AEMCA Medical Emergencies 4 — Questions and Answers
Question 1: A patient presents with confusion, fever (103°F), muscle rigidity, and autonomic instability after starting a new antipsychotic. What condition should be suspected?
- Serotonin syndrome
- Neuroleptic malignant syndrome (Correct answer)
- Anticholinergic toxicity
- Malignant hyperthermia
Correct answer: Neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) is a life-threatening reaction to antipsychotics characterized by hyperthermia, muscle rigidity, altered mental status, and autonomic dysfunction.
Question 2: Which of the following best describes the Somogyi effect in diabetic patients?
- Morning hyperglycemia due to insufficient evening insulin
- Rebound hyperglycemia following nocturnal hypoglycemia (Correct answer)
- Dawn phenomenon caused by growth hormone surge
- Post-meal hyperglycemia despite adequate insulin dosing
Correct answer: Rebound hyperglycemia following nocturnal hypoglycemia
The Somogyi effect is rebound hyperglycemia that occurs after nocturnal hypoglycemia triggers counter-regulatory hormone release.
Question 3: A patient on dialysis presents with peaked T-waves on ECG and blood pressure of 80/50. Which intervention should be considered FIRST?
- Sodium bicarbonate IV push
- Calcium gluconate IV (Correct answer)
- Furosemide IV bolus
- Potassium-binding resin (Kayexalate)
Correct answer: Calcium gluconate IV
Calcium gluconate IV is the first intervention in severe hyperkalemia as it immediately stabilizes the cardiac membrane, buying time for potassium-lowering measures.
Question 4: In thyroid storm, which of the following is the CORRECT order of medication administration?
- Iodine → PTU → beta-blocker → steroids
- PTU → beta-blocker → iodine → steroids (Correct answer)
- Beta-blocker → steroids → PTU → iodine
- Steroids → iodine → beta-blocker → PTU
Correct answer: PTU → beta-blocker → iodine → steroids
PTU must be given before iodine to block new thyroid hormone synthesis before iodine is administered, which would otherwise fuel more hormone production.
Question 5: A patient presents with altered mental status, fever, headache, and a non-blanching petechial rash. What is the priority action?
- Obtain a lumbar puncture before any treatment
- Administer antibiotics immediately without delay (Correct answer)
- Order a CT head before any intervention
- Isolate the patient and wait for culture results
Correct answer: Administer antibiotics immediately without delay
Meningococcal meningitis with septicemia requires immediate antibiotics; delaying treatment for imaging or lumbar puncture significantly increases mortality.
Question 6: Which finding differentiates hypertensive emergency from hypertensive urgency?
- Blood pressure greater than 180/120 mmHg
- Presence of end-organ damage (Correct answer)
- Patient's age and comorbidities
- Symptomatic complaints such as headache
Correct answer: Presence of end-organ damage
Hypertensive emergency is defined by evidence of acute end-organ damage (stroke, MI, renal failure, retinopathy) regardless of the exact blood pressure value.
Question 7: A patient with known alcohol use disorder presents with tremors, diaphoresis, hypertension, and visual hallucinations 48 hours after last drink. What is the priority treatment?
- Haloperidol for hallucinations
- Benzodiazepines to prevent seizures and delirium tremens (Correct answer)
- Naltrexone to reduce alcohol cravings
- IV thiamine only, no sedatives needed
Correct answer: Benzodiazepines to prevent seizures and delirium tremens
Benzodiazepines are the cornerstone of alcohol withdrawal management, preventing progression to life-threatening delirium tremens and seizures.
AEMCA Medical Emergencies 4
A patient presents with confusion, fever (103°F), muscle rigidity, and autonomic instability after starting a new antipsychotic.
What condition should be suspected?