Showing Questions of the Day archives since inception
| Title | Posted | View |
|---|---|---|
| The diagnosis of acute pancreatitis requires the presence of what clinical features? | Dec 31, 2024 | |
| Sporotrichosis is an infection acquired by the fungus Sporothrix schenckii. The incubation period is up to three months so a careful history in the ED is important. Describe the typical presentation. | Dec 30, 2024 | |
| Kawasaki disease is an acute systemic vasculitis that most commonly affects children of Asian or Pacific Islander descent that are < 5 years old. KD is a clinical diagnosis based on the presence of fever for 5 days combined with what features? | Dec 29, 2024 | |
| What is the peak age for occurrence of febrile seizures? | Dec 28, 2024 | |
| Diagnosing aorto-enteric fistula is challenging, as it can manifest with a wide range of nonspecific symptoms. What is the most commonly used diagnostic modality? How reliable is it for the diagnosis of AEF? | Dec 27, 2024 | |
| Peripartum cardiomyopathy is a leading cause of heart failure and cardiogenic shock in pregnant women. When during pregnancy does PPCM occur? When managing arrythmias in such patients, what commonly used anti-arrhythmic is to be avoided? | Dec 26, 2024 | |
| What is the definition of peripartum cardiomyopathy? When does it present during pregnancy? | Dec 25, 2024 | |
| The use of glucocorticoids in the ED for anaphylaxis is common. What is the benefit of using glucocorticoids for anaphylaxis? | Dec 24, 2024 | |
| The mortality of patients presenting to the ED with aortic dissection has decreased over the last 10 years. How does the mortality of a patient with AD presenting to the ED on the weekend compare to the mortality of a patient presenting on a weekday? | Dec 23, 2024 | |
| Infant botulism results after spores of the bacterium Clostridium botulinum are ingested, temporarily colonize an infant’s large intestine, and produce botulinum neurotoxin. What food is associated with the development of infant botulism? Why? | Dec 22, 2024 | |
| How does the success rate of pharmacological cardioversion compare to that of electric cardioversion for hemodynamically stable new-onset atrial fibrillation patients presenting to the ED? | Dec 21, 2024 | |
| When Hereditary Angioedema is mistaken for histaminergic angioedema, unnecessary and ineffective treatment results. What clinical signs and symptoms suggest HAE as opposed to histamine-induced angioedema? | Dec 20, 2024 | |
| Status epilepticus in pregnancy can be safely managed with which medications? | Dec 19, 2024 | |
| High anion gap and high osmolarity with an osmolar gap are two different entities but can co-exist in some instances and can be an essential clue for certain toxic alcohol exposure. What are the causes of a high serum osmolarity with an osmolar gap? | Dec 18, 2024 | |
| While both are desquamating conditions, Staphylococcal Scalded Skin Syndrome requires appropriate antibiotics and TEN requires elimination of an offending drug. TEN and SSSS can present with similar symptoms. What is the key distinguishing feature? | Dec 17, 2024 | |
| Definitive diagnosis of HELLP syndrome is dependent on the presence of specific laboratory findings. Name them. | Dec 16, 2024 | |
| Hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome is a hypertensive disorder of pregnancy. At what point in pregnancy does HELLP occur? | Dec 15, 2024 | |
| Increases in cations such as potassium, magnesium, and calcium can lower the anion gap but are usually found on routine labs. However, other cations that are not routinely measured. In the right context, a low anion gap should suggest what toxicity? | Dec 14, 2024 | |
| Many patients with chronic kidney disease have chronically elevated cardiac troponin levels. How does acute kidney injury impact troponin levels? | Dec 13, 2024 | |
| Mycoplasma pneumoniae is a common infectious cause of community-acquired pneumonia. In addition to respiratory involvement 8% of cases result in extrapulmonary manifestations. What are they? | Dec 12, 2024 | |
| Accidental iron ingestions tend to occur in children < age 5. In teenagers and adults, iron poisoning is usually from suicide attempts or chronic blood transfusions. What is the most useful lab test to determine the potential for iron toxicity? | Dec 11, 2024 | |
| First-line acute therapy for hemodynamically stable patients with PSVT includes vagal maneuvers such as the modified Valsalva maneuver (Valsalva along with passive leg raise). How effective is this maneuver for terminating PSVT? | Dec 10, 2024 | |
| You are managing a febrile infant in the ED without an apparent source of infection. An elevation of what blood test is considered a risk factor for HSV infection, prompting consideration of empiric acyclovir administration? | Dec 9, 2024 | |
| Heparin-induced thrombocytopenia is an immune-mediated adverse reaction to heparin products. When does HIT occur after heparin exposure? | Dec 8, 2024 | |
| In patients with polymorphic VT, it is important to stabilize the cardiac membrane by maintaining what three electrolytes above what levels? | Dec 7, 2024 | |
| What is the most common cause of pregnancy-associated MI? | Dec 6, 2024 | |
| Ingestion of a caustic agent can result in severe GI damage. Alkali fluids bond with tissue protein rapidly on contact often resulting in corrosiveness in the esophagus. What about acidic substances – where do they inflict damage? Why? | Dec 5, 2024 | |
| Hydroxyzine is an H1-receptor antagonist used for managing allergies, anxiety, opioid withdrawal, and insomnia. Hydroxyzine is associated with what cardiovascular adverse effect? | Dec 4, 2024 | |
| A predominance of neutrophils in the CSF suggests bacterial meningitis. In what circumstances do lymphocytes predominate in bacterial meningitis? | Dec 3, 2024 | |
| In a patient with acute hemoptysis presenting to the ED, which is a more effective treatment, nebulized TXA or IV TXA? | Dec 2, 2024 | |
| Typically, initial bleeding from an Aorto-enteric fistula causes clot formation causing the bleeding to stop. When the temporary clot dislodges rebleeding occurs, resulting in exsanguination. What is the time between initial bleed and exsanguination? | Dec 1, 2024 | |
| Neuroleptic malignant syndrome, classically due to exposure to a dopamine antagonist, is a clinical tetrad of altered mental status, hyperthermia, rigidity, and dysautonomia. When does NMS typically present after exposure to the instigating drug? | Nov 30, 2024 | |
| Adrenal insufficiency can be challenging to diagnose. Glucocorticoids, or course, are the most common class of medications to cause adrenal insufficiency. What is the second most common class of medications to cause adrenal insufficiency? | Nov 29, 2024 | |
| There is evidence for an association between chronic rhinosinusitis and a higher risk for acute stroke. What is the presumed connection? | Nov 28, 2024 | |
| Drug-induced reaction with eosinophilia and systemic symptoms (DRESS) syndrome, a life-threatening drug reaction, should be considered in any patient with a skin eruption and fever who has started a new medication within what recent timeframe? | Nov 27, 2024 | |
| Many patients with chronic kidney disease have chronically elevated cardiac troponin levels. When evaluating such patients for acute coronary syndrome, is a specific troponin assay preferred? | Nov 26, 2024 | |
| Giant cell arteritis is considered an ophthalmic emergency, as rapid and permanent loss of vision can occur. Treatment should not be delayed to reach a definitive diagnosis. What is the immediate therapy? | Nov 25, 2024 | |
| Wellens syndrome is based on ECG findings of deeply inverted or biphasic T-waves in Leads V2 and V3 (may also be seen in leads V1, V4, V5, and V6), without any significant ST-segment elevation. Wellens syndrome is specific for what lesion? | Nov 24, 2024 | |
| Herpes zoster ophthalmicus refers to herpes zoster involvement of the ophthalmic division of the fifth cranial nerve. Ophthalmoplegia can complicate HZO. When is the onset of ophthalmoplegia in relationship to the rash? What is the prognosis? | Nov 23, 2024 | |
| Cannabis hyperemesis syndrome is characterized by recurrent episodes of intractable nausea, abdominal pain, and vomiting lasting 24-48 hours. CHS is typically observed in individuals who have been using cannabis chronically for at least how long? | Nov 22, 2024 | |
| The prevalence of stump appendicitis has gradually increased., especially in recent years. When does stump appendicitis occur following appendectomy? | Nov 21, 2024 | |
| Oxygen is a first-line treatment for an ongoing cluster headache. How is Oxygen administered for CH? | Nov 20, 2024 | |
| TIA is an acute neurovascular syndrome attributable to a vascular territory that rapidly resolves, leaving no evidence of tissue infarction on MRI. What portion of patients presenting with TIA symptoms are found to have lesions on MRI with DWI? | Nov 19, 2024 | |
| Primary ST-segment depression (i.e. not secondary to RBBB) that is maximal in which leads is specific for posterior MI? | Nov 18, 2024 | |
| Chilaiditi's sign is an important mimic of pneumoperitoneum – how does the clinician differentiate the two on X-ray? | Nov 17, 2024 | |
| Exposure to iodinated contrast media can result in what significant endocrine complication? | Nov 16, 2024 | |
| Patients with active malignancy may present to the ED with an acute Pulmonary Embolism. Patients and family members will often ask about duration of anticoagulation. What is the usual duration of anticoagulant therapy in such a patient? Why? | Nov 15, 2024 | |
| Although the most notable risk factor for osmotic demyelination syndrome is rapid correction of hyponatremia, it is also seen when sodium correction occurs at recommended rates due to the presence of other risk factors. Name such risk factors. | Nov 14, 2024 | |
| Autonomic dysreflexia is a life-threatening condition that can affect patients with a spinal cord injury when the damage has occurred above what spinal level? | Nov 13, 2024 | |
| Thiamine deficiency results in high output heart failure (wet beriberi) and Wernicke's encephalopathy. While the most common cause of thiamine deficiency is persistent vomiting in alcoholics, it should also be considered in what other patient groups? | Nov 12, 2024 | |
| The presence of GI symptoms in a person soon after consuming fish along with neurological symptoms should raise suspicion of Ciguatera fish poisoning. Administration of what medication can help minimize the severity and duration of the illness? | Nov 11, 2024 | |
| For a patient going into alcohol withdrawal, when does hallucinosis begin after onset of withdrawal symptoms? What type of hallucinations develop? | Nov 10, 2024 | |
| Per the CDC, when a patient is diagnosed with PID, all sexual contacts within what recent timeframe should be tested and treated for N. gonorrhoeae and C. trachomatis? | Nov 9, 2024 | |
| Orbital cellulitis refers to infection of the globe and surrounding soft tissues posterior to the orbital septum. Orbital cellulitis is primarily a clinical diagnosis; what is the role of imaging? What imaging study is ordered? | Nov 8, 2024 | |
| Clinically, what distinguishes toxic epidermal necrolysis from Stevens-Johnson syndrome? | Nov 7, 2024 | |
| Internuclear ophthalmoplegia is characterized by the weakness or inability to adduct the affected eye, secondary to a lesion most commonly in the pons, but can also result from a lesion in the midbrain. What are the most common etiologies? | Nov 6, 2024 | |
| Hand-foot-and-mouth disease is most commonly seen in children under the age of 10 years. HFMD can be seen in adults, but the presentation may be atypical. How does the presentation in adults differ? | Nov 5, 2024 | |
| Management of an acute aortic dissection involves reducing both heart rate and BP to decrease aortic wall stress. This is usually accomplished with a combination of IV beta blockers (e.g., esmolol, metoprolol, labetalol) and which vasodilators? | Nov 4, 2024 | |
| Nonacetaminophen Drug-induced liver injury carries substantial morbidity and mortality and should be considered in patients presenting with abnormal liver tests. Antimicrobials are the most common offending agents. Name the most common offenders. | Nov 3, 2024 | |
| The Jarisch-Herxheimer reaction is a well-reported phenomenon most commonly occurring after the treatment of syphilis with penicillin. How does it manifest and when does it occur following antibiotic administration? | Nov 2, 2024 | |
| Neuroleptic malignant syndrome is seen mostly with the use of which medications? | Nov 1, 2024 | |
