
Previous MI
Chronic Renal Failure
Asthma, COPD: Angina – BB, CCB
Diabetes – ACEi & CCB, avoid diuretics
Hyperlipidemia – ACEi & CCB, avoid
diuretics/BBCHF – diuretics & ACEi, avoid
CCB/BB
Previous MI – BB/ACEi
Chronic renal failure – diuretics,

Complete Answers Emergency Medicine Neurology
Guide 2023 / 2024
(Brand New!!) TB Guide All Q&As Included!! A++
1) A woman presents with 30 minutes of double vision, vertigo, difficul- ty
swallowing, and difficulty speaking. During her initial evaluation, these
symptoms resolve and her neurologic exam returns to normal.Which of
the following is the most appropriate diagnosis and the most likely affected
artery?
Embolic ischemia – anterior cerebral artery
Thrombotic stroke – left anterior descending artery
Transient ischemic attack – middle cerebral artery
Transient ischemic attack – vertebrobasilar arteries
Answer ( D )
Explanation:
Transient ischemic attacks (TIAs) are characterized by an abrupt onset of focal
neurologic symptoms lasting less than 24 hours and often lasting only five to
20 minutes. TIAs suggest impending thrombotic-ischemic stroke. Carotid
pathology leads to TIAs demonstrated by hemiparesis, hemisensory, aphasia,
confusion andtransient monocular blindness. Vertebrobasilar insufficiency
leads to TIAs markedby hemiplegia or quadriplegia, varying sensory changes,
blindness, hemianopsia,diplopia, vertigo, dysarthria, dysphagia and facial,
motor, and sensory change.
Investigation includes Doppler ultrasonography of the carotids and
vertebrobasilarsystem. Head CT scan will not show any acute changes. MRA
angiography may also be indicated. Selected cases may require
endarterectomy, angioplasty or lifelong anticoagulation.
Embolic ischemia typically produces symptoms that last longer than three
hoursand anterior cerebral artery (A) lesions do not produce vertigo and

diplopia.
Thrombotic stroke (B) indicates infarct, which indicates permanent, not
temporaryor resolved, neurologic defect. Middle cerebral artery (C) lesions do
not produce vertigo.
2) One Step Further
Question:What is the difference between plegia and paresis?
Answer: Plegia refers to paralysis (flaccid, no movement) while paresis refers to
weakness (move-ment, but abnormal strength).
3) A 64-year-old man complains of pain and paresthesias in his right hand
intermittently for several weeks.He works in a factory putting together electronics.On exam, he has decreased sensation of his right 1st through 4th digits
and an atrophied thenar eminence.What test in the ED will help diag-nose his
condition?
CT scan of the head
Electromyelography (EMG)
Percuss the right volar wrist
Urine drug screen
Answer ( C )
Explanation:
This patient has median mononeuropathy, also known as carpal tunnel
syndrome,a compression neuropathy of the median nerve as it traverses under
the flexor retinaculum at the wrist.The median nerve provides sensation
primarily to the palmar aspect of the 1st, 2nd, 3rd, andradial side of the 4th.When
it is compressed,the patient experiences pain, paresthesias, and numbness in
that distribution.TheTinel’s test is performed by lightly tapping the volar
surface of the wrist over the median nerve.This should elicit a sensation of
tingling or pins and needles in the distribution of the median nerve. Carpal
tunnel syndrome is first treated with wristsplinting and initiation of a more
ergonomic work environment. NSAIDs may alsobe helpful. If symptoms do
not improve, the patient should be referred to a hand specialist who may elect

to perform a carpal tunnel release procedure
CT scan of the head (A) would be useful if there issuspicion that this patients
symptoms are from a central process such as an acute stroke. However, his
numbness is in a peripheral nerve distribution and not dermatomal.An EMG
(B) is used most commonly by neurologists to confirm damage to peripheral
nerves. It may be used for carpal tunnel syndrome if the symptoms do not
resolve with conservative management.A variety of heavy metals are associated
with a periph-eral neuropathy (lead, mercury), but these require special
serologic testing, not aurine drug screen (D).The patient is at risk for
occupational exposures because he works in a factory; however, most heavy
metal poisonings are associated withother symptoms.
4) One Step Further
Question: What is the Phalen maneuver?
Answer: The opposing dorsal sur- faces of the hands are pressed together with
the wrists flexed for 60 seconds. It ispositive for median nerve problems if this
reproduces or worsens symptoms.
5) A 42-year-old man displays personality changes and confusion for 2 days.He
denies pain. Upon presentation, you discover a weak right leg, speech
impairment and low-grade fever. Upper extremity and left leg strength, rectal
sensation and muscle tone, reflex testing and four-extremity sensory examination are normal. Nuchal rigidity, involuntary tremors, clonus and spasticityare
absent. A brain MRI shows left temporal lobe edema. Cerebrospinal fluid
analysis has an elevated number of red blood cells and the Gram stain is
negative for bacteria.Which of the following is the most likely diagnosis?
Encephalitis
Meningitis
Myelitis
Sydenham’s chorea

