FACEM Patient Assessment and Evaluation 2

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?

Accepted Answer

Aortic dissection

Answer

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?

Accepted Answer

Pericardial, hepatorenal, splenorenal, pelvic

Answer

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?

Accepted Answer

CT pulmonary angiography

Answer

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?

Accepted Answer

AEIOU TIPS

Answer

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?

Accepted Answer

Class III

Answer

Class III hemorrhagic shock involves 30–40% blood loss with hypotension, tachycardia >120, tachypnea 30–40, and altered mental status.

(FACEM) Fellowship of the Australasian College for Emergency Medicine Practice Test

(FACEM) Fellowship of the Australasian College for Emergency Medicine Practice Test

FACEM Patient Assessment and Evaluation 2