Neuro Alert
An 82 y/o patient developed sudden dysarthria and RUE weakness. Onset at 8am. He/she arrives at the ED at 11 am. IV is inserted, labs sent. Which imaging study should be ordered STAT?
A. Non-contrast head CT
B. Contrast head CT
C. CT- A (angiogram) of the head
D. Non-contrast MRI of head
A. Non-contrast head CT
Which of the following bites has the highest risk of infection?
A. Cat bite to the hand
B. Human bite to the face
C. Dog bite to the thigh
D. Spider bite to the arm
A. Cat bite to the hand
A 2-year-old child is brought to the emergency department with a barking cough, stridor that worsened tonight, and a temperature of 101 F. What is the treatment?
A. Nebulized albuterol
B. Inhaled steroids
C. Nebulized epinephrine and dexamethasone
D. Humidified oxygen
C. Nebulized epinephrine and dexamethasone
Which of the following is the most common cause of infectious diarrhea in children both in developed and developing countries?
1. Campylobacter
2. Shigella
3. Rotavirus
4. Norovirus
5. Salmonella
3. Rotavirus
A 32-year-old female sees you to request breast cancer screening after learning that her 45-year-old sister was diagnosed with breast cancer. She has no other known history of breast cancer. The patient does not have a family history of ovarian, tubal, or peritoneal cancers. Menarche occurred at 13 years of age and she has never been pregnant. On examination there is no nipple discharge or axillary lymphadenopathy and she has no palpable breast masses. Based on U.S. Preventive Services Task Force guidelines, which one of the following should you recommend as the next step in evaluation?
A) Monthly breast self-examinations
B) Screening mammography
C) Screening breast ultrasonography
D) Genetic counseling
D) Genetic counseling
You are on a plane ride when a passenger suddenly becomes unresponsive. Which statement below is true?
A. You should immediately start chest compressions
B. You should check a pulse, if none present, open the airway, give 2 rescue breaths and start chest compressions
C. You should check a pulse, if none present, immediately start chest compressions
D. You are aware that Good Samaritan laws protect you in all 50 states, but these laws do not exist during airflight
C. You should check a pulse, if none present, immediately start chest compressions
A 24 yo male presents with a 3-day history of a rash that is increasing in size. It is not painful or tender. It is flat, oval, 14 cm x 7 cm in size, has central clearing and has no fluctuance. No associated fever/chills or systemic symptoms. No new medications. No recall of any insect bite. He recently vacationed on Martha’s Vineyard in MA.
A. Prescribe ceftriaxone 1gm IM/IV
B. Prescribe doxycycline 100 mg BID x 10 days
C. Obtain a Lyme titer; if positive treat with ceftriaxone.
D. Obtain a Lyme titer; if positive, confirm with a Western blot study and if positive treat with ceftriaxone
B. Prescribe doxycycline 100mg BID x 10 days
A 16-year-old female patient is evaluated for a 4-day history of sore throat, nonproductive cough and rhinorrhea. She is afebrile, and exam reveals enlarged erythematous tonsils without exudate, and no lymphadenopathy. What is the next step?
A. Supportive care
B. Rapid strep test
C. Treat with oral PCN for 10 days
D. Treat with azithromycin for 5 days
A. Supportive care
Which one of the following medications has been shown to increase the resolution of metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease?
A) Glyburide
B) Metformin
C) Pioglitazone
D) Repaglinide
E) Vitamin D (cholecalciferol)
C) Pioglitazone
Which one of the following is associated with at least 6 months of exclusive breastfeeding in infants?
A) Higher incidence of infant peanut allergy
B) Higher infant HDL-cholesterol levels
C) Lower risk for infant atopic dermatitis
D) Lower maternal incidence of endometrial cancer
E) Lower maternal incidence of hypothyroidism
C) Lower risk for infant atopic dermatitis
A 14 y/o female arrives at the triage area of your local rural hospital Emergency Department with worsening abdominal pain for the past 2 days. The patient’s parents are out of town for the day and unavailable by cell phone. The patient is accompanied by her 16 y/o sister. The triage nurse asks for your advice.
In this case, you would recommend:
A. Do not perform a H&P on the patient until parental consent is available
B. Obtain a history from the patient, but do not perform a physical exam until parental consent is available.
C. Inquire if the patient could be pregnant, and if so, proceed with further care
D. Perform an H&P and proceed with diagnostic testing if there is concern for acute pathology that could worsen if a delay were to occur
D. Perform an H&P and proceed with diagnostic testing if there is concern for acute pathology that could worsen if a delay were to occur
You are evaluating a 6 y/o for abdominal pain. You have a moderate degree of suspicion that the patient may have appendicitis. The American College of Radiology (ACR) and American Academy of Pediatrics (AAP) recommends which of the following as the first choice to evaluate this patient?
A. Abdominal x-ray
B. Abdominal Ultrasound
C. CT scan of abdomen and pelvis
D. MRI abdomen and pelvis
B. Abdominal Ultrasound
A 3-year-old girl presents with 4-day history of fever without other symptoms. Ears, throat, lungs and abdominal exams are normal, but she appears mildly lethargic. What should be your next step?
A. Treat fever and reevaluate her in 24 hours
B. Order urinalysis with cultures
C. Order an abdominal ultrasound
D. Administer IV fluids and antibiotics
B. Order urinalysis with cultures
A 73-year-old female presents with chronic diarrhea. You suspect microscopic colitis and order colonoscopy. Based on the suspected diagnosis, you should expect which one of the following colonoscopy findings?
