Emergency Questions

Choose the correct statement about these laboratory results: sodium, 136 mEq/L; potassium,
4.1 mEq/L;chloride, 108 mEq/L; sodium bicarbonate, 12 mEq/L; glucose, 600 mg/dL; venous pH,
7.10:

A. The anion gap is 26.

B. The corrected potassium is 2.3 mEq/L.

C. The corrected potassium is 5.9 mEq/L.

D. The corrected sodium is 126 mEq/L.

E. The corrected sodium is 152 mEq/L.

Which of the following medications is most important to administer first in hyperkalemia?

A. Albuterol

B. Calcium gluconate

C. Dextrose

D. Insulin

E. Kayexalate

A 30-year-old man presents to the ED complaining of 2 days of worsening severe right flank pain
that began abruptly and actively vomiting. The pain radiates from his flank around to the
abdomen and down toward the scrotum. Vital signs are notable for an HR of 107 beats/minute
and oral temperature of 39 c. A CT scan reveals a 9-mm obstructing stone of the left ureter with
hydronephrosis. Urinalysis is positive for 2+ blood, 2+ leukocytes, 2+ nitrites, 40 to 50 WBC/hpf,
and many bacteria. You administer pain medicine, antiemetics, and IV antibiotics. Which of the
following is the most appropriate next step in management?

A. Consult urology for possible surgical intervention

B. Observe in ED for 6 hours

C. Discharge with PO antibiotics and analgesics

D. Discharge with antibiotics, pain medicine, and instructions to drink large amounts of water
and cranberry juice
A 25-year-old married woman presents to the ED with a 6-hour history of worsening lower
abdominal pain, most severe in the RLQ. She also noticed some vaginal spotting in the morning.
She also reports nausea. Her last menstrual period was 2 months ago, but her cycles are always
irregular. She has a history of (PID). Her BP is 120/75 mm Hg, HR is 95 beats/minute, RR is 16
breaths/minute. Her abdomen is tender in the RLQ and pelvic examination reveals right adnexal
tenderness. (β-hCG) is positive. likely diagnosis?

A. ectopic pregnancy

B. cholecystitis

C. ovarian torsion

D. UTI

Related to ruptured berry aneurysm:

A. HTN increase risk of rupture twice and smoking increase it five times

B. HTN doesn't increase risk of rupture

C. smoking does'nt increase risk of rupture

D. none of the above

What physical finding would lead you to suspect a metabolic etiology of coma?

A. Asymmetric muscle tone

B. Increased blood pressure and decreased pulse rate

C. Preserved pupillary reflexes

D. When the eyelids are forcibly opened, the eyes flutter upward exposing the sclera

All of the following are ECG findings that are more consistent with acute pericarditis than an
acute MI except:

A. PR-segment depression
B. Simultaneous ST elevations and T-wave inversions

C. Diffuse ST elevations not isolated to a particular anatomic distribution

D. ST elevations that are upwardly concave rather than convex

For unresponsive traumatic bleeding patient, according to last change in ATLS trauma life
support:

A. You start blood products after one litre of colloids

B. you start blood products after one litre of NS

C. you start blood products after 4 litres of NS

D. all of the above

ESI emergency severity index includes three vital signs which are:

A. BP, TEMPERATRUE, RR

B. BP, HR, SO2

C. HR, RR, SO2

D. BP, HR, RR

A 3 -year-old man with no past medical problems presents to the ED with palpitations. For the
past days he has been feeling weak. Over the last 6 hours, he has noticed that his heart is racing.
He denies chest pain and shortness of breath. He has never felt this way before. His BP is 140/8
mm Hg, HR is 180 beats/minute, RR is 14 breaths/minute, and oral temperature is 98.9°F. His
physical examination is normal. You obtain the following rhythm strip (Figure). What is your
first-line treatment for this patient?

