QUESTION:1:C:EC1230:0:0
Approximately what percentage of cervical spine fractures are seen on the cross-table-lateral view alone?

ANSWER:A
95%
ANSWER:B

90%
ANSWER:C

85%
ANSWER:D
75%

ANSWER:E
50%
QUESTION:2:E:EC1230:0:0

CT scanning of the cervical spine is indicated in all the following, except:
ANSWER:A
To delineate areas not well-visualized with standard radiographs

ANSWER:B
To delineate anatomy at the area of injury

ANSWER:C
To further evaluate the cervical spine in patients with significant cervical pain despite normal plain films
ANSWER:D

To visualize the cervicothoracic junction when not visualized on plain radiography
ANSWER:E
To further assess ligamentous injury

QUESTION:3:B:EC1230:0:0
A 24 year old healthy male patient presents to the ED following a low velocity MVC. He is awake and alert with no evidence of
intoxication or significantly painful injury. He has bilateral trapezius and paracervical muscle tenderness, but none at the midline.
 Are cervical spine X-rays required?
ANSWER:A

Yes
ANSWER:B
No

QUESTION:4:D:EC1230:0:0
All of the following are true regarding SCIWORA except:
ANSWER:A

Associated with complete injury in younger children
ANSWER:B
Associated with incomplete injury in adolescents

ANSWER:C
May deteriorate several hours after initial injury

ANSWER:D
Most commonly lower cervical injury
ANSWER:E

Associated with distraction injury
QUESTION:5:A:EC1230:0:0
Which of the following fractures are not flexion injuries?

ANSWER:A
Bilateral pedicle fracture

ANSWER:B
Atlanto-occipital dislocation
ANSWER:C

Clay Shoveler's fracture
ANSWER:D
Bilateral facet dislocation

ANSWER:E
Type II odontoid fracture






QUESTION:6:E:CA1330:0:0
In a grossly unstable patient with atrial fibrillation, initial therapy may include:

ANSWER:A
Cardioversion
ANSWER:B

Diltiazem with calcium pretreatment
ANSWER:C

Magnesium bolus followed by an infusion
ANSWER:D
Amiodarone bolus and infusion

ANSWER:E
All of the above
QUESTION:7:C:CA1330:0:0

Rapid atrial fibrillation results in a reduction in cardiac output most prominently from:
ANSWER:A
Loss of atrial kick

ANSWER:B
Release of atrial natriuretic factor

ANSWER:C
Reduction in diastolic filling time
ANSWER:D

Release of B-type natiuretic peptide
ANSWER:E
None of the above

QUESTION:8:B:CA1330:0:0
Traditional teaching holds that cardioversion of new onset atrial fibrillation does not result in embolic events. "New onset" in this
 traditional view generally refers to what time frame?
ANSWER:A

Less than 1 hour
ANSWER:B
Less than 2-3 days

ANSWER:C
Less than 1 week

ANSWER:D
Less than 1 month
ANSWER:E

Less than 1 year
QUESTION:9:A:CA1330:0:0
Successful cardioversion may result in an increase in cardiac output within a few minutes after conversion; in a patient with rapid
atrial fibrillation, by what mechanism?
ANSWER:A

Reduction in rate and therefore an increase in diastolic filling time
ANSWER:B

Rapid return of atrial "kick"
ANSWER:C
Increasing AV nodal block

ANSWER:D
All of the above
ANSWER:E

None of the above














QUESTION:10:E:CA1330:0:0
ECG predictors of WPW-atrial fibrillation include which of the following:

ANSWER:A
Very rapid (close together) R-R intervals, equal to a rate of > 250 beats per minute
ANSWER:B

Wide QRS complexes
ANSWER:C

Bizarre QRS complexes
ANSWER:D
Delta wave on prior ECG

ANSWER:E
All of the above
QUESTION:11:C:CA1700:0:0

The most sensitive test for detecting appendicitis is:
ANSWER:A
The presence of rebound tenderness during examination of the abdomen

ANSWER:B
The white blood cell count

ANSWER:C
Helical CT scan using enteric contrast
ANSWER:D

C-reactive protein
ANSWER:E
Right sided tenderness upon rectal examination

QUESTION:12:E:CA1700:0:0
Pain medicine should not be given to abdominal pain patients who are:

ANSWER:A
Less than 4 years old
ANSWER:B

Elderly
ANSWER:C
Specifically request Demerol

ANSWER:D
Have renal failure

ANSWER:E
None of the above
QUESTION:13:E:CA1700:0:0

Elderly (over age 80) patients with abdominal pain:
ANSWER:A
Most often have urosepsis

