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Emergency Medicine Pretesttm Self-Assessment and Review Notice Emergency Medicine PreTestTM Self-Assessment and Review Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the prod- uct information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Emergency Medicine PreTestTM Self-Assessment and Review Second Edition Adam J. Rosh, MD, MS Assistant Professor Department of Emergency Medicine Wayne State University School of Medicine Assistant Residency Director Detroit Receiving Hospital Detroit, MI New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009, 2008 by The McGraw-Hill Companies, Inc. All rights reserved. Except as per- mitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-159862-0 MHID: 0-07-159862-6 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-159861-3, MHID: 0-07-159861-8. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. Where such designations appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To contact a representative please e-mail us at [email protected]. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGraw-Hill”) and its licen- sors reserve all rights in and to the work. Use of this work is subject to these terms. Except as per- mitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETE- NESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any dam- ages resulting therefrom. McGraw-Hill has no responsibility for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. Contributors Tara R.Sood, MD Resident, Department of Emergency Medicine New York University/Bellevue Hospital Center New York, NY Chapter 17 Fernando Soto, MD Associate Professor Pediatric Emergency Medicine Section University of Puerto Rico Chapter 13 Ethan S.Wiener, MD Associate Director Pediatric Emergency Medicine Goryeb Children’s Hospital Morristown Memorial Hospital Morristown, NJ Chapter 13 This page intentionally left blank Student Reviewers Radhika Lu Bauer, PhD NYU School of Medicine Class of 2010 Phillip G. Blanc Harvard School of Public Health UMDNJ-Robert Wood Johnson Medical School MPH/MD Candidate Class of 2009 Mary Bonar, DO Penn State University Medical Center Department of Emergency Medicine PGY-1 Ilana Harwayne-Gidansky SUNY Downstate College of Medicine Class of 2009 Dip Jadav Texas A&M Health Science Center College of Medicine Class of 2008 Tina Nguyen, MD Harbor-UCLA Medical Center Department of Emergency Medicine PGY-1 vii This page intentionally left blank Contents Introduction . xiii Acknowledgment . xv Chest Pain and Cardiac Dysrhythmias Questions . 1 Answers . 24 Shortness of Breath Questions . 49 Answers . 63 Abdominal and Pelvic Pain Questions . 77 Answers . 105 Trauma Questions . 129 Answers . 148 Fever Questions . 177 Answers . 190 Shock and Resuscitation Questions . 207 Answers . 221 Poisoning and Overdose Questions . 235 Answers . 250 ix x Contents Altered Mental Status Questions . 267 Answers . 280 Gastrointestinal Bleeding Questions . 297 Answers . 306 Musculoskeletal Injuries Questions . 317 Answers . 332 Headache Questions . 345 Answers . 357 Weakness and Dizziness Questions . 373 Answers . 385 Pediatrics Questions . 399 Answers . 419 Vaginal Bleeding Questions . 439 Answers . 450 Environmental Exposures Questions . 461 Answers . 474 Contents xi Eye Pain and Visual Change Questions . 489 Answers . 497 Wound Care Questions . 507 Answers . 514 Endocrine Emergencies Questions . 521 Answers . 526 Psychosocial Disorders Questions . 533 Answers . 540 Bibliography . 549 Index . 553 This page intentionally left blank Introduction Emergency Medicine: PreTest Self-Assessment and Review, Second Edition, is intended to provide medical students, as well as house officers and physi- cians, with a convenient tool for assessing and improving their knowledge of emergency medicine. The 500 questions in this book are similar in for- mat and complexity to those included in Step 2 of the United States Medical Licensing Examination (USMLE). They may also be a useful study tool for Step 3 and clerkship examinations. Each question in this book has a corresponding answer, a reference to a text that provides background for the answer, and a short discussion of various issues raised by the question and its answer. A listing of references for the entire book follows the last chapter. For multiple-choice questions, the one best response to each question should be selected. For matching sets, a group of questions will be preceded by a list of lettered options. For each question in the matching set, select one lettered option that is most closely associated with the question. To simulate the time constraints imposed by the qualifying examina- tions for which this book is intended as a practice guide, the student or physician should allot about one minute for each question. After answering all questions in a chapter, as much time as necessary should be spent reviewing the explanations for each question at the end of the chapter. Atten- tion should be given to all explanations, even if the examinee answered the question correctly. Those seeking more information on a subject should refer to the reference materials listed or to other standard texts in emergency medicine. xiii This page intentionally left blank Acknowledgment A hearty thanks goes out to my family for their love and support, especially Ruby; the dedicated medical professionals of the Emergency Departments at New York University/Bellevue Hospital and Wayne State University/Detroit Receiving Hospital; Catherine Johnson for giving me this opportunity, and my patients, who put their trust in me, and teach me something new each day. —AJR xv This page intentionally left blank Chest Pain and Cardiac Dysrhythmias Questions 1. A 59-year-old man presents to the emergency department (ED) com- plaining of new onset chest pain that radiates to his left arm. He has a his- tory of hypertension, hypercholesterolemia, and a 20-pack-year smoking history. His electrocardiogram (ECG) is remarkable for T-wave inversions in the lateral leads. Which of the following is the most appropriate next step in management? a. Give the patient two nitroglycerin tablets sublingually and observe if his chest pain resolves. b. Place the patient on a cardiac monitor, administer oxygen, and give aspirin. c. Call the cardiac catheterization laboratory for immediate percutaneous inter- vention (PCI). d. Order a chest x-ray; administer aspirin, clopidogrel, and heparin. e. Start a β-blocker immediately. 2. A 36-year-old woman presents to the ED with sudden onset of left- sided chest pain and mild shortness of breath that began the night before.
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