Knowing is not enough; we must apply. Willing is not enough; we must do. -Johann Wolfgang von Goethe
Now onto this week’s podcast
A 55-year-old man who is taking several antihypertensive medications presents to the ED with nausea, vomiting, shortness of breath, and a rash after eating a home-cooked Thai meal at a friend’s house about 1 hour ago. The symptoms began within seconds of the first bite of his meal. Despite the patient being administered 2 doses of intramuscular epinephrine, diphenhydramine, dexamethasone, and crystalloid fluids, his blood pressure remains at 75/38 mm Hg. Which other medication should be considered in this patient?
A 45-year-old woman with type 1 diabetes mellitus presents with fatigue in the setting of medication non-compliance. Her laboratory tests reveal a Na+ 125, K+ 3.1, chloride 97, bicarbonate 10, glucose 761, and pH 7.21. The patient is started on intravenous fluids. What therapy is most important to start next?
A. Hypertonic saline
B. Potassium repletion
C. Regular insulin
D. Sodium bicarbonate
A 56-year old woman with a known left bundle branch block presents after a syncopal episode. EKG shows a regular, wide complex tachycardia with a rate of 160 beats/minute. Which of the following EKG features suggests a diagnosis of ventricular tachycardia over a diagnosis of supraventricular tachycardia with aberrancy?
A. Absence of AV dissociation
B. Capture and fusion beats
C. Irregular rhythm
D. QRS duration < 110 milliseconds.
A 74-year-old woman with a history of congestive heart failure, hypertension, and coronary artery disease presents with confusion, abdominal pain, and nausea. Her medications include hydrochlorothiazide, aspirin, and digoxin. The patient’s ECG is shown above. She has a potassium level of 6.3 mEq/ml. Which of the following treatments should be initiated?
A. Activated charcoal
B. Calcium gluconate infusion
C. Digoxin immune Fab
An 18-year-old woman with no significant past medical history falls while rock climbing and sustains a knee dislocation. Posterior tibial and dorsalis pedis pulses are unable to be palpated on the affected side. Her last meal was 2 hours ago. Which of the following statements is true regarding pre-procedural fasting?
A. Current fasting guidelines are based on results of randomized controlled trials comparing fasting status and incidence of aspiration
B. She is at risk of complications from knee dislocation and reduction should be performed regardless of fasting status
C. She should wait an additional 4 hours, until it is 6 hours since her last meal, since she is at increased risk of aspiration
D. Vomiting and loss of airway reflexes during procedural sedation is common
A 32-year-old woman who is 8 weeks pregnant by dates presents to the ED with a 2-cm laceration to her index finger sustained while she was cutting a tomato. On review of systems, she also notes 2 days of vaginal spotting and lower abdominal cramping. Vital signs are within normal limits. Physical exam is consistent with a simple 2-cm laceration. The pelvic exam reveals a closed os and no adnexal tenderness or masses. Which of the following statements best describes the next step in management?
A. Delay treating her laceration until her pregnancy status is further clarified
B. Treat her laceration as indicated, and perform a beta-hCG quantitative level
C. Treat her laceration as indicated, perform a beta-hCG quantitative level, and obtain a pelvic ultrasound
D. Treat her laceration as indicated, then discharge with outpatient obstetrical follow-up
Thanks to Megha for the question suggestion. Remember to write “Roshcast” in the submit feedback box as you work through the question bank to flag questions you would like us to cover in future episodes.
For those of you thinking it is too early to start studying, do not forget there are 1200 questions in the Rosh review bank so you are better off starting sooner rather than later to get through it. Many of you already have the yearly subscription, so take full advantage by reviewing the questions there now. Lastly, follow us on Twitter at @Roshcast for updates and high-yield EM pearls in 140 characters or less!
Until next time,
Jeff and Nachi
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