NAC OSCE Emergency Medicine

Question 1

A 45-year-old male presents to a Canadian ED with crushing substernal chest pain radiating to the left arm, diaphoresis, and an ECG showing 2 mm ST elevation in leads II, III, and aVF.
What is the MOST time-critical intervention target?

Accepted Answer

Door-to-balloon time <90 minutes for primary PCI, or fibrinolysis within 30 minutes if PCI is unavailable

Answer

Troponin result before any intervention

Answer

Echocardiogram to confirm wall motion abnormality first

Answer

Cardiology consultation before any treatment

Question 2

A 28-year-old woman is brought to the ED after ingesting an unknown quantity of acetaminophen 4 hours ago. Which investigation is MOST critical to guide treatment?

Accepted Answer

Serum acetaminophen level at 4 hours post-ingestion plotted on the Rumack-Matthew nomogram

Answer

Liver function tests alone

Answer

Urine toxicology screen

Answer

Serum acetaminophen level immediately on arrival

Question 3

According to Canadian Triage and Acuity Scale (CTAS), which level is assigned to a patient presenting with severe respiratory distress, SpO₂ 88%, and inability to complete sentences?

Accepted Answer

CTAS 1 — Resuscitation (immediate life threat)

Answer

CTAS 2 — Emergent (15-minute assessment target)

Answer

CTAS 3 — Urgent (30-minute target)

Answer

CTAS 4 — Less urgent (60-minute target)

Question 4

A 55-year-old male presents in anaphylactic shock after a bee sting. What is the FIRST-line treatment according to Canadian Emergency Medicine guidelines?

Accepted Answer

IM epinephrine 0.3-0.5 mg (1:1000) into the anterolateral thigh

Answer

IV antihistamine (diphenhydramine) as first priority

Answer

IV corticosteroids as the mainstay of treatment

Answer

Inhaled salbutamol as first-line bronchodilator

Question 5

A 65-year-old woman presents with sudden onset of the worst headache of her life. CT head is negative. What is the next MOST critical investigation?

Accepted Answer

Lumbar puncture for xanthochromia and red blood cell count (or CT angiography if available)

Answer

MRI brain with contrast

Answer

Neurology consult and observation only

Answer

EEG to rule out seizure activity

Question 6

A 3-year-old child is brought to the ED with 48 hours of profuse watery diarrhoea and vomiting. She is listless, has sunken eyes, no tears, and dry mucous membranes. Using the WHO/CPS dehydration scale, what is her dehydration status and MOST appropriate initial management?

Accepted Answer

Severe dehydration (>10% body weight) — IV rehydration with 20 mL/kg NS bolus, reassess and repeat as needed

Answer

Moderate dehydration — oral rehydration solution only

Answer

Mild dehydration — encourage breastfeeding and monitor at home

Answer

Severe dehydration — immediate blood transfusion

A 45-year-old male presents to a Canadian ED with crushing substernal chest pain radiating to the left arm, diaphoresis, and an ECG showing 2 mm ST elevation in leads II, III, and aVF.What is the MOST time-critical intervention target?

A 45-year-old male presents to a Canadian ED with crushing substernal chest pain radiating to the left arm, diaphoresis, and an ECG showing 2 mm ST elevation in leads II, III, and aVF.
What is the MOST time-critical intervention target?