Answer ( A )
Explanation:
Encephalitis and meningitis manifest with similar symptoms, especially early
in the infection. The classic meningitis triad is fever, headache and altered
mental status, while altered mental status plus focal neurologic deficit is more
descriptiveof encephalitis. Herpes simplex encephalitis causes 10% of all
diagnosed cases.More than half of these cases are fatal if untreated. HSV-1,
commonly contractedin childhood (cold sores, fevers, and blisters), reactivates
in adulthood to cause the majority of cases. Symptoms include up to 5 days of
fever and headache, followed by behavior and personality changes, seizures,
speech and memory deficits, hallucinations and altered consciousness. Frontal
lobe pathology, leadingto behavior and personality changes, and temporal lobe
pathology, leading to mem-ory and speech problems, are most common. Herpes encephalitis is associated with elevated red blood cells on CSF analysis. In
adults, T2-weighted MRI revealshyperintensity corresponding to edematous
changes in the temporal lobes, inferiorfrontal lobes, and insula, with a
predilection for the medial temporal lobes. Foci ofhemorrhage occasionally can be observed on MRI. Untreated HSV encephalitis is associated with high
morbidity and mortality.Therefore, in suspected cases
of encephalitis without an obvious source, empiric treatment with intravenous
acyclovir is recommended.Young children and the immunocompromised are at
greatest risk for HSV disease.
Meningitis (B) presents in a similar fashion to encephalitis early on. However,
encephalitis is typically associated with behavioral and personality changes
andneurologic deficits. Myelitis (C) (infection or inflammation of the spinal
cord), typically presents with spinal pain, various sensory deficits, extremity
weakness,reflex changes and bowel or bladder changes. Sydenham’s chorea
(D) occurs mainly in children with acute rheumatic fever or other Group A
beta-hemolytic Streptococcus infection. It is characterized by face, hand and
feet rapid jerking movements. Adult presentation is extremely rare.

Complete Answers Emergency Medicine Practice Exam TEST BANK
Latest 2023 – 2024 )
100% Correct Answers Guaranteed in TB with All-New Q&A – A++1. A 68-year-old female presents to the emergency department with signs and
symptoms of an acute ischemic stroke. The initial CT scan is normal. Her
blood pressure is 164/105. What is the most appropriate treatment for the
blood pressure of this patient?
A Atenolol PO
B Clonidine PO
C Close monitoring
D Labetolol IV
E Nicardipine IV
Answer: C
Aggressively lowering blood pressure may decrease blood flow to the ischemic
tissue, thus decreasing the chances of recovery or increasing the risk of further
infarction. In the setting of an acute ischemic stroke, blood pressure elevation
should be monitored closely, with some elevation expected.* This elevation is
expected to decline without medication in the first few hoursto days, but if
elevationcontinues to a systolic blood pressure greater than 220mmHg, or
mean arterial pressure greater than 120mmHg, medication is advised.
Medications may includeintravenous labetolol or nicardipine, with close
monitoring of the patient. After theacute phase following a stroke, appropriate
oral medications may be considered for outpatient hypertension management.

You are evaluating a 67-year-old male with known cirrhosis of the liver
secondary to alcoholic liver disease, although he has been sober for the pastyear.
He is brought in to the emergency department by his daughter, who notes that
for the past few days he has seemed to be more confused. On ex-amination you
note the patient to be mildly confused but alert to person andplace. He has
noticeable asterixis. He is not currently taking any medicationsand his blood
alcohol level is undetectable. What is the treatment of choicein this case based
on your physical examination findings?