ANSWER:B
Have a 25%-40% chance of needing surgery for the abdominal condition
ANSWER:C

Are more likely than younger patients to have a classic presentation of appendicitis
ANSWER:D

Have a 10% prevalence of abdominal aortic aneurysm
ANSWER:E
b and d
















QUESTION:14:E:CA1700:0:0
The only sure way(s) to rule out the diagnosis of mesenteric ischemia are:

ANSWER:A
Ultrasound
ANSWER:B

Angiography
ANSWER:C

Surgery
ANSWER:D
CT Scan

ANSWER:E
b and c
QUESTION:15:B:CA1700:0:0

Discharging patients with the diagnosis of "abdominal pain of unknown etiology":
ANSWER:A
Should never be done from the emergency department

ANSWER:B
Should be accompanied by instructions for a re-examination in 12-24 hours

ANSWER:C
Should only be done in male patients
ANSWER:D

Should never accompany the use of pain medicine
ANSWER:E
Should never accompany the use of an H-2 blocker

QUESTION:16:C:CB1230:0:0
Attenuation coefficient refers to:

ANSWER:A
The amount of radiation needed to penetrate a given size patient
ANSWER:B

The width of the CT scan "slice"
ANSWER:C
The amount of radiation absorbed by a pixel

ANSWER:D
The degree of angulation required to properly image the brain on CT scan

ANSWER:E
The number of pixels per CT "slice"
QUESTION:17:C:CB1230:0:0

One of the most important areas to search for subarachnoid blood on the CT scan is:
ANSWER:A
Around the cingulate gyrus

ANSWER:B
Over the convexity of the brain
ANSWER:C

 In the Sylvian fissure
ANSWER:D

Adjacent to the tentorium
ANSWER:E
Near the foramen magnum
















QUESTION:18:A:CB1230:0:0
The primary difference in appearance between a brain tumor and brain abscess on CT scan is:

ANSWER:A
The enhanced "rim" of an abscess is smooth and thin
ANSWER:B

Abscess will not adequately enhance with contrast
ANSWER:C

The amount of edema is always greater around an abscess
ANSWER:D
Multiple brain tumors may found in a single brain but abscesses occur in pairs

ANSWER:E
There is no difference in appearance between a brain tumor and brain abscess
QUESTION:19:D:CB1230:0:0

A hemodynamic infarction occurs when:
ANSWER:A
Extreme blood pressure elevations precipitate intraparenchymal hemorrhagic infarction

ANSWER:B
Hypotension causes the atrophied brain to pull away from the dura causing a subdural hemorrhagic infarction

ANSWER:C
Hypotension causes sludging and thrombosis of one or both carotid arteries
ANSWER:D

Hypotension causes regional ischemia in "watershead areas" of the brain
ANSWER:E
A cardiac embolus lodges in the middle cerebral artery

QUESTION:20:B:CB1230:0:0
Which skull fracture not well visualized on CT?

ANSWER:A
Parietal Fracture
ANSWER:B

Basilar Skull Fracture
ANSWER:C
Frontal Sinus Fracture

ANSWER:D
Depressed Skull Fracture

ANSWER:E
All the above are well visualized on CT
QUESTION:21:A:CB1700:0:0

All of the following agents are effective in rate control of rapid atrial fibrillation in the ED EXCEPT:
ANSWER:A
Digoxin

ANSWER:B
Diltiazem
ANSWER:C

Verapamil
ANSWER:D

Propranolol
ANSWER:E
Amiodarone
















QUESTION:22:E:CB1700:0:0
Contraindications to the use of Ibutilide for conversion of atrial fibrillation include all of the following EXCEPT:

ANSWER:A

Congenital prolongation of Q-T interval
ANSWER:B

Hypomagnesemia
ANSWER:C
Concurrent use of Procainamide

ANSWER:D
Concurrent use of Dofetilide
ANSWER:E

Concurrent use of Diltiazem
QUESTION:23:E:CB1700:0:0
In addition to defibrillation, which of the following antiarrhythmic agents has been shown to improve survival to hospital discharge
and neurologic status following pre-hospital ventricular fibrillation/pulseless V-tach?