A) Granulomas
B) Normal mucosa
C) Patchy ulcerations
D) Pseudomembranes
B) Normal mucosa
A 35-year-old female presents for evaluation of bilateral breast pain that varies in intensity with her menstrual cycle. She drinks 2 cups of caffeinated coffee per day and does not take any regular medications. Her past medical history is unremarkable and she does not have any family history of breast cancer. A physical examination, including a clinical breast examination, is normal. A urine hCG test is negative. Which one of the following would be the most appropriate next step?
A) A trial of dietary caffeine elimination
B) A trial of topical diclofenac
C) Prolactin and TSH levels
D) Ultrasonography
E) Diagnostic mammography
B) A trial of topical diclofenac
A 65 y/o non-smoker with history of controlled HTN and hyperlipidemia, presents for a routine exam. According to USPSTF, which of the following should be performed to assess his risk of stroke?
1. No additional testing for stroke risk
2. Auscultate for carotid bruits
3. Obtain carotid duplex ultrasound
4. Obtain CTA of the carotid arteries
1. No additional testing for stroke risk
The most common cause of large bowel obstruction is:
A. Adhesions (from previous surgery)
B. Neoplasm
C. Herniation
D. Volvulus
B. Neoplasm
LARGE bowel obstruction = neoplasm
SMALL bowel obstruction = adhesions
An otherwise healthy 12-year-old is brought to your office by a parent because the child has had an itchy scalp for the last 2 months. The patient has tried multiple dandruff shampoos and is now using tea tree oil without relief. On examination you note several 1- to 2-cm annular lesions on the scalp with small black dots and scale. There is tender lymphadenopathy of the occipital scalp. Which one of the following would be the most appropriate next step?
A) Obtaining a scraping for culture
B) Initiating topical fluocinonide solution
C) Initiating topical ketoconazole shampoo
D) Initiating oral itraconazole (Sporanox)
E) Initiating oral terbinafine
E) Initiating oral terbinafine
A 78-year-old male with a history of hypertension, type 2 diabetes, ongoing tobacco use, and carotid endarterectomy presents to the emergency department with bloody diarrhea and severe lower abdominal pain. Which one of the following is the most likely diagnosis?
A) Angiodysplasia
B) Arteriovenous malformation
C) Colon cancer
D) Irritable bowel syndrome
E) Ischemic colitis
E) Ischemic colitis
A 26-year-old nulliparous female presents for an evaluation after she discovered a breast mass while showering. An examination confirms a 4 × 3-cm nonpainful mass in the upper outer quadrant of the right breast. Which one of the following should you recommend?
A) Screening mammography of the breast
B) Diagnostic mammography of the breast
C) Ultrasonography of the breast
D) MRI of the breast
E) Surgical referral for excision and biopsy
C) Ultrasonography of the breast
An 82 yo patient developed sudden dysarthria and RUE weakness. Onset at 8am. He/she arrives at the ED at 11 am. BP= 200/100; At 12 noon, the labs and head CT are reported as “normal.” The patient is NOT a candidate for thrombolytic therapy
Your management will include....?
A. Start IV nicardipine (for BP control), start aspirin 325 mg po.
B. Start IV nicardipine, do NOT start ASA 325 mg
C. Do NOT start IV nicardipine, start ASA 325 mg
D. Do NOT start IV nicardipine, do NOT start ASA 325 mg
D. Do NOT start IV nicardipine, do NOT start ASA 325mg
A 21 yo college student presents to the ED with friends who report the student swallowed “a full bottle” of acetaminophen 45 minutes before arrival. They also note the patient has been drinking alcohol. The patient is awake but appears intoxicated.
Which of the following would be the best course of action:
A. Administer syrup of ipecac
B. Perform a gastric lavage
C. Administer activated charcoal
D. Administer N-acetylcysteine
C. Administer activated charcoal
A 15-year-old patient who was recently hospitalized for anorexia nervosa sees you for a follow-up visit in your clinic to discuss the next steps in treatment. Which one of the following therapies is the recommended next step in treatment for this patient?
A) Self-guided treatment
B) Cognitive behavioral therapy
C) Focal psychodynamic psychotherapy
D) Interpersonal psychotherapy
E) Family-based therapy
E) Family-based therapy
A 40-year-old female presents with symptoms of heartburn and regurgitation of sour-tasting fluid into her throat after meals. She experiences these symptoms at least twice per week and says that they have been significantly affecting her quality of life. She has tried lifestyle modifications, including elevating the head of her bed and avoiding trigger foods, without significant relief. Which one of the following would be the most appropriate initial management of this patient's condition?
A) An antacid as needed
B) An H2-receptor antagonist as needed
C) A proton pump inhibitor (PPI) as needed
D) A PPI daily for 4–8 weeks
E) Esophageal pH monitoring
D) A PPI daily for 4–8 weeks
A 45-year-old gravida 2 para 2 with a history of irregular menses and bilateral tubal ligation presents with a 2-month history of bilateral milky nipple discharge. Her last menstrual period was 1 week ago. She does not take any medications. A physical examination reveals a small amount of milky nipple discharge bilaterally with no breast masses. A urine pregnancy test is negative. Laboratory testing reveals normal thyroid and kidney function, and a prolactin level of 95 ng/mL (N 5–20). Pituitary MRI with gadolinium shows a 7-mm enhancing mass. Which one of the following would be the most appropriate pharmacotherapy for this patient’s condition?
A) Bromocriptine (Parlodel)
B) Cabergoline
C) Levonorgestrel/ethinyl estradiol
D) Metoclopramide (Reglan)
E) Risperidone (Risperdal)
B) Cabergoline