Mixed Deck — All FACEM Topics Flashcards

When using the Canadian C-Spine Rule to clear the cervical spine clinically, which factor makes radiographic imaging mandatory?

Answer: Age over 50 years

The Canadian C-Spine Rule mandates imaging for high-risk factors including age ≥65, dangerous mechanism, or paresthesias in extremities.

For a patient in refractory ventricular fibrillation after 3 defibrillation attempts, what is the correct dose of IV amiodarone as per ACLS guidelines?

Answer: 300 mg IV bolus

300 mg IV bolus of amiodarone is given after the third defibrillation attempt in refractory VF/pulseless VT, with a second dose of 150 mg available.

Which ethical principle MOST strongly underpins a physician's obligation to advocate for systemic change when individual clinical interventions are insufficient to address a patient population's needs?

Answer: Justice

Justice demands fair distribution of health resources and opportunities, compelling physicians to advocate beyond individual patient encounters when systemic inequity exists.

A patient is found unresponsive with miosis, respiratory rate of 6 breaths/min, and oxygen saturation of 78%. What is the most appropriate antidote?

Answer: Naloxone 0.4–2mg IV

The classic opioid toxidrome — miosis, respiratory depression, and decreased consciousness — is rapidly reversed by naloxone, a competitive opioid antagonist.

What role does collaboration play in emergency medicine research within the Fellowship?

Answer: Collaboration helps create innovative solutions to complex problems.

Collaboration is a cornerstone of effective emergency medicine research within the FACEM Fellowship. By bringing together diverse expertise and perspectives, collaboration facilitates the generation of innovative solutions to complex problems encountered in emergency care. This interdisciplinary approach often leads to more comprehensive and impactful research outcomes.

Activated charcoal is most effective when administered within what timeframe after ingestion, and for which drug type?

Answer: Within 1 hour; for drugs that bind well to charcoal (e.g., most organic compounds)

Activated charcoal is most effective within 1 hour of ingestion for organic compounds that bind well; it is NOT effective for metals (iron, lithium), alcohols, or strong acids/bases.

When inserting a thoracostomy tube for haemothorax, which intercostal space and anatomical landmark is the standard insertion site?

Answer: 5th intercostal space, mid-axillary line

The 5th intercostal space at the mid-axillary line ('safe triangle') avoids the diaphragm and neurovascular bundle while providing optimal drainage.

A 50-year-old male presents with sudden severe eye pain, halos around lights, nausea, and vomiting. Examination reveals a mid-dilated, non-reactive pupil and a hazy cornea. Which condition requires immediate ophthalmologic consultation?

Answer: Acute angle-closure glaucoma

Acute angle-closure glaucoma presents with sudden IOP elevation causing corneal edema, mid-dilated fixed pupil, and severe pain and must be treated urgently to prevent vision loss.

A senior emergency physician advocates publicly for increased mental health resources in the ED. Which principle of professional advocacy does this BEST exemplify?

Answer: Using clinical evidence and position to influence health system policy

Physician advocacy involves leveraging clinical expertise and professional standing to drive systemic improvements in patient care and resource allocation.

In a patient with end-stage renal failure, which analgesic metabolite accumulates and causes CNS toxicity including seizures?

Answer: Norpethidine (normeperidine)

Norpethidine is a renally cleared active metabolite of pethidine (meperidine) that accumulates in renal failure and causes excitatory CNS effects and seizures.

In a nerve agent exposure, which antidote combination is given FIRST to a symptomatic casualty?

Answer: Atropine and pralidoxime

Atropine (for muscarinic effects) and pralidoxime (to reactivate acetylcholinesterase before aging) are the primary antidotes given together for nerve agent exposure.

A hiker in Australia is bitten by an unknown snake and develops local pain and systemic symptoms. Which first aid measure is MOST important?

Answer: Apply pressure immobilization bandaging to the entire bitten limb

Pressure immobilization bandaging slows lymphatic spread of venom and is the recommended first aid for Australian elapid snake envenomation; tourniquets and incision/suction are contraindicated.

A junior registrar in the ED asks for help managing a complex toxicology case. What is the supervisor's ideal educational response?

Answer: Use Socratic questioning to guide the registrar's reasoning while maintaining patient safety

Socratic questioning promotes active learning and clinical reasoning development without undermining trainee autonomy or compromising patient safety.

When preparing for awake fibreoptic intubation, topicalisation of the airway with lignocaine should not exceed which total dose to prevent systemic toxicity?

Answer: 9 mg/kg when applied topically to mucous membranes

Topical lignocaine on mucous membranes is absorbed rapidly; up to 9 mg/kg can be used topically as absorption is slower than IV, but this remains a generous ceiling requiring careful dosing.

As an emergency medicine leader, you notice that a junior registrar is consistently dismissed in multidisciplinary team meetings despite raising valid clinical concerns. What is the MOST appropriate leadership response?

Answer: Address the team dynamics openly and create structured opportunities for all members to contribute safely

Effective leaders create psychologically safe environments where all team members can contribute, rather than placing the burden of change solely on the junior clinician.

When performing nasogastric tube insertion in an unconscious intubated patient, which technique reduces the risk of inadvertent intracranial placement?

Answer: Avoiding NG tubes in patients with suspected basilar skull fracture and using orogastric route

In basilar skull fracture, the NG route risks intracranial passage through the cribriform plate; the orogastric route eliminates this risk entirely.

What is the recommended compression-to-ventilation ratio in adult CPR for a single rescuer?

Answer: 30:2

The 2020 AHA guidelines recommend a 30:2 compression-to-ventilation ratio for adult CPR with a single rescuer, prioritizing chest compressions.

A junior doctor under your supervision discloses they are struggling with anxiety that is affecting their clinical performance. As their supervisor, the MOST appropriate initial response is to:

Answer: Listen non-judgementally, assess immediate patient safety, and collaboratively develop a support plan

A compassionate and constructive supervisory response balances immediate patient safety with the junior doctor's wellbeing, following a structured and collaborative approach.

Which mechanism explains why beta-blockers are effective in treating thyrotoxic crisis (thyroid storm)?

Answer: They block adrenergic receptor-mediated symptoms and reduce peripheral T4 to T3 conversion

Propranolol, a non-selective beta-blocker, reduces adrenergic symptoms of thyroid storm and inhibits peripheral deiodination of T4 to the more active T3.

An emergency department head is preparing a business case for an additional consultant position. Which argument is MOST likely to be persuasive to hospital executives?

Answer: Evidence linking current consultant ratios to increased adverse events, length of stay, and downstream costs

Executives respond to evidence-based arguments that link clinical need to measurable outcomes and financial impact, rather than morale or precedent.