LMCC Emergency Medicine 1 — Questions and Answers
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?
- Administer aspirin 325 mg and arrange urgent percutaneous coronary intervention (PCI) (Correct answer)
- Start IV heparin alone and monitor ECG
- Administer nitroglycerin and discharge with cardiology follow-up
- Order echocardiography before initiating any treatment
Correct answer: Administer aspirin 325 mg and arrange urgent percutaneous coronary intervention (PCI)
ST-elevation myocardial infarction (STEMI) requires immediate aspirin administration and urgent reperfusion via PCI within 90 minutes of first medical contact.
Question 2: A 25-year-old woman develops urticaria, angioedema, and hypotension minutes after receiving penicillin. What is the first-line treatment?
- IV diphenhydramine 50 mg
- Epinephrine 0.3–0.5 mg IM in the lateral thigh (Correct answer)
- IV methylprednisolone 125 mg
- Inhaled salbutamol (albuterol)
Correct answer: Epinephrine 0.3–0.5 mg IM in the lateral thigh
Intramuscular epinephrine is the first-line treatment for anaphylaxis because it reverses bronchoconstriction, vasodilation, and mucosal edema simultaneously.
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?
- Start heparin infusion and admit to neurology
- Administer IV alteplase (tPA) after confirming no contraindications (Correct answer)
- Arrange carotid Doppler ultrasound before treatment
- Perform MRI brain and defer treatment until results available
Correct answer: Administer IV alteplase (tPA) after confirming no contraindications
IV alteplase is indicated for ischemic stroke within 4.5 hours of onset when hemorrhage is excluded and no contraindications are present.
Question 4: Which set of criteria best defines the Systemic Inflammatory Response Syndrome (SIRS) used as a component of sepsis identification?
- Fever >38°C, HR >100, RR >20, WBC >12,000 or <4,000 (2 of 4 criteria) (Correct answer)
- Fever >39°C, HR >120, RR >30, WBC >15,000 (all 4 required)
- Hypotension, altered mental status, lactate >2 mmol/L
- Temperature <36°C, HR >90, PaCO2 <32 mmHg only
Correct answer: Fever >38°C, HR >100, RR >20, WBC >12,000 or <4,000 (2 of 4 criteria)
SIRS is defined by 2 or more of: temperature >38°C or <36°C, HR >90, RR >20 or PaCO2 <32 mmHg, WBC >12,000 or <4,000 or >10% bands.
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?
- Administer subcutaneous insulin immediately
- Start IV normal saline fluid resuscitation and monitor electrolytes (Correct answer)
- Give IV sodium bicarbonate to correct acidosis
- Restrict fluids to prevent cerebral edema
Correct answer: Start IV normal saline fluid resuscitation and monitor electrolytes
IV fluid resuscitation with normal saline is the first priority in DKA to restore intravascular volume before insulin is initiated, as insulin without fluids can worsen hypovolemia.
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?
- Warfarin (starting immediately)
- Low-molecular-weight heparin (LMWH) such as enoxaparin (Correct answer)
- Rivaroxaban (a direct oral anticoagulant)
- Unfractionated heparin by subcutaneous injection only
Correct answer: Low-molecular-weight heparin (LMWH) such as enoxaparin
LMWH is the anticoagulant of choice during pregnancy because it does not cross the placenta, unlike warfarin, and direct oral anticoagulants are not approved in pregnancy.
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?
- Immediate chest X-ray to confirm diagnosis before intervention
- Needle decompression at the second intercostal space, midclavicular line on the right (Correct answer)
- Urgent intubation and positive pressure ventilation
- Pericardiocentesis for suspected cardiac tamponade
Correct answer: Needle decompression at the second intercostal space, midclavicular line on the right
Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression; delaying for imaging can be fatal.
LMCC Emergency Medicine 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?