SAEM M4 Exam-with 100% verified solutions 2024-2025, Exams of Nursing

Download SAEM M4 Exam-with 100% verified solutions 2024-2025 and more Exams Nursing in PDF only on Docsity! SAEM M4 Exam-with 100% verified solutions 2024- 2025 True or False: gastric distension due to excessive volume or rate of ventilation impairing ventilatory function is a reason to intubate a neonate False management for nursemaid elbow injury apply pressure to the radial head while flexing and supinating elbow A 17 year old boy injured his right shoulder playing football. He tried to arm-tackle a player when his right arm was pulled away from his body and back (abducted and extended). He felt a sudden pain in his shoulder. He presents to the emergency department holding his arm in slight abduction and external rotation by his good arm. He has severe pain with adduction or internal rotation. What is the most common fracture associated with this injury? compression fracture of the posteriolateral aspect of the humeral head (Hill-Sachs deformity) What are most common heart rhythms seen in pediatric arrest? bradycardia or asystole risk factors for neonatal resuscitation prematurity IUGR multiple gestation thick meconium In the post-arrest setting, which of the following is the drug of choice in treating hypotension in a child: epi Low body temperatures in newborns can lead to severe physiologic consequences, which include all EXCEPT: Answers: 1. metabolic acidosis 2. increased oxygen consumption 3. hypoglycemia 4. apnea 5. hyperglycemia 3. hypoglycemia In a newborn, bradycardia is most commonly an indicator of: hypoxemia All the following are signs of hypoxemia in a newborn, EXCEPT: Answers: 1.cyanosis 2.lethargy 3.tachycardia 4.unresponsiveness 5.bradycardia 3. tachycardia A newborn presents to the emergency department a few days after hospital discharge. The infant has been noted to be drooling, choking, and coughing, and the mother reports seeing bubbles at the baby's mouth. Which is the most likely explanation? 3.Iron supplement overdose 4.Lithium overdose 1. Acetaminophen overdose A 45 year-old is brought in 8 hours after a large overdose of his lithium. What is the best treatment method for this overdose? Answers: 1.Activated charcoal 2.Gastric lavage 3.Hemodialysis 4.Whole bowel irrigation 3.Hemodialysis A 42 year-old woman presents with an overdose of her Xanax (alprazolam) that her family indicates she has been taking for years to help with her anxiety. The bottle indicates that the prescription was filled yesterday with 90 pills and is now empty. The patient is minimally responsive to painful stimuli and does not react when you suction secretions out of her posterior pharynx. What is your next management step? Answers: 1.Administration of flumazenil 2.Administration of narcan 3.Close observation 4.Intubation for airway support 4.Intubation for airway support A 72 year-old presents with an intentional overdose of a bottle of aspirin about 3 hours prior to presentation in the ED. Which of the following arterial blood gas results would you expect to come from this patient? Answers: 1.pH 7.14 pCO2 68 pO2 102 HCO3 23 2.pH 7.33 pCO2 48 pO2 58 HCO3 29 3.pH 7.45 pCO2 21 pO2 124 HCO3 14 4.pH 7.47 pCO2 31 pO2 96 HCO3 25 3.pH 7.45 pCO2 21 pO2 124 HCO3 14 A teenager presents one hour after ingesting a "handful" of acetaminophen tablets. Which of the following statements is TRUE? Answers: 1.An acetaminophen level drawn at hour four dictates need for antidotal therapy. 2.Serial liver function tests are indicated in all acetaminophen ingestions. 3.Renal sequelae are expected. 4.The intravenous formulation of N-acetylcysteine is safer than oral N- acetylcysteine. 