ANSWER:A
Lidocaine
ANSWER:B

Procainamide
ANSWER:C
Bretylium

ANSWER:D
Amiodarone

ANSWER:E
None of the above
QUESTION:24:C:CB1700:0:0

With respect to the role of Glycoprotein inhibitors in the treatment of acute transmural MI, which of the following statements is
true?
ANSWER:A
Abciximab + LMWH has been shown to be associated with worse outcome and greater bleeding risk than Abciximab + Unfractionated heparin
 (NICE trial)
ANSWER:B

Abciximab has been shown to improve end-point survival for AMI without PTCA (GUSTO 4)
ANSWER:C
Abciximab + half dose rPA has been shown to improve end-point survival for AMI (GUSTO 5)

ANSWER:D
Tirofiban + Unfractionated heparin has been shown to improve end-point survival in AMI

ANSWER:E
None of the above
QUESTION:25:B:CB1700:0:0

Which are the following are true regarding tenecteplase (TNK-tPA)?
ANSWER:A
Greater cost than alteplase (t-PA) or retevase (rPA)

ANSWER:B
Non-weight based dosing is associated with increased risk of bleeding complications

ANSWER:C
Significant mortality benefit over t-PA
ANSWER:D

Shorter half-life than t-PA
ANSWER:E
None of the Above













QUESTION:26:C:CC1500:10:11
All of the following are true except:

ANSWER:A
LMWHs have better bioavailability than UFH
ANSWER:B

LMWHs have a more predictable anticoagulant response than UFH
ANSWER:C

 LMWHs have shorter half-lives than UFH
ANSWER:D
LMWHs have a lower incidence of heparin-induced thrombocytopenia than UFH

ANSWER:E
LMWHs do not require monitoring of the aPTT
QUESTION:27:C:CC1500:0:0

LMWHs have been shown to be useful in the treatment of venous thrombo-embolism (VTE).  Which of the following statements is false?

ANSWER:A
Meta-analyses of randomized controlled trials show that LMWHs are at least as safe and effective as UFH in preventing recurrent VTE
for patients with DVT
ANSWER:B

Outpatient therapy of DVT with LMWH leads to marked cost savings
ANSWER:C
When LMWH are utilized in the outpatient setting, aPTT levels must be followed

ANSWER:D
LMWH are not currently recommended for outpatient therapy in patients with pulmonary embolism

ANSWER:E
None of the above
QUESTION:28:B:CC1500:46:46

LMWHs have been studied for use in patients with non-ST segment elevation acute coronary syndromes (ACS).  Which of the following
agents has demonstrated superiority over UFH in randomized controlled trials?
ANSWER:A
 nadroparin

ANSWER:B
enoxaparin
ANSWER:C

dalteparin
ANSWER:D
 tinzaparin

ANSWER:E
None have shown superiority over UFH

QUESTION:29:D:CC1500:0:0
Preliminary investigations into the use of enoxaparin in patients with ACS who also undergo PCI, glycoprotein IIb-IIIa inhibitor
therapy, or thrombolysis suggest all the following except:
ANSWER:A
Compared with historical controls, enoxaparin appears to cause no excess bleeding in patients who undergo PCI

ANSWER:B
Compared with historical controls, enoxaparin appears to cause no excess bleeding when used in conjunction with abciximab

ANSWER:C

Enoxparin appears to result in similar infarct-related artery patency rates compared with UFH when used with thrombolytic agents in
patients with STE-myocardial infarction.
ANSWER:D
Enoxaparin should be used instead of glycoprotein IIb-IIIa inhibitors for patients with ACS who undergo PCI

ANSWER:E
All of the above are correct











QUESTION:30:C:CC1500:0:0
Exclusion criteria for the outpatient use of LMWH include all the following except:

ANSWER:A
Age >75
ANSWER:B

Age <18
ANSWER:C

History of CHF
ANSWER:D
Evidence of pulmonary embolus

ANSWER:E
Active bleeding
QUESTION:31:C:CC1600:0:0

The Epley maneuver works to treat benign paroxysmal positional vertigo by:
ANSWER:A
Deconditioning the central nervous sytem

ANSWER:B
Moving otolithic material from the utricle to the posterior vertical semicircular duct

ANSWER:C
Moving otolithic material from the posterior vertical semicircular duct to the utricle
ANSWER:D

sealing a leak at the round or oval window
ANSWER:E
Activating central nervous sytem vertigo inhibition systems

QUESTION:32:B:CC1600:0:0
Common causes of dizziness include all of the following except:

