NCCPA Emergency Medicine 3 — Questions and Answers
Question 1: A 55-year-old diabetic presents with painless lower extremity ulcer and crepitus on palpation. Imaging shows gas in soft tissues. What is the immediate management?
- IV antibiotics and wound care
- Hyperbaric oxygen therapy
- Emergent surgical debridement plus broad-spectrum antibiotics (Correct answer)
- CT scan before any intervention
Correct answer: Emergent surgical debridement plus broad-spectrum antibiotics
Necrotizing fasciitis requires emergent surgical debridement as the definitive treatment; antibiotics alone are insufficient and delay surgery increases mortality.
Question 2: What is the first-line treatment for anaphylaxis?
- IV diphenhydramine
- IV methylprednisolone
- Epinephrine 0.3mg IM in the anterolateral thigh (Correct answer)
- Inhaled albuterol
Correct answer: Epinephrine 0.3mg IM in the anterolateral thigh
Epinephrine IM (0.3mg of 1:1000 solution) in the anterolateral thigh is the first and most critical intervention for anaphylaxis.
Question 3: A 35-year-old presents with sudden-onset monocular vision loss, painless, described as a 'curtain coming down.' Fundoscopy shows cherry-red spot with pale retina. What is the diagnosis?
- Central retinal vein occlusion
- Central retinal artery occlusion (Correct answer)
- Acute angle-closure glaucoma
- Retinal detachment
Correct answer: Central retinal artery occlusion
Central retinal artery occlusion presents with sudden painless monocular vision loss, cherry-red spot at the fovea, and diffuse retinal pallor.
Question 4: Which of the following best describes the Beck's triad associated with cardiac tamponade?
- Hypertension, bradycardia, irregular respirations
- Hypotension, muffled heart sounds, jugular venous distension (Correct answer)
- Tachycardia, widened pulse pressure, fever
- Chest pain, ST elevation, friction rub
Correct answer: Hypotension, muffled heart sounds, jugular venous distension
Beck's triad consists of hypotension, muffled heart sounds, and jugular venous distension due to pericardial fluid compressing cardiac chambers.
Question 5: A patient presents after drowning with oxygen saturation of 84% on room air. CXR shows diffuse bilateral infiltrates. What syndrome is developing?
- Pulmonary embolism
- Acute Respiratory Distress Syndrome (ARDS) (Correct answer)
- Tension pneumothorax
- Aspiration pneumonitis only
Correct answer: Acute Respiratory Distress Syndrome (ARDS)
Near-drowning can cause ARDS characterized by hypoxemia, bilateral infiltrates, and reduced lung compliance from surfactant washout and inflammation.
Question 6: What is the most common cause of upper GI bleeding in an emergency department patient?
- Mallory-Weiss tear
- Esophageal varices
- Peptic ulcer disease (Correct answer)
- Gastric cancer
Correct answer: Peptic ulcer disease
Peptic ulcer disease (gastric and duodenal ulcers) accounts for approximately 40% of upper GI bleeding cases, making it the most common cause.
Question 7: A 22-year-old athlete collapses during a game in 100°F heat. Temperature is 41.5°C (106.7°F), and he is confused and diaphoretic. What is the priority treatment?
- Oral rehydration and rest in shade
- IV normal saline bolus only
- Rapid external cooling with ice water immersion (Correct answer)
- Acetaminophen for fever reduction
Correct answer: Rapid external cooling with ice water immersion
Exertional heat stroke (temperature >40°C with CNS dysfunction) requires immediate aggressive cooling — ice water immersion is the fastest and most effective method.
NCCPA Emergency Medicine 3
A 55-year-old diabetic presents with painless lower extremity ulcer and crepitus on palpation.
Imaging shows gas in soft tissues.
What is the immediate management?