Emergency Medicine Board Review Practice Questions

These free EM practice questions are selected from the Board Vitals emergency medicine board review study guide.

Sample Emergency Medicine Questions

Question 1. Trauma QID 32863

A 50 y/o man is brought into the ER by coworkers following an accidental splash into his eyes with chemicals. The workers don’t know what the liquid was but they work in a factory where they etch glass. He was walking by a coworker when he was accidentally splashed by a liquid the coworker was working with. He immediately screamed and other people came to his aid, attempting to flush his eyes with cups of water. Reportedly his is on medication for hypertension. Upon arrival you see him in obvious distress with vitals of BP 160/100, HR 120, RR 22, Temp 99.1, Sat 98% on RA. When you are able to look at his eyes you see they are both very injected with a flaking cornea and edema and erythema of both lids. What is the next course of action for this patient? What is the suspected chemical?

A. This is a burn from lye. Burns from alkali are the most serious chemical injury and he needs immediate irrigation with a Morgan Lens and saline until the pH returns to 7.4.
B. This is a burn from Acetone. Although painful, it is not as serious as from acid or base so he just needs to stand over the eye wash station and irritate for a few minutes with water.
C. This is a burn from Sulphuric acid and is very serious. He needs irrigation with saline via a Morgan Lens until the pH is back to 7.4.
D. This is a burn from Hydrofluoric acid which is extremely acidic and in addition to damaging the eyes, can severely burn the surrounding skin. He needs Morgan Lens irrigation until a pH of 7.4 is reached and his skin needs to be treated with bacitracin and local burn care.
E. This burn is likely from cleaning chemicals like detergent. It requires irrigation with water at the eye wash station until he feels better.

Answer: D. This is a burn from Hydrofluoric acid which is extremely acidic and in addition to damaging the eyes, can severely burn the surrounding skin. He needs Morgan Lens irrigation until a pH of 7.4 is reached and his skin needs to be treated with bacitracin and local burn care.

Explanation:

This is a burn of the eye from Hydrofluoric acid or HF. It is extremely acidic and caustic and is used to etch glass – being one of the few acids that will cut glass. It is stored in a wax lined container. It can cause severe eye burns as well as to the skin so it needs Morgan Lens irrigation with saline until the pH of the eye is back to 7.4. The surrounding tissue should also be investigated for burns as well and should be treated if present.

Reference: Peak, Dallas E., et al. “Chapter 4. Ophthalmic Trauma.” The Atlas of Emergency Medicine, 3e. Eds. Kevin J. Knoop, et al. New York, NY: McGraw-Hill, 2010

 

Question 2. Head and ENT QID 32802

A 19 y/o F returns from Spring break with severe pain in both of her eyes for a day. She says she was on vacation for 4 days in the Caribbean and halfway through her last day there, she began to notice pain and blurred vision in both eyes. She does not wear glasses or contacts. There was no trauma, no fever, or other symptoms. Her vitals in the ER are unremarkable. Her visual acuity without correction is 20/100 in both eyes. On exam, she has severe photophobia, and both eyes are injected but the pupils are normally reactive. You perform a fluorescein exam and see the following. What do you tell the patient? What is the treatment?

32802_q1.jpg (225×224)

A. Tell her she has herpetic conjunctivitis and needs oral and ocular antiherpetic drugs.
B. Tell her she has iritis. She can get pred forte drops and follow up with an eye doctor in a few days.
C. Tell her she has severe conjunctivitis that has spread into the corneas. She needs ciprofloxacin eye drops and urgent ophtho follow up.
D. Tell her she has ultraviolet keratitis. Tell her she can keep both eyes patched when able and instill 1% cyclopentolate drops to treat symptoms which should resolve in 48 hours.
E. Tell her she needs eye surgery. She has numerous ocular foreign bodies.

Correct: D. Tell her she has ultraviolet keratitis. Tell her she can keep both eyes patched when able and instill 1% cyclopentolate drops to treat symptoms which should resolve in 48 hours.

Explanation:

Ultraviolet keratitis can come from prolonged direct sunlight. It usually resolves within two days and cyclopentolate or similar drops can help with pain until it does. Binocular patching is also helpful. Herpetic keratitis causes a dentritic pattern of uptake. Iritis does not have fluorescein uptake. This is not infectious. A corneal abrasion appears as irregular, scratch-type uptake, not punctate uptake.

Reference: Riordan-Eva P (2014). Disorders of the Eyes & Lids. In Papadakis M.A., McPhee S.J., Rabow M.W. (Eds), Current Medical Diagnosis & Treatment 2015

 

Board Vitals Emergency Medicine Question Bank has hundreds of questions targeted to the ABEM Emergency Medicine board and In-Training exams. Click here for a free trial.

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