ABEM Cardiovascular & Respiratory Emergencies 5

Question 1

A patient presents with narrow-complex tachycardia at 160 bpm, regular rhythm, and hemodynamic stability. Vagal maneuvers fail. What is the FIRST-LINE pharmacologic treatment?

Accepted Answer

Adenosine 6mg rapid IV push

Answer

Adenosine 6mg rapid IV push is first-line for stable SVT because it transiently blocks AV nodal conduction and terminates re-entry circuits.

Question 2

A patient with end-stage renal disease presents with peaked T-waves, widening QRS, and a sine-wave pattern on ECG. The MOST immediately life-saving treatment is:

Accepted Answer

Calcium gluconate IV

Answer

Calcium gluconate immediately stabilizes the cardiac membrane in severe hyperkalemia, buying time while other measures to lower potassium are implemented.

Question 3

Which clinical sign differentiates obstructive shock from distributive shock?

Accepted Answer

Cool, clamped extremities with elevated JVP

Answer

Obstructive shock (e.g., PE, tamponade, tension pneumothorax) presents with elevated JVP and cool extremities due to mechanical obstruction impeding cardiac output.

Question 4

A 65-year-old smoker with known COPD presents in respiratory failure. ABG shows pH 7.22, PaCO2 78, PaO2 52. The MOST appropriate initial ventilatory support is:

Accepted Answer

Non-invasive positive pressure ventilation (BiPAP)

Answer

BiPAP is the preferred initial ventilatory support for COPD exacerbation with hypercapnic respiratory failure as it reduces intubation rates and mortality.

Question 5

A previously healthy 30-year-old male presents with sudden pleuritic chest pain and dyspnea after lifting weights. CXR shows a 25% pneumothorax on the right. He is hemodynamically stable. Management is:

Accepted Answer

Needle aspiration or small-bore chest tube

Answer

A symptomatic primary spontaneous pneumothorax >15-20% in a stable patient is treated with needle aspiration or small-bore chest tube placement.

(ABEM) American Board of Emergency Medicine Practice Test

(ABEM) American Board of Emergency Medicine Practice Test

ABEM Cardiovascular & Respiratory Emergencies 5