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

An epidural hematoma with significant midline shift and neurological deterioration is a neurosurgical emergency requiring immediate craniotomy to relieve mass effect.

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

The Parkland formula (4 mL × kg × %TBSA) calculates total 24-hour crystalloid (Ringer's lactate); half is given in the first 8 hours and the remaining half over the next 16 hours.

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

Naloxone is the specific opioid antagonist that rapidly reverses respiratory depression, miosis, and sedation; ventilatory support should accompany its use.

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

A well-appearing, fully immunized child over 3 months with fever and no source can be managed with antipyretics, close outpatient follow-up, and clear return precautions without routine workup.

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 amiodarone 300 mg is the preferred antiarrhythmic for shock-refractory ventricular fibrillation per ACLS guidelines, followed by a repeat dose of 150 mg if needed.

LMCC - Licentiate of the Medical Council of Canada Practice Test

LMCC - Licentiate of the Medical Council of Canada Practice Test

LMCC Emergency Medicine 3