Emergency Exam questions with accurate answers, 2022 update, 100% proven pass rate

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A 40-year-old man is brought to the emergency room after his wife found him alone in a confused state. He admits to overdosing in a suicide attempt, but does not specify the drug taken. En route to ... the hospital, he is drowsy and ataxic with blurred vision. His past medical history is significant for asthma, insomnia, depression, and substance abuse. His temperature is 38.3C (100F), blood pressure is 130/80mm Hg, pulse is 100/min, and respirations are 22/min. Examination shows dry mucus membranes and skin; pupils are 8mm bilaterally. There is no neck stiffness. Lungs are clear to auscultation. Heart sounds are within normal limits. Abdominal examination shows reduced bowel sounds with no tenderness. A Foley catheter is placed in the ER and 600 ml of urine is collected over one hour. Which of the following is the most likely diagnosis? A. Salicylate intoxication B. Serotonin syndrome C. Cocaine intoxication D. Diphenhydramine poisoning@ E. Phencyclidine poisoning 2. A 46-year-old male is admitted to the hospital because of right hand cellulitis. He has a history of intravenous drug use, hepatitis C infection and septic arthritis of the knee. He smokes one pack of cigarettes and drinks one pint of vodka daily. He is started on vancomycin. On the following day, the swelling and redness of his arm decreases. However, he complains of bugs crawling on his skin. His temperature is 38.3C (100.9 F), blood pressure is 160/90 mm Hg, pulse is 110/min, and respirations are 18/min. Examination shows mild hand tremors and diaphoresis Which of the following is the most appropriate next step in management? A. Start chlordiazepoxide@ B. Give haloperidol C. Start propranolol D. Stop vancomycin E. Start methadone 3. A 35-year-old woman is brought to the emergency room after an apparent suicide attempt. Her current prescription of imipramine was found at her bedside along with a suicide note. En route to the hospital, she suffered a seizure. She has been treated with many different anti-depressants over the past several years without improvement. Her temperature is 38.3C (101F), blood pressure is 90/50 mm Hg, pulse is 120/min and respirations are 24/min. EKG shows QRS widening (0.18sec). She is given sodium bicarbonate along with supportive treatment. Which of the following is the most likely mechanism that explains the beneficial effects of sodium bicarbonate? A. Alkalinization of urine will promote diuresis of the antidepressants B. Acidification of urine will promote diuresis of the antidepressants C. Sodium load of sodium bicarbonate will alleviate depressant action on sodium channels@ D. Sodium load of sodium bicarbonate will alleviate depressant action on potassium channels E. Sodium load of sodium bicarbonate will alleviate depressant action on calcium channels 4. A 32-year-old male is admitted to the hospital because of confusion. He was recently diagnosed with schizophrenia His temperature is 38.6C (101.6F), blood pressure is 160/100 mm Hg, pulse is 116/min, and respirations are 22/min. He is not oriented to time, place or person. Mucus membranes are dry. Profuse diaphoresis is present. Lungs are clear to auscultation. Abdominal, neck and extremity muscles are rigid. Muscle tone is increased. Deep tendon reflexes are 2+. Laboratorystudies show a serum CK of 50,000 IU/L. CSF fluid analysis shows a total white blood cell count of 5/microL. Which of the following is the most appropriate next step in management? A. Risperidone B. Dantrolene@ C. L-Dopa D. Prednisone E. Antibiotics 5. A 38-year-old homeless man is brought to the emergency room. He is obtunded and unable to speak. No previous medical history is known. His temperature is 34.0C (93.2F), blood pressure is 90/60 mm Hg, pulse is 60/min and respirations are 6/min. Oxygen saturation is 86% on room air. Pupils are 5 mm in size, bilaterally. Oropharynx is dry. Lungs are clear to auscultation. Abdomen is soft; bowel sounds are decreased; there is no organomegaly. Extremities reveal several needle marks. Babinski sign is negative. Deep tendon reflexes are 2+ throughout. Which of the following is the most appropriate next step in management? A. CT scan of the head B. Glucagon C. Methadone D. Naloxone@ E. Flumazenil 6. A mother brings her 16-year-old daughter to the ER after she had two episodes of coffee ground emesis. The mother reports that for the past two weeks, the teen has not been acting like herself; she has been especially