1.

The following are possible causes of acute chest pain, EXCEPT one:
A. spont. Pneumothorax
B. MI
C. aortic dissection
D. Claude-Bernard-Horner syndrome
E. thoracic trauma

2. The following blood tests are diagnostic for acute MI:

A. cardiac troponin T
B. elevated ESR
C. CRP
D. LDL-cholesterol
E. D-dimers

3. The following statements regarding pulmonary embolism (PE) are true, EXCEPT one:
A. Fibrinolysis is indicated in massive PE with hemodynamic compromise
B. Oral anticoagulation should be given for 6 months
C. Clopidogrel is indicated in patients with PE with contraindications to anticoagulants
D. Spiral CT and V/Q scan are crucial for diagnosis
E. Clinical findings include tachycardia and low SPO2

4. Which of the following is an indication for fibrinolysis in ST-elevation MI:

A. New RBBB in the context of chest pain
B. ST-segment elevation on the ECG in 2 or more contiguous leads, accompanying chest
pain lasting for less than 12 hrs
C. Increased cardiac troponin
D. Increased myoglobin
E. Failure of primary percutaneous coronary angioplasty

5. In a patient with acute aortic dissection, the following are true, EXCEPT one:
A. If misdiagnosed, mortality exceeds 90%
B. Type A involves ascending aorta
C. Hypotension, shock and new heart murmur can be physical signs
D. Echocardiography and a spiral CT can be crucial for diagnosis
E. Elevated cardiac troponin is associated with prognosis (D dimer nt troponin)

6. The following are risk factors of progression to cardiogenic shock in a patient with acute MI,
EXCEPT one:
A. Anterior infarction
B. Right ventricular infarction
C. Age >65yrs
D. Prior infarction
E. Female gender
 7. Which of the following therapeutic measures are specific for septic shock:
A. Fluid replacement
B. Vasopressors
C. Recombinant human activated protein C (Xygris)
D. Natrium bicarbonate if pH<7.1
E. Fibrinolysis with t-PA

8. In a pacient with acute aortic dissection the following are true, except one:
A. B. C. D.
F. E. Elevated cardiac troponim is associated with prognosis

9. The most important therapy in complete pneumothorax with acute respiratory failure is:
A. Oxygen therapy 8 L/min
B. Endotracheal intubation and mechanical ventilation
C. Pleural aspiration
D. Iv diuretics and cardiotonics
E. Circulatory function support with sympathomimetic vasoconstrictor amines

10. Which is the drug of choice in case of anaphylaxis?

A. Antihistamines
B. IV crystalloids
C. IV corticosteroids
D. IV adrenaline
E. 60mg prednisone

11. . Immediate therapy in a case of cardiogenic acute pulmonary edema includes the following,
EXCEPT for:
A. IV fractioned morphine
B. CPAP Oxygen therapy
C. IV Nitroglycerin
D. IV Metoprolol
E. IV Furosemide

A 46 year old female is admitted with a history of 3 weeks dyspnea minimal effort and fatigue, symptoms
that have aggravated progressively, Clinical exam: temperature 37.6 C, respiratory exam – no rales, raised
jugular venous pressure, BP 85/60 mm HG, regular HR 110/min, dampened cardiac sounds, mild edema
in both feet (questions 12-13).

12. What investigation would you consider NOT to be needed performed in the initial evaluation?
A. ECG
B. Echocardiography
C. Chest CT
D. Chest X-ray
E. Complete blood count
Chest X-ray in this patient is shown below (1) and the cardiac echo confirms the radiological suspicion

13. Rg
14. G
15. G
16. rgr

A 65 yo female presents to the ED for dyspnea ad retrosternal pain which started 3 hrs before (…) the
hospital. Five days prior the patient had been released from hospital after an orthopedic surgery
replacement for coxarthrosis. The clinical exam reveals cyanosis, tachypnea 40 RR, BP 90/60, P
120bpm, resp exam: slight diminished breath sounds in the basal right thorax (…)

17. Based on this info, the most probable diagnosis is:

A. Late onset nosocomial pneumonia with Gram neg bacteria
B. Acute MI
C. Acute aortic dissection
D. Pulmonary Embolism
E. Status asthmaticus

18. What do you expect to see on the ABG analysis?

A. Decreased PO2 and decreased( PCO2 or normal)
B. Decreased PO2 and increased PCO2
C. Increased PO2 and increased PCO2
D. Increased PO2 and decreased PCO2
None of the above

19. Which therapy should be started in this patient?

A. IV heparin 5000 UI every 6 hours
B. Heparin bolus followed by iv heparin in continuous perfusion at a rate that keeps INR
twice the normal values
C. Primary angioplasty
D. GP IIb/IIIa inhibitor
E. Heparin bolus followed by continuous IV heparin at a rate that keeps INR btw 2-3

