A 24-year-old man presents to the emergency department with two days of relentless vomiting, without any clear trigger, hematemesis, fever, sick contacts or diarrhea. He has had several similar episodes in the past. Upon further history, he admits to consuming over 2 grams of cannabis per day. You suspect cannabinoid hyperemesis syndrome.
A 55-year-old man presents to the emergency department with his usual chronic back pain from a prior motor vehicle accident. There are no red flag features for back pain. He is requesting an early refill of his immediate-release oxycodone. He has been prescribed extended-release and immediate-release oxycodone for several years. This is his fifth presentation requesting an early refill. You suspect opioid use disorder (OUD).
A 4-year-old boy presents to your emergency department with a history of a possible foreign body ingestion. The possible ingestion was unwitnessed, but the parents are concerned it may have been a button battery. The child appears completely well on initial assessment. He has no significant past medical history.
Early intensive blood pressure control after intracerebral hemorrhage is associated with improved functional outcomes.
In patients younger than 6 years, a coin is not likely to pass if it is the size of a quarter or larger.
Azithromycin is associated with a greater reduction in the severity of wheezing-related symptoms than placebo in pre-school age children who present to the emergency department with moderate-to-severe acute wheezing.
Which one of the following statements about sodium–glucose cotransporter-2 inhibitor-associated diabetic ketoacidosis is false?
Low doxycycline prescription fill rates are observed following emergency department visits for sexually transmitted infections.
In outpatients with a non-high pretest probability, age-adjusted D-Dimer levels can safely rule out leg DVT without the need for LEL compression ultrasonography.
Among patients with acute atrial fibrillation for whom acute rhythm control is a safe option, vernakalant is more effective than procainamide.
For children aged 6 to 17, with acute nonoperative limb injury, pain scores at 60 minutes after drug administration improved with ibuprofen plus acetaminophen compared with ibuprofen alone.
Which one of the following statements about signs suggestive of child physical abuse is false?
Pulse oximetry derived oxygen saturation (SpO2) readings may be up to 1.5 percentage points higher for critically ill patients with darker skin tone than those with lighter skin tone.
The Glasgow Coma Scale is a valuable prognostic tool for predicting delayed neuropsychiatric sequelae in carbon monoxide poisoning.
Which one of the following statements regarding the use of tranexamic acid in adults with gastrointestinal bleeding is false?
In patients with acute ischemic stroke with salvageable brain tissue identified by perfusion imaging who do not initially receive thrombectomy, intravenous alteplase administered 4.5 to 24 hours after onset provides functional benefit.
The Sudbury vertigo risk score can identify the risk for a serious diagnosis in patients presenting with vertigo.
Which one of the following is not a risk factor for traumatic intracranial hemorrhage in patients 65 years or older presenting in the emergency department for a ground-level fall-related head injury?
A strategy using the combined measurement of the biomarkers glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase-L1 (UCH-L1) has 100% sensitivity and 100% negative predictive value for ruling out intracranial injury in patients with mild traumatic brain injury.
For acute traumatic pain management in the Emergency Department, methoxyflurane can significantly reduce pain scores with pain relief occurring within 10-30 minutes.
Which one of the following statements regarding angioedema is false?
Among children with gastroenteritis-associated vomiting, the provision of ondansetron after an emergency department visit leads to lower risk of moderate-to-severe gastroenteritis during the subsequent 7 days.
The absence of regional wall motion abnormalities on bedside cardiac ultrasound performed by emergency physicians can safely rule out non-ST-elevation acute coronary syndrome as a cause for chest pain.
In CT scans done for blunt abdominal trauma, over a third of children will have non-trauma related incidental findings noted.
Which one of the following statements comparing intravenous ketorolac with intravenous analgesic dose ketamine for the treatment of pain in chest trauma is false?
Nebulized ketamine provides equivalent analgesia for acute pain in the emergency department compared to IV morphine.
There is an increase in respiratory adverse events in children with upper respiratory infection undergoing emergency department sedation.
Which one of the following statements about heat stroke is false?
Opioid prescriptions for headache in the emergency department are associated with higher rates of long-term prescription opioid use.
Which one of the following outcomes at one year is associated with emergency department opioid prescriptions?