isolated and has had a poor appetite and poor sleep. Her medical history is significant for anemia, for which she takes iron sulfate and folic acid. She also takes acetaminophen for occasional back pain. Presently, the patient's blood pressure is 110/70 mmHg and heart rate is 120/min. Which of the following is most likely to establish the diagnosis? A. Liver function tests B. Upper Gl endoscopy C. Serum iron level@ D. CT scan of the head E. Serum acetaminophen level 7. A 47-year-old man is brought to the ED by EMS after being found wandering in the street mumbling. His BP is 150/75 mm Hg, HR is 110 beats per minute, temperature is 100.5°F, RR is 16 breaths per minute, oxygen saturation is 99% on room air, and fingerstick glucose is 98 mg/dL. On examination, the patient is confused with mumbling speech. His pupils are dilated and face is flushed. His mucous membranes and skin are dry. Which of the following toxic syndromes is this patient exhibiting? a. Sympathomimetic syndrome b. Anticholinergic syndrome@ c. Cholinergic syndrome d. Opioid syndrome e. Ethanol syndrome 8. A 25-year-old man is carried into the ED by two of his friends who state that he is not breathing. The patient has a history of heroin abuse. His vital signs are BP 115/70 mm Hg, HR 99 beats per minute, temperature 98.9°F, RR 3 breaths per minute, and oxygen saturation 87% on room air. You notice fresh needle marks and miotic pupils. You begin bag-valve mask ventilation and his oxygen saturation increases to 99%. Which of the following is the most appropriate next step in management? a. Continue bag-valve-mask ventilation until he breathes on his own. b. Perform endotracheal intubation of the patient.c. Evaluate response to administration of naloxone.@ d. Put the patient on supplemental oxygen. e. Place a nasogastric tube and administer activated charcoal. 9. A 42-year-old man who is actively seizing is brought to the ED by EMS after a massive ingestion of an unknown substance. The man is known to have a history of acquired immunodeficiency syndrome (AIDS). An intravenous (IV) line is established and anticonvulsant therapy is administered. After high doses of diazepam, phenobarbital, and phenytoin, it is determined that the seizures are refractory to standard anticonvulsant therapy. Which of the following substances did this patient most likely ingest? a. Cocaine b. Diphenhydramine c. Tricyclic antidepressant (TCA) d. Haloperidol e. Isoniazid (INH)@ 10. A 26-year-old man is brought to the emergency room by police with depressed mental status. Out of fear of arrest, he swallowed a handful of pills as the police officers approached him. On examination, he responds to painful stimuli but is somnolent. His respiratory rate is 8/min and after naloxone bolus infusion increases to 12/min. Lungs are clear to auscultation. Which of the following additional findings is most likely to be present in this patient? A. Miosis, bradycardia, hypertension B. Miosis, tachycardia, hypotension C. Miosis, bradycardia, hypotension@ D. Miosis, tachycardia, hypertension E. Mydriasis, tachycardia, hypertension 11. A 29-year-old male is brought to the emergency room because of sudden onset confusion and fever. He was recently admitted to the hospital for hallucinations and was discharged in stable condition. His temperature is 38.6C (101.6 F), blood pressure is 150/100 mm Hg, pulse is 112/min, and respirations are 24/min. Mucus membranes are dry. Profuse diaphoresis is present. Lungs are clear to auscultation. Abdominal muscles are rigid. Muscle tone is increased; "lead pipe rigidity" is noted in all four extremities. Deep tendon reflexes are 2+. Tremor is noted. Which of the following is the most likely diagnosis? A. Tetanus B. Meningitis C. Drug induced idiosyncratic reaction@ D. Cocaine intoxication E. Lithium intoxication 12. A 26-year-old man is brought to the emergency room after an attempted suicide by medication overdose. For the past hour, he has suffered two seizures. His temperature is 38.8C (102F), blood pressure is 110/85 mmHg, pulse is 90/min, and respirations are 22/min. He is not oriented to time, place, and person. Pupils are dilated, but reactive to light and accommodation; skin is flushed and dry. Abdominal examination shows reduced bowel sounds. EKG shows prolonged QRS complexes (0.19 sec). Toxicology studies are pending. Which of the following is the most appropriate indicator of severity of intoxication? A. Serum drug levels B. Urine drug levels C. Duration of QRS complex@ D. Pupillary sizeE. Bowel sounds 13. A 42-year-old male is admitted to