| Giant cell arteritis is the most common vasculitis in adults older than 50, but the initial diagnosis remains clinically challenging. How does GCA typically present? | Oct 31, 2024 | |
| Endometriosis is generally not a diagnosis made in the ED but the complications may be encountered by emergency physicians. When endometriosis occurs outside of the pelvis, the most common location is in the thorax. How does this typically present? | Oct 30, 2024 | |
| Amniotic fluid embolism is a life-threatening obstetric complication following abortion or delivery. What are the 4 diagnostic criteria put forth by the American Society for Maternal-Fetal Medicine to improve recognition of this disease? | Oct 29, 2024 | |
| Magnesium sulfate is used routinely to prevent the development of seizures in pregnant women with severe features of Preeclampsia. What are the criteria for “severe” features? | Oct 28, 2024 | |
| Acute Chest Syndrome in a patient with sickle cell disease is defined as new pulmonary infiltrates on a chest X-ray with symptoms (e.g. chest pain, fever, tachycardia, cough, wheezing, and hypoxemia). What is the underlying cause of ACS? | Oct 27, 2024 | |
| A predominance of lymphocytes in the CSF suggests viral meningitis. When is a predominance of neutrophils seen with viral meningitis? | Oct 26, 2024 | |
| Biphasic anaphylaxis may occur up to 72 hours after resolution of anaphylaxis. For how long should a patient be observed in the ED following treatment for anaphylaxis before discharge? | Oct 25, 2024 | |
| What is the effect of repeated fist clenching during blood collection on serum potassium level? | Oct 24, 2024 | |
| Absence status epilepticus is a form of nonconvulsive status epilepticus. Unlike most epileptic etiologies, ASE may not result in a grossly abnormal neurologic examination or obvious signs of seizure activity. How does ASE typically present? | Oct 23, 2024 | |
| What is the classic clinical presentation of Normal Pressure Hydrocephalus? | Oct 22, 2024 | |
| Guillain-Barré syndrome is an autoimmune neuropathic disorder of peripheral nerves usually following an infection or on rarer occasions following vaccinations. What is the most common etiology of GBS? | Oct 21, 2024 | |
| Why do patients with acute pulmonary embolism experience chest pain? | Oct 20, 2024 | |
| Symptoms of hypercalcemia include nonspecific GI symptoms; bone-related (osteoporosis, pathologic fractures); GU (renal stones, polyuria); and neuropsychiatric (confusion, memory loss). Symptoms are usually evident at what serum calcium level? | Oct 19, 2024 | |
| Treatment of Malignant hyperthermia includes discontinuation of trigger agents, active cooling measures, hyperventilation, and administration of what medication? Within what timeframe after diagnosis? | Oct 18, 2024 | |
| Mechanical thrombectomy has revolutionized the care of large vessel occlusion acute ischemic strokes. What is the benefit of intravenous thrombolysis prior to mechanical thrombectomy in such patients? | Oct 17, 2024 | |
| Calciphylaxis predominantly affects the dialysis population and is characterized by calcification of cutaneous arterioles accompanied by painful necrotic skin ulcers. What accounts for its high morbidity and mortality? | Oct 16, 2024 | |
| In the ED, diagnosis of Guillain-Barre syndrome is predominately clinical. An LP and CSF analysis is performed to assess the wide differential associated with acute GBS. What are the CSF findings consistent with GBS? | Oct 15, 2024 | |
| What is the most common etiology of Ludwig's angina in adults? In children? | Oct 14, 2024 | |
| A syphilis epidemic is occurring in the U.S., with sustained increases in primary and secondary syphilis. When do the clinical features of primary syphilis appear after exposure? | Oct 13, 2024 | |
| Lipoid pneumonia is caused by the accumulation of lipids in the alveoli. Exogenous lipoid pneumonia is caused by aspiration or inhalation of oil-based substances. Why is the incidence of exogenous lipoid pneumonia is growing exponentially? | Oct 12, 2024 | |
| Acute auricular perichondritis must be diagnosed appropriately in the ED as delayed diagnosis may lead to liquefactive cartilage necrosis and permanent cosmetic outcomes. What organism is the most common causative agent? What is the management? | Oct 11, 2024 | |
| Sydenham chorea is a manifestation of acute rheumatic fever. The condition is associated with Group A Beta-hemolytic Streptococcus causing pharyngitis, taking approximately 6-8 weeks to develop. How does it present? | Oct 10, 2024 | |
| Pediatric ovarian torsion is difficult to diagnose and can lead to significant morbidity and possible mortality if not treated emergently. If ovaries appear normal on imaging, can the clinician feel comfortable excluding the diagnosis? | Oct 9, 2024 | |
| Internuclear ophthalmoplegia is readily diagnosed by the combination of ipsilateral adduction weakness and contralateral abduction nystagmus. In a young patient, INO is often suggestive of what diagnosis? In an older patient? | Oct 8, 2024 | |
| Pyloric stenosis typically presents between 3 weeks and 3 months after birth. Risk factors include prematurity, firstborn, positive parental history of pyloric stenosis, maternal smoking, and early exposure to what medication? | Oct 7, 2024 | |
| Approximately 15% of esophageal rupture cases are spontaneous in nature (i.e., Boerhaave); however, a majority are iatrogenic, typically during or after esophagogastroduodenoscopy. What is the preferred diagnostic test for esophageal perforation? | Oct 6, 2024 | |
| Transient global amnesia is characterized by a loss of anterograde memory, i.e., the inability to form new memories. TGA resolves in 24 hours or less. Does the presence of retrograde amnesia exclude the diagnosis of TGA? | Oct 5, 2024 | |
| Non-cardiogenic pulmonary edema is a well-reported side effect of naloxone administration and occurs in both adults and children. What is the presumed etiology? | Oct 4, 2024 | |
| Pott's puffy tumor is soft tissue swelling of the forehead due to subperiosteal edema, granulation tissue, or accumulation of pus; most patients present with forehead swelling and frontal headache, often with fever. What is the most common cause? | Oct 3, 2024 | |
| Implementation of buprenorphine in the ED has become a public health priority. How does the clinician avoid precipitating precipitated withdrawal, defined as a rapid worsening of opioid withdrawal symptoms shortly after buprenorphine administration? | Oct 2, 2024 | |
| A Virchow’s node is found in the left supraclavicular region between the two heads of the sternocleidomastoid muscle. Virchow’s node correlates with what diagnosis? | Oct 1, 2024 | |
| Oral dexamethasone is the preferred treatment of choice for croup. What is the recommended dose? How dose the dose change based on severity of the croup? | Sep 30, 2024 | |
| Annual influenza vaccination is recommended for all persons aged at least 6 months who do not have contraindications. Is egg allergy a contraindication to influenza vaccination? | Sep 29, 2024 | |
| Early repolarization is an electrocardiographic anomaly, also known as “J- point elevation | Sep 28, 2024 | |
| Dressler syndrome is a condition in which sterile pericarditis develops shortly after myocardial infarction. However, Dressler syndrome can result from other causes. What are other causes of this syndrome? | Sep 27, 2024 | |
| How does the ratio of serum AST to ALT suggest alcoholic liver disease? | Sep 26, 2024 | |
| Ophthalmoplegia occurs in 7-31% of cases of Herpes zoster ophthalmicus. Does the ophthalmoplegia occur at the same time as the painful vesicular rash in the trigeminal nerve dermatome? How does it present? | Sep 25, 2024 | |
| Elevations in intracranial pressure occur commonly after SAH due to increased intracranial blood volume, cerebral edema, or development of hydrocephalus. The BP should be lowered to what level in the ED for patients with aneurysmal SAH? | Sep 24, 2024 | |
| Following cholecystectomy, common bile duct dilation of up to what diameter is reported to be within normal range? | Sep 23, 2024 | |
| Brugada syndrome is a genetic disease associated with a significant risk for fatal cardiac arrhythmias, especially in young men with no evidence of structural heart disease. What are the recognized factors that can induce the Brugada electrocardiogra | Sep 22, 2024 | |
| Respiratory monitoring is essential to the care of Guillain-Barre syndrome in the ED. Neuromuscular weakness resulting in respiratory failure can occur rapidly, requiring intubation. Can NIV respiratory support such as BIPAP be used? | Sep 21, 2024 | |
| Spinal epidural abscess carries a high rate of morbidity and mortality. What portion of patients are misdiagnosed on their first ED visit? What is the classic clinical triad? How often does the clinical triad occur in SEA cases? | Sep 20, 2024 | |
| The Sister Mary Joseph nodule is a typically firm, painful, indurated, and irregularly shaped an umbilical or paraumbilical nodule that typically measures < 2 cm. What is the clinical significance of this lesion? | Sep 19, 2024 | |
| For patients with cirrhosis, should a prolonged INR be corrected before a procedure such as paracentesis/thoracentesis? | Sep 18, 2024 | |
| If ignored, subclavian steal syndrome can cause syncope or neurological deficits. What is the definition of subclavian steal? | Sep 17, 2024 | |
| The close differential diagnosis of Serotonin Syndrome is neuroleptic malignant syndrome. The clinical manifestations of NMS and SS are remarkably similar. What clinical features help to distinguish the two? | Sep 16, 2024 | |
| When do febrile seizures typically occur following onset of an illness? | Sep 15, 2024 | |
| Ischemic transient monocular vision loss arises from a decrease in blood flow in the ophthalmic artery or one of its branches. Permanent retinal ischemia ensues after the occlusion has lasted for how long? | Sep 14, 2024 | |
| Acute chest syndrome is the leading cause of mortality, accounting for 25% of deaths in individuals with sickle cell disease. Most ACS do not have a clear etiology, but three major causes have been proposed. What are the etiologies of ACS? | Sep 13, 2024 | |
| Catecholaminergic polymorphic ventricular tachycardia is characterized by emotion- or exercise-induced polymorphic VT in individuals without cardiac structural defects. At what age does CPVT first manifest? What is the initial clinical presentation? | Sep 12, 2024 | |
| Empiric anticoagulation is occasionally used in patients with suspected DVT to avoid complications if the workup is delayed. What is the effect of empiric rivaroxaban on the diagnostic performance of D-dimer? | Sep 11, 2024 | |
| A proximal DVT is found as an incidental finding on imaging of the lower extremity. Is anticoagulation recommended even though the patient has no symptoms referable to the DVT? | Sep 10, 2024 | |
| What well known disease does multisystem inflammatory syndrome in children mimic? | Sep 9, 2024 | |
| Legionella is an atypical organism that can cause community-acquired pneumonia and can be easily overlooked, especially during the COVID-19 pandemic. What symptoms are commonly associated with Legionella pneumonia? | Sep 8, 2024 | |
| Measles cases have recently been on the rise in the United States and globally due to falling vaccination rates. Koplik spots are pathognomonic for measles. When do they present and what is their appearance? | Sep 7, 2024 | |
| Pemberton's sign, facial plethora and venous congestion developing when a patient places the arms above the head. What causes this sign? | Sep 6, 2024 | |
| There is a 2.5% prevalence of carotid webs in patients with acute ischemic stroke. What is a carotid web? | Sep 5, 2024 | |
| Once a diagnosis of pulmonary embolism is made, prompt initiation of anticoagulation is imperative as it has been shown to reduced mortality. If necessary, what conservative efforts can be employed to reduce RV afterload? | Sep 4, 2024 | |
| Guidelines suggest early IV loop diuretic administration for the treatment of acute heart failure in the setting of congestion due to volume overload. For a patient on a long-term loop diuretic, what dose should be administered in the ED? | Sep 3, 2024 | |
| Bradycardia is the most common arrhythmia in inferior AMIs, presenting in approximately 75% of patients with inferior acute MI within 15 minutes of infarction. What is the etiology of the bradycardia in acute inferior MIs? | Sep 2, 2024 | |
| Guillain-Barre syndrome is characterized by progressive weakness and diminished/absent reflexes; respiratory failure occurs in 20-30% of cases. GBS is typically triggered by an antecedent event up to 4 weeks prior. What are the most common triggers? | Sep 1, 2024 | |
