Premier. Clinical Knowledge Assessment 1.0

This is a normal x-ray

There is a fracture that needs casting

There is a fracture that needs a cast-shoe, weight bear as tolerated

There is a fracture that need a cast shoe and should remain non-weight bearing

There is a fracture of the scaphoid seen on xray and patient should be placed in a thumb spica splint

There is not a fracture on xray but the patient should be placed in a thumb spica splint and referred to ortho as an outpatient

This patient should be treated as a sprain and placed in a volar splint

This patient should be sent immediately to the ER

A septal hematoma is of little concern

This person should see a plastic surgeon as soon as possible

There is a fracture that needs reducing immediately

You may consider reduction if it is within 6 hours of the injury but this is not necessary. Otherwise, this is a fracture that only needs treatment at a later date if there are any further complications, either cosmetic or difficulty with breathing through his nose

Non-weight bearing for 3 days

RICE (Rest/Ice/Compression/Elevation)

An MRI for further evaluation

Percocet for pain relief

This is a normal xray

There is a fracture that needs a cast

There is a fracture that needs a knee immobilizer at full extension and referral to ortho within 48 hours

This patient should be send to the ER

This is a normal xray

There is a fracture that can be treated like a sprain and placed a velcro splint for 3 days

There is a fracture that needs a splint and referral to ortho for fracture care

This patient should be send to the ER

This patient needs an outpatient CT

This patient should have his ribs wrapped

This patient should be given pain meds and an incentive spirometer

This patient should be sent to the ER to r/o a cardiac or pulmonary contusion

This is a normal x-ray

There is a fracture that needs a splint, or a short leg cast

There is a fracture that should be buddy taped to a healthy toe

The patient needs additional x-rays of her foot and ankle

This is a normal x-ray and can go home with pain meds

There is a fracture that require surgery within 24 hours

There is a fracture but can go home with pain meds

There is a fracture but patient should be sent to the ER for further evaluation

This is a normal x-ray

There is a fracture seen

There is a soft tissue sign that suggests a fracture of the radial head that can be treated with a sling

There is a soft tissue sign that suggests a fracture of the radial head that requires immobilization for 6 weeks

This is a normal x-ray

This patient has a Colles fracture which should be placed in a sugar-tong, reverse sugar-tong, or double sugar-tong splint

This patient has a Colles fracture which should be placed in a circumferential cast

The presence of a puncture wound at the site of the fracture would not change management

This patient needs a CBC and a PT/PTT in addition to treatment of acute epistaxis

The epistaxis is likely posterior and could be treated with a Mirocel sponge, or a nasal tampon

Pressure should be held over the bony part of the nose, as high as possible

The bleeding site is likely on the nasal septum. Once identified it should be cauterized with silver nitrate, and then packed

A and D are correct

Mom should be reassured that this is likely viral and discharged with NSAIDS

This is OM and should be treat with Amoxicillin (90mg/kg/day in 2 divided doses)

This patient should be referred to ENT to consider typanostomy tubes

Both A and B are reasonable approaches

The presence of diarrhea and conjunctivitis makes GAS less likely

The presence of tender lymphadenopathy and a tonsillar exudate makes GAS more likely

Group A strep causes pharyngitis; whereas Group B strep is normal GI flora that can cause serious illness in the neonate

All of the above

This patient likely has parotitis and should be treated with antibiotics, Augmentin 875mg bid x 7 days, and lemon drops

This patient may have a parotid tumor and needs a CT of his parotid ASAP

This patient likely has the mumps which can impact his future fertility

Sialolithiasis is an unlikely cause of this symptom

All patients with this presentation should be treated with antibiotic ointment. Erythromycin QID x 3-5 days. You need to stress the necessity of good hygiene since this is very contagious.

Only patients with mucopurulent discharge should be treated with antibiotic ointment. Erythromycin QID x 3-5 days. You need to stress the necessity of good hygiene since this is very contagious.

In contact lens wearers, Pseudomonas infections are more common so a quinolone antibiotic ointment is the preferred treatment (Ciloxan BID x 5-7 days)

B and C are true

This abscess needs to be drained in addition to antibiotics and referral to a dentist

This patient should be treated with clindamycin 150mg tid x 7 days or PCN VK 500 mg QID x 7 days without surgical drainage

This patient should be treated with pain medication and referred to a dentist

This patient should be sent to the ER for treatment by an oral surgeon

He should have labs sent including a troponin and referred to a cardiologist within 72 hours

He can safely be sent home, reassured with a normal EKG, and referred back to his PMD for further management

He should be given an Aspirin while at Premier and sent to the ER by EMS for evaluation of his unstable angina

You should take a more thorough history and your recommendation should be guided by the results

Hypertension

Cholesterol

Family History

Smoking

Diabetes

All are major risk factors for CAD

Send the patient directly to the ER

Draw labs and have your therapy guided by their results

Give the patient a dose of IV Lasix, 40mg, and reassess in 2 hours

Increase the PO Lasix to 40mg q day and have the patient follow up with her cardiologist

Give a dose of Xarelto and discharge to home for follow up with cardiology

Give a dose of Xarelto and PO Cardizem for rate control. Discharge to home for follow up with cardiology

Refer patient directly to the ER

Either B or C are appropriate

This patient likely has a viral infection but should be treated with an antibiotic in case it is bacterial

This patient likely has a viral infection and should not be treated with antibiotics. He should receive symptomatic therapy.