the hospital with fever and shortness of breath. He has HIV infection, hepatitis C infection, and alcohol induced cardiomyopathy. His temperature is 38.6 C (101.5 F). Thrush is noted in the oropharynx. Chest x-ray reveals right lower lobe consolidation. He is started on fluconazole and moxifloxacin. His pneumonia and thrush improve over the next 2 days. However, on the third day, he develops palpitations. His EKG strip is shown below: Which of the following is the most appropriate next step in management? A. Calcium gluconate B. Magnesium sulphate@ C. Sotalol D. Amiodarone E. Adenosine 14. A 34-year-old homeless man is brought to the emergency room in a confused state. He complains of epigastric pain, vomiting and blurred vision. His temperature is 36.8C (98.2F), blood pressure is 110/60 mm Hg, pulse is 110/min and respirations are 22/min. Physical examination shows poor oral hygiene and dry mucous membranes. Lungs are clear to auscultation. Abdominal exam shows mild epigastric discomfort. Funduscopic examination reveals optic disc hyperemia. Laboratory studies show: Serum sodium 136 mEq/L Serum potassium 3.0 mEq/L Chloride 93 mEq/L Bicarbonate 6 mEq/L Blood urea nitrogen (BUN) 30 mg/dL Serum creatinine 0.8 mg/dL Blood glucose 80 mg/dL Serum ketones negative Plasma lactate 2.2 mEq/L Which of the following is the most likely cause of his symptoms? A. Ethylene glycol poisoning B. Mesenteric ischemia C. Septic shock D. Diabetic ketoacidosis E. Methanol poisoning@ 15. You receive notification from EMS that they are bringing in a 17-yearold adolescent boy who was found unconscious by a police officer. The police officer at the scene states that he snuck up on a group of kids that he thought were using drugs. Two of them got away and one just fell to the ground seconds after standing up. Lying on the ground next to the adolescent were plastic bags. The emergency medical technician (EMT) states that the patient was in ventricular fibrillation. He was shocked in the field and is now in a sinus rhythm. The EMT also administered IV dextrose, thiamine,and naloxone without any change in mental status. Which of the following substances was the patient most likely abusing? a. Butane@ b. Ethanol c. Heroin d. Cocaine e. PCP 16. A 61-year-old man with a history of depression and hypertension is brought to the ED by EMS for altered mental status. The patient’s wife states that he stopped taking his fluoxetine 1 month ago and now only takes metoprolol for his hypertension. The patient’s BP is 75/40 mm Hg, HR is 39 beats per minute, RR is 14 breaths per minute, oxygen saturation is 99% on 100% oxygen, and fingerstick glucose is 61 mg/dL. The patient is awake and moaning, responding only to deep stimuli. His extremities are cool to the touch. You suspect an overdose of metoprolol. You endotracheally intubate the patient for airway control. Which of the following is the most appropriate next step in management? a. Normal saline bolus, administer atropine, administer 1-g calcium gluconate bolus, then insert a transvenous cardiac pacer b. Put the patient on pacer pads, then administer norepinephrine drip c. Cardioversion with 200 J, then administer atropine d. Normal saline bolus, atropine, norepinephrine e. Normal saline bolus, atropine, glucagon@ 17. A 22-year-old woman presents to the ED by ambulance from a dance club. The paramedics report that the patient was agitated in the club and had a generalized seizure. Her BP is 165/100 mm Hg, HR is 119 beats per minute, temperature is 101.9 °F, RR is 17 breaths per minute, oxygen saturation is 98% on room air, and fingerstick glucose is 92 mg/dL. On examination, the patient is hyperactive and appears to be hallucinating. Her pupils are dilated to 6 mm bilaterally and reactive. Her neck is supple. Examination of the heart is unremarkable except for tachycardia. Her lungs are clear and abdomen is soft and nontender. The patient moves all four extremities. Laboratory results are as follows: Sodium 109 mEq/L WBC 12,000/mm 3 Potassium 3.5 mEq/L Hct 49% Chloride 83 mEq/L Platelets 350/μL Bicarbonate 20 mEq/L BUN 10 mg/dL Creatinine 1 mg/dL Glucose 103 mg/dL Which of the following substances did this patient most likely consume? a. Cocaine b. Heroin c. 3,4-Methylenedioxymethamphetamine (MDMA)@ d. Ketamine (special K) e. PCP 18. A 32-year-old woman is brought to the emergency department by her husband because of slurred speech and difficulty walking. She has also been very drowsy for the past several hours, a non-typical behavior for a very active woman. She has a history of bipolar