| What metabolic abnormality can be the presenting symptom of an acute overdose of tramadol? | Aug 30, 2024 | |
| Renal clearance steadily decreases from the 3rd decade; older adults are at greater risk of clinically significant kidney injury from drugs such as NSAIDS. Why doesn’t serum creatinine alone reflect the extent of renal impairment in older patients? | Aug 29, 2024 | |
| In the setting of acute pancreatitis, when does the serum lipase level begin to increase? When does it peak? When does it normalize? | Aug 27, 2024 | |
| Lithium therapy is associated with what electrolyte disorder, mandating regular serum monitoring? | Aug 26, 2024 | |
| Treatment of catamenial pneumothorax is surgical intervention, specifically video-assisted thoracoscopic surgery. What are the main criteria for the diagnosis of catamenial pneumothorax? | Aug 25, 2024 | |
| IDSA/ATS guidelines recommend Legionella antigen testing for any patient with community acquired pneumonia with one of five risk factors. What are they? | Aug 22, 2024 | |
| Traditionally, benzodiazepines have been first-line treatment for moderate to severe alcohol withdrawal syndrome. However, there is a growing body of evidence to support use of what 3 nonbenzodiazepine, nonbarbiturate agents for management of AWS? | Aug 21, 2024 | |
| Decerebrate and decorticate posturing are indicative of advanced insults to the brain. Does such posturing define irreversible structural brain injury? | Aug 20, 2024 | |
| Most cases of Locked-in syndrome are due to an ischemic cause, such as basilar artery occlusion. The prognosis of LIS is not good, but in the acute setting patients benefit from rapid intervention. What are the key 3 clinical findings of classic LIS? | Aug 19, 2024 | |
| A patient presents with severe urinary retention, relieved by urinary catheterization. The patient also notes onset of acute dyspnea along with the urinary retention. What is the concern? | Aug 18, 2024 | |
| Digoxin toxicity is most commonly due to unintentional overdose or decreased drug clearance due to hepatic or renal dysfunction. Most patients with acute toxicity present with anorexia, emesis, and fatigue. How does chronic toxicity usually present? | Aug 17, 2024 | |
| The severity of spinal cord injury can range from transient to permanent injury. On this spectrum, the least severe injury is neuropraxia, which is defined as a transient loss of motor or sensory function. For how long does neuorpaxia last? | Aug 16, 2024 | |
| Syphilis has a wide range of manifestations; its clinical course can be divided into three phases: primary, secondary, and tertiary. How does primary syphilis typically manifest clinically? | Aug 15, 2024 | |
| Spontaneous bacterial peritonitis carries a high risk of death. Its prevalence in patients with cirrhosis is 11%, and nearly 25% of patients die despite appropriate antibiotic treatment. What is the current empiric treatment for SBP? | Aug 14, 2024 | |
| In a nonpregnant patient, the most common cause of an intraparenchymal hemorrhage is hypertension. What is the most common cause in the pregnant patient? | Aug 13, 2024 | |
| The more common form of Wellens syndrome (Type-B,75% of cases) manifests as deeply inverted and symmetrical T waves typically seen in V2 & V3. How does the second form of Wellens syndrome manifest on ECG? | Aug 11, 2024 | |
| Postdural puncture headache is a recognized complication following epidural anesthesia. According to the International Headache Society, a PDPH occurs within what time frame following a lumbar puncture? | Aug 10, 2024 | |
| Management of amanita mushroom poisoning includes activated charcoal to disrupt the enterohepatic circulation of the amatoxin and IV hydration to eliminate toxin. Beyond this, what medication is indicated in acute amanita phalloides poisoning? | Aug 4, 2024 | |
| Inappropriate ICD shocks account for 30% of all ICD therapies and may be due to non-malignant supraventricular arrhythmias or over-sensing. What are causes of ICD over-sensing? | Aug 3, 2024 | |
| A patient with a complete CN III palsy with pupil involvement has an aneurysm until proven otherwise. If the CTA is normal, the standard is to transfer to a hospital with interventional radiology for angiogram. What are the ocular findings on exam? | Jul 31, 2024 | |
| In children with suspected Acute Bacterial Arthritis, empiric antibiotic therapy active against S. aureus is recommended. However, in infants and preschool aged children (6 - 48 months of age) empiric antibiotics should target what pathogen? | Jul 30, 2024 | |
| What is Kounis syndrome? | Jul 29, 2024 | |
| Lateral medullary syndrome (Wallenberg syndrome) is one of the brainstem stroke syndromes caused by occlusion of posterior inferior cerebellar artery. What clinical signs define this syndrome? | Jul 25, 2024 | |
| Severe abdominal pain out of proportion to physical examination findings should be assumed to be acute mesenteric ischemia until disproven. What explains the pain being disproportionate to the clinical findings? | Jul 24, 2024 | |
| Dialysis disequilibrium syndrome is a neurological disorder with varying severity which is primarily caused by the rapid removal of urea during hemodialysis. In which patients does DDS most commonly occur? | Jul 22, 2024 | |
| Patients with an ICD in place in whom the rate of ventricular tachycardia is below the ICD therapy threshold may present with monomorphic VT that is not detected or treated by the ICD. What is the typical VT rate threshold for ICDs? | Jul 17, 2024 | |
| An aortoesophageal fistula usually presents with a sentinel episode of hematemesis followed by a massive episode of hematemesis. What is the timeframe between the herald hemorrhage and the actual hemorrhage? | Jul 11, 2024 | |
| More than 109,000 drug overdose deaths occurred in the U.S. in 2022; nearly 70% involved illegally manufactured fentanyls. What is the most commonly documented route of use in overdose deaths? | Jul 9, 2024 | |
| Severe alcohol withdrawal syndrome may present with delirium, agitation, hyperthermia, tachycardia and varying degrees of hypertension. Seizures can occur at any time. When is severe AWS seen after ethanol cessation? | Jun 10, 2024 | |
| In recent years, tranexamic acid has been explored as a treatment for various causes of uncontrolled or coagulopathic bleeding in Emergency Medicine. What neurologic adverse effect has been reported after TXA administration? | Jun 1, 2024 | |
| Malignant hyperthermia is a deadly condition that may be encountered in the ED. The earliest signs are tachycardia and rise in EtCO2; muscle rigidity with hyperthermia usually occurs later. MH has an association with what medication used in the ED? | May 19, 2024 | |
| What are the target systolic BP and Heart rate for a patient in the ED with an acute aortic syndrome? | Mar 13, 2024 | |
| A blood pressure difference between arms may be seen in acute aortic dissection due to pseudohypotension if the aortic dissection has dissected into the brachiocephalic or subclavian arteries. Which arm should be used for BP titration? | Mar 10, 2024 | |
| Confirmation of cyanide poisoning with laboratory measurement of cyanide concentrations is rarely available in clinical real time. Empirical treatment should be considered in which patients? | Mar 8, 2024 | |
| How does auto-brewery syndrome occur? | Feb 29, 2024 | |
| According to current American Burn Association guidelines for acute fluid resuscitation during the first 48 hours following burn injury for adults with burns covering at least 20% total body surface area, fluids should be administered at what rate? | Feb 18, 2024 | |
| What is the empiric antibiotic regimen to be initiated for a patient diagnosed with necrotizing soft tissue infection? | Jan 22, 2024 | |
| An important adverse event to be aware of following mRNA COVID-19 vaccination is herpes reactivation. Is herpes reactivation a contraindication to another vaccination dose? | Dec 20, 2023 | |
| Vector change defibrillation is the technique of switching defibrillation pads from anterior-lateral to anterior–posterior position, a strategy for refractory ventricular fibrillation. What explains why VC defibrillation can be effective? | Dec 18, 2023 | |
| How effective is use of IV thrombolytics during cardiopulmonary resuscitation for cardiac arrest presumed to be related to pulmonary embolism? | Dec 2, 2023 | |
| When evaluating an infant in the ED for a history of fever, what temperature defines a fever, and within what recent timeframe must the fever have occurred? | Nov 24, 2023 | |
| What does the current literature say about the use of IV lidocaine for pretreatment in neuroprotective intubation for a patient with elevated ICP? | Nov 14, 2023 | |
| Acute altitude illness includes acute mountain sickness, high altitude cerebral edema, and high altitude pulmonary edema. What is typically the earliest clinical finding of high altitude cerebral edema? | Oct 26, 2023 | |
| Compared with adults, immune thrombocytopenic purpura in children is more often benign and self-limiting. What is the management of ITP in a child with no bleeding or only mild bleeding but with platelets <10×10(9)/L? | Oct 15, 2023 | |
| Jaundice usually becomes evident at serum bilirubin levels greater than what level? | Oct 13, 2023 | |
| The signs and symptoms of ethylene glycol intoxication are often non-specific yet requires rapid recognition and early treatment. CNS depression occurs within what timeframe following ingestion? When do cardiopulmonary manifestations develop? | Oct 4, 2023 | |
| What is believed to be the only pathognomonic feature of Fat Embolism Syndrome? | Sep 28, 2023 | |
| Following an alkalai caustic ingestion, what lab abnormality is likely indicative of clinically significant tissue injury? | Sep 16, 2023 | |
| Posterior circulation stroke presents most commonly with dizziness or vertigo and must be distinguished from more benign diagnoses. MRI is considered the gold. How reliable is MRI for PC stroke among patients presenting with dizziness? | Sep 14, 2023 | |
| What is the risk of the development of epilepsy among children who experience a febrile seizure? | Aug 23, 2023 | |
| Morel-Lavallée lesion a closed soft tissue degloving injury usually associated with high-velocity trauma. Timely identification and management are crucial. When do patients with such a lesion typically present? | Aug 13, 2023 | |
| What peritoneal total white blood cell count indicates peritoneal dialysis-related peritonitis? | Jul 9, 2023 | |
| Recent research suggests that patients presenting to the ED with a TIA have higher odds of stroke within 90 days if they do not have complete neurovascular imaging during the ED visit or within 2 days. What defines “complete neurovascular imaging”? | Jun 7, 2023 | |
| Local anesthetic systemic toxicity remains the lone situation in which IV lipid emulsion is routinely recommended. What are the contraindications to IV lipid emulsion therapy? | Apr 26, 2023 | |
| For patients presenting with Bell’s palsy, approximately 94% of patients with incomplete paralysis at onset regain full function. What is the prognosis for patients with complete paralysis? | Mar 27, 2023 | |
| When ordering a CTA to evaluate the possibility of a thoracic aortic aneurysm based on an enlarged mediastinum on CXR, or the patient’s clinical presentation, CTA of the entire aorta must be obtained, not a CT of the chest. Why? | Mar 16, 2023 | |
| A patient undergoes a CT angiogram and subsequently develops symptoms of severe hyperthyroidism. What is this phenomenon called? | Mar 9, 2023 | |
| Organisms producing necrotizing soft tissue infections include Vibrio species. Vibrio infections are usually associated with what predisposing characteristics? | Mar 6, 2023 | |
| Approximately what portion of patients with acute pulmonary embolism meet criteria discharge from the Emergency Department for outpatient treatment? What proportion are actually discharged from the ED? | Feb 27, 2023 | |
| The classic presentation of Boerhaave's syndrome is Mackler's triad. What are the three components of this triad? | Feb 20, 2023 | |
| Among patients presenting the the ED who are diagnosed clinically with a TIA, what portion is found to have ischemic lesions on MRI? | Feb 19, 2023 | |
| Sporotrichosis typically begins as a papule which changes to a violaceous lesion; other lesions then develop along the proximal lymphatics. What is the usual source of infection? How long is the incubation period? | Feb 17, 2023 | |
