Premier. Clinical Knowledge Assessment 1.0

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Quizzes Created: 1 | Total Attempts: 112

Questions: 51 | Attempts: 112 | Updated: Mar 20, 2023

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Premier. Clinical Knowledge Assessment 1.0 - Quiz

Questions and Answers

1.

Please provide me any feedback regarding this assessment.Were there any questions that were confusing? etc.Thank you.
2.

A patient presents c/o foot pain after tripping earlier today.
- A.
  
  This is a normal x-ray
- B.
  
  There is a fracture that needs casting
- C.
  
  There is a fracture that needs a cast-shoe, weight bear as tolerated
- D.
  
  There is a fracture that need a cast shoe and should remain non-weight bearing
Correct Answer
C. There is a fracture that needs a cast-shoe, weight bear as tolerated

Explanation
The correct answer suggests that there is a fracture present in the foot that requires a cast-shoe. However, the patient can bear weight on the foot as tolerated, indicating that the fracture is not severe enough to require complete non-weight bearing. This suggests that the fracture is stable and can be managed with the use of a cast-shoe for support while allowing the patient to bear some weight on the foot.

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3.

This patient hurt his wrist playing basketball. He is tender over his snuff box but has no other pain.
- A.
  
  There is a fracture of the scaphoid seen on xray and patient should be placed in a thumb spica splint
- B.
  
  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
- C.
  
  This patient should be treated as a sprain and placed in a volar splint
- D.
  
  This patient should be sent immediately to the ER
Correct Answer
B. 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

Explanation
The patient is tender over the snuff box, which is a common sign of scaphoid fracture. However, the x-ray does not show a fracture. Despite this, the patient should still be placed in a thumb spica splint as a precautionary measure and referred to orthopedics as an outpatient for further evaluation. This is because scaphoid fractures are often missed on initial x-rays and can develop later. The thumb spica splint helps immobilize the wrist and provides support while waiting for further evaluation.

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4.

This patient was struck in the nose with a football.
- A.
  
  A septal hematoma is of little concern
- B.
  
  This person should see a plastic surgeon as soon as possible
- C.
  
  There is a fracture that needs reducing immediately
- D.
  
  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
Correct Answer
D. 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

Explanation
The correct answer states that reduction may be considered if the injury occurred within 6 hours, but it is not necessary. If the injury is beyond 6 hours, the fracture does not require immediate treatment. Instead, treatment may be needed at a later date if there are any complications such as cosmetic issues or difficulty breathing through the nose. This suggests that the patient does not need to see a plastic surgeon immediately, but should monitor for any potential complications in the future.

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5.

This patient presents with pain over her lateral malleolus after tripping. At discharge you recommend:
- A.
  
  Non-weight bearing for 3 days
- B.
  
  RICE (Rest/Ice/Compression/Elevation)
- C.
  
  An MRI for further evaluation
- D.
  
  Percocet for pain relief
Correct Answer
B. RICE (Rest/Ice/Compression/Elevation)

Explanation
The patient in this scenario is experiencing pain over her lateral malleolus after tripping. RICE (Rest/Ice/Compression/Elevation) is the appropriate recommendation for this patient. Resting the affected area will allow for healing and prevent further injury. Applying ice will help reduce swelling and alleviate pain. Compression with a bandage or brace can provide support and reduce swelling. Elevation of the leg will also help reduce swelling by allowing fluid to drain away from the injured area. This combination of interventions is commonly recommended for acute injuries and can help promote healing and relieve symptoms.

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6.

This patient complains of knee pain after a fall.
- A.
  
  This is a normal xray
- B.
  
  There is a fracture that needs a cast
- C.
  
  There is a fracture that needs a knee immobilizer at full extension and referral to ortho within 48 hours
- D.
  
  This patient should be send to the ER
Correct Answer
C. There is a fracture that needs a knee immobilizer at full extension and referral to ortho within 48 hours

Explanation
Based on the information provided, the patient experienced knee pain after a fall. The correct answer states that there is a fracture that needs a knee immobilizer at full extension and referral to ortho within 48 hours. This implies that the x-ray revealed a fracture in the knee, which requires immobilization and a referral to an orthopedic specialist within a specific time frame. This course of action is appropriate for managing a fracture in the knee.

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7.

This child fell 3 days ago and complains of persistent wrist pain.
- A.
  
  This is a normal xray
- B.
  
  There is a fracture that can be treated like a sprain and placed a velcro splint for 3 days
- C.
  
  There is a fracture that needs a splint and referral to ortho for fracture care
- D.
  
  This patient should be send to the ER
Correct Answer
C. There is a fracture that needs a splint and referral to ortho for fracture care

Explanation
The child's persistent wrist pain and the fact that they fell 3 days ago suggest that there may be a fracture. The x-ray confirms this by showing a fracture. Since it is a fracture, it requires proper splinting and orthopedic care for appropriate treatment. Referral to an orthopedic specialist is necessary to ensure proper management of the fracture.

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8.

This patient presents after being punched in the ribs. You do an xray and think that you may see a small nondisplaced fracture of the left 7th rib, no pneumothorax or other abnormalities.
- A.
  
  This patient needs an outpatient CT
- B.
  
  This patient should have his ribs wrapped
- C.
  
  This patient should be given pain meds and an incentive spirometer
- D.
  
  This patient should be sent to the ER to r/o a cardiac or pulmonary contusion
Correct Answer
C. This patient should be given pain meds and an incentive spirometer
9.

This patient stubbed her toe. It's black and blue.
- A.
  
  This is a normal x-ray
- B.
  
  There is a fracture that needs a splint, or a short leg cast
- C.
  
  There is a fracture that should be buddy taped to a healthy toe
- D.
  
  The patient needs additional x-rays of her foot and ankle
Correct Answer
C. There is a fracture that should be buddy taped to a healthy toe

Explanation
The correct answer is "There is a fracture that should be buddy taped to a healthy toe." This is because the patient stubbed her toe and it is black and blue, indicating bruising and possible trauma. The x-ray reveals a fracture, which should be treated by buddy taping the fractured toe to a healthy toe for support and stabilization.

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10.

This elder patient says that she tripped over her slippers yesterday. She didn't strike her head and has no complaints except pain in her right hip when she walks.
- A.
  
  This is a normal x-ray and can go home with pain meds
- B.
  
  There is a fracture that require surgery within 24 hours
- C.
  
  There is a fracture but can go home with pain meds
- D.
  
