‫اﻟﺳﻼم ﻋﻠﯾﻛم‬

‫ﺣل ﻣﺟﻣوﻋﺔ ﻣﻧﻧﺎ ‪ ..‬ﻗﺎﺑل ﻟﻼﻏﻼط ‪..‬‬

‫اي ﻣﻧﺎﻗﺎﺷﺎت او رأي ﻣﺧﺗﻠف ‪ ..‬اھﻼ وﺳﮭﻼ‬

‫‪Any thing green is us‬‬

‫‪Part 2 2018‬‬

‫‪GOOD LUCK‬‬
 low anion gab is less than 3

1. 30 Y.O female i h h f ch nic mig aine e en ed 4 h af e e d e n ne f

he medica i n. She c m lain f mi ing and dia hea. She ha em , a a ia,
h e efle ia, le ha g , and d a h ia. He lab h ed dec ea e ani n ga , ele a ed
WBC, and diabe e in i id ic e. Wha i he m likel medica i n?
A. L h
B. Val a e
C. E g ,
D. Ace amin hen hydrofluoric acid

2. Inge ed ing em al agen , ha i he m likel EKG finding: L ng cQT

3. Si - ea - ld e en i h Abd minal ain. She ha had m de a e c n an e
mbilical ain f e e al h i h a cia ed na ea. He a en n ed a h n he
leg and b ck f e e al da hich he a ib e i i n i . Thi e amina i n
dem n a e and a feb ile nc mf able a ien diff e f D min ende ne ih
eb nd g a ding he ma ke a la a h n he leg and b ck diff e j in
ende ne . Which f he f ll ing i he m im an ne e and e al a i n. ​U e
a a ​ CT can f abd men and el i ASO i e Bl d c l e .
4. L in de e had d ink hi ca adia fl id? Wha i he likel finding? l ng QT a
he an e EG
5. L ng QT EKG, ha he likel D : n mal alb min and l Ca
6. H e he mia, M ?
A. Ice a e imme i n ill 37
B. E a a i e c ling and IV fl id
7. F bi e, hich edic c me?
A. V ace e Rosen says both are worst outcome no
B. Lac f ede a e a g specification if one more than the other
8. Jell fi h ing came , n em ing en acle hich ne f he f ll ing ill
inc ea e he a ien ain?
A. Dil ed Vinega
use see water
B. Backing b de
C. I l alc h l
D. Ta Wa e
9. Y ng a e a lan in a de e inge ed an he bal hing did n men i n jim n eed
d fl hed kin, dila ed il , em f 40, hich f he f ll ing i he a e ic and
diagn ic?
A. Ph g e
B. Nal n
10. M he h i e m e en ed a a a ma ca e, ecei ed 10 mg f m hine a
he a in ain, hen he bab a deli e ed he a c an ic and n c ing i h d ing
and im la i n, be ne e ?
 such, we recommend ICD implantation for
both primary and secondary prevention of
SCD in patients with SQTS unless
absolutely contraindicated or refused by the
patien

patients with SQTS who have refused or are not

candidates for ICD therapy, or in those with
recurrent ventricular arrhythmias resulting in
frequent ICD therapy, we recommend adjunctive
pharmacologic we recommend quinidine
 A. Nal n
I asked peds ED consultant
B. PPV cause it is iatrogenic not
C. De e dependent motherv

D. ?
11. An he ne na e i h l APGAR, im ed i h ii e e e en ila i n
i h highe HR, hen de e i a ed and n che ai e, be ne e ?
A. Re a d a e e f a ea
B. In ba e
C. E ine h ine
D. Che c m e i n
12. C m le e hea bl ck, an c ane acing
13. 10 m n h ld i h fe e , n clea f c ? U ine c l e
14. 9 m n h ld b gh in a n im ing a i i a ed and feb ile emedica ed i h
Am icillin e am n meningeal ign , a ed ei e 1 ime?
A. Rea e and di cha ge i h ec al dia e am
B. LP Most likely partial treated meningitis with Sz
C. CT b ain so LP and abx
Since he is less than 18 months “ still having
D. Bl d & ine c l e, cbc
Ant. fontanel and there is no signs of
15. Fail e ca e EKG localization no need for CT
16. Fail e ace? O e en ing
17. ANOTHER acemake e i n?
When ha ing an ECG f a aced hm i h a ic e f RBBB ha d hink i
ha ening ? if RBBB think about
displacement
a) Lead di lacemen
b)
18. Be i e f he an en acing:
A. R gh I e a J g a 9 FR
B. R gh I e a J g a 6FR
C. Righ S bcla ian Up to date recommends 4-5
D. Lef bcla ian Wiki em: cordis kit 7 fr
So go with 6
E. Lef In e nal j g la Smaller is better
19. NSTEMI = ca h Ballon pump - fluids — etc
20. NSTEMI + ac e mi al eg ge: n gical i n Depends on the Q!