In pediatric patients, receiving pre-emptive preprocedural oxygenation or procedural oxygenation is associated with having a lower risk of airway, breathing and circulation interventions during sedation compared with patients not receiving procedural oxygenation.
Which one of the following statements about the management of sudden vision loss is false?
Which one of the following statements about CT imaging in abdominal trauma and the Pediatric Emergency Care Applied Research Network (PECARN) intra-abdominal injury prediction rule is true?
Among critically ill adults undergoing tracheal intubation, preoxygenation with noninvasive ventilation (bilevel positive airway pressure) results in a lower incidence of hypoxemia during intubation than preoxygenation with an oxygen mask.
Which one of the following statements regarding opioid prescribing in the emergency department is false?
Experienced health care practitioners demonstrate high accuracy in diagnosing pediatric elbow fractures on x-ray.
Which one of the following statements about the evaluation of the acute abdomen is false?
In the prehospital setting, the incidence of true electrical capture in patients receiving transcutaneous pacing is less than 20%.
For out of hospital cardiac arrest with a shockable rhythm, initial anterior-posterior placement of the defibrillator pads by Emergency Medical Services results in higher return of spontaneous circulation than anterior-lateral placement.
In patients with acute brain injury, a single (2g) ceftriaxone dose decreased the risk of early ventilator-associated pneumonia.
Which one of the following statements about CT scanning for head injury is false?
Physician gestalt is superior to existing screening tools for identifying sepsis in critically ill patients presenting to the emergency department.
Patients should be advised that a steroid flare-up may occur in the first 24 to 48 hours after knee joint injection.
Older patients are at risk of sustaining serious intracranial injuries with ground level falls.
The likelihood of favorable functional status for patients with in-hospital cardiac arrest receiving CPR for 32 minutes or longer is less than 1%.
Which one of the following statements about the treatment of pulmonary embolism (PE) is false?
Which one of the following statements about the diagnosis of pulmonary embolism (PE) is false?
When compared to intubation, non-invasive airway management of comatose patients with acute poisoning is associated with a greater clinical benefit.
There is no significant protection against surgical site infection with the use of sterile gloves for wound repairs at the emergency department compared to using clean gloves.
When treating patients with migraine with both IV metoclopramide 10mg and IV dexamethasone, 16 mg of dexamethasone is more effective than 4mg.
Intranasal ketorolac is inferior to intravenous for the treatment of renal colic in adults in the emergency department.
A 12-year-old boy arrives at midnight at the emergency room with acute testicular pain. You suspect testicular torsion.
You see an 86-year-old patient who is admitted to the hospital with hypoactive delirium. His head CT is normal and no infectious cause is found. His creatinine level is 130 umol/L (baseline 95 umol/L), the rest of the blood results is unremarkable. He is followed for chronic lumbar pain for which he takes long-acting morphine 30 mg twice a day, the dose has been the same for many years. He also takes verapamil for hypertension. According to his family, he also has a history of recurrent falls, associated with involuntary muscle movements that cause him to fall without warning symptoms. On physical examination, he is irritable and inattentive. You also notice myoclonus without any focal neurological deficits. You suspect opioid-induced neurotoxicity (OIN).
A 54-year-old female presents to your rural emergency department with a complaint of a new rash. She has a history of gout and has been started on allopurinol over the last few months. She has a diffuse morbiliform rash, is febrile, and is found to have elevated LFTs and eosinophils. You suspect drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome.
The use of non-contrast multislice CT alone is unable to rule out aneurysmal subarachnoid haemorrhage at 24 hours after headache onset.
Most patients with covert brain infarctions discovered after CT of the head in the emergency department are informed of these findings.
There is compelling evidence to support the hypothesis that the omicron variant causes laryngotracheobronchitis.
In the context of traumatic injuries, which one of the following statements about the tranexamic acid (TXA) use is false?
After cannabis legalization, the percentage of moderately injured drivers with a THC level above the legal limit, measured at participating trauma centers, more than doubled.
Point of care ultrasound assessment is more accurate than comprehensive physical examination in the detection of pleural effusions.
Which one of the following statements about button battery ingestion in children is false?
