Ep 49 Roshcast Emergency Board Review

Life is like riding a bicycle. To keep your balance, you must keep moving.

Welcome back to RoshCast for Episode 49! We have a lot of exciting material in this episode. Definitely don’t skip this one! For those taking the initial certification exam, it’s just around the corner. Go back and listen to old episodes and review.

Question 1

A 14-year-old boy developed an itchy, painful, erythematous rash on his hands, forearms, and face about a day after hiking in nearby woods with some friends. Your exam shows linear erythematous papules over his forearms with similar swelling and erythema around his eyes (including eyelids), cheeks, and forehead. You suspect poison ivy that he reports he has had in the past. Which of the following is most likely to improve the course of his illness?

A. Oral diphenhydramine every six hours

B. Three-week prednisone taper

C. Topical 1% hydrocortisone three times daily

D. Topical calamine lotion twice daily

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Question 2

Which of the following patients will benefit most from receiving tissue plasminogen activator for acute pulmonary embolism detected in the emergency department?

A. 55-year-old man with a history of hypertension with vital signs showing HR 100/min, BP 80/40 mm Hg, R 24/min, and oxygen saturation 92%

B. 55-year-old man with a history of hypertension with vital signs showing HR 145 bpm, BP 136/86 mm Hg, R 24/min, and oxygen saturation 92%

C. 55-year-old woman with a history of hypertension and systemic lupus erythematosus with vital signs showing HR 100 bpm, BP 116/86 mm Hg, R 24/min, and oxygen saturation 85%

D. 55-year-old woman with a history of hypertension with vital signs showing HR 110 bpm, BP 122/80 mm Hg, R 24/min, and oxygen saturation 92% with evidence of right ventricular dysfunction on echocardiogram

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Question 3

A 55-year-old woman presents to the emergency department unresponsive. She and her friend had finished eating 60 minutes earlier when the patient collapsed to the floor while talking. Which of the following foods is most likely the cause?

A. Apricot kernels

B. Fava beans

C. Peanuts

D. Poppy seeds

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Question 4

Which of the following is due to the intense thermal radiation seen in lightning strikes?

A. Cataract formation

B. Hypertension and tachycardia

C. Mydriasis

D. Tympanic membrane rupture

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Question 5

A 32-year-old woman with no past medical history presents to the emergency department with a four-day history of bloody diarrhea and abdominal cramping. She states that her boyfriend is having similar symptoms but did not want to come to the hospital. Their symptoms started two days after they shared a meal at their favorite fried chicken restaurant. The patient’s vital signs are 37.4℃, HR 89/min, BP 112/70 mm Hg, RR 17/min. Physical examination is significant for moist mucus membranes with brisk capillary refill and mild diffuse tenderness to palpation of the abdomen. Which of the following is the most appropriate management of this patient’s illness?

A. Admit for IV azithromycin and rehydration

B. Admit for IV rehydration and observation for resolution of diarrhea

C. Discharge home with ciprofloxacin

D. Discharge home with metronidazole

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