Department of Emergency Medicine. Drexel University College of Medicine. Philadelphia, Pennsylvania. Fever. Vaginal Bleeding. Lawrence R. Emergency Medicine: PreTest® Self-Assessment and Review, 4e. Adam J. Rosh, Ciara J. Barclay-Buchanan. Search Textbook Autosuggest Results. Chest Pain. Editorial Reviews. About the Author. Adam J. Rosh, MD, MS, FACEP, Attending Physician, Emergency Medicine PreTest Self-Assessment and Review, Fourth Edition 4th Edition, site Edition. by.
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EMERGENCY MEDICINE: PRETEST SELF‐ASSESSMENT AND REVIEW, second edition. By Rosh, Adam J., MD, MS. New York, NY. possibility of human error or changes in medical sciences, neither the Case Files ®: Emergency Case Files Em First Aid for the Emergency Medicine Boards. PreTest Emergency Medicine, 3rd Edition () [PDF] | Free Medical Books 5 MB.
A post-workshop survey assessed student perception and satisfaction Table S3. Results Nine of the 15 EM-matched seniors at our institution attended the voluntary, noncredit procedure workshop. They held expectations of becoming more comfortable with the procedures, and did not expect competence to develop in 1 day. Students reported an increased confidence post-workshop in the following procedures: intubation 1.
Psychomotor skills testing of procedures showed that on average, 2. Some did report they could allocate more time for practice. Discussion EM-related competencies in medical school curricula may lack uniformity and standardization. The resulting gap in expected versus actual skill sets is of concern to educators, supervising clinicians, and the public.
A standardized EM boot camp may help mitigate these deficiencies by developing specialty-specific competencies.
Currently, there is no existing framework for the setting up of an EM boot camp. We looked to the EPAs, EM resident milestones, and competencies for guidance to inform the design of a proposed EM boot camp curriculum.
Since EPAs outline general competencies and are not discipline-specific, these gaps are not unexpected. Admittedly, these are included in categories likely to be covered well in medical school, but there are specific issues unique to EM that fall under these domains.
For example, patient disposition PC 7 is integral to daily EM practice and therefore would need to be addressed. Based on our mapping, it is clear that any proposed EM boot camp should, at a minimum, focus on the key gap areas related to EM, such as airway management, pain management, procedural sedation, ultrasound, and patient observation in the emergency department ED , reassessment, and disposition.
Practice and instruction — in the list of core procedures and clinical competencies — that we have identified here would also be beneficial. Finally, there is a need for reinforcement of general, but essential topics such as patient-centered communication and professionalism.
For example, timely chart completion, duty hour reporting, and procedure logging PROF 2 should be addressed in a proposed EM boot camp. A Professionalism in Residency session to address the development of the professional identity of trainees as EM physicians would be similarly beneficial. We identified some supplemental topics based on a review of literature on surgery and EM-resident-aimed boot camps. Similarly, high-yield topics such as sepsis, stroke, and asthma may be reviewed to help students critically understand the current status and best practices.
It is important to note that boot camps themselves may be subject to variability and inconsistencies that may limit their generalizability across programs. Therefore, we propose a core standardized EM boot camp curriculum across schools to help optimize learning outcomes.
Because rape is a violent crime, nongenital injuries are common, particularly of the face and extremities. Preexisting pregnancy must be ruled out before offering pregnancy prophylaxis.
Follow-up is necessary to assess the effectiveness of pregnancy and sexually transmitted disease prophylaxis, and patients frequently require additional counseling. Chapter 13 Judgments about quality of life are highly subjective and individual, and physicians should refrain from making such judgments about their patients.
When a patient is known to have an untreatable terminal illness, it is appropriate to withhold resuscitation, but this level of knowledge is rarely available in the emergency setting.
Chapter Malpractice stress syndrome is a pattern of response characterized by disbelief, anger, and depression, followed by isolation, embarrassment, and self-doubt. The greatest predictor of dysfunction is isolation. Peer support groups composed of other physicians who have experienced litigation are very helpful in preventing or relieving the sense of isolation.
