A 62-year-old female with a medical history of COPD and angina presents with acute onset of dizziness, chest pain and shortness of breath. Her HR is 152 and BP is 86/56. Her EKG shows irregular narrow complex rhythm without P waves. Treatment?
A. Metoprolol IV, then consult
B. Digoxin IV, then consult
C. Synchronized cardioversion, then consult
D. Pacemaker, then consult
A 72-year-old male from a nursing home with a history of dementia presents with fever and poor eating. He is febrile with a temp of 102.4 rectal. His BP is 146/80 and pulse is 101. Urine is negative for WBC and CXR is below. What is the best initial intervention?
A. Surgical consultation
B. Nitro and start BiPAP
C. Proventil / ipratropium
D. Ceftriaxone / azithromycin
This EKG represents an inferior lateral wall STEMI. There are ST elevations in the inferior leads II, III, aVF as well as V5 and V6. The reciprocal changes are noted in aVL, V1, V2.
A 43-year-old female complaining of right upper quadrant pain for 2 hours that she describes as a constant 9/10. States she has gone “vegan” after recent foods gave her heartburn. Pulse is 112, BP 122/82 and T = 102.4. What is your diagnosis?
A. Ascending cholangitis – Physician consultation
B. Acute appendicitis – CT scan
C. Choledocholithiasis – Ultrasound
D. Acute pyelonephritis – Start antibiotics
A 46-year-old male presents after a motorcycle crash. He has altered mental status and is hypotensive. CXR is below. What the best management?
A. Duonebs and BiPAP
B. Duonebs and steroids
C. Invasive procedure and consult
D. Chest CT and IV fluids
A 42-year-old male presents with intolerable, intermittent vertigo with movement of his head that last for approximately one minute. What is the recommended initial management?
A. Dix-Hallpike maneuver
B. MRI and consult
C. Transcranial Doppler ultrasound and consult
D. Orthostatic vital signs and IV fluid administration
A. LBBB – Locate old ECG
B. Pericarditis – Start NSAIDS
C. STEMI – Give aspirin and consult
D. Early repolarization – Order GI cocktail
An 18-month-old boy is brought in via ambulance after becoming unresponsive in the grocery store with his aunt. He was walking with her and became agitated when she would not allow him to get the candy he wanted. As he began to cry, his aunt observed him become somewhat cyanotic, after which, he squatted down for about 30 seconds before he suddenly collapsed. He was unresponsive for about 10 seconds before regaining consciousness.
Upon examination, you are able to hear a holosystolic murmur along the left sternal border that widely radiates throughout the precordium. What is the best initial intervention?
A. Echocardiogram
B. Behavioral counseling
C. Intravenous fluids
D. Immediate physician referral
A 56-year-old man presents with chest pain that started 30 minutes ago. He rates the pain as an 8 on a scale of 10 and states it is radiating from his left chest into the neck and arm. He also feels nauseated and has been sweating. His past medical problems include HTN and hyperlipidemia, for which he takes HCTZ and atorvastatin (Lipitor). His EKG is shown.
What is the correct diagnosis?
A. Anterior Wall MI
B. Dressler Syndrome
C. Inferior Wall MI
D. Pericarditis
A 67-year-old man presents with sudden onset paralysis of the lower extremities that started with acute onset of severe chest pain. He became nauseated and light headed about the same time. EKG appears normal. The chest radiograph is shown. He has smoked 1 pack/day since age 25.
What is the most appropriate initial intervention?
A. Stat head CT
B. Stat MRI of LS spine
C. Straight leg raises
D. Abdominal ultrasound
E. Immediate physician referral
A 43-year-old woman presents for evaluation of fatigue, malaise and pharyngitis. Her fever of 100.7°F started eight days ago after she underwent abscess drainage from her gums. She thought it would get better; however, it is persistent and now she has noticed painless lesions shown on her hands and feet.
During examination, you also notice subungual hemorrhages of her fingers. Chest radiograph shows pulmonary infiltrates. During cardiac auscultation, you hear a murmur suggestive of tricuspid regurgitation that the patient denies having previously been knowledgeable of.
What is the most appropriate intervention?
A. Echocardiogram and blood cultures
B. Antibiotics
C. Anticoagulants
D. Immediate physician referral
A 63-year-old man was hospitalized 24 hours ago for acute myocardial infarction. He is found obtunded in his bed by the nursing staff. His blood pressure is 82/56 mmHg and heart rate is 126 bpm. He is clutching his chest and appears dyspneic. Auscultation of his lungs reveals new onset rales.
What is the most appropriate initial intervention?
A. Vasopressors
B. Fluid bolus and reevaluation
C. BiPAP and nitroglycerin
D. Immediate physician referral
A 3-year-old girl is brought in for evaluation of pharyngitis, a fever of 103.7° F, anorexia, restlessness and drooling. She appears acutely ill and does not want to answer any of your questions. When she does answer, her voice sounds muffled. Additionally, you note inspiratory stridor.
These examination findings are most suggestive of which condition?
A. Croup
B. Epiglottitis
C. Peritonsillar abscess
D. Pertussis
E. Tonsillitis
A 24-year-old woman presents with complaints of intermittent vertigo. She has had seven days of symptoms within the past two months. Episodes last between 30 and 45 minutes. She indicates that she has a sensation of the room spinning and usually has a ringing sensation in her ears. The audiometry readings obtained at your visit indicate a low-frequency sensory hearing loss.
What is the most appropriate diagnosis?
A. Cholesteatoma
B. Cerumen impaction
C. Meniere’s disease
D. Migraine headache
E. Transient ischemic attack
A 24-year-old woman presents with symptoms of unquenchable thirst after being prescribed 60mg prednisone for seven days in the treatment of contact dermatitis. Dipstick of her urinalysis reveals a specific gravity of 1.004 that is otherwise normal.
She does not care for the taste of tap water and therefore drinks bottled water, which allows her to confidently say she drinks ten or more liters per day. Uric acid levels are found to be 420 µmol/L. Glycosylated Hemoglobin is 5.4%.
Which of the following are the most appropriate diagnosis and first step?
A. Cushing syndrome – MRI
B. Diabetes insipidus – Consult
C. Diabetes mellitus – Start PO Med
D. Parkinson disease – Consult neurology
E. Psychogenic polydipsia – Consult psych
A 76-year-old woman presents with acute onset of periumbilical abdominal pain three hours ago. Her past medical history is significant for hypertension and peripheral artery disease. An echocardiogram performed three months ago showed left ventricular ejection fraction of 38%.
She states she is severely nauseous and has vomited four times, as well as having three bowel movements since onset. Her physical examination of her abdomen is non-revealing. She has no rebound tenderness, no specific point tenderness, no palpable splenomegaly or hepatomegaly. She does have heme positive stool in the vault.
What is the most appropriate diagnosis?
A. Acute kidney injury
B. Acute mesenteric ischemia
C. Congestive heart failure
D. Crohn’s disease
E. Diverticulitis
A 28-year-old man presents with symptoms of testicular pain. He indicates that two days before evaluation he was lifting and moving heavy gym equipment. He describes the pain as having developed in the scrotum but now radiates along the spermatic cord.
On exam, he is exquisitely tender along the posterior portion of the left scrotum, where a single enlarged, tender mass is palpated. The inguinal canals are normal to palpation and Prehn’s sign is positive.
Which of the following is the most likely diagnosis?
A. Cancer
B. Epididymitis
C. Indirect hernia
D. Renal calculi
E. Testicular torsion
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