I. Start the exam by click the “Start” button
II. Preview all questions below
1.A 58-year-old man presents to the emergency department (ED) with reported blister formation over both feet that initially began 2 days He denies any past medical history, medications, or allergies. His social history is significant for alcohol dependence and recently becoming undomiciled. He denies any sick contacts or recent travel. Upon physical examination, these lesions are fluid-filled and his feet are grossly cyanotic and tender to the touch. His foot is shown below. What is the most likely diagnosis in this patient?
- Trench foot
- Thermal burn
2. A 43-year-old insulin-dependent diabetic woman presents with an intensely pruritic rash across her back for the last several She reports a recent trip to the Caribbean with her family last week, none of whom has similar symptoms. She denies any insect bites, new detergents, soaps, or clothes, and has otherwise been at her baseline of health with no consti- tutional symptoms. The patient is on insulin glargine for her diabetes and reports a hemoglobin A1C of less than 7 mg/dL. Upon physical examina- tion, the patient has small vesicular lesions on an erythematous base with no visible purulence. The rash does not follow a dermatome distribution and is clustered across her back. Which of the following is the most appro- priate treatment choice for this patient?
- Calamine lotion
- Chlorhexidine lotion
- Diphenhydramine (Benadryl)
- Parenteral antibiotics
3. A 32-year-old otherwise healthy man develops dizziness, nausea, and confusion after running a race. Emergency medical services (EMS) are available on-site and the patient is given intravenous (IV) He is oriented to person and time but not place. He appears generally confused and it is difficult to obtain contact information from him. The patient is brought to the ED whereupon his symptoms generally resolve, except for diffuse muscle fatigue. Laboratory tests are drawn at this time, which are essentially normal, except for minimally elevated hepatic transaminases. Given this patient’s symptoms and laboratory evaluation, what is the most likely diagnosis?
- Heat syncope
- Heat edema
- Heat stroke
- Heat exhaustion
4. A 42-year-old man presents to the ED after sustaining an electric shock when he was changing a wall The patient complains of pain in the finger that was shocked. Visual inspection reveals localized erythema at the distal tip but good capillary refill, 2+ radial, and ulnar pulses and full range of motion of that hand and extremity. Chest auscultation reveals a normal S1 and S2 with clear and equal breath sounds bilaterally. There are no other signs of trauma. What diagnostic test should be performed next in the complete evaluation of this patient?
- Basic metabolic panel
- Chest radiograph
- Electrocardiogram (ECG)
- Arterial Doppler
5. An 18-year-old man presents to the ED with right leg pain and swell- ing after swimming at a local He reports swimming in the ocean, whereupon he felt a sharp sting in his right leg. Upon physical examina- tion, there is no gross deformity of the right lower extremity and there is a palpable dorsalis pedis and posterior tibial pulse. There is tenderness to palpation over the lateral calf with many punctuate, erythematous lesions as seen below. Which of the following is the most appropriate treatment of choice for this patient?
- Fresh water
- Vegetable oil
- Household window cleaner
6. A 49-year-old man presents to the ED with pain, erythema, and swell- ing to his left forearm after a chemical spill sustained at He irrigated the area with water and applied a cold packet before arriving but states that the burning sensation in his arm is now worse. The patient works in a glass factory and reports using a rust-removing agent. What tissue-saving treat- ment must be administered emergently?
- Limb tourniquet
- Calcium gluconate
- Alkalinization of urine
- Silver sulfadiazine ointment
- Surgical debridement
7. A 23-year-old construction worker is brought by ambulance to the ED with bilateral knee He reports mixing cement the day before and kneeling in the process. The patient states that his jeans were soaked through most of the day but did not attempt to wash the cement off. Upon physical examination, you see marked tissue necrosis of both knees extend- ing to the bone in some places. Which chemical was this patient most likely exposed to?
- Formic acid
8. A 40-year-old veterinary assistant presents to the ED with puncture wounds over her right upper extremity and She reports being bitten multiple times by a cat in her care, and also states that the cat’s immuniza- tions were up to date. The injury was sustained 2 days ago with minimal initial symptoms. However, today the patient noticed redness and pain in that area. She denies any fever, chills, nausea, vomiting, or any other constitutional symptoms. Her initial vitals include an oral temperature of 99.7°F, a heart rate (HR) of 90 beats per minute, blood pressure (BP) of 125/75 mm Hg, respiratory rate (RR) of 14 breaths per minute, and an oxygen saturation of 99% on room air. Multiple punctate wounds may be seen over her right lateral neck extending down to her deltoid with sur- rounding erythema and edema. Which antibiotic coverage for the specific organism involved in this type of injury would be most appropriate?
