Emergency Medicine Question Bank

Read the Emergency Medicine Question Bank sample questions

1. 1.A 3-month-old boy is brought to the ED by his 16-year-old mother after the infant reportedly stopped breathing and became dusky. The mother reports that she quickly "blew into his mouth" and some formula came out of his nose. Thereafter, he started breathing again and his appearance turned pink and healthy. Your examination is remarkable only for generalized hypotonia. Your most appropriate action is to:

   • A.Discuss postprandial regurgitation with the mother and discharge the baby with instructions to keep the head elevated after feeding
   • B.Start the infant on theophylline 6 mg/kg per day and arrange follow-up with a pediatrician the following day.
   • C.Admit the infant to the hospital for further evaluation.Correct
   • D.Arrange for a home apnea monitor and schedule an outpatient workup with a pediatrician

   Why: In alcohol withdrawal with malnutrition, IV thiamine must be given before/with any glucose to prevent precipitating Wernicke encephalopathy. The BM (4.2) is normal so glucose is not urgently needed; thiamine repletion is the priority next step.

2. 2.The goal of disaster triage to:

   • A.First assess the nonambulatory patients.
   • B.First assess the "walking wounded.â€
   • C.Give priority to the most salvageable patients with the most urgent conditionCorrect
   • D.Provide an initial needs assessment.

   Why: Streptococcus pneumoniae is a Gram-positive coccus classically sensitive to benzylpenicillin (penicillin G). The atypicals (Mycoplasma, Legionella) lack a conventional cell wall or are intracellular, and Bordetella is not reliably penicillin-sensitive.

3. 3.In 2007, revised guidelines for prophylaxis against infective endocarditis were developed and endorsed by the American Dental Association, the Infectious Diseases Society of America, and the American Academy of Pediatrics. According to these latest guidelines:

   • A.All patients with porcine valve replacements should now routinely receive prophylaxis against methicillinresistant Staphylococcus aureus (MRSA) prior to dental procedures.
   • B.Genitourinary or gastrointestinal operations or procedures require less intense prophylaxis than do oral or respiratory procedures.
   • C.In patients with prosthetic heart valves, the number needed to treat (NNT) to prevent one case of infective endocarditis is less than 1000.
   • D.High-risk adults with penicillin allergy may receive cephalexin 2 g, clindamycin 600 mg, or either azithromycin or clarithromycin 500 mg.Correct

   Why: Urethral underactivity (stress incontinence) reflects weak sphincter tone; duloxetine, a serotonin–norepinephrine dual-reuptake inhibitor, increases urethral sphincter tone and is the most clinically useful drug class. Anticholinergics treat overactivity, not underactivity.

4. 4.An unconscious patient who is 32 weeks pregnant presents with probable carbon monoxide (CO) poisoning. Choose the true statement:

   • A.Because fetal hemoglobin does not bind CO as readily as adult hemoglobin does, significant fetal toxicity is rare.
   • B.The maternal Pao2 is usually depressed in CO poisoning
   • C.Oxygen treatment of CO poisoning in the pregnant woman should be extended 5 times longer than is needed to complete the maternal course of treatmentCorrect
   • D.If the patient requires intubation, establishing a normal Pco2 will result in a normal pH

   Why: Beta-blockers do not cause hypothyroidism; they only blunt peripheral conversion of T4 to T3 and mask hyperthyroid symptoms. Pituitary failure, thionamide over-treatment, and Hashimoto's are all genuine causes of hypothyroidism.

5. 5.A 59-year-old man is brought to the ED by his son. The patient is disheveled and cannot walk without assistance. He appears apathetic and does not respond to questions. His son reports that the patient drinks alcohol daily and had complained of double vision. First-line therapy must include:

   • A.Glucose-containing intravenous fluid.
   • B.Intravenous thiamine followed by intravenous fluids.Correct
   • C.Intravenous magnesium.
   • D.Ophthalmology consultation.

