OSCE Emergency Assessment 2 — Questions and Answers
Question 1: A patient presents with stridor and drooling after a bee sting. Which intervention is the FIRST priority?
- Administer diphenhydramine IV
- Administer epinephrine 0.3mg IM into the thigh (Correct answer)
- Establish IV access and give methylprednisolone
- Apply ice to the sting site and monitor
Correct answer: Administer epinephrine 0.3mg IM into the thigh
Epinephrine IM is the first-line treatment for anaphylaxis with airway compromise, as it rapidly reverses bronchoconstriction and vasodilation.
Question 2: During a trauma assessment, you note paradoxical chest wall movement on the left side. What injury does this most likely indicate?
- Open pneumothorax
- Tension pneumothorax
- Flail chest (Correct answer)
- Hemothorax
Correct answer: Flail chest
Flail chest occurs when multiple rib fractures create a free-floating segment that moves paradoxically (inward on inspiration, outward on expiration).
Question 3: A 70-year-old presents with sudden onset severe tearing back pain and BP 180/110. The MOST important immediate diagnostic step is:
- 12-lead ECG
- Chest X-ray
- CT angiography of the chest and abdomen (Correct answer)
- Troponin level
Correct answer: CT angiography of the chest and abdomen
CT angiography is the gold standard for diagnosing aortic dissection, which is the most likely diagnosis given tearing pain and hypertension.
Question 4: When assessing a patient's disability (D) in the primary survey, which tool is used for rapid neurological status?
- Mini-Mental State Examination
- Glasgow Coma Scale (Correct answer)
- NIH Stroke Scale
- Confusion Assessment Method
Correct answer: Glasgow Coma Scale
The Glasgow Coma Scale (GCS) assesses eye, verbal, and motor responses and is the standard rapid neurological assessment in the primary survey.
Question 5: A patient with suspected carbon monoxide poisoning has a normal pulse oximetry reading. Why is this unreliable?
- Pulse oximetry cannot measure saturations above 95%
- Carboxyhemoglobin is detected as oxyhemoglobin by standard pulse oximetry (Correct answer)
- CO causes methemoglobinemia which saturates at 85%
- The peripheral vasoconstriction prevents an accurate waveform
Correct answer: Carboxyhemoglobin is detected as oxyhemoglobin by standard pulse oximetry
Standard pulse oximeters cannot distinguish carboxyhemoglobin from oxyhemoglobin, giving a falsely normal SpO2 reading in CO poisoning.
Question 6: In a patient with a GCS of 8, what airway intervention is indicated?
- Nasopharyngeal airway only
- Oropharyngeal airway and supplemental oxygen
- Definitive airway via endotracheal intubation (Correct answer)
- Non-rebreather mask at 15L/min
Correct answer: Definitive airway via endotracheal intubation
A GCS of 8 or less indicates inability to protect the airway, requiring definitive airway management with endotracheal intubation.
Question 7: A patient in hemorrhagic shock receives 2L of crystalloid without improvement. What is the next appropriate step?
- Administer a third liter of normal saline
- Initiate massive transfusion protocol with packed red blood cells (Correct answer)
- Start vasopressors such as norepinephrine
- Obtain a CT scan to identify the bleeding source
Correct answer: Initiate massive transfusion protocol with packed red blood cells
Failure to respond to initial crystalloid resuscitation in hemorrhagic shock indicates the need for blood products via a massive transfusion protocol.
OSCE Emergency Assessment 2
A patient presents with stridor and drooling after a bee sting.
Which intervention is the FIRST priority?