NAC OSCE Emergency Medicine 2

Question 1

A 30-year-old male presents to a Canadian ED after a syncopal episode during exercise. ECG shows a short PR interval and a delta wave. What is the diagnosis and the MOST critical concern?

Accepted Answer

Wolff-Parkinson-White syndrome — risk of rapid conduction during AF causing ventricular fibrillation and sudden cardiac death

Answer

WPW syndrome (short PR, delta wave) carries risk of rapid antegrade conduction via the accessory pathway during AF, potentially causing VF and sudden death; electrophysiology referral for ablation is indicated.

Question 2

A 70-year-old patient with COPD presents in acute hypercapnic respiratory failure (pH 7.28, pCO₂ 78 mmHg, SpO₂ 84%). According to Canadian Thoracic Society guidelines, what is the FIRST-line ventilatory support?

Accepted Answer

Non-invasive positive pressure ventilation (NIV/BiPAP)

Answer

CTS guidelines recommend NIV (BiPAP) as first-line for acute hypercapnic respiratory failure in COPD exacerbation; it reduces intubation rates and mortality compared to conventional oxygen therapy.

Question 3

A 22-year-old female presents with right lower quadrant pain, nausea, and a positive urine hCG. Her last period was 7 weeks ago. Transvaginal ultrasound shows no intrauterine gestational sac and free fluid in the pelvis. What is the MOST critical diagnosis to exclude?

Accepted Answer

Ruptured ectopic pregnancy — surgical emergency requiring immediate OB/GYN involvement

Answer

A positive hCG with no intrauterine sac and free pelvic fluid strongly suggests ruptured ectopic pregnancy, which can cause haemorrhagic shock and death; immediate surgical consultation is mandatory.

Question 4

According to ACLS guidelines used in Canadian hospitals, what is the recommended energy for the first defibrillation shock for ventricular fibrillation with a biphasic defibrillator?

Accepted Answer

120-200 J (biphasic) as recommended by the manufacturer, or 200 J if unknown

Answer

AHA/Canadian Resuscitation guidelines recommend 120-200 J for biphasic defibrillators (manufacturer-specific) for initial VF shock, with 200 J if the effective dose is unknown; subsequent shocks use equal or higher energy.

Question 5

A 60-year-old male with known liver cirrhosis presents vomiting large volumes of bright red blood. He is haemodynamically unstable. What is the MOST important immediate pharmacological intervention while awaiting endoscopy?

Accepted Answer

IV octreotide (somatostatin analogue) to reduce portal pressure, plus IV PPI

Answer

In variceal bleeding, octreotide (or terlipressin) reduces splanchnic blood flow and portal pressure; it should be given immediately alongside PPI, antibiotics (ceftriaxone), and blood products while arranging urgent endoscopy.

NAC OSCE Practice Test

NAC OSCE Practice Test

NAC OSCE Emergency Medicine 2