| When evaluating for acute pulmonary embolism, the first step of the diagnostic strategy is estimating the clinical probability of PE as low, moderate, or high. What is the PE prevalence within each category? | Feb 16, 2023 | |
| According to the American College of Gastroenterology, what study is the initial diagnostic test in patients with ongoing hemodynamically significant hematochezia? | Feb 14, 2023 | |
| Acute iron overdose is associated with significant morbidity and mortality. The American Academy of Clinical Toxicology recommends whole bowel irrigation for which patients presenting for evaluation of an acute iron overdose? | Feb 13, 2023 | |
| Blue sclera is indicative of what diagnosis? | Feb 11, 2023 | |
| Acute mesenteric ischemia is caused by insufficient blood flow to the mesenteric organs. What are the 4 distinct pathophysiologic mechanisms of acute mesenteric ischemia? Most cases of acute mesenteric ischemia are due to occlusion of what vessel? | Feb 10, 2023 | |
| Osmotic demyelination syndrome is a complication of a rise in serum sodium occurring too rapidly, most frequently a result of overcorrecting for hyponatremia. What is the typical clinical presentation of ODS? What is the treatment? | Jan 28, 2023 | |
| A toddler is brought into the ED after ingesting a coin. Imaging reveals that the coin is in the stomach. The patient’s mother asks how long it will take for the coin to pass. What do you tell her? | Jan 21, 2023 | |
| When faced with subtle inferior ST elevation on an ECG, how can the clinician determine if it is significant and whether it suggests ACS as opposed to pericarditis? | Jan 11, 2023 | |
| A patient presents to the ED with a presentation consistent with alcoholic ketoacidosis but exhibits diffuse abdominal tenderness on exam. Do you consider another diagnosis? | Jan 10, 2023 | |
| Chlamydial pneumonia among infants typically occurs at age 1-3 months and is a subacute pneumonia. What are the characteristic signs of chlamydial pneumonia among infants? | Jan 6, 2023 | |
| Necrotizing enterocolitis is the most common acquired GI emergency in the newborn infant. 90% of cases occur in patients with what history, which should raise concern for the diagnosis in infants presenting with abdominal symptoms and signs? | Jan 2, 2023 | |
| When evaluating a sickle cell patient for acute pulmonary embolism, why do many experts recommend V/Q scanning instead of CTPA? | Dec 28, 2022 | |
| Local anesthetic systemic toxicity remains the lone situation in which intravenous lipid emulsion is routinely recommended. In refractory hemodynamic instability, lipid emulsion may be trialed as a heroic measure for which overdoses? | Dec 23, 2022 | |
| In the setting of a hyperglyecmic emergency (e.g. DKA, HS), how is the true or corrected serum sodium concentration calculated? | Dec 19, 2022 | |
| Grey Turner's sign is classically associated with severe acute pancreatitis. However, it has also been reported with what other conditions? | Dec 17, 2022 | |
| Acute MR, a life-threatening complication of MI, is a cardiac emergency as it presents with sudden onset flash pulmonary edema, hypotension, and cardiogenic shock. Does the lack of murmur essentially exclude the diagnosis? Why/why not? | Dec 7, 2022 | |
| Based on the most recent literature, what are the current recommendations regarding temperature control after cardiac arrest? | Dec 2, 2022 | |
| A child with a tympanostomy tube in place presents to the ED with persistent painless otorrhea that is bloody. What is the usual cause? What is the treatment? | Nov 30, 2022 | |
| By how much does the serum sodium concentration decrease for every 100 mg/100 mL increase in serum glucose? Is this relationship affected by the level of glucose elevation? | Nov 20, 2022 | |
| Appropriate management of acute pancreatitis during the first 24 hours after presentation is critical. What clinical marker is most closely associated with the development of pancreatic necrosis? | Nov 18, 2022 | |
| Myxedema coma is a life-threatening condition resulting from severe deficiency of thyroid hormone due to chronic undiagnosed or untreated hypothyroidism. When should the Emergency Physician suspect a diagnosis of myxedema coma? | Nov 12, 2022 | |
| False-positive urine drug screens for amphetamines is not uncommon. Name several medications familiar to the Emergency Physician that have been implicated as causative agents of false-positive UDS results for amphetamines. | Nov 11, 2022 | |
| HELLP syndrome is a devastating illness that typically occurs at what point in pregnancy? What is the definitive therapy? | Nov 10, 2022 | |
| Patients with a Bartholin abscess commonly present to the ED. What is your concern if the patient is a perimenopausal woman? | Oct 31, 2022 | |
| After insertion of a chest tube for a pneumothorax, the patient suddenly develops severe, uncontrollable coughing. What is the concern? | Oct 25, 2022 | |
| Accelerated idioventricular rhythm is a typically benign dysrhythmia seen in both children and adults. Its similarities to ventricular tachycardia results in misdiagnosis and unnecessary treatment. What are the specific ECG features of AIVR? | Oct 23, 2022 | |
| The defining feature of perilunate injuries is dislocation of the capitate head from the concavity of the distal lunate. What is the difference between a perilunate dislocation and a trans-scaphoid perilunate dislocation (TSPLD)? | Oct 21, 2022 | |
| Coronary artery embolism is responsible for around 3% of cases of MI. One etiology of ACS is embolism from Lambl's excrescences. What are Lambl's excrescences? | Oct 20, 2022 | |
| Myocardial infarction is a known complication of tPA use for acute ischemic stroke. What is the mechanism? | Oct 19, 2022 | |
| False-positive and -negative hs-cTn assay results are rare but can occur. False-positive values may result from sample preparation, instrument malfunction, assay interference, and macro troponin complexes. What can cause false-negative values? | Oct 17, 2022 | |
| An underlying cardiomyopathy should be suspected in a young patient with ventricular arrhythmias/sudden cardiac arrest. Epsilon waves are small deflections at the end of the QRS complex, typically seen in leads V1-V3. What is their significance? | Oct 16, 2022 | |
| Traumatic hyphema, the accumulation of blood in the anterior chamber of the eye due to damage to the vessels of the ciliary body or the iris, can lead to permanent vision loss. How? | Oct 15, 2022 | |
| When managing a patient with serotonin syndrome in the ED, If benzodiazepines and supportive care fail to improve agitation and correct vital signs, what is the next step? | Oct 14, 2022 | |
| Ingestion of which toxic alcohol will result in falsely elevated lactate levels, often obscuring the diagnosis? | Oct 13, 2022 | |
| Consider Giant Cell Arteritis in all elderly patients with a headache, visual loss, or diplopia. Which patients with suspected GCA should be admitted for high dose IV steroids instead of discharge with PO prednisone pending temporal artery biopsy? | Oct 12, 2022 | |
| Consider empiric methylene blue treatment in any symptomatic case where there is a suspicion for methemoglobinemia. A known history of what condition is a contraindication to methylene blue administration? | Oct 9, 2022 | |
| Following an aneurysmal subarachnoid hemorrhage, aneurysm rebleeding has a mortality rate of up to 60%. When does rebleeding occur? Which patients are at risk? | Oct 7, 2022 | |
| Arthropod-borne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes and ticks. What is the most common cause of neuroinvasive arboviral disease in children? | Oct 6, 2022 | |
| How does QRS concordance (i.e., in all 6 chest leads the QRS complexes go in the same direction, either up or down) aid in the diagnosis of a Wide Complex Tachycardia? | Oct 1, 2022 | |
| Defibrillation is highly time? and quality?dependent. By how much does the effectiveness of defibrillation fall with each passing minute? | Sep 30, 2022 | |
| Sinus bradycardia is commonly seen in inferior STEMI and is generally thought to be due to increased vagal tone as well as SA node infarction. How does an inferior STEMI result in Complete Heart Block? | Sep 25, 2022 | |
| Morel-Lavallée lesions are closed degloving injuries due to trauma that can be difficult to diagnose due to their resemblance to other subcutaneous lesions. What is the diagnostic modality of choice? | Sep 24, 2022 | |
| The primary alternative diagnoses for Monkeypox include chickenpox (Varicella zoster virus) and smallpox (Variola major or minor virus). What is the most distinguishing characteristic of monkeypox? | Sep 23, 2022 | |
| In most cases, Monkeypox symptoms resolve over a two-to-four-week course. However, severe illness or death can occur. What are the manifestations of severe disease? | Sep 22, 2022 | |
| Patients with Monkeypox develop a pruritic or painful indurated and umbilicated rash on days 1 to 3, affecting the face in up to 95% of cases. These lesions progress from maculopapular to vesicular to pustular. How long do the lesions last? | Sep 20, 2022 | |
| In a child presenting to the ED with DKA, what is the significance of pyuria? Should antibiotics be started prior to hospitalization? | Sep 16, 2022 | |
| When administering thrombolysis to a patient in cardiac arrest for which there is a high suspicion that acute pulmonary embolism is the cause of cardiac arrest, for how long should CPR be continued? | Sep 12, 2022 | |
| What is the significance of the Spot Sign on computed tomography angiography in spontaneous intracerebral hemorrhage? | Sep 11, 2022 | |
| Immediate surgical decompression via canthotomy is the treatment for orbital compartment syndrome. Retinal ischemia for greater than what timeframe to high risk for permanent blindness? | Sep 10, 2022 | |
| Anterior shoulder dislocations are commonly treated in the ED. How does the presence of a Hill-Sachs lesion affect follow-up management? | Sep 9, 2022 | |
| How does the indication for use of thrombolysis for acute ischemic stroke in children differ from that in adults? | Sep 4, 2022 | |
| Why are patients with hyperemesis gravidarum at risk for thyrotoxicosis? | Sep 3, 2022 | |
| Toxicodendron dermatitis resulting from contact with poison ivy, oak, or sumac is a very common cause for ED visits. What is the minimum length of treatment with oral corticosteroids? | Aug 31, 2022 | |
| Malignant hyperthermia is an autosomal dominant genetic disorder characterized by hyperthermia, tachycardia, tachypnea, hypercarbia, increased oxygen consumption, and muscle rigidity. In the ED, MH is most likely to occur in what setting? | Aug 28, 2022 | |
| Acute aortic syndrome (AAS) includes acute aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer. Timely diagnosis of AAS is crucial. What is the major cause of early death with AAS? | Aug 26, 2022 | |
| Phlegmasia cerulea dolens is caused by extensive DVT of the extremities which may lead to compartment syndrome, venous gangrene, and even death. What is the most common etiology? | Aug 25, 2022 | |
| Immunoglobulin A vasculitis, also known as Henoch-Schonlein purpura, is a systemic autoimmune vasculitis that affects the small blood vessels. It commonly presents with what tetrad of symptoms? | Aug 21, 2022 | |
| The rate of symptomatic ICH following r-tPA for acute ischemic stroke is about 6% and clinicians must be familiar with clinical management. What timeframe following thrombolysis constitutes a clinically relevant SICH attributable to thrombolysis? | Aug 19, 2022 | |
| The clinical presentation of Hypokalemic periodic paralysis ranges from mild fatigue and constipation to paralysis with cardiac arrhythmias. HPP is almost always triggered by one of three precipitants. Name them. | Aug 16, 2022 | |
| Differentiating among seizure, syncope, and psychogenic nonepileptic seizure in a patient with transient LOC can be difficult. What is the significance of finding lateral tongue bites on exam? What about bite injuries limited to the tongue tip? | Aug 13, 2022 | |
| Disseminated Lyme Disease can present as Lyme Carditis. Patients with symptoms suggestive of LC, (eg. marked 1st-, 2nd-, 3rd-degree AV block) should be hospitalized for IV antibiotics. When does Lyme Carditis typically occur after onset of infection? | Aug 10, 2022 | |
| What lesion is the most common cause of acute myocardial infarction with ST elevation both in the inferior and anterior leads? | Aug 9, 2022 | |
| CTA uses a thin-section CT acquisition timed to peak arterial or venous enhancement. The dataset is interpreted using primary transverse reconstructions, multiplanar reformations, and 3-D renderings. Is a CT with IV contrast the same as a CTA? | Aug 6, 2022 | |
