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EM Comat Exam Study Guide Solutions Updated 2024

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EM Comat Exam Study Guide Solutions Updated 2024 Treatment for high altitude pulmonary edema - ANSWER-Supplemental O2 High altitude pulmonary edema typically develops within 1 week of ascent to high altitude. Patients have a normal cardiac exam (which rules out cardiogenic pulmonary edema) and...

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  • November 19, 2024
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EM Comat Exam Study Guide
Solutions Updated 2024

Treatment for high altitude pulmonary edema - ANSWER✔✔-Supplemental O2




High altitude pulmonary edema typically develops within 1 week of ascent to high

altitude. Patients have a normal cardiac exam (which rules out cardiogenic pulmonary

edema) and a normal serum procalcitonin concentration. The most effective treatments

are rapid descent and supplemental O2.




CF: recent arrival at a high altitude, bilateral crackles on pulmonary exam. Normal

cardiac examination, diffuse, patchy infiltrates on CXR, +/- mild leukocytosis




Management: rapid descent, supplemental O2, +/- nifedipine, sildenafil, tadalafil


Elderly patient with small cell lung cancer presenting with acute confusion, lethargy

and nausea. Most appropriate diagnostic step? - ANSWER✔✔-Serum Electrolytes




Copyright ©SOPHIABENNETT 2025 ACADEMIC YEARALL RIGHTS RESERVED. Page 1/35

,Sx are due to hyponatremia, paraneoplastic SIADH




Most patients are euvolemic- no edema or jugular venous distention




Hypertonic 3% saline




if asymptomatic- fluid restriction +/- salt tablets


Treatment of bacterial keratitis - ANSWER✔✔-topical fluoroquinolones, remove

contacts


if still wearing them




CF :purulent discharge, pain




pseudomonas- gram neg


EKG finding of pericardial effusion - ANSWER✔✔-Electrical Alterans- beat to beat

variations in the amplitude of the QRS complex




Copyright ©SOPHIABENNETT 2025 ACADEMIC YEARALL RIGHTS RESERVED. Page 2/35

,Pericardial effusions can develop as a complication of viral infection and may result in

cardiac tamponade. CXR will reveal an enlarged and globular cardiac silhouette, while

ECG can demonstrate either low-amplitude QRS complexes or electrical alterans.




CF: chest discomfort, fatigue, dyspnea


Treatment for Necrotizing Otitis Externa - ANSWER✔✔-IV ciprofloxacin




Suspect NOE when ana elderly patient presents with severe ear pain that is worse at

night and has granulation tissue within the external auditory canal. NOE is most

commonly caused by pseudomonas aeruginosa and as such, IV ciprofloxacin is most

commonly used as first line therapy.




severe ear pain that is worse at night and with chewing




+/- lower CN deficits




Edematous EAC with purulent drainage




Copyright ©SOPHIABENNETT 2025 ACADEMIC YEARALL RIGHTS RESERVED. Page 3/35

, Granulation tissue in the external auditory canal




Elevated ESR +/- leukocytosis




surgical debridement is reserved for those who do not respond to antibiotics


What type of injury causes upper extremity hypertension with LE hypotension +/-

hoarseness? - ANSWER✔✔-Blunt Thoracic Aortic Injury




BTAI can occur as a complication of rapid deceleration (fall from height). While

complete rupture results in rapid exsanguination and death, incomplete rupture can

have a variety of clinical manifestations including UE hypertension with LE




Dx- CT angio


TEE


Cannot use TTE (does not fully visualize the thoracic aorta)




Management- surgery




Copyright ©SOPHIABENNETT 2025 ACADEMIC YEARALL RIGHTS RESERVED. Page 4/35

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