LMCC Emergency Medicine 3

Question 1

A 25-year-old motorcyclist presents after a high-speed collision with a GCS of 11 (E3V3M5), unequal pupils, and a depressed skull fracture on CT.
Which finding most urgently indicates neurosurgical intervention?

Accepted Answer

Epidural hematoma with >5 mm midline shift and declining GCS

Answer

Skull fracture alone without intracranial hemorrhage

Answer

Subarachnoid hemorrhage with normal GCS

Answer

Linear skull fracture overlying the middle meningeal artery

Question 2

A 40-year-old man sustains burns covering his anterior trunk and both arms (approximately 27% TBSA) in a house fire. Using the Parkland formula, how much IV fluid should be administered in the first 8 hours?

Accepted Answer

27 × 4 × body weight (kg) × 0.5 mL of Ringer's lactate

Answer

27 × 4 × body weight (kg) ÷ 4 mL of normal saline

Answer

27 × 4 × body weight (kg) × 0.5 mL of colloid

Answer

27 × 2 × body weight (kg) mL of D5W

Question 3

A 22-year-old woman is brought in unresponsive with a suspected opioid overdose (pinpoint pupils, RR 4/min, SpO2 82%). What is the immediate treatment?

Accepted Answer

Administer naloxone 0.4–2 mg IV/IM/intranasal and support ventilation

Answer

Perform rapid-sequence intubation immediately

Answer

Give IV flumazenil as first-line reversal agent

Answer

Apply a non-rebreather mask and await toxicology results

Question 4

A 3-year-old child presents with fever of 39.2°C, appears well, is playful, and has no localizing source of infection. What is the most appropriate management?

Accepted Answer

Oral acetaminophen, close follow-up within 24–48 hours, and parental education on warning signs

Answer

Immediate blood culture, urine culture, LP, and empiric IV antibiotics

Answer

Immediate chest X-ray and blood culture only

Answer

Administer prophylactic oral amoxicillin and discharge

Question 5

During cardiac arrest, after two cycles of CPR following defibrillation for refractory ventricular fibrillation, what is the drug of choice to administer?

Accepted Answer

IV amiodarone 300 mg bolus

Answer

IV lidocaine 1.5 mg/kg bolus

Answer

IV magnesium sulfate 2 g

Answer

IV atropine 1 mg

Question 6

A 60-year-old hypertensive man presents with tearing chest pain radiating to the back, unequal arm blood pressure, and a widened mediastinum on chest X-ray. What is the priority diagnostic test and initial treatment?

Accepted Answer

Urgent CT angiography of the chest, IV beta-blocker to reduce heart rate and BP

Answer

Immediate coronary angiography for suspected STEMI

Answer

Echocardiogram only, then administer thrombolytics

Answer

V/Q scan to rule out pulmonary embolism; anticoagulate empirically

Question 7

A 17-year-old boy presents with sudden-onset severe left scrotal pain and nausea that began 2 hours ago. Physical examination reveals a high-riding testis with absent cremasteric reflex. What is the most appropriate action?

Accepted Answer

Immediate urological consultation for emergency surgical exploration without delay for imaging

Answer

Scrotal ultrasound with Doppler is required before any surgical consideration

Answer

Administer analgesics and elevate scrotum; order ultrasound in the morning

Answer

Prescribe antibiotics for suspected epididymitis and follow up in 48 hours