  There is a fracture but patient should be sent to the ER for further evaluation
Correct Answer
C. There is a fracture but can go home with pain meds

Explanation
The patient has reported pain in her right hip when she walks, and the x-ray shows a fracture. However, there is no indication of any other serious symptoms or complications that would require immediate surgery or a visit to the emergency room. Therefore, the patient can be sent home with pain medication to manage the discomfort caused by the fracture.

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11.

This patient fell onto his elbow. He is neurovascularly intact but he reports persistent pain.
- A.
  
  This is a normal x-ray
- B.
  
  There is a fracture seen
- C.
  
  There is a soft tissue sign that suggests a fracture of the radial head that can be treated with a sling
- D.
  
  There is a soft tissue sign that suggests a fracture of the radial head that requires immobilization for 6 weeks
Correct Answer
C. There is a soft tissue sign that suggests a fracture of the radial head that can be treated with a sling

Explanation
The patient fell onto his elbow and is experiencing persistent pain. The x-ray shows a soft tissue sign that suggests a fracture of the radial head. This type of fracture can be treated with a sling, indicating that immobilization is necessary but not for a prolonged period of time.

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12.

This patient fell onto his outstretched hand
- A.
  
  This is a normal x-ray
- B.
  
  This patient has a Colles fracture which should be placed in a sugar-tong, reverse sugar-tong, or double sugar-tong splint
- C.
  
  This patient has a Colles fracture which should be placed in a circumferential cast
- D.
  
  The presence of a puncture wound at the site of the fracture would not change management
Correct Answer
B. This patient has a Colles fracture which should be placed in a sugar-tong, reverse sugar-tong, or double sugar-tong splint

Explanation
The patient fell onto his outstretched hand, which is a common mechanism of injury for a Colles fracture. A Colles fracture is a fracture of the distal radius with dorsal displacement of the distal fragment. It is typically treated with a sugar-tong, reverse sugar-tong, or double sugar-tong splint. These splints provide stability to the fracture site and allow for proper alignment and healing. A circumferential cast may not provide enough support and immobilization for this type of fracture. The presence of a puncture wound at the site of the fracture would not change the management, as the primary concern is addressing the fracture itself.

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13.

A patient, not anticoagulated, present with epistaxis from his right nare for the 3^rd time in 2 years
- A.
  
  This patient needs a CBC and a PT/PTT in addition to treatment of acute epistaxis
- B.
  
  The epistaxis is likely posterior and could be treated with a Mirocel sponge, or a nasal tampon
- C.
  
  Pressure should be held over the bony part of the nose, as high as possible
- D.
  
  The bleeding site is likely on the nasal septum. Once identified it should be cauterized with silver nitrate, and then packed
- E.
  
  A and D are correct
Correct Answer
D. The bleeding site is likely on the nasal septum. Once identified it should be cauterized with silver nitrate, and then packed

Explanation
The correct answer is A. The bleeding site is likely on the nasal septum. Once identified, it should be cauterized with silver nitrate and then packed. This is the most appropriate course of action for a patient presenting with recurrent epistaxis. The use of silver nitrate cauterization helps to stop the bleeding by sealing off the blood vessels in the nasal septum. Packing the nose afterwards helps to maintain pressure on the site and prevent further bleeding. The other options mentioned in the explanation, such as CBC and PT/PTT tests, are not directly related to the treatment of acute epistaxis.

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14.

A 4 year old is crying, complaining of severe ear pain for the past 24 hours. Her temperature is 100.8 and she does not appear toxic
- A.
  
  Mom should be reassured that this is likely viral and discharged with NSAIDS
- B.
  
  This is OM and should be treat with Amoxicillin (90mg/kg/day in 2 divided doses)
- C.
  
  This patient should be referred to ENT to consider typanostomy tubes
- D.
  
  Both A and B are reasonable approaches
Correct Answer
D. Both A and B are reasonable approaches

Explanation
Both A and B are reasonable approaches because the given scenario describes a 4-year-old child with severe ear pain for the past 24 hours, a temperature of 100.8, and no signs of toxicity. These symptoms are consistent with acute otitis media (OM), which can be caused by both viral and bacterial infections. Viral OM is more common and typically resolves on its own with supportive care, such as NSAIDs for pain relief. However, bacterial OM may require antibiotic treatment with Amoxicillin. Therefore, both approaches of reassurance with NSAIDs (for viral OM) and treatment with Amoxicillin (for bacterial OM) are reasonable in this case.

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15.

An 8 year old reports a sore throat for the past two days.
- A.
  
  The presence of diarrhea and conjunctivitis makes GAS less likely
- B.
  
  The presence of tender lymphadenopathy and a tonsillar exudate makes GAS more likely
- C.
  
  Group A strep causes pharyngitis; whereas Group B strep is normal GI flora that can cause serious illness in the neonate
- D.
  
  All of the above
Correct Answer
D. All of the above

Explanation
The correct answer is "All of the above." The presence of diarrhea and conjunctivitis makes Group A Streptococcus (GAS) less likely because these symptoms are not typically associated with GAS pharyngitis. On the other hand, the presence of tender lymphadenopathy and a tonsillar exudate makes GAS more likely as these are common findings in GAS pharyngitis. It is important to differentiate between Group A and Group B streptococci as Group A strep causes pharyngitis, while Group B strep is normal GI flora that can cause serious illness in neonates.

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16.

A fully immunized adult presents complaining of a swollen cheek that developed acutely over the past 4 hours.
- A.
  
  This patient likely has parotitis and should be treated with antibiotics, Augmentin 875mg bid x 7 days, and lemon drops
- B.
  
  This patient may have a parotid tumor and needs a CT of his parotid ASAP
- C.
  
  This patient likely has the mumps which can impact his future fertility
- D.
  
  Sialolithiasis is an unlikely cause of this symptom
Correct Answer
A. This patient likely has parotitis and should be treated with antibiotics, Augmentin 875mg bid x 7 days, and lemon drops

Explanation
The correct answer suggests that the patient likely has parotitis, which is inflammation of the parotid gland. The recommended treatment is antibiotics, specifically Augmentin 875mg bid (twice a day) for 7 days, along with lemon drops. This treatment is appropriate because parotitis is commonly caused by bacterial infection, and Augmentin is an antibiotic effective against the most common bacteria that cause parotitis. Lemon drops can help stimulate saliva production and relieve symptoms.

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17.