A amoxicillin
B prednisone
C lactulose
D folic acid
E thiamine
Answer (C).
This patient most likely has hepatic encephalopathy due to end-stage liver diseaseAsterixis indicates an increase in serum ammonia. The treatment of choice is
lactulose. Both folic acid and thiamine are used in the treatment of alcoholic
liver disease, but do not treat elevated ammonia levels. Antibiotics may be
usedsecondarily in patients nonresponsive to lactulose, but amoxicillin is not
preferred.Prednisone is not a treatment for hepatic encephalopathy.

A 76-year-old man, is brought to the emergency department by his niece
after she found him wandering around his yard in the cold wearing only
a tee shirt and jeans. When she set up his pill container about 36 hours earlier,
he seemed his usual self but, in retrospect, possibly a little more confused than
usual.The niece says that he has “high blood,” treated with a”white fluid pill,”
“sugar diabetes,” treated with an oral medication, and early”old timer’s”
dementia treated with “a memory pill.” Vital signs include an oral temperature
of 100.8F, pulse 100 beats per minute, respirations 24 andsomewhat shallow,
and blood pressure of 88/52. Initial examination revealsa slightly dehydrated,
stuporous man appearing older than his stated age, who smells strongly of
urine. He has no lateralizing signs.What is the mostlikely cause of the mental
status changes?
A hyperglycemic hyperosmolar stateB
lactic acidosis
C stroke
D urinary tract infection
E worsening dementia
Answer: A
The combination of confusion and dehydration in a patient with diabetes type
2 who is taking a diuretic strongly suggest hyperosmolar state.* Patients with
lacticacidosis (B) have marked hyperventilation and, usually, signs and
symptoms of a serious illness. The lack of lateralizing signs makes a stroke (C)

less likely.
Urinary tract infection (D) could certainly cause confusion and incontinence in an elderly man and should be investigated. Alzheimer dementia (E) progresses
slowly;sudden decompensation is usually due to delirium.

A 66-year-old man with a history of HTN and diabetes mellitus, type 2,
presents to the emergency department with complaints of palpitations for over
2 weeks, tachypnea, and chest pain. He denies history of CAD, stroke,TIA, or
congestive heart failure. He is afebrile, with vital signs as follows: BP 145/98,
HR 138, and RR 22. His EKG is shown (Figure 1). Troponins are negative X
Which of the following choices is the most appropriate next diagnostic
study for this patient?
A Transthoracic echocardiogramB
Cardiac catheterization
C Nuclear stress test
D Holter monitor
E Event recorder
Answer: A
Choice A, transthoracic echocardiogram, is correct, as it can demonstrate
thepresence of valvular heart disease. The presence of valvular heart
disease can change the recommendations for embolism prophylaxis.*
Choice B, cardiaccatheterization, is useful in patients suspected to have
unstable angina, or whohave sustained a myocardial infarction. Choice C,
nuclear stress test, is useful in patients suspected to have angina pectoris,
and may be a useful diagnostic study in this patient with cardiac risk
factors (once the issue of atrial fibrillation has been treated). Choices D and
E would be useful tests if the EKG had not established a diagnosisfor this
patient, with the Holter monitor indicated in patientsexperiencing symptoms
on a daily basis, and the event recorder indicated in patients demonstrating
more sporadic symptoms.
What absolute tissue pressure generally is used as a guideline for diag-

nosing compartment syndrome?
A 10 mm
HgB 20 mm
HgC 30 mm
Hg D 40 mm
Hg
E 50 mm Hg
Answer: C
Many trauma surgery services use an absolute tissue pressure of approximately
30 mm Hg as the threshold for diagnosing compartment syndrome.* Based on
theentire clinical picture, patients with numbersin that range or higher will likely
requiresurgical decompression with a fasciotomy, while lower numbers will
probably be managed with a more conservative approach.

A 6-year-old female presents to the emergency department with left wrist
pain after falling off the monkey bars at the school playground. Imaging of the
left upper extremity shows the following fracture pattern:
Which type of Salter-Harris Classification is observed?
A Type I
B Type II
C Type
IIID Type
IV
E Type V
Answer: A
A Salter-Harris Type I (A) involves the entire epiphysis.*
Type II (B) is the entire epiphysis along with a portion of the
metaphysis,Type III (C) involves a portion of the epiphysis only,
Type IV (D) involves a portion of the epiphysis along with a portion of the
metaph-ysis, and
Type V (E) is a compression injury of the epiphyseal plate (nothing is “broken
off”).