ANSWER:A
Near syncope
ANSWER:B

Optic neuropathy
ANSWER:C
Dysequilibrium

ANSWER:D
Anxiety

ANSWER:E
Vertigo
QUESTION:33:D:CC1600:0:0

Most antivertigo medications work because they are:
ANSWER:A
Antihistamines

ANSWER:B
Phenythiazines
ANSWER:C

Antidepressants
ANSWER:D

Anticholinergics
ANSWER:E
Benzodiazepines
















QUESTION:34:A:CC1600:0:0
A major distinguishing feature for acute labyrinthits as compared to vestibular neuronitis is that the former:

ANSWER:A
Is associated with auditory dysfunction
ANSWER:B

Is associated with Meniere's disease
ANSWER:C

Is associated with lack of response to antihistamine therapy
ANSWER:D
Is associated with CNS malignancy

ANSWER:E
None of the Above
QUESTION:35:C:CC1600:0:0

Peripheral nystagmus is suggested by:
ANSWER:A
Vertical direction

ANSWER:B
Extinguishing on examination

ANSWER:C
Enhancement with eye closure
ANSWER:D

Fast component only
ANSWER:E
Asymmetry

QUESTION:36:B:CC1700:0:0
The advantages of supine-oblique views include all of the following, except:

ANSWER:A
Improved visualization of the cervicothoracic junction
ANSWER:B

Improved visualization of the odontoid
ANSWER:C
Improved visualization of the posterior column

ANSWER:D
Improved visualization of the neural foramena

ANSWER:E
None of the above
QUESTION:37:B:CC1700:0:0

In the NEXUS trial, the most commonly injured vertebral body was
ANSWER:A
C1

ANSWER:B
C2
ANSWER:C

C4
ANSWER:D

C5
ANSWER:E
C6
















QUESTION:38:C:CC1700:0:0
Which of the following are important limitations in the diagnosis of traumatic aortic disruption using TEE?

ANSWER:A
Inability to visualize small intimal flaps
ANSWER:B

Inability to visualize small pseudoaneurysms
ANSWER:C

Inability to visualize aortic branch vessels
ANSWER:D
Inability to visualize the distal aorta

ANSWER:E
Inability to visualize the aortic arch
QUESTION:39:B:CC1700:0:0

The failure rate of nonoperative management for blunt splenic injury:
ANSWER:A
Correlates inversely with the AAST injury grade on CT

ANSWER:B
Correlates directly with the AAST injury grade on CT

ANSWER:C
Correlates inversely with the degree of hemoperitoneum on CT
ANSWER:D

Correlates directly with baseline splenic size
ANSWER:E
Is not related to findings on abdominal CT

QUESTION:40:B:CC1700:0:0
Approximately what percentage of anterior abdominal gunshot wounds can be successfully managed without surgery?

ANSWER:A
10%
ANSWER:B

30%
ANSWER:C
50%

ANSWER:D
60%

ANSWER:E
90%
QUESTION:41:C:CD0900:0:0

All of the following are considered criteria for the diagnosis of Kawasaki's disease except:
ANSWER:A
Conjunctival injection

ANSWER:B
Fissured lips
ANSWER:C

Exudative pharyngitis
ANSWER:D

Palmar desquamation
ANSWER:E
Fever for > 5 days
















QUESTION:42:B:CD0900:0:0
Erythema multiforme must be distinguished from which life-threatening condition?

ANSWER:A
Disseminated Intravascular Coagulation
ANSWER:B

Steven's Johnson Syndrome
ANSWER:C

Sepsis
ANSWER:D
Meningococcemia

ANSWER:E
Impetigo
QUESTION:43:E:CD0900:0:0

The most common thrombocytopenic purpura of childhood is:
ANSWER:A
Henoch-Schonlein purpura

ANSWER:B
Rocky Mountain spotted fever

ANSWER:C
Enterovirus infection
ANSWER:D

Purpura fulminans
ANSWER:E
Idiopathic Throbocytopenia Purpura

QUESTION:44:A:CD0900:0:0
All of the following are part of the differential diagnosis of a maculopapular rash except:

ANSWER:A
Hand-foot-mouth syndrome
ANSWER:B

Pityriasis rosea
ANSWER:C
Erythema Infectiosum

ANSWER:D
Scarlet fever

ANSWER:E
Roseola infantum
QUESTION:45:C:CD0900:0:0

What is the most important clinical issue to identify in a case of Staphylococcal Scalded Skin Syndrome?
ANSWER:A
Precipitating event

ANSWER:B
Presence of fever
ANSWER:C

Dehydration
ANSWER:D

Use of lubricants
ANSWER:E
None of the above