ABEM Cardiovascular & Respiratory Emergencies 4 — Questions and Answers
Question 1: A 28-year-old asthmatic presents with severe wheezing, cannot speak in full sentences, HR 128, and SpO2 88%. After initial bronchodilators, what adjunct treatment is MOST appropriate?
- IV aminophylline
- Systemic corticosteroids (Correct answer)
- Ipratropium nebulization only
- Immediate intubation
Correct answer: Systemic corticosteroids
Systemic corticosteroids (IV methylprednisolone or oral prednisone) reduce airway inflammation and decrease length of stay in severe asthma exacerbations.
Question 2: Which type of aortic dissection (Stanford classification) requires immediate surgical intervention?
- Type B dissections only
- Type A dissections involving the ascending aorta (Correct answer)
- Both Type A and B equally
- Neither; all dissections are managed medically first
Correct answer: Type A dissections involving the ascending aorta
Stanford Type A dissections involve the ascending aorta and require emergent surgery due to risk of cardiac tamponade, coronary occlusion, and stroke.
Question 3: A patient is found in pulseless electrical activity (PEA). Which of the H's and T's should be considered FIRST given a history of massive hemorrhage?
- Hypothermia
- Hypovolemia (Correct answer)
- Hydrogen ion excess
- Thrombosis (PE)
Correct answer: Hypovolemia
Hypovolemia from hemorrhage is the most immediately reversible cause of PEA and should be addressed with rapid volume resuscitation.
Question 4: What is the mechanism by which PEEP (positive end-expiratory pressure) improves oxygenation in ARDS?
- Increases FiO2 delivery
- Recruits collapsed alveoli and prevents derecruitment (Correct answer)
- Reduces pulmonary vascular resistance
- Increases cardiac output
Correct answer: Recruits collapsed alveoli and prevents derecruitment
PEEP keeps alveoli open at end-expiration, recruits previously collapsed lung units, and improves ventilation-perfusion matching in ARDS.
Question 5: A 75-year-old female on digoxin presents with nausea, yellow-green visual halos, and bradycardia with a junctional rhythm on ECG. Digoxin toxicity is suspected. The MOST important electrolyte to check and correct is:
- Sodium
- Potassium (Correct answer)
- Calcium
- Phosphate
Correct answer: Potassium
Hypokalemia potentiates digoxin toxicity by competing with digoxin for the same Na+/K+ ATPase binding site; correcting potassium is essential.
Question 6: A 40-year-old male with HIV presents with progressive dyspnea and dry cough. CXR shows bilateral interstitial infiltrates. LDH is markedly elevated. The most likely diagnosis is:
- Community-acquired pneumonia
- Pneumocystis jirovecii pneumonia (PCP) (Correct answer)
- Pulmonary Kaposi's sarcoma
- Tuberculosis
Correct answer: Pneumocystis jirovecii pneumonia (PCP)
PCP is the most common opportunistic lung infection in HIV patients with low CD4 counts and classically presents with bilateral interstitial infiltrates and elevated LDH.
Question 7: A 50-year-old male develops acute onset dyspnea and hypoxia 3 days after an MI. Echocardiogram shows a new VSD. Which finding would you expect on physical exam?
- Loud systolic murmur at the left sternal border (Correct answer)
- Diastolic murmur at the apex
- Continuous machine-like murmur
- Pericardial friction rub
Correct answer: Loud systolic murmur at the left sternal border
Post-MI ventricular septal defect causes a harsh holosystolic murmur heard best at the left lower sternal border due to left-to-right shunting.
ABEM Cardiovascular & Respiratory Emergencies 4
A 28-year-old asthmatic presents with severe wheezing, cannot speak in full sentences, HR 128, and SpO2 88%.
After initial bronchodilators, what adjunct treatment is MOST appropriate?