ABPS Emergency Medicine & Acute Care 2 — Questions and Answers
Question 1: A patient presents with sudden severe headache described as 'the worst headache of my life.' CT head is negative. What is the next best diagnostic step?
- MRI brain with gadolinium
- Lumbar puncture for xanthochromia (Correct answer)
- Cerebral angiography immediately
- Discharge with follow-up in 24 hours
Correct answer: Lumbar puncture for xanthochromia
A thunderclap headache with a negative CT requires lumbar puncture to detect xanthochromia, which indicates subarachnoid hemorrhage that CT may miss if performed late.
Question 2: Which of the following findings on a chest X-ray is most consistent with a tension pneumothorax requiring immediate needle decompression?
- Bilateral pleural effusions
- Tracheal deviation away from the affected side with absent breath sounds (Correct answer)
- Mediastinal widening
- Bilateral infiltrates with air bronchograms
Correct answer: Tracheal deviation away from the affected side with absent breath sounds
Tension pneumothorax causes tracheal deviation away from the affected side and absent breath sounds, reflecting mediastinal shift from elevated intrapleural pressure.
Question 3: A 3-year-old child is brought in after ingesting an unknown quantity of iron tablets. Which antidote is indicated for severe iron toxicity?
- N-acetylcysteine
- Deferoxamine (Correct answer)
- Activated charcoal
- Atropine
Correct answer: Deferoxamine
Deferoxamine is the chelating agent of choice for severe iron poisoning, binding free iron and facilitating its renal excretion.
Question 4: In the ABCDE approach to trauma assessment, what does the 'C' primarily stand for?
- Circulation with hemorrhage control (Correct answer)
- Cervical spine immobilization
- Cardiac monitoring
- Chest X-ray
Correct answer: Circulation with hemorrhage control
In primary trauma survey, 'C' refers to Circulation with hemorrhage control, emphasizing assessment and management of bleeding and perfusion.
Question 5: A patient presents with bradycardia, hypotension, hypothermia, and hyponatremia. Which diagnosis should be immediately considered?
- Addisonian crisis
- Myxedema coma (Correct answer)
- Diabetic ketoacidosis
- Septic shock
Correct answer: Myxedema coma
Myxedema coma is a life-threatening hypothyroid emergency presenting with bradycardia, hypotension, hypothermia, hyponatremia, and altered mental status.
Question 6: Which medication is used to reverse the anticoagulant effect of warfarin in a patient with life-threatening bleeding?
- Protamine sulfate
- Vitamin K alone
- Fresh frozen plasma plus Vitamin K (Correct answer)
- Tranexamic acid
Correct answer: Fresh frozen plasma plus Vitamin K
For life-threatening warfarin-related bleeding, the combination of fresh frozen plasma (for immediate reversal) and Vitamin K (for sustained reversal) is the recommended treatment.
Question 7: A 45-year-old with a history of alcoholism presents with confusion, ophthalmoplegia, and ataxia. Which treatment should be given immediately?
- Glucose infusion first, then thiamine
- Thiamine (Vitamin B1) IV before glucose (Correct answer)
- Naloxone and flumazenil
- IV magnesium sulfate
Correct answer: Thiamine (Vitamin B1) IV before glucose
Thiamine must be administered before glucose in suspected Wernicke's encephalopathy because giving glucose first can precipitate or worsen the condition by depleting thiamine reserves.
ABPS Emergency Medicine & Acute Care 2
A patient presents with sudden severe headache described as 'the worst headache of my life.' CT head is negative.
What is the next best diagnostic step?