7-30-25 Board Review

A 65-year-old man with STEMI presents to a rural ED without a cath lab. He is hypotensive and in ventricular tachycardia requiring cardioversion. Which of the following most accurately describes the appropriate next step?

• Wait until the patient is fully stabilized before initiating transfer

• Transfer the patient only if he requests it and signs informed consent

• Transfer the patient with appropriate personnel and equipment despite instability

• Admit the patient locally for ongoing medical management

Which of the following criteria is not required for a transfer to be considered “appropriate” under EMTALA?

• A) Medical treatment to minimize risk prior to transfer

• B) Consent from the receiving facility with capacity to treat

• C) Use of certified transport personnel with proper equipment

• D) Completion of a full financial screening before transfer

A pregnant patient in active labor arrives at a non-obstetric ED. According to EMTALA, what is the most appropriate action?

• Transfer the patient immediately to the nearest labor and delivery unit

• Perform an MSE and stabilize the patient for transfer if possible

• Keep the patient and manage the delivery regardless of facility capabilities

• Obtain consent and discharge the patient home if she prefers

Under EMTALA, which of the following does constitute a violation?

• Ambulance arrives during diversion status and is turned away without evaluation

• A hospital transfers an unstable trauma patient to a trauma center with appropriate documentation

• A patient refuses transfer despite explanation of benefits and risks

• A hospital delays financial questions until after MSE is completed

What is the sending physician’s responsibility regarding interfacility transport?

• Ensure that the patient is accompanied by two providers

• Personally accompany the patient if advanced life support is needed

• Determine the appropriate level of transport care or delegate this appropriately

• Confirm that the receiving facility has space, then transfer without further action

A 74-year-old woman presents with fever, left lower quadrant pain, and mild nausea for 2 days. She is hemodynamically stable and tolerating oral intake. A CT scan confirms uncomplicated acute diverticulitis. Which of the following is the most appropriate management?

• Admit for IV antibiotics and bowel rest

• Begin oral antibiotics and discharge with close follow-up

• Withhold antibiotics and discharge without follow-up

• Proceed with urgent colectomy due to age and infection

Which of the following findings most suggests complicated diverticulitis on CT imaging?

• Mild pericolic fat stranding

• Bowel wall thickening without fluid collection

• Small pericolic abscess

• Absence of diverticula

In patients with diverticulitis, which of the following features most strongly predicts complicated disease?

• Nausea and anorexia

• Leukocytosis of 12,000

• CRP >175 mg/L

• Left lower quadrant pain for 2 days

A 78-year-old male presents with left lower quadrant pain and a palpable mass. CT shows a 6 cm pericolic abscess. He is hemodynamically stable. What is the most appropriate next step?

• Start oral antibiotics and discharge

• Percutaneous drainage plus IV antibiotics

• Proceed to urgent exploratory laparotomy

• Colonoscopy to confirm diagnosis

Which of the following statements is true regarding the use of antibiotics in uncomplicated diverticulitis?

• All patients must receive antibiotics for 10–14 days

• Antibiotics reduce recurrence and long-term complications

• Antibiotics may be withheld in select low-risk patients

• Broad-spectrum IV antibiotics are first-line for all presentations