A. Synchronized cardioversion at 100 J

B. Adenosine 6 mg IV push

C. Adenosine 12 mg IV push

D. Valsalva maneuver
E. Verapamil 3 mg IV push

A 67-year-old woman presents to the ED complaining of a 2-day history of malaise, subjective

fever, chills, diffuse headache, and right-sided jaw pain. She also notes diminished vision in her
right eye. Her symptoms are minimally relieved with acetaminophen. She denies any sick
contacts. The patient’s BP is 130/75 mm Hg, HR is 95 beats/minute, RR is 16 breaths/minute,
oral temperature is 100.6°F, and oxygen saturation is 99% on room air. She is tender on the right
side of her scalp. You initiate empirical treatment. What is the likely diagnosis?

A. migraine

B. temporal arteritis

C. cluster headache

D. tension headache

You are a passenger aboard an airplane when a 78-year-old woman starts complaining of chest
pain and difficulty breathing. You are the only medical professional available and volunteer to
help. Fortunately, the aircraft is well-equipped with basic medical equipment, advanced cardiac
life support (ACLS) medications, and a cardiac monitor. On examination, the passenger’s BP is
75/40 mm Hg, HR is 180 beats/minute, and RR is 14 breaths per minute. On examination, the
patient is in obvious distress but able to answer basic questions. Her heart is tachycardic,
regular, and without murmurs, rubs, or gallops. Physical examination is remarkable for a
bounding carotid pulse. You attach the cardiac monitor and see a regular rhythm at 180 beats
per minute with wide QRS complexes and no obvious P waves. After asking the pilot to make an
emergency landing, what is the most appropriate next step?

A. Administer IV amiodarone

B. Perform synchronized cardioversion

C. Administer IV verapamil

D. Administer IV lidocaine

E. Administer IV procainamide

Regarding Lidocaine, all are true except?

A. Lidocaine is given intravenously when used as local anesthetic

B. Lidocaine: overdose can cause refractory seizures.

C. Lidocaine is used in resuscitation as alternative to Amiodarone

D. According to ACLS 2020 Lidocaine can be given intravenous or intraosseous in resuscitation

When treating Hypertension in ER, all true except:

A. Hypertensive emergencies are treated by oral drugs only

B. Captopril, Enalapril, and clonidine are oral drugs used when no end organ damage is found

C. Headache and epistaxis are common presentations of high BP

D. Captopril more potent than Enalapril

Which of the following ECG changes is generally the first seen in the hyperkalemic patient?

A. Peaked T waves

B. QRS widening

C. P-wave flattening

D. “sine-wave”–like QRS morphology

A 65-year-old man presents to the ED with a headache, drowsiness, and confusion. He has a
history of long-standing HTN. His BP is 230/120 mm Hg, pulse is 87 beats/minute, RR is 18
breaths/minute, and SO2 is 97% on room air. On examination, you note papilledema. A head
(CT) scan is performed and there is no evidence of ischemia or hemorrhage. Which of the
following is the most appropriate method to lower his BP?

A. Administer mannitol for rapid reduction in BP and intracranial pressure (ICP)

B. Administer a high-dose diuretic to reduce preload

C. Administer labetalol until his BP is 120/80 mm Hg

D. Administer labetalol until his BP is 180/100 mm Hg

A 69-year-old woman with HTN, DM type 1, is brought to (ED) for acting funny over the last
hour. The patient did not know where she was despite being in her own house. She also did not
recognize her family and was speaking incomprehensibly. Her (BP) is 150/80 mm Hg, heart rate
(HR) is 90 beats/minute, respiratory rate (RR) is 16 breaths/minute, and temperature is 98.9°F.
On physical examination she is diaphoretic, agitated, and tremulous. (ECG) is sinus rhythm with
normal ST segments and T waves. Which of the following is the most appropriate course of
action for this patient?

A. Administer a benzodiazepine

B. (CT) scan of the head

C. check glucose level

D. Request a psychiatric

Which of the following knee injuries is MOST likely to be associated with vascular trauma?

A. Tibial plateau fracture

B. Femoral condyle fracture

C. Anterior dislocation

D. Posterior dislocation

E. Lateral dislocation

Which of the following is the most common oncologic emergency?

A. Hypercalcemia

B. Pneumonia

C. SVCS

D. SCC

The outcome of resuscitation and the likelihood of survival are greatest when the initial cardiac
rhythm is which of the following?

