PA Family Medicine EOR Questions and
answer
Deteriorating mental status/unconscious patient
ABC's
IOM's - correct answer-*A*irway security
*B*reathing
*C*irculation
*I*V access
*O*2 saturation
*M*onitor vitals
Acute Respiratory Distress Syndrome - correct answer-↓ PaO2 and ↑ PaCO2 from fluid
collapsing the *alveoli*
MCC: 6-72 hrs s/p *Sepsis*
Associated w/ Renal & Hepatic failure
↓ BP or shock w/ crackles, rales, wheezing
Tx: Mechanical Vent w/ *PEEP*
Anaphylaxis (Type 1 Hypersensitivity) - correct answer-Upper airway obstruction
Urticaria
Bronchospasm
Hypotension
Cardiovascular Collapse
Tx: Epinephrine + O2 + IVF
Cardiac failure/arrest - correct answer-CPR: 100-120bpm
Bag-Valve: 10 respirations/min, Consider advanced airway
Rx: EPI 1mg Q 3-5min, Amiodarone 300mg then 150mg
Reversible causes of cardiac arrest
*H's & T's* - correct answer-*H*ypovolemia
*H*ypoxia
*H*ydrogen ion (acidosis)
*H*ypo-hyperkalemia
*H*ypothermia
*T*ension pneumo
*T*amponade (cardio)
*T*oxins
*T*hrombosis (pulm)
*T*hrombosis (cardio)
,Hypertensive Crisis v. Urgency v. Emergency - correct answer-Crisis: Systolic BP
>180mmHg or Diastolic BP >130mmHg
Urgency: Severely elevated BP w/o evidence of end-organ damage
Emergency: HTN w/ acute end-organ damage
Encephalopathy, Stroke, Aortic dissection, MI, Acute renal failure
Hypertensive Emergency - correct answer-BP > 180/130 with evidence of organ damage
Tx: IV *Labetalol or Nicardipine* to ↓ MAP by 25% in 1st hour then normalize BP over next
8-24hrs
CAUTION: Organ Ischemia w/ ↓ in MAP
Placentae previa - correct answer-*Painless vaginal bleeding*
<30 weeks = ↑ risk of transfusion need, ↑ risk of preterm/perinatal mortality
Tx: C-sec
>30 weeks = good prognosis
Foreign body aspiration - correct answer-MC: Rt main bronchus
Dx: CXR - unilateral emphysema if in trachea
Tx: Rigid bronchoscopy
Myocardial infarction - correct answer-Chest pressure & *dyspnea* at rest and worsening
over >30min
Confusion, syncope, vertigo, diaphoresis
ST- segment Elevation on EKG
Elevated troponin
Tx of MI - correct answer-Morphine
O2
Nitrates
Aspirin & Clopidigrel - ↓ morbidity/mortality
BBs > ACEI > CCBs > Statins > Heparin
Appendicitis - correct answer-Periumbilical, colicky pain → RLQ *McBurney's point*
Rebound Tenderness, Psoas, Rovsing
Loss of appetite
Nauea/Vomiting/Fever
MCC: Fecolith
Dx: US or CT
Tx: Appendectomy + Abx
Jefferson (C1) Fracture - correct answer-Burst fracture of C1 via axial load (football
player/diver)
Unstable: immobilize c spine
,C-spine Xrays: AP, Lateral, Oblique, Odontoid
Pulmonary embolus - correct answer-Sudden onset of SOB, CP, *Tachycardia*
EKG: Nonspecific ST changes, Right heart strain, S1Q3T3
CKR: Westermark's sign
Dx: CT Pulmonary Angiogram
Tx: Anticoags > thrombolytics > embolectomy
Pneumothorax - correct answer-Decreased breath sounds- unilateral
Sharp chest pain, worse w/ deep breaths or coughs
Xray shows air outside lung
Tx: *1st line*: 14ga. Needle decompression 2nd ICS MCL
2nd line: Chest tube ICS MCL
Types of Pneumothoraces
A. Tall thin men 20-40
B. Complication of underlying lung disease
C. Stab wound, Gun Shot, or MVA w/ direct blow to chest
D. Pleural Edema or Anascara and ↑ thoracic pressure - correct answer-A. Spontaneous
Pneumo
B. Secondary Spontaneous Pneumo
C. Traumatic Pneumo
D. Tension Pneumo
Black Widow Spider bite - correct answer-Pinprick spider-bite
Acetylcholine-Induced Myalgias
Severe cramping of chest & abdomen
Tx: Opioids + *Benzo's* > Latrodectus Antivenom
Brown Recluse Spider Bite - correct answer-Cytotoxin
