EDAIC Emergency Medicine 3 — Questions and Answers
Question 1: In the management of status epilepticus, if benzodiazepines fail, which is the preferred second-line agent?
- Phenobarbital
- Levetiracetam or valproate (Correct answer)
- Propofol
- Midazolam infusion
Correct answer: Levetiracetam or valproate
Levetiracetam, valproate, or fosphenytoin are recommended second-line agents for benzodiazepine-refractory status epilepticus per current guidelines.
Question 2: A patient with pulmonary embolism develops cardiac arrest. What is the most appropriate intervention?
- Immediate surgical embolectomy
- Systemic thrombolysis with alteplase (Correct answer)
- Catheter-directed thrombolysis
- Anticoagulation with heparin and CPR
Correct answer: Systemic thrombolysis with alteplase
Systemic thrombolysis with alteplase is the recommended treatment for PE-associated cardiac arrest due to rapid administration and availability.
Question 3: Which acid-base disorder is most commonly seen in salicylate (aspirin) poisoning in adults?
- Pure metabolic acidosis
- Pure respiratory alkalosis
- Mixed respiratory alkalosis and metabolic acidosis (Correct answer)
- Metabolic alkalosis
Correct answer: Mixed respiratory alkalosis and metabolic acidosis
Salicylates directly stimulate the respiratory center causing respiratory alkalosis, while also producing an organic acidosis, resulting in a mixed pattern.
Question 4: What is the correct needle decompression site for tension pneumothorax using the second intercostal space approach?
- Second ICS, midclavicular line, above the third rib (Correct answer)
- Second ICS, midclavicular line, below the second rib
- Second ICS, anterior axillary line, above the third rib
- Second ICS, midaxillary line, below the second rib
Correct answer: Second ICS, midclavicular line, above the third rib
Needle decompression is performed at the 2nd ICS, midclavicular line, above the upper border of the third rib to avoid the neurovascular bundle.
Question 5: In acute upper GI hemorrhage, what is the primary hemodynamic target for initial resuscitation before endoscopy?
- Hemoglobin > 10 g/dL
- Restrictive transfusion targeting Hb 7 g/dL (Correct answer)
- MAP > 75 mmHg
- Heart rate < 60 bpm
Correct answer: Restrictive transfusion targeting Hb 7 g/dL
Restrictive transfusion strategy targeting Hb of 7 g/dL has been shown to improve outcomes in acute upper GI bleeding compared to liberal transfusion.
Question 6: A patient with known opioid addiction is found unresponsive with pinpoint pupils and respiratory rate of 4/min. What is the initial dose of naloxone IV?
- 2 mg bolus
- 0.4-2 mg titrated to respiratory response (Correct answer)
- 0.04 mg to avoid precipitating withdrawal
- 4 mg immediately
Correct answer: 0.4-2 mg titrated to respiratory response
Naloxone 0.4-2 mg IV titrated to adequate respiratory effort is recommended to reverse opioid toxicity while minimizing acute withdrawal.
Question 7: Which finding on a FAST (Focused Assessment with Sonography in Trauma) examination is most concerning for cardiac tamponade?
- Pleural effusion
- Pericardial effusion with right ventricular collapse (Correct answer)
- Hepatic laceration
- Peritoneal free fluid
Correct answer: Pericardial effusion with right ventricular collapse
Pericardial effusion with diastolic right ventricular collapse on FAST indicates elevated intrapericardial pressure causing cardiac tamponade.
EDAIC Emergency Medicine 3
In the management of status epilepticus, if benzodiazepines fail, which is the preferred second-line agent?