| Studies have demonstrated the utility of MRI for detection of subarachnoid hemorrhage after an initial false-negative NCCT. Yet, why do guidelines still recommend LP for cases of suspicious SAH, even after negative MRI? | Aug 1, 2022 | |
| Epinephrine is the first-line therapy for anaphylaxis. A patient weighing over what weight should receive the adult dose of 0.5 mg IM? | Jul 31, 2022 | |
| Visceral disseminated varicella zoster virus (VZV) infections frequently affect immunocompromised patients. What is typically the initial symptom of visceral disseminated VZV infection? | Jul 30, 2022 | |
| COVID-19 symptom rebound following Paxlovid treatment is being increasingly recognized. The data available are limited to case reports. How long after treatment does relapse occur in such patients? Is another course of Paxlovid indicated? | Jul 29, 2022 | |
| Hypokalemia functions as a strong indicator of what other abnormality? | Jul 28, 2022 | |
| What diagnosis should be considered in a patient with recent rapid weight loss and acute gastrointestinal complaints? | Jul 26, 2022 | |
| What two lab abnormalities can result in pseudohyperkalemia? | Jul 24, 2022 | |
| Empiric coverage for neurolisteriosis with ampicillin should be included for appropriate patients. Listeria monocytogenes can cause meningoencephalitis or (more rarely) meningitis without parenchymal involvement primarily in which patient groups? | Jul 21, 2022 | |
| A feared complication of herpes zoster is disseminated herpes. A patient may have a few scattered lesions outside of the sharply demarcated and localized rash in about 33% of immunocompetent patients. How, then, is disseminated herpes defined? | Jul 20, 2022 | |
| What antibiotic commonly encountered in Emergency Medicine practice is a reversible cause of new CNS symptoms including dysarthria and ataxia in patients presenting to the ED with these complaints? | Jul 19, 2022 | |
| How common is resuscitation-associated injury in patients resuscitated from Out-Of-Hospital cardiac arrest? | Jul 11, 2022 | |
| Floppy baby syndrome is a neonatal syndrome that presents as weak suck, ptosis, constipation, and decreased activity. What is the cause? | Jul 10, 2022 | |
| Mondor disease of the breast is characterized by thrombophlebitis of the superficial veins of the anterolateral thoracoabdominal wall, occurring most commonly in women in the third to fifth decades. Is anticoagulation required? | Jul 6, 2022 | |
| Should a patient with a positive C difficile test in the absence of symptoms be treated? | Jul 3, 2022 | |
| Angiotensin-converting enzyme inhibitor accounts for one-third of all angioedema-related visits to the ED. When does ACEI-i occur after initiation of treatment? | Jul 2, 2022 | |
| Transient global amnesia presents with sudden onset anterograde memory loss that lasts for less than 24 hours. TGA is often precipitated by what factors? | Jun 30, 2022 | |
| What is the significance of ST-elevation in aVR, along with ST depression in multiple leads, in a patient presenting with symptoms consistent with acute coronary syndrome? | Jun 28, 2022 | |
| Orbital compartment syndrome is a vision-threatening diagnosis that requires quick identification and immediate treatment for preservation of vision. What is the duration of ischemia necessary to cause irreversible vision loss? | Jun 22, 2022 | |
| May-Thurner syndrome is a cause of left leg swelling with or without DVT, typically in women between the 2nd and 4th decades. Timely endovascular management is necessary to help prevent life-threatening complications. What is this syndrome? | Jun 20, 2022 | |
| What is the recommended treatment for a first episode of nonfulminant C difficile infection? | Jun 16, 2022 | |
| Human granulocytic anaplasmosis is a tick-borne disease with an increasing incidence associated with morbidity and mortality. How does anaplasmosis typically present? | Jun 11, 2022 | |
| Acute carotid blowout syndrome (CBO) is usually fatal. Patients with impending CBO who present with a self-resolving sentinel hemorrhage require prompt referral to vascular surgeons. In which group of patients does CBO occur? | Jun 8, 2022 | |
| According to current guidelines, for a patient with febrile neutropenia, antibiotics should be administered within what timeframe of ED arrival? | Jun 7, 2022 | |
| Button batteries present a risk of severe injury to children if ingested. Airway injuries are a severe consequence of BB ingestion and result from the liquefactive necrotic effects of BB impactions. What are the 2 most common airway injuries? | Jun 1, 2022 | |
| What are the criteria for the diagnosis of Wellens’ syndrome? | May 10, 2022 | |
| Angioedema secondary to tPA is a well-documented occurrence in patients presenting with an acute ischemic stroke. What are the risk factors for development of this complication to tPA? | May 8, 2022 | |
| Hydrofluoric acid burns are unique among chemical burns in that they can cause visually mild burns with significant deep tissue injury and systemic toxicity. How much of a burn should raise concern for systemic toxicity? | May 3, 2022 | |
| Acute intracranial hemorrhage is not a contraindication for systemic anticoagulation in the ED in the setting of what diagnosis? | Apr 27, 2022 | |
| Fat embolism syndrome is classically characterized by what triad? | Apr 15, 2022 | |
| Orthodromic AV reentrant tachycardia accounts for 95% of reentrant tachycardias in WPW patients, caused by anterograde conduction via the AV node with retrograde conduction via the accessory pathway. What are ECG signs suggesting orthodromic AVRT? | Apr 13, 2022 | |
| Spontaneous splenic rupture is a known complication of infectious mononucleosis, with an average age of occurrence of 22 years. What is the timeframe from onset of symptoms to splenic rupture? | Mar 29, 2022 | |
| A child presents to the ED following an alkali caustic ingestion. His only symptom is drooling. Do you arrange for immediate endoscopy? | Mar 26, 2022 | |
| A patient who has had a recent cardiac transplant presents to the ED. Both troponin and BNP are elevated. Is this concerning? If so, why? | Mar 25, 2022 | |
| Not widely appreciated is that cardiogenic pulmonary edema can present with consolidation on only one side, i.e., unilateral cardiogenic pulmonary edema. What is the main cause of unilateral cardiogenic pulmonary edema? | Mar 16, 2022 | |
| Nutcracker syndrome mimics other causes of abdominal and flank pain such as renal colic and requires appropriate referral. What is nutcracker syndrome? | Mar 12, 2022 | |
| A high school wrestler presents to the ED several days after sustaining an auricular hematoma. How do you manage this injury? I&D? Needle Aspiration? Simple ENT referral without ED intervention? | Mar 9, 2022 | |
| You are managing a patient with DKA and have placed the patient on an insulin infusion. What is the target decrease in glucose per hour? If the target is not reached, by how much should the insulin infusion be increased? | Mar 7, 2022 | |
| What is the most common cutaneous manifestation in patients with laboratory-confirmed COVID-19? | Mar 2, 2022 | |
| According to the Infectious Diseases Society of America, what is the recommended first-line treatment for patients with an initial Clostridioides difficile infection? | Feb 25, 2022 | |
| Transient global amnesia is characterized by sudden onset anterograde amnesia lasting < 24 hrs, without other accompanying neurological symptoms. Many TGA episodes occur after what type of activity? | Feb 22, 2022 | |
| A patient presents with unilateral facial paralysis and you suspect Bell’s Palsy. Does the presence of altered facial sensation, vestibular dysfunction, or pharyngeal symptoms exclude the diagnosis? | Feb 13, 2022 | |
| On occasion, Emergency Physicians may be involved in a neonatal resuscitation in the ED. Cessation of resuscitation efforts should be considered for newly born babies who have failed to respond to resuscitative efforts after what time period? | Feb 10, 2022 | |
| Pheochromocytoma is an often undiagnosed adrenal tumor that typically presents in early adulthood and characterized by intermittent surges of catecholamines. Management of hypertensive emergency in such patients is unique. What agent is recommended? | Feb 6, 2022 | |
| Amniotic fluid embolism presents with sudden respiratory distress, seizure, and circulatory collapse. The presence of what hallmark finding helps to differentiate AFE from other conditions with a similar presentation? | Jan 29, 2022 | |
| A patient is appropriately treated for N. gonorrhoeae STI. How long after treatment should symptoms resolve before the clinician considers treatment failure? | Jan 27, 2022 | |
| The 2022 Clinical Guideline on Acute Left-Sided Colonic Diverticulitis from the American College of Physicians suggests that clinicians initially manage select patients without antibiotics. This would not apply to which groups of patients? | Jan 19, 2022 | |
| What is the most common etiology of the acute onset of facial diplegia, or bilateral facial nerve palsy? | Jan 16, 2022 | |
| Women of childbearing age who are overweight are the population most at increased risk for idiopathic intracranial hypertension. What headache description should raise suspicion for IIH? | Dec 24, 2021 | |
| A cirrhotic patient with acute variceal hemorrhage presents to the ED. He is admitted for urgent endoscopy, but returns to the ED as an ICU hold. The patient develops severe rebleeding. Whom do you consult for the therapy of choice? | Dec 22, 2021 | |
| Exactly what is Malignant otitis externa? | Dec 20, 2021 | |
| Guillain-Barré syndrome results in progressive symmetric muscle weakness accompanied by depressed or absent deep tendon reflexes. It can also manifest with cranioneuropathy and dysautonomia. What are the most common infections associated with GBS? | Dec 19, 2021 | |
| An ED patient who takes metformin requires a CT with IV contrast. Must all patients who take metformin and require iodinated IV contrast have the medication held for 48 hours? | Dec 17, 2021 | |
| The color Doppler appearance of the ovary should not be relied upon to rule out ovarian torsion. Why? | Dec 10, 2021 | |
| Pituitary apoplexy is an emergent condition; when the diagnosis is suspected, a pituitary protocol MRI should be obtained. What are the classic triad of symptoms? | Dec 7, 2021 | |
| Miller-Fisher syndrome, a variant of Guillain-Barré syndrome, is an acute, autoimmune response that typically follows either a URI or diarrheal illness. How does it present clinically? | Dec 6, 2021 | |
| Which of the following traumatic lesions does a brain MRI consistently miss more frequently than a CT scan: A. Subdural hematomas B. Intraparenchymal contusions C. Epidural hematomas D. Linear skull fractures. | Dec 4, 2021 | |
| In the U.S. there is a marked disparity in survival from bystander-witnessed ventricular fibrillation out-of-hospital cardiac arrest. What is the survival in communities with high-performing EMS as compared to those in the lowest decile? | Dec 3, 2021 | |
| The majority of causes of acute ataxia in pediatric patients are benign. What are the most common etiologies? | Dec 2, 2021 | |
| What is a peri-mesencephalic subarachnoid hemorrhage? | Dec 1, 2021 | |
| A patient presents to the ED with one-sided facial droop and numbness, ptosis, horizontal nystagmus and ataxia. This is pathognomonic for what diagnosis? What is the most common underlying cause? | Nov 28, 2021 | |
| Antipsychotics and antiemetics are frequent causes of drug-induced dystonia. Recent use of what illicit substance is an important risk factor for acute dystonia? Why are younger patients more susceptible to the development of drug-induced dystonia? | Nov 27, 2021 | |
| Benign paroxysmal positional vertigo can be confidently diagnosed if the Dix-Hallpike maneuver elicits transient upbeat-torsional nystagmus, but only if it is performed on appropriate patients. The maneuver should only be performed on which patients? | Nov 25, 2021 | |
| Pheochromocytomas are catecholamine-producing tumors that can be imminently life-threatening. The presentation is highly variable. What are the most common symptoms? | Nov 24, 2021 | |
| Is postexposure prophylaxis of hepatitis C is recommended for health care personnel who have occupational exposure to HCV-contaminated blood or body fluids in the workplace? | Nov 20, 2021 | |
| There appear to be two distinct etiologies of acute heart failure in patients with COVID-19. What are they? | Nov 9, 2021 | |
