DOH Emergency Medicine & Critical Care — Questions and Answers
Question 1: According to HAAD/DOH guidelines, what is the recommended first-line treatment for anaphylaxis in adults?
- Intravenous hydrocortisone 200 mg
- Intramuscular epinephrine 0.3–0.5 mg (1:1000) (Correct answer)
- Intravenous diphenhydramine 50 mg
- Subcutaneous epinephrine 0.1 mg (1:10000)
Correct answer: Intramuscular epinephrine 0.3–0.5 mg (1:1000)
Intramuscular epinephrine 0.3–0.5 mg of 1:1000 solution into the anterolateral thigh is the first-line treatment for anaphylaxis due to its rapid absorption and life-saving effect.
Question 2: A patient presents with a Glasgow Coma Scale (GCS) score of 8. What does this indicate?
- Mild traumatic brain injury requiring observation
- Severe brain injury requiring immediate airway protection (Correct answer)
- Moderate brain injury manageable with supplemental oxygen
- Normal neurological status in a sedated patient
Correct answer: Severe brain injury requiring immediate airway protection
A GCS of 8 or below indicates severe brain injury and is the threshold at which airway protection through intubation is typically required.
Question 3: Which ECG finding is most consistent with ST-elevation myocardial infarction (STEMI) requiring immediate intervention?
- ST depression ≥ 1 mm in two contiguous leads
- ST elevation ≥ 1 mm in two contiguous limb leads
- T-wave inversion in leads V1–V3
- New left bundle branch block (LBBB) with ST changes (Correct answer)
Correct answer: New left bundle branch block (LBBB) with ST changes
A new left bundle branch block with associated ST changes is treated as a STEMI equivalent and requires immediate reperfusion therapy per international and UAE cardiac care protocols.
Question 4: In a patient with diabetic ketoacidosis (DKA), which electrolyte must be closely monitored and replaced before starting insulin therapy?
- Sodium
- Potassium (Correct answer)
- Calcium
- Magnesium
Correct answer: Potassium
Potassium must be checked and corrected to ≥3.5 mEq/L before insulin is given, as insulin drives potassium intracellularly and can cause life-threatening hypokalemia.
Question 5: What is the correct compression-to-ventilation ratio for adult cardiopulmonary resuscitation (CPR) with a single rescuer?
- 15:2
- 30:2 (Correct answer)
- 5:1
- 20:2
Correct answer: 30:2
Current AHA and ILCOR guidelines recommend a 30:2 compression-to-ventilation ratio for single-rescuer adult CPR to minimize interruptions to chest compressions.
Question 6: A patient in septic shock is not responding to 30 mL/kg of IV crystalloid. What is the next recommended step according to Surviving Sepsis Campaign guidelines?
- Administer a second bolus of 30 mL/kg crystalloid
- Initiate vasopressor therapy with norepinephrine (Correct answer)
- Begin dopamine infusion at low dose
- Transfuse packed red blood cells
Correct answer: Initiate vasopressor therapy with norepinephrine
Norepinephrine is the first-choice vasopressor when fluids fail to restore mean arterial pressure ≥65 mmHg in septic shock.
Question 7: Which of the following is the primary endpoint for evaluating adequate fluid resuscitation in a trauma patient?
- Systolic blood pressure > 90 mmHg
- Urine output of 0.5–1 mL/kg/hour (Correct answer)
- Heart rate < 100 beats/minute
- Serum lactate > 4 mmol/L
Correct answer: Urine output of 0.5–1 mL/kg/hour
A urine output of 0.5–1 mL/kg/hour is a reliable clinical indicator of adequate organ perfusion and fluid resuscitation in trauma patients.
Question 8: Which ventilator strategy is recommended for patients with Acute Respiratory Distress Syndrome (ARDS) to minimize ventilator-induced lung injury?
- High tidal volume (10–12 mL/kg ideal body weight) with low PEEP
- Low tidal volume (6 mL/kg ideal body weight) with high PEEP (Correct answer)
- Pressure control ventilation with tidal volume >10 mL/kg
- Volume control ventilation targeting PaO2 > 100 mmHg
Correct answer: Low tidal volume (6 mL/kg ideal body weight) with high PEEP
Lung-protective ventilation using low tidal volumes of 6 mL/kg ideal body weight and appropriate PEEP reduces barotrauma and improves outcomes in ARDS.
Question 9: A patient arrives in the emergency department with suspected opioid overdose. Which medication should be administered immediately?
- Flumazenil 0.2 mg IV
- Naloxone 0.4–2 mg IV/IM/IN (Correct answer)
- Activated charcoal 50 g orally
- Physostigmine 2 mg IV
Correct answer: Naloxone 0.4–2 mg IV/IM/IN
Naloxone is a competitive opioid antagonist that rapidly reverses opioid-induced respiratory depression and altered consciousness.
Question 10: In the trauma primary survey, what does the 'C' in the modified <C>ABCDE approach stand for?
- Circulation assessment
- Catastrophic hemorrhage control (Correct answer)
- Cervical spine immobilization
- Consciousness level assessment
Correct answer: Catastrophic hemorrhage control
In the modified <C>ABCDE approach, 'C' stands for Catastrophic hemorrhage control, which takes priority even before airway management in major trauma.
Question 11: Which of the following is a contraindication to thrombolytic therapy in ischemic stroke?
- Age > 65 years
- Recent intracranial surgery within 3 months (Correct answer)
- Blood glucose of 7 mmol/L
- Mild neurological deficits
Correct answer: Recent intracranial surgery within 3 months
Recent intracranial surgery, severe head trauma, or prior stroke within 3 months are absolute contraindications to thrombolytic therapy due to the risk of hemorrhagic transformation.
Question 12: What is the initial energy dose recommended for defibrillation of ventricular fibrillation using a biphasic defibrillator?
- 100 joules
- 150–200 joules (Correct answer)
- 300 joules
- 360 joules
Correct answer: 150–200 joules
Biphasic defibrillators are typically used at 150–200 joules for the initial shock in ventricular fibrillation, which is effective and reduces myocardial damage compared to monophasic devices.
Question 13: Which of the following correctly describes the AVPU scale used in emergency neurological assessment?
- Alert, Verbal, Pain, Unresponsive (Correct answer)
- Alert, Voice, Pupils, Unconscious
- Awake, Verbal, Pupils, Unresponsive
- Alert, Verbal, Pressure, Unresponsive
Correct answer: Alert, Verbal, Pain, Unresponsive
The AVPU scale assesses level of consciousness as Alert, responds to Verbal stimuli, responds to Pain stimuli, or Unresponsive.
Question 14: A patient with known chronic kidney disease presents with peaked T waves, widened QRS, and a serum potassium of 7.2 mEq/L. What is the FIRST priority intervention?
- Administer sodium bicarbonate IV
- Give calcium gluconate IV to stabilize the cardiac membrane (Correct answer)
- Start insulin and dextrose infusion
- Initiate emergency hemodialysis
Correct answer: Give calcium gluconate IV to stabilize the cardiac membrane
Calcium gluconate is the first-line intervention in severe hyperkalemia with ECG changes because it immediately stabilizes the cardiac membrane and prevents arrhythmia.