You are evaluating a 67-year-old male with known cirrhosis of the liver
secondary to alcoholic liver disease, although he has been sober for the pastyear.
He is brought in to the emergency department by his daughter, who notes that
for the past few days he has seemed to be more confused. On ex-amination you
note the patient to be mildly confused but alert to person andplace. He has
noticeable asterixis. He is not currently taking any medicationsand his blood
alcohol level is undetectable. What is the treatment of choicein this case based
on your physical examination findings?

A 76-year-old man, is brought to the emergency department by his niece
after she found him wandering around his yard in the cold wearing only
a tee shirt and jeans. When she set up his pill container about 36 hours earlier,
he seemed his usual self but, in retrospect, possibly a little more confused than
usual.The niece says that he has “high blood,” treated with a”white fluid pill,”
“sugar diabetes,” treated with an oral medication, and early”old timer’s”
dementia treated with “a memory pill.” Vital signs include an oral temperature
of 100.8F, pulse 100 beats per minute, respirations 24 andsomewhat shallow,
and blood pressure of 88/52. Initial examination revealsa slightly dehydrated,
stuporous man appearing older than his stated age, who smells strongly of
urine. He has no lateralizing signs.What is the mostlikely cause of the mental
status changes?
A hyperglycemic hyperosmolar stateB
lactic acidosis
C stroke
D urinary tract infection
E worsening dementia
Answer: A
The combination of confusion and dehydration in a patient with diabetes type
2 who is taking a diuretic strongly suggest hyperosmolar state.* Patients with
lacticacidosis (B) have marked hyperventilation and, usually, signs and
symptoms of a serious illness. The lack of lateralizing signs makes a stroke (C)

A 66-year-old man with a history of HTN and diabetes mellitus, type 2,
presents to the emergency department with complaints of palpitations for over
2 weeks, tachypnea, and chest pain. He denies history of CAD, stroke,TIA, or
congestive heart failure. He is afebrile, with vital signs as follows: BP 145/98,
HR 138, and RR 22. His EKG is shown (Figure 1). Troponins are negative X
Which of the following choices is the most appropriate next diagnostic
study for this patient?
A Transthoracic echocardiogramB
Cardiac catheterization
C Nuclear stress test
D Holter monitor
E Event recorder
Answer: A
Choice A, transthoracic echocardiogram, is correct, as it can demonstrate
thepresence of valvular heart disease. The presence of valvular heart
disease can change the recommendations for embolism prophylaxis.*
Choice B, cardiaccatheterization, is useful in patients suspected to have
unstable angina, or whohave sustained a myocardial infarction. Choice C,
nuclear stress test, is useful in patients suspected to have angina pectoris,
and may be a useful diagnostic study in this patient with cardiac risk
factors (once the issue of atrial fibrillation has been treated). Choices D and
E would be useful tests if the EKG had not established a diagnosisfor this
patient, with the Holter monitor indicated in patientsexperiencing symptoms
on a daily basis, and the event recorder indicated in patients demonstrating
more sporadic symptoms.
What absolute tissue pressure generally is used as a guideline for diag-

A 6-year-old female presents to the emergency department with left wrist
pain after falling off the monkey bars at the school playground. Imaging of the
left upper extremity shows the following fracture pattern:
Which type of Salter-Harris Classification is observed?
A Type I
B Type II
C Type
IIID Type
IV
E Type V
Answer: A
A Salter-Harris Type I (A) involves the entire epiphysis.*
Type II (B) is the entire epiphysis along with a portion of the
metaphysis,Type III (C) involves a portion of the epiphysis only,
Type IV (D) involves a portion of the epiphysis along with a portion of the
metaph-ysis, and
Type V (E) is a compression injury of the epiphyseal plate (nothing is “broken
off”).

Complete Answers Emergency Medicine Pretest exam ( Latest 2023 )
Get Ready for A++ Test with Latest Q&As & Answers

