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* nbme-em
 #846114  
  kennychan - 12/06/17 16:46
 
  A 77-year-old woman is brought to the emergency department because of a 4-hour history of pain in her left leg after she fell at home. She is unable to bear weight on her leg. She has no history of serious illness and takes no medications. Vitals are WNL. On examination, the left lower extremity is held in external rotation and is 1 inch shorter than the right lower extremity. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?
a) Dislocation of the knee
b) Fracture of the acetabulum
c) Fracture of the femoral nectk
d) Fracture of the pelvis
e) Fracture of the tibial plateau

Please help!
 
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* Re:nbme-em
#3354479
  kennychan - 12/06/17 17:11
 
  A 62 year-old man with chronic low back pain comes to the emergency department because of a 2-day history of feeling light-headed. He has not had chest pain or palpitations. He says that he usually has constipation, but he has had bowel movements daily for the past 5 days. The stools are dark reddish brown. His temperature is 37C, pulse is 140/min and regular, respirations are 24/min, and blood pressure is 80/55 mm Hg. The patient is too light-headed to check orthostatic. The lungs are clear to auscultation. The abdomen is soft, nontender, and not distended. Rectal examination shows soft, dark red stool; test of the stool for occult blood is positive. Fingerstick blood glucose concentration is 92 mg/dL. Lab studies show:
Hemoglobin 8.8
Hematocrite 22%
Leukocyte count 8000
Platelet count 240/mm3
Serum
Lactate 6 mg/dL (N 5-15)
Coagulation studies are within normal limits. An ECG shows no abnormalities other than sinus tachycardia. A blood sample is sent for typing and crossmatch lab studies. A subclavian catheter is inserted, and its position is confirmed by CXT. After administration of 0.9% saline (2L) through a large-bore peripheral intravenous catheter, pulse is 120/min and regular, and blood pressure is 100/70 mm Hg. Repeat serum lactate concentration is 4.5 mg/Dl. Central venous pressure is 11 mm Hg (N 3-8). Which of the following is the most appropriate next step in management?

a) Continued 0.9% saline infusion
b) Dopamine fusion
c) Norepinephrine infusion
d) Packed blood cell transfusion
e) Whole blood transfusion

A 47-year-old man is brought to the emergency department by paramedics 15 minutes after he was involved in a motor vehicle collision in which he was the restrained driver. The patient was traveling at about 5 miles per hour (8km/hr) in a parking lot when his car struck a parked vehicle. Paramedics say that the damage to both vehicles was minimal. The patient says he consumed two beers earlier in the evening. On arrival, he is awake, alert, and fully oriented. His temperature is 37 C, pulse is 88/min, respirations are 14/min, and blood pressure is 124/78 mm Hg. Examination shows tenderness and swelling of the right elbow but no other abnormalities. The physician recommends that an x-ray of the elbow be performed. The patient says that would prefer to leave; he is able to verbalize the risks of leaving using his own words. Which of the following is the most appropriate next steps in management?
a) Allow the patient to leave against medical advice
b) Call the police
c) Detain the patient until his blood alcohol concentration is measured
d) Discharge the patient with a diagnosis of elbow contusion
e) Obtain x-rays despite the patientís wishes

Please help!
 
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* Re:nbme-em
#3354534
  tchops - 12/07/17 10:06
 
  C)
D)
C)
 
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