1.An acetaminophen level drawn at hour four dictates need for antidotal therapy. A 2 year old child presents with an overdose of her mother's iron containing multivitamins. What antidote should you consider for iron toxicity? Answers: 1.Deferoxamine 2.Glucagon 3.Methylene blue 4.Pyridoxine 1.Deferoxamine Severe lead toxicity can commonly result in which of the following clinical symptoms Answers: 1.Constipation 2.Dermatitis 3.Memory loss 4.Stocking glove peripheral neuropathy 3.Memory loss A 27 year old woman is brought into the emergency department by her roommate 30 minutes after ingesting a bottle of aspirin in a suicide attempt. Which of the following acid-base disorders is most likely to be present in this patient? Answers: 1.Respiratory acidosis due to somnolence causing decreased respiratory drive 2.Respiratory alkalosis due to stimulation of the respiratory center and increased CO2 production 3.Primary respiratory acidosis with compensatory metabolic alkalosis 4.Primary metabolic acidosis with compensatory respiratory alkalosis 2.Respiratory alkalosis due to stimulation of the respiratory center and increased CO2 production 3.Mannitol and steroids should be administered immediately to any patient suspected of developing cerebral edema. 4.Mortality of patients developing cerebral edema is 90%. 5.Patients with serum glucose below 250 mg/dL still being treated with insulin are most likely to develop clinically evident cerebral edema. 3.Mannitol and steroids should be administered immediately to any patient suspected of developing cerebral edema. Metabolic abnormalities often seen with hypothyroidism include all of thefollowing EXCEPT: Answers: 1.hyponatremia 2.hyperglycemia 3.hypercholesterolemia 4.respiratory acidosis from hypoventilation 5.anemia 2.hyperglycemia Laboratory abnormalities typically seen with adrenal insufficiency include all of the following EXCEPT: Answers: 1.hypoglycemia 2.hyponatremia 3.hypokalemia 4.hypercalcemia 5.azotemia 3.hypokalemia Regarding the treatment of suspected but not confirmed adrenal insufficiency, which of the following is most appropriate? Answers: 1.cosyntropin 0.25mg IV x 1 2.dexamthasone 4mg IV every 6 hours 3.hydrocortisone 100mg IV every 6 hours 4.cortisone 100mg IM every 6 hours 5.withholding of steroids until confirmation of the diagnosis of adrenal insufficiency 2.dexamthasone 4mg IV every 6 hours Symptoms of secondary adrenal insufficiency include all of the following EXCEPT: Answers: 1.weakness 2.anorexia 3.hyperpigmentation 4.nausea and vomiting 5.weight loss 3.hyperpigmentation Treatment with hyperbaric oxygen (HBO) is associated with contraindications. Which of the following is not a relative or absolute contraindication to HBO? Answers: 1.untreated pneumothorax 2.COPD with air trapping 3.otitis media 4.pregnancy 4.pregnancy Which of the following is not a common sign or symptom of thyrotoxicosis? Answers: 1.hypothermia 2.cogestive heart failure 3.tachycardia 4.hyperhidrosis 5.nervousness 1.hypothermia ! Which of the following is true regarding the use of iodine in the treatment of thyroid storm? Answers: 1.Iodine should be the first drug administered in the treatment of thyroid storm. 2.Iodine should be administered only after treatment with propranolol. 3.Iodine should be administered at least one hour after propylthiouracil (PTU) has been given. 1. hydralazine You need to treat an adult with no past medical history, who presents with a hypertensive emergency. You have access to all of the following agents. Which of the following is the preferred agent and initial dose? Answers: 1. clonidine PO 0.1 mg 2. esmolol IV 100-500 mic/kg load 3. hydralazine IM 0.1-0.2 mg/kg 4. labetolol PO 0.2-1.0 mg/kg bolus 5. metoprolol PO 10 mg 2. esmolol IV 100-500 mic/kg load A 24 year old woman is playing racquetball and sustains a direct blow from the ball to the right eye. She presents to the emergency department complaining of eye pain and double vision. On exam, her right eye does not track properly with upward gaze. This finding suggests which of the following injuries? Select all that apply 1.Inferior orbital rim fracture 2.Superior orbital rim fracture 3.Inferior orbital wall fracture 4.Ethmoid fracture 5.Zygomatic arch fracture 3.Inferior orbital wall fracture The most sensitive bedside test for nerve injury in a finger after trauma is: Select all that apply 1.light touch 2.O'Riain wrinkle test 3.pain 4.temperature sensation 5.two-point discrimination 5.two-point discrimination In a patient with a suspected ruptured globe from penetrating trauma to the eye, all of the following should be performed EXCEPT: Answers: 1.administration of broad spectrum antibiotic therapy 2.ascertainment of intraocular pressure via tonometry 3.ascertainment of tetanus status 4.ophthalmology