LMCC Emergency Medicine

Question 1

A 58-year-old man presents with crushing chest pain radiating to the left arm for 45 minutes. ECG shows ST elevation in leads II, III, and aVF. What is the most appropriate immediate management?

Accepted Answer

Administer aspirin 325 mg and arrange urgent percutaneous coronary intervention (PCI)

Answer

Start IV heparin alone and monitor ECG

Answer

Administer nitroglycerin and discharge with cardiology follow-up

Answer

Order echocardiography before initiating any treatment

Question 2

A 25-year-old woman develops urticaria, angioedema, and hypotension minutes after receiving penicillin. What is the first-line treatment?

Accepted Answer

Epinephrine 0.3–0.5 mg IM in the lateral thigh

Answer

IV diphenhydramine 50 mg

Answer

IV methylprednisolone 125 mg

Answer

Inhaled salbutamol (albuterol)

Question 3

A 70-year-old man presents with sudden-onset right-sided weakness and aphasia. CT head shows no hemorrhage. Onset was 1.5 hours ago. What is the next best step?

Accepted Answer

Administer IV alteplase (tPA) after confirming no contraindications

Answer

Start heparin infusion and admit to neurology

Answer

Arrange carotid Doppler ultrasound before treatment

Answer

Perform MRI brain and defer treatment until results available

Question 4

Which set of criteria best defines the Systemic Inflammatory Response Syndrome (SIRS) used as a component of sepsis identification?

Accepted Answer

Fever >38°C, HR >100, RR >20, WBC >12,000 or <4,000 (2 of 4 criteria)

Answer

Fever >39°C, HR >120, RR >30, WBC >15,000 (all 4 required)

Answer

Hypotension, altered mental status, lactate >2 mmol/L

Answer

Temperature <36°C, HR >90, PaCO2 <32 mmHg only

Question 5

A 19-year-old with type 1 diabetes presents with blood glucose of 28 mmol/L, pH 7.22, bicarbonate 14 mEq/L, and large urinary ketones. What is the priority in initial management?

Accepted Answer

Start IV normal saline fluid resuscitation and monitor electrolytes

Answer

Administer subcutaneous insulin immediately

Answer

Give IV sodium bicarbonate to correct acidosis

Answer

Restrict fluids to prevent cerebral edema

Question 6

A 35-year-old woman who is 32 weeks pregnant presents with acute dyspnea, pleuritic chest pain, and tachycardia after a 10-hour flight. CT pulmonary angiography confirms pulmonary embolism. What anticoagulant is preferred?

Accepted Answer

Low-molecular-weight heparin (LMWH) such as enoxaparin

Answer

Warfarin (starting immediately)

Answer

Rivaroxaban (a direct oral anticoagulant)

Answer

Unfractionated heparin by subcutaneous injection only

Question 7

A trauma patient develops sudden tracheal deviation to the left, absent breath sounds on the right, hypotension, and distended neck veins. What is the immediate treatment?

Accepted Answer

Needle decompression at the second intercostal space, midclavicular line on the right

Answer

Immediate chest X-ray to confirm diagnosis before intervention

Answer

Urgent intubation and positive pressure ventilation

Answer

Pericardiocentesis for suspected cardiac tamponade