   Why: Cephalexin (a first-generation cephalosporin) covers Staphylococcus aureus, the usual pathogen in lactational mastitis, and is compatible with breastfeeding. Dicloxacillin's listed 5-day course is too short, vancomycin is not orally absorbed, and amoxicillin lacks reliable anti-staphylococcal coverage.

6. 6.You are treating an irritable 10-month-old child with supraventricular tachycardia (SVT). The best treatment option to stop the dysrhythmia in this child is:

   • A.Adenosine as rapid intravenous pushCorrect
   • B.Vagal stimulation alone.
   • C.Intravenous verapamil.
   • D.Oral digoxin.

   Why: Creatinine clearance overestimates GFR because creatinine is also tubularly secreted, making it the least accurate of the listed methods. Inulin, iohexol, and iothalamate clearances are true filtration markers and are more accurate.

7. 7.One of your security guards grabs you as you come through the door to start a shift and says, "You've got to give this guy something to calm him down." You see a disheveled middleage man being held down by two officers. You learn that the patient has been in substance abuse rehabilitation but you don't know what drugs he abused. The rehab center did send a note stating that he had a seizure moments before they called the police and that he has had no access to acutely ingesting anything. The patient is tachycardic, hypertensive, tremulous, diaphoretic, and hallucinating, yelling "the demons are on me, get rid of the demons." For rapid tranquilization you choose to administer:

   • A.LorazepamCorrect
   • B.Haloperidol.
   • C.Olanzapine
   • D.Risperidone.

   Why: Bromocriptine has the longest safety record in pregnancy and is preferred when fertility/conception is desired. Cabergoline, pramipexole, and pergolide have less pregnancy safety data.

8. 8.Proper decontamination involves:

   • A.Spraying off particulate matter that remains on the skin with water.
   • B.Intubating critically ill patients before gross decontamination
   • C.Irrigating ocular exposures after the whole-body decontamination.
   • D.Removing clothing quicklyCorrect

   Why: In a broad-complex tachycardia that may be VT, verapamil is contraindicated because it can cause profound hypotension and hemodynamic collapse if the rhythm is ventricular. Amiodarone and lidocaine are appropriate, and adenosine is comparatively safe diagnostically.

9. 9.A 72-year-old man with a history of chronic obstructive pulmonary disease (COPD) presents to the emergency department with a complaint of progressive shortness of breath. He has an arterial blood gas analysis on room air with a pH of 7.26, a PCO2 of 52 mmHg, and a PO2 of 48 mmHg. An arterial blood gas analysis performed 6 months ago, when the patient was in stable condition, showed a pH of 7.40, PCO2 of 43 mmHg, and a PO2 of 72 mmHg. Oxygen is started at 4 L via facemask. A repeat arterial blood gas drawn 30 minutes later shows a pH of 7.22, a PCO2 of 65 mmHg, and a PO2 of 70 mmHg. The most likely cause of this patient's worsening hypercapnia is:

   • A.Worsening shunt.
   • B.ncreased ventilation–perfusion mismatchCorrect
   • C.Anxiety.
   • D.Worsening diffusion abnormality.

   Why: Estrogen therapy is the single most effective treatment for postmenopausal vasomotor symptoms such as hot flushes and night sweats. Clonidine and SERMs are far less effective, and testosterone is not a primary therapy for these symptoms. [REVIEW: keyed answer may be incorrect — estrogen (b) is the most effective treatment, not testosterone.]

10. 10.Choose the correct statement concerning the treatment of asthma in pregnancy:

    • A.The use of subcutaneous epinephrine early in pregnancy has been associated with an increased risk of fetal malformationsCorrect
    • B.Theophylline is associated with an increased incidence of premature labor
    • C.Parenteral beta-agonists given near-term promote uterine contractility and lead to premature delivery
    • D.The dosage of corticosteroids must be reduced during pregnancy.

    Why: Haloperidol, a high-potency antipsychotic, is preferred for acute severe agitation/delirium in the elderly because it has minimal anticholinergic and hypotensive effects. Benzodiazepines and chlorpromazine risk oversedation, falls, and worsening confusion.