consultation 5.visual acuity assessment 2.ascertainment of intraocular pressure via tonometry Following a motor vehicle crash, a 25 year old man presents complaining of a painful right eye. Visual acuity is 20/200 in the right eye and 20/25 in the left eye. The right eye protrudes from the orbit and the patient has right eye pain with extraocular movement. What is the most likely cause of his symptoms? Answers: 1.chemosis 2.hyphema 3.orbital blow-out fracture 4.retrobulbar hematoma 5.ruptured globe 4.retrobulbar hematoma Following a brawl at a local bar, a gentleman presents with an impressive right-sided periorbital ecchymosis. All of the following physical examination findings would suggest an orbital blowout fracture EXCEPT: Answers: 1.anesthesia of the right infraorbital region 2.diplopia with upward gaze 3.proptosis 4.right-sided epistaxis 5.right-sided infraorbital subcutaneous emphysema 3.proptosis Which of the following cervical spine fractures is considered stable? Answers: 1.Flexion teardrop fracture 2.Bilateral facet dislocation 3.Transverse process fracture 4.Jefferson fracture of C1 5.Hangman's fracture of C2 3.Transverse process fracture Regarding the epidemiology of asthma in the United States, which of the following is true? Answers: 1.Etiology is thought to be genetic, not environmental 2.Incidence is comparable for Caucasians and African-Americans 3.More common in males than females in adult and pediatric populations 4.Prevalence increased in the 1980's, and then decreased in the 1990's 4.Prevalence increased in the 1980's, and then decreased in the 1990's Which of the following patients is the most likely to develop S. pneumoniae pneumonia? Answers: 1.59 year old woman who is a cigarette smoker. 2.61 year old man with hypertension 3.64 year old man with type 2 diabetes 4.65 year old woman with no past medical history 3.64 year old man with type 2 diabetes A 28 year old man is shot in the right chest. His vital signs are: T 97.9, HR 120, BP 70/50, RR 12, SPO2 84%. He has significant JVD, his trachea is deviated to the left, and he has decreased breath sounds on the right. The patient's diagnosis is: Answers: 1.Hypovolemic shock 2.Tension pneumothorax 3.Cardiac tamponade 4.Lung laceration 5.Spinal cord injury 2.Tension pneumothorax Regarding the diagnosis of pulmonary embolism (PE), which is correct. Answers: 1.Autospsy studies indicate that approximately 30% of patients who die in the hospital have undiagnosed PE 2.By 80 years of age, one out of four people will develop deep venous thrombosis 3.One-year mortality of PE is 25% even with early diagnosis and treatment 4.Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in 33% 4.Pulseless electrical activity in Emergency Department cardiac arrest victims is associated with PE in 33% Regarding the role of malignancy in the diagnosis of pulmonary embolism (PE): Answers: 1.Hematologic malignancies such as leukemia and have the highest incidence of venous thromboembolism 2.25% of PE patients without identifiable risk factors are diagnosed with cancer within 2 years. 3.The risk of PE is decreased in patients on chemotherapy 4.Autopsy studies indicate that greater than 60% of patients who die of ovarian cancer have PE. 2.25% of PE patients without identifiable risk factors are diagnosed with cancer within 2 years. A 25 year old female presents with fever, productive cough, and shortness of breath. Physical exam reveals T101, RR 24 and SpO2 of 94%. Her left tympanic membrane is inflamed and there are TM bullae. The chest X-ray reveals a large right middle lobe pneumonia. The organism most commonly associated with this type of presentation is: Answers: 1.Legionella pneumoniae 2.Strep pneumoniae 3.H. influenzae 4.Mycoplasma pneumoniae 5.Moraxella catarrhalis 4.Mycoplasma pneumoniae A pneumonia caused by which of the following organisms is classically associated with currant jelly sputum? Answers: 1.Strep. pneumoniae 2.viral 3.H. influenzae 4.Mycoplasma 5.Klebsiella 5.Klebsiella 3.posterior descending branch of the right coronary artery 4.right coronary artery (RCA) 5.right ventricular branch of the right coronary artery 1.left anterior descending (LAD) A 65-year-old female presents 2 weeks after an MI complaining of chest