- A first-generation cephalosporin/Staphylococcus aureus
- Amoxicillin/clavulanate (Augmentin)/Pasteurella multocida
- Clindamycin/Streptococcus sp.
- Vancomycin/methicillin-resistant S aureus
- Bacitracin ointment/S aureus
9. A 26-year-old woman presents to the ED with a history of spilling hot soup over her left arm earlier in the She states that she immediately put her hand under cold water and applied ice. Upon physical examina- tion, the involved area covers the dorsum of her hand and extends up to the middle of her forearm with no circumferential or digital involvement. She can freely flex and extend all joints of that upper extremity. In addition, two large fluid-filled bullae are noted in the area of the forearm. What is the burn degree and relative area of involvement in this patient?
10. A 60-year-old male cook reports spilling hot oil over his left thigh while attempting to pull a pan off of the He presents to the ED with erythema extending over his left thigh without any blister formation or circumferential involvement. The patient reports that he was wearing thick pants at the time of the accident that he removed quickly and promptly irrigated the area with water. There are no other signs of injury. What is the burn degree and relative area of involvement in this patient?
11. You are the physician staffing a clinic in the Rocky Mountains when 29-year-old male mountain-climber presents with nausea, vomiting, and dizziness. Upon review of systems, he denies fever, cough, abdominal pain, or dysuria but does report anorexia and some ankle What diuretic is the drug of choice in this patient?
12. A 25-year-old female scuba diver presents to the ED with multiple areas of periarticular joint pain and red, itchy Her initial vitals include an oral temperature of 98°F, BP of 110/65 mm Hg, HR of 88 beats per minute, RR of 14 breaths per minute, and oxygen saturation of 97% on room air. Upon physical examination, the patient has pain upon palpation of bilateral knees and ankles with full range of motion in these joints. Areas of erythema that do not follow a specific dermatomal pattern cover most of the lower extremities, torso, and back with areas of excoriation where patient reports scratching. There are no other lesions. Which of the following is the most likely diagnosis?
- Sexually transmitted disease (STD)
- Decompression sickness
- Descent barotrauma
- Ascent barotrauma
- Nitrogen narcosis
13. A 19-year-old rookie Navy Seal presents to the ED with a history of syncope upon ascent from a The length and depth of the dive was within decompression regulation. He currently complains of feeling light-headed with a moderate frontal headache. Vital signs include HR of 86 beats per minute, BP of 130/65 mm Hg, and RR of 16 breaths per minute with oxygen saturation of 93% on room air. Upon physical examination, he appears somewhat confused and is oriented only to person and place. He has no focal neurologic deficits. What underlying event is the cause for this patient’s symptoms?
- Pulmonary embolism
- Cardiac ischemia
- Transient ischemic attack
- Dysbaric air embolism
- Nitrogen narcosis
14. A farmer in Texas presents to the ED with right leg numbness, localized edema, and He reports being out in the field when the symptoms began. He denies contact with insecticides and reports being at his baseline of health prior to the event. His initial vitals include HR of 105 beats per minute, BP of 175/90 mm Hg, and RR of 22 breaths per min- ute with oxygen saturation of 97% on room air. Which of the following is the most appropriate initial treatment of choice in this patient?
- Tetanus prophylaxis
- Antibiotic prophylaxis
15. A 23-year-old man presents to the ED after sustaining a bee The patient points to his left arm when asked where the pain is. Upon physical examination, you see a single puncture wound with surround- ing erythema and swelling. The patient is in no respiratory distress and is phonating well. Chest auscultation reveals clear breath sounds bilaterally with no wheezing. The oropharynx is patent without any tonsillar or uvu- lar displacement. Which of the following is the most appropriate next step in management?