21. 6 h che ain EKG STD in an e i lead me a STE in 2 infe i lead , me

e i ne lead nl , he dia h e ic i h able i al ign ? Ini ial mX ?​ ( I
emembe he e a an ST ele a i n in he infe i lead a ell )
A. Ca h ab,
Depends on the ECG
B. P e EKG,
C Th mb c e
22. 3 h che ain, EKG an e i STEMI nea e ci cen e i 100 min e a a ,
n e ained and can gi e PA i hin 5 min e , ha be M ?
A. T a fe PCI if next :- aspirin
B. h mb l ic
C. Half d e h mb l ic,
D.ASA, cl id g el and an ic ag la i n.
23. WPW + A fib EKG?
A. P ca a de
B. Aden ine
C. BB
24. 5​ da PCI came i h HF ic e and ne ​ lic ​m m ?
made Effusion
A. f ee all e Tempo
→
or

B. Pa illa m cle e
C. Pe ica di i
25. ESRD came i h che ain, Pe ica di i n EKG and h f Che ain, M ?
A. ib fen f 2 eek
B. He d a
C. C lchicine,
D. Fib in l i

26. A 5- ea - ld male i b gh b hi m m f a a h n hi back. Hi back i h n i h

cl e- f he lef flank le i n. The emainde f hi h ical e amina i n i n mal Which f
he f ll ing i he m likel ca e?
a. Send L me di ea e i e ,
b. ​Ca ch d ec e e ce a ch d ab e
c. ITP
d. HSP
27. ET CO2 a e ha he D ? I a ai a ing / me emembe i a he ic e
h gh!
 next
page
.

28. ET CO2 a e i h n ane b ea h, ne ? ​A. Seda e he a e ​. B. Che be.

29. P ROSC be a ame e ? Next

100
A. MAP 70 - 90 70
-

Page
.

B. Lac a e < 4 < 2

C. Hb > 7
30. B nchi li i g a nic a h me ice a ED in e i a di e , h ia, be 2
e ? Indication for intubation are;
A. CPAP Apnea
Hypoxia despite O2
B. In ba i n Sever distress af534 Bipap

31. P egnan i h e e i nal che ain, n fe e , c gh, ECG n ided, ne e ? N

e ab hi e i n
A. High d e ASA
stenosis
B. BB if Aortic
C. He a in and admi i n if PE
D. ??

32. Pa ien a e c ibed a medica i n and d c e lained him ha i ma ca e li and

ng e elling. Same a ien e en ed la e i h angi edema, ha i he be
de c i i n?
A. Medical e
B. E ec ed ad e e effec
C. P e en able ad e e effec

33. Ca e f cabie be ED M ?
A. Inf m la nd and linen ca ef ll de ed / ea ed in b iled a e
 Endobronchial intubation – bifid waveform Reversal-of-alveolar-slope-in-emphysema

waveform represents the pulsation of an extra-large

heart, transmitted to the lung parenchyma
Cardiac-oscillations
Bronchospasm – sawtooth slope

Mechanical-airway-obstruction

typically seen in poor lung compliance, but

it can also occur in pregnant women and
obese patients.

pig-tail
 Cuff
←

leak

B: occurs with obstruction to expiratory gas flow (eg,

obstructive lung disease, bronchospasm, kinked ETT) or leaks
in the breathing system.
C: dip in the plateau
indicates a spontaneous respiratory effort during mechanical
ventilation, as in hypoxia, hypercarbia, or inadequate anesthe-
sia
34. Ven ila ed COPD became h po ic, en e ing p o ided TV: 8/kg, PEEP ?, RR 12,
ph ician di connec he en , comp e ed he che and pa ien became be e , ha
ho ld be dec ea ed in o en e ing o p e en ame i e f om ec ing?
A. Tidal ol me
B. RR
C. In pi a o flo a e

35. ARDS p e en ion a pe i ing ep i endo emen ?

Tv
A. High TV low

peep
B. Lo PEEP High
C. P one
D. Inc ea e o cilla o en ila ion not recon ended

36. ARDS ha be ?
A. Vol me c cled mode
B. B TV 7 ml/Kg 6mi 1kg

37. P ha d chenne m c la d oph fo in ba ion ach ca dia and Bp:220/100??

A. Roc oni m e omida e,
B. Roc oni m + ke amine,
C. S ccin lcholine + e omida e
D. S ccin lcholine + ke amine

38. I ola ed TBI, pa al ed b ccin lcholine, ho la e became ach ca dic h pe en i e

and emp of 40? Ne ?
A. Sep ic o k p and AB
B. Dan olene,
C. Cold NS,
D. Ace aminophen

39. Flail che be ini ial M ?

A. In ba e,
B. 100% non eb ea he ,
C. RT dec bi
D. Lef dec bi
40. 38 eek a ma, came i h h po en ion look ell, Ale , p ima e _ e? Gi en
fl id , Be ini ial ep?
A. Change o i ion,
If PE :

Pulmonary HTN: . Diuretics are indicated for the management of volume overload, and common diuretics—with the exception of spironolactone—are considered safe,
although limited data exist regarding their effect on the fetus. 29 Specific agents for treating pulmonary hypertension include endothelin receptor agonists (ERAs),
phosphodiesterase inhibitors, and prostanoids

IF MITRAL STINOSIS: Beta blockers are the mainstay of treatment for patients with symptomatic mitral stenosis. Diuretics may also be used for patients with symptoms
of heart failure + surgery

If aortic stenosis: conservative management is often possible, especially if the aortic valve area is greater than 1.0 cm
Is symptoms are sever then surgery

If mitral/aortic regurgitation: When necessary, medical therapy consists of diuresis, digoxin, and vasodilators.

Prosthetic heart valve : warfarin is considered t togenic in the first trimester. Neither unfractionated heparin (UFH) nor low-molecular-weight heparin (LMWH) crosses the
placenta and are not teratogenic. However, their use throughout pregnancy is not recommended due to the increased risk of thromboembolic events as compared to
using UFH or LMWH in the first trimester, followed by warfarin for the remainder of pregnancy
international normalized ratio of 2.5 to 3.5 can be achieved with a warfarin dose less than or equal to 5 mg, warfarin may be used throughout pregnancy after a full
discussion with the patient about the benefits and risks of the therapy. If a dose more than 5 mg is required, UFH or LWMH should be used in the first trimester, with
warfarin being resumed for the second and third trimesters. 12,25 Warfarin should again be replaced by UFH or LWMH several weeks before delivery.

flail chest
 B. Blood an f ion,
C. Eme gen C ec ion

41. Yo ng female in ol ed in MVA, e ained, h po en i e BP 90/60, ach ca dic 150,

clea p ima and econda e , and nega i e FAST, complain of che pain and
di ine ,, ECG p o ided (poo q ali ECG, fa eg la na o no P a e ). Be M ?
A. IV fl id ,
B. PRBc
C. Ca dio e ion.

