LMCC Emergency Medicine 2

Question 1

A 55-year-old hypertensive man presents with blood pressure of 210/130 mmHg, papilledema, and serum creatinine rising from 90 to 180 μmol/L over 3 days.
What defines this as a hypertensive emergency vs. urgency?

Accepted Answer

The presence of acute end-organ damage (retina, kidney, brain)

Answer

The absolute blood pressure level above 200 mmHg systolic

Answer

Symptoms of headache and visual blurring alone

Answer

Diastolic pressure exceeding 130 mmHg

Question 2

A 30-year-old man with known epilepsy presents with continuous tonic-clonic seizures lasting 8 minutes. What is the first-line pharmacologic treatment?

Accepted Answer

IV lorazepam 0.1 mg/kg

Answer

IV phenytoin 20 mg/kg loading dose

Answer

IM diazepam 10 mg

Answer

Oral levetiracetam 500 mg

Question 3

A 68-year-old COPD patient on home oxygen presents in acute respiratory failure with pH 7.28, PaCO2 72 mmHg, and PaO2 52 mmHg. He is conscious and can cooperate. What is the preferred initial ventilatory support?

Accepted Answer

Non-invasive positive pressure ventilation (NIPPV/BiPAP)

Answer

High-flow oxygen via non-rebreather mask

Answer

Immediate endotracheal intubation

Answer

Heliox (helium-oxygen mixture)

Question 4

A 22-year-old university student presents with fever, severe headache, neck stiffness, and a non-blanching petechial rash. What is the most critical immediate action?

Accepted Answer

Administer IV ceftriaxone immediately, before CT or LP if meningococcal meningitis is suspected

Answer

Perform lumbar puncture before administering antibiotics

Answer

Order CT head and await results before any treatment

Answer

Administer IV dexamethasone and wait for culture results

Question 5

A 28-year-old woman with 7 weeks of amenorrhea presents with right lower quadrant pain, vaginal bleeding, and a positive urine hCG. Her blood pressure is 90/60 mmHg and heart rate is 118 bpm. What is the priority?

Accepted Answer

IV access, fluid resuscitation, type and crossmatch, and urgent surgical/gynecology consultation

Answer

Transvaginal ultrasound to confirm ectopic pregnancy before any intervention

Answer

Serial serum beta-hCG levels to confirm diagnosis

Answer

Administer methotrexate and observe in the emergency department

Question 6

A 45-year-old man presents with 12 hours of periumbilical pain that has migrated to the right iliac fossa, anorexia, and low-grade fever. WBC is 14.5 × 10⁹/L. What is the most likely diagnosis and appropriate management?

Accepted Answer

Acute appendicitis; surgical consultation for appendectomy

Answer

Mesenteric adenitis; treat with antibiotics alone

Answer

Ovarian torsion; urgent gynecology referral

Answer

Renal colic; analgesics and outpatient urology follow-up

Question 7

A firefighter is brought in after 20 minutes in a burning building. He has a headache, nausea, and confusion. Oxygen saturation reads 98% on pulse oximetry. What is the most likely diagnosis and treatment?

Accepted Answer

Carbon monoxide poisoning; administer 100% oxygen via non-rebreather mask

Answer

Smoke inhalation with normal oxygenation; supportive care only

Answer

Cyanide poisoning; administer hydroxocobalamin

Answer

Psychogenic hyperventilation; reassurance and rebreathing