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Emergency Med NBME Form 1 Correct Questions & Answers; Latest 2023 / 2024
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Emergency Med NBME Form 1 Correct Questions & Answers
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Emergency Med NBME Form 1 CT angio of chest: BL PE ED: pt inc resp distress 145/min 30/min 80/50 mmHg POx: 86% RA most app next step in mgnt? Correct Answer: intravenous administration of alteplase hemodynamically unstable PE patients are candidates for treatment with IV thrombolysis or mechanical thrombectomy > streptokinase, urokinase (also known as urinary plasmin ogen activator), and alteplase if pt stable/stabilizes - can give other anticoagulants (like unfractionated heparin and enoxaparin mentioned in the answer choices) remember this is ED - so need to stabilize the pt before doing anything else > make sure th ey're alive and well lol can think surg options as well > IVC filter - for those w/ CIs to anticoagulation > embolectomy - for those w/ bad prognosis 28 yo male - prog SOB past 4 hrs > 3 days of chest congestion and cough (yellow sputum) > 6 months ag o: hospitalized 2 days for similar symptoms PMHx: asthma, NKDA med: albuterol by metered -dose inhaler > using this more freq past 2 days ED: mild resp distress, accessory muscles BMI: 23 100.6F 106/min, reg 18/min 132/86 mmHg POx: 96% RA PE: exp wheezes BL give him supplemental O2 therapy - most app next step in mgnt? Correct Answer: administration of nebulized albuterol remember that w/ asthma (unlike COPD) - you have to give ICS after SABA, before LABA > SABA > ICS > LABA > inc ICS > or al steroids just think what we give in the hospital - BIOMES > Beta agonists, Ipratropium, O2, Mg sulfate, Epi, Steroids > duonebs babyyy severe exacerbation: use of accessory muscles, tripod position, hypoxia, tachypnea, impending resp failure 32 yo fe male - 30 min after onset of dizziness, numbness, neck pain > vigorous aerobics class > sharp pain on R.side of neck that spread to back of head > sens of spinning > L.sided numbness ED: AOx3 99.7F 90/min, reg 130/80 mmHg PE: mild narrowing of R. pal pebral fissure; R.pupil 2 mm; L.pupil 4 mm; both reactive to light; EOCM; fundo exam gucci; palate does not elevate on R.; tongue protrudes midline; DTRs 2+; muscle strength gucci; Babinski absent; sens to pinprick dec over L.side of body and R.side of fac e; sens to vib/proprioception intact; intention tremor RUE; gait mildly ataxic; speech mildly slurred most likely dx? Correct Answer: vertebral artery dissection seen a previous case from UWorld - young guy skiing and presented w/ similar symptoms I guess homegirl has lat medullary syndrome aka Wallenberg syndrome 2/2 occlusion or dissection of intracranial vertebral artery or PICA in young adults - MC causes of stroke = arterial dissection and cardiogenic embolism previously reported following mino r head and neck trauma > cervical spine manipulation 68 yo male - 2 wks of abd cramps after eating > 5 lb weight loss > occ loose stools - no blood PMHx: HTN, CHF, NKDA meds; metoprolol, digoxin, amlodipine 6 months ago: LV EF 20% 98.6F 96/min 18/min 138/72 mmHg POx: 97% PE: S3; BL basilar crackles; abd - soft w/ minimal gen tenderness to palp next step in dx? Correct Answer: CT angiography homeboy has mesenteric ischemia > usually presents w/ severe acute abd pain out of proportion ~ pt will comp lain of severe pain but not very tender on PE RFs: > 50 yo; CHF; atherosclerotic heart dz; diuretics/vasoconstrictive drugs; AFib; recent MI dx made late bc elderly don't get severe acute abdomens sudden onset = art vascular occlusion > sup mesenteric art insidious onset = venous thrombosis or nonocclusive infarction (intestinal angina) > presents like angina but after eating, instead of exercise peritoneal signs aka "acute abdomen" do angiography - dx/tx x-rays: dilated loops of bowel; air-fluid level; irregular thickening of bowel wall (thumbprinting); pneumatosis intestinalis (gas in bowel wall) 35 yo male - prog redness/swelling of R.knee for past 3 days 98.6F 84/min 16/min 134/74 mmHgThe benefits of buying summaries with Stuvia:
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