42. Open book pel ic f ac e ? H po en ion? Be ne ep?

A. Ra bed hee o e el i ​,
B. E e nal fi a o ,
C. In e en ional adiolog ,
D. ? No fl id no blood

43. La e decele a ion?

A. Eme gen C. ec ion,
B. US

44. Sho lde d o ia, al ead called fo help, McRobe , Fole and p ap pic p e e?
Wha mo app op ia e ne ?
A. Mediola e al epi io om
B. Ro a e 180 deg ee
C. Co k c e ?
D. P h bab ho lde o che

45. Mo common complica ion h pe ba ic?

A. Middle ea ba o a ma 1st
B. P lmona ba o
C. O2 o ici 2nd
D. M opia

46. S onge ab ol e con aindica e IO line?

A. Cell li i
. F ac e​,
C. o eogene i Impe fec a.
D. O eom eli i
47. 8 ea child i h b n on che la accin on 4 mon h old ne ep?
A. Home
B. Te an
C. B n cen e
analgesia ( in 2019 )

48. Pic e of e an , need o in ba e, ha ' he pa al ic of choice?

A. Ke amine
Next if he present within 4 day succinylcholine
B. Vec oni m late if later vecuronium

page
-
.

C. Panc oni m
D. S ccin lcholine initial -

49. Bab i e i h child , no famil fo con en , and he pa ien i p e en ing i h a pic e

of f ac e and he pa en a e no an e ing hei phone?
A. T ea
B. Take con en f om bab i e
C. Wai fo he a en ​ no eme gen

50. G imacing , pink mo ing all limb HR : 93 , hallo eg la b ea hing, APGAR co e?

A. 7
B. 6 Neat
page
C. 8 -

D. 10
51. Pa ien a ma che , EKG lo ol age, m ffled Hea o nd, e ended ein , BP i hin
no mal?
A. S olic lef en ic la collap e

52. 45 COPD on e oid did no men ion he gende , ​fall 2 da back​, came i h limbing
and d ll hip pain. Hip X-Ra i h nila e al hip and i looked like AVN - a
p o ided , ha i he mo likel a emen ?
A. Mo e in female .
thin
B. Mo e in obe e. in
C. 90-95% bila e al NO !

53. A pi in o Le el 40 mmol Af e bica b inf ion > le el 5 , pH = 7.5, ine

pH =8. Wha i o e plana ion?
A. Ini ial le el a fal el high,
B. En e ohepa ic ci c la ion
C. Shif f om CNS o pla ma,
Re- distribution from the
cells after u give the
sodium bicarbonate

D. H pokalemia
Rosen
54. As per start protocol a patient presented to the ED ​ alking and confused​ ith stable vital
signs but can t follo simple commands is?
A. Red
B. Green
C. Yello
D. Black

55. X-ra Child foreign bod ( ​batter ​) in esophagus no , Looking ver ell, Ne t step?
A. Emergent endoscop

56. foreign bod -Ra sho ed not provided needle shaped in 5 cm duodenum, Looking
ver ell, Ne t step?
A. OR,
B. Endoscop
C. E pectant
D. Serial evaluation and stool check

57. Which is true about Succin lcholine?

A. Fasciculation ith higher dose (1.5 mg > 1 mg per kg )
B. We calculate the dose based on ideal bod eight not actual bod eight
C. Masseter more in children than adult
RSI: Ideal body wieght ( ketamine, propofol, rocronnium)
D. Based on ideal eight

58. Acetaminophen to , 12 tablet 500 mg per da several da s ago, Come ith abd pain,
LFT normal, acetaminophen level is 50? Ne t step?
A. Start it NAC infusion​,
B. Repeat in 4 hours both acetaminophen and LFTs
C. Nomogram application

59. Case of CO poisoning, H perbaric Therap MOA?

A. Prevent neurocognitive sequelae
60. Case of ROSC case ECG onl sho ed TWI, hat is the poor predictors of survival?
A. Pulseless Electrical activit
B. Lo pH We guess

C. Lactic of 4
61. IVF pregnanc , 7 eeks, orried and concerned as the patient in the room ne t to her s
had a CXR, hich of the follo ing is statements is true?
A. The bab is safe, radiation recei ed is < than the total radiation the mother
is e posed to throughout her pregnanc​ ,
B. The bab is safe as he is passed the period ere embr ogenesis happened 2
eeks
C. Bab in not safe as -----
D. Bab is not safe ----

62. TTP case M ? Plasma e change

63. TTP case D ? Blood film
64. Perilunate X-ra , and case of foosh, asking hat carpal bone affected?
A. Capitate
B. Lunate
C. Scaphoid
D. pisiform
65. Child ith supracond lar fracture intact neurovascular asking ou the best M ?
A. Closed reduction and ortho in 2 eeks
B. ORIF Depends on xray—
Next page
C. Back slab and F/U

66. Pediatric air a hat is correct?

A. lar ngeal opening is C3- C4 compared to adults here is is C4-C5,
B. ider epiglottis and harder h oepiglottic ligament is harder
C. Narro est position at the th roid cartilage
D. ?

