The next patient that you are seeing in the ED is a 17 y/o female that is brought into the ED from the country club that she worked at. She was cleaning up at the snack bar when the deep fryer exploded and hot oil went all over her face, forearms, and chest. Upon evaluation you note that the skin is white to yellow in color. When you apply pressure to the skin it can be felt but there is diminished two point discrimination. Cap refill is 8 seconds in the fingers and <2 seconds in the toes. Pt states she is not feeling pain but she is incredibly anxious and in a moderate amount of distress secondary to pain. What degree of burn does this patient have and what percentage of the body surface does it cover?
Superficial partial thickness; 18%
Deep partial thickness; 27%
Full thickness; 18%
4th degree; 27%
Calculate the amount of fluids that should be given to the patient in question 1. Assume she is 60 kg. The EMS has given her a 500 mL PTA. How much additional fluid would you give her in mL/hr assuming you are starting the fluids 1 hour after the burn?
166 mL per hour lactated ringers for first 8 hours; 100 mL per hour lactated ringers for next 16 hours
166 mL per hour dextran; 100 mL per hour lactated ringers for next 16H
391 mL/hr of lactated ringers for next 7 hours (to finish out the first 8 hours) and then 202.5 mL/hr lactated ringers for next 16 hrs
Your next patient to see on your post surgical rounds is a 35 y/o obese white female w/ hx of HTN and hyperlipidemia who is 2 days post cholecystectomy. Pt states she has been up moving around but that she suddenly began to have some abdominal pain and tension/tightness in her shoulders and jaw. Which of the following is your top ddx?
Which of the following medications should not be given to someone with cardiogenic shock?
Beck's Triad consists of jugular venous distention, hypotension, and distant or muffled heart sounds is associated with which condition?
Which of the following is the gold standard for cardiac enzymes for the determination of an acute MI?
Which of the following should be administered to someone with an acute NSTEMI?
Your next patient is a 55 y/o male with diabetes who is post op day 2 of a hernia repair. Pt now has redness, warmth and tenderness around his surgical incision. Which of the following set of organisms might be responsible for the infection?
S. aureus, S. epidermidis, S pyrogenes
C. Diff, VRE, Enterobacter, Bacillilus
E. Coli, Pseudomonas, Klebsiella, Proteus
N. Meningitis, Arbor Virus, Staph, Chlamydia
Pt is a 24 y/o male who comes into the ED due to copious amounts of bloody diarrhea over the past several days. Pt states they he is having an average of 7 BM per day, and that he has lost 10 pounds without trying to in the last month, since the sx began. On exam Pt is ill appearing w/ a HR of 110, BP 100/60, T 39C. What is your top differential at this time?
Pt is a 60 y/o woman who comes to the ED due to LLQ pain which is 9/10 in severity and nausea and vomiting. On exam Pt has tenderness w/ rebound and guarding in the LLQ. Pt is actively vomiting. On further review of records Pt has a prior CT scan which showed diverticulosis in the LLQ. What is your first steps in treating this patient
BMP/CBC, Bowel Rest (NPO), Morphine 0.1 mg/kg IV and levofloxacin 750 mg IV, zofran 4 mg IV
Pt is a 65 y/o male who is post op day 3 from a bowel resection for colon cancer. He has been doing well until recently. His family members note that he has become acutely confused and is worried that he is developing dementia. As the genius you are you note that he still has his indwelling foley cath that was supposed to be removed post-op day 1. Which of the following is your top diagnosis?
Drug reaction to morphine sulfate
Pt is a 28 y/o female 20 weeks pregnant with her first child. She comes to the ED because she is experiencing more fatigue than normal, dyspnea, and what she believes are palpitations. On exam you note that there is a late systolic murmur that crescendos into S2 with a midsystolic click. The patient is worried she is having a heart attack. What are you going to tell her is probably the issue and what is your treatment of choice?
Mitral Valve Prolapse; atenolol
Acute MI; ASA
Nothing... she's just pregnant and a hypochondriac
Which of the following is NOT an absolute contraindication to have a classic stress test?
Acute MI w/in 2 days
Unstable angina not stabilized by medical therapy
Rate contorolled AFib
Symptomatic severe aortic stenosis
A 27 y/o male is brought to the ED by the EMS after being found by his parents unconscious in his bathroom at home. On exam you note that the pt has perioral cyanosis and constricted pupils. Pt is very slightly responsive to painful stimuli but is otherwise nonresponsive. Pt's vitals show RR 10 BP 80/50 HR 120. What is your first step in treating this patient?
The finding of Xanthrochromia is classic in epidural hematomas
Which of the following is not a sign of acute myocardial infarction?
All of the symptoms can be s/s of MI
Which of the following is not part of the treatment for a salicylate overdose?
Charcoal 1 g/kg to minimize absorption and hasten elimination
Pt is brought in by EMS to your ER after being stuck in their car was stranded on I-75 on the snowpocalypse. The EMS wrapped him in blankets warmed in moist heat. Upon arrival to the ED you note that there is mild edema and erythema on their hands and toes w/o blisters. Pt states that PTA he noted burning and stinging in his fingers and toes. Now Pt states that his fingers and toes are simply throbbing.
1st degree frostbite AKA "Frostnip"
2nd Degree Frostbite
3rd Degree Frostbite
Pt comes in to the ED with a cat bite on his forearm. Pt is in no acute distress and hemostasis was achieved just PTA. When you look at the wound you note that there is 3 puncture wounds on the L forarm. What is your first step in managing this Pt's cat bite?
Irrigate with copious amounts of normal saline and debridement of devitalized tissue
Prophylactic abx w/ amoxicillin/clavulanate
Which of the following is not a risk factor for post surgical infections?