You see an 86-year-old patient who is admitted to the hospital with hypoactive delirium. His head CT is normal and no infectious cause is found. His creatinine level is 130 umol/L (baseline 95 umol/L), the rest of the blood results is unremarkable. He is followed for chronic lumbar pain for which he takes long-acting morphine 30 mg twice a day, the dose has been the same for many years. He also takes verapamil for hypertension. According to his family, he also has a history of recurrent falls, associated with involuntary muscle movements that cause him to fall without warning symptoms. On physical examination, he is irritable and inattentive. You also notice myoclonus without any focal neurological deficits.
In patients with acute ischemic stroke treated with alteplase, the use of non-vitamin K antagonist oral anticoagulants in the past seven days is associated with an increased risk of intracranial hemorrhage.
Topical skin adhesives for superficial laceration repair in children have a similar cosmetic outcome to sutures, adhesive tape and staples.
Which one of the following statements about patients with non-consensus transient ischemic attack (TIA) as compared to classic TIA is false?
A 42 year old woman presents to the ER with a five day history of low back pain with burning pain radiating into her right foot. She has a 12 year history of chronic low back pain with intermittent left sided “sciatica” pain in her thigh. She notes “tingling” in her genital area. There is no incontinence. On examination, you find that her anal tone and perianal sensation are normal, as are power, tone, reflexes, and sensation in the legs. You recommend analgesics and advise her to seek review if she develops bilateral sciatica, becomes incontinent, or develops leg weakness. Three days later, she returns with cauda equina syndrome (CES) and undergoes surgical decompression. She is left with lower limb weakness, numbness of the genitalia, loss of sexual function, and urinary and faecal incontinence.
The use of ultrashort-acting B-blockers in sepsis and septic shock with persistent tachycardia improves mortality.
In patients with corneal abrasions topical tetracaine drops provide greater pain relief compared to artificial tears without an increased rate of adverse effects.
Which one of the following statements about the medical needs of emergency department (ED) patients presenting with acute altered mental status due to presumed alcohol or illicit substance intoxication is false?
Ultrasound guidance improves overall successful arthrocentesis of medium sized joint effusions (elbow, wrist or ankle).
A 25-year-old female burnt her left arm and hand while pouring soup out of a pot. Upon examining the patient, you note that the burn involves the epidermis and some parts of the dermis. The burn has blisters and a moist appearance that blanches with pressure.
Peripheral nerve blocks are effective as a rapid treatment option for the treatment of primary headache disorders, which include migraine, tension headache, and cluster headaches.
In children diagnosed with radial head subluxation, missed upper extremity fractures are rare.
Reliance on pulse oximetry to triage patients and adjust supplemental oxygen levels may place Black patients at increased risk for hypoxemia.
Which one of the following statements about hereditary angioedema is false?
Use of nonsteroidal anti-inflammatory drugs is not advised during pregnancy beginning at 20 weeks’ gestation.
There is compelling evidence to support the hypothesis that the omicron variant causes laryngotracheobronchitis.
Most patients with covert brain infarctions discovered after CT of the head in the emergency department are informed of these findings.
Elevated blood pressure readings in the emergency department are associated with adverse cardiovascular outcomes within 2 years of the visit.
Which one of the following statements about the management of a cutaneous abscess in the emergency department is false?
Which one of the following has been associated with a reduction in post lumbar puncture headache occurrence?
In patients with acute myocardial infarction and anemia, electing to transfuse patients with an 80g/L hemoglobin threshold is non-inferior to employing a 100g/L threshold.
A 40 year-old female presents to your office with complaints of episodic headaches that are not responding to over-the counter ibuprofen. Headaches are accompanied by nausea and photophobia, and have caused her to miss work. She would like you to prescribe an antibiotic, as she feels these are sinus headaches, having been diagnosed with this previously when she presented to an after-hours clinic. However, you suspect a diagnosis of migraine, but there are several mimics that should be considered in the diagnosis first.
The risk of intracranial hemorrhage after a head injury for patients 65 years and older on a direct oral anticoagulant is significantly higher compared with patients not on anticoagulation.
For patients in the emergency department with severe agitation, intramuscular ketamine resulted in a significantly shorter time to adequate sedation than a combination of intramuscular midazolam and haloperidol.
Among patients presenting to the emergency department, which one of the following complaints has the worst 7 day mortality?
Which one of the following statements about conditions related to cannabis use is false?
In patients aged 60 years and older with unstable distal radius fractures, there are no clinically meaningful patient-reported outcome differences 24 months after injury between patients choosing surgical treatment and those opting for closed reduction and casting.