disorder, insomnia, migraineheadaches, seizures and hypothyroidism. Her temperature is 37(98.6F), blood pressure is 110/70 mm Hg, pulse is 76/min, and respirations are 16/min. She is lethargic and falls asleep during the interview and physical examination. Pupils are 5 mm in size and reactive to light. Neck is supple. Oropharynx is clear. Chest auscultation is unremarkable. Abdomen is soft and non-tender; bowel sounds are normal. Limited neurologic examination shows 1+ deep tendon reflexes in all four extremities; there is no Babinski sign; strength is 5/5 throughout. There is no nystagmus or hand tremor. Blood sugar is 130 mg/dl. Which of the following is the most likely cause of her symptoms? A. Cerebrovascular accident B. Phenytoin toxicity C. Benzodiazepine overdose@ D. Ethanol intoxication E. Lithium toxicity 19. A 31-year-old woman with a known psychiatric history presents to the ED after ingesting an unknown quantity of pills from her medication vial. In the ED, she complains of nausea, abdominal cramping, and feels unsteady on her feet. On physical examination, you observe that she is tachycardic and ataxic. Which of the following substances will best be treated by activated charcoal that could present like this? a. Phenobarbital b. Carbamazepine@ c. Lye (sodium hydroxide) d. Lithium e. Acetaminophen 20. A 27-year-old man presents to the ED extremely agitated complaining of mild chest pain and dyspnea. He states that he was snorting cocaine all afternoon. You place him on a monitor and get his vital signs. His BP is 215/130 mm Hg, HR is 112 beats per minute, temperature is 100.1°F, RR is 17 breaths per minute, and oxygen saturation is 98% on room air. An ECG reveals sinus tachycardia at a rate of 116. Which of the following is the most appropriate medication to administer? a. Haloperidol b. Labetalol c. Esmolol d. Diltiazem e. Diazepam@ 21. A 30-year-old man is brought to the ED by police officers. The patient is agitated, vomiting, and complaining of body aches. He states that he is withdrawing from his medication. His vital signs are BP 160/85 mm Hg, RR 20 breaths per minute, HR 107 beats per minute, and temperature 99.7°F. On examination he is diaphoretic, has rhinorrhea, piloerection, and hyperactive bowel sounds. Which of the following substances is this patient most likely withdrawing from? a. Ethanol b. Cocaine c. Nicotine d. Methadone@ e. Clonidine 22. A 25-year-old man is brought into the ED by two police officers because of suspected drug use. The patient is extremely agitated and is fighting the police officers. It takes three hospital staff members and the two police officers to keep him on the stretcher. His vital signs are BP 150/80 mm Hg, HR 107 beats per minute, temperature 99.7°F, RR 18 breaths per minute, and oxygen saturation 99% on room air. Physical examination is unremarkable except for cool, diaphoretic skin, persistent verticaland horizontal nystagmus, and occasional myoclonic jerks. Which of the following is the most likely diagnosis? a. Cocaine intoxication b. Cocaine withdrawal c. Anticholinergic toxidrome d. PCP intoxication@ e. Opiate withdrawal 23. A 20-year-old female is brought to the emergency room after getting struck by a motor vehicle. She appears confused. According to her parents, she has no other medical problems and does not take any prescription medications. However, they have noticed her increase in appetite recently. She occasionally drinks alcohol and smokes half a pack of cigarettes daily. Her temperature is 37.2C (99F), blood pressure is 150/90mm Hg, pulse is 110/min, and respirations are 22/min. Examination reveals dry mouth and conjunctival injection. Pupils are equal, reactive to light and accommodation. She has impaired time orientation and shortterm memory. Which of the following is the most likely explanation for this patient's symptoms? A. Benzodiazepine overdose B. Opioid overdose C. Cocaine intoxication D. Alcohol intoxication E. Marijuana overdose@ 24. A 34-year-old male is brought to the emergency department by his neighbor. The neighbor found the man lying on the floor beside an empty bottle of unknown substance. At the hospital, the patient is conscious and alert, but in severe pain. His temperature is 36.8C (98.2F), blood pressure is 130/70 mm Hg, pulse is 90/min and respirations are 20/min. Abdomen is benign, with normal bowel sounds. Pupils are 5 mm, bilaterally. His tongue is white, heavy drooling of saliva is noted and he is unable to swallow. Which of the following is the most likely explanation for this patient's symptoms? A. Anticholinergic