DOH Emergency Medicine & Critical Care 2 — Questions and Answers
Question 1: In the management of a tension pneumothorax, what is the immediate life-saving intervention?
- Chest X-ray followed by chest tube insertion
- Needle decompression at the 2nd intercostal space, mid-clavicular line (Correct answer)
- Positive pressure ventilation with high FiO2
- Endotracheal intubation and mechanical ventilation
Correct answer: Needle decompression at the 2nd intercostal space, mid-clavicular line
Needle decompression at the 2nd intercostal space mid-clavicular line provides immediate relief of tension pneumothorax without waiting for imaging.
Question 2: Which of the following is the most appropriate initial management for a patient with status epilepticus lasting more than 5 minutes?
- Phenytoin IV loading dose
- Intravenous lorazepam 0.1 mg/kg (Correct answer)
- Oral diazepam 10 mg
- Levetiracetam IV infusion over 30 minutes
Correct answer: Intravenous lorazepam 0.1 mg/kg
Intravenous benzodiazepines such as lorazepam are the first-line treatment for status epilepticus due to rapid onset of action.
Question 3: What is the most common cause of acute upper gastrointestinal bleeding in adults presenting to the emergency department?
- Mallory-Weiss tear
- Esophageal varices
- Peptic ulcer disease (Correct answer)
- Arteriovenous malformation
Correct answer: Peptic ulcer disease
Peptic ulcer disease accounts for approximately 40–50% of all upper GI bleeds and is the most common cause in the emergency setting.
Question 4: A patient presents with severe chest pain radiating to the back, unequal blood pressures in both arms, and widened mediastinum on chest X-ray. What is the most likely diagnosis?
- Acute myocardial infarction
- Pulmonary embolism
- Aortic dissection (Correct answer)
- Tension pneumothorax
Correct answer: Aortic dissection
The combination of tearing chest pain radiating to the back, unequal arm blood pressures, and widened mediastinum is classic for aortic dissection.
Question 5: In the management of acute stroke, what is the maximum time window for administering IV tissue plasminogen activator (tPA) from symptom onset?
- 2 hours
- 3–4.5 hours (Correct answer)
- 6 hours
- 12 hours
Correct answer: 3–4.5 hours
IV tPA can be administered within 3–4.5 hours of symptom onset in eligible ischemic stroke patients according to current stroke guidelines.
Question 6: Which of the following best describes the management priority using the ABCDE approach in a critically ill patient?
- Disability assessment before airway management
- Airway secured first, then breathing, circulation, disability, exposure (Correct answer)
- Circulation restored before airway is assessed
- Exposure and environment controlled before airway assessment
Correct answer: Airway secured first, then breathing, circulation, disability, exposure
The ABCDE approach follows a strict sequential order: Airway, Breathing, Circulation, Disability, and Exposure to ensure life-threatening problems are identified and treated in order of priority.
Question 7: What is the recommended target mean arterial pressure (MAP) in patients with septic shock according to international guidelines adopted in UAE practice?
- ≥55 mmHg
- ≥65 mmHg (Correct answer)
- ≥75 mmHg
- ≥85 mmHg
Correct answer: ≥65 mmHg
A MAP of ≥65 mmHg is the recommended hemodynamic target in septic shock to ensure adequate tissue perfusion.
DOH Emergency Medicine & Critical Care 2
In the management of a tension pneumothorax, what is the immediate life-saving intervention?