A patient has awakened with crusty, red eyes for the past 3 days. He has no other eye complaints
- A.
  
  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.
- B.
  
  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.
- C.
  
  In contact lens wearers, Pseudomonas infections are more common so a quinolone antibiotic ointment is the preferred treatment (Ciloxan BID x 5-7 days)
- D.
  
  B and C are true
Correct Answer
D. B and C are true

Explanation
The correct answer is B and C are true. This means that only patients with mucopurulent discharge should be treated with antibiotic ointment, specifically erythromycin QID x 3-5 days. Additionally, in contact lens wearers, Pseudomonas infections are more common, so a quinolone antibiotic ointment, such as Ciloxan BID x 5-7 days, is the preferred treatment. It is important to stress the necessity of good hygiene since this condition is highly contagious.

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18.

A patient presents complaining of dentalgia. On exam, he has a fluctuant area above his Right 1^st incisor
- A.
  
  This abscess needs to be drained in addition to antibiotics and referral to a dentist
- B.
  
  This patient should be treated with clindamycin 150mg tid x 7 days or PCN VK 500 mg QID x 7 days without surgical drainage
- C.
  
  This patient should be treated with pain medication and referred to a dentist
- D.
  
  This patient should be sent to the ER for treatment by an oral surgeon
Correct Answer
A. This abscess needs to be drained in addition to antibiotics and referral to a dentist

Explanation
The correct answer states that the abscess needs to be drained in addition to antibiotics and referral to a dentist. This is because the patient presents with dentalgia (tooth pain) and has a fluctuant area above their right 1st incisor, indicating the presence of an abscess. Abscesses are usually caused by a bacterial infection and can lead to severe pain and swelling. Antibiotics alone may not be sufficient to treat the abscess, as the pus-filled pocket needs to be drained to effectively remove the infection. Referral to a dentist is necessary for proper evaluation and treatment of the underlying dental issue causing the abscess.

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19.

A 45 year old without any medical history reports 15 minutes of chest tightness associated with mild nausea and diaphoresis this morning while driving to work. He says that he has had similar discomfort over the past two weeks when he climbed the stairs. He feels fine now.
- A.
  
  He should have labs sent including a troponin and referred to a cardiologist within 72 hours
- B.
  
  He can safely be sent home, reassured with a normal EKG, and referred back to his PMD for further management
- C.
  
  He should be given an Aspirin while at Premier and sent to the ER by EMS for evaluation of his unstable angina
- D.
  
  You should take a more thorough history and your recommendation should be guided by the results
Correct Answer
C. He should be given an Aspirin while at Premier and sent to the ER by EMS for evaluation of his unstable angina

Explanation
The patient's symptoms of chest tightness, mild nausea, and diaphoresis, along with a history of similar discomfort while climbing stairs, are concerning for unstable angina. Unstable angina is a serious condition that requires immediate evaluation and treatment. Giving the patient aspirin while at Premier can help to reduce the risk of further cardiac events. Referring the patient to the emergency room by EMS is necessary for further evaluation and management of his condition.

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20.

Which of the following is not a major risk factor for CAD?
- A.
  
  Hypertension
- B.
  
  Cholesterol
- C.
  
  Family History
- D.
  
  Smoking
- E.
  
  Diabetes
- F.
  
  All are major risk factors for CAD
Correct Answer
F. All are major risk factors for CAD

Explanation
All of the given options - Hypertension, Cholesterol, Family History, Smoking, and Diabetes - are major risk factors for CAD (Coronary Artery Disease). CAD is a condition where the arteries that supply blood to the heart become narrowed or blocked due to the buildup of plaque. Hypertension (high blood pressure), high cholesterol levels, a family history of CAD, smoking, and diabetes are all well-established risk factors that can contribute to the development of CAD. Therefore, none of the options listed are not major risk factors for CAD.

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21.

A 70 woman reports increasing shortness of breath with exertion over 1 week. She has one pillow orthopnea and a mild cough. Her meds are ASA, Lisinopril, Lasix 20mg, Carvedilol. Her vitals are normal except for an SaO2=92% on RA. Her cardiac exam is normal. She has rales at both bases and she has 2+ pitting edema in both legs. Her EKG is normal except for LVH.
- A.
  
  Send the patient directly to the ER
- B.
  
  Draw labs and have your therapy guided by their results
- C.
  
  Give the patient a dose of IV Lasix, 40mg, and reassess in 2 hours
- D.
  
  Increase the PO Lasix to 40mg q day and have the patient follow up with her cardiologist
Correct Answer
C. Give the patient a dose of IV Lasix, 40mg, and reassess in 2 hours

Explanation
Based on the patient's symptoms of increasing shortness of breath, one pillow orthopnea, mild cough, rales at both bases, and 2+ pitting edema in both legs, along with an SaO2 of 92% on room air, it suggests that the patient is experiencing acute decompensated heart failure (ADHF). Giving the patient a dose of IV Lasix, 40mg, and reassessing in 2 hours is the appropriate course of action in this situation. IV Lasix is a loop diuretic that helps to relieve fluid overload and reduce symptoms of heart failure. Reassessing the patient's symptoms after administration of Lasix will help determine if further intervention or hospitalization is necessary.

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22.

A 60 year old patient presents complaining of palpitations for 3 days. He has no other history or complaints. HR=140’s. BP 130/70 SaO2=100%. His cardiac exam reveals an irregularly irregular tachycardia. Lungs are clear.
- A.
  
  Give a dose of Xarelto and discharge to home for follow up with cardiology
- B.
  
  Give a dose of Xarelto and PO Cardizem for rate control. Discharge to home for follow up with cardiology
- C.
  
  Refer patient directly to the ER
- D.
  
  Either B or C are appropriate
Correct Answer
C. Refer patient directly to the ER
23.

A 20 year old with a history or asthma presents with increasing wheezing for the past 24 hours, after exposure to a neighbor’s cat. No fever. No Cough. Has never been intubated. Has been admitted twice in the past 5 years. On exam, Patient is not in any distress. SaO2=96%. RR=18. Lungs have scattered wheezes in all lung fields. The remainder of the exam is normal. Initial peak flow is 380. Which of the following is appropriate for this patient?
- A.
  
  Albuterol via HCN q 20-30 minutes
- B.
  
  Atrovent via HFN q 20-30 minutes
- C.
  
  Peak flows pre- and post- treatment
- D.
  
  Prednisone 40 mg PO or Solumedrol 125 mg IV (there is not difference in their efficacy)
- E.
  