Chapter Physicians and other licensed health care professionals are required to report any suspicion of child abuse. Every state provides complete legal immunity for any good-faith report of suspected abuse. Although parents are frequently angry and upset and may threaten lawsuits, a physician cannot be successfully sued for reporting child abuse unless the report is intentionally false.
The answer is B. Chapter Failure-to-thrive syndrome results from severe neglect starting in early infancy. Physical examination shows evidence of longstanding malnutrition, and the child often exhibits wide-eyed, wary behavior. Admission to the hospital generally results in prompt weight gain, which is diagnostic. A skeletal survey is needed to evaluate for physical abuse, and an extensive social service assessment is mandatory.
Chapter Battered women seek care for a wide variety of complaints. The most significant reason for failing to make the diagnosis is simple failure to ask. However, only about one-third of battered women will speak to a physician or nurse about the violence in their lives if direct inquiry is made. Therefore, the diagnosis is not ruled out by a negative answer. Although battered women may resort to substance abuse, there is no established link between substance use and the cause of violence.
Multiple injuries in various stages of healing, substantial delay between injury and presentation, and frequent visits for vague complaints are factors suggestive of a diagnosis of domestic violence.
Women stay in violent relationships for a variety of reasons, including the very real fear of escalating violence. The highest number of fatalities from domestic violence occur when the woman leaves or tries to leave the relationship. Leaving the relationship may not be the immediate goal of the patient, and she may be loath to have her husband and the father of her children arrested.
Many battered women respond truthfully if questioned directly in a sensitive, nonjudgmental way. However, the woman needs to know that she does not deserve to be beaten. Chapter Most perpetrators of violence are males with a history of substance abuse. The most common functional disorder related to violence is schizophrenia, especially the paranoid subtypes. Although the most dangerous functional disorder is mania, depression is not a strong predictor of violence.
If a medical emergency is present, the patient must be stabilized without regard for the financial status of the patient. A patient in active labor is defined as having an emergency under EMTALA and can only be stabilized by delivery of the infant and the placenta. However, the burden of proving stability is with the transferring physician and hospital. Chapter Bullets should not be handled with metal instruments because the instrument may leave marks that can confuse interpretation.
Cutting through holes in clothing or through skin wounds can destroy valuable indications of the force, direction, and nature of the wounding instrument. Scrubbing wounds can destroy powder marks from gunshots and obscure abrasions. Clothing and belongings must be secured to prevent the possibility of tampering.
Chapter Each person who requires restraint should be approached by a team of four or five trained individuals with a single leader. Ideally, one person can control each extremity and another can control the head.
The minimum necessary force should be used, and not every patient requires four-point leather restraint. Patients who require restraint should not leave the ED without complete evaluation. The chart must reflect the reason for the restraints and a specific physician order for the type and duration of restraint. The patient must be reevaluated frequently. The answer is E.
Emergency Medicine: PreTest® Self-Assessment and Review, 4e
It is in resuscitation that the duties to protect and preserve life most often conflict with the duties to relieve suffering and respect autonomy.
Patient autonomy is a highly prized ideal in U.
Which of the following agents may cause truncal and jaw muscle rigidity? Which of the following agents may precipitate bronchospasm in patients with reactive airway disease?
A Lidocaine and bupivicaine are both amide anesthetics B Warming and buffering has been shown to reduce the pain of injection C The duration of anesthesia is twice as long with bupivicaine as with lidocaine D Duration of anesthesia is prolonged with epinephrine E Epinephrine can damage local tissue defenses A The first signs of toxicity are dizziness, tinnitus, periorbital tingling, and nystagmus B Systemic convulsions are rare and usually self-limited C Most allergic reactions are to aminoamide compounds D For patients allergic to local anesthetics, diphenhydramine hydrochloride 1 percent can be injected into the wound E To prevent toxicity, avoid rapid injections of local anesthetic into the wound A Digital nerve blocks are more efficacious than metacarpal blocks B A gauge needle is inserted through the skin into each side of the extensor tendon, just proximal to the web C The needle is advanced toward the palm until its tip is palpable beneath the volar surface of the finger D It is not necessary to anesthetize the dorsum of the involved digit E The total volume of anesthetic agent should not exceed 4 mL 7 Copyright The McGraw-Hill Companies, Inc.
