EMLE Trial Exams 2020 Last Update: 04/02/2021 Dec.

Modifications

December exams modification

Exam 7 (‫)نسخة سؤال وجواب فقط‬
Q 9) Answer is overfeeding not malignancy

Explanation version
Exam 1
Q 23)

In tumor lysis syndrome, a constellation of clinical signs and symptoms may develop prior to the initiation of
chemotherapy or, more commonly, within 72 hours after administration of cytotoxic therapy.[20]Inquiries should be
made with regard to the following:

Time of onset of symptoms of malignancy

Presence of abdominal pain and distension

Presence of urinary symptoms - Such as dysuria, oliguria, flank pain, and hematuria

Occurrence of any symptoms of hypocalcemia - Such as anorexia, vomiting, cramps, seizures, spasms, altered mental
status, and tetany

Symptoms of hyperkalemia - Such as weakness and paralysis.

https://emedicine.medscape.com/article/282171-clinical?src=mbl_msp_android&ref=share

Q 28) the answer is (C)

Because of the rarity (<0.01%) of ureteral stones in the normal age group of pregnant women and the large ureters
secondary to pregnancy hormones, one should look for predisposing factors such as hyperparathyroidism if renal stones
are discovered. The diagnosis, evaluation, and therapy are similar as in the nonpregnant patient, except lithotripsy is
contraindicated. Pain caused is usually excruciating. There is no such thing as a ureteral filter.

Reference: Lange Q And A obs and gyn p. 141

Q 34)

Predisposing high-risk factors for non-traumatic aortic dissection include:

 Hypertension (occurs in 70% of patients with distal Standford type B AAD)

 An abrupt, transient, severe increase in blood pressure (e.g., strenuous weight lifting and use of
sympathomimetic agents such as cocaine, ecstasy, or energy drinks)
 Genetic conditions including Marfan syndrome (In an IRAD review, Marfan syndrome was present in 50% of
those under age 40, compared with only 2% of older patients), Ehlers-Danlos syndrome, Turner syndrome, and
bicuspid aortic valve, coarctation of the aorta. In patients with Marfan syndrome, cystic medial necrosis is seen
in the tissues

1
EMLE Trial Exams 2020 Last Update: 04/02/2021 Dec. Modifications

 Pre-existing aortic aneurysm

 Atherosclerosis
 Pregnancy and delivery (risk compounded in pregnant women with connective tissue disorders such as Marfan
syndrome)
 Family history
 Aortic instrumentation or surgery (coronary artery bypass, aortic or mitral valve replacement, and percutaneous
stenting or catheter insertion)
 Inflammatory or infectious diseases that cause vasculitis (syphilis, cocaine use).

Reference:

https://www.ncbi.nlm.nih.gov/books/NBK441963/

Q 45) the answer is (A)

Nonmaternal deaths are due to factors that have nothing to do with the pregnancy, such as gunshot wounds or motor
vehicle accidents. Domestic violence is, sadly, the most common cause.

Lange Q and A obs and gyn p. 160

Q 60)

What is a single-use device? According to the Food and Drug Administration a single-use device, also referred to as a
disposable device, is intended for use on one patient during a single procedure. It is not intended to be reprocessed (i.e.,
cleaned and disinfected or sterilized) and used on another patient.

Reference:

https://www.cdc.gov/oralhealth/infectioncontrol/faqs/single-use-devices.html

Q71)

Olfactory loss due to head trauma is a common condition. Depending on the severity of the head trauma, anosmia might
occur in up to 30% of patients. The period of time until recovery has been reported to be a couple of months in most
cases. However, recovery from post-traumatic olfactory loss might occur much later.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2767158/

Exam 5
Q 16) debatable

The right answer is d

High estrogen levels appear to be etiologi-cally implicated in the syndrome of cholestatic hepatosis. Why they
predispose to cholestasis is unclear. This may also recur with the use of birth control pills.

Reference: Lange Q and A obs and gyn p. 159

2
EMLE Trial Exams 2020 Last Update: 04/02/2021 Dec. Modifications

Q 52) not debatable

(D) The three most common causes of maternal mortality are hemorrhage, hypertension, and pulmonary embolism. Of
these, the hypertensive disorders are the most common. Anesthesia, heart disease, collagen diseases, and asthma are
also causes of maternal death, but they are not among the top three as recorded in current maternal death statistics.
Maternal mortality is steadily declining, and causes are changing in relative incidence.

Reference: Lange Q and A obs and gyn p.

Exam 6
Q 28) for more explanation

Q 47) not debatable, thoracotomy is the right answer.

The classic physical findings in cardiac tamponade included in Beck’s triad are hypotension, jugular venous distension,
and muffled heart sounds.

Surgical options include creating a pericardial window or removing the pericardium. Emergency department
resuscitative thoracotomy and the opening of the pericardial sac is a therapy that can be used in traumatic arrests with

3
EMLE Trial Exams 2020 Last Update: 04/02/2021 Dec. Modifications

suspected or confirmed cardiac tamponade. These options are preferable to needle pericardiocentesis for traumatic
pericardial effusions.

