Grandest of Views
"Back in 1902"
"What we do is hard"
Allergic to BS
Oh my back!
100
You are implementing the START triage system. A 45-year-old woman is ambulatory, follows commands, has a respiratory rate of 24/min, and a radial pulse is palpable. What triage category should this patient receive?
What is Minor (Green)
100
Alcoholic male with left lower lobe pneumonia on chest X-ray. Name most common bacteria that causes pneumonia.
Pneumococcal/Strep pneumo
100
5 y.o. boy with ingestion at home. Comes in sedated with RR 15, BP 70/50, O2 sat 92% on RA, pupils 1-2 mm bilateral and reactive. EKG shows initially prolonged QT but patient then develops polymorphic VTach. What is the most likely medication/substance ingested?
Methadone
100
What is the next best step?
Consult GI for emergent EGD
100
22 y.o. male is stabbed in chest and has SOB: bedside US is below. What is the next best step
Chest tube
200
The Incident Command System is utilized in large mass gathering or mass casualty incidents. What title is given to the individual responsible for overseeing the entire command system?
What is the Incident Commander
200
What clinical factor differentiates heat stroke from heat exhaustion?
CNS dysfunction/Altered mental status
200
5 y.o. boy ingested antifreeze in the garage. He presents with tachycardia but otherwise is stable and resting comfortably. What urine lab abnormality would you expect to find?
Calcium oxalate crystals in the urine
200
45 y.o. woman drinks drain cleaner in a suicide attempt. What acid-base injury occurs and what diagnostic procedure needs to be done within 12 hrs?
Alkaline injury (liquefactive) - EGD
200
77 y.o. male presents with flashes in his right eye then painless vision loss. Below is bedside US imaging: what is the diagnosis?
Retinal detachment
300
A patient presents after a nearby explosion with hearing loss and bloody otorrhea. Otoscopic exam reveals tympanic membrane perforation.As both structures share similar vulnerability, what thoracic injury must be evaluated for?
What is a pneumothorax
300
What is the earliest laboratory indicator of acute radiation syndrome?
Decreased abs lymphocyte count
300
2 yo girl ingested a couple of her grandparent's tablets. She presents with bradycardia, hypotension but otherwise stable and alert. Pupils are normal and reactive. EKG shows sinus bradycardia. Blood glucose is normal. What is the medication ingested?
Beta-blocker
300
What classic physical examination finding helps establish a diagnosis of hepatic encephalopathy?
Asterixis
300
44 y.o. woman presents with atraumatic right leg swelling, with pain and erythema. Below is ultrasound image while pressing on the affected area. What is the diagnosis and treatment?
DVT: anticoagulation
400
In the MARCH algorithm derived from Tactical Combat Casualty Care, reflecting as the leading cause of preventable death in mass shootings, what does "M" stand for?
What is Massive Hemorrhage
400
Patient is brought in from a house fire. Labs show elevated lactic acid with metabolic acidosis on ABG. What is most important medicine to give?
Hydroxocobalamin (Cyanokit)/Sodium thiosulfate + nitrites
400
A 48 yo woman overdoses on Aspirin. What type of acid-base disturbance will be seen on labs and blood gas?
Metabolic acidosis and respiratory alkalosis
400
What is the most common finding on abdominal CT in a patient with acute mesenteric ischemia?
Bowel wall edema
400
62 y.o. male with lung cancer presents with SOB. On exam, he is tachycardic, hypotensive, has jugular venous distention, and muffled heart sounds. On bedside US, what sonographic finding is most diagnostic for his condition?
Diastolic right ventricular wall collapse
500
What 1966 publication, often called the "white paper," highlighted the inadequacy of emergency medical care in the United States and catalyzed the development of modern EMS systems?
What is "Accidental Death and Disability: The Neglected Disease of Modern Society"?
500
Neck pain after MVC. Upper extremity strength 1/5, lower extremity strength 4/5. What is the neurologic/spinal syndrome?
Central Cord Syndrome
500
Name 3 indications for emergent hemodialysis in acute aspirin/salicylate toxicity
1) Rapidly rising ASA level
2) ASA acute level >100 mg/dL; chronic >40 (60) mg/dL
3) Altered mental status/seizure (cerebral edema)/coma
4) Kidney or liver failure
5) Pulmonary edema
6) Severe acid-base abnormality/pH <7.2
7) Worsening clinical condition despite therapy
500
48 y.o. woman has worsening RUQ pain 8 hrs after eating lunch that is sharp and radiating to her right shoulder. On exam, she is tachycardic, has scleral yellowing with epigastric/RUQ tenderness. Which noninvasive imaging study is the most sensitive for her condition?
MRCP
500
In the rapid ultrasound for shock and hypotension (RUSH) exam, which view of the heart assesses for right ventricular failure/enlargement, and what pathology would this indicate?
Apical four-chamber view; pulmonary embolism (PE)