NBME Emergency Medicine

Question 1

A patient develops hives, wheezing and hypotension minutes after a bee sting. What is the immediate first-line treatment?

Accepted Answer

IM epinephrine in the anterolateral thigh

Answer

Intramuscular epinephrine is first-line for anaphylaxis and should not be delayed. Antihistamines and steroids are adjuncts only.

Question 2

An unresponsive patient has a respiratory rate of 6/min and pinpoint pupils. Which drug should be given?

Accepted Answer

Naloxone

Answer

Respiratory depression with miosis suggests opioid toxicity, which is reversed by the opioid antagonist naloxone.

Question 3

What is the antidote for acetaminophen overdose?

Accepted Answer

N-acetylcysteine

Answer

N-acetylcysteine replenishes glutathione and prevents hepatotoxicity from the toxic metabolite NAPQI. It is most effective when started within 8 to 10 hours of ingestion.

Question 4

A trauma patient has severe dyspnea, absent breath sounds on the right, hypotension, distended neck veins and tracheal deviation to the left. What is the next best step?

Accepted Answer

Immediate needle decompression

Answer

These findings indicate tension pneumothorax, a clinical diagnosis. It requires immediate needle decompression followed by chest tube placement, without waiting for imaging.

Question 5

What is the recommended goal door-to-balloon time for primary PCI in a patient with STEMI?

Accepted Answer

90 minutes

Answer

For STEMI, the goal first-medical-contact-to-device time is 90 minutes or less for primary percutaneous coronary intervention. If PCI is not available, fibrinolysis should begin within 30 minutes.

NBME Practice Test

NBME Practice Test

NBME Emergency Medicine