20. Which of the following conditions are risk factors for this pathology?
A. Prolonged immobilization
B. Lower limb fractures
C. Pregnancy
D. Malignancy
E. All of the above

21. Which of the following ECG patterns is NOT present in case of sustained monomorphic
ventricular (..)
A. Wide QRS complexes (over 120 msec)
B. ST-T segment changes opposing the QRS axis
C. Ventricular capture beats
 D. Fusion beats
E. At least three different morphology of the QRS complexes during the arrhythmic
episodes

A 50 yo male, heavy smoker, comes to the ED two hours after the onset of a severe, constricting pain.
Immediately after the ER admission the patient presents syncope. Physical exam after (…) distended and
pulsatile jugulars, no pulm rales, HR= 37bpm regular, BP= 105/60 (…) symmetrical. EKG recordings are
shown below.

22. The following is true about this bradycardia with EXCEPTION of:
A. It is usually initially reflex-induced due to acute coronary artery occlusion
B. Tends to respond to iv atropine
C. Usually resolved with immediate successful coronary revascularization
D. Temporary cardiac pacing is useful when pharmacologic treatment is not efficient
E. It represents a class I indication for permanent cardiac pacing

A 22 year old female comes to the ED after a syncope developed after prolonged standing (>30….)
relatively warm environment (in a church where she was practipating at her best friend wedding….) was
preceded by lightheadedness, fatigue and intense perspiration. She recovered immediately assued a
recumbent position (questions 23-24).

23. The most probable diagnosis is:

A. Hypoglycemic crisis;
B. Vasovagal syncope
C. Cardiac syncope
D. Carotidian syncope;
E. Primary autonomic failure

24. There is no family history of sudden cardiac death and her screening tests and baseline ECG (…)
normal. The correct management in this case is:
A. Reassurance, education about how to avoid this condition and discharge
B. Holter monitoring is mandatory
 C. ECG monitoring in the ED and carotid sinus compression test
D. Tilt test
E. Carotidian Doppler is mandatory

A 60 year old male, presents at the ED due to sudden onset, fast rate, regular palpitations associated with
dyspnea at rest, intense vertigo and blurred vision. He had a history inferior MI (1 year before….. primary
PCI of right coronary artery 12 hours from the event)) with preserved LV function …. Ahowed a LV EF
of 55%). ACG at admission is
bellow (figure 3) (questions 25-
26):

25. Most probable diagnosis is:

A. Ventricular fibrillation
B. Sustained ventricular tachycardia
C. Sinus tachycardia
D. Atrial flutter
E. Atrial fibrillation with aberrancy

26. His BP is 70/50 mm Hg. Emergency treatment is:

A. Synchronous external electric shock
B. Iv Digoxin
C. Lidocaine iv infusions 0.5 mg/min
D. Asynchronous external electric shock
E. Vagal maneuvers

A 20 year old male college student complains of frequent episodes of palpitations, which (…) They have a
sudden onset, continue for a few minutes and end abruptly. His ECG shows (…)
27. What is your diagnosis?
A. RBBB
B. Ant lat MI sequelae
C. Wolff Parkinson White syndrome
D. Atrial tachycardia
E. Right ventricular hypertrophy

28. The severity of injuries in case of an electrocution does NOT depend on:
A. Source of current, atmosphere (lightning) or man-made
B. Type of current, continuous or alternative current
C. Intensity and voltage
D. Host factors (pre-existing injuries)
E. Current pathway through the body

29. In case of animal bites:

A. For superficial wounds, no treatment necessary
B. For deep wounds AB must be started, but rabies vaccine will not be administered unless
(…) occur
C. Clinical management and wound care involves cleaning, suturing, sterile dressing,
and tetanus vaccination (IM ATPA)
D. Not all snake bites are considered venomous
E. There is no difference btw a wild animal bite and a domestic animal bite

30. Death in case of immersion in fresh water occurs from:

A. Asphyxiation acute pulm edema
B. Sinus blockage
C. Acute resp failure
D. Ventricular fibrillation
E. Third degree AV-block
31. Cardiovascular pathology in a lightning-struck patient are the following, EXCEPT of:
A. Reduced myocardial contractility
B. Myocardial infarction
C. Atrial arrhythmia
D. Ventricular arrhythmia
E. Spasms of coronary arteries

32. The first-line medical therapy for non-variceal GI bleeding is:

A. IV PPI (omeprazole, pantoprazole)
B. Packed RBC transfusions
C. Wide-spectrum antibiotics
D. Placement of nasogastric tube
E. IV H2 Receptor antagonists ( ranitidine, cimetidine)