pain, fever, and shortness of breath. She has a new friction rub on exam and a leukocytosis. She most likely has: Answers: 1.congestive heart failure 2.Dressler's syndrome 3.new myocardial infarction 4.pneumonia 5.pulmonary embolism 2.Dressler's syndrome A 25 year old man returns to the ED, 24 hours after being released from the hospital with a new diagnosis of schizophrenia. He has recently started to take haloperidal for his psychotic symptoms. In the ED he is noted to have involuntary contractions of the muscles of the face, a protruding tongue, deviation of the head to one side, and sustained upward deviation of the eyes. Vital signs are stable, and initial labs show no electrolyte or hematological abnormalities. Of the following choices, the preferred medication for this condition is: Answers: 1.diphenhydramine 2.lorazepam 3.phenobarbital 4.metoprolol 2.lorazepam A 55 year-old male presents with new onset agitation and confusion. Which of the following medical histories would suggest a psychiatric (non- organic) cause? Answers: 1.History of diabetes mellitus only 2.History of alcohol abuse only 3.History of hypothyroidism only 4.History of chronic obstructive pulmonary disease only 3.History of hypothyroidism only A 53 year-old known alcoholic presents with agitation, vomiting and altered mental status. His fingerstick glucose is 148. His serum ethanol level is undetectable and his head CT is normal. An ABG shows a pH of 7.21, pCO2 of 34, pO2 of 98 on room air. His basic chemistry panel includes a sodium of 136, potassium 4.1, chloride 108, bicarbonate 14, BUN 12, creatinine 1.1. What substance are you concerned that he may have ingested Answers: 1.Ethylene glycol 2.Salicylates 3.Isopropyl alcohol 4.Methanol 3.Isopropyl alcohol A 60 year old male presents with new onset confusion. Which of the following suggests a functional, as opposed to an organic etiology? Answers: 1.abnormal vital signs 2.acute onset 3.auditory hallucinations 4.disorientation 3.auditory hallucinations An 80 year old nursing home patient is brought to the emergency department with an acute onset of confusion. Which of the following metabolic abnormalities is the most likely explanation? Answers: 1.hypocalcemia 2.hypokalemia 3.hypernatremia 4.hyperphosphatemia 3.hypernatremia All patients with shock should receive as the first priority: Answers: 1.Trendelenburg positioning 2.Supplemental oxygen 3.Intravenous fluids 4.Antibiotics 3.Group A beta-hemolytic Streptococcus All of the following are common complications of septic shock EXCEPT: Answers: 1.Disseminated intravascular coagulation (DIC) 2.Adult respiratory distress syndrome (ARDS) 3.Acute tubular necrosis (ATN) 4.Pulmonary embolus (PE) 5.High-output congestive heart failure (CHF) 4.Pulmonary embolus (PE) Which of the following is not a known complication of subarachnoid hemorrhage in the immediate several weeks following the initial bleed? Answers: 1.seizure 2.cerebral artery vasospasm 3.rebleeding 4.hydrocephalus 5.hypernatremia 5.hypernatremia Which of the following descriptors of epidural hematoma is FALSE? Answers: 1.Biconvex blood collection between the skull and dura 2.Most often a result of a skull fracture that traverses a venous sinus 3.Classically associated with a "lucid" interval prior to coma 4.Present in only about 1% of severe head injury patients 5.Immediate surgical evacuation is indicated 2.Most often a result of a skull fracture that traverses a venous sinus ! Epidural hematomas are least likely in which age group? Answers: 1.Children less than 2 years 2.Children between 8 and 14 3.Elderly 4.Adults excluding elderly 5.Prevalence is the same throughout age groups 1.Children less than 2 years Which of the following symptoms is not associated with epidural hematomas? Answers: 1.Sleepiness 2.Nausea 3.Severe headache 4.Neurologic deficits 5.Hemotympanum 5.Hemotympanum ! A 65 year old male with a past medical history of poorly controlled hypertension presents with new onset unilateral arm and leg weakness. There is no disturbance of consciousness and there is no evidence of cortical findings (such as aphasia, agnosia, or hemianopsia). What is the most likely location of the vascular obstruction? Answers: 1.anterior cerebral artery 