poisoning B. Caustic poisoning@ C. Tricyclic antidepressant poisoning D. Cyanide poisoning E. Alcohol intoxication 25. A 35-year-old woman calls her family physician after her 7-year old son accidentally splashed an unknown liquid containing acid on his face. Some liquid likely entered his eye, as the child is complaining of severe pain in his right eye. She knows a doctor living in her immediate neighborhood but is hesitant about what to do next. Which of the following is the most appropriate initial course of action that the mother should take? A Call 911 immediately B. Go to local emergency room immediately C. Go to the doctor in the neighborhood immediately D. Wash the eye with copious amount of water@ E. Do not try to wash the eye as it can enhance the damage 26. A worried and anxious pregnant mother brings her 3-year-old son to the emergency room after he experienced several episodes of vomiting and abdominal pain for the past two hours. His vomit is coffee ground in appearance. He is irritable and lethargic. His blood pressure is 80/50mmHg and pulse rate is 120/min. Examination shows a normal oropharynx; chest auscultation is within normallimits. Abdomen is soft and mildly tender at the epigastrium; there is no hepatosplenomegaly. Extremities are cold to touch. Initial laboratory studies show: Hemoglobin 10.3 g/L Leukocyte count 14,500/mm3 Bicarbonate 18 mEq/L Chest x-ray is within normal limits. Abdominal imaging shows radio opaque tablets in the stomach. Intravenous normal saline is started. Which of the following is the most appropriate next step in management? A. Sodium bicarbonate B. Deferoxamine@ C. Magnesium sulphate D. Hemodialysis E. Calcium EDTA 27. A 32-year-old male comes to the hospital complaining of pain, swelling and redness of his right arm. His past medical history is significant for substance abuse. His temperature is 38.9 C (102.0 F), blood pressure is 110/60 mm Hg, pulse is 110/min and respirations are 14/min. He is started on intravenous clindamycin. The next day the swelling and pain improve, but he develops nausea, vomiting, abdominal cramps and diarrhea. He is restless and asks for pain medication to treat his aching muscles and joints. His temperature now is 37.3C (99.1F), blood pressure is 120/70 mm Hg, pulse is 80/min and respirations are 16/min. His laboratory studies at the time of admission and the following day show: Hemoglobin 13.0 g/L 12.8 g/L Leukocyte count 17,500/ mm3 8,500/ mm3 NeutrophiIs 86% 64% Lymphocytes 14% 26% Which of the following is the most appropriate next step in management? A Stool for Clostridium difficile toxin B. Discontinue clindamycin C. Start chlordiazepoxide D. Start methadone@ E. Start intravenous morphine 28. A 34-year-old homeless male is brought to the ER in a confused state. He complains of flank pain. His past medical history is unknown. His temperature is 36.8C (98.2F), blood pressure is 110/60 mm Hg, pulse is 110/min and respirations are 22/min. His appearance is disheveled. Pupils are equal, 4 mm in size and reactive to light. Funduscopic examination is within normal limits. Lungs have crackles at both bases. Mild costovertebral angle tenderness is present. Foley catheter is placed and urine appears red. Laboratory studies show: Serum sodium 136 mEq/L Serum potassium 3.5 mEq/L Chloride 93 mEq/L Bicarbonate 6 mEq/L Blood urea nitrogen (BUN) 34 mg/dl Serum creatinine 2.8 mg/dl Blood glucose 80 mg/dlCalcium 6.5 mg/dl Serum ketones negative Plasma lactate 2.4 mEq/L Which of the following is the most appropriate next step in management? A. Broad spectrum antibiotics B. Fomepizole@ C. N-acetylcysteine D. Regular insulin E. Glucagon 29. A 26-year-old bar employee is brought to the emergency room because of agitated, combative behavior in which three people had to restrain her. She has also been hallucinating during this entire period. Her temperature is 37.7C (100F), blood pressure is 160/90 mm Hg, pulse is 126/min, and respirations are 18/min. She is confused and agitated during the examination. Pupils are 6 mm in diameter and respond to light; prominent nystagmus is present. The remainder of her examination is unremarkable. Which of the following is the most likely diagnosis? A. Barbiturate intoxication B. Phencyclidine intoxication@ C. Cocaine intoxication D. Marijuana Intoxication E. Opioid intoxication 30. A 38-year-old man is brought to the emergency room by EMS after an apparent suicide attempt. En route to the hospital, he appeared confused and suffered a seizure. He has a history of hypertension and major depression. His