- Subcutaneous epinephrine 0.01 mL/kg
- IV epinephrine 0.01 mL/kg
16. An 18-year-old man is brought into the ED and reports that a stray dog at the park bit The patient complains of right forearm pain, where he was bitten. Upon physical examination, you note a superficial macer- ated laceration on the dorsal surface of the distal forearm with no active bleeding. The patient is able to freely flex and extend all joints in the right upper extremity. In addition to localized wound care, antibiotics, and tetanus prophylaxis, what other expeditious measures should be taken in the care of this patient?
- Reporting the incident to local authorities
- Rabies immunization
- Tight suturing of the laceration
- Irrigation with povidone-iodine solution
17. A 31-year-old man presents to the ED with left calf He reports general malaise, nausea, and myalgias since a recent trip to Arkansas. His initial vitals include oral temperature of 99°F, HR of 76 beats per minute, BP of 128/70 mm Hg, RR of 16 breaths per minute, and oxygen saturation of 98% on room air. Upon physical examination, there are diffuse petechiae of the left lower extremity from the anterior distal tibia to the mid-thigh. Closer examination reveals a small necrotic lesion at the level of the lateral mid-calf with surrounding edema as seen below. The patient’s calf is tender to the touch and upon dorsiflexion. Which of the following is the most likely cause of this patient’s clinical symptoms?
- Deep venous thrombosis (DVT)
- Scorpion sting
- Brown recluse spider bite
- Black widow spider bite
18. A 23-year-old avid high-altitude skier presents to the ED with intense pain, tearing, and bilateral ocular foreign body He denies any trauma, past medical problems or contact lens use. His physical examination is significant for bilateral decreased visual acuity, injected conjunctiva, and diffuse punctuate corneal lesions with a discrete inferior border. His pupils are equal, round, and reactive to light. Given this patient’s history and physical examination, which of the following is the most likely diagnosis?
- Corneal abrasion
- Ultraviolet keratitis
- Corneal foreign body
- Corneal laceration
19. A 44-year-old woman returns from a mountain excursion with headache symptoms, nausea, and vomiting that are Her initial vital signs in the ED are HR of 93 beats per minute, BP of 120/60 mm Hg, RR of 18 breaths per minute, and oxygen saturation of 96% on 2-L nasal cannula. Her chest examination is clear to auscultation with no palpable overlying crepitus and there are no signs of peripheral edema. Which of the following medications is indicated in this patient?
20. A 20-year-old college student presents to the ED with a cutaneous lesion as depicted He is brought in by friends who report being out in an open field during stormy weather when the injury occurred. The patient denies any recent travel or sick contacts. He also denies any symp- toms except for some generalized confusion. Which aspect of the physical examination of this patient is initially most pertinent to the nature of this type of injury?
- Testing of cranial nerves
- Otoscopic evaluation of tympanic membranes
- Evaluation of gait cadence
- Testing of cerebellar deficits
- Palpating the cervical spine for tenderness
21. A 24-year-old man presents to the ED with diffuse facial pain, pruritus, erythema, and dizziness after reportedly falling on to an His initial vital signs include HR of 102 beats per minute, BP of 118/75 mm Hg, and RR of 18 breaths per minute with oxygen saturation of 98% on room air. What is the initial appropriate assessment in this clinical scenario?
- Give tetanus prophylaxis.
- Begin local wound care.
- Assess airway, breathing, and circulation.
- Start IV fluid administration.
- Give oral antihistamines.
22. A 26-year-old man presents to the ED in agony with a Gila monster still attached to his arm after being He reports that he is the animal’s main handler, with no prior biting incidents. He reports localized pain but denies weakness, nausea, or feeling light-headed. The animal bite occurred about 45 minutes ago. After the animal is carefully removed, what should be done next in the care of this patient?
- Check for any remaining embedded teeth and begin wound care.
- Administer antivenin.
- Give tetanus prophylaxis.
- Administer broad-spectrum antibiotics.
- Apply suction device.
23. An anxious college student presents to the ED at 2 AM stating a bat woke him He heard something flying around his bedroom and, when he turned the lights on, he saw a bat fly into his closet. He is unsure if he was bit by the bat but noticed bat droppings in his bed. Which is the most appropriate management for the patient?
- Reassure him that there is nothing to do and discharge him.
- Immunoprophylax with human rabies immune globulin and human diploid cell vaccine.
- Administer ciprofloxacin 500 mg.
- Admit him to the hospital for 24 hours of observation.
- Immunoprophylax with human diploid cell vaccine.