ABEM Cardiovascular & Respiratory Emergencies 4

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?

Accepted Answer

Systemic corticosteroids

Answer

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?

Accepted Answer

Type A dissections involving the ascending aorta

Answer

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?

Accepted Answer

Hypovolemia

Answer

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?

Accepted Answer

Recruits collapsed alveoli and prevents derecruitment

Answer

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:

Accepted Answer

Potassium

Answer

Hypokalemia potentiates digoxin toxicity by competing with digoxin for the same Na+/K+ ATPase binding site; correcting potassium is essential.

(ABEM) American Board of Emergency Medicine Practice Test

(ABEM) American Board of Emergency Medicine Practice Test

ABEM Cardiovascular & Respiratory Emergencies 4