67. Wrest drop + h pochromic anemia? What is the metal to icit ?

A. Lead
B. Iron
C. Arsenic

68. You have a pediatrics patient ith ankle sprain Ankle Otta a rule, discussing ith a
medical student hich of the follo ing is most accurate?
A. Not applicable on kids
B. 100 % sensitive, a fracture can not be there is it is -ve
C. Includes squee e test
D. ??
0,1 gy equal 10 rad
-Gartland type I >> splint in the ED, arm in 90 degrees of
flexion & neutral rotation , ortho in 48 hr
- Gartland type III >> immediate orthopedic consultation
and surgical Tx in OR.

type 2 :- contraversy consult

69. In adia i n e e1 m m a ea a e ela ed hich em?
A. GI
B. Hema l g
C. C nnec i e i e

70. Man came af e c ba di ing c m laining f j in ain i h di inc i e ma -like a h all

e hi b d , Wha i he M ​?
A. Recomp e ion he ap
B. 100% O2

71. Pa ien n a fa in f DVT, e en ed i h le i ic che ain, CTA

inde e mina e ​ PE, IN 2.6, D-dime 1000, S able i al , ​no EKG, Echo, o op i
p o ided​, ha i he be managemen ?

?!
A. IVC fil e
B. Th mb l ic
C. Bila e al LL d le US
D. he High D-dime i diagn ic

72. Wha e i acce able define bma i e PE?

A. T op i
B. H en i n

73. Lef l e Ab ain, LMP 7 eek , BHCG 1000, an abd minal US; em e
ided , ne ?
A. T an aginal US

74. P - lee e, n mal CT?

A. In e nal he nia

75. B el b c i n, n H f e i ge ie , AB mall b el b c i n, m
likel ca e? First adhesion
A. Inca ce a ed he nia n adhe i n in he i n Second tumor

76. 2 da e a i e, came i h fe e a h and m cle ache , ha i he likel D ?

A. To ic hock nd ome
B. SSSS
77. Tibial la ea f ac e/ imal ibia m c mm nl a cia ed inj ie ?
A. ACL
B. MCL
 C. meni c
D. P li eal A e

78. Se age cleane fain ed, f ll ed b 2 he c lleag e all e e e en all dead likel
sodium nitrate
? H d gen S lfide
79. T a ma ic b ain inj n a fa in? Be c e f ac i n?
A. PCC + i amin K
B. FFP + ia im K
C.
80. C le f da af e bl d an f i n i h m m f a h and hee e , afeb ile and
able hem d namic ?
A. In a a c la hem l i The one with delayed symptoms is extra vascular hemolysis
B. e a a c la hem l i but it present with jaundice and low grade fever
C. alle gic eac i n
D. feb ile eac i n

81. Ca ic inge i n, be ime c e? 12 - 24 H

82. Pedia ic DKA ca e, de el ed headache hen LOC, M ? Manni l

83. A e T na he V&D, ach ca dia, hee ing and fl hed kin?
A. Sc mb oid
B. Te d in
C. Cig a e a

84. GI bleeding, kn Alc h lic ld he had li e ah l g ,m med be ef l? N

Ab , Oc e ide, an a le.

85. OD n DM medica i n became h gl cemic ice be medica i n? Oc e ide

86. In hich f he f ll ing li id em l i n he a ld be an i n? N l cal

ane he ic in he i n
A. Ve apamil
B. S al l Lipid emulsion therapy: verapamil, local anasthesics, propranolol, TCA

87. Ana h la i ca e, n BB, ecei ed 2 e d e f e ine h ine? Wha i he likel

ca e ?
A. he medica i n H
B. Im e d ing
88. B n che ci c mfe en ial? Ha d en ila e? Be T ? Che e cha m

89. B n ca e e ficial be M , n accina ed, be ide nd ca e? Te an id

90. P egnan i h RUQ ain, i and ja ndice, n fe e , e am m h - e j

minimal ende ne , lab high LFT n h and and bili? Likel D ?
A. He a i i if labs thousands yes
B. Ch le a i can be ,
C. C Fa li e can be, can' emembe if he h ed la ele
↳ pt are more sick

91. TXA i hin 3 h ed ce m ali

92. TXA f a hem hagic h ck

93. A l ng ca e h en i e, ach ca dic and feb ile, a king ha be diagn ic l? A.

Lac ic Acid, B. TSH, C.ASA le el D. ? More hx ..

94. L TSH, High T3, n mal T4 a king he D ?

A. H e h idi m Normal
B. . Th idi i , Ts Normal ( Ty High)
TSH
.

,
, ,

C. T3 ic i

95. Sine a e EKG, a ien mi ed 10 HD e i n , efe ed f m HD cen e nl d ne

10 min e hen became c nf ed? Be ini ial n Calci m
A. Re me HD
B. S di m bica b 10 15 min -

C. In lin and gl c e 30 min I hour -

96. Ca e f alc h lic ke acid i

97. IV he in ab e, came i h de cending a al i , M ?

A. An i o in
B. Imm n gl b lin
C. Ab

98. Ca e f ng i h all he m a h mime ic id me , a king f m likel

inge an ? Am he amine

99. Ca e f gan h ha e a king f he g al f a ine? D ec e i n

100. Th id m and hea fail e ( EF 20 % ) ha medica i n gi e ?
A. O al an l l ( 80 mg )
B. e i ne IM ✓

101. Time ide effec ced al eda i n?

A. 20 min e
5-20 minutes from the last medication given
B. A ime f gi ing he medica i n

102. SBP nega i e edic i e al e m c mm nl a bed ide :

A. Le k e e a e Rosen
B. ein
C. c l e E c li and

103. Di e ic li i ?
A. Change in b el habi

)
Admission:
104. B nchi li i admi i n? Age less than 3 months
A. Ch onic l ng di ea e Preterm - 34 weeks wiki
Underlying Heart or Lung diseases
B. Age le han 6 m n h Sat less than 90 with other
findings
C. Fe e Unable to tolerate PO