33. The management of variceal GI bleeding does NOT include:

A. Endoscopic variceal ligation
B. Fluid and blood-product replacement
C. Use of octreotide
D. Variceal injection therapy (sclerotherapy)
E. Prevention of recurrent bleeding using Ca channel blockers

34. Acute abdominal pain associated with vomiting, constipation and abdominal distention in a
patient with (…) abdominal surgery most likely suggests:
A. Cholangitis
B. Cholecystitis
C. Bowel obstruction
D. Appendicitis
E. Diverticulitis

35. A 70 year old patient with chronic renal failure presents with limb paresthesia and muscle cramps.
His ECG (figure 5) one should suspect:
A. left ventricle hypertrophy
B. hyperkalemia
C. acute myocardial infarction
D. left ventricular aneurysm
E. intracerebral hemorrhage
 36. Precipitating factors of hepatic encephalopathy include
A. hypernatremia
B. hyperkalemia
C. hyperhydration
D. GI bleeding;
E. excessive dietary fat intake

37. A sudden onset severe and well localized abdominal pain does NOT likely suggest:
A. perforated viscus
B. mesentric infarction
C. ruptured aneurysm
D. myocardical infarction;
E. acute gastroenteritis

38. The management of a patient with severe abdominal pain hemodynamic instability should begin
with:
A. US examination
B. Abdominal X-ray
C. Hemodynamic resuscitation
D. Antibiotics
E. Abdominal CT

35 (II). Which of the following regarding (…) atrial fibrillations is TRUE:

A. Chest compressions are stopped while AED is charging to avoid electrocution risk
B. A break in chest compressions should not take more than 30 sec in order to obtain max
resuscitation efficacy
C. Current guidelines recommend using single pad AED
D. Chest compressions stop only during shock delivery
 E. Can be carried out only by professionally trained medical staff

36 (II). Which of the following signs are NOT PRESENT at phys exam in a patient with a
hyperglycemic emergency?

A. Signs of volume depletion

B. Neurological findings
C. A fruity odor
D. Kussmaul respiration
E. Hypothermia

37 (II). Which of the following statements are true regarding diabetic ketoacidosis?

A. The effective serum osmolarity is very high, usually >320mOsm/kg

B. The arterial pH is > 7,30
C. Coma are frequent
D. The plasma glucose usually > 250 mg/dl
E. The plasma glucose usually > 600 mg/dl

38 (II). Which of the following statements are false regarding abd pain in hyperglycemic emergencies?

A. Is present especially in HHS (hyperosmolar hyperglycemic state)

B. Is assoc. with the severity of the metabolic acidosis
C. Is correlated with the severity of hyperglycemia or dehydration
D. Is more frequent in adults than in children
E. Disappears after the resolution of acidosis

39 (II). Which of the following signs are not present at phys examination in a patient with a
hyperglycemia emergency?

A. Signs of volume depletion

B. Immunological findings
C. A fruity odor
D. Kussmaul respirations
E. Hypothermia

40 (II). Which of the following therapeutic measures are not indicated in DKA and HHS?

A. Fluid replacement
B. IV insulin administration to all patients irresponsive of serum potassium
C. Replete potassium defects
D. Sodium bicarbonate
E. Maintenance of a slightly elevated serum glucose until the patient is stable

41 (II). Which of the following does not induce insulin shock?

A. Metformin
B. Excessive carbohydrates meal
C. Overexertion without additional calories intake
 D. Renal failure
E. Alcohol ingestion

42 (II). Which of the following signs are NOT present at phys exam in a patient with hypoglycemia?

A. Pale and clammy skin

B. Low BP
C. Normal/rapid pulse
D. Kussmaul respirations
E. Confusion

43 (II). The highest recurrence rate of bleeding in gastro-duodenal ulcers occurs with:

A. Forrest II A
B. Forrest I B
C. Forrest II C
D. Forrest II B
E. Forrest III

46. Regarding blue toe syndrome – one of the following statements is FALSE:

A. fingers are painful and cyanotic

B. peripheral pulse is present
C. foot is cold
D. it is an embolic occlusion of digital arteries with atherothrombotic material
E. fingers are cold

47. One of the following statements regarding cardiopulmonary resuscitation (CRP) is TRUE:

A. agonal breathing occurs shortly after the heart stops in all the cardiac arrests
B. basic life support (BLS) consists of a series of procedures performed to restore the
circulations of oxygenated blood after a sudden respiratory and/or cardiac arrest
C. BLS should start in the first 7 minutes
D. In BLS, pulmonary ventilation should be performed only by the medical team
E. agonal breathing is not a sign of cardiac arrest

48. One of the following statements regarding Advanced Life Support (ALS) is FALSE:

A. cardioversion is used to convert atrial or ventricular tachyarrhythmias

B. asystole is non-shockable
C. pulseless Electrical Activity is non-shockable
D. ventricular tachycardia is unshockable rhythm
E. ventricular tachycardia is shockable.