2.middle cerebral artery 3.posterior cerebral artery 4.lacunar 5.basilar artery 4.lacunar Which of the following might suggest central rather than peripheral vertigo? Answers: 1.Sudden onset 2.Diplopia 3.Horizontal nystagmus on extreme lateral gaze 4.Transient and episodically related to head movement 5.Prominent vomiting and diaphoresis 2.Diplopia spasm of the glottis and rigidity of the chest wall musculature. Which of the following analgesics was likely used? Answers: 1.Demerol 2.Dilaudid 3.Fentanyl 4.Morphine 3.Fentanyl A 25 year old male college student with a history of type I diabetes mellitus presents to the emergency department complaining of worsening headache, vomiting, and fever. On exam, he has a temperature of 101.6 F, meningismus, and photophobia. A lumbar puncture is performed and reveals a CSF glucose consistent with bacterial meningitis. What is the normal ratio between CSF and serum glucose? Answers: 1. 1:1 2. 2:1 3. 0.4:1 4. 0.6:1 4. 0.6:1 An 18 year old male is transported to the emergency department after being involved in a motor vehicle collision. On initial evaluation, he is found to be comatose, hypotensive, and is diagnosed clinically as having a tension pneumothorax on the left side. What is the correct statement regarding needle decompression or chest tube placement in this patient? Answers: 1.A chest x-ray is unnecessary before needle decompression 2.An 18 French chest tube would be appropriate in this situation. 3.Placement of the needle should be in the 3rd ICS, midaxillary line. 4.The chest tube should be inserted under the lower edge of the rib 1.A chest x-ray is unnecessary before needle decompression A fracture in which there are more than two fragments is: Answers: 1.compound 2.comminuted 3.oblique 4.spiral 5.transverse 2.comminuted Incomplete angulated fractures of long bones are denoted by the term: Answers: 1.greenstick fracture 2.march fracture 3.open fracture 4.Salter-Harris fracture 1.greenstick fracture What other injury(s) may be associated with calcaneal fracture after a fall? Answers: 1.C-1 fracture 2.closed head injury 3.lumbar compression fracture 4.pelvis fracture 5.spleen injury 3.lumbar compression fracture A 35 year old woman presents complaining of left wrist pain for several months. She works as a waitress and has noticed increasing wrist pain associated with intermittent numbness and tingling of her thumb, index finger and long finger on the left hand. She states the pain is worse at night and after work. On exam she has tingling in her leftthumb and first digit when her wrists are held in flexion for 60 seconds. This is a positive ____________ test and suggests the diagnosis of ______________. Answers: 1.Finkelstein test/De Quervain's tendonitis 2.Phalen's test/carpal tunnel syndrome 3.Phalen's test/ulnar nerve compression 4.Tinel's sign/carpal tunnel syndrome 5.Tinel's sign/radial nerve compression 2.Phalen's test/carpal tunnel syndrome Which of the following statements regarding the topical ophthalmic anesthetic proparacaine is TRUE? All of the following may be used in the treatment of acute angle closure glaucoma (AACG) EXCEPT? Answers: 1.carbonic anhydrase inhibitors 2.laser iridectomy 3.mannitol 4.mydriatic agents 5.topical beta blockers 4.mydriatic agents Which of the following eye drops will dilate the pupil? Answers: 1.pilocarpine 2.Pred Forte 3.proparacaine 4.sulfacetamide 5.tropicamide 5.tropicamide A 5 year old boy presents with fever and sore throat. On physical exam, the child has enlarged tonsils with exudates. Which of the following is true? Answers: 1.The etiology of the infection is most likely bacterial 2.Viruses rarely cause exudative pharyngitis 3.If the infection is bacterial, the primary role of antibiotic therapy is to prevent complications 4.Treatment of choice is azithromycin 5.Vaccination prevents recurrence 3.If the infection is bacterial, the primary role of antibiotic therapy is to prevent complications All of the following are true regarding adult epiglottitis EXCEPT: Answers: 1.Type b H. influenza is the most common bacterial pathogen to cause acute epiglottitis. 2.Adult epiglottitis is a cellulitis of the supraglottic structures of the airway including the epiglottis, vallecula, and the base of the tongue. 