Local tissue destruction & necrosis
Tx: wound care
Hydrocarbon Pneumonitis - correct answer-Ingestion of furniture polish
Mild CNS depression
Aspiration = coughing
Dx: *CXR* & pulmonology consult = diffuse b/l inflitrates
May lead to ARDS
Ethylene glycol ingestion (antifreeze) - correct answer-Osmolal gap
Anion-Gap Metabolic Acidosis
Acute renal failure (ATN)
*Calcium Oxalate* in urine
Hypocalcemia
Tx: Fomepizole or Ethanol
, Salicylate toxicity - correct answer-ASA, Wintergreen, Pepto-Bismol
Respiratory Alkalosis (early)
GAP metabolic acidosis (late)
Hypoglycemia
*Tinnitus*
Tx:
Activated Charcoal (if <1hr from ingestion)
Urinary alkalinization w/ *Sodium Bicarb*
IV K+
Hemodialysis
Carbon Monoxide Poisoning - correct answer-HA, Nausea, Dizziness
Cherry-red skin
↑ Carboxyhemoglobin levels
Tx: 100% O2, Hyperbaric
Mild Intermittent Asthma - correct answer-Symptoms: < 2x/wk
Night Sxs: < 2x/mo
FEV: > 80% prediciton
Tx: No daily meds
Mild Persistent Asthma - correct answer-Symptoms: >2x/wk but <1x/d
Night Sxs: >2x/mo
FEV: >80% prediction
Tx: *Low-dose ICS* > Cromolyn, leukotriene (S/E: ↑ mucous production)
Moderate Persisitent Asthma - correct answer-Symptoms: Daily Sxs + Daily use of
B2-agonist
Night Sxs: >1x/wk
FEV: 60-80% prediction
Tx: *Low-Med dose ICS + Long-acting B2-agonist*
Severe Persistent Asthma - correct answer-Symptoms: Continuous w/ impaired physical
activity
Night Sxs: Frequent
FEV: <60%
Tx: High-dose ICS + Long-acting B2-agonist + oral steroid (<60mg/d)
Community Acquired Pneumoniae - correct answer->40 y/o
Sudden onset of rigors, rusty colored sputum
PE: Dullness to percussion
CXR: *Splinting lobar infiltrate*
Labs: ↑ WBC
- S. pneumo (MC)
Tx: PCN > Azithro > Amox > Levaquin (COPD)
*Bullous Myringitis*
answer
Deteriorating mental status/unconscious patient
ABC's
IOM's - correct answer-*A*irway security
*B*reathing
*C*irculation
*I*V access
*O*2 saturation
*M*onitor vitals
Acute Respiratory Distress Syndrome - correct answer-↓ PaO2 and ↑ PaCO2 from fluid
collapsing the *alveoli*
MCC: 6-72 hrs s/p *Sepsis*
Associated w/ Renal & Hepatic failure
↓ BP or shock w/ crackles, rales, wheezing
Tx: Mechanical Vent w/ *PEEP*
Anaphylaxis (Type 1 Hypersensitivity) - correct answer-Upper airway obstruction
Urticaria
Bronchospasm
Hypotension
Cardiovascular Collapse
Tx: Epinephrine + O2 + IVF
Cardiac failure/arrest - correct answer-CPR: 100-120bpm
Bag-Valve: 10 respirations/min, Consider advanced airway
Rx: EPI 1mg Q 3-5min, Amiodarone 300mg then 150mg
Reversible causes of cardiac arrest
*H's & T's* - correct answer-*H*ypovolemia
*H*ypoxia
*H*ydrogen ion (acidosis)
*H*ypo-hyperkalemia
*H*ypothermia
*T*ension pneumo
*T*amponade (cardio)
*T*oxins
*T*hrombosis (pulm)
*T*hrombosis (cardio)
,Hypertensive Crisis v. Urgency v. Emergency - correct answer-Crisis: Systolic BP
>180mmHg or Diastolic BP >130mmHg
Urgency: Severely elevated BP w/o evidence of end-organ damage
Emergency: HTN w/ acute end-organ damage
Encephalopathy, Stroke, Aortic dissection, MI, Acute renal failure
Hypertensive Emergency - correct answer-BP > 180/130 with evidence of organ damage
Tx: IV *Labetalol or Nicardipine* to ↓ MAP by 25% in 1st hour then normalize BP over next
8-24hrs
CAUTION: Organ Ischemia w/ ↓ in MAP
Placentae previa - correct answer-*Painless vaginal bleeding*
<30 weeks = ↑ risk of transfusion need, ↑ risk of preterm/perinatal mortality
Tx: C-sec
>30 weeks = good prognosis
Foreign body aspiration - correct answer-MC: Rt main bronchus
