1. Which patient is LEAST at risk of experiencing a heat related emergency?

A. 80-year-old male with a past medical history of congestive heart failure on sertraline and tramadol

B.  3-year-old female accidentally left in a vehicle on a hot summer day

C.  40-year-old male with a past medical history of multidrug abuse and homelessness

D.  50-year-old male with a past medical history of hypertension on metoprolol but otherwise healthy

E. 76-year-old female with a past medical history of mild dementia who lives alone

2. 35-year-old male with a past medical history of hypertension and obesity goes hiking with his friends. They get lost and end up spending several hours in the hot sun. You find them taking shelter under a tree. You suspect that he has some heat exhaustion, but he is complaining of a pruritic, erythematous rash. Once you get them to safety, what can be prescribed for the rash:

A. Diphenhydramine

B. Chlorhexidine cream

C. 1% salicylic acid

D. Prednisone

D. A, B, C

E. All of the above

3. Who is most at risk for acalculous cholecystitis?

A. 40-year-old female with a past medical history of obesity who is pregnant

B. 50-year-old male with a past medical history of chronic alcohol abuse

C. 25-year-old female with a family history of gallstones status post endoscopic retrograde cholangiopancreatography (ERCP)

D. 75-year-old female with a with a past medical history of diabetes mellitus admitted to the ICU for pneumonia on vasopressors

E. 35-year-old male stung by a scorpion in Madagascar

4. How sensitive is bilirubin for acute cholecystitis?

A. 20%

B. 40%

C. 60%

D. 80%

5. What is NOT a cutaneous sign of hemoperitoneum?

A. Crescent sign

B. Fox sign

C. The Blue Scrotum Sign of Bryant

D. Stabler sign

E. Cullen Sign

F. Grey Turner Sign

6. Pancreatitis can occur with a normal lipase level especially in chronic pancreatitis.

A. True

B. False

7.  25-year-old female presents after returning from a trip to Africa. She is complaining of “turning yellow.” She has had a week of intermittent fevers, chills myalgias, and abdominal pain. No headache, cough, dyspnea, chest pain, dysuria, or rashes. Her abdominal pain is localized to the right upper quadrant. The etiology of her pain is:

A. Viral Hepatitis

B. Acute Cholecystitis

C. Gilbert’s Syndrome

D. Hepatocellular Carcinoma

E. Choledocholithiasis

8.  65-year-old male with a past medical history of chronic alcohol abuse, congestive heart failure, diabetes mellitus, and cirrhosis presents complaining of fever. His abdomen is tender and distended on examination. There is a large amount of ascites on bedside ultrasound. A polymorphonuclear leukocyte (PMN) count of ____ indicates spontaneous bacterial peritonitis.

A. >150

B. >200

C. >250

D. >300

9.  Spontaneous bacterial peritonitis is most commonly caused by:

A. Gram negative Enterobacteriaceae

B. Pneumococcus

C. Enterococcus

D. Cryptococcus

E. Eikenella

10. In a study of 31,614 admissions of patients with cirrhosis and ascites, the overall mortality was 7.6%. What diagnostic test was associated with a reduction in mortality from 8.9% to 6.3%?

A. Abdominal Ultrasound

B. CT Abdomen/Pelvis

C. Paracentesis

D. Hepatitis C Antibody

E. Blood Cultures


Tintinalli, J. E., & Cline, D. M. (2013). Tintinallis emergency medicine: Just the facts. New York: McGraw-Hill Medical.

Jain, et al. History, Physical Examination, Laboratory Testing, and Emergency Department Ultrasonography for the Diagnosis of Acute Cholecystitis. Acad Emerg Med. 2017 Mar;24(3):281-297.

Epperla et al. A Review of Clinical Signs Related to Ecchymosis. WMJ. 2015 Apr;114(2):61-5.

Gaetano, et al. The benefit of paracentesis on hospitalized adults with cirrhosis and ascites. J Gastroenterol Hepatol. 2016 May;31(5):1025-30.


1.D 2.E 3.D 4.B 5.A 6.A 7.A 8.C 9.A 10.C