| Although pediatric stroke may be considered uncommon, the reported incidence is comparable with that of primary pediatric CNS tumors. Pediatric cases of ischemic stroke most commonly occurs in what age group? | Nov 7, 2021 | |
| Botulism is a neurotoxin-mediated, life-threatening disease characterized by flaccid descending paralysis that begins with cranial nerve palsies and might progress to extremity weakness and respiratory failure. How does neurotoxin exposure occur? | Nov 6, 2021 | |
| The diagnosis of Postpartum cardiomyopathy should be suspected in a patient presenting with signs/symptoms of heart failure if they develop during what period during the pregnancy? | Nov 5, 2021 | |
| According to the 2021 AHA/ACC Guidelines, for patients with acute symptoms suggestive of ACS and a normal ECG, a single normal nhs-cTn concentration can be used to exclude myocardial injury if symptoms began within what timeframe before ED arrival? | Nov 3, 2021 | |
| A history of recent antibiotic use is considered a “classic” risk factor for C. difficile infection. How recent must the antibiotic use have been to be considered a risk factor for CDI? | Oct 30, 2021 | |
| Dizziness after a head injury has many potential causes. What is the most common cause? | Oct 29, 2021 | |
| Presentations of Moyamoya disease include headaches, seizures, altered mental status, TIA, and stroke. What is Moyamoya diease? | Oct 28, 2021 | |
| This diagnosis typically presents as a sudden onset, excruciating thunderclap headache that may be associated with N/V and photophobia and may be as common as subarachnoid hemorrhage. Name the diagnosis. | Oct 25, 2021 | |
| A study of over 88,000 ED visits by children < 10 years with a diagnosis of radial head subluxation (nursemaid’s elbow) found that missed upper extremity fractures were observed in 247 cases (0.3%). What are the risk factors for missed fracture? | Oct 23, 2021 | |
| Thyrotoxic hypokalemic periodic paralysis is an endocrinologic disease that presents with acute episodic paralysis. How does THPP typically present and which group is at greatest risk? | Oct 21, 2021 | |
| Between 3% and 9% of adults who present with DKA have normal or only mildly elevated glucose concentrations (<250?mg/dl) - termed euglycemic DKA. Euglycemic DKA occurs in which patient groups? | Oct 18, 2021 | |
| Cardiac troponin can be significantly elevated after strenuous exercise; even 30 mins of high-intensity exercise can result in troponin elevation. What is the clinical significance of this troponin elevation? | Oct 15, 2021 | |
| Name three diagnoses to be considered in a cyanotic patient with hypoxia that does not improve with supplemental oxygen. | Oct 14, 2021 | |
| Antimicrobial chemoprophylaxis of close contacts of a patient with meningococcal disease is important to prevent secondary cases. What antibiotics are recommended for chemoprophylaxis? | Oct 10, 2021 | |
| When using buprenorphine to treat opioid withdrawal in the ED, it must be administered only to patients in active opioid withdrawal. Why? | Oct 9, 2021 | |
| What is the most common cause of infectious bloody diarrhea in the United States? What is the treatment? | Sep 30, 2021 | |
| What are the criteria to establish a diagnosis of Acute Pancreatitis? | Sep 28, 2021 | |
| Superior mesenteric artery syndrome is a cause of proximal intestinal obstruction. What causes SMAS? | Sep 25, 2021 | |
| Antibiotic use remains the most important risk factor for C. difficile infection. Although many antibiotics carry some risk of enabling CDI, which class of antibiotics now demonstrates particularly strong CDI association? | Sep 20, 2021 | |
| Syphilis has seen a 73% increase in the number of cases since 2013 in the US. Secondary syphilis is the most commonly recognized manifestation of syphilis. Describe the classic rash of secondary syphilis. | Sep 17, 2021 | |
| The abdominal “seat belt sign” correlates with increased risk of underlying intra-abdominal injury, including the insidious hollow viscus organ and mesentery injury. Is the ASBI defined by abrasion or contusion, or are both required? | Sep 14, 2021 | |
| In a young child, Mongolian spots can mimic abusive bruising. Mongolian spots are not bruises, but may appear to be. What are they? | Sep 13, 2021 | |
| In a recent study of > 10,000 patients diagnosed with TIA or non-disabling stroke in the ED, the rate of confirmation for the diagnosis of TIA or stroke between emergency physicians and neurologists was 55.4%. What were the most common stroke mimics? | Sep 9, 2021 | |
| Catecholaminergic polymorphic ventricular tachycardia shows up at an early age with misleading clinical symptoms, such as emotion- or exercise-related syncope. At what age do symptoms typically appear? What abnormalities are seen on resting ECG? | Sep 6, 2021 | |
| Rebleeding following Aneurysmal Subarachnoid Hemorrhage has a mortality is the leading cause of morbidity and poor outcome. When does the majority of rebleeding occur following aSAH? What level of BP is associated with rebleeding? | Sep 4, 2021 | |
| Kawasaki disease is a vasculitis of childhood that is critical to recognize and treat due to associated morbidity and mortality. Classic KD is defined by a daily fever for > 5 days with at least 4 of 5 clinical criteria. Name them. | Sep 3, 2021 | |
| A Morel-Lavallée lesion is an internal degloving injury that can serve as a nidus of infection if not treated appropriately. It typically presents after a high-speed injury and can lead to devastating morbidity. How is it diagnosed? Management? | Sep 1, 2021 | |
| Clinicians may use FFP for the reversal of warfarin-induced anticoagulation. What is the onset of action of FFP? What is the INR of FFP? | Aug 29, 2021 | |
| C. trachomatis infection among neonates is most frequently recognized by conjunctivitis. A chlamydial etiology should be considered for all infants below what age who present with conjunctivitis? | Aug 25, 2021 | |
| C. trachomatis or N. gonorrhoeae are the most common etiologies of cervicitis. What are the two major diagnostic signs that characterize cervicitis? | Aug 24, 2021 | |
| The toxic effects of what agent should be suspected in any potentially exposed or suicidal patient presenting with altered mental status, cardiovascular collapse, and marked hyperlactatemia? | Aug 23, 2021 | |
| Pulmonary embolism can have ECG findings suggestive of acute RV strain, such as deep T-wave inversions in leads V1, V2 and V3, RBBB, or S1Q3T3. PE can also present with ST-segment elevation mimicking anterior wall MI. What is the mechanism? | Aug 16, 2021 | |
| Placental abruption is the complete or partial detachment of the placenta from the uterus and can cause both neonatal and maternal morbidity and mortality. How does placental abruption present? | Aug 15, 2021 | |
| Neurogenic pulmonary edema is defined as acute respiratory distress triggered by severe sympathetic discharge from acute compromise in the CNS. Are the triggers for NPE essentially limited to the various types of intracranial hemorrhages? | Aug 14, 2021 | |
| In the case of a maternal cardiac arrest, according to ACLS protocols, a bedside C-section should be performed if maternal ROSC is not achieved in what time frame? (assuming fetal age suggests possible viability) | Aug 13, 2021 | |
| A Segond fracture is an avulsion fracture of the knee that involves the lateral aspect of the tibial plateau. What is the significance of this avulsion that mandates an MRI in all cases? | Aug 7, 2021 | |
| Cardiac memory is characterized by transient deep, symmetric T-wave inversion (TWI) and is considered to be a benign finding. What is cardiac memory? | Aug 6, 2021 | |
| What are the CDC recommendations regarding HPV vaccination for survivors of a sexual assault evaluated in the ED? | Aug 5, 2021 | |
| A pregnant woman presents with focal neurological symptoms concerning for an acute ischemic stroke. A non-contrast head CT is obtained. If there is concern for a large vessel occlusion, what imaging study is obtained – CTA or MRI with contrast? | Aug 3, 2021 | |
| A Monteggia fracture is defined as a proximal one-third ulna fracture associated with a radial head dislocation or subluxation. Why are such fractures so important to properly diagnose in the ED? | Aug 2, 2021 | |
| Ileocolic intussusception is the most common cause of GI obstruction in children and represents a common abdominal emergency in early childhood. What is the first-line diagnostic test of choice when evaluating children for intussusception? | Aug 1, 2021 | |
| Procalcitonin can help differentiate viral from bacterial pathogens in patients admitted for Community Acquired Pneumonia. Typical bacteria result in higher PCT levels than atypical bacteria or viruses. Why? How reliable is PCT testing for CAP? | Jul 31, 2021 | |
| What is the empiric prophylactic antimicrobial regimen for chlamydia, gonorrhea, and trichomonas for adolescent and adult female sexual assault survivors? | Jul 30, 2021 | |
| A definitive diagnosis of chancroid requires identifying on special culture media that is not widely available from commercial sources. When should the clinician suspect chancroid, which is caused by H. ducreyi? | Jul 27, 2021 | |
| Yersinia pestis is the bacterium that causes plague, which occurs following an infected flea bite or direct contamination of a skin lesion. The most common clinical presentation of plague in humans is bubonic plague. How does it present? | Jul 26, 2021 | |
| HIV testing is recommended for which persons presenting to the ED seeking Sexually Transmitted Infection evaluation? | Jul 24, 2021 | |
| As opposed to DKA, Hyperglycemic Hyperosmolar State is not associated with significant ketone production because sufficient insulin is present to prevent lipolysis and the development of ketosis. What is the fluid deficit in a 100-kg person with HHS? | Jul 20, 2021 | |
| Fournier gangrene is a life-threatening infection that can result in significant morbidity and mortality. The diagnosis is often delayed even though the clinician has carefully observed the skin of the perineum. Why? | Jul 19, 2021 | |
| When using propofol for procedural sedation, the clinician must keep in mind that there is more variable and prolonged duration of action after repeated doses. Why? | Jul 18, 2021 | |
| The peak incidence of neonatal mastitis, an infection that occurs in full-term neonates, is in the second week of life. Is a septic work-up required for an afebrile, well-appearing infant with mastitis? | Jul 7, 2021 | |
| What is sensitivity of rapid SARS-CoV-2 antigen tests? | Jul 6, 2021 | |
| Spontaneous stone migration out of the common bile duct occurs in up to 20% of choledocholithiasis cases. GGT > 90 U/L is sensitive and specific for CBD stones. How long before the GGT normalizes, even if the obstruction resolves immediately? | Jul 5, 2021 | |
| Accelerated idioventricular rhythm is seen most commonly following reperfusion with PCI or thrombolytic therapy but it may rarely be seen in the setting of acute MI. What heart rate suggests the rhythm is ventricular tachycardia and not AIVR? | Jul 4, 2021 | |
| A patient presents to the ED with acute angioedema. Swelling of the lips is noted, but vocal changes are not present. Should prophylactic intubation be considered? | Jul 3, 2021 | |
| The treatment of Fournier’s Gangrene consists of rapid initiation of antibiotics and surgical debridement. What is the initial antibiotic regimen to be started in the ED? | Jun 25, 2021 | |
| Black hairy tongue is a benign entity characterized by hypertrophy and elongation of filiform papillae on the surface of the tongue, with brownish-black discoloration. What factors can cause this condition? | Jun 22, 2021 | |
| You have performed procedural sedation on a female ED patient who is breastfeeding her baby. She asks how long after the procedure can she go back to breastfeeding. What do you advise her? | Jun 19, 2021 | |
| Compared to acute cholecystitis, Emphysematous Cholecystitis carries a much higher mortality rate. Unlike acute cholecystitis, EC does not result from obstruction of the gallbladder neck or cystic duct due to gallstones. How does EC occur? | Jun 12, 2021 | |
| When evaluating a patient with DKA in the ED, how much more accurate is an ABG than a Venous Blood Gas in identifying the severity of the acidemia? | Jun 10, 2021 | |
| Among patients presenting with acute myocarditis, what is the prognosis? That is, what portion will recover fully? Require transplantation? | Jun 8, 2021 | |
| What is the classic clinical presentation of isopropanol intoxication and its hallmark feature in the lab results? | Jun 7, 2021 | |
