EDAIC Emergency Medicine 5 — Questions and Answers
Question 1: A patient presents with aortic dissection type A. What is the most critical immediate management step?
- Urgent CT angiography of the chest
- Emergency surgical repair (Correct answer)
- IV labetalol to reduce heart rate and BP
- Anticoagulation with heparin
Correct answer: Emergency surgical repair
Type A aortic dissection involving the ascending aorta carries 1-2% mortality per hour without surgery and requires immediate operative intervention.
Question 2: Which finding on arterial blood gas analysis is most consistent with acute cyanide poisoning?
- Respiratory acidosis with hypoxemia
- Metabolic acidosis with high venous oxygen saturation (Correct answer)
- Metabolic alkalosis with normal lactate
- Respiratory alkalosis with low PaCO2
Correct answer: Metabolic acidosis with high venous oxygen saturation
Cyanide inhibits cytochrome c oxidase, blocking cellular oxygen utilization, causing lactic acidosis with paradoxically high venous PO2 as cells cannot extract oxygen.
Question 3: In a patient with acute coronary syndrome, which antiplatelet agent is preferred alongside aspirin for PCI?
- Clopidogrel 75mg daily
- Ticagrelor 180mg loading dose (Correct answer)
- Aspirin 325mg alone
- Dipyridamole
Correct answer: Ticagrelor 180mg loading dose
Ticagrelor with a 180mg loading dose is preferred over clopidogrel in ACS because it provides faster, more consistent, and greater platelet inhibition.
Question 4: What is the correct management for a child with epiglottitis presenting with stridor and drooling?
- Immediate direct laryngoscopy to examine the epiglottis
- Urgent throat swab for culture before antibiotics
- Calm environment, avoid agitation, secure airway in OR (Correct answer)
- High-flow nebulized epinephrine and oral steroids
Correct answer: Calm environment, avoid agitation, secure airway in OR
Children with epiglottitis should be kept calm to avoid complete airway obstruction; intubation should be performed in a controlled OR setting with ENT available.
Question 5: A patient is brought in with organophosphate poisoning. Which combination of antidotes is required?
- Naloxone and flumazenil
- Atropine and pralidoxime (2-PAM) (Correct answer)
- Physostigmine and pyridoxine
- Diazepam and activated charcoal only
Correct answer: Atropine and pralidoxime (2-PAM)
Atropine blocks muscarinic effects of acetylcholine excess while pralidoxime reactivates acetylcholinesterase if given before aging of the enzyme-inhibitor complex.
Question 6: What is the Cushing's reflex (triad) in the context of raised intracranial pressure?
- Bradycardia, hypotension, and tachypnea
- Hypertension, bradycardia, and irregular respirations (Correct answer)
- Tachycardia, hypertension, and shallow breathing
- Hypotension, tachycardia, and Cheyne-Stokes respirations
Correct answer: Hypertension, bradycardia, and irregular respirations
The Cushing reflex consists of hypertension, bradycardia, and irregular respirations (Cheyne-Stokes) and signals imminent brainstem herniation from severely raised ICP.
Question 7: In a patient with high spinal cord injury (above T6) and autonomic dysreflexia, what is the immediate priority?
- IV methylprednisolone infusion
- Identification and removal of the noxious stimulus (Correct answer)
- Atropine for associated bradycardia
- Trendelenburg positioning
Correct answer: Identification and removal of the noxious stimulus
Autonomic dysreflexia is triggered by a noxious stimulus below the level of injury (most commonly bladder distension); removing the stimulus is the first priority.
EDAIC Emergency Medicine 5
A patient presents with aortic dissection type A.
What is the most critical immediate management step?