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Book Review Chapters 295-298

This book review covers topics such as the percentage of Americans involved in ethanol-related MVCs, signs and symptoms of ethanol withdrawal, management of alcohol withdrawal, and stress factors in Emergency Medicine.

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Book Review Chapters 295-298

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  1. Book ReviewChapters 295-298 Dan Breece, D.O. December 15th, 2009

  2. 1) What percent of Americans will be involved in an ethanol-related MVC in their lifetime? • 10% • 20% • 25% • 40% • 45% 0

  3. 2) Signs and symptoms of ethanol withdrawal are most likely to reach peak intensity at how many hours after the patient’s last drink? • 12 hours • 24 hours • 36 hours • 48 hours • 72 hours 0

  4. 3) When managing a patient with alcohol withdrawal and who has seized; a CT exam of the patient’s head is indicated when? • When focal seizures have not occurred. • When focal neurologic findings are not present with head trauma. • When a patient has a persistent postictal defect in consciousness. • Just Pan Scan them!!! 0

  5. 4) What is the initial dose of Ativan in the treatment of alcohol withdrawal? • 1-2 mg IV followed by 1-2mg IV q 15-30 min until light sedation is obtained. • 1-2 mg IV followed by 2-4mg IV q 15-30 min until light sedation is obtained. • 2-4 mg IV followed by 2-4mg IV q 15-30 min until light sedation is obtained. • 2-4 mg IV followed by 2-4 mg IV q 1h until light sedation is obtained. 0

  6. 5) Administration of more than what dose of Ativan is an indication for admission (When treating Alcohol Withdrawal)? • 4mg • 6mg • 8mg • 10mg • 12mg 0

  7. 6) At-risk drinking is defined as drinking above certain limits that increases risk for injury and/or illness. (Currently the drinker is not experiencing any problems, medical, legal, or social.) How does the NIAAA define at-risk drinking for men no older than 65 years of age? • 6 drinks per week or more then 2 drinks at a time. • 10 drinks per week or more than 3 at a time. • 12 drinks per week or more than 4 at a time. • 14 drinks per week or more than 4 at a time. 0

  8. 7) This ultimate manifestation of impairment, accounts for one-third of the premature deaths among physicians? • Alcohol • Drugs • Suicide • Ultimate Fighting 0

  9. 8) What are the most common sources of stress, career dissatisfaction, and attrition in Emergency Medicine? • Bob- if you are a Resident (be careful on this choice). • Hospital administration. • Losing your job. • Malpractice suits. • Patients. • Shift work and scheduling difficulties. 0

  10. 9) What is the length of the human circadian clock? • 23 hours • 24 hours • 24.5 hours • 25 hours 0

  11. 10) When planning shift rotations it is healthier to rotate…? • Backward • Forward • In Circles • Sideways *If you have a problem here- it is Joel’s fault! 0

  12. 11) When rotating shifts, it takes longer to reset the biological clock across…? • 8 hour change. • 12 hour change. 0

  13. Participant Scores

  14. 12) This type of sleep is known as a compromise to minimize circadian disruption. (Especially good for night shifters.) • Anchor sleep • Circadian rhythm sleep • Docking sleep • Sleeping with the enemy • Sleep is over-rated! 0

  15. 13) When establishing rapport with patients it is recommended to? • Stand in the room whenever possible so you can leave when needed. • Use complex language. • If a patient is laying down then respect their personal space and don’t bend down and get on their eye level when speaking. • Set expectations for the patient during the initial encounter. 0

  16. 14) In respect to conflict resolution; Demanding patients or families are best handled by…? • Acknowledging their expectations and attempting to compromise. • Calling security. • Getting a co-worker to witness the event. • Getting Frank to stand behind you and just stare them down. • Talking firmly. 0

  17. 15) Annually, how many physicians complete suicide? • 50 • 100 • 1000 • 2000 0

  18. 16) Child neglect from early infancy can result in this syndrome? • Almate syndrome. • Dolchets syndrome. • Failure to Thrive. • Munchausen Syndrome. 0

  19. 17) Frank is doing his PEDS EM month. He notices that a mother brings her child for him to see multiple times during the month. He also notices that the child has been to the ED several times over the past year and extensive work ups have been performed without any findings to explain stated symptoms from mom. This may be an example of? • Dolchets syndrome. • The mother’s way of asking Frank for a date. • Munchausen syndrome by proxy. • Projection syndrome. 0

  20. 18) Approximately what percent of children diagnosed in an ED as victims of sexual abuse in one report had unrelated complaints such as abdominal pain, asthma, and sore throat? • 5% • 10% • 15% • 20% • 30% 0

  21. 19) Should a speculum exam be performed if the victim is a younger adolescent and you do not suspect perforating vaginal trauma? • No • Yes 0

  22. 20) At what age is it considered that children are incapable of inducing accidents or accidentally ingesting any drugs or poisons? • 2 years • 1 years • Younger than 9 months • Younger than 6 months 0

  23. 21) Children with multiple bruises should be evaluated with what labs? • BMP, CBC, COAGS • BMP, LFT’s, CBC • CBC with Diff and COAGS • Level 1 trauma panel • EBV titer, Monospot, CBC 0

  24. 22) In evaluating possible abused children, one needs to consider abdominal trauma. If you were to get an Abdominal X-Ray and it revealed a distended stomach with a “double-bubble sign”…. What would you suspect? • Bowel perforation • Cecum injury • Duodenal hematoma • Pancreatic injury • Sigmoid volvulus 0

  25. Participant Scores

  26. 23) Which state does not require child abuse cases to be reported? • Alaska • All states require them to be reported • Hawaii • Michigan • Ohio • Wisconsin 0

  27. 24) What may happen if a physician fails to report a suspected case of child abuse? • Fines may be imposed • Imprisonment • Misdemeanor charges • Nothing • All the above 0

  28. 25) What percent of all sexual assaults are estimated to be male? • 1% • 5% • 10% • 17% • 20% 0

  29. 26) During a female rape examination, you can use this to detect small vulvar lacerations? • Bromine Blue • Litmus paper • Toluidine Blue • Woods lamp 0

  30. 27) This will reveal semen stains on a person’s body? • Bromine Blue • Litmus paper • Toluidine Blue • Woods lamp 0

  31. 28) When should pregnancy prophylaxis be administered? • Within 24 hrs • Within 36 hrs • Within 48 hrs • Within 72 hrs • Within 7 days 0

  32. 29) Will emergency contraception disrupt an existing pregnancy? • No • Yes 0

  33. 30) When considering treatment for STD’s… What is the recommended regimen for gonorrhea prophylaxis in a pregnant patient? • Azithromycin 1 gram PO • Clindamycin 300mg PO BID for 7 days • Ciprofloxacin 500mg PO once • Ceftriaxone 125mg IM single dose • Ceftriaxone 250mg IM single dose 0

  34. 31) What is the recommended regimen for Chlamydia prophylaxis in a pregnant patient? • Amoxicillin 500mg PO tid for 7 days • Doxycycline 100mg PO bid for 7 days • Erythromycin base 500mg PO bid for 7 days • Ofloxacin 300mg PO bid for 7 days 0

  35. 32) What is the recommended regimen for symptomatic trichomoniasis in pregnancy? • Metronidazole 250mg PO tid for 7 days • Clindamycin 300mg PO bid for 7 days • Metronidazole 2gm PO single dose • No treatment 0

  36. 33) Which example represents a high risk HIV exposure and therefore has a recommendation for Post Exposure Prophylaxis? • Unprotected receptive anal intercourse with known HIV + assailant. • Unprotected receptive vaginal intercourse with a known HIV + assailant. • Unprotected vaginal intercourse with an assailant of unknown HIV status from a low-risk population. • If you are in prison and when you wake up you feel a bit funny in a certain location. 0

  37. Participant Scores

  38. 34) What type of consumer eats both plants and animals? • Herbivores • Carnivores • Omnivores 0

  39. 35) A right angle is ? • 10 Degrees • 45 Degrees • 90 Degrees • 180 Degrees 0

  40. 36) The French gave America a gift to honor independence for the United States. What was the gift? • The Liberty Bell • The National Anthem • The Statue of Liberty • The American Flag 0

  41. 37) Bull is to Horn as Deer is to ________? • Antlers • Head • Hoof • Jerky 0

  42. 38) What are igneous rocks formed from? • Magma • Chemical composition • Other Rocks • Just guess 0

  43. 39) Scientists who study artifacts to learn about their past are? • Geographers • Biologists • Archaeologists • Native Americans 0

  44. 40) If it takes 70 minutes to dress and be at work by 8:50AM. What time is the alarm set for? • 6:20AM • 7:40AM • 8:20AM • 7:00AM 0

  45. 41) In what part of a plant does photosynthesis occur? • Stem • Leaves • Roots • Flower 0

  46. 42) What is the term for the time it takes the earth to complete one revolution around the sun? • Year • Month • Day • Lunar year 0

  47. 43) Approximately how many shifts do I have left? • 20-30 • 30-40 • 50-60 • 70-80 • Less than you 0

  48. Participant Scores

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