  Antibiotics, Zithromax 500mg PO, or Levaquin 500 mg PO
- F.
  
  CXR
- G.
  
  Counseling on trigger avoidance
- H.
  
  Family transport the the ED
- I.
  
  EMS transport to the ED
Correct Answer(s)
A. Albuterol via HCN q 20-30 minutes
B. Atrovent via HFN q 20-30 minutes
C. Peak flows pre- and post- treatment
D. Prednisone 40 mg PO or Solumedrol 125 mg IV (there is not difference in their efficacy)
G. Counseling on trigger avoidance

Explanation
This patient is presenting with an acute exacerbation of asthma triggered by exposure to a cat. The absence of fever and cough, as well as the patient's normal exam findings and oxygen saturation, suggest that the exacerbation is mild to moderate. The appropriate management for this patient would include bronchodilators such as albuterol via handheld nebulizer (HCN) and ipratropium bromide (Atrovent) via handheld nebulizer (HFN) every 20-30 minutes to relieve wheezing. Peak flow measurements should be taken before and after treatment to assess response. Systemic corticosteroids such as prednisone or solumedrol should be given to reduce airway inflammation. Counseling on trigger avoidance should also be provided.

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24.

A 20 year old with a history or asthma presents with increasing wheezing for the past 72 hours. No fever. No Cough. Has never been intubated. Has been admitted twice in the past 5 years. On exam, patient is in moderate distress. He is not speaking in full sentences. SaO2=96%. RR=32. Lungs have scattered wheezes in all lung fields with a markedly prolonged expiratory phase. Initial peak flow is 80. The remainder of the exam is normal. Which of the following is appropriate for this patient?
- A.
  
  Albuterol via HCN q 20-30 minutes
- B.
  
  Atrovent via HFN q 20-30 minutes
- C.
  
  Peak flows pre- and post- treatment
- D.
  
  Prednisone 40 mg PO Solumedrol 125 mg IV (there is not difference in their efficacy)
- E.
  
  Antibiotics, Zithromax 500mg PO, or Levaquin 500 mg PO
- F.
  
  CXR
- G.
  
  Counseling on trigger avoidance
- H.
  
  Family transport the the ED
- I.
  
  EMS transport to the ED
Correct Answer(s)
A. Albuterol via HCN q 20-30 minutes
B. Atrovent via HFN q 20-30 minutes
D. Prednisone 40 mg PO Solumedrol 125 mg IV (there is not difference in their efficacy)
G. Counseling on trigger avoidance
I. EMS transport to the ED

Explanation
The appropriate management for this patient includes administering Albuterol via HCN and Atrovent via HFN every 20-30 minutes to relieve the wheezing and improve respiratory distress. Prednisone 40 mg PO and Solumedrol 125 mg IV should be given to reduce inflammation and further improve symptoms. Counseling on trigger avoidance is important to prevent future exacerbations. Finally, EMS transport to the ED is necessary due to the patient's moderate distress and the need for immediate medical attention.

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25.

A 30 year old c/o 6 days of a cough, occasionally productive of clear or white sputum. Pt has no other PMH and is not a smoker. On exam he is in no distress. T=99.6 SaO2=97%. His exam is normal.
- A.
  
  This patient likely has a viral infection but should be treated with an antibiotic in case it is bacterial
- B.
  
  This patient likely has a viral infection and should not be treated with antibiotics. He should receive symptomatic therapy.
- C.
  
  This patient should be discharged without antibiotics and referred for an outpatient CT to r/o a small infiltrate
- D.
  
  This patient should be treated with antihistamines
Correct Answer
B. This patient likely has a viral infection and should not be treated with antibiotics. He should receive symptomatic therapy.

Explanation
The patient's symptoms of a cough with clear or white sputum, absence of distress, normal examination findings, and absence of any significant medical history or smoking history suggest that he likely has a viral infection. Antibiotics are not effective against viral infections, so treating him with antibiotics would be unnecessary and potentially harmful. Symptomatic therapy, such as over-the-counter cough suppressants or throat lozenges, would be appropriate to provide relief from his symptoms.

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26.

A 69 year old former smoker, with COPD, presents complaining of several days of increasing SOB, and her sputum has become a dark yellow. Her daughter says that she seems more confused than usual. On exam, she is in no apparent distress but she is breathing through pursed lips. T=100.2 SaO2=90% on 2L n/c. Her lung exam has distant breath sounds, scattered wheezes, and moist crackles at the right base.
- A.
  
  Albuterol via HCN q 20-30 minutes
- B.
  
  Atrovent via HFN q 20-30 minutes
- C.
  
  Peak flows pre- and post- treatment
- D.
  
  Prednisone 40 mg PO Solumedrol 125 mg IV (there is not difference in their efficacy)
- E.
  
  Antibiotics, Zithromax 500mg PO, or Levaquin 500 mg PO
- F.
  
  Counseling on trigger avoidance
- G.
  
  Discharge to home with close follow up at Premier
- H.
  
  Transport to the ED
Correct Answer(s)
A. Albuterol via HCN q 20-30 minutes
B. Atrovent via HFN q 20-30 minutes
D. Prednisone 40 mg PO Solumedrol 125 mg IV (there is not difference in their efficacy)
E. Antibiotics, Zithromax 500mg PO, or Levaquin 500 mg PO
H. Transport to the ED

Explanation
The correct answer is to transport the patient to the ED. The patient's symptoms of increasing shortness of breath, dark yellow sputum, confusion, and abnormal vital signs indicate a worsening of her condition and potential respiratory distress. Given her history of COPD and the findings on lung exam, it is important to provide immediate medical attention in a higher level of care setting, such as the emergency department, where she can receive further evaluation, monitoring, and appropriate treatment.

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27.

A healthy 40 year old non-smoker presents c/o a fever with rigors, cough productive of green sputum, and right sided pleuritic chest pain. T=102.1, SaO2=94% on RA. His exam is normal except for his lung exam which reveals crackles at the left base. Which if the following is FALSE?
- A.
  
  This patient has bronchitis and should be treated with PO antibiotics, ZPak, or Levaquin 750 mg q day
- B.
  
  This patient has pneumonia and may be treated with PO antibiotics, ZPak, or Levaquin 750 mg q day
- C.
  
  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
- D.
  
