Midterm2 Flashcards

Question

# Next step? 24F brought to ED with generalized tonic-clonic movements that have persisted for the last 10 minutes. PMHx of epilepsy. Physical exam is significant for blood in the mouth and ongoing generalized tonic-clonic movements. What is your first line treatment?

Answer 1

Benzodiazepenes

Answer 2

IV Fosphenytoin: 20 PE/kg at IV Phenytoin: 20 milligrams/kg IV Levetiracetam: 2000-4000 milligrams

Answer 3

48M brought to ED by his partner after witnessing a 2 mins GTC seizure. PMHx of EtOH use disorder. Has had 15 drinks/d for last 3d. Before this, he drank 8 beers/d. His last drink was 2hrs ago. Vitals normal, physical exam normal other than appearing intoxicated. Labs are significant for Na of 112. What is the cause of this seizure? **Hyponatremia (2/2 beer potomania/chronic EtOH use). Time-line and active intoxication does nto fit with withdrawal seizure, which occurs more commonly >12-48 hours after last drink. **

Answer 4

33F is brought to ED by family after repeated history of seizures. Husband reports that they tend to occur during arguments, where the patient will stop talking, fall to the ground, and start shaking. The patient does not have any urinary incontinence or tongue biting, and has full recollection afterwards. The patient's daughter provides a cell phone video of one of the seizures, in which the patient is seen making jerky, asynchronus movements of her arms and legs. Her eyes are shut and she makes loud moaning sounds. She does not have any post-ictal confusion. No significant PMHx. FamHx of cousin with absence seizures. Vitals and labs are normal. a) GTC seizure b) Vasovagal syncope c) Hypoglycemia d) **PNES (forced eye closure, asynchronous movements, making loud noises during event and lack of post-ictal period all typical for PNES)** e) Hypernatremia

Answer 5

39F presents to ED after an episode of new sudden onset L hand jerking that within seconds spread to the elbow and then the entire L limb. The episode eventually led to a fall with loss of awareness but no head trauma. This has never happened before. PMHx is minimal. 30PY + current smoker. On exam, afebrile with no neck stiffness. Neuro exam is normal. BMP and EKG are normal. a) Echo b) LP c) **CT head (low threshold for CT in first ever seizure, but also a MUST in focal seizure for concern of structural lesion like a tumor)** d) EEG e) Urine drug testing

Answer 6

**Delirium** The Confusion Assessment Method (CAM) is the best-validated and most widely used tool for diagnosing delirium. The CAM is considered positive when a patient fulfills both criteria a and b as well as either c or d: a) The mental status change is of acute onset and fluctuating course. b) There is inattention. The patient has difficulty focusing his attention (being easily distracted or having trouble following a conversation). c) There is disorganized thinking. The patient's thinking is disorganized or incoherent (such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject). d) There is an altered level of consciousness. This can be anything other than alert (vigilant, lethargic, stuporous).

Answer 7

83M with a 1yr hx of memory loss is suddenly disoriented and fluctuates between lethargy and agitation. Which finding best differentiates delirium from dementia? a) Decline in short term memory b) **Fluctuating disturbance of conciousness (i.e. fluctuating course of symptoms)** c) Steady progression of cognitive deficits over years d) Impairment of language function e) Non-reversible

Answer 8

**Delirium** The Confusion Assessment Method (CAM) is the best-validated and most widely used tool for diagnosing delirium. The CAM is considered positive when a patient fulfills both criteria a and b as well as either c or d: a) The mental status change is of acute onset and fluctuating course. b) There is inattention. The patient has difficulty focusing his attention (being easily distracted or having trouble following a conversation). c) There is disorganized thinking. The patient's thinking is disorganized or incoherent (such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject). d) There is an altered level of consciousness. This can be anything other than alert (vigilant, lethargic, stuporous).

Answer 9

**Delirium** The Confusion Assessment Method (CAM) is the best-validated and most widely used tool for diagnosing delirium. The CAM is considered positive when a patient fulfills both criteria a and b as well as either c or d: a) The mental status change is of acute onset and fluctuating course. b) There is inattention. The patient has difficulty focusing his attention (being easily distracted or having trouble following a conversation). c) There is disorganized thinking. The patient's thinking is disorganized or incoherent (such as rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject). d) There is an altered level of consciousness. This can be anything other than alert (vigilant, lethargic, stuporous).

Answer 10

80F brought in to clinic by daughter d/t progressive memory loss over last year. Misplacing items, forgetting recent conversations, and unable to remember the month. No personality changes. Independent with most ADLs except finances. Neuro exam is normal including normal gait and coordination. A recent CT brain is normal. a) Vascular Dementia b) Delirium c) **Alzheimer's Dementia (story of being brought in by family d/t memory problems, affecting ADLs, sounds like AD. Normal CT makes vascular dementia and hydrocephalus less likely.)** d) Hydrocephalus e) Frontotemporal Dementia

Answer 11

14F is brought to ED following an overdose. On arrival, 38.3C, 115HR, 16RR, 85/40BP, 95% O2 on RA. Patient is agitated and confused, and reports blurry vision. Pupils are 8mm, minimally reactive. Lungs are clear, bowel sounds are hypoactive, and skin is warm and dry. EKG shows sinus tachycardia. What is the most likely toxidrome? a) **Anticholinergic toxidrome (dry skin is the most important distinguishing feature from this and stimulant overdose)** b) Cholinergic toxidrome c) Cocaine intoxication d) Acetaminophen overdose e) Antifreeze poisoning | Red as a beet, dry as a bone, etc.

