ER SMARTY PANCE QUESTIONS AND ANSWERS
Patient will present as → a 46-year-old male who presents to the ED with dysphagia,
hypersalivation, agitation, and generalized muscle twitching. The patient's wife says that
she has been trying to get him to drink water but he can't seem to swallow. Past medical
history revealed patient had right arm pain and paraesthesia one week prior which had
failed to resolve. Further questioning revealed the patient had been bitten by a racoon
about three months ago while hiking in the woods. He didn't seek medical attention. CT
scan and lumbar puncture were unremarkable. Nuchal biopsy was carried out and
samples of the patient's saliva and serum sent for DFA and PCR. - Answers - rabies
Which of the following is associated with Negri bodies?
A Rabies
B Mumps
C Measles
D Herpes simplex - Answers - A
Negri bodies are round cytoplasmic inclusions seen in neuronal cells of patient with
rabies. All others are not associated with Negri bodies.
A patient is brought to the emergency on account of pain, numbness, and intense
itching at a wound site on his leg which he obtained from a Raccoon bite about 6 weeks
ago. There is also associated hydrophobia, aerophobia, fever, and headache. Which is
the most likely diagnosis?
A
Tetanus
B
Rabies
C
Measles
D
Mumps - Answers - B
Symptoms mentioned above occur in the prodromal period of Rabies. Rabies occurs
following bite from infected raccoons, dog, bats etc.
Which one of the following would not be part of your immediate management plan for a
patient with 46% BSA involvement of deep-partial thickness thermal burns?
A Fluid resuscitation and urethral catheterization
B Prophylactic systemic antibiotics
C Analgesic administration
D Topical antibiotics on burn sites - Answers - B
Prophylactic systemic antibiotics administration is not indicated in the management of
burns. All other options are correct.
A burn that extends into the bone and muscle best describes
, A 1st degree burn
B 2nd degree burn
C 3rd degree burn
D 4th degree burn - Answers - D
A burn that extends into the bone and muscle best describes a 4th degree burn
Which of the following sutures is not absorbable?
A Catgut
B Vicryl
C Polypropylene
D Dexon
E Chromic catgut - Answers - C
The goal of suturing is to approximate the skin and eliminate unnecessary dead space.
Tension at the wound site should be minimized. To achieve maximal cosmetic result, a
suture is chosen based on the clinical situation. Monofilament sutures have significantly
lowered the incidence of infection compared with multifilament sutures that can harbor
bacteria. Nonabsorbable sutures (i.e., nylon, silk, polypropylene [prolene], braided
polyester [Mersilene/ Surgidac, ethibond/ Ti-cron], and polybutester) are usually used to
close the superficial layer of skin. Absorbable sutures (i.e., catgut, chromic catgut,
Dexon II [polycaprolate], Maxon, and Vicryl [Polyglactin 10], Poliglecaprone [PDSII], and
Caprosyn) are used to close deep layers of skin.
Facial sutures should be removed at
A 24 hours
B 3 to 5 days
C 7 to 10 days
D 14 days
E Only absorbable sutures should be used on the face - Answers - B
Postoperative care for lacerations does not include routine use of prophylactic
antibiotics unless there is evidence of bacterial contamination or a risk factor is evident.
Sutured or stapled lacerations should be covered with a protective, nonadherent
dressing for at least 24 to 48 hours to avoid contamination. Patients should be
instructed to observe the wound for the presence of warmth, redness, swelling, or
drainage. Sutures or staples should be removed after approximately 7 days. Facial
sutures should be removed within 3 to 5 days. Sutures in areas subject to high tension
should be left in place for 10 to 14 days.
Which of the following provides definitive diagnosis of rabies?