  You should calculate a CURB65 or PORT score to determine if the inpatient or outpatient setting is most appropriate
Correct Answer
A. This patient has bronchitis and should be treated with PO antibiotics, ZPak, or Levaquin 750 mg q day

Explanation
The given answer is FALSE because bronchitis is typically a viral infection and does not require treatment with antibiotics. Antibiotics are only indicated if there is a bacterial infection or if the patient has risk factors for a bacterial infection. The patient's symptoms, such as productive cough with green sputum and crackles on lung exam, are more consistent with pneumonia rather than bronchitis. Therefore, the patient may be treated with PO antibiotics, such as ZPak or Levaquin, for pneumonia.

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28.

A 40 year old woman presents c/o dyspnea with minimal exertion, anxiety and R. sided pleuritic chest pain. T=99 RR=20 HR=110 SaO2=94%. Her exam is normal. What is a reasonable approach to her diagnostic evaluation?
- A.
  
  This patient is PERC positive and no further diagnostic evaluation is warranted
- B.
  
  A D-Dimer should be ordered to further evaluate this patient
- C.
  
  This patient should be sent for a CTA immediately
- D.
  
  Given the high pre-test probability, this patient should be anticoagulated without a definitive diagnosis
Correct Answer
C. This patient should be sent for a CTA immediately
29.

A middle aged man reports a nonproductive cough each night while he is supine. He often awakes with a sore throat. He denies and fever or other constitutional symptoms.
- A.
  
  This patient likely has a viral bronchitis
- B.
  
  This patient needs an urgent chest CT to r/o an endobronchial lesion
- C.
  
  This patient may have GERD and should be treated with a PPI
- D.
  
  This patient should be treated with an antibiotic
Correct Answer
C. This patient may have GERD and should be treated with a PPI

Explanation
The patient's symptoms of a nonproductive cough at night while supine and waking up with a sore throat suggest that they may have gastroesophageal reflux disease (GERD). GERD occurs when stomach acid flows back into the esophagus, causing irritation and symptoms such as coughing and sore throat. Treatment with a proton pump inhibitor (PPI) can help reduce the production of stomach acid and alleviate the symptoms of GERD. Therefore, this patient should be treated with a PPI.

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30.

A patient reports several episodes of RUQ pain, exacerbated by greasy food. Presently, she describes her pain as 3 out of 10. She is afebrile and her abdominal exam is normal except for RUQ pain with deep palpation.
- A.
  
  This patient should be sent to the ER to evaluate her probable gall bladder disease
- B.
  
  This patient should be sent for a CT to evaluate possible pancreatitis
- C.
  
  This patient needs a RUQ ultrasound. If one is not available now, patient should be send to the ER to see a surgeon
- D.
  
  This patient needs routine chemistries, a lipase, and an ultrasound. These should be ordered STAT and referred to a surgeon for an outpatient evaluation
Correct Answer
D. This patient needs routine chemistries, a lipase, and an ultrasound. These should be ordered STAT and referred to a surgeon for an outpatient evaluation

Explanation
The patient's symptoms of RUQ pain, exacerbated by greasy food, raise suspicion for gall bladder disease. The normal abdominal exam except for RUQ pain with deep palpation further supports this possibility. Ordering routine chemistries, a lipase, and an ultrasound would help evaluate the patient for gall bladder disease and pancreatitis, which can present with similar symptoms. Referring the patient to a surgeon for an outpatient evaluation ensures appropriate follow-up and management. Sending the patient to the ER is not necessary unless there are signs of acute complications.

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31.

Regarding acute pancreatitis, which is FALSE:
- A.
  
  A history of ETOH abuse is a risk factor
- B.
  
  Cholelithiasis is a risk factor
- C.
  
  Amylase is more sensitive than Lipase
- D.
  
  Ranson criteria can be used to predict mortality
Correct Answer
C. Amylase is more sensitive than Lipase

Explanation
Amylase is not more sensitive than Lipase in the diagnosis of acute pancreatitis. Lipase is actually considered to be more specific and more sensitive than amylase in diagnosing acute pancreatitis. Lipase levels remain elevated for a longer duration compared to amylase, making it a more reliable marker for the diagnosis of acute pancreatitis.

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32.

A healthy 26 year old reports 12 hours of RLQ pain, nausea, a low grade fever and anorexia. Currently, he reports mild, 2 out of 10 pain. It is 7pm. You should:
- A.
  
  Send routine labs and instruct the patient to return if the pain gets worse.
- B.
  
  Contact a surgeon and try to get the patient seen first thing tomorrow
- C.
  
  Send labs now. Arrange for an outpatient CT tomorrow
- D.
  
  Send the patient to the ED
Correct Answer
D. Send the patient to the ED

Explanation
Based on the symptoms described (RLQ pain, nausea, low grade fever, anorexia) and the fact that the patient is currently experiencing mild pain, it is important to send the patient to the emergency department (ED). These symptoms could be indicative of appendicitis, which is a medical emergency that requires immediate evaluation and potentially surgery. Therefore, sending the patient to the ED is the most appropriate course of action to ensure timely and appropriate care.

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33.

A 55 year old man presents with a low grade fever and LLQ abdominal pain for 5 days. He said that he has had similar symptoms twice in the past. One exam, T=99.9. His abdominal exam reveals normal bowel sounds, and tenderness to deep palpation over his left lower quadrant with some voluntary guarding. +rebound.
- A.
  
  This patient needs a STAT outpatient CT to evaluate the cause of his abdominal pain
- B.
  
  This patient should be sent directly to the ER for evaluation
- C.
  
  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
- D.
  
  A and C
Correct Answer
D. A and C

Explanation
The patient's symptoms of low grade fever, LLQ abdominal pain, and tenderness to deep palpation over the left lower quadrant with voluntary guarding are consistent with diverticulitis. The fact that he has had similar symptoms twice in the past further supports this diagnosis. A CT scan is necessary to evaluate the cause of his abdominal pain and confirm the diagnosis of diverticulitis. Antibiotic treatment with Levaquin and Flagyl is also appropriate for presumptive diverticulitis. Therefore, options A and C are both correct.

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34.

A 66 year old man without any significant past medical history presents with painless, gross hematuria. He is afebrile and his exam is normal. His urinalysis reveals TNTC RBC’s. Which of the following is FALSE?
- A.
  
  There is significant concern for a malignancy
- B.
  
  The patient should be sent to the ER for evaluation
- C.
  
  The patient should have a urine culture and then started on empiric antibiotics, Levaquin 500 mg q day x 7 days
- D.
  