49. One of the following statements regarding Advanced Life Support (ALS) is TRUE:

A. the dose of adrenaline is 1 mg iv every 3-5 minutes

B. amiodarone is useful before the first electrical shock
C. adrenaline is given in ventricular fibrillation after the first shock
 D. Mg is given in AF
E. Sodium bicarbonate is used in life-threatening hypokalemia.

50. One of the following is FALSE regarding the RIFLE criteria:

A. the RIFLE criteria is used to asses severity

B. the RIFLE criteria is used to asses evolution and prognosis
C. the RIFLE criteria is used for AKI classification
D. RIFLE is an acronym of Risk, Injury, Failure, Loss and End-stage kidney disease
E. the RIFLE criteria is used for chronic kidney disease classification.

51. The most efficient therapy to reduce serum potassium in the emergency setting of refractory
hyperkalemia is:

A. IV glucose 10% with insulin

B. Hemodialysis
C. nebulized 5 mg Salbutamol in repeated doses
D. IV furosemide 1 mg/kg iv in slow infusion
E. Ca gluconate 10 ml iv in slow infusion.

52. A 55 year old insulin-requiring diabetic female patient is brought to ED after having been found lying
in her home, conscious, partially cooperative with bradypshychia, bradilalia and intense perspiration. Her
family mentions she had vomited and had aqueous diarrhea two days prior to this event. During this time
she had not stopped her usual insulin therapy. The most likely diagnosis is:

A. septic shock
B. severe hyperglycemia progressing to hyperglycemic coma;
C. severe hyperglycemia secondary to persistence of insulin-therapy in the clinical settings
mentioned above;
D. acute cerebral edema secondary to dehydration
E. lactic acidosis.

53.

54. Differential diagnosis for acute epigastric pain does NOT include:

A. Peptic ulcer disease

B. Appendicitis
C. Acute MI
D. Ruptured ovarian cyst
E. Acute pancreatitis

55. The following conditions may represent with acute abdomen signs, EXCEPT:

A. Acute appendicitis
B. Acute small bowel obstruction
C. Mesenteric vascular occlusion
 D. Nephrotic colic
E. Peritonitis

56. A 65 year old diabetic male patient represents to the ED for acute epigastric pain with dizziness,
nausea and vomiting. His HR=56, BP= 90/60. What investigation would you perform first?

A. CBC
B. ECG
C. Chest R(x)
D. Abdominal US
E. (…) lipase measurement

57

58. The following causes of coma are (…) with focal or lateralizing signs, EXCEPT:

A. Cerebral hemorrhage
B. Subdural hematoma
C. Brain abcess
D. Subarachnoid hemorrhage
E. Basilar artery occlusion

59. The following causes of coma do not (…) meningeal irritation, EXCEPT:

A. Opioid intoxication
B. Hypoglycemia
C. Uremia
D. Hepatic coma
E. Meningitis

60. In coma induced by acute alcoholic intoxication clinical signs include the following, EXCEPT:

A. Hypothermia
B. Hypotension
C. Meningeal irritation signs
D. No focal neurological signs
E. Normal CT scan

61. In which of the following conditions the prognosis of coma is best?

A. Anoxic coma
B. Metabolic coma
C. Hemorrhagic coma
D. Head injury
E. Vegetative state

62. If the diagnosis of coma is uncertain, the first intention treatment consists of:

A. Mannitol
 B. Naloxone and glucose thiamine combination
C. Lumbar puncture
D. Broad spectrum antibiotics
E. Sub-cut administration of heparin

63. Severe hypothermia is characterized by all EXCEPT:

A. 28-32 °C (…)temperature
B. P(…)lized
C. Hallucinations
D. W
E. Osborne wave on the electrocardiogram

64.

65. Treatment in case of drowning includes all the following EXCEPT one:

A. Removal of oral-pharyngeal obstruction

B. Correction of alkalosis
C. O2 therapy with facial mask
D. Drying and thermal protection of the patient
E. Antibiotics

66. The mechanism of death in case of drowning in fresh water is the following:

A. Sinus bradycardia and heart arrest

B. Acute pulmonary edema
C. Rapid rhythm atrial fibrillation
D. Ventricular fibrillation
E. Acute resp failure

67.