Before giving nitroglycerin, must rule out…
Answer: right ventricular infarct and car-diac tamponade
What are the possible EKG manifestations of right heart strain?
Answer: RAD,S1Q3T3, RBBB, Afib, peaked P in II
Best med for rate control in A fib?
Answer: diltiazem (great AV nodal targeting)
EKG finding of hypocalcemia?
Answer: long QT
EKG finding of hypercalcemia?
Answer: short QT
Management of pneumothorax?
Answer: If small (<20%) in otherwise healthy patient,observe for 6 hours and
CXR before discharge
Possible CXR finding of Boerhaave?
Answer: lateral displacement of the left medi-astinal pleura
Most sensitive test for aortic dissection?
Answer: TEE is bestCT is second best
aortogram is too invasive!
Rx for cocaine chest pain?
Answer: benzodiazepines
(beta-blockers are contra-indicated!)
ST elevation in leads II, III, AVF?
Answer: inferior infarct
ST elevation in leads V1 + V2?
Answer: septal infarct
ST elevation in leave V3 + V4?
Answer: anterior infarct
ST elevation in I, AVL, V5,V6?
Answer: lateral infact
WPW in setting of A fib isrisky for? Rx?
Answer: conversion to ventricular fibrillation
Procainamide
EKG manifestations of hyperkalemia?
Answer: peaked T wave, wide QRS, no Pwaves
How to manage stable hyperkalemia (no EKG changes)?
Answer: kayexalate (binds and actually removes K, instead of just shifting it
inward like insulin does)
How to manage unstable hyperkalemia (+ EKG findings)?
Answer: calcium glu-conate
Function of glucagon in endoscopy?
Answer: relaxes the GE junction!
Which type of effusions are exudative?
Answer: malignant
What qualifies as an exudative effusion?
Answer: fluid-to-blood protein >0.5fluid-to-blood LDH >0.6
LDH >200

Complete Answers Emergency Medicine Procedures Exam Latest 2023 – 2024
New Qs & As Guarantee A++ Exam Success – Pass Guaranteed!

A 48-year-old man presents with bilateral swollen lower extremities. Whichof
the following may lead to a false-negative result for proteinuria on a urine
dipstick?
Alkaline urine
Dilute urine
Hematuria
Prolonged dipstick immersion in urine
Answer ( B )
Explanation:
Urine dipstick tests are often performed to evaluate for the presence of
proteinuriaas a surrogate for impaired renal function. This occurs through a
color change of tetrabromophenol blue. There is an approximate relationship
between the proteinconcentration and color intensity; however, reliably
positive results occur only at concentrations above 30 mg/dL. As such, dilute
urine can generate false-negativeresults for proteinuria.
In contrast, alkaline urine (A), hematuria (C), and prolonged dipstick
immersion inurine (D) can all generate false-positive results.
In which clinical scenario is ocular tonometry contraindicated?
A 21-year-old woman with a corneal ulcer
A 37-year-old woman with conjunctivitis
A 49-year-old man with a penetrating injury to the globe
A 62-year-old man with acute angle closure glaucoma
Answer: 49-year-old man with a penetrating injury to the globe

Explanation: Tonometry is used to estimate intraocular pressure (IOP) and can
be useful in diag-nosing conditions such as acute angle closure glaucoma and
orbital compartmentsyndrome secondary to trauma. Several devices exist for
measuring intraocular pressure. Most use applanation tonometry or
precalibrated measurement based on applied corneal pressure to measure
intraocular pressure. Other techniques (Schiotz technique and MacKay-Marg
method) involve creating a corneal deformitywith a plunger and measuring the
deformity. Prior to the advent of tonometers, ophthalmologists depended on
tactile estimation of intraocular pressure.The onlycontraindication to
performing tonometry is suspected or confirmed open globe injury because
applying pressure to the globe can worsen the injury.
Tonometry is relatively contraindicated in the presence of an eye infection (B)
or corneal ulcer (A), but it can be performed if a sterilized cover is placed over
the endof the device. Tonometry is routinely used in the diagnosis of acute
angle closureglaucoma (D). Pressures > 20 mm Hg are considered pathologic.

One Step Further
Question: What test should be done prior to performance of applanation
tonometry in cases where a ruptured globe may be present?: Answer: Seidel’s test, which is positive for a ruptured globe when swirling vitreous
humor isvisualized on blue-light examination postinstillation of fluorescein.
During an exam, passive flexion of a patient’s neck causes a reflexive
flexion of his hips and knees.What is this finding called?
Brudzinski sign
Griesinger’s sign
Kernig’s sign
Levine’s sign
Answer ( A )
Explanation:
This finding describes Brudzinski sign, which is used as an indicator of

meningealirritation such asin patients with acute meningitis.The test is
performed by applyingflexion to the patient’s neck. A positive test is the
observance of a reflexive flexionof the hips and knees. Care should be taken
regarding a positive Brudzinski sign,as this does not always indicate acute
meningitis. In addition to meningitis, it canalso be observed in patients with
subarachnoid hemorrhage or encephalitis. All conditions that cause meningeal
irritation.
Griesinger’s sign (B) is swelling of the posterior auricular area and may be
seenwith certain types of sinus thrombosis. Kernig’s sign (C) is usually
assessed along with Brudzinski. It is performed by flexing the hip and knee to
90° and then attempting to extend the knee. This will cause significant pain in
a patient with meningeal irritation. Levine’s sign (D) is described as leaning
forward on a
closed fist in the chest area and is sometimes seen in patients with acute
coronarysyndrome.