  The patient should be referred to a urologist
Correct Answer
B. The patient should be sent to the ER for evaluation

Explanation
The patient should be sent to the ER for evaluation because painless, gross hematuria could be a sign of a serious condition such as bladder or kidney cancer. It is important to rule out any life-threatening conditions and provide appropriate and timely medical care.

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35.

A 20 year old woman presents complaining of urinary frequency and dysuria. She is afebrile. She has mild, right sided CVAT. Her urinalysis reveal TNTC WBC’s, moderate RBC’s, ++Leuk Esterase, + protein.
- A.
  
  She should be started on Bactrim DS bid x 5 days
- B.
  
  She should be started in Levaquin 500mg PO q day x 7 days
- C.
  
  She can be treated for her discomfort with Pyridium 100mg bid PRN for 2 days
- D.
  
  A and C
- E.
  
  B and C
Correct Answer
E. B and C

Explanation
The correct answer is B and C. The woman's symptoms of urinary frequency and dysuria, along with the presence of TNTC WBC's and moderate RBC's in her urinalysis, suggest a urinary tract infection (UTI). The mild, right-sided CVAT indicates possible kidney involvement. Levaquin and Bactrim DS are both antibiotics commonly used to treat UTIs. Pyridium is a medication that can provide relief for discomfort associated with UTIs. Therefore, starting the woman on Levaquin or Bactrim DS and treating her discomfort with Pyridium would be appropriate in this case.

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36.

A 41 year old man presents with acute onset of severe left flank pain radiating to his testicle. He is vomiting and diaphoretic. His vitals are normal but he appears very uncomfortable. His abdominal and testicular exam are normal. Labs and urinalysis are pending.
- A.
  
  This patient may need to be sent to the ER for pain control and a STAT CT
- B.
  
  This patient needs a stat testicular ultrasound to r/o torsion
- C.
  
  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
- D.
  
  Flomax is contraindicated
Correct Answer
C. 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

Explanation
The patient's presentation of acute onset severe left flank pain radiating to his testicle, along with vomiting and diaphoresis, is consistent with renal colic. Renal colic is caused by the passage of a kidney stone, which can cause severe pain. The suggested treatment of IV fluids, Toradol 30mg IV, and a KUB (kidney-ureter-bladder X-ray) is appropriate for managing renal colic. If the pain can be controlled, the patient can be safely discharged for follow-up with urology.

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37.

A 3 week old infant is brought in by mom with a fever of 100.9 rectally. Fontanelles are flat, neck is supple, lungs are clear, and there is no rash.
- A.
  
  This patient should be sent to the ER for a septic work-up
- B.
  
  This patient should be started on empiric antibiotics and can safely discharged home
- C.
  
  Mom should be reassured that the baby is fine and should be instructed to return for a T>101.4
- D.
  
  The patient should have routine labs, an xray, and urinalysis at Premier and therapy should be guided by the results
Correct Answer
A. This patient should be sent to the ER for a septic work-up

Explanation
A 3 week old infant with a fever of 100.9 rectally is a concerning sign, especially in such a young age. The fact that the fontanelles are flat, neck is supple, lungs are clear, and there is no rash does not rule out the possibility of a serious infection. In infants, a fever can be a sign of a potentially life-threatening condition such as sepsis. Therefore, it is important to send the patient to the emergency room for a septic work-up to determine the cause of the fever and provide appropriate treatment.

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38.

Dad brings his 3 year boy to Premier with a fever. The child is cranky and dad says that for the past 24 hours he has been eating and playing less than usual. The child offers no complaints. T=102.9. Neck is supple, ENT exam is normal. Lungs are clear. Abdomen is soft. The boy is circumcised.
- A.
  
  This patient needs a urinalysis
- B.
  
  This patient should receive empiric antibiotics, Zithromax 10mg/kg on day 1, then 5 mg/kg on days 2 through 5
- C.
  
  This patient needs labs, a chest x-ray, and a urinalysis
- D.
  
  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
Correct Answer
D. 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

Explanation
The patient's symptoms, such as fever and decreased appetite, are not indicative of a specific infection. The physical examination findings, including a supple neck, normal ENT exam, clear lungs, and soft abdomen, do not suggest any specific underlying condition. Therefore, there is no immediate need for further evaluation or treatment with antibiotics. Discharging the patient with symptomatic relief medication and instructing the father to return if the child develops any specific site of infection is appropriate in this case.

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39.

A 2 year old is brought to Premier after falling off of a sofa and striking her head. Per mom, there was no loss of consciousness and the child cried immediately. Since the fall, the child has been acting normally. On exam, the child has a red area on her forehead. The remainder of her exam is normal.
- A.
  
  This patient needs to be transported to the ER
- B.
  
  I’m not sure if patient should be observed for 4 hours and if normal, can be discharged with mom, or if the patient needs a head CT but I will be guided by the PECARN rules
Correct Answer
B. I’m not sure if patient should be observed for 4 hours and if normal, can be discharged with mom, or if the patient needs a head CT but I will be guided by the PECARN rules
40.

A 4 year old is brought in by his parents with 3 days of diarrhea. His HR=110 bpm. He weighs 44 lbs. His mucous membranes are dry and his abdominal exam is normal. What is an appropriate order for IV fluid replacement? (20 ml/kg is the standard replacement)
- A.
  
  ½ NS 400 cc bolus
- B.
  
  D5NS 400 cc bolus
- C.
  
  NS 400 cc/hr
- D.
  
  NS 400 cc bolus
Correct Answer
D. NS 400 cc bolus

Explanation
An appropriate order for IV fluid replacement in this case would be NS 400 cc bolus. This is because the child has been experiencing diarrhea for 3 days, which can lead to dehydration. The heart rate of 110 bpm indicates that the child may be tachycardic, which can be a sign of dehydration. The weight of 44 lbs suggests that the child is of average weight for a 4-year-old. The dry mucous membranes also indicate dehydration. Therefore, a bolus of normal saline (NS) is appropriate to rapidly restore fluid volume and correct dehydration.

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41.

A 60 year old with a h/o HTN presents with weakness in her right arm and difficulty speaking which began 45 minutes ago. You appropriately suspect that she is having a left MCA CVA.
- A.
  
  You should get a set of vital and get IV access. Check an EKG and then send her to the ER
- B.
  
  You should check her blood pressure and treat it if elevated before sending her to the ER
- C.
  
  You should arrange for a STAT CT
- D.
  