Answer 12

24M is found unresponsive with slow, shallow breathing and pinpoint pupils. What is the most appropriate next step? a) Naltrexone **b) Naloxone - Pinpoint pupils + abnormal breathing + unresponsive = opioid OD** c) CBC d) CT head e) Blood gas

Answer 13

23F with MDD is brought to ED by EMS after being found with AMS in bathroom. Next to her was an empty bottle of diphenhydramine (antihistamine). a) Cool, clammy skin b) Diaphoresis c) Short QTc interval d) Diarrhea e) **Dry mouth (antihistamines cause anticholinergic toxidrome, which can cause dry mouth)** | Dry as a bone, mad as a hatter, etc.

Answer 14

44M presents to ED w/ 3hr hx of headache. Also has blurry vision. PMHx of HTN tx w/ HCTZ. Has not been taking med for last week b/c traveling in Japan. Oriented only to person and place. Vitals are normal except BP of 245/115. Fundoscopy shows bilateral retinal hemorrhage and exudates. Physical is -ve otherwise. CBC, lytes, BG, Cr, and CT head are all normal. a) Antibiotics b) Repeat CT head in 6hrs c) **Labetalol (story sounds like HTN encephalopathy, so anti-HTN med tx)** d) Thiamine e) LP

Answer 15

10mo boy brought to ED by parents due to 3d hx of fever (39.1C). Immunization complete. Uncircumsized. No fever source found on physical exam. What is your most appropriate next step? a) Reassurance b) LP **c) Urinalysis and culture** d) Antibiotics e) Sputum culture

Answer 16

A 37-year-old man is referred to you by his partner due to escalating alcohol use. During your conversation, he admits he has “been drinking more than I should” and is “open to hearing what the options are,” but he also insists that he’s “still managing everything just fine” and “doesn’t need to quit completely.” He has not made any specific plans to change his behaviour. **Which stage of change is he most likely in?** A. Maintenance B. Contemplation C. Preparation (Determination) D. Action **E. Precontemplation** *The patient recognizes a problem ("been using more than I should") and is open to discussion, which is characteristic of Contemplation.* | Background reading 29 Addiction: Page 6

Answer 17

You are seeing a 30-year-old man with alcohol use disorder who reports being “ready to make a change” and wants to cut back. Which of the following is the most appropriate initial approach? A. Encourage him to reflect on the pros and cons of drinking B. Discuss triggers and relapse prevention C. Reassure him that change is difficult but not urgent D. Express concern and schedule a follow-up visit **E. Help him decide on achievable goals for cutting back** | Background reading 29 Addiction: Page 6

Answer 18

**Which of the following diagnosis - treatment pairs is most accurate?** **A. Alcohol use disorder — Acamprosate** B. Cocaine withdrawal — Benzodiazepines C. Opioid intoxication — Methadone D. Cannabis use disorder — Naltrexone E. Amphetamine use disorder — SSRIs | Background reading 29 Addiction: Page 8

Answer 19

Which of the following timelines best describes the typical onset of alcohol withdrawal seizures? A. Within 24–72 hours of the last drink B. Within 6–8 hours of the last drink **C. Within 12–48 hours of the last drink** D. 5–7 days after the last drink E. Only during delirium tremens | Background reading 29 Addiction: Page 8

Answer 20

Which of the following scenarios most appropriately warrants a urine drug test (UDT)? A. A 20-year-old who admits daily fentanyl use but is calm and alert B. A 26-year-old with undifferentiated agitation and tachycardia **C. A 34-year-old patient requesting methadone as part of a substance use program. ** *UDTs can be helpful for monitoring abstinence as part of a substance use program. * D. A 45-year-old in the ED for alcohol withdrawal and tremors E. A 50-year-old admitted for cellulitis and stable vitals | Background reading 29 Addiction: Page 2

Answer 21

A 16-month-old presents with fever and decreased activity. You use the Pediatric Assessment Triangle to rapidly determine whether the child appears “toxic.” Which of the following findings corresponds to an abnormal appearance under the Pediatric Assessment Triangle? **A. Inconsolable irritability - the rest are also features of the PAT, but fall under breathing and circulation rather than appearance** B. Nasal flaring C. Grunting respirations D. Delayed capillary refill E. Peripheral mottling

Answer 22

A simple febrile seizure requires: Age 6 months–5 years, Generalized onset, Duration <15 minutes, No recurrence within 24 hours. Focal features reclassify as complex febrile seizure.

Answer 23

Which of the following findings is most consistent with a simple febrile seizure? A. Seizure lasting 18 minutes but generalized B. Two brief seizures in 12 hours **C. First seizure associated with fever, lasts 4 minutes, generalized** D. Focal jerking of right arm with rapid recovery E. Occurs in a 5-year-old child with known epilepsy

Midterm2 Flashcards

(48 cards)