(Answered 2023) Emergency Medicine COMAT Exam
A++ Exam with All New Qs & As – Guaranteed Pass!<\/p>\n\n\n\n
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<\/p>\n\n\n\n
(Answered 2023) Emergency Medicine Genitourinary ExamAll New Qs & As for A++ Exam – Pass Guaranteed!<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
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<\/p>\n\n\n\n
(Answered 2023) Emergency Medicine Trauma Exam
Pass A++ Exam with Confidence – All New Qs & As Guaranteed!<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
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).<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
Complete Answers Emergency Medicine EOR Exam ( Latest 2023)
TEST BANK
All New Q&A in TB – 100% Correct for A++!<\/p>\n\n\n\n
Answer:<\/p>\n\n\n\n
Answer: vagalmaneuvers or antianxiety medication<\/p>\n\n\n\n
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<\/p>\n\n\n\n
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<\/p>\n\n\n\n
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<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
Complete Answers Emergency Medicine Practice Exam TEST BANK
Latest 2023 \u2013 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.<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
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<\/p>\n\n\n\n
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<\/p>\n\n\n\n
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<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
Complete Answers Emergency Medicine Practice Exam TEST BANK
Latest 2023 \u2013 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.<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
Complete Answers Emergency Medicine Pretest exam ( Latest 2023 )
Get Ready for A++ Test with Latest Q&As & Answers<\/p>\n\n\n\n
Complete Answers Emergency Medicine Procedures Exam Latest 2023 \u2013 2024
New Qs & As Guarantee A++ Exam Success – Pass Guaranteed!<\/p>\n\n\n\n
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.<\/p>\n\n\n\n
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\u00b0 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.<\/p>\n\n\n\n
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\/\u00b5L. 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.<\/p>\n\n\n\n
QUESTION BANK Medicine – Emergency Medicine Exam ( Latest 2023 \u2013 2024 )
New Full Exam | Questions and Answers<\/p>\n\n\n\n
(Answered 2023) Emergency Medicine COMAT ExamA++ Exam with All New Qs & As – Guaranteed Pass! Answer: Associated with five P’s – pain, paraesthesia, pallor,pulselessness, &poikilothermiaCritical level = Btwn 10 mmHg & 35mmHgPoor outcomes = >30 mmHgFasciotomy is the definitive treatment (Answered 2023) Emergency Medicine Genitourinary ExamAll New Qs & As for A++ Exam – […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"categories":[25],"tags":[],"class_list":["post-120061","post","type-post","status-publish","format-standard","hentry","category-exams-certification"],"_links":{"self":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/120061","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/comments?post=120061"}],"version-history":[{"count":0,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/posts\/120061\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/media?parent=120061"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/categories?post=120061"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.learnexams.com\/blog\/wp-json\/wp\/v2\/tags?post=120061"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}