The management of penetrating cardiac injuries has evolved to favor emergency department thoracotomy for the
hemodynamically unstable or pulseless patient, and median sternotomy/anterolateral thoracotomy for the
hemodynamically stable patient.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4855741/

https://www.ncbi.nlm.nih.gov/books/NBK431090/

Q 41)

Hypoxia for longer than about 3 minutes causes brain damage and coma, with dilated pupils unresponsive to light, inert
or rigid limbs, unresponsiveness to all stimuli, abolition of brainstem reflexes and, ultimately, no electrical activity on
EEG (brain death).

https://www.sciencedirect.com/topics/medicine-and-dentistry/brain-hypoxia

Q69) for more explanation:

• Glucose challenge test (GCT) is a screening test and glucose tolerance test (GTT) is a confirmatory test for gestational

Diabetes mellitus (GDM).

• It should be done for patients who are at high risk of development of GDM or if GDM is suspected.

• Previous eclampsia does not predispose the patient to GDM.

Indications:

1. Age >25years

2. BMI >25

3. Previous GDM

4. Family h/o DM in first-degree relative

5. Previous baby with macrosomy/congenital anomalies

6. H/o abnormal glucose tolerance/IR (PCOS)

7. Macrosomia/polyhydramnios in current pregnancy

8. Previous unexplained stillbirth

4
EMLE Trial Exams 2020 Last Update: 04/02/2021 Dec. Modifications

Reference:

*Smart Study Series Obstetrics and Gynecology 3rd edition P.157

*Williams Obstetrics, 24 edition, P.1172

Exam 8
Q 8) numbers in the choices appears like that on the website

Q 47) choices are not related to question

Disinfection is a process in addition to cleaning. When is it necessary?

a) When a patient touches a door handle

b) When an item comes into contact with mucous membranes

c) When you re-use a bedpan made of pulp

d) It isn’t necessary unless you know a patient has an HCAI

The answer is: b

Exam 9
Q 9)

5
EMLE Trial Exams 2020 Last Update: 04/02/2021 Dec. Modifications

A teardrop or teardrop sign is found in several regions of the body:

Teardrop sign (ankle)

teardrop sign (intracapsular breast implant rupture)

Teardrop sign (superior mesenteric vein)

Extension teardrop fracture of the cervical spine

Flexion teardrop fracture of the cervical spine

Pelvic teardrop

Teardrop sign (inferior orbital wall fracture)

https://radiopaedia.org/articles/teardrop-disambiguation?lang=us

Q 30) debatable

I think d is the right answer

Pleural ultrasound can detect physiologic amounts of pleural fluid (5ml),15 but a minimal volume of 20ml is more
reliably detected,16 and ultrasound is 100% sensitive for effusions >100ml.

Pleural biopsy should be considered, only if TB or malignancy is suggested.

Chest radiographs are useful to confirm the presence of effusion. The findings of effusion vary with the amount of
effusion. On an upright posteroanterior (PA) view, minimum 200ml of fluid is required to obliterate the costophrenic
angle, called the meniscus sign of a pleural effusion. However, in a lateral view, 50 ml of fluid can be diagnosed with this
sign. Ultrasound of chest is more sensitive and useful for diagnosis of pleural effusion and also helps in planning
thoracentesis.

https://www.ncbi.nlm.nih.gov/books/NBK448189/

Q) 67 not debatable

Nonalcoholic fatty liver disease is the most common cause of mild alteration of liver enzyme levels in the western world,
and, according to the National Health and Nutritional Survey, point-prevalence is about 23% among American adults.48
The biochemical picture includes mildly raised aminotransferase levels, and GGT levels can be elevated up to 3 times the
upper reference value in nearly half of patients in the absence of ethanol consumption.49 As with chronic viral hepatitis,
an AST/ALT ratio greater than 1, which is observed in 61% of patients with advanced fibrosis and 24% of patients with no
or initial fibrosis, is highly suggestive of advanced liver disease.50 Suspicion of nonalcoholic fatty liver disease is
increased by the presence of conditions linked to the metabolic syndrome and insulin resistance (increased body mass
index, diabetes, hyperlipemia, hypertension), although the disease may occur in patients without these associated
factors.48,49 The diagnostic approach to suspected nonalcoholic fatty liver disease is aimed at ruling out other causes
of liver disease since there is no specific blood test for diagnosis. Distinguishing between simple steatosis with or
without minimal inflammation and nonalcoholic steatohepatitis with fibrosis with confidence is not possible on clinical
grounds alone, and therefore liver biopsy should be performed in order to confirm diagnosis and assess prognosis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC545762/#!po=2.10084

Exam 10

6
EMLE Trial Exams 2020 Last Update: 04/02/2021 Dec. Modifications

Q 42) for more explanation..

Acute subdural hematomas are less than 72 hours old and are hyperdense compared with the brain on computed
tomography scans. The subacute phase begins 3-7 days after acute injury. Chronic subdural hematomas develop over
the course of weeks and are hypodense compared with the brain.

https://emedicine.medscape.com/article/1137207-overview