FACEM Patient Assessment and Evaluation 2 — Questions and Answers
Question 1: A 68-year-old male presents with sudden-onset severe tearing chest pain radiating to the back. BP is 180/100 mmHg in the right arm and 150/85 mmHg in the left arm. Which diagnosis must be immediately considered?
- Acute STEMI
- Aortic dissection (Correct answer)
- Pulmonary embolism
- Hypertensive crisis
Correct answer: Aortic dissection
A blood pressure differential >20 mmHg between arms combined with tearing back pain is a classic presentation of aortic dissection.
Question 2: When performing a focused assessment with sonography in trauma (FAST), which four windows are assessed?
- Pericardial, hepatorenal, splenorenal, pelvic (Correct answer)
- Pericardial, aortic, hepatorenal, pelvic
- Hepatic, splenic, aortic, renal
- Pericardial, hepatic, splenic, renal
Correct answer: Pericardial, hepatorenal, splenorenal, pelvic
The FAST exam assesses the pericardial (subxiphoid), hepatorenal (Morison's pouch), splenorenal, and pelvic (pouch of Douglas) windows for free fluid.
Question 3: A 45-year-old woman presents with pleuritic chest pain, dyspnea, and a history of long-haul flight 5 days ago. Her Wells score is 7. What is the most appropriate next step?
- Chest X-ray and discharge if normal
- D-dimer assay before imaging
- CT pulmonary angiography (Correct answer)
- V/Q scan as first-line imaging
Correct answer: CT pulmonary angiography
A Wells score ≥5 indicates high probability of PE; D-dimer is not useful at this probability and CTPA should be performed directly.
Question 4: In assessing a patient with altered mental status, which mnemonic is commonly used to systematically evaluate reversible causes?
- AEIOU TIPS (Correct answer)
- SBAR
- AMPLE
- CIAMPEDS
Correct answer: AEIOU TIPS
AEIOU TIPS stands for Alcohol/Acidosis, Epilepsy, Insulin, Opiates/Overdose, Uremia, Trauma/Temperature, Infection, Psychiatric, Stroke/Structural, and is used to identify reversible causes of AMS.
Question 5: A trauma patient arrives with an open femur fracture. During primary survey, you note GCS 12, BP 88/60 mmHg, HR 128 bpm, RR 24. Which class of hemorrhagic shock does this best represent?
- Class I
- Class II
- Class III (Correct answer)
- Class IV
Correct answer: Class III
Class III hemorrhagic shock involves 30–40% blood loss with hypotension, tachycardia >120, tachypnea 30–40, and altered mental status.
Question 6: Which clinical finding is most specific for cardiac tamponade during the initial assessment?
- Hypotension
- Distended neck veins
- Muffled heart sounds
- Pulsus paradoxus >10 mmHg (Correct answer)
Correct answer: Pulsus paradoxus >10 mmHg
Pulsus paradoxus >10 mmHg is the most specific physical finding for cardiac tamponade, reflecting impaired cardiac filling during inspiration.
Question 7: A 30-year-old male is brought in by ambulance after a syncopal episode during exercise. ECG shows a short PR interval and a delta wave. Which condition does this suggest?
- Brugada syndrome
- Long QT syndrome
- Wolff-Parkinson-White syndrome (Correct answer)
- Hypertrophic cardiomyopathy
Correct answer: Wolff-Parkinson-White syndrome
A short PR interval with a delta wave on ECG is pathognomonic of Wolff-Parkinson-White syndrome due to an accessory conduction pathway.
FACEM Patient Assessment and Evaluation 2
A 68-year-old male presents with sudden-onset severe tearing chest pain radiating to the back.
BP is 180/100 mmHg in the right arm and 150/85 mmHg in the left arm.
Which diagnosis must be immediately considered?