3.The incidence of adult epiglottitis has increased in recent years, whereas the incidence of pediatric epiglottitis has decreased. 4.Smokers have a higher incidence of adult epiglottitis. 5.The rapidity of symptoms' onset does not correlate with the likelihood of need for airway intervention. 5.The rapidity of symptoms' onset does not correlate with the likelihood of need for airway intervention. The five diagnostic criteria for Ludwig's angina include all the following EXCEPT: Answers: 1.large amounts of visible pus in the submandibular space 2.bilateral cellulitis 3.presence of gangrene 4.sparing of the glandular tissues 5.spread of cellulitis by continuity, not by lymphatics 1.large amounts of visible pus in the submandibular space A 58 year old woman presents to the emergency department one day after her cat bit her index finger. Physical examination shows signs of flexor tenosynovitis. She is admitted to the hospital for IV antibiotics, hand elevation, and emergent hand surgery consultation to consider debridement of the finger. Which of the following would be least likely expected in a patient with flexor tenosynovitis? Answers: 1.tenderness over the flexor tendon sheath 2.swelling of the finger 3.pain with passive extension 4.erythema of the flexor surface of the involved digit 4.erythema of the flexor surface of the involved digit A patient with a history of difficult-to-control hypertension is now 6 to 8 weeks pregnant and presents with a hypertensive emergency. Which of the following IV antihypertensives should be avoided? Answers: 1.nitroprusside 2.hydralazine 3.esmolol 4.labetolol 5.nicardipine 1.nitroprusside The pharmacologic interventions most likely to improve outcome when given in the field, as compared to those given upon arrival in the emergency department, include all of the following EXCEPT: Answers: 1.dextrose 2.epinephrine 3.albuterol 4.adenosine 5.diazepam 4.adenosine Regarding the EMS role in prehospital care, all the following are true EXCEPT: Answers: 1.Survival after cardiac arrest is less than 10% when resuscitation efforts are initiated after 10 minutes from the arrest. 2.Thrombolytic therapy in the field is the standard of care for patients suspected of having an acute coronary syndrome. 3.Pharmacotherapy that can be initiated in the field by paramedics in mostjurisdictions includes naloxone for opiate overdose, diazepam for seizure control,and beta agonists for acute asthma exacerbations. 4.Automatic external defibrillators (AEDs) can be used by firefighters, policemen andother trained first responders. 5.EMS personnel evaluate and release many patients they deem well enough not toneed hospital treatment. 2.Thrombolytic therapy in the field is the standard of care for patients suspected of having an acute coronary syndrome. A 53 year old man with non-insulin dependent diabetes mellitus presents with pain, redness, and swelling of the right foot and lower leg, accompanied by a temperature of 102. X-rays reveal no subcutaneous gas and show no evidence of osteomyelitis. The patient has been admitted on three previous occasions for cellulitis of the right foot and notes that this episode is identical. Which of the following antibiotics is the most appropriate initial therapy for a presumed diagnosis of cellulitis? Answers: 1.oral dicloxacillin 2.intravenous nafcillin 3.intravenous gentamicin 4.intravenous ampicillin-sulbactam 5.intravenous cefazolin 4.intravenous ampicillin-sulbactam Which of the following is FALSE regarding the common skin disorder, seborrheic dermatitis? Answers: 1.characterized by erythema and waxy scaling 2.uncommon between infancy and puberty 3.differential diagnosis includes Tinea capitis, psoriasis of scalp, cutaneous lupus erythematosus 4.initial therapy often consists of high dose topical steroids 5.found in skin folds and hair-bearing of face scalp, chest and groin 4.initial therapy often consists of high dose topical steroids ! A Wood's light is an ultraviolet source that emits light of 365nm wavelength resulting in different fluorescent patterns when directed at different organisms. Which of the following correctly matches the organism to its fluorescent pattern? Answers: 1.Erythrasma - red or pink 2.Tinea versicolor - green or yellow 3.Pseudomonas - yellow or green 4.Porphyria cutanea - urine color change to orange or yellow 5.All of the above 5.All of the above Which of the following is true regarding topical corticosteroid use? Answers: 1.Potency is measured by the ability to induce vasoconstriction. 