Category: Mock Oral Boards (Page 4 of 4)

Round 10 (Allergic Reaction)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

A 45 year old female is exposed to peanut butter and shrimp pizza and begins to have an apparent allergic reaction…

Initial Vitals
  • Temp 98.8
  • HR 130
  • RR 35
  • BP 70/40
  • O2 92%
Critical Actions
  • Verbalize Airway Evaluation
  • Complete a FOCUSED History and Exam
  • Normal Saline Bolus
  • Epinephrine both IM and (subsequently) IV
  • Glucagon 1mg IV
Final Diagnosis

Refractory Anaphylaxis Due to Beta Blockers

Tips and Tricks

You still need to obtain a quick history and exam even if you know the diagnosis in the first few seconds of the case

Additional Reading
  • Basic approach to anaphylaxis (EM Clerkship)
  • Tranexamic acid as first-line emergency treatment for episodes of bradykinin-mediated angioedema induced by ACE inhibitors. (PubMed)
  • Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. (PubMed)

Round 9 (Seizure)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

The nurse brings back a young adult male from the lobby who is having a seizure…

Initial Vitals
  • Temp 98.8
  • HR 90
  • RR 10
  • BP 120/80
  • O2 92%
Critical Actions
  • Verbalize ABCs on a Critical Patient
  • Obtain Immediate Blood Glucose Level
  • Give Benzodiazepine
  • Initiate Workup of New-Onset Seizures
  • Give Pyridoxine (Vitamin B6)
Final Diagnosis

Isoniazid Toxicity

Tips and Tricks

When the patient is unable to provide history, attempt to obtain the information from external sources

Additional Reading
Corrections

Ketamine not Keppra as potential induction agent for status epilepticus (32:40)

Round 8 (Fall)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

EMS brings in an elderly man who has fallen…

Initial Vitals
  • Temp 98.6
  • HR 58
  • RR 16
  • BP 105/60
  • 99%
Critical Actions
  • Treat the patient’s pain
  • Consult orthopedics for a hip fracture
  • Obtain an EKG
  • Treat Severe Hyperkalemia
  • Consult nephrology for dialysis
Final Diagnosis

Ground level fall resulting in hip fracture, missed dialysis, and severe hyperkalemia

Tips and Tricks

Patient’s will frequently have more than one final diagnosis. Do not prematurely close an the initial, obvious, diagnosis.

A man can have as many diseases as he damn well pleases!

Hickam’s dictum
Additional Reading

Round 7 (Headache)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

Just a routine day at your hospital, your next patient has a chief complaint of headache…

Initial Vitals
  • Temp 98.8
  • HR 88
  • RR 16
  • BP 130/80
  • O2 99%
Critical Actions
  • Identify Acute Angle Closure Glaucoma
  • Initiate Appropriate Treatment for Acute Angle Closure Glaucoma
  • Emergent Consult to Ophthalmology
  • Recheck Intra-Ocular Pressure After Initiating Treatment
Dangerous Actions
  • Giving NSAIDS (The Patient Had This on Allergy List)
  • Performing a Lateral Canthotomy
Final Diagnosis

Acute Angle Closure Glaucoma

Tips and Tricks

Do not be surprised or scared when an examiner has a monotone voice and flat affect

Additional Reading

Round 6 (Back Pain)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

A notorious, disheveled frequent flyer presents to your emergency department for her back pain and is asking for more Dilaudid…

Initial Vitals
  • Temp 99.0
  • HR 99
  • RR 18
  • BP 118/78
  • O2 99%
Critical Actions
  • Ask about Red Flags for Spinal Infection
  • Perform a Thorough Spinal Exam
  • Obtain MRI Spine with Contrast
  • Initiate Broad Spectrum Antibiotics
  • Treat Pain when Pathology Identified
Final Diagnosis

Spinal Epidural Abscess

Tips and Tricks

Don’t let consultants or other members of your team talk you out of appropriate management of a patient

Additional Reading

Round 5 (Geriatric Fall)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

The nurse is asking you to evaluate a 70 year old male who has been placed in a hall bed after hitting the back of his head. She wants to know if you would like to call a trauma alert…