A. Agonal rhythm
B. Asystole

C. Idioventricular rhythm

D. Pulseless bradycardia

E. Ventricular fibrillation (VF)

A patient taking warfarin arrives to the ED with severe hemoptysis. Which of the following
would be best initial management?

A. Administer FFP

B. Check complete blood cell count

C. Cryoprecipitate

D. Transfusion of uncrossmatched redblood cells

E. Withhold warfarin for 1 day

What is the MOST common location of pain in a pregnant woman with appendicitis?

A. Right upper quadrant

B. Right lower quadrant

C. Left upper quadrant

D. Left lower quadrant

E. Umbilicus

Both Wernicke encephalopathy and normal pressure hydrocephalus present with what
abnormality?

A. Ataxia

B. Headache

C. Mydriasis

D. Ophthalmopleg
E. Urinary incontinence

Which patient requires electrical cardioversion?

A. A 50-year-old male with 1 hour of chest pain, bradycardia with a heart rate in the 40s, and ST
elevations in the inferior leads on his ECG

B. A 75-year-old female with a history of hypertension who comes to the ED with palpitations.
The monitor shows an irregular narrow-complex tachycardia with a heart rate of 120 beats per
minute.

C. A 60-year-old male with a history of a myocardial infarction who has shortness of breath,
blood pressure of 88/50, and a wide-complex tachycardia.

D. A 35-year-old female who admits to drinking several energy drinks before arrival in the ED, is
complaining of shortness of breath, has a blood pressure of 110/90, and has a narrow-complex
tachycardia with a heart rate of 150 beats per minute.

Where is fluid most likely to accumulate and be visible on FAST examination?

A. Pericardium

B. Right upper quadrant

C. Left upper quadrant

D. Posterior to bladder

What is considered the antidote to sulfonyurea toxicity?

A. Glucagon

B. High-dose insulin euglycemic therapy

C. Octreotide

D. Phosphodiesterase inhibitor
Which of the following is the BEST view to request when assessing for the presence of
pneumothorax on chest x-ray?

A. Supine anteroposterior

B. Upright posteroanterior (PA)

C. Inspiratory PA

D. Lateral decubitus with the patient lying on the unaffected side

E. Expiratory PA

A 46-year-old woman is brought to the ED by her husband for 1 day of worsening confusion. The
patient has a history of systemic lupus erythematosus (SLE) and takes chronic oral steroids. She
has not been feeling well for the last few days. Her BP is 167/92 mm Hg, HR is 95 beats/minute,
RR is 16 breaths/minute, and temperature is 100.3°F. On examination, the patient is oriented to
name and has diffuse petechiae on her torso and extremities. Laboratory results reveal
hematocrit 23%, platelets 17,000/mL, BUN 38 mg/dL, and creatinine 1.9 mg/dL. Which of the
following is the most likely diagnosis?

A. Henoch-Schönlein purpura (HSP)

B. Disseminated intravascular coagulopathy (DIC)

C. von Willebrand disease

D. Idiopathic thrombocytopenic purpura (ITP)

E. Thrombotic thrombocytopenic purpura (TTP)

Medics bring you a 27-year-old, 70-kg man after he sustains a single gunshot wound to the leg.
The medics tell you there was “a lot” of blood at the scene. Vital signs: heart rate 110/min,
blood pressure120/90 mm Hg, respiratory rate 16/min. You estimate the blood loss at a
minimum of:

A. 250 cc.

B. 500 cc.

C. 1 L.

D. 1.5 L.

E. 2 L.

A 55-year- l w man with a past medical history of diabetes walks into the emergency
department (ED) stating that her tongue and lips feel swollen. During the history, she tells y u
she recently started a new blood pressure medication. Her only other medication is a baby
aspirin. Her vitals at triage are BP 130/70 mm Hg, heart rate (HR) 85 beats/minute, respiratory
rate (RR) 16 breaths/minute, temperature 98.7°F, and oxygen saturation 99% on room air. On
physical examination, you detect mild lip and tongue swelling. Over the next hour, you notice
that not only are her tongue and lips getting more swollen, but her face is starting to swell, her
Temp. 37.5 Which is the most likely causative agent?

A. Metoprolol

B. Furosemide

C. Aspirin

D. Lisinopril

E. Diltiazem

Abd