A MRI
B Blood culture
C PCR of saliva sample
D None of the above - Answers - C
PCR of a saliva sample can detect viral RNA. It is diagnostic
A patient is first seen with burns to the entire right arm, the anterior right leg, and
genitals. The estimated burn surface area would be calculated as:
Patient will present as → a 46-year-old male who presents to the ED with dysphagia,
hypersalivation, agitation, and generalized muscle twitching. The patient's wife says that
she has been trying to get him to drink water but he can't seem to swallow. Past medical
history revealed patient had right arm pain and paraesthesia one week prior which had
failed to resolve. Further questioning revealed the patient had been bitten by a racoon
about three months ago while hiking in the woods. He didn't seek medical attention. CT
scan and lumbar puncture were unremarkable. Nuchal biopsy was carried out and
samples of the patient's saliva and serum sent for DFA and PCR. - Answers - rabies
Which of the following is associated with Negri bodies?
A Rabies
B Mumps
C Measles
D Herpes simplex - Answers - A
Negri bodies are round cytoplasmic inclusions seen in neuronal cells of patient with
rabies. All others are not associated with Negri bodies.
A patient is brought to the emergency on account of pain, numbness, and intense
itching at a wound site on his leg which he obtained from a Raccoon bite about 6 weeks
ago. There is also associated hydrophobia, aerophobia, fever, and headache. Which is
the most likely diagnosis?
A
Tetanus
B
Rabies
C
Measles
D
Mumps - Answers - B
Symptoms mentioned above occur in the prodromal period of Rabies. Rabies occurs
following bite from infected raccoons, dog, bats etc.
Which one of the following would not be part of your immediate management plan for a
patient with 46% BSA involvement of deep-partial thickness thermal burns?
A Fluid resuscitation and urethral catheterization
B Prophylactic systemic antibiotics
C Analgesic administration
D Topical antibiotics on burn sites - Answers - B
Prophylactic systemic antibiotics administration is not indicated in the management of
burns. All other options are correct.
A burn that extends into the bone and muscle best describes
, A 1st degree burn
B 2nd degree burn
C 3rd degree burn
D 4th degree burn - Answers - D
A burn that extends into the bone and muscle best describes a 4th degree burn
Which of the following sutures is not absorbable?
A Catgut
B Vicryl
C Polypropylene
D Dexon
E Chromic catgut - Answers - C
The goal of suturing is to approximate the skin and eliminate unnecessary dead space.
Tension at the wound site should be minimized. To achieve maximal cosmetic result, a
suture is chosen based on the clinical situation. Monofilament sutures have significantly
lowered the incidence of infection compared with multifilament sutures that can harbor
bacteria. Nonabsorbable sutures (i.e., nylon, silk, polypropylene [prolene], braided
polyester [Mersilene/ Surgidac, ethibond/ Ti-cron], and polybutester) are usually used to
close the superficial layer of skin. Absorbable sutures (i.e., catgut, chromic catgut,
Dexon II [polycaprolate], Maxon, and Vicryl [Polyglactin 10], Poliglecaprone [PDSII], and
Caprosyn) are used to close deep layers of skin.
Facial sutures should be removed at
A 24 hours
B 3 to 5 days
C 7 to 10 days
D 14 days
E Only absorbable sutures should be used on the face - Answers - B
Postoperative care for lacerations does not include routine use of prophylactic
antibiotics unless there is evidence of bacterial contamination or a risk factor is evident.
Sutured or stapled lacerations should be covered with a protective, nonadherent
dressing for at least 24 to 48 hours to avoid contamination. Patients should be
instructed to observe the wound for the presence of warmth, redness, swelling, or
drainage. Sutures or staples should be removed after approximately 7 days. Facial
sutures should be removed within 3 to 5 days. Sutures in areas subject to high tension
should be left in place for 10 to 14 days.
Which of the following provides definitive diagnosis of rabies?
A MRI
B Blood culture
C PCR of saliva sample
D None of the above - Answers - C
PCR of a saliva sample can detect viral RNA. It is diagnostic
A patient is first seen with burns to the entire right arm, the anterior right leg, and
genitals. The estimated burn surface area would be calculated as:
