Section 14. Urgent Care Problems
MULTIPLE CHOICE
1. Which type of heat-related illness involves a core body temperature of at least 104°F and may
present with hot dry skin, acute mental status changes, absent sweat, and tachypnea?
A.
Heat cramps
B.
Heat syncope
C.
Heat exhaustion
D.
Heat stroke
2. What percentage of burns is involved using the rule of nines if both front legs are burned?
A.
9%
B.
18%
C.
24%
D.
36%
3. Which drug commonly prescribed for burns is active against a wide spectrum of microbial
pathogens and is the most frequently used agent for partial- and full-thickness thermal
injuries?
A.
Clotrimazole cream (Lotrimin)
B.
Mafenide acetate (Sulfamylon)
C.
Silver nitrate
D.
Silver sulfadiazine (Silvadene)
4. A sunscreen with a sun-protection factor of at least what number will block most harmful
ultraviolet radiation?
A.
4
B.
8
C.
10
D.
15
5. Which clinical feature is a late sign of increased intracranial pressure?
A.
Dilated, nonreactive pupils
B.
Altered level of consciousness
C.
Loss of judgment
D.
Amnesia
6. What number represents normal neurological function on the Glasgow Coma Scale?
A.
7
B.
9
C.
10
D.
15
7. Which diagnostic test is the best to diagnose a subdural hematoma?
A.
History
B.
Positron emission tomography
C.
Magnetic resonance imaging (MRI)
D.
Computed tomography (CT) scan
8. Patients with a spontaneous pneumothorax should be counseled that up to what percentage
may experience a reoccurrence at some point?
A.
5% to 15%
B.
20% to 25%
C.
30% to 50%
D.
60% to 80%
9. Most adult poisonings are:
A.
Intentional and self-inflicted
B.
Accidental
C.
Caused by someone wishing to do harm to the person
D.
Not attributed to any reason
10. Which method is used to remove heavy metals, such as lead?
A.
Chelation
B.
Dialysis
C.
Gastric lavage
D.
Bowel irrigation
11. If a previously frostbitten area becomes frostbitten again after it has healed, what might
occur?
A.
Permanent tissue damage may occur, resulting in necrosis to that body part.
B.
The area will be super sensitive.
C.
The area is prone to a repeat frostbite.
D.
The area is as susceptible as any other area.
12. What population represents almost 75% of wounds?
A.
Boys in the mid-to-late teens
B.
Men in their early 20s
C.
Women in the mid-40s
D.
Toddlers between 18 and 30 months
13. Which solution should be used when irrigating lacerated tissue over a wound on the arm?
A.
Dilute povidone-iodine solution
B.
Hydrogen peroxide (H2O2)
C.
Saline solution infused with an antibiotic
D.
Saline irrigation or soapy water
14. Which type of burn injury results in destruction of the epidermis with most of the dermis, yet
the epidermal cells lining hair follicles and sweat glands remain intact?
A.
Superficial burns
B.
Superficial partial-thickness burns
C.
Deep partial-thickness burns
D.
Full-thickness burns
15. Which carboxyhemoglobin (COHb) level correlates with the clinical symptoms of confusion,
lethargy, and ST-segment depression on the electrocardiogram?
A.
Less than 10%
B.
20% COHb
C.
30% COHb
D.
40% to 60% COHb
16. Which causes the greatest percentage of mammalian bites?
A.
Dogs
B.
Cats
C.
Humans
D.
Rodents
17. Which arthropod bite can contain cytotoxic and hemolytic toxins that may destroy tissue?
A.
Tick
B.
Brown recluse spider
C.
Wasp
D.
Stinging caterpillar
18. What condition is sometimes confused with anaphylaxis from an insect sting?
A.
Heat stroke
B.
Toxic syndrome
C.
Vasovagal reaction
D.
Inflammatory response
19. Delayed serum sickness–type reactions in response to multiple bee, wasp, or fire-ant stings
can be managed with which of the following?
A.
A corticosteroid such as prednisone (Deltasone), 60 to 100 mg, tapered over 2
weeks
B.