D. Unimm ni ed
RR more than 70 Rosen

105. C ? De a + acemic

106. A 9 m n h ld i h ic e f b nchi li i , S able :

A. Admi he a ien
B. S c ion and ea ance
C. Gi e he a ien An ibi ic
D. Be a ag ni

107. Child a ea ing c n hen a ed c gh, hee e m e in igh ? Be

diagn ic me h d? B nch c

108. RBBB aced h hm came ih nc e? Likel ca e ? Lead di l dgemen ?!

109. EKG f T ifa cic la bl ck

110. C ing bab 6 m n h i h e i dic knee abd men, feed ell, c en l ell>
be ne e ? Head e e amina i n
infantil colic
 Normal fetal heart rate is from 120-160 so this is brady .. i would call OB

111. T a ma in 27 eek , - e ima and ec nda e , f abd men 20 min e

CTG n mal? (​ fe al hea a e 110​) ne ? 4 h CTG, C n l GYN, US
100 WBC
I n both
←
T
112. SBP WBC 500, ne hil 75% (​ i n hi SBP in e i neal dial i a ien ​ )
113. HB + e needle ick, he ic im j c m le ed 3 d e f accina i n? Ne e ?
A. If S face an ib d > 10, n need f f he managemen

114. TBI hich i e?

A. Ce eb al flo i he goal
B. E ce i e fl id e kee MAP
C. E ce i e Va e
D. H e en ila i n i afe

115. W c me in TBI i h n mal CT?

A. SAH
B. Edema + c n i n
C. S bd al
D. A nal inj

116. Kid i h e ha ngeal ab ce ? Vi al able,n in di e

A. ENT f ge
B. Clindam cin and lbac am
clinda or augmente or chepalaxin
117. Image f Pi ia i ea

118. Ca e f em hig lga i

119. Acc ding ne diabe e g ideline , hich f he f ll ing e en mic a c la

c m lica i n ?
A. 50% ed c i n HbA1C + gl cemic m ni
B. Red ce gl c e b 50% if highe han 250
C. Inc ea e in lin and ed ce gl c e
D. Dec ea e in lin and ed ce gl c e

120. H e K , n be a bl cke enal file,​ a king f he ca e ele a ed K​? Medica i n , ac e

kidne inj hyperkalemia induced by antihypertensive : ARBs ends with artan, ACEI ends
with pril, Spironolactone

121. Ca e f ac e enal b la nec i

122. 38 eek egnan i h a icella e , ne e had i bef e, be m ?

A. Eme gen CS e en an mi i n fe ,
 B. IVIG
C. Vaccine

123. 45 ne m nia, heal h , able? O a ien d c cline

124. O i i e e na i h DM elde ? Ci fl acin

125. 9-m n h- ld male i b gh b hi a en f e al a i n f an abd minal ma ha he
n iced hile changing hi dia e . Ph ical e amina i n dem n a e a n n ic, ac i e infan
i h a al able, n n ende ma mea ing 4 6 cm. Which f he f ll ing die i m
likel e eal he diagn i ?
A. Renal US
B. Sc al US
C. X- a
D. CT

126. D cke , M ?
A. I iga e and a l -----
B. S e
C. C e i h Calci m

127. l cal h i al i h 3 blem , h can i i i e hich k n: I an e ed he

i k manife a i n/c m ac mea e I d n emembe he i n Next
page
128. Y ha e decided in ba e a a ien , e c ibed mida lam f m he ha mac , clinicall
he a ien i de e i a ing and need gi e mida lam n , de i and he n e g
an nlabeled medica i n inge f m ha mac , I he be ac i n.
A. Admini e he inge Wha in he inge.
B. Di ca d he medica i n and a k he ha mac f a ne labeled inge.
C. Label he inge a me d e ala m and admini e i .

12 . Alad e en ed i h lace a i n, he e ed ha he been hi b a c ffee able. While

e amining he be ide f he lace a i n, ha e n iced me b i e f diffe en age in he
b d , he n e ell ​ he emembe he f e en i i and he hink he a d g
eeke . Be ac i n?
A. ffe he cial and admi i n af e e i ing ab h ical ab e .
B. gi e he NSAID and j cha ged h me.
C. A k he ab d g eeking habi .
D. e he and di cha ge he h me

130. Pa ien came f m a el i h fl like m m Feb ile and Re i a di e ?

A. P ec elf and aff and lace him in an ai b ne i la i n n il f ll
in e iga ed.
Threat or hazard Assessment consists of determining
the following:
1. when and where hazardous processes have occurred
in the past.
2. the severity of the physical effects of past hazardous
processes (magnitude).
3. the frequency of occurrence of hazardous processes.
4. the likely effects of a hazard if it were to occur now

Risk assessment involves —> looking for weaknesses

(vulnerabilities) that would make your hospital more
susceptible to damage from a hazard.
1. threat/hazard assessment, as above,
2. location of buildings, highways, and other
infrastructure that will be subject to the hazard
3. potential exposure to the physical effects of a
hazardous situation
4. the vulnerability of the community when subjected to
the physical effects of the event.

