A
B
C
D
E
100
a patient with tracheomalacia would most likely present with airway compression during which phrase of respiration
exhalation
100
A patient presents with complaints of dizziness upon standing. If orthostasis is suspected, what changes in blood pressure and HR would you expect to see when the patient is sitting vs standing?
HR increase by 20-30 and BP decrease by 20-30
100
A 21 Yo M patient presents with complaints of chronic sinus infections and persistent ear infections, and they have now developed a cough. CXR reveals the below image:
Assuming this condition is genetic, what are the chances that he passes this condition onto his offspring
none, those with PCD are infertile if male
100
An alcoholic patient is sitting the in the ED when suddenly he vomits. If the patient aspirates his vomit, what portion of the lungs would likely be affected?
Lower portion of lower lobes
100
A patient with ARDS is on high flow oxygen, yet still has persistent hypoxemia. What ratio of PaO2:FiO2 would indicate that the patient has SEVERE ARDS.
<100
200
A premature infant is diagnosed with RSV. A monoclonal Ab specific to RSV is given to the patient, what is the name of this medication?
Palivizumab
200
An infant was born at 29 weeks gestation and you are concerned whether or not her lungs are mature enough to tolerate breathing. What is the amniotic L:S ratio that would indication pulmonary maturity in this patient?
>2
200
A 35 yo man presents to the the ED 3 days prior to a trip to the Rocky Mountains with increased respiratory rate and altered mental status. PE shows increased respiratory rate. CMP notable for hyperkalemia and hypercalcemia. ABGs reveal an anion gap of 10 (WNL) and blood pH of 7.25. Urinalysis reveals increased pH. Assuming the pt. was prescribed a certain medication for a trip, an OD on this med would cause artificial depression of the activity of which enzyme?
Carbonic anhydrase IV
200
A 14 yo female pt presents to the clinic with c/o a growing mass on the lateral neck. PE reveals a compressible mass. If the mass is a cyst located in an area that typically disappears following embryological development, what muscle would we most likely expect it to be directly anterior to?
SCM
200
A pt presents to the ED after falling down the stair. PE shows pleuritic chest pain and severe TTP on the lateral aspect of rib seven. Your colleague decides to treat the suspected rib fracture by tightly wrapping the chest of the patient. What complications could arise from your co-workers poor treatment of the condition?
Atelectasis and pneumonia. Need to allow for deep breathing and rib expansion
300
A women presents with a gram negative infection. Assuming that the bacteria releases LPS when destroyed, what cell surface receptors in the patients body would be able to bind and react to this LPS?
CD14, TLR4
300
A newborn presents with respiratory distress, which is especially worse during feeding, resulting in severe malnutrition. You go to place an NG tube to help feed them, and find that you cannot pass the tube through the nasal cavity. Additionally, PE shows greater than normal Rhinorrhea from the left nostril. What is the likely diagnosis?
Choanal atresia
300
A 37 weeks gestation pregnant women undergoes a vaginal delivery of her son. Mother's hx is significant for HTN and gestational diabetes. What is the specific mechanism that places the infant at increased risk for developing NRDS
high maternal insulin levels decreases surfactant production, increasing risk of NRDS
300
a 28 week gestation infant is delivered prematurely. He subsequently developed NRDS and is given oxygen. A few days after being place on high flow oxygen, the patient no longer responds to visual stimuli. Fundoscopic exam reveals an overgrowth of vessels in the retina. What cellular signaling molecule, likely induced by the patients hyperoxic state, caused the patient's condition?
VEGF
300
A patient gets a cut on his finger while working at a saw mill and is exposed to bacteria to which he has no adaptive immunity towards. Assuming that the innate immune system is the only aspect providing protection at this time, via which activation routes could the complement system be turned on?
Lectin, Alternate
400
A patient presents to the ED with abdominal pain, nausea and vomiting. Serum amylase and lipase are significantly elevated. Hx is significant for high alcohol intake. While in the ED, pt develops hypoxia and hypocapnia consistent with respiratory distress syndrome. What was the pt's initial presenting diagnosis that likely lead to the ARDS
Pancreatitis
400
A patient presents to your clinic for counseling on infection control and prevention. He has recently had his spleen removed. With this in mind, you know that the patient would be most susceptible to bacteria with this characteristic.
Susceptible to encapsulated bacteria
400
A patient presents to the ED with submandibular swelling x 1 day. s/p Lower L molar extraction x 3 days ago. PE reveals a patient in respiratory distress secondary to oropharyngeal swelling, drooling, dysphagia and mandibular protrusion. What is the most likely infection etiology?
Strep viridans
400
This class(es) of shock may result in fluid overload due to the body's normal compensatory mechanisms
Cardiogenic/ obstructive
400
A 3yo patient presents with respiratory complaints. Hx reveals that about a week and a half ago, pt had a sharp barky cough and received a neck x-ray, which showed a steeple sign on AP films. Pt's mother states that he was starting to recover when the cough suddenly got worse. Endoscopy reveals this image in the trachea:
What is the best medication course to treat this condition?
Vanc or Clinda + a 3rd gen ceph
500
A 14 year old with a peanut allergy gets hit with a PB&J during a food fight at school. She subsequently develops swelling of the airways, tachypnea, tachycardia and hypotension. Assuming that the patient is going into shock, what category of shock does her condition belong to?
distributive shock
500
Pt presents to the ED following a stab wound to the L 5th intercostal space at the anterior axillary line. Vitals are: BP 85/40, HR 125, RR 25. ECG is significant for electric alternans. JVD+. What emergent invasive (but non-surgical) procedure could be done in the ED to relieve the patient's sxs?
pericardiocentesis
500
List 3 mechanisms of O2 induced hypercapnia
500
22Yo Male presents to ED following an MVA x 30 minutes ago. Vitals. HR: 78, RR: 28, Temp: 98.9, O2: 80. Breath sounds are present bilaterally with crackles on both inhalation and exhalation. CXR shows no opacities, no mediastinal widening, and no bony abnormalities. PE is also positive for a patterned injury to the anterior chest in the shape of a steering wheel, but is negative for JVD. ABG shows significant hypoxemia and moderate hypercapnia. Your colleague gives IV fluids, believing that the pt is suffering from shock. Why should they have their medical license revoked?
Pt. has pulmonary contusion. Don't give IV fluids in to them, as it will worsen the pulmonary edema present
500
A 35 Yo female patient presents with hypovolemia shock. Weight is 80kg. You want to administer lactated ringers. How much fluid should you administer in this situation.
20cc/kg x body weight = 20cc x 80 = 1600cc fluids