Saturday

Board Review: Yellow Fever

A 45 year old male presents to your emergency department with 1 day of headache, body aches, nausea and vomiting?  On further history you learn that the patient recently returned from a trip to Africa and you suspect Yellow Fever.  Which of the following below would increase your suspicion for Yellow Fever? (scroll down for the answer) 

A) Low pulse relative to fever  

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Board Review: Anti-epileptics

Which anti-epileptic is most likely to cause hyponatremia? 

A. Carbamazepine

B. Dilantin

C. Valproic Acid 

D. Lacosamide

E. Levetiracetam

 

 

 

 

 

Answer is A - Carbamazepine or Tegretol

Bonus Question: What is the first line management in Trigeminal Neuralgia? 

 

 

 

 

 

Answer: Carbamazepine or Tegretol

 

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Board Review: Hyperthermia and Altered Mental Status

A 40 year old man presents via ambulance after he was found stumbling around a park on a hot summer day. He is mumbling, not responding to questions appropriately, and very disoriented. His skin is dry and hot to touch. Rectal temperature is 106.1 F. IV access has been obtained and normal saline has been started. What is next most effective immediate treatment for cooling?

A. Rectal Acetaminophen

B. Cooling with fans and skin wetting from a spray bottle.  

C. Bladder lavage. 

D. Ice packs placed on axillae and groin. 

E. Cardiopulmonary bypass/ ECMO. 

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Board Review: Crush Injury

A 30 year old mechanic presents for a right lower leg injury. He was working on his car when it fell on his right leg. Urinanalysis reveals dark urine with a dipstick positive for large mount of blood. Serum CK is 28,000 units/L. The primary treatment modality is: 

A. Sodium Bicarbonate

B. Furosemide

C. Mannitol

D. Normal Saline

E. Calcium Gluconate

 

 

 

 

Answer is D - Normal Saline

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Board Review: Infectious Disease

A 52 year old male with history of asplenia after a car accident presents with a fever for 8 days. Tmax is 101.8. Denies any other symptoms. Denies rash. Reports he walks every morning through a path in the woods behind his house. Denies recent travel, animal exposure, sexual history. Blood pressure is 120/80, heart rate is 110, Temperature is 101.0 F, respiratory rate is 18, SpO2 is 100% on room air. Physical exam is otherwise unremarkable. Blood work is significant for evidence of hemolytic anemia and peripheral smear shows maltese cross. What is the next step in management? 

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Board Review: Pediatrics

A 2 year old boy presents with his mom for recurrent bouts of abdominal pain and vomiting. Mom denies fevers but noticed decreased appetite. Mom states there has been a "stomach bug" going around the daycare. Vitals reveal a blood pressure of 90/50, heart rate of 120, rectal temperature of 99.0, respiratory rate of 36, SpO2 of 100% on room air. Exam is unremarkable, revealing a playful child with a normal abdominal and GU exam. The nurse asks you to reassess the patient and you see a very uncomfortable child, crying and holding his abdomen, his legs drawn toward his abdomen.

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Board Review: Skin and Soft Tissue Infections

A 32 year old male history of IV drug use presents for redness to his right arm extending the antecubital fossa. He has pain out of proportion to the area and pain outside of the erythematous margins. He is febrile to 103.2 F, heart rate is 125, blood pressure is 80/40. Patient is given normal saline. Vancomycin and Cefepime are started. What is the next step in management? 

A. Immediate Surgical Consult and Clindamycin. 

B. Draw labs to risk stratify via the LRINEC score and a CT scan

C. Immediate Surgical Consult and a CT scan. 

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Board Review: Epistaxis

A 30 year old male with no past medical history presents to the ED for epistaxis. You notice actice bleeding from right nare but cannot determine the exact source. Direct pressure was attempted for 20 minutes followed by application of a topical vasoconstrictor bleeding persists. What is the next best step in management of this patient's epistaxis? 

A. Irrigation

B. Posterior Packing

C. Anterior Packing

D. Cautery with silver nitrate 

 

 

 

 

 

Answer: C - Anterior Packing

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Board Review: Dental Problems

A 35 year old female presents to the Emergency Department with sudden onset of right lower dental pain. Patient had a dental extraction for a dental carie 5 days ago. What is the most likely diagnosis?

A. Acute Necrotizing Ulcerative Gingivitis 

B. Pulpitis 

C. Dental Abscess

D. Alveolar Osteitis 

E. Post-Extraction Pain

 

 

 

 

 

 

 

Answer is D - Alveolar Osteitis (Dry Socket)

 

Loss of healing clot leads to pain and inflammation 3-5 days post extraction. 

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Board Review: Anaphylaxis

A 50 year old male with history of atrial fibrillation and a seafood allergy presents after eating seafood. He is on a beta-blocker for rate control. He has facial swelling, hives, trouble breathing and nausea. You give epinephrine x 2 intramuscularly but the patient is not improving. What is your next step in management. 

A. Epinephrine IM

B. Epinephrine IV

C. Glucagon

D. Glucocorticoid 

E. Pepcid

 

 

 

 

 

Answer: C - Glucagon

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