An oral antihistamine, such as hydroxyzine, for 2 weeks
C.
An H2 blocker such as cimetidine for 1 week
D.
0.1 mg (1 mL of 1:10,000 solution epinephrine) in 10 mL of normal saline and
administer as a slow IV push over 10 minutes
20. After a head injury, what is it called when air enters into the cerebrospinal fluid (CSF)–filled
spaces within the head?
A.
Pneumocephalus
B.
Hemotympanum
C.
Battle’s sign
D.
Raccoon sign
21. CSF may leak through the cribriform plate region of the skull following a head injury and
cause which of the following?
A.
Ear CSF otorrhea
B.
Leakage of CSF from the eye
C.
Nasal CSF rhinorrhea
D.
Leakage of CSF from the mouth
22. What condition is characterized by a brief loss of consciousness, then a brief “lucid” moment,
followed by momentary unconsciousness minutes after the injury?
A.
Concussive hematoma
B.
Bleeding dyscrasias
C.
Subdural hematoma
D.
Epidural hematoma
23. A patient with a basilar skull fracture may experience an impaired downward gaze or diplopia
from which affected cranial nerve?
A.
CN II
B.
CN III
C.
CN IV
D.
CN V
24. A history of overuse or excessive force, as opposed to a fall, hyperextension, or the twisting of
a joint, is more likely related to which musculoskeletal injury?
A.
A sprain
B.
A strain
C.
A partial fracture
D.
A fracture
25. In a healthy adult, the process of remodeling after fracture of the humerus takes how long?
A.
Approximately 4 weeks
B.
Approximately 2 months
C.
Approximately 3 months
D.
Approximately 4 months
26. A patient who sustains blunt chest trauma and/or penetrating chest trauma must have which of
the following imaging examinations?
A.
Upright anterior/posterior and lateral chest x-ray
B.
Supine anterior/posterior and lateral chest x-ray
C.
Upright bilateral chest x-ray
D.
Supine anterior/posterior chest x-ray
27. If a suspected pneumothorax is discovered in the primary-care setting, what should happen
first?
A.
Emergency medical services should be activated.
B.
Support cardiovascular and respiratory status as needed.
C.
Administer supplemental oxygen to reabsorb the pneumothorax.
D.
Initiate stabilizing treatments, including emergency chest-tube placement.
28. Hepatic necrosis with jaundice may occur after ingesting massive doses of which medication?
A.
Phenobarbital
B.
Diazepam
C.
Ritalin
D.
Acetaminophen
29. Pink, cherry-red tissues and skin may result from which type of poisoning?
A.
Arsenic
B.
Lead
C.
Carbon monoxide
D.
Strychnine
30. In which type of burn is the injury more extensive than it appears, and the cardiac conduction
system may be affected, leading to sudden death or arrhythmias?
A.
Chemical burns
B.
Electrical burns
C.
Radiation burns
D.
Thermal burns
31. Eddie, age 4, presents to the emergency department with a live insect trapped in his ear canal
causing a lot of distress. What should be your first step?
A.
Remove the insect with tweezers.
B.
Immobilize the insect with 2% lidocaine.
C.
Sedate Eddie with diazepam.
D.
Shine a light in the ear for the insect to “find its way out.”
32. When giving discharge instructions to a patient with a laceration injury to his lower leg, which
is the most important one?
A.
Recommend isometric exercises to prevent a deep vein thrombosis (DVT).
B.
Recommend cleansing the wound every 4 hours to prevent an infection.
C.
Keep the leg elevated at waist level to prevent any edema.
D.
Keep the leg completely immobile to prevent extension of the laceration.
33. Cerebellar function may be assessed by performing which examination/test?
A.
Gag reflex
B.
Pupillary response
C.
Romberg’s test
D.
Apley’s test
34. In the epithelialization phase of wound healing, the wound will have only what percentage of
its normal tensile strength at 3 weeks?
A.
Less than 15%
B.
15% to 20%
C.
25% to 40%
D.