  Call 911
Correct Answer
D. Call 911

Explanation
In this scenario, the patient is experiencing symptoms of a stroke (weakness in right arm and difficulty speaking) which began 45 minutes ago. Time is crucial in stroke management, as immediate medical attention can help minimize damage and improve outcomes. Therefore, the correct course of action is to call 911, as emergency medical services can provide timely transportation to the hospital where the patient can receive appropriate care.

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42.

A 56 year old man presents with a left facial droop which began yesterday. The remainder of his neuro exam is normal. Vitals are stable. Which of the following statements is FALSE?
- A.
  
  This patient needs a STAT CT
- B.
  
  This patient likely has Bell’s palsy. You are reassured that the forehead is involved.
- C.
  
  This patient should be tested for Lyme Disease
- D.
  
  This patient should be treated with prednsone 60-80 mg daily, with the addition of Valtrex 1000 mg TID in severe cases.
Correct Answer
A. This patient needs a STAT CT

Explanation
The statement "This patient needs a STAT CT" is false because the patient's neuro exam is normal and there are no indications of a more serious underlying condition such as a stroke or tumor. A CT scan is not necessary in this case.

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43.

The evaluation of a minor head injury in a patient who is over 65 years old must include a head CT
- A.
  
  True
- B.
  
  False
Correct Answer
A. True

Explanation
As people age, their risk of complications from head injuries increases. Therefore, when evaluating a minor head injury in a patient over 65 years old, it is important to include a head CT scan. This imaging test can help identify any potential brain injuries or bleeding that may not be immediately apparent. By conducting a head CT, healthcare professionals can ensure that any necessary treatment or intervention is provided promptly, reducing the risk of further complications or long-term damage.

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44.

A man presents complaining of diffuse hives and itching which began yesterday. The patient denies any shortness of breath or difficulty swallowing. He cannot identify an allergen. His lung exam is normal. Which of the following is true?
- A.
  
  This patient should be treat with Benadryl 25 mg q 6 prn
- B.
  
  This patient should receive prednisone 40mg, tapered over 5-7 days
- C.
  
  This patient should receive albuterol via HFN
- D.
  
  This patient should be treated with Epinephrine SQ
- E.
  
  This patient may be treated with Pepcid 20mg bid
Correct Answer(s)
A. This patient should be treat with Benadryl 25 mg q 6 prn
B. This patient should receive prednisone 40mg, tapered over 5-7 days
E. This patient may be treated with Pepcid 20mg bid

Explanation
The correct answer is "This patient should be treat with Benadryl 25 mg q 6 prn, This patient should receive prednisone 40mg, tapered over 5-7 days, This patient may be treated with Pepcid 20mg bid." This is because the patient is presenting with diffuse hives and itching, which are symptoms of an allergic reaction. Benadryl is an antihistamine that can help relieve these symptoms. Prednisone is a corticosteroid that can help reduce inflammation and allergic reactions. Pepcid is an H2 blocker that can help reduce stomach acid production, which may be beneficial in some cases of allergic reactions.

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45.
You see a child at Premier whose injuries are concerning for abuse:
- Age inappropriate injuries
- Injuries inconsistent with the history
- Suspicious burns
- Etc.
- A.
  
  You need to fill out a CY47 form
- B.
  
  You need to call the clinical line
- C.
  
  You need to call the Child Line
- D.
  
  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
- E.
  
  All of the above
Correct Answer
E. All of the above

Explanation
The correct answer is "All of the above". This means that if you see a child at Premier with concerning injuries that may indicate abuse, you should fill out a CY47 form, call the clinical line, call the Child Line, and if you are not completely certain that the child will be safe, you should send them to the ER via EMS. All of these actions are necessary to ensure the well-being and safety of the child.

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46.

Which is true of this EKG?
- A.
  
  1st degree Heart block
- B.
  
  2nd degree Heart block (type 1)
- C.
  
  2nd degree Heart block (type 2)
- D.
  
  3rd Degree Heart block (Complete Heart Block)
- E.
  
  T-wave inversion
- F.
  
  ST depression
- G.
  
  Acute MI
- H.
  
  Sinus Tachycardia
- I.
  
  Supraventricular Tachycardia
- J.
  
  Atrial Fibrillation
- K.
  
  Atrial Flutter
- L.
  
  Ventricular Tachycardia
Correct Answer
K. Atrial Flutter
47.

Which is true of this EKG?
- A.
  
  1st degree Heart block
- B.
  
  2nd degree Heart block (type 1)
- C.
  
  2nd degree Heart block (type 2)
- D.
  
  3rd Degree Heart block (Complete Heart Block)
- E.
  
  T-wave inversion
- F.
  
  ST depression
- G.
  
  Acute MI
- H.
  
  Sinus Tachycardia
- I.
  
  Supraventricular Tachycardia
- J.
  
  Atrial Fibrillation
- K.
  
  Atrial Flutter
- L.
  
  Ventricular Tachycardia
Correct Answer(s)
F. ST depression
G. Acute MI
48.

Which is true of this EKG?
- A.
  
  1st degree Heart block
- B.
  
  2nd degree Heart block (type 1)
- C.
  
  2nd degree Heart block (type 2)
- D.
  
  3rd Degree Heart block (Complete Heart Block)
- E.
  
  T-wave inversion
- F.
  
  ST depression
- G.
  
  Acute MI
- H.
  
  Sinus Tachycardia
- I.
  
  Supraventricular Tachycardia
- J.
  
  Atrial Fibrillation
- K.
  
  Atrial Flutter
- L.
  
  Ventricular Tachycardia
Correct Answer
D. 3rd Degree Heart block (Complete Heart Block)
49.

Which is true of this EKG?
- A.
  
  1st degree Heart block
- B.
  
  2nd degree Heart block (type 1)
- C.
  
  2nd degree Heart block (type 2)
- D.
  
  3rd Degree Heart block (Complete Heart Block)
- E.
  
  T-wave inversion
- F.
  
  ST depression
- G.
  
  Acute MI
- H.
  
  Sinus Tachycardia
- I.
  
  Supraventricular Tachycardia
- J.
  
  Atrial Fibrillation
- K.
  
  Atrial Flutter
- L.
  
  Ventricular Tachycardia
Correct Answer(s)
E. T-wave inversion
F. ST depression
50.

Which is true of this EKG?
- A.
  
  1st degree Heart block
- B.
  
  2nd degree Heart block (type 1)
- C.
  