Dx: CXR - unilateral emphysema if in trachea
Tx: Rigid bronchoscopy
Myocardial infarction - correct answer-Chest pressure & *dyspnea* at rest and worsening
over >30min
Confusion, syncope, vertigo, diaphoresis
ST- segment Elevation on EKG
Elevated troponin
Tx of MI - correct answer-Morphine
O2
Nitrates
Aspirin & Clopidigrel - ↓ morbidity/mortality
BBs > ACEI > CCBs > Statins > Heparin
Appendicitis - correct answer-Periumbilical, colicky pain → RLQ *McBurney's point*
Rebound Tenderness, Psoas, Rovsing
Loss of appetite
Nauea/Vomiting/Fever
MCC: Fecolith
Dx: US or CT
Tx: Appendectomy + Abx
Jefferson (C1) Fracture - correct answer-Burst fracture of C1 via axial load (football
player/diver)
Unstable: immobilize c spine
,C-spine Xrays: AP, Lateral, Oblique, Odontoid
Pulmonary embolus - correct answer-Sudden onset of SOB, CP, *Tachycardia*
EKG: Nonspecific ST changes, Right heart strain, S1Q3T3
CKR: Westermark's sign
Dx: CT Pulmonary Angiogram
Tx: Anticoags > thrombolytics > embolectomy
Pneumothorax - correct answer-Decreased breath sounds- unilateral
Sharp chest pain, worse w/ deep breaths or coughs
Xray shows air outside lung
Tx: *1st line*: 14ga. Needle decompression 2nd ICS MCL
2nd line: Chest tube ICS MCL
Types of Pneumothoraces
A. Tall thin men 20-40
B. Complication of underlying lung disease
C. Stab wound, Gun Shot, or MVA w/ direct blow to chest
D. Pleural Edema or Anascara and ↑ thoracic pressure - correct answer-A. Spontaneous
Pneumo
B. Secondary Spontaneous Pneumo
C. Traumatic Pneumo
D. Tension Pneumo
Black Widow Spider bite - correct answer-Pinprick spider-bite
Acetylcholine-Induced Myalgias
Severe cramping of chest & abdomen
Tx: Opioids + *Benzo's* > Latrodectus Antivenom
Brown Recluse Spider Bite - correct answer-Cytotoxin
Local tissue destruction & necrosis
Tx: wound care
Hydrocarbon Pneumonitis - correct answer-Ingestion of furniture polish
Mild CNS depression
Aspiration = coughing
Dx: *CXR* & pulmonology consult = diffuse b/l inflitrates
May lead to ARDS
Ethylene glycol ingestion (antifreeze) - correct answer-Osmolal gap
Anion-Gap Metabolic Acidosis
Acute renal failure (ATN)
*Calcium Oxalate* in urine
Hypocalcemia
Tx: Fomepizole or Ethanol
, Salicylate toxicity - correct answer-ASA, Wintergreen, Pepto-Bismol
Respiratory Alkalosis (early)
GAP metabolic acidosis (late)
Hypoglycemia
*Tinnitus*
Tx:
Activated Charcoal (if <1hr from ingestion)
Urinary alkalinization w/ *Sodium Bicarb*
IV K+
Hemodialysis
Carbon Monoxide Poisoning - correct answer-HA, Nausea, Dizziness
Cherry-red skin
↑ Carboxyhemoglobin levels
Tx: 100% O2, Hyperbaric
Mild Intermittent Asthma - correct answer-Symptoms: < 2x/wk
Night Sxs: < 2x/mo
FEV: > 80% prediciton
Tx: No daily meds
Mild Persistent Asthma - correct answer-Symptoms: >2x/wk but <1x/d
Night Sxs: >2x/mo
FEV: >80% prediction
Tx: *Low-dose ICS* > Cromolyn, leukotriene (S/E: ↑ mucous production)
Moderate Persisitent Asthma - correct answer-Symptoms: Daily Sxs + Daily use of
B2-agonist
Night Sxs: >1x/wk
FEV: 60-80% prediction
Tx: *Low-Med dose ICS + Long-acting B2-agonist*
Severe Persistent Asthma - correct answer-Symptoms: Continuous w/ impaired physical
activity
Night Sxs: Frequent
FEV: <60%
Tx: High-dose ICS + Long-acting B2-agonist + oral steroid (<60mg/d)
Community Acquired Pneumoniae - correct answer->40 y/o
Sudden onset of rigors, rusty colored sputum
PE: Dullness to percussion
CXR: *Splinting lobar infiltrate*
Labs: ↑ WBC
- S. pneumo (MC)
Tx: PCN > Azithro > Amox > Levaquin (COPD)
*Bullous Myringitis*
