ABEM Cardiovascular & Respiratory Emergencies 2

Question 1

A 58-year-old male presents with acute onset tearing chest pain radiating to the back, BP 180/100 in the right arm and 140/85 in the left arm. The most likely diagnosis is:

Accepted Answer

Aortic dissection

Answer

Aortic dissection classically presents with tearing back pain and a blood pressure differential >20 mmHg between arms.

Question 2

Which of the following ECG findings is MOST specific for right heart strain in pulmonary embolism?

Accepted Answer

S1Q3T3 pattern

Answer

The S1Q3T3 pattern (S wave in lead I, Q wave and T-wave inversion in lead III) is the classic but not sensitive ECG finding in PE suggesting right heart strain.

Question 3

A patient with known COPD presents with acute exacerbation. SpO2 is 82%. What is the target oxygen saturation range for this patient?

Accepted Answer

88-92%

Answer

In COPD patients with chronic hypercapnia, target SpO2 is 88-92% to avoid suppressing the hypoxic drive and worsening hypercapnia.

Question 4

A 45-year-old woman presents with sudden syncope. ECG shows a prolonged QTc of 520ms and polymorphic VT. The first-line treatment is:

Accepted Answer

Magnesium sulfate IV

Answer

Torsades de pointes (polymorphic VT with prolonged QT) is treated first with IV magnesium sulfate 1-2g regardless of serum magnesium level.

Question 5

In cardiac tamponade, Beck's triad includes hypotension, muffled heart sounds, and:

Accepted Answer

Jugular venous distension

Answer

Beck's triad consists of hypotension, muffled heart sounds, and jugular venous distension (JVD) due to impaired cardiac filling.

(ABEM) American Board of Emergency Medicine Practice Test

(ABEM) American Board of Emergency Medicine Practice Test

ABEM Cardiovascular & Respiratory Emergencies 2