| The peak incidence of neonatal mastitis, an infection that occurs in full-term neonates, is in the second week of life. Is a septic work-up required for an afebrile, well-appearing infant with mastitis? | Jun 7, 2021 | |
| Optic neuritis is an inflammatory, demyelinating condition of the optic nerve. It is the presenting symptom in 25% of cases of multiple sclerosis and occurs in 70% of MS patients at some time during the illness. How does optic neuritis present? | Jun 6, 2021 | |
| What is the average age of presentation of Brugada syndrome? Describe the classic ECG findings. | Jun 5, 2021 | |
| In patients with cardiovascular risk factors presenting with acute dysphagia, it is crucial to maintain a high level of suspicion for what entity? | Jun 4, 2021 | |
| A positive urine screen for cannabis indicates use within what recent timeframe? | Jun 3, 2021 | |
| In the US, there has been a 73% increase in syphilis since 2013. Early recognition is essential. Secondary syphilis is the most commonly recognized manifestation of syphilis. What is the classic clinical presentation of secondary syphilis? | May 27, 2021 | |
| What are the thresholds to initiate antihypertensive therapy for patients in the ED with acute ischemic stroke who are eligible for fibrinolytic therapy? For AIS patients who are not eligible? | May 25, 2021 | |
| The diagnosis of pregnancy can be problematic in dialysis patients. Why must beta HCG levels be interpreted with caution in such patients? | May 23, 2021 | |
| Which children presenting in diabetic ketoacidosis are candidates for treatment with subcutaneous insulin and which such patients require regular insulin via continuous IV infusion? | May 19, 2021 | |
| Retinal detachment is an emergency given that early diagnosis and treatment can prevent permanent visual impairment. How do patients describe the visual symptoms? | May 8, 2021 | |
| A young adult presents to the ED with acute monocular vision loss, pain with eye movement, and dyschromatopsia (reduced contrast in colors). This is the classic presentation of what entity? | May 7, 2021 | |
| Loperamide abuse is increasing as it is being used to either achieve opioid-like euphoria or self-medicate the symptoms of opioid withdrawal. Ingestion of high dose loperamide results in what arrhythmia? | May 5, 2021 | |
| Clinicians should consider facial nerve palsy as a potential neurologic complication when managing patients with COVID-19 infection. What is the treatment? | May 3, 2021 | |
| Congenital syphilis is a re-emerging infection in the U.S. with a myriad of presentations. What is Pseudoparalysis of Parrot? | Apr 30, 2021 | |
| Cerebral fat embolism syndrome is classically seen in patients with large displaced fractures or sickle cell disease. Why does fat embolism occur in these patients and how do emboli reach the CNS? | Apr 28, 2021 | |
| A young man presents to the ED with acute chest pain and hives and his ECG depicts ST changes consistent with ACS. He is diagnosed with Kounis Syndrome. What is Kounis Syndrome? | Apr 22, 2021 | |
| The etiology of postdural puncture headache is attributed to loss of CSF in relation to spinal fluid production. How does this result in headache? | Apr 21, 2021 | |
| According to the American Society of Hematology guidelines, thrombolysis is reasonable to consider for which patients with an acute proximal DVT? | Apr 20, 2021 | |
| Varicocele occurs on the left side in 85 - 90% of all cases; bilateral varicocele is seen in up to 10% of cases. If you identify an isolated right-sided varicocele, what is your concern? | Apr 19, 2021 | |
| It is crucial to distinguish Periorbital cellulitis from Orbital cellulitis. What clinical signs suggest orbital cellulitis as opposed to periorbital cellulitis? | Apr 18, 2021 | |
| Babesiosis, a tick-borne illness, can present as a flu-like illness with anemia, thrombocytopenia, and jaundice. What is the treatment? | Apr 17, 2021 | |
| Do children with a febrile seizure often have a recurrent febrile seizure during the same illness? | Apr 13, 2021 | |
| Loperamide is a commonly used OTC anti-diarrheal. At supratherapeutic doses loperamide can cause euphoria and is used to blunt symptoms of opioid withdrawal. Ingestion of high dose loperamide has been reported to result in what cardiotoxicity? | Apr 12, 2021 | |
| Normal intraocular pressure is 8-21 mm Hg. In cases of Orbital compartment syndrome, elevated IOP is essential to the diagnosis. What level of IOP should prompt emergency consultation/of therapy to decompress the orbit in the setting of OCS? | Apr 11, 2021 | |
| After intubating an obese patient in the ED, in what position should the patient be placed for mechanical ventilation? | Apr 9, 2021 | |
| Recent literature indicates that in the majority of cases of status epilepticus treated in the ED, benzodiazepines are underdosed. What is the proper benzodiazepine dose for first-line treatment of status epilepticus? | Apr 7, 2021 | |
| Crowned dens syndrome is mostly seen in elderly patients, and can cause neurological findings. What is this syndrome? | Apr 6, 2021 | |
| Central retinal artery occlusion is an ophthalmic emergency which typically causes acute, painless visual loss. Diagnosis is often based on clinical exam. What are the findings on exam? | Apr 5, 2021 | |
| Bilateral sciatica is classically associated with cauda equina syndrome. Does the presence of unilateral sciatica exclude the diagnosis of CES? | Apr 4, 2021 | |
| It is commonly held that positive sensory symptoms (e.g. tingling, aura) are due to stroke mimics (e.g. migraines, seizure) and negative symptoms (e.g. loss of sensation) are more often from TIA/stroke. How are thalamic strokes an exception? | Apr 3, 2021 | |
| Although the diagnosis of herpes zoster can often be established on clinical grounds alone, on occasion it may be necessary to obtain lab testing to confirm the diagnosis in presentations that are not straightforward. What test should be obtained? | Apr 1, 2021 | |
| Internuclear ophthalmoplegia is a very localizing finding on exam and should prompt the need for imaging, typically MRI. What is the clinical finding of the presence of INO? | Mar 28, 2021 | |
| Acute angle-closure glaucoma is an emergency that often requires a high degree of suspicion from the Emergency Physician. A key element is that patients with acute angle-closure glaucoma often have onset of symptoms in low-light conditions. Why? | Mar 25, 2021 | |
| Acute pulmonary embolism is commonly associated with tachycardia, but large studies have shown that sinus bradycardia may be present in > 2% of patients with PE, and 3.5% have 1st-degree AV block at presentation. How does PE result in bradycardia? | Mar 24, 2021 | |
| Thyrotoxic hypokalemic periodic paralysis causes transient skeletal muscle paralysis secondary to intracellular potassium sequestration; it classically presents with proximal extremity muscle paralysis. Why is a large carbohydrate load a trigger? | Mar 20, 2021 | |
| What acute ischemic stroke mimic diagnoses are most commonly treated with intravenous thrombolysis? | Mar 19, 2021 | |
| MRI with diffusion weighted imaging (DWI) is the standard for identifying acute stroke and measuring the size of the infarct. What portion of acute ischemic strokes will be negative using DWI criteria? | Mar 15, 2021 | |
| In patients with hemophilia, intramuscular injections should be avoided due to the risk of hematoma formation. How, then, do you address a situation where a tetanus vaccine is indicated? | Mar 14, 2021 | |
| The most common cause of cardiogenic shock is a myocardial infarction, though many causes exist. What is the median time from MI to occurrence of shock? | Mar 12, 2021 | |
| Euglycemic diabetic ketoacidosis is associated with the use of SGLT2 inhibitors. Is an insulin infusion typically recommended for the treatment of EDKA given the normal glucose? What about in patients who do not use insulin for home glucose control? | Mar 11, 2021 | |
| You diagnose an ED patient with a gonorrhea or chlamydia STI. The patient’s recent sexual partners in should be tested and treated. How recent? For how long should the patient be advised to have no sexual contact? When should testing be repeated? | Mar 10, 2021 | |
| The Charles Bonnet syndrome, which may be more common than is generally appreciated, is not well recognized by clinicians and may often be misdiagnosed as psychosis or early dementia. What is this syndrome? | Mar 6, 2021 | |
| Priapism is divided into 3 subtypes: ischemic (low-flow/veno-occlusive), nonischemic (high-flow/arterial), and stuttering. What medication commonly used in the ED can cause ischemic priapism? | Mar 3, 2021 | |
| Neuraminidase inhibitors are commonly used in the treatment of influenza. NAI’s reduce the duration of symptoms by how long? What is their effect on hospitalization and adverse events (e.g. pneumonia) from influenza? | Feb 28, 2021 | |
| High-grade AV block (HAVB) from inferior MI is usually due to ischemia proximal to the bundle of His. This escape rhythm has a narrow QRS, and many patients tolerate this rhythm without hemodynamic compromise. How does HAVB from anterior MI differ? | Feb 25, 2021 | |
| A patient arrives in the ED after giving birth en route. She suddenly experiences the onset of severe pulmonary edema, hypotension, and a cutaneous rash. What diagnosis immediately comes to mind? How is the diagnosis made? | Feb 20, 2021 | |
| It has been suggested that severe clinical deterioration may occur many hours following a drowning event as a consequence of worsening pulmonary edema. Is this accurate and how common is this? | Feb 14, 2021 | |
| A patient presents to the ED complaining of a FB sensation in his throat and odynophagia after eating grilled meat at a barbeque. You suspect a bush bristle ingestion; X-ray and laryngoscopy are normal in the ED. What is your next step? | Feb 11, 2021 | |
| Chronic postthrombotic change is the preferred radiographic term for residual material and wall thickening that remains in the vein after an acute DVT. How is it differentiated from an acute DVT on ultrasound? | Feb 9, 2021 | |
| When managing an ED patient exhibiting ECG abnormalities due to acute hyperkalemia, calcium is typically used. If calcium is felt to be contraindicated (e.g. the patient exhibits marked hypercalcemia) what alternative can be considered? | Feb 8, 2021 | |
| Posterior Reversible Encephalopathy Syndrome usually evolves over hours, and typically presents with seizures, disturbed vision, headache, and encephalopathy accompanied by markedly elevated blood pressure. PRES often develops in which patients? | Feb 6, 2021 | |
| Parenteral anti-hypertensive medication is initiated for BP readings above what level for patients with preeclampsia/eclampsia? | Feb 5, 2021 | |
| Children have milder symptoms of COVID?19 infection and are often asymptomatic compared to adults. What about infants? Are they at much less risk of infection and complications? | Feb 2, 2021 | |
| What is the impact of the COVID-19 pandemic on survival rates from out-of-hospital cardiac arrest? | Jan 29, 2021 | |
| Does a negative computed tomography pulmonary angiogram (CTPA) obtained from the ED to exclude acute pulmonary embolism, also reliably exclude an acute aortic dissection? | Jan 23, 2021 | |
| Cannabis use is increasing in the general population and many nursing mothers use cannabis. Does THC accumulate in breast milk? What about cannabidiol (CBD)? | Jan 21, 2021 | |
| Other than heart failure, conditions associated with BNP level elevations include pulmonary embolism, pulmonary hypertension, valvular heart disease, and ARDS. What condition can falsely lower BNP levels? What condition may falsely elevate levels? | Jan 17, 2021 | |
| Bilateral sciatica is classically associated with Cauda Equina Syndrome. Does the presence of unilateral sciatica essentially rule out the diagnosis of CES? | Jan 13, 2021 | |
| What is a wandering spleen, a cause of an acute surgical abdomen? | Jan 13, 2021 | |
| Patients may present to the ED for evaluation of bleeding following medical abortion. When does the heaviest bleeding occur following misoprostol administration, corresponding to the time when pregnancy tissue is expelled from the uterus? | Jan 12, 2021 | |
| The mainstay of treatment of acute hypertensive cardiogenic pulmonary edema is high dose nitrates. Why is furosemide not recommended in the initial resuscitation of such patients? | Jan 7, 2021 | |
| Droperidol carries a “black box warning” from the FDA for QT prolongation and torsades des pointes. How common is TdP after droperidol administration in the ED? | Jan 4, 2021 | |
