08-14-2014, 04:38 PM
1. A 29-year-old man is brought to the emergency department because of an injury he sustained to his right hand and wrist when his hand was caught in machinery He is in great pain but is otherwise stable. The hand is badly mangled with several large lacerations. The bleeding has stopped except for some oozing. The thumb is distorted and is not in the normal anatomic position. The index finger is partially avulsed. Which of the following is the most appropriate first step?
A) Administer a narcotic analgesic
B) Clean and explore the wound to assess tendon injuries
C) Do motor testing of the fingers and thumb
D) Do sensory testing of the fingers and thumb
E) Obtain x-rays of the hand and wrist
2. A 99-year-old woman is transferred from the nursing facility where she resides to the emergency department because of pain in her low back and right hip resulting from a fall 25 minutes ago. The patient says she got out of bed and tried to walk to the bathroom unassisted and fell. She did not lose consciousness. She rates the back and hip pain as a 9 on a 10-point scale. Medical history is remarkable for lumbar spinal stenosis, early Alzheimer disease, and glaucoma with visual impairment. Medications include 81-mg aspirin, rivastigmine, and timolol eye drops. She has no medication allergies. She eats well-balanced meals provided by the nursing facility. Physical examination discloses a large ecchymosis over the right hip that is tender to palpation. Imaging studies of the back and hip show no fracture. Acetaminophen and oxycodone are prescribed. Prior to discharge of the patient to the nursing facility, which of the following is the most appropriate additional recommendation for this patient?
A) Bisacodyl suppositories
B) Docusate sodium capsules
C) Increased fiber intake
D) Increased fluid intake
E) Limitation of physical activity
3. A 67-year-old man with a history of chronic obstructive lung disease is brought to the emergency department by his family. He is in mild respiratory distress with respirations 32/min and some accessory respiratory muscle use. On physical examination he is alert and afebrile. Chest examination is significant for bilateral lower lobe wheezing, loud upper airway sounds, and a cough productive of thick, yellow sputum. In addition to administration of antibiotics, which of the following is the most appropriate treatment at this time?
A) Immediate intubation and mechanical ventilation
B) Initiation of bi-level positive airway pressure (BiPAP) ventilation and admission to medical intensive care unit
C) Serial inhaled albuterol treatments
D) Serial inhaled salmeterol treatments
E) Supplemental oxygen via 40% Venturi face mask
Thanks
A) Administer a narcotic analgesic
B) Clean and explore the wound to assess tendon injuries
C) Do motor testing of the fingers and thumb
D) Do sensory testing of the fingers and thumb
E) Obtain x-rays of the hand and wrist
2. A 99-year-old woman is transferred from the nursing facility where she resides to the emergency department because of pain in her low back and right hip resulting from a fall 25 minutes ago. The patient says she got out of bed and tried to walk to the bathroom unassisted and fell. She did not lose consciousness. She rates the back and hip pain as a 9 on a 10-point scale. Medical history is remarkable for lumbar spinal stenosis, early Alzheimer disease, and glaucoma with visual impairment. Medications include 81-mg aspirin, rivastigmine, and timolol eye drops. She has no medication allergies. She eats well-balanced meals provided by the nursing facility. Physical examination discloses a large ecchymosis over the right hip that is tender to palpation. Imaging studies of the back and hip show no fracture. Acetaminophen and oxycodone are prescribed. Prior to discharge of the patient to the nursing facility, which of the following is the most appropriate additional recommendation for this patient?
A) Bisacodyl suppositories
B) Docusate sodium capsules
C) Increased fiber intake
D) Increased fluid intake
E) Limitation of physical activity
3. A 67-year-old man with a history of chronic obstructive lung disease is brought to the emergency department by his family. He is in mild respiratory distress with respirations 32/min and some accessory respiratory muscle use. On physical examination he is alert and afebrile. Chest examination is significant for bilateral lower lobe wheezing, loud upper airway sounds, and a cough productive of thick, yellow sputum. In addition to administration of antibiotics, which of the following is the most appropriate treatment at this time?
A) Immediate intubation and mechanical ventilation
B) Initiation of bi-level positive airway pressure (BiPAP) ventilation and admission to medical intensive care unit
C) Serial inhaled albuterol treatments
D) Serial inhaled salmeterol treatments
E) Supplemental oxygen via 40% Venturi face mask
Thanks