LMCC Emergency Medicine

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?

Accepted Answer

Administer aspirin 325 mg and arrange urgent percutaneous coronary intervention (PCI)

Answer

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?

Accepted Answer

Epinephrine 0.3–0.5 mg IM in the lateral thigh

Answer

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?

Accepted Answer

Administer IV alteplase (tPA) after confirming no contraindications

Answer

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?

Accepted Answer

Fever >38°C, HR >100, RR >20, WBC >12,000 or <4,000 (2 of 4 criteria)

Answer

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?

Accepted Answer

Start IV normal saline fluid resuscitation and monitor electrolytes

Answer

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.

LMCC - Licentiate of the Medical Council of Canada Practice Test

LMCC - Licentiate of the Medical Council of Canada Practice Test

LMCC Emergency Medicine