ABPS Emergency Medicine & Acute Care 1 — Questions and Answers
Question 1: A 55-year-old male presents with sudden onset crushing chest pain radiating to the left arm and diaphoresis. ECG shows ST elevation in leads II, III, and aVF. Which vessel is most likely occluded?
- Left anterior descending artery
- Right coronary artery (Correct answer)
- Left circumflex artery
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in leads II, III, and aVF indicates an inferior STEMI, which is typically caused by occlusion of the right coronary artery.
Question 2: A patient presents in anaphylactic shock after a bee sting. Which is the FIRST-line treatment?
- IV diphenhydramine
- IV corticosteroids
- Intramuscular epinephrine (Correct answer)
- Nebulized albuterol
Correct answer: Intramuscular epinephrine
Intramuscular epinephrine (0.3–0.5 mg of 1:1000) into the anterolateral thigh is the first-line and life-saving treatment for anaphylaxis.
Question 3: Which of the following Glasgow Coma Scale (GCS) scores indicates severe traumatic brain injury?
- 13–15
- 9–12
- 3–8 (Correct answer)
- 6–8
Correct answer: 3–8
A GCS score of 3–8 defines severe traumatic brain injury and typically warrants immediate airway management and neurosurgical evaluation.
Question 4: A 70-year-old woman presents with hypotension, distended neck veins, and muffled heart sounds following blunt chest trauma. What is the most likely diagnosis?
- Tension pneumothorax
- Hemothorax
- Cardiac tamponade (Correct answer)
- Aortic dissection
Correct answer: Cardiac tamponade
Beck's triad — hypotension, distended neck veins, and muffled heart sounds — is classic for cardiac tamponade, especially after chest trauma.
Question 5: When managing a patient with suspected cervical spine injury in the emergency setting, which airway technique is generally preferred?
- Blind nasotracheal intubation
- Rapid sequence intubation with in-line cervical stabilization (Correct answer)
- Cricothyrotomy immediately
- Bag-valve-mask ventilation only
Correct answer: Rapid sequence intubation with in-line cervical stabilization
Rapid sequence intubation (RSI) with manual in-line cervical stabilization is the preferred method to secure the airway while minimizing cervical spine movement.
Question 6: A patient presents with a serum sodium of 118 mEq/L and severe neurological symptoms including seizures. What is the recommended initial management?
- Rapid correction with hypotonic saline at 1 mEq/L/hr
- Hypertonic saline (3%) to raise sodium by 1–2 mEq/L/hr acutely (Correct answer)
- Free water restriction alone
- Furosemide and normal saline infusion
Correct answer: Hypertonic saline (3%) to raise sodium by 1–2 mEq/L/hr acutely
In symptomatic severe hyponatremia, hypertonic saline (3%) is given to raise serum sodium by 1–2 mEq/L/hr until symptoms resolve, while avoiding overcorrection to prevent osmotic demyelination syndrome.
Question 7: Which of the following is the most appropriate initial fluid resuscitation for septic shock in adults per Surviving Sepsis Campaign guidelines?
- 10 mL/kg albumin over 30 minutes
- 30 mL/kg IV crystalloid within the first 3 hours (Correct answer)
- 2 L normal saline over 4 hours
- Immediate vasopressor initiation without fluids
Correct answer: 30 mL/kg IV crystalloid within the first 3 hours
Surviving Sepsis Campaign guidelines recommend at least 30 mL/kg of IV crystalloid fluid within the first 3 hours of recognizing septic shock.
ABPS Emergency Medicine & Acute Care 1
A 55-year-old male presents with sudden onset crushing chest pain radiating to the left arm and diaphoresis.
ECG shows ST elevation in leads II, III, and aVF.
Which vessel is most likely occluded?