2.To achieve large differences in potency, it is more effective to vary the dose of a particular steroid than to change the type of steroid. 3.Once initiating topical steroids, it is best to maintain the same application schedule without interruption until the symptoms no longer remain. 4.Hydrocortisone is the preferred agent for areas of the body characterized by thickened skin (e.g. palms and soles). 5.Fluorinated steroids should be used in pregnant woman. 1.Potency is measured by the ability to induce vasoconstriction. ! In establishing a differential diagnosis of abdominal pain, which of the following is true? Answers: 1.The onset of pain prior to the occurrence of nausea and vomiting is more often suggestive of a surgical etiology. 2.Cervical motion tenderness is a useful physical finding for differentiating women with or without acute appendicitis. 3.In patients with sickle cell anemia who present with abdominal pain and diarrehea, shigellosis should be a top consideration. 4.Radiation of pain to the scapula is suggestive of acute hepatitis. 5.Diverticultis tends to cause pain in the right upper quadrant. 1.The onset of pain prior to the occurrence of nausea and vomiting is more often suggestive of a surgical etiology. Of the following pain patterns, which is likely associated with diagnosis of peptic ulcer disease? Answers: 1.non-radiating, burning epigastric pain 2.pain that awakens a patient in the middle of the night 3.unrelenting pain over a period of weeks 4.relief of abdominal pain with antacids 5.pain that is worse preceding a meal 3.unrelenting pain over a period of weeks A 46 year old woman presents to the emergency department complaining of abrupt onset of intermittent severe pain in the left flank and abdomen that woke her from sleep. She is pacing around the stretcher and appears extremely uncomfortable. She has never experienced this type of pain previously and denies fevers or other symptoms. Renal calculus is suspected. Which of the following is true regarding the diagnosis of renal calculi in this patient? Answers: 1.Urnalysis demostrating hematuria confirms the diagnosis. 2.KUB detects less than 10% of calculi. 3.Ultrasound is the study of choice for detecting small ureteral calculi. 4.Helical CT scan greater than 95% sensitve and specific for renal calculi. 5.Intravenous pyelogram (IVP) may be used in patients with renal insufficiency. 4.Helical CT scan greater than 95% sensitve and specific for renal calculi. Regarding esophageal perforation, which of the following is INCORRECT: Answers: 1.Over 90% of spontaneous esophageal perforations occur in the proximal esophagus. 2.Esophageal perforation may result from forceful vomiting, coughing, childbirth or heaving lifting. 3.Over 80% of esophageal are iatrogenic, usually as complications of upper endoscopy, dilation, or sclerotherapgy. 4.Esophageal perforation has been reported as a complication of nasogastric tube placement, endotracheal intubation, and esophagotracheal Combitube intubaton. 5.latrogenic perforations of the esophagus usually occur in the proximal esophagus or esophagogastric junction. 1.Over 90% of spontaneous esophageal perforations occur in the proximal esophagus. Of the options below, the therapy best for symptomatic 3rd degree heart block is: Answers: 1.lidocaine 2.transcutaneous pacer 3.atropine 4.oxygen 5.cardioversion 2.transcutaneous pacer The best treatment, of the options below, for a patient with second degree AV block Mobitz Type II is: Answers: 1.amiodarone 2.epinephrine 3.aspirin 4.transvenous pacing 5.lidocaine 4. transvenous pacing A previously healthy 25 year old female arrives at the emergency department with 3 days of headache, nausea, palpitations, and diaphoresis. She initially presented 2 days ago to the hospital's walk-in clinic, where her blood pressure was found to be moderately elevated. At her clinic visit, the initial evaluation for end-organ damage was negative.