Vulnerability to a given hazard depends on:

1. Proximity to a possible hazardous event
2. Population density in the area proximal to the event
3. Scientific understanding of the hazard
4. Public education and awareness of the hazard
5. Existence or non-existence of early-warning systems
and lines of communication
6. Availability and readiness of emergency infrastructure
7. Construction styles and building codes
8. Cultural factors that influence public response to
warnings
131. The mo common mo ali f om in ima e pa ne ab e? Placen al ab p ion?
Sc een
132. Pa ien GERD came af e ea i h epiga ic pain D GERD di cha ged hen
no o be an ACS and came i h a e , ha i he cogni i e e o : Ancho ing

133. A on a king o no o ell hi fa he o D of cance :

A. Tell him i ne hical,
B. ell him o a k hi fa he opinion,
C. make e all famil ag ee i h hi on,
D. o on ell he pa ien and di c he M i h hi on
13 . o a e he e iden on he hif and o no ice he con l an i gi ing ong do e of a
pecific medica ion, in hich o kno b e idence hi do e i b he ape ic, and hi
con l an i kno n o be a ogan and doe n' like nego ia ion. ha Will o do?
A. Sh hi he e ide ce.
B. B.change he do e i ho him kno ing.
C. C.do no hing
135. While a e o p e c ibing a medica ion fo pa ien of o , he a k o fo a fa o o
i e an e a pe of medica ion o he can di pen e i fo hi f iend, ho a o
e pon e?
A. ef e and be in conflic i h him.
B. do no de c ibe i o plea e him.
C. Do he p e c ip ion i ill no ha m
D. A k fo mone
136. D g ho ed of C e a e of 25% , 14% placebo calc la e n mbe needed o
ea ? 9
137. p e e p obabili igh defini ion
138. Pa ien i h d ia and penile di cha ge in addi ion o co e ing gono hea ha el e
ho ld o co e ?
A. Chlam dia
139. incompe en pa ien hi g a dian i ef ing T ha ill p e en clinical de e io a ion,
ha ill o do?
A. No in e en ion
B. In e ene ega dle migh be he an e a men ioned legal g a dian
C. Look fo ano he g a dian
D. A k he pa ien migh be he an e a capaci diffe en han compe enc

140. Diph he ia ca e?
A. Ab and an i o in
141. Bab bo n in p i a e ho pi al, po ci c mci ion, bleeding 3 oaked diape , bleeding
i con olled no , ne ?
A. Blood o k fo bleeding di o de
B. Vi amin K injec ion
C. Di cha ge i h ea ance
142. Lo e lip lace a ion in ol ing e milion? Men al ne e block
143. Pa ien kno n C ohn i h en e oen e ic fi la and ch onic dia hea ha
elec ol e abno mali i e pec ed ?
A. H poK
B. H poMg
144. O al lace a ion choice of e? Vic l 4
145. Feb ile ei e e ion?
146. Indica ion fo enal image in a ma?
A. F a k he a ia
B. Mic o copic Hema ia
C. Flank pain
D. Flank ecch mo i Suture - many options exist (1 single deep suture
through all 3 layers, 1 suture above and 1 below)
147. 45 lad i h a ma i h mid ce ical pine ende ne , no mal ne o-e am, and
nega i e CT. Ne ?
A. hi ade hia c c a a d di cha ge i h e ge f
B. Admi and ob e a ion
C. ED MRI

148. H of a ma, pa ien i ha ing ende ne o e he e nocla ic la join , pec ing

po e io di loca ion, hich of he follo ing i he be me hod?
A. CT i h c a
B. AP and la e al che a
C. Cla icle a

149. P egnan lad i h ho lde di loca ion, a king hich of he follo ing a emen
mo acc a e?
. G d eda i i he ai hi g f a cce f ed c i
B. Koche me hod ha a lo e a e of complica ion
C. T ac ion-co n e ac ion i he main me hod

150. E plain ho epid al ca e nila e al dila ed p pil?

A. Midb ain comp e ion,
 B. oc lomo o comp e ion again he en o i m

151. And nonin a i e po i i e p e e en ila ion i h COPD ea he be a o clea

mo e CO2 i ?
A. I c ea i g he iPAP Rosen
B. Inc ea ing he peep
C. Inc ea e IPAP & EPAP
D. Can emembe o he op ion

152. EKG i h ST ele a ion a he aVR & dep e ion o e all of he lead ? Le ion?
A. Main em lef co ona a e -
AUR > Vi
B. p o imal LAD, -
C.RCA
153. Ca e of mi al al e eno i , EKG ho ing P- a e mi alli no p o ided , A king
o be managemen ?
Need more details
A. Be a blocke
B. di e ic can emembe he e

154. Ca e of a g n ho , Pa ien i den ing g n ho ho e e o can ee an e i an o le

o nd and he fo m he bleeding i con olled, he e a king o ha o ld o do?
. Repo o he police​.
B. Wo nd ca e and di cha ge home.
C. info m he e hical commi ee
155. Ca e of Angioedema hich of he follo ing p od c i he be fo b ad kinin
ind ced angioedema?
A. FFP
B. C op ecipi a e
C. De mop e in

156. A ca e of meningi i hich of he follo ing i e?

A. Re i ed fo all ho ehold
B. ifampin i he d g of choice fo H. infl en a
C. N f e c cca e i gi i
D. Ac i ed fo e e heal h ca e p o ide ho a e po ed o he pa ien