Greater than 50%
35. Which of the following statements is true about antibiotic prophylaxis for most wounds?
A.
Antibiotics are not indicated.
B.
Antibiotics should always be ordered for a wound.
C.
Antibiotics need to be ordered for at least 2 weeks.
D.
Antibiotics should be ordered only if sutures are in place.
36. Which condition is often an unrecognized contributor to heat-related illness?
A.
Autonomic neuropathy
B.
Beta-adrenergic blockade
C.
Myocardial infarction
D.
Acclimatization
37. Why do benzodiazepines have less potential for toxicity than barbiturates?
A.
They cause decreased neuronal activity, depressed central sympathetic tone, and
inhibit cardiac contractility.
B.
They increase ligand affinity and the frequency of ion channel opening, but not the
duration of time the channel remains open.
C.
They act directly on inhibitory gamma-aminobutyric acid (GABA) receptors.
D.
They increase the average opening time of chloride ion channels.
38. What is the most common cause of infectious conjunctivitis?
A.
Adenovirus
B.
Rhinovirus
C.
Staphylococcus aureus
D.
Streptococcus
39. A patient presents to the emergency department with delirium, dilated pupils bilaterally, and
hypoactive bowel sounds. Skin is flushed and dry; mucous membranes are dry. Upon
admission, a urinary catheter was inserted with no output. These clinical manifestations
describe which common toxidrome?
A.
Cholinergic
B.
Sedative-hypnotic
C.
Anticholinergic
D.
Sympathomimetic
40. Why are people with cystic fibrosis (CF) especially vulnerable to heat stroke?
A.
Intravascular coagulation prevents the production of chloride.
B.
Blood flow to the skin is impaired in temperatures above 95
C.
Sweat glands are inactive in CF.
D.
Salts from perspiration are not reabsorbed after sweating.
41. What is true about an acclimatized person?
A.
Aldosterone secretions are diminished
B.
Heat dissipation is impeded
C.
Cardiac output increases
D.
Aerobic muscle metabolism decreases
42. If no clinical decompensation is noted when evaluating a poisoned patient, what should you
do next?
A.
Evaluate for signs of trauma and central nervous system involvement.
B.
Evaluate the airway, breathing, and circulation.
C.
Order a basic metabolic panel and liver function test panel.
D.
Obtain a urine sample for a toxicology screen.
43. What should you use to alkalinize urine to a pH of greater than 7.0?
A.
Dextrose
B.
Sodium bicarbonate
C.
Activated charcoal
D.
Ipecac syrup
44. What is the most dangerous complication of acute mastoiditis?
A.
Otitis media with effusion
B.
Meningitis
C.
Tympanic membrane rupture
D.
Intracranial abscess
45. What would confirm if the joint was tapped in a knee fracture?
A.
A presence of hemarthrosis with fat globules
B.
The inability to flex the knee joint
C.
A large effusion
D.
Pain is elicited during passive range of motion
46. Hyperhidrosis (trench foot) is a differential diagnosis for what condition?
A.
Hyperthermia
B.
Necrosis
C.
Frostbite
D.
Erythema pernio
47. What is the aim of gastrointestinal decontamination for poisoned patients?
A.
Evacuating toxins from the stomach before they can be absorbed.
B.
Neutralizing the poison by inducing vomiting and diarrhea.
C.
Restricting the amount of xenobiotic from reaching the systemic circulation.
D.
Absorbing the toxins that have reached systemic circulation.
48. What must be present for a diagnosis of acute diarrhea?
A.
Positive test for bacterial, viral, or parasitic infection
B.
Passing six or more stools daily without improvement for at least 3 days
C.
Loose stools with fever greater than 100F
D.
Greater than 50%
49. Which of the following is not a cause of secondary constipation?
A.
Hard stools
B.
Diet
C.
Pregnancy
D.
Medications
50. Which of the following is not a differential diagnosis of heat stroke?
A.
Cerebrovascular accident
B.
Central nervous system infections
C.
Diabetic ketoacidosis
D.
Alcohol intoxication