Provided by PEER VIII. PEER (Physician’s Evaluation and Educational Review in Emergency Medicine) is ACEP’s gold standard in self-assessment and educational review. These questions are from the latest edition of PEER — PEER VIII, which made its debut at ACEP’s 2011 Scientific Assembly. To learn more about PEER VIII, or to order it, go to www.acep.org/bookstore.
- An obese young woman presents with a 1-month history of vomiting and dull headaches that are typically worse in the morning. Urine pregnancy test result is negative. Which of the following studies is likely to be diagnostic?
A. Abdominal CT scan
B. Abdominal series
C. Lumbar puncture
D. Pelvic ultrasound examination
- A 42-year-old woman with a history of a hiatal hernia and chronic gastric reflux symptoms presents with sudden-onset left upper quadrant abdominal pain and retching. Vital signs include blood pressure 86/40, pulse 121, temperature 37°C (98.6°F), and SpO2 98% on room air. The upper abdomen is mildly distended, and breath sounds are decreased in the left lower lobe of the lungs. The nurse is unable to pass a nasogastric tube. Laboratory test results include the following: lactate, 8 mg/dL; pH, 7.13; and hemoglobin, 12 g/dL. Chest radiographs reveal a distended stomach above the diaphragm. After appropriate fluid resuscitation, which of the following should be initiated in the emergency department?
A. Broad-spectrum antibiotics
C. Packed red blood cells
D. Sodium bicarbonate
- A 45-year-old man presents with severe neck pain after falling onto his head from a scaffold. He is breathing spontaneously. He has sensation to the level of the clavicle, including his arms to his thumbs, but not below it. He can shrug his shoulders but cannot flex at the elbows or move his arms or legs. If this is a complete neurologic lesion, at what level is his spinal cord injury?
- A 68-year-old man presents with acute shortness of breath and lightheadedness. He denies chest pain and other medical problems but has a history of hypertension. Vital signs include blood pressure 85/50, pulse 120, respirations 36, and oxygen saturation 93% on room air. He is able to speak five-word sentences. Examination reveals that his skin is poorly perfused, his lungs are clear, his heart sounds are regular without murmurs, and he has no peripheral edema. An ECG reveals ST-segment depression in the lateral leads. What is the next best treatment step?
A. Intravenous digitalis
B. Intravenous dobutamine
C. Small bolus of normal saline
D. Sublingual nitroglycerin
- A patient who recently had an upper respiratory viral syndrome now presents with pneumonia and a cavitary lesion on chest radiograph. Which of the following antibiotic choices provides adequate coverage for the likely organisms?
A. Ampicillin and gentamicin
B. Ceftriaxone and azithromycin
C. Isoniazid, rifampicin, and ethambutol
D. Vancomycin and levofloxacin
Answers 1. C 2. A 3. C 4. C 5. D