temperature is 37.7C (100F), blood pressure is 70/40 mm Hg, pulse is 40/min, and respirations are 12/min. Examination shows normal heart sounds and diffuse wheezing. Extremities are cold and clammy. EKG shows AV block. The patient is given intravenous fluids and atropine; however, his bradycardia and hypotension do not improve. Which of the following is the most appropriate next step in management? A. Epinephrine B. Aminophylline C. Digoxin specific antibody D. Glucagon@ E. Pacemaker 31. A 24-year-old woman is brought to the emergency room after ingesting 14 acetaminophen tablets, 500 mg each, two hours ago. She does not smoke but drinks alcohol on the weekends. She is alert and oriented. Her temperature is 37.2C (99F), blood pressure is 110/60mm Hg, pulse is 90/min and respirations are 18/min. Examination shows no abnormalities. Laboratory studies show: Hct 40% WBC 6,000/mm3 Platelet 390,000/mm3 Which of the following is the most appropriate next step in management? A. Administer the loading dose of N-acetylcysteine B. Obtain serum acetaminophen levels in two hours@ C. Obtain serum acetaminophen levels now D. Transfer to liver transplantation facility E. Discharge her home without further work up32. A group of teenagers attend an indoor barbecue on a cold winter night. They all ate servings of potato salad and barbecue chicken. A few hours later, they present to the local emergency room with headache, nausea, vomiting, vague abdominal discomfort and confusion. One of the teenagers mentions a pet dog that was in the room with them had similar symptoms. A quick physical examination of one patient reveals tachycardia, tachypnea and a pinkish-skin hue. Which of the following is the most likely diagnosis? A. Viral illness B. Carbon monoxide poisoning@ C. Acute gastroenteritis D. Cyanide poisoning E. Methemoglobinemia 33. A 40-year-old man is brought to the emergency room for retrosternal and epigastric pain after ingesting an unknown amount of "lye" (drain cleaner) 45 minutes ago. His past medical history is significant for major depression and suicide attempt. He is unable to swallow his saliva and is drooling. His temperature is 36.8C (98.2F), blood pressure is 120/70mm Hg, pulse is 110/min, and respirations are 20/min. Examination shows oropharyngeal erythema and edema. Lungs are clear to auscultation. Abdominal examination reveals tenderness at the epigastrium without rebound or guarding. Chest x-ray shows no abnormalities. Intravenous hydration is started. Which of the following is the most appropriate next step in treatment? A. Gastric decontamination with ipecac B. Administer activated charcoal in water C. Neutralization and dilution of the alkali D. Upper gastrointestinal contrast studies and endoscopy@ E. Administer high dose systemic steroids 34. A 34-year-old farmer is brought to the hospital after attempting suicide. His body and clothes are soiled with vomitus. He is short of breath and appears agitated. His family reports no previous medical history or regular use of prescription medications. His temperature is 36.6C (98F), blood pressure is 110/60 mm Hg, pulse is 50/min, and respirations are 22/min. His oxygen saturation is 86% on room air. Examination shows watering of the eyes and 1 mm pupils, bilaterally. Lung examination shows widespread rhonchi with prolonged expiration. Abdominal examination shows increased bowel sounds. Neurologic examination shows muscle fasciculations. What would be the most appropriate next step in management of this patient? A. Obtain EKG for QRS duration B. Remove all the clothing and wash the body@ C. Obtain a chest x-ray D. Obtain a head CT scan E. Give physostigmine 35. A 60-year-old male is found lying down on the street by police one winter morning. He has been taking ibuprofen for headaches, fluphenazine for his schizophrenia and amitriptyline for chronic painful neuropathy secondary to postherpetic neuralgia. He is also receiving cephalexin for cellulitis of the right lower leg. His temperature is 34C (90F), blood pressure is 80/50 mm Hg, pulse is 88/min, and respirations are 12/min. Which of the following medications most likely have contributed to the development of hypothermia in this patient? A. Ibuprofen B. Amitriptyline C. Cephalexin D. Fluphenazine@E. Glucagon 36. A 45-year-old woman is brought to the ER by ambulance after a neighbor found her to be in a somewhat obtunded state with an empty bottle of medication next to her. While en route to the ER she suffered a tonic clonic seizure. Her past medical history is significant for major depression. Her temperature