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

Hypertensive emergency is defined by severely elevated blood pressure accompanied by acute end-organ damage, not by blood pressure level alone.

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 benzodiazepines (lorazepam preferred) are first-line for status epilepticus due to their rapid onset, efficacy, and safety profile in acute seizure termination.

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

NIPPV/BiPAP is the preferred initial intervention for acute hypercapnic respiratory failure in cooperative COPD patients, reducing intubation rates and mortality.

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

In suspected bacterial meningitis with a petechial rash (meningococcemia), antibiotics must be given immediately without waiting for CT or lumbar puncture, as delay increases mortality.

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

Hemodynamic instability in a pregnant patient with these findings suggests a ruptured ectopic pregnancy, requiring immediate resuscitation and emergent surgical intervention.

LMCC - Licentiate of the Medical Council of Canada Practice Test

LMCC - Licentiate of the Medical Council of Canada Practice Test

LMCC Emergency Medicine 2