AEMCA MCQ 5 — Questions and Answers
Question 1: A patient with a suspected cervical spine injury needs rapid sequence intubation (RSI). Which agent provides optimal intubating conditions with minimal hemodynamic effect in a normotensive trauma patient?
- Ketamine 1.5 mg/kg IV + succinylcholine 1.5 mg/kg IV
- Midazolam 0.1 mg/kg IV alone
- Etomidate 0.3 mg/kg IV + rocuronium 1.2 mg/kg IV (Correct answer)
- Diazepam 10 mg IV + vecuronium 0.1 mg/kg IV
Correct answer: Etomidate 0.3 mg/kg IV + rocuronium 1.2 mg/kg IV
Etomidate provides hemodynamic stability during induction, and high-dose rocuronium (1.2 mg/kg) achieves intubating conditions comparable to succinylcholine without its contraindications.
Question 2: Which of the following ECG findings is most consistent with hyperkalemia?
- Shortened PR interval and delta waves
- Peaked T waves, widened QRS, and a sine-wave pattern (Correct answer)
- Prolonged QTc and U waves
- Sinus tachycardia with ST depression
Correct answer: Peaked T waves, widened QRS, and a sine-wave pattern
Hyperkalemia classically produces peaked T waves, then PR prolongation, wide QRS, and ultimately a sine-wave pattern as potassium levels rise.
Question 3: A patient on warfarin presents with a severe closed head injury. Which reversal agent is preferred for immediate anticoagulation reversal?
- Vitamin K 10 mg IV alone
- Four-factor prothrombin complex concentrate (4F-PCC) (Correct answer)
- Fresh frozen plasma (FFP) 4 units
- Protamine sulfate 1 mg per 100 units of heparin
Correct answer: Four-factor prothrombin complex concentrate (4F-PCC)
4F-PCC provides rapid reversal of warfarin-related coagulopathy within minutes and is preferred over FFP due to faster onset and smaller volume.
Question 4: When performing end-tidal CO2 (ETCO2) monitoring after intubation, a reading of 20 mmHg in a cardiac arrest patient with good CPR quality suggests:
- Adequate perfusion and good prognosis
- Esophageal intubation
- Possible pulmonary embolism causing reduced pulmonary blood flow (Correct answer)
- Hyperventilation artifact only
Correct answer: Possible pulmonary embolism causing reduced pulmonary blood flow
Low ETCO2 (≤20 mmHg) despite good CPR in arrest may indicate pulmonary embolism or severe circulatory failure reducing pulmonary perfusion.
Question 5: A patient is found pulseless and a shockable rhythm is identified. After the first shock, what is the correct next action per current ACLS guidelines?
- Analyze rhythm immediately and deliver a second shock if still shockable
- Resume CPR for 2 minutes before re-analyzing the rhythm (Correct answer)
- Administer epinephrine 1 mg IV immediately after the shock
- Check for a carotid pulse before resuming CPR
Correct answer: Resume CPR for 2 minutes before re-analyzing the rhythm
After each defibrillation attempt, CPR is resumed immediately for 2 minutes before rhythm re-analysis, as the heart needs time to perfuse and potentially organize.
Question 6: Which of the following is a contraindication to the use of succinylcholine during RSI?
- Increased intracranial pressure
- Rapid sequence intubation in less than 8 hours post-injury
- Burns more than 48–72 hours old or crush injuries with suspected hyperkalemia (Correct answer)
- Systolic blood pressure below 90 mmHg
Correct answer: Burns more than 48–72 hours old or crush injuries with suspected hyperkalemia
Succinylcholine is contraindicated in burns >48–72 hours old, crush injuries, and denervation injuries because up-regulated acetylcholine receptors can cause fatal hyperkalemia.
Question 7: A 55-year-old female presents with sudden-onset tearing chest pain radiating to the back, unequal blood pressures in both arms, and no ST changes on ECG. What is the most likely diagnosis?
- Acute anterior STEMI
- Aortic dissection (Correct answer)
- Massive pulmonary embolism
- Esophageal rupture (Boerhaave syndrome)
Correct answer: Aortic dissection
Tearing chest/back pain with unequal arm blood pressures and a normal ECG is the classic presentation of aortic dissection requiring emergent surgical evaluation.
AEMCA MCQ 5
A patient with a suspected cervical spine injury needs rapid sequence intubation (RSI).
Which agent provides optimal intubating conditions with minimal hemodynamic effect in a normotensive trauma patient?