157. MVA of a kid ha a iding a bic cle handleba , Wha i he mo likel inj ed?
A. Pa c ea ic a d i e i a i j ie
B. Diaph agma ic inj
C. Li e inj
158. 56- ea -old gen leman kno o ha e h pe en ion p e en ed o he eme genc i h
cen al che pain ea ing in na e ai ing o he back al o ha ing ome p e- ncopal
epi ode hich of he follo ing i he be ne ep and managemen ?J -a
p o ided i h ide media in m.
A. S a abe a f b h e i g he hea a e a d b d e e
B. Ni op ide
C. Nica dipine
D. H d ala ine

159. 45- ea -old lad medicall f ee came i h lef flank pain inal i ho ed
mic o copic hema ia e amina ion ho ed mild lef lo e fo a ende ne ha i he
be managemen ?
A. Ke ac
B. CT
C. Tam lo in
D. Ul a o nd

160. Q e ion on ef ac o VT a e , ha likel o con e i ?

A. Lidocaine
B. a​ i da e Refractory so amio is already used .. lidocaine will be the
next choice
C. magne i m
D. Digo in

161. Which of he follo ing i e ega ding panc ea i i ?

A. Am la e i mo e pecific han lipa e
B. A a e a d i a e ha e he a e e i i i
C. Am la e peak ea lie emain ele a ed fo a longe pe iod han lipa e
D. The deg ee of ele a ion co ela e i h he e e i

162. Ca e of co d p olap e?
A. E e a e he e e i g a
B. P h i in
C. Eme gen C ec ion
D. Gi e e b aline o hal e ine con ac ion and inc ea e blood flo o he fe .
 Panchal et al 2018 Focused Update on ACLS
CLINICAL STATEMENTS
AND GUIDELINES
Downloaded from http://ahajournals.org by on October 4, 2020

Figure 1. Adult Cardiac Arrest Algorithm—2018 Update.

CPR indicates cardiopulmonary resuscitation; ET, endotracheal; IO, intraosseous; IV, intravenous; PEA, pulseless electrical activity; pVT, pulseless ventricular tachycar-
dia; and VF, ventricular fibrillation.

(Figures 1 and 2). The recommended dose of lidocaine is ized bolus dose for ease of execution,11 this 2018 rec-
1.0 to 1.5 mg/kg IV/IO for the first dose and 0.5 to 0.75 ommended dose is made with a focus on patient safety
mg/kg IV/IO for a second dose if required. Although the through weight-based dosing. The recommended dose
most recent clinical trial of lidocaine used a standard- for amiodarone is unchanged, with randomized tri-

e744 December 4, 2018 Circulation. 2018;138:e740–e749. DOI: 10.1161/CIR.0000000000000613

 Panchal et al
Downloaded from http://ahajournals.org by on October 4, 2020
Figure 2. Adult Cardiac Arrest Circular Algorithm—2018 Update.
CPR indicates cardiopulmonary resuscitation; ET, endotracheal; IO, intraosseous; IV, intravenous; pVT, pulseless ventricular tachycardia; and VF, ventricular
fibrillation.
als supporting an initial IV/IO dose of 300 mg with a
second IV/IO dose of 150 mg if required.10,11 Both the
ROC-ALPS and ALIVE trials permitted dose reductions
in lower-weight patients; however, higher cumulative
bolus doses of amiodarone have not been studied in
cardiac arrest. It is also important to note that the cap-
tisol-based formulation of amiodarone is currently mar-
keted only as a premixed infusion, not in concentrated
form, making it impractical for rapid administration
during cardiac arrest. The polysorbate-based formula-
tion is currently available in concentrated form for rapid
administration.
The writing group reaffirms that magnesium
should not be used routinely during cardiac arrest
management but may be considered for torsades
de pointes (ie, polymorphic VT associated with long-
QT interval). Unfortunately, these recommendations
are based on low-quality evidence, representing a
significant knowledge gap concerning the use of
magnesium for VF/pVT. Future randomized studies
are needed with rigorous evaluation of the impact of
magnesium on survival and neurological outcomes to
Circulation. 2018;138:e740–e749. DOI: 10.1161/CIR.0000000000000613
2018 Focused Update on ACLS
CLINICAL STATEMENTS
AND GUIDELINES
determine the importance of magnesium administra-
tion in this condition.
The writing group is aware of increased interest in
and early studies of β-adrenergic–blocking drugs used
during cardiac arrest.18,19 The question of the effective-
ness of these drugs has been referred to ILCOR for
future systematic review.
ANTIARRHYTHMIC DRUGS
IMMEDIATELY AFTER ROSC
FOLLOWING CARDIAC ARREST
The 2018 ILCOR systematic review sought to deter-
mine whether the prophylactic administration of an-
tiarrhythmic drugs after successful termination of VF/
pVT cardiac arrest results in better outcome. This pro-
phylaxis includes continuation of an antiarrhythmic
medication that was given during the course of re-
suscitation or the initiation of an antiarrhythmic after
ROSC to sustain rhythm stability after VF/pVT cardiac
arrest. Although improved survival is the ultimate goal
of such treatment, other shorter-term outcomes (even
December 4, 2018 e745
163. 12- ea -old gi l ha e been ha ing e e ci e-ind ced knee and hip pain fo fo eek
doe no ecall an hi o of a ma. On e am o kno o ha he ha ing limi ed hip
in e nal o a ion abd c ion and fle ion. hich of he follo ing i he be diagno ic ep?
A. Hip - a
If there is more hx and pt is obese xray for SCFE
B. Hip l a o nd Hx of travel or URTI : transient synovitis so ESr and
C. ESR and C eac i e p o ein CRP as intial and MRI if best