| While the diagnosis of Ludwig's angina is clinical, further imaging can be helpful to better diagnose or exclude this condition in early or unclear cases. What is the imaging modality of choice and what do you specifically request? | Jan 3, 2021 | |
| Patients with acute intermittent porphyria usually have several presentations to the emergency department with abdominal pain before a diagnosis is established. How does AIP typically present? | Dec 31, 2020 | |
| Based upon current evidence, are fluoroquinolones as a class associated with increased risk of tendon rupture? | Dec 30, 2020 | |
| Outpatient management of patients with low?risk pulmonary embolism is recommended; up to 51% of patients with acute PE may be suitable for outpatient management. What percent of cases of acute PE are actually discharged home from the ED in the U.S.? | Dec 29, 2020 | |
| Immunosuppression is a commonly reported adverse effect of opioids. By what mechanism does this occur? | Dec 28, 2020 | |
| What is the current CDC recommended treatment for uncomplicated gonorrhea? | Dec 27, 2020 | |
| According to the latest AHA ACLS guidelines, ventilation with what initial oxygen concentration should be used during resuscitation of neonates? | Dec 26, 2020 | |
| What is the most common cause of pediatric Status Epilepticus (SE)? | Dec 24, 2020 | |
| Patients with 1st and 2nd degree burns are often evaluated in the ED, and patients typically inquire as to how long such burns take to heal. What is the usual time required for a 1st degree burn to heal? A 2nd degree burn? | Dec 23, 2020 | |
| Female-specific risk factors for acute coronary syndrome are often overlooked when assessing an individual patient. Name 3 such risk factors. | Dec 18, 2020 | |
| What is the first line imaging modality for diagnosis of malignant otitis externa in the ED? | Dec 12, 2020 | |
| Central retinal artery occlusion is an ophthalmic emergency because irreversible ischemic damage to the retina can occur in as little as 90 min. It is considered to be an | Dec 10, 2020 | |
| Clinicians caring for patients in the ED with findings suspicious for infection should be aware of retiform purpura, which signifies cutaneous vascular compromise and can indicate a necrotizing soft tissue infection. What are retiform purpura? | Dec 5, 2020 | |
| Studies of peripheral nerve blocks have found that lidocaine with epinephrine can result in a marked increase in systolic BP and heart rate. Thus, some clinicians recommend replacing the epinephrine with what medication in patients with hypertension? | Dec 4, 2020 | |
| Why is adenosine for treatment of SVT less effective in infants weighing < 10 kg? | Dec 2, 2020 | |
| Pyelonephritis in pregnancy is requires IV antibiotics and admission for continued monitoring of mother and fetus. Why? | Nov 30, 2020 | |
| Name two antibiotics that can cause a false positive result for opioids on a urine drug screen. | Nov 29, 2020 | |
| Chilblains has been increasingly recognized in association with COVID-19. What is Chillblains? | Nov 20, 2020 | |
| When used as a local anesthetic, what is the currently generally accepted maximum pediatric dose of lidocaine? Of lidocaine with epinephrine? | Nov 17, 2020 | |
| The HINTS exam is a set of 3 bedside ocular motor tests designed to distinguish between central and peripheral causes of dizziness. Unfortunately, in the ED it is frequently used inappropriately. The HINTS exam should only be used for which patients? | Nov 16, 2020 | |
| Back pain is the most common presenting symptom of Cauda Equina Syndrome, followed by bladder dysfunction and saddle hypoesthesia. What urinary symptoms are consistent with Cauda Equina Syndrome? | Nov 11, 2020 | |
| A necrotizing soft tissue infection extending into the perineal, perianal, and genital area is termed Fournier gangrene. If the infection extends well beyond this area, can the diagnosis of Fournier gangrene still be considered? | Nov 8, 2020 | |
| Naloxone has utility in the management of acute clonidine ingestion, specifically for its ability to prevent the morbidity of endotracheal intubation. What dose of naloxone is recommended in this situation? | Nov 7, 2020 | |
| The high sensitivity of CT for subarachnoid hemorrhage decreases gradually after 6 hrs following the onset of symptoms. Why? | Nov 5, 2020 | |
| According to the new 2020 ACLS updates, should double sequential defibrillation be used routinely for refractory V. Fib/V. Tach? | Nov 4, 2020 | |
| Use of short-acting opioids such as heroin or oxycodone several times daily for at least how long is needed before opioid dependence develops? | Nov 2, 2020 | |
| A seizure unique to infants and commonly has a delayed diagnosis is infantile spasms. The peak age for onset is 4-8 months but they can present earlier. They can be associated with long term problems such as developmental delays. How do they present? | Nov 2, 2020 | |
| Following acute methanol ingestion, there is a clinically silent period. For how long does this period last? Why does a clinically silent period occur? | Oct 31, 2020 | |
| Wake-up strokes constitute 1/5 of all ischemic strokes. Studies suggest that patients have a 55% higher risk of having a stroke between the hours of 6:00 am and noon. Why? | Oct 30, 2020 | |
| What do 2020 ACLS guidelines recommend regarding the use of cricoid pressure during endotracheal intubation of pediatric patients? | Oct 26, 2020 | |
| Patients with salicylate toxicity can display the classic “triple acid-base disorder” on laboratory testing. What are the three components and their respective causes? | Oct 25, 2020 | |
| An ED patient is diagnosed with post-myocardial infarction pericarditis. Clinically, there is no evidence for tamponade. A transthoracic echo is obtained revealing a pericardial effusion of 12 mm. What is your concern? | Oct 24, 2020 | |
| Epiploic appendagitis is a known mimic of acute appendicitis. How does epiploic appendagitis typically present clinically? | Oct 23, 2020 | |
| Neonatal HSV meningitis is challenging to diagnose. A number of diagnostic tests can raise suspicion for HSV infections, though no single test is diagnostic. What CSF results are consistent with neonatal HSV meningitis? | Oct 21, 2020 | |
| The HEART score is widely used to stratify patients with chest pain in the ED. How reliable is it for cocaine-associated chest pain (CACP)? | Oct 20, 2020 | |
| This is the most common cause of acquired epilepsy worldwide – a diagnosis that is being diagnosed more frequently in the US. What is it? | Oct 18, 2020 | |
| When managing a case of decompensated hypothyroidism (formerly known as myxedema coma) in the ED what medication must be administered before thyroid hormone repletion? | Oct 15, 2020 | |
| The Cheiro-Oral Syndrome is characterized by sensory disturbances involving the peri-oral area and the upper extremity, typically isolated to the hand or fingers. What is the underlying cause? | Oct 14, 2020 | |
| Traditionally, management strategies for concussion have relied on passive rest. Why is early diagnosis of concussion with referral to specialists within the first week of injury now seen as important in mitigating morbidity? | Oct 12, 2020 | |
| A patient presents to the ED with acute lower extremity pain and decreased pulses. A rectal temperature is found to be much lower than the oral temperature. What diagnosis is suggested? | Oct 11, 2020 | |
| Population studies indicate that for 3 - 12 months after an episode of Herpes Zoster, > 50 years are at higher risk for stroke or MI, even after adjusting for other variables. Why? | Oct 10, 2020 | |
| According to the American Heart Association/American Stroke Association guidelines, is the presence of an unruptured intracranial aneurysm a contraindication to the administration of IV TPA for acute ischemic stroke? | Oct 9, 2020 | |
| A patient presents to the ED with an acute exacerbation of COPD and you determine that oral antibiotics are appropriate. Patients who have received antibiotics within what recent timeframe should be treated with an antibiotic of an alternative class? | Oct 8, 2020 | |
| In general, patients with an acute exacerbation of COPD with mild symptoms can be managed without antibiotics. In addition to patients with moderate-to-severe disease, which groups of patients presenting to the ED with an AECOPD may benefit from anti | Oct 7, 2020 | |
| The superior oblique muscle is innervated by CN IV. 4th CN palsies are the most difficult to detect since other extraocular muscles compensate. In the absence of trauma, isolated 4th CN palsies are almost always due to what etiology? | Oct 5, 2020 | |
| Stevens-Johnson syndrome and toxic epidermal necrolysis are severe mucocutaneous reactions characterized by extensive necrosis and detachment of the epidermis. How are SJS and TEN distinguished? | Oct 3, 2020 | |
| How elevated must serum lipase be as compared to upper limit of normal to meet diagnostic criteria for acute pancreatitis? | Oct 2, 2020 | |
| During Wide Complex Tachycardia one may detect QRS complexes that are narrower and have a more normal morphology than that of the wide-QRS beats. These are fusion beats, which denote ventricular activation from 2 separate sites. What do they signify? | Sep 29, 2020 | |
| A hallmark of methemoglobinemia is a decrease in oxygen saturation out of proportion to the clinical presentation. Pulse oximetry readings will plateau at about 85% SpO2 regardless of increasing MetHb concentration levels. Why does this occur? | Sep 28, 2020 | |
| About 360 cases of meningococcal disease occur annually in the US. Meningococcal disease, caused by Neisseria meningitidis, usually presents clinically as meningitis, bacteremia, or both. It can also present as what other invasive syndromes? | Sep 26, 2020 | |
| How reliable is a triage fever (Temperature of 100.4 or greater) in the ED as a screen for COVID-19 infection? | Sep 24, 2020 | |
| The most common cause of a spontaneous hemothorax is a spontaneous pneumothorax; other causes include malignancy, vascular malformation, endometriosis, and TB. You have diagnosed a spontaneous hemothorax in the ED. What is the management? | Sep 23, 2020 | |
| The most common initial presentation of Moyamoya disease is ischemic stroke. Transient ischemic attack is also a frequent initial presentation and may be recurrent. What is Moyamoya disease? | Sep 20, 2020 | |
| There is no specific antiviral therapy for measles. Treatment is supportive. However, what medication should be administered immediately upon diagnosis? | Sep 19, 2020 | |
| A long-term complication of Bell’s Palsy is crocodile tears syndrome. What is this syndrome? | Sep 16, 2020 | |
| Erythema multiforme is an acute dermatologic condition classically presenting with a targetoid rash affecting the extremities or trunk. What is the most common etiology? | Sep 11, 2020 | |
| Systemic vasodilation begins in the early first trimester of pregnancy, decreasing SVR by up to 40%, maintaining cardiac output with an increase in heart rate. When does the increase in HR peak and by how much? When does the HR return to normal? | Sep 10, 2020 | |
| Hemiplegic Migraine (HM) is a known stroke mimic. If a patient presents with acute extremity weakness and no other signs/symptoms, how is HM ruled out? | Sep 9, 2020 | |
| Causes of RV failure during an acute MI are insufficient myocardial contractility, excessive preload, and excessive afterload. Should your threshold to electrocardiovert new-onset dysrhythmias be higher or lower with RV failure? | Sep 6, 2020 | |
| Hyperviscosity syndrome is a potentially catastrophic oncologic emergency. It should be considered in any patient with a markedly elevated WBC (i.e. >100) or Hgb (i.e., approaching 20 g/dl) with symptoms of hypoperfusion. What is the classic triad? | Sep 5, 2020 | |
| How common is SARS-CoV-2 infection among frontline U.S. health care personnel? | Sep 4, 2020 | |
| Chlorine gas exposure often occurs as a result of mixing an acid-containing household cleaner with bleach. Acute bronchospasm is the common presenting symptom. What is effective adjunctive therapy for patients not responding to Beta-agonist therapy? | Sep 2, 2020 | |
| A complication of COVID-19 is distal ischemia resulting in tissue necrosis of fingers or toes, sometimes occurring before other symptoms. How should the Emergency Physician manage such cases? | Aug 31, 2020 | |
| Emergency Physicians frequently manage children with acute gastroenteritis. Should you recommend the use of probiotics for such children? | Aug 27, 2020 | |
| What is the recommended timing of influenza vaccination? This year, is early vaccination against influenza (e.g. in July and August) recommended? | Aug 22, 2020 |