A year-old male presents with a laceration he sustained after stepping on broken glass at the beach.
The examination reveals an 8-cm cut on the medial plantar aspect of the left foot. Which peripheral nerve block is appropriate?
A year-old male kick boxer sustains a lower lip laceration during a practice match. The wound is complex and crosses the vermilion border. Which is the best way to achieve anesthesia? Chapter 33 Fentanyl is a potent, synthetic opioid. Because it does not trigger histamine release like other opioid analgesics, it causes little hemodynamic compromise.
All the other agents listed cause dose-dependent hypotension. Chapter 33 Truncal and jaw muscle rigidity are rare side effects of fentanyl that can lead to impaired ventilation. If naloxone is unsuccessful, paralysis and endotracheal intubation may be necessary. Chapter 15 Methohexital is an ultra-short-acting barbiturate that provides sedation and amnesia for short, invasive procedures. Barbiturate administration may precipitate bronchospasm in patients with moderate to severe reactive airway disease, thus limiting its use in those patients.
There is some evidence that ketamine may have a mild, transient bronchodilatory effect. Midazolam, etomidate, and propofol have no clinically significant effect on bronchial smooth muscle tone. Of the listed agents, only ketamine provides analgesia in addition to sedation. Chapter 32 The duration of anesthesia after bupivicaine is nearly four times longer than that for lidocaine. With either agent, the duration of action is prolonged when combined with epinephrine.
However, the local vasoconstrictive action of epinephrine may result in local hypoxia that impairs white blood cell function, thereby damaging local tissue defenses.
Both lidocaine and bupivicaine are amide anesthetics. Chapter 32 EMLA eutectic mixture of local anesthetics is a eutectic mixture of 5 percent lidocaine and prilocaine that is used to produce anesthesia over intact skin.
In the ED, its primary use is to produce anesthesia before venipuncture and lumbar puncture. In other settings, this cream has been used for anesthesia of split-thickness graft donor sites, curettage of molluscum contagiosum, cautery of genital warts, and myringotomy. EMLA is not recommended for topical anesthesia of lacerations because it induces an exaggerated inflammatory response, thereby damaging host defenses and inviting the development of infection.
Chapter 32 Slow injections limit the chance for local anesthetic toxicity. When history of allergy is uncertain, an antihistamine such as diphenhydramine injected directly into the wound can be used as an alternative and achieves anesthesia in approximately 30 min.
True allergic reactions to local anesthetics are rare, especially to aminoamide compounds such as lidocaine and bupivicaine. The ester derivatives of paraaminobenzoic acid, such as procaine, are responsible for most local anesthetic allergic reactions. Toxicity should be suspected in patients who complain of dizziness, tinnitus, and periorbital tingling.
Rarely, systemic convulsions follow. These are usually self-limited because of rapid redistribution of the drug, with resultant lower serum levels.
Chapter 32 The dorsal branch of the digital nerve supplies the dorsal aspect of each digit and should be included in the digital block. Digital nerve blocks are less time consuming and more efficacious than metacarpal blocks. Chapter 32 The posterior tibial nerve innervates the sole of the foot.
To perform a peroneal nerve block, 1 percent lidocaine is injected into the subcutaneous tissue lateral to the posterior tibial artery at the upper border of the medial malleolus. None of the other nerves listed supply the plantar surface of the foot.
The saphenous nerve provides sensation to the skin over the medial malleolus. The sural nerve supplies the lateral foot and fifth toe. The superficial peroneal nerve innervates the dorsum of the foot and the other toes, except the adjacent sides of the first and second toes, which derive sensation from the deep peroneal nerve.
Chapter 32 A regional block is preferred for a complex lower lip laceration because it preserves tissue planes and landmarks, facilitating anatomically correct repair. The mental nerve supplies the skin and mucus membranes of the lower lip. The mental foramen is located inside the lower lip at its junction with the lower gum, just posterior to the first premolar tooth.