164. Elde l lad epo ed oda hi o of ppe limb eakne p eceded b fi e da

hi o of Uppe limb p e ea ie and pinp ick and Se han on e amina ion he e i a
eakne bila e all and he ppe limb h ee o of fi e i h dec ea e pain en a ion,
pa ing he lo e limb . Which of he follo ing a emen i e and ega d o hi
inj ?
A. H pe e en ion i he Mechani m of inj of cen al co d nd ome
B. Comple e e ol ion of he mo o occ pon aneo l in h ee mon h i h
cen al co d nd ome
C. i h an e io co d nd ome
D. i h an e io co d nd ome

165. A child a bi en b he Neighbo dog a ide f om on ca e ha o ld o do

kno ing ha he dog i no accina ed ho e e The neighbo S a ed ha he in hi al
a e?
A. Gi e abie IVIG and accine
B. Gi e abie accine
C. C fi e he d g f 10 da
D. Kill he dog

166. Cl e headache gi en O2 and ace aminophen ill in pain?

A. bQ ma ip an Depends on the Q if early reassessment the
O2 should be continued for 30 min if it fails
B. Con in e O2 fo 30 min e triptan can be used if no contradiction

167. T igeminal ne algia? Ca bama epine

168. COPD on Home O2, came i h mode a e e ace ba ion, gi en e oid and
b onchodila o , VBG ch onic e pi a o acido i . Ne ?
A. Ab and home If improved
B. Admi ion HSP Admission if :
Moderate to sever abdominal pain
169. Cla ic HSP ca e? Multiple joints arthritis
A. Admi ion and IVIG Inability to ambulate
Protienurea
B. S e oid GI bleed
C. Di cha ge Renal involvements

TTT:
NASIDS
Steroids
IVIG if renal
170. Cla ic pedia ic ca e cena io ha goe i h HSP, D , e op ion did no make
en e?
A. ASO i e
B. U ine dip
171. Ca e e e diffic l ai a a no an icipa ed, he ph ician p oceeded i h RSI,
af e 2 failed a emp he pa ie became h po ic < 90%, did no pick p i h BVM, be
ne ep?
A. T a 3 d a emp
B. Call he mo ai a e pe f om a nea b place i hin he depa men
C. Eme gen acheo om
D. Eme gen c ico h oido om d ing hi ime an LMA can be placed empo a

172. Gian cell a e i i ? S a e oid i h he ma olog follo - p

173. Gian cell a e i i + blindne ? Admi ion ?

174. P e en ed o o i h a conce n of abdominal pa holog fo hich he a

in e iga ed m l iple ime and e e all nega i e, ha i he likel d ?
A. con e ion
B. h ch d ia i
C. malinge ing

175. Ca e goe i h GBS . an e e m eli i , hi o of fl , e he gi e o pgoing

plan a efle con med lla i no a ma o back pain, ha i he be ne ep?
A. E e ge MRI
B. LP,
C. CT,
D. S e oid

176. Wo o come fo feb ile ne openia?

A. Le kemia
B. L ng cance
C. GBS
D. B ea Ca
177. E e pic, hich a emen i e?
A. Hea b e i he ia ce ig a i
B. Heal b blood ppl
C. Pa ch make fa e eco e

178. Kid i h a hma gi en neb and e oid no imp o emen ? Ne ?

A. Mg lfa e
B. Ke amine

179. Che be a c ion 6 ho , hen pa ien became h po ic clinicall c ackle a he

che be ide? CXR collap ed l ng no p o ided ?
A. Re-e a i a ede a
B. Pe i en ai leak
C. B onchial inj ?
D. Rec en pne mo ho a

180. Yo face a BA pa ien ho i h po ic and agi a ed, decided o in ba e? Be

me hod?
A. De a ed e e ce i ba i
B. Rapid e ence in ba ion
C. S gical

181. 2 ea child i h HF and ca diogenic hock?

A. D a i
B. P o aglandine
C.p op anolol
D. Indome hacin

182. Elde l i h EF 20% h po en i e ca diogenic hock? Be ino op?

A. Dob amine
B. N e i e h i e
C. Epineph ine
D. Dopamin

183. P egnan 12 eek no p e io F/U came i h na ea and omi ing, Vi al high

blood p e e, pic e p o ided of mola p egnanc ? A king ha ' be ini ial
managemen ?
or
A. D&C
B. H-HCG e e c fi he D
OB
 C. Me ho e a e
184. Ca e i h pical che pain, kno n an ipho pholipid, had ame epi ode 6 mon h
back and ca h a no mal, likel diagno i ?
A. X- nd ome
B. Na o ing of he co ona ie Next page
C. A oimm ne pe ica di i
D. Small ao ic-co ona o
185. Child emp ied hi g andmo he bag of med , came i h e i e, ide QRS, R a e
in aVR men ioned in Q; EKG no p o ided , ha i he likel medica ion?
A. Me op olol
B. P a also it can cause seizure

C. A enolol

186. female , MVA i h lef leg open o nd , h po en i e . ha ho ld be ne :

A. Splin Same Q from 1200
B. Che and pel i a
C. I female
A 65-year-old iga ionpedestrian
of he f ac e andafter
presents Abbeing struck by a car moving at
about 20 mph. She has

an obvious, open, deformed leg fracture and was unable to walk at the scene.
Her prehospital vital

signs are P 105, 85/55, and 100% RA. She is awake and alert and in significant
pain. You confirm that

her airway, breathing, and pulses are intact. On visual inspection, she has an
open tibial shaft fracture

and has decreased sensation distal to the fracture. Which of the following is the
most important next

step in management?

A. Splint application to leg

B. Irrigation of leg wound

C. IV gentamicin and cefazolin

D. Tetanus immunization

E. Chest and pelvis x-rays