On exam
Cardiovascular
Pulmonary
Too much of a good thing
Mixed bag
100

Type of "sign" on abdominal exam where respiration is interrupted due to pain upon palpation may indicate cholecystitis.

What is Murphy's sign?

100

Pt presents with palpitations. EKG shows irregular rhythm without P waves and no significant Q waves or ST segment changes, QRS is 0.09, HR 135. You diagnose this rhythm as?

What is afib?
100

A patient with potential asthma presents to pulmonary clinic for further evaluation. To obtain the best info on her respiratory status you order which test? 

What is pulmonary function testing?

100

A patient comes to your floor from the PACU and is more lethargic than you would expect, breathing but poorly responsive. You look at the MAR and see pt was given a total of 6 mg of Ativan for agitation post-op. You are concerned and want to reverse the effect. What drug would you consider using?

What is flumazenil? 

100

Immunizations are examples of which type of prevention? 

What is primary prevention?

200

This type of respiration pattern, alternating tachypnea and apnea, indicates damage to respiratory centers of the brain.

What is Cheyne-Stokes respirations?

200

56 yo M presents to ED with substernal chest pain, pain with inspiration, systolic apical murmur, fever, and ST elevation in all leads. You suspect?

What is pericarditis?

200

The gold standard for diagnosis of sleep apnea (OSA) is what test? 

What is an overnight sleep study/polysomnography?

200

32 yo pharmacist comes into your ED after a suicide attempt and admits to calling 911 after taking 60 tablets of Tylenol about 6 hours ago. You call poison control who suggests you administer what drug? 

What is acetylcysteine? 

200

In WA state who has the highest authority to make medical decisions when a patient is unable to do so?

What is a legal guardian? 

300

This type of skin dimpling on the breast may indicate breast cancer.

What is peau d'orange? 

300
62 yo M post-op day 1 from CABG develops hypotension with pulses paradoxus, no urinary output for the past 2h, and POC echo shows R systolic collapse. You suspect what diagnosis? 

what is cardiac tamponade?

300

55 yo M is being treated for latent pulmonary TB. You know he will need to take chemoprophylaxis with isoniazid (INH) daily for how long? 

What is 6 months? 

300

Xanthopsia (objects appear yellow) is classically associated with toxicity of what drug? 

What is digoxin? 
300

55 yo F presents with headaches, fever, fatigue, muscle aches that started with stiffness and pain in her neck and through her shoulders, low back, and hips. She is A&Ox3. Workup shows elevated ESR and CRP. You suspect what diagnosis? 

What is temporal arteritis? 

400

Grasping and stabilizing the patient's ankle with one hand and briskly pushing the foot upwards towards the head is a test that looks for what? 

What is clonus?

400

24 yo F presents to ED c/o "heart pounding out of my chest" and dyspnea x 4h. Similar episodes in past have spontaneously resolved. Takes no medications. BP 120/80. EKG shows SVT with rate 200. Your first immediate action is to?

what is a vagal maneuver?

400

62 yo M with h/o COPD presents to office with cough and body aches x 3d. Influenza A is positive. The CDC recommendation to treat influenza is with what drug?

What is Tamiflu?

400

Your ICU patient comes in after overdose with fever 41.5C, muscle rigidity, tremor, tachycardia, hyperreflexia, dry mucus membranes, and agitation. You suspect what toxidrome? 

What is serotonin syndrome?

400

An anxious and tachycardic pt who sustained blunt chest trauma presents with JVD, narrowing pulse pressure, and distant heart tones. You suspect what condition? 

What is cardiac tamponade? 

500

Discoloration progressing from white to blue to red over time on distal extremities due to vasospasm is consistent with what diagnosis? 

what is Raynaud's phenomenon?
500

Patient presents with severe dyspnea, RR 32, O2 sat 84%, P 112, BP 82/50, cold extremities, and confusion. During exam he coughs up pink-tinged frothy sputum. You suspect?

What is cardiogenic shock?

500

Pt is initiating breaths on SIMV. O2 sat is 98% on FiO2 40%. You notice the spontaneous tidal volumes are 130 mL per breath, and pt is getting tachycardia and is c/o fatigue. Respiratory muscle fatigue can be best reduced by making what ventilator change? 

What is adding pressure support (PS)? 

500

Your patient is agitated and EMS report empty bottles were found at her bedside. Her symptoms include paranoia, dry mucus membranes, reddened skin, hyperthermia, dilated pupils, decreased bowel tones, and urinary retention. You suspect what toxidrome?

What is anticholinergic poisoning?

500

In an unstable trauma patient following a MVC, CXR shows a widened mediastinum, left 2nd rib fracture, and tracheal deviation to the right. You are concerned for which life-threatening diagnosis? 

What is aortic rupture?