Initial Vitals
  • Temp 103.7 (Hidden by Examiner)
  • HR 115
  • RR 18
  • BP 110/75
  • O2 99%
Critical Actions
  • Diagnose Fournier’s Gangrene on Secondary Survey
  • Obtain Full Vital Signs Including Temperature
  • Perform Sepsis “Core Measures”
  • Initiate Appropriate Treatment for Fournier Gangrene
  • Immediate Surgical Consultation
Final Diagnosis

Septic Shock due to Fournier Gangrene

Tips and Tricks

Always ask for the patient’s temperature if it is not given with initial vital signs

Additional Reading

Round 4 (Flank Pain)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

The nurse tells you that you have a new patient and is requesting a verbal order for nausea medicine. She advises you that the patient is the CEO of your hospital…

Initial Vitals
  • Temp 98.9
  • HR 99
  • RR 18
  • BP 120/80
  • O2 98%
Critical Actions
  • Perform Genitourinary Exam
  • Rule Out Abdominal Aortic Aneurysm
  • Consult Urology
  • Treat the Patient’s Pain
  • Resist Delays on Consultant Pushback
Dangerous Actions
  • Delaying Urology Consultation to Obtain an Ultrasound
Final Diagnosis

Testicular Torsion with Referred Pain

Tips and Tricks

Don’t forget to verbalize genitourinary exam when appropriate

Additional Reading
Corrections

It is rare for testicular torsion to occur at this age

Round 3 (Chest Pain)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

An ill appearing patient has been rushed back from the lobby, clutching his chest, you are needed immediately at the bedside…

Initial Vitals
  • Temp 99.1
  • HR 95
  • RR 20
  • BP 120/80
  • O2 98%
Courtesy of LITFL Medical Blog
https://creativecommons.org/licenses/by-nc-sa/4.0/
Critical Actions
  • Obtain Early EKG
  • Notify Cardiology of Inferior STEMI
  • Bring Crash Cart to Bedside
  • Administration of Heparin
  • Counsel the Family
Dangerous Actions
  • Giving Nitroglycerine to Patient with Inferior MI and on Sildenafil
  • Giving Aspirin to Patient with Allergy to Aspirin
Final Diagnosis

Cardiac Arrest due to Inferior STEMI

Tips and Tricks

Ask about allergies prior to administering medications

Additional Reading

Round 2 (Seizure)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

EMS brings in a postictal 34 year old female after she has a seizure. She is complaining of a headache…

Initial Vitals
  • Temp 98.9
  • HR 110
  • RR 10
  • BP 175/115
  • O2 95%
Critical Actions
  • Articulate Full Neurologic Exam
  • Early Blood Glucose
  • Identification of Pregnancy
  • Administer Magnesium
  • Treat the Patient’s Blood Pressure
Final Diagnosis

Eclampsia

Tips and Tricks

All women of childbearing age should receive a pregnancy test early in the case

Additional Reading

Round 1 (Altered Mental Status)

CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

You are called to the resuscitation bay for a poorly responsive patient that has been brought in by EMS.

Initial Vitals
  • Temp 98.8
  • HR 78
  • RR 4
  • BP 124/78
  • O2 98%
Critical Actions
  • Obtain Early Blood Glucose
  • Administer Dextrose
  • Obtain Salicylate and Acetaminophen Levels
  • Admit for Further Observation
  • Psychiatry Consult
Final Diagnosis

Intentional Sulfonylurea Overdose

Tips and Tricks

All unresponsive patients should receive a blood glucose level early in the case

Additional Reading

MUST LISTEN (re ABEM)

ABEM-style cases presented on EM Clerkship are not my actual ABEM exam cases, and they are not derived from my actual exam cases. I will never be discussing my specific exam details with anybody, including on this podcast. The cases were created independently, by me, for the purpose of medical education and improving patient care. Topics are chosen from the publicly available ABEM model of clinical practice and are built from scratch using a my own custom template. If you would like a copy of this template, please email me and I can send you a copy.

-Zack

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