BCEN Medical Emergencies and Conditions 3 — Questions and Answers
Question 1: A patient presents with chest pain, diaphoresis, and ST-elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
Inferior STEMI (ST elevation in II, III, aVF) is typically caused by right coronary artery occlusion, which supplies the inferior wall of the left ventricle.
Question 2: A patient with suspected opioid overdose has a respiratory rate of 4 breaths/min and pinpoint pupils. What is the correct initial naloxone dose?
- 0.1 mg IV titrated slowly
- 0.4 mg IV/IM, repeat every 2-3 minutes as needed (Correct answer)
- 2 mg IV given as a single bolus
- 0.01 mg/kg IV for weight-based dosing only
Correct answer: 0.4 mg IV/IM, repeat every 2-3 minutes as needed
Standard initial naloxone dosing is 0.4 mg IV/IM, titrated to adequate respirations, with repeat doses every 2-3 minutes if needed.
Question 3: Which finding is most consistent with cardiac tamponade?
- Wide pulse pressure with bounding pulses
- Beck's triad: hypotension, muffled heart sounds, jugular venous distension (Correct answer)
- Unilateral absence of breath sounds
- Tracheal deviation away from affected side
Correct answer: Beck's triad: hypotension, muffled heart sounds, jugular venous distension
Beck's triad (hypotension, muffled heart sounds, JVD) classically describes cardiac tamponade from pericardial fluid compression.
Question 4: A patient develops urticaria, wheezing, and hypotension 10 minutes after receiving IV penicillin. What is the FIRST drug to administer?
- Diphenhydramine 50 mg IV
- Methylprednisolone 125 mg IV
- Epinephrine 0.3-0.5 mg IM (1:1000) (Correct answer)
- Albuterol via nebulizer
Correct answer: Epinephrine 0.3-0.5 mg IM (1:1000)
Epinephrine is the first-line treatment for anaphylaxis; it reverses bronchospasm, vasodilation, and prevents mast cell degranulation.
Question 5: A patient presents with fever, neck stiffness, photophobia, and a petechial rash. Which intervention is most time-critical?
- Obtain lumbar puncture before any treatment
- Administer broad-spectrum antibiotics immediately (Correct answer)
- Order CT head before proceeding
- Obtain blood cultures and wait for results before antibiotics
Correct answer: Administer broad-spectrum antibiotics immediately
Bacterial meningitis with purpuric rash (suggesting meningococcemia) requires immediate antibiotics; delay increases mortality even by minutes.
Question 6: Which lab finding is most indicative of acute hepatic failure in the emergency setting?
- ALT 200 IU/L with normal bilirubin
- Elevated ammonia with coagulopathy (INR > 1.5) and encephalopathy (Correct answer)
- Total bilirubin 4.0 mg/dL with pruritus
- Alkaline phosphatase three times upper normal limit
Correct answer: Elevated ammonia with coagulopathy (INR > 1.5) and encephalopathy
Acute hepatic failure is defined by coagulopathy and encephalopathy in the absence of pre-existing liver disease, with hyperammonemia contributing to mental status changes.
Question 7: A patient with type 1 diabetes presents with blood glucose of 480 mg/dL, pH 7.21, bicarbonate 11 mEq/L, and fruity breath. Which is the most important initial intervention?
- Administer IV sodium bicarbonate to correct acidosis
- Start insulin drip immediately without fluid resuscitation
- Initiate aggressive IV fluid resuscitation with 0.9% NS (Correct answer)
- Give subcutaneous insulin and observe for 2 hours
Correct answer: Initiate aggressive IV fluid resuscitation with 0.9% NS
Fluid resuscitation is the first priority in DKA to restore intravascular volume before insulin is started, as insulin without fluids can cause dangerous hypokalemia and cardiovascular collapse.
BCEN Medical Emergencies and Conditions 3
A patient presents with chest pain, diaphoresis, and ST-elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?