is 38.3C (100.9F), blood pressure is 90/70 mm Hg, pulse is 120/min, and respirations are 16/min. She is able to respond to painful stimuli. Pupils are 8 mm in size bilaterally. Skin is warm and flushed. Lungs are clear to auscultation. Abdomen is soft and non-tender. Bowel sounds are decreased. There is no neck stiffness. EKG shows QRS duration of 130 msec, a change from her previous EKG a month ago. Which of the following is the most appropriate next step in management? A. Lumbar puncture B. Echocardiogram C. Thyroid function tests D. Calcium gluconate E. Sodium bicarbonate@ 37. After being fired from his job, a 35-year-old man attempts suicide by drinking from a bottle labeled “insecticide.” Three hours later, emergency medical services (EMS) brings him into the emergency department (ED) and you notice that he is extremely diaphoretic, drooling, and vomiting. He is awake but confused. His vital signs include a blood pressure (BP) of 170/90 mm Hg, heart rate (HR) of 55 beats per minute, respiratory rate (RR) of 22 breaths per minute, temperature of 98.6°F, and oxygen saturation of 95% on room air. Physical examination demonstrates pinpoint pupils and crackles and wheezing on lung examination. What is the treatment to reverse this patient’s poisoning? a. Naloxone b. N-acetylcysteine (NAC) c. Atropine and pralidoxime (2-PAM) @ d. Flumazenil e. Physostigmine 38. A 19-year-old man is brought to the ED by EMS after he was found lying on the floor at a dance club. EMS states that the patient seemed unconscious at the dance club, but as soon as they transferred him onto the gurney, he became combative. Upon arrival in the ED, his BP is 120/65 mm Hg, HR is 75 beats per minute, temperature is 98.9°F, RR is 12 breaths per minute, and oxygen saturation is 98% on room air. On physical examination, his pupils are midsized, equal, and reactive to light. His skin is warm and dry. Lung, cardiac, and abdominal examinations are unremarkable. As you walk away from the bedside, you hear the monitor alarm signaling zero respirations and the oxygen saturation starts to drop. You perform a sternal rub and the patient sits up in bed and starts yelling at you. As you leave him for the second time, you hear the monitor alarm again signal zero respirations. You administer naloxone, but there is no change in his condition. Which of the following is most likely the substance ingested by this patient? a. γ-Hydroxybutyrate (GHB)@ b. Diazepam c. Cocaine d. Phencyclidine (PCP) e. Heroin 39. A 43-year-old woman presents to the ED with a 3-week history of intermittent headache, nausea, and fatigue. She was seen at her private doctor’s office 1 week ago along with her husband and children, who also have similar symptoms. They were diagnosed with a viral syndrome and told to increase their fluid intake. She states that the symptoms began approximately when it started to get cold outside. The symptoms are worse in the morning and improve while she is at work. Her BP is 123/75mm Hg, HR is 83 beats per minute, temperature is 98.9°F, and oxygen saturation is 98% on room air. Physical examination is unremarkable. You suspect her first diagnosis was incorrect. Which of the following is the most appropriate next step to confirm your suspicion? a. Order a mono spot test. b. Perform a nasal pharyngeal swab to test for influenza. c. Consult psychiatry to evaluate for malingering. d. Order a carboxyhemoglobin (COHb) level.@ e. Order a lead level. 40. An 18-year-old woman is brought to the ED by her mother. The patient is diaphoretic and vomiting. Her mom states that she thinks her daughter tried to commit suicide. The patient admits to ingesting a few handfuls of acetaminophen (Tylenol) approximately 3 hours ago. Her temperature is 99.1°F, BP is 105/70 mm Hg, HR is 92 beats per minute,RR is 17 breaths per minute, and oxygen saturation is 99% on room air. On examination, her head and neck are unremarkable. Cardiovascular and pulmonary examinations are within normal limits. She is mildly tender in her right upper quadrant, but there is no rebound or guarding. Bowel sounds are normoactive. She is alert and oriented and has no focal deficits on neurologic examination. You administer 50 g of activated charcoal. At this point, she appears well and has no complaints. Her serum acetaminophen (APAP) concentration 4 hours after the reported time of ingestion returns at 350 μg/mL. You plot the level on the nomogram seen below. Which of the following is the most appropriate next step in manag [Show More]

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