In unvaccinated adults with COVID-19 infection and risk factors for disease progression, treatment with fluvoxamine reduces the risk of hospitalization compared with placebo.
A 54-year-old female presents to your rural emergency department with a complaint of a new rash. She has a history of gout and has been started on allopurinol over the last few months. She has a diffuse morbiliform rash, is febrile, and is found to have elevated LFTs and eosinophils. You suspect drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome.
Proper preservation of amputated parts consists of wrapping the part in saline soaked gauze inside a watertight bag and placing it on ice.
Among critically ill adults undergoing tracheal intubation, administration of an intravenous fluid bolus compared with no fluid bolus significantly decreased the incidence of cardiovascular collapse.
In the assessment of a patient with undifferentiated acute flank pain, earlier use of Point of Care Ultrasound (PoCUS) is associated with a shorter length of stay in the acute care setting, without compromising diagnostic accuracy.
A 25-year-old woman presents to your clinic with a recent fever and tender swelling and redness in her axilla. She reports she has experienced this a few times in the past associated with purulent drainage that resolved on its own. You suspect hidradenitis suppurativa (HS).
Concerning the management of traumatic hemothorax requiring drainage, a 14-Fr percutaneous catheter (pigtail) is as effective as a chest tube.
For treatment of acute ischaemic stroke, use of tenecteplase results in similar functional outcomes compared to alteplase in patients presenting with acute ischaemic stroke who meet standard criteria for thrombolysis.
Which one of the following statements about widow spiders is false?
In using point-of-care ultrasound to diagnose hydronephrosis, longitudinal views of the kidney show good sensitivity and specificity compared with a combination of longitudinal and transverse views
In nonhypotensive patients with acute symptomatic pulmonary embolism (PE), a high heart rate portends an increased risk of all-cause and PE-related mortality.
Which one of the following statements about immobilization of torus fractures of the wrist in children is true?
The administration of intravenous or intraosseous calcium during out-of-hospital cardiac arrest improves sustained return of spontaneous circulation.
The use of non-contrast multislice CT alone is unable to rule out aneurysmal subarachnoid haemorrhage at 24 hours after headache onset.
Which one of the following statements about eye injuries in athletes is false?
Which one of the following statements about spontaneous bacterial peritonitis in patients with cirrhosis is false?
Which one of the following statements about dental injuries in athletes is false?
In a patient presenting to the emergency room with angioedema, a prior history of hypertension is predictive of the need for intubation.
Which one of the following statements about the sideline management of head and neck injuries in athletes is false?
For possible mandibular fractures, the sideline physician should have the athlete bite down to check for malocclusion.
Among adult patients with refractory ventricular fibrillation during out-of-hospital cardiac arrest, survival to hospital discharge occurs more frequently among those who receive double sequential external defibrillation (DSED; rapid sequential shocks from two defibrillators) than among those who receive standard defibrillation.
Regarding entrapped rings, which one of the following statements is false?
In a pediatric patient with a mild to moderate exacerbation of asthma presenting to the emergency department, a single dose of dexamethasone is not inferior to two doses of dexamethasone.
Which one of the following statements regarding local anesthetic systemic toxicity (LAST) is false?
Which one of the following statements about bacterial meningitis is false?
Among patients with trauma at risk of massive transfusion, there is no significant reduction of 24-hour blood product consumption after administration of 4 factor prothrombin complex concentrate.
Females with incident nonvalvular atrial fibrillation discharged from the emergency department are less likely to receive oral anticoagulants than males.
The treatment of tobacco dependence with a brief negotiation interview in the emergency department can increase the rate of abstinence at 3 months.
Which one of the following statements regarding stercoral colitis is false?
You are considering implementing use of dexmedetomidine (DEX) for sedation in your rural emergency department.
Endovascular treatment is efficacious for patients with ischaemic stroke caused by an anterior circulation large-vessel occlusion who presented 6–24 h from onset or last seen well, and who were selected on the basis of the presence of collateral flow on CTA.
Intra-articular lidocaine may be a safe and effective alternative to intravenous sedation for facilitating reduction of anterior shoulder dislocations in the emergency department.
Bougie use during emergency tracheal intubation in children is associated with procedural success.