  2nd degree Heart block (type 2)
- D.
  
  3rd Degree Heart block (Complete Heart Block)
- E.
  
  T-wave inversion
- F.
  
  ST depression
- G.
  
  Acute MI
- H.
  
  Sinus Tachycardia
- I.
  
  Supraventricular Tachycardia
- J.
  
  Atrial Fibrillation
- K.
  
  Atrial Flutter
- L.
  
  Ventricular Tachycardia
Correct Answer
I. Supraventricular Tachycardia

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Current Version
Mar 20, 2023

Quiz Edited by
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Jul 24, 2016

Quiz Created by
AWilkesPUC

Premier. Clinical Knowledge Assessment 1.0

Please provide me any feedback regarding this assessment.Were there any questions that were confusing? etc.Thank you.

A patient presents c/o foot pain after tripping earlier today.

This patient hurt his wrist playing basketball. He is tender over his snuff box but has no other pain.

This patient was struck in the nose with a football.

This patient presents with pain over her lateral malleolus after tripping. At discharge you recommend:

This patient complains of knee pain after a fall.

This child fell 3 days ago and complains of persistent wrist pain.

This patient presents after being punched in the ribs. You do an xray and think that you may see a small nondisplaced fracture of the left 7th rib, no pneumothorax or other abnormalities.

This patient stubbed her toe. It's black and blue.

This elder patient says that she tripped over her slippers yesterday. She didn't strike her head and has no complaints except pain in her right hip when she walks.

This patient fell onto his elbow. He is neurovascularly intact but he reports persistent pain.

This patient fell onto his outstretched hand

A patient, not anticoagulated, present with epistaxis from his right nare for the 3rd time in 2 years

A 4 year old is crying, complaining of severe ear pain for the past 24 hours. Her temperature is 100.8 and she does not appear toxic

An 8 year old reports a sore throat for the past two days.

A fully immunized adult presents complaining of a swollen cheek that developed acutely over the past 4 hours.

A patient has awakened with crusty, red eyes for the past 3 days. He has no other eye complaints

A patient presents complaining of dentalgia. On exam, he has a fluctuant area above his Right 1st incisor

A 45 year old without any medical history reports 15 minutes of chest tightness associated with mild nausea and diaphoresis this morning while driving to work. He says that he has had similar discomfort over the past two weeks when he climbed the stairs. He feels fine now.

Which of the following is not a major risk factor for CAD?

A 60 year old patient presents complaining of palpitations for 3 days. He has no other history or complaints. HR=140’s. BP 130/70 SaO2=100%. His cardiac exam reveals an irregularly irregular tachycardia. Lungs are clear.

A 30 year old c/o 6 days of a cough, occasionally productive of clear or white sputum. Pt has no other PMH and is not a smoker. On exam he is in no distress. T=99.6 SaO2=97%. His exam is normal.

A healthy 40 year old non-smoker presents c/o a fever with rigors, cough productive of green sputum, and right sided pleuritic chest pain. T=102.1, SaO2=94% on RA. His exam is normal except for his lung exam which reveals crackles at the left base. Which if the following is FALSE?

A 40 year old woman presents c/o dyspnea with minimal exertion, anxiety and R. sided pleuritic chest pain. T=99 RR=20 HR=110 SaO2=94%. Her exam is normal. What is a reasonable approach to her diagnostic evaluation?

A middle aged man reports a nonproductive cough each night while he is supine. He often awakes with a sore throat. He denies and fever or other constitutional symptoms.

A patient reports several episodes of RUQ pain, exacerbated by greasy food. Presently, she describes her pain as 3 out of 10. She is afebrile and her abdominal exam is normal except for RUQ pain with deep palpation.

Regarding acute pancreatitis, which is FALSE:

A healthy 26 year old reports 12 hours of RLQ pain, nausea, a low grade fever and anorexia. Currently, he reports mild, 2 out of 10 pain. It is 7pm. You should:

A 66 year old man without any significant past medical history presents with painless, gross hematuria. He is afebrile and his exam is normal. His urinalysis reveals TNTC RBC’s. Which of the following is FALSE?

A 20 year old woman presents complaining of urinary frequency and dysuria. She is afebrile. She has mild, right sided CVAT. Her urinalysis reveal TNTC WBC’s, moderate RBC’s, ++Leuk Esterase, + protein.

A 41 year old man presents with acute onset of severe left flank pain radiating to his testicle. He is vomiting and diaphoretic. His vitals are normal but he appears very uncomfortable. His abdominal and testicular exam are normal. Labs and urinalysis are pending.

A 3 week old infant is brought in by mom with a fever of 100.9 rectally. Fontanelles are flat, neck is supple, lungs are clear, and there is no rash.

Dad brings his 3 year boy to Premier with a fever. The child is cranky and dad says that for the past 24 hours he has been eating and playing less than usual. The child offers no complaints. T=102.9. Neck is supple, ENT exam is normal. Lungs are clear. Abdomen is soft. The boy is circumcised.

A 4 year old is brought in by his parents with 3 days of diarrhea. His HR=110 bpm. He weighs 44 lbs. His mucous membranes are dry and his abdominal exam is normal. What is an appropriate order for IV fluid replacement? (20 ml/kg is the standard replacement)

A 60 year old with a h/o HTN presents with weakness in her right arm and difficulty speaking which began 45 minutes ago. You appropriately suspect that she is having a left MCA CVA.

A 56 year old man presents with a left facial droop which began yesterday. The remainder of his neuro exam is normal. Vitals are stable. Which of the following statements is FALSE?

The evaluation of a minor head injury in a patient who is over 65 years old must include a head CT

A man presents complaining of diffuse hives and itching which began yesterday. The patient denies any shortness of breath or difficulty swallowing. He cannot identify an allergen. His lung exam is normal. Which of the following is true?

You see a child at Premier whose injuries are concerning for abuse:Age inappropriate injuriesInjuries inconsistent with the historySuspicious burnsEtc.

Which is true of this EKG?

Which is true of this EKG?

Which is true of this EKG?

Which is true of this EKG?

Which is true of this EKG?

A patient, not anticoagulated, present with epistaxis from his right nare for the 3^rd time in 2 years

A patient presents complaining of dentalgia. On exam, he has a fluctuant area above his Right 1^st incisor

You see a child at Premier whose injuries are concerning for abuse:
Age inappropriate injuries
Injuries inconsistent with the history
Suspicious burns
Etc.