EM 2 - Q's - National Board of Medical Examiners PDF

Exam Section: Item 1 of 50 National Board of Medical Examiners Time Remaining: Mark Emergency Medicine Self-Assessment...

Exam Section: Item 1 of 50 National Board of Medical Examiners Time Remaining: Mark Emergency Medicine Self-Assessment 4 hr 59 min 54 sec 1. A 67-year-old woman comes to the emergency department 60 minutes after the sudden onset of shortness of breath. She also has had a 2-day history of swelling of her abdomen and legs. She received the diagnosis of carcinoma of the right breast 6 years ago and underwent lumpectomy followed by rad iotherapy and chemotherapy. She has type 2 diabetes mellitus well controlled with diet. On arrival, she is in severe respiratory distress. Her pulse is 122/min, respirations are 28/min, and blood pressure is 94/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Exam ination shows jugular venous distention. Heart sounds are distant. A pericardia! rub is heard best at the second to fourth left intercostal spaces. The abdomen is distended and nontender. The liver is enlarged. There is 2+ edema of the lower extremities. An ECG shows sinus tachycardia and ST-segment elevations throughout all leads. An x-ray of the chest is shown. Which of the following is the most appropriate next step in diagnosis? 0 A) Bedside cardiac ultrasonography 0 B) Cardiac catheterization 0 C) CT scan of the chest I https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause 1. A 67-year-old woman comes to the emergency department 60 minutes after the sudden onset of shortness of breath. She also has had a 2-day history of swelling of her abdomen and legs. She received the diagnosis of carcinoma of the rig ht breast 6 years ago and underwent lumpectomy followed by radiotherapy and chemotherapy. She has type 2 diabetes mellitus well controlled with diet. On arrival, she is in severe respiratory distress. Her pulse is 122/min, respirations are 28/min, and blood pressure is 94/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 88%. Exam ination shows jugular venous distention. Heart sounds are distant. A pericardia! rub is heard best at the second to fourth left intercostal spaces. The abdomen is distended and nontender. The liver is enlarged. There is 2+ edema of the lower extremities. An ECG shows sinus tachycardia and ST-segment elevations throughout all leads. An x-ray of the chest is shown. Which of the following is the most appropriate next step in diagnosis? 0 A) Bedside cardiac ultrasonography 0 B) Cardiac catheterization 0 C) CT scan of the chest 0 D) Dopamine infusion 0 E) Hepari n infusion Q F) Noninvasive ventilation Q G) Orotracheal intubation Q H) Thrombolytic infusion.,. https://t.me/USMLENBME2CK ~, r, Next Lab Values Calculator Review Help Pause Exam Section: Item 2 of 50 National Board of Medical Examiners Time Remaining: Mark Emergency Medicine Self-Assessment 4 hr 59 min 25 sec 2. A 14-month-old girl is brought to the emergency department 20 minutes after having a generalized tonic-clonic seizure at home. The seizure began after she awoke from a nap and lasted approximately 3 minutes. She was drowsy afterward. This morning, her parents noted that she had mild rh inorrhea. She was born at term following an uncompl icated pregnancy and delivery. Development has been appropriate for age. On exam ination, she is alert and responsive. Her tem perature is 39.8°C (103.6°F), pulse is 140/min, respirations are 24/min, and blood pressure is 90/60 mm Hg. There are copious nasal secretions. The neck is supple. The lungs are clear to auscultation. Muscle strength is normal. Which of the following is the most appropriate next step in management of this patient's seizure? 0 A) Reassurance 0 B) CT scan of the head 0 C) Beg in anticonvu lsant therapy 0 D) EEG 0 E) Lumbar puncture r ~, r, Previous Next https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause Exam Section: Item 3-4 of 50 National Board of Medical Examiners Time Remaining: Mark Emergency Medicine Self-Assessment 4 hr 58 min 45 sec The following vignette applies to the next 2 items. The items in the set must be answered in sequential order. Once you click Proceed to Next Item, you will not be able to add or change an answer. A 71-year-old woman is brought to the emergency department by her fami ly because of a 1-day history of intermittent agitation and confusion. During the past 2 days, she has had a cough and has felt cold. She has hypertension, coronary artery disease, and Graves disease; she takes lisinopril, methimazole, and lovastatin. She has no known allergies. On arrival, she is oriented to person but not to place or time. Her temperatu re is 39.4 °C (103°F), pulse is 150/min and reg ular, respirations are 26/min, and blood pressu re is 114/52 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 92%. The skin is warm and moist to the touch. Cardiac examination shows no murmur or gallop. Rhonchi are heard in the right lung base. The abdomen is soft and nontender. Cranial nerves, motor function, sensation, and cerebellar function appear to be intact, but patient agitation prevents a detai led neurologic examination. Patellar reflexes are 3+ bilateral ly. 3. Item 1 of 2 In addition to x-ray of the chest, which of the following is most likely to confirm the diagnosis? A) Blood culture B) Complete blood count with differential C) CT scan of the head D) Measurement of serum calcium and magnesium concentrations E) Thyroid function testing.... r ~, r, Previous Next https://t.me/USMLENBME2CK Lab Values Calculator Review Help Pause Exam Section: Item 3-4 of 50 National Board of Medical Examiners Time Remaining: Mark Emergency Medicine Self-Assessment 4 hr 58 min 32 sec... 4. Item 2 of 2 Acetaminophen and 0.9% saline (2 L) are admin istered , and supplemental oxygen via nasal cannu la is initiated. One hour later, her temperature is 38.2°C (100.8°F), pu lse is 145/m in, respirations are 22/min, and blood pressure is 135/65 mm Hg. Oxygen saturation is 97%. Laboratory studies show: Leukocyte count 17,000/mm3 (17 x 109/L) Segmented neutrophils 85% Bands 3% Lymphocytes 10% Monocytes 2% Serum Na + 145 mEq/L (145 mmol/L) Creatinine 1.3 mg/dL (114.9 µmol/L) Thyroid-stimulating hormone 0.0 1 µIU/m L (0.01 mlU/L) Lactic acid 2.4 mEq/L (2.4 mmol/L) [N