To avoid nerve injury, 1 percent lidocaine with epinephrine is injected close to, but not into, the mental foramen. The inferior alveolar and lingular nerves do not supply the lower lip and thus would not be effective in this patient.
Stable angina is characterized by all of the following EXCEPT A episodic chest pain lasting 30 to 45 min B may be accompanied by light-headedness, palpitations, diaphoresis, dyspnea, nausea, or vomiting C auscultation may reveal transient S4 or apical systolic murmur indicative of mitral regurgitation D provoked by exertion or stress E an ECG taken during an acute attack may show ST-segment depression or T-wave inversion Unstable crescendo or preinfarction angina is characterized by all of the following EXCEPT A exertional angina of recent onset, usually defined as within 4 to 8 weeks B elevated troponin and new Q waves C angina of worsening character, characterized by increasing severity and duration D angina at rest angina decubitus E increased requirement for nitroglycerin to control angina What percentage of unstable angina patients can be identified by positive troponin assays?
How long after coronary artery occlusion can echocardiography detect wall-motion abnormalities? Rupture of a papillary muscle is usually associated with an infarction of which area of myocardium?
For which of the following subgroups of patients were these relatively small benefits of tPA over streptokinase fewer or nonexistent? Of the following criteria, which is the BEST for thrombolytic therapy? By which percentage does aspirin by itself reduce cardiovascular mortality when given in the early stages of coronary occlusion?
A year-old man presents to the ED after a 1-min episode of loss of consciousness while eating dinner. Which artery is MOST likely to be diseased in a patient who suffers a syncopal episode secondary to cerebral ischemia?
A year-old man complains of recurrent syncope associated with upper extremity exercise. What is the MOST likely cause? What diagnosis should be suspected in an elderly patient who experiences a syncopal episode after head turning or shaving?
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A B C D E vasovagal syncope carotid sinus hypersensitivity orthostatic syncope cardiomyopathy seizure disorder Which of the following conditions is NOT associated with a risk of aortic dissection?
A Burning or gnawing pain may be present with AMI B An acid or foul taste in the mouth suggests dypepsia is more likely than angina C Tenderness to palpation in the epigastric region may be elicited with AMI D Relief of pain with antacids strongly suggests a gastrointestinal etiology E Epigastric or lower chest discomfort may be described with both cardiac and noncardiac causes Physical examination and laboratory findings that may be present in AMI include all of the following EXCEPT A B C D E chest wall tenderness sinus tachycardia or bradycardia hypertension or hypotension crackles on pulmonary examination non—anion-gap metabolic acidosis Which category of hypertension BEST describes this presentation?
How quickly and to what level should the blood pressure be lowered in a patient with a hypertensive emergency? A year-old man presents with a painful, swollen leg that occurred over 2 days. He smokes two packs of cigarettes per day, and he is moderately overweight. He recalls striking his calf against a coffee table 3 days before and suffered an abrasion.
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Oral Medicine and Pathology at a Glance. Crispian Scully. Case Files Geriatrics. Patricia Metting.A skeletal survey is needed to evaluate for physical abuse, and an extensive social service assessment is mandatory. English Download options: There is some evidence that ketamine may have a mild, transient bronchodilatory effect.
Additional ECGs increase diagnostic yield. Which artery is MOST likely to be diseased in a patient who suffers a syncopal episode secondary to cerebral ischemia? Chapter 51 The pain of pericarditis is generally pleuritic, retrosternal in location, and may radiate to the back, neck, or jaw. The procedure boot camp was a voluntary, noncredit full-day event. Description of the needs assessment for EM boot camp curriculum, mapping, and procedure workshop is detailed in the following section: Needs assessment for EM boot camp curriculum A systematic approach was used in order to identify the gaps in medical education and to identify topics that would be essential for inclusion in an EM boot camp curriculum.
Multiple injuries in various stages of healing, substantial delay between injury and presentation, and frequent visits for vague complaints are factors suggestive of a diagnosis of domestic violence. Chapter Physicians and other licensed health care professionals are required to report any suspicion of child abuse.
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