QUESTION: 97

A 24-year-old male with a history of gang violence presents to the emergency room with 3 stab wounds to the abdomen. He was intubated in the field for airway protection and is barely conscious. Blood pressure is 70/30 mm Hg and pulse is 140/min. On exam, 3 penetrating wounds covered by abdominal pressure pads are noted.
Which of the following is the best next step in management of this patient?

IV fluids
Abdominal x-ray
Obtain consent for surgery
IV antibiotics

Answer(s): A

Explanation:

This patient is in hemorrhagic shock and requires immediate resuscitation. Of the choices listed, the best next step in management is IV fluids after obtaining venous access. The best form of venous access is 2 large-bore IVs in the periphery and/or central venous access. Applying direct pressure to the abdomen (a) does not treat the underlying cause. Getting an abdominal x-ray (b) will take too long for a patient with this rate of blood loss. IV antibiotics (c) may be needed later in the care of this patient, but stabilizing blood pressure is now the more urgent need. Surgical consent (e) is implied in a life-threatening emergency in which a patient cannot communicate his wishes.

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QUESTION: 98

A 47-year old man comes to the emergency department with fever, headache, photophobia, and a stiff neck.
What is the next best step in the management of this patient?

Head Ct scan
Lumbar puncture
Ceftriaxone and vancomycin

Answer(s): B

Explanation:

When you suspect bacterial meningitis, administer antibiotics quickly. Further, do blood cultures stat simultaneously with a lumbar puncture (LP), or immediately prior. Penicillin can never be used as empiric therapy for meningitis; it is not sufficiently broad in coverage to be effective empiric therapy. In this case, perform the
LP.

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QUESTION: 99

Condition not associated with increased alpha fetoprotein:

Myelomeningocele
Down syndrome
Spina bifida
Gastroschisis

Answer(s): B

Explanation:

Down syndrome associated with DECREASED levels of alpha fetoprotein. Not increased.

Reference:

https://en.m.wikipedia.org/wiki/Triple_test

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QUESTION: 100

A pregnant woman comes with weakness and elevated liver function tests. She is in her 35th week of pregnancy. The prothrombin time is normal. The smear of blood shows fragmented red cells. Platelet count is low.
What is the treatment?

Delivery of the baby
Fresh frozen plasma
Prednisone

Answer(s): A

Explanation:

Deliver the baby with the HELLP syndrome. HELLP syndrome stands for hemolysis, elevated liver function tests, and low platelets. This disorder is idiopathic and can be distinguished from DIC by the normal coagulation studies, such as the prothrombin time and aPTT.

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QUESTION: 97

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QUESTION: 99

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QUESTION: 100

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