OSCE Emergency Assessment 3 — Questions and Answers
Question 1: A patient presents with sudden onset of unilateral pleuritic chest pain and dyspnea. Breath sounds are absent on the right. The trachea is midline. The MOST likely diagnosis is:
- Tension pneumothorax
- Simple pneumothorax (Correct answer)
- Massive hemothorax
- Pulmonary embolism
Correct answer: Simple pneumothorax
Absent breath sounds unilaterally with pleuritic pain and dyspnea, but midline trachea, indicates a simple (not tension) pneumothorax.
Question 2: When performing the SAMPLE history in an emergency, what does the 'E' stand for?
- Examination findings
- Events leading to the complaint (Correct answer)
- Exercise tolerance
- Extremity assessment
Correct answer: Events leading to the complaint
In the SAMPLE mnemonic, E stands for Events leading to the current illness or injury, providing context for the chief complaint.
Question 3: A patient with DKA has a serum potassium of 5.8 mEq/L on admission. When should potassium replacement begin?
- Immediately with insulin therapy
- When potassium falls below 5.0 mEq/L (Correct answer)
- When potassium falls below 3.5 mEq/L
- Only after the anion gap closes
Correct answer: When potassium falls below 5.0 mEq/L
Potassium replacement in DKA should begin when the level falls below 5.0 mEq/L, as insulin therapy will drive potassium intracellularly and cause hypokalemia.
Question 4: Which finding in a trauma patient most urgently indicates a needle decompression?
- SpO2 of 94% with absent breath sounds
- Tracheal deviation, absent breath sounds, and hypotension (Correct answer)
- Bilateral crackles and oxygen saturation of 90%
- Rib fractures on chest X-ray with mild dyspnea
Correct answer: Tracheal deviation, absent breath sounds, and hypotension
Tension pneumothorax presents with tracheal deviation away from the affected side, absent breath sounds, and hemodynamic compromise requiring immediate needle decompression.
Question 5: A 30-year-old presents with altered mental status, fever 39.8°C, neck stiffness, and photophobia. The FIRST intervention should be:
- Perform a lumbar puncture immediately
- Obtain a CT head before any treatment
- Administer antibiotics and dexamethasone, then perform LP (Correct answer)
- Start IV fluids and obtain blood cultures only
Correct answer: Administer antibiotics and dexamethasone, then perform LP
In suspected bacterial meningitis, antibiotics and dexamethasone should be given immediately before LP if there will be any delay, as treatment must not be deferred.
Question 6: What is the correct compression-to-ventilation ratio for adult CPR with two