AEMCA Medical Emergencies 5 — Questions and Answers
Question 1: A patient presents with severe hypotension, bradycardia, and bronchospasm after ingesting a large amount of eye drops. What toxidrome is most likely?
- Anticholinergic toxidrome
- Cholinergic toxidrome (Correct answer)
- Opioid toxidrome
- Sympathomimetic toxidrome
Correct answer: Cholinergic toxidrome
Tetrahydrozoline (found in eye drops) can cause a cholinergic-like toxidrome with bradycardia, hypotension, and bronchospasm in overdose, especially in children.
Question 2: Which of the following is the hallmark of distributive shock that distinguishes it from other shock types?
- Decreased cardiac output with elevated SVR
- Normal or elevated cardiac output with decreased SVR (Correct answer)
- Decreased preload with elevated heart rate
- Elevated CVP with pulmonary congestion
Correct answer: Normal or elevated cardiac output with decreased SVR
Distributive shock (septic, anaphylactic, neurogenic) is characterized by profound vasodilation with decreased SVR and typically a compensatory elevated cardiac output.
Question 3: A patient with sickle cell disease presents with chest pain, fever, and progressive hypoxia. What is the most likely life-threatening complication?
- Splenic sequestration
- Acute chest syndrome (Correct answer)
- Vaso-occlusive pain crisis only
- Aplastic crisis
Correct answer: Acute chest syndrome
Acute chest syndrome is a leading cause of death in sickle cell disease, characterized by new pulmonary infiltrates with fever, chest pain, and hypoxia.
Question 4: In a patient with suspected myasthenic crisis, which test can help differentiate it from cholinergic crisis?
- Tensilon (edrophonium) test (Correct answer)
- Serum acetylcholine receptor antibody level
- Nerve conduction velocity study
- CT chest for thymoma
Correct answer: Tensilon (edrophonium) test
The Tensilon test uses edrophonium (an anticholinesterase) — if symptoms improve, it confirms myasthenic crisis; if they worsen, it suggests cholinergic crisis.
Question 5: A patient presents with confusion, polyuria, and a blood glucose of 920 mg/dL without ketoacidosis. What condition is this?
- Diabetic ketoacidosis (DKA)
- Hyperosmolar hyperglycemic state (HHS) (Correct answer)
- Euglycemic DKA
- Reactive hypoglycemia
Correct answer: Hyperosmolar hyperglycemic state (HHS)
Hyperosmolar hyperglycemic state features extreme hyperglycemia (>600 mg/dL) with severe dehydration and altered mental status, but without significant ketoacidosis.
Question 6: Which presentation is MOST consistent with a patient experiencing neurogenic shock?
- Hypertension, tachycardia, cold clammy skin
- Hypotension, bradycardia, warm dry skin (Correct answer)
- Hypotension, tachycardia, poor skin turgor
- Hypertension, bradycardia, diaphoresis
Correct answer: Hypotension, bradycardia, warm dry skin
Neurogenic shock from spinal cord injury presents with hypotension and paradoxical bradycardia with warm, dry skin due to loss of sympathetic tone below the injury.
Question 7: A patient with a known peanut allergy develops urticaria, angioedema, and stridor within minutes of eating. After administering IM epinephrine, the patient does not improve. What is the next action?
- Administer a second dose of IM epinephrine and prepare for airway management (Correct answer)
- Switch to IV diphenhydramine as epinephrine failed
- Administer IV corticosteroids and observe for 30 minutes
- Perform immediate needle decompression
Correct answer: Administer a second dose of IM epinephrine and prepare for airway management
A second dose of epinephrine can be given 5-15 minutes after the first if the patient does not respond; progressive stridor also demands preparation for surgical airway.
AEMCA Medical Emergencies 5
A patient presents with severe hypotension, bradycardia, and bronchospasm after ingesting a large amount of eye drops.
What toxidrome is most likely?