One Step Further
Question: What cerebrospinal fluid (CSF) findings are seen in bacterial
meningitis?
Answer: High protein, low glucose, presence of polymorphonuclearcells.
Which of the following tests best differentiates a subarachnoid hemorrhage from a traumatic lumbar puncture?
Absolute RBC value of 700 RBCs/µL in tube 3
Clearing of RBCs from tube 1 to tube 3 of 15%
CSF glucose < 50 mg/dl
Presence of xanthochromia
Answer ( D )
Explanation:
Differentiating between a traumatic lumbar puncture (LP) and a subarachnoid

hemorrhage (SAH) can be very difficult but the presence of xanthochromia is
pathognomonic for SAH. Traumatic LPs are common occurring in up to 30%
of procedures. Traditionally, the rate of clearance of red blood cells (RBCs)
from thespinal fluid from tube 1 to tube 4 was used to assess for a traumatic tap.
However,other methods are more sensitive. Xanthochromia occurs when RBCs undergo hemolysis in the CSF. It occurs within a few hours of RBCs leaking
into the CSF and can persist for up to 4 weeks. It is uncommon for
xanthochromia to occur immediately after exposure of RBCs to CSF. Thus it
would be uncommon to find xanthochromia after a traumatic tap unless there
was also a SAH. Some reports have seen xanthochromia after a traumatic tap
when the RBC count exceeds 30,000/µL. Xanthochromia is detected either by
seeing a yellowish tinge to the CSF after centerfuging the sample or by spectral analysis.
There is no consensus from the current literature about an absolute CSF
RBCcount (A) that can be used as a cutoff to differentiate SAH from a
traumatic tap. RBC clearing from tube 1 to tube 3 (or 4) of at least 25-30%
(B) has been considered to support the diagnosis of a traumatic tap.
However, it is possible to have a traumatic tap in a patient with an SAH and
this method would not help in thissituation. CSF glucose (C) is not helpful in
the differentiation of these two entities.

One Step Further
Question: What is the role of dexamethasone in a child presenting with a highrisk for H. influenzae meningitis?
Answer:Treatment with dexamethasonehas been shown to decrease hearing loss
associated with H. influenzae meningitisin children.
How do you calculate mean arterial pressure (MAP)? [DBP = diastolic
blood pressure, SBP = systolic blood pressure]
MAP = [DBP + (2 x SBP)]/3
MAP = DBP + 1/3(SBP

QUESTION BANK Medicine – Emergency Medicine Exam ( Latest 2023 – 2024 )
New Full Exam | Questions and Answers

BLS order
Answer:
C – chest compression
A – airway
B – breathing
Shockable rhythms for AED
Answer: V-fib, pulseless V-tach
1st step in advanced Cardiac arrest algorithm
Answer: Start CPR
2nd step in advanced Cardiac arrest algorithm if asystole or PEA
Answer: Epineph-rine ASAP
2nd step in advanced Cardiac arrest algorithm if v fib and v tach
Answer: SHOCK!
3rd step in advanced Cardiac arrest algorithm if v fib and v tach
Answer: Shockagain , then epi every 3-5 min
last step in advanced Cardiac arrest algorithm if v fib and v tach
Answer: Amio-darone or lidocaine
ST elevation MI what to do
Answer:
Cardiac cath
OR if not there
Thrombolysis (alteplase)
ACS (acute coronary syndrome)
Answer: NSTEMI, STEMI, unstable angina
Widened mediastinum, Unequal BP,Tearing pain radiates to back
Answer: Aorticaneurysms
What kind of MI has bradycardia
Answer: Inferior MI!
Dont give B blockers to what MI
Answer: Inferior wall MI

Complete Answers BUNDLE | Latest | Emergency Medicine – TEST BANK, COMAT, Genitourinary, Trauma, EOR, Neurology Guide, Practice, Pretest exam, Procedures | Exam 1 – 9 | 100% Correct Answers Guaranteed in TB with All-New Q&A – A !

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