This patient should be discharged without antibiotics and referred for an outpatient CT to r/o a small infiltrate

This patient should be treated with antihistamines

This patient has bronchitis and should be treated with PO antibiotics, ZPak, or Levaquin 750 mg q day

This patient has pneumonia and may be treated with PO antibiotics, ZPak, or Levaquin 750 mg q day

If this patient has been treated with PO antibiotics for the past 3 days by his family doctor, inpatient treatment with IV antibiotics is warranted

You should calculate a CURB65 or PORT score to determine if the inpatient or outpatient setting is most appropriate

This patient is PERC positive and no further diagnostic evaluation is warranted

A D-Dimer should be ordered to further evaluate this patient

This patient should be sent for a CTA immediately

Given the high pre-test probability, this patient should be anticoagulated without a definitive diagnosis

This patient likely has a viral bronchitis

This patient needs an urgent chest CT to r/o an endobronchial lesion

This patient may have GERD and should be treated with a PPI

This patient should be treated with an antibiotic

This patient should be sent to the ER to evaluate her probable gall bladder disease

This patient should be sent for a CT to evaluate possible pancreatitis

This patient needs a RUQ ultrasound. If one is not available now, patient should be send to the ER to see a surgeon

This patient needs routine chemistries, a lipase, and an ultrasound. These should be ordered STAT and referred to a surgeon for an outpatient evaluation

A history of ETOH abuse is a risk factor

Cholelithiasis is a risk factor

Amylase is more sensitive than Lipase

Ranson criteria can be used to predict mortality

Send routine labs and instruct the patient to return if the pain gets worse.

Contact a surgeon and try to get the patient seen first thing tomorrow

Send labs now. Arrange for an outpatient CT tomorrow

Send the patient to the ED

This patient needs a STAT outpatient CT to evaluate the cause of his abdominal pain

This patient should be sent directly to the ER for evaluation

This patient should be started on Levaquin 500 mg q day x 14 days and Flagyl 500mg TID x 14 for presumptive diverticulitis. He should reviece a referral to a gastroenterologist

A and C

There is significant concern for a malignancy

The patient should be sent to the ER for evaluation

The patient should have a urine culture and then started on empiric antibiotics, Levaquin 500 mg q day x 7 days

The patient should be referred to a urologist

She should be started on Bactrim DS bid x 5 days

She should be started in Levaquin 500mg PO q day x 7 days

She can be treated for her discomfort with Pyridium 100mg bid PRN for 2 days

A and C

B and C

This patient may need to be sent to the ER for pain control and a STAT CT

This patient needs a stat testicular ultrasound to r/o torsion

This patient likely has renal colic and should be treated with IV fluids, Toradol 30mg IV, a KUB, and if the pain can be controlled can be safely discharged for f/u with urology

Flomax is contraindicated

This patient should be sent to the ER for a septic work-up

This patient should be started on empiric antibiotics and can safely discharged home

Mom should be reassured that the baby is fine and should be instructed to return for a T>101.4

The patient should have routine labs, an xray, and urinalysis at Premier and therapy should be guided by the results

This patient needs a urinalysis

This patient should receive empiric antibiotics, Zithromax 10mg/kg on day 1, then 5 mg/kg on days 2 through 5

This patient needs labs, a chest x-ray, and a urinalysis

This patient should be discharged with his father without any further evaluation. Motrin or Tylenol for symptomatic relief, and instructed to return if he develops any localizing site of infection

½ NS 400 cc bolus

D5NS 400 cc bolus

NS 400 cc/hr

NS 400 cc bolus

You should get a set of vital and get IV access. Check an EKG and then send her to the ER

You should check her blood pressure and treat it if elevated before sending her to the ER

You should arrange for a STAT CT

Call 911

This patient needs a STAT CT

This patient likely has Bell’s palsy. You are reassured that the forehead is involved.

This patient should be tested for Lyme Disease

This patient should be treated with prednsone 60-80 mg daily, with the addition of Valtrex 1000 mg TID in severe cases.

You need to fill out a CY47 form

You need to call the clinical line

You need to call the Child Line

If you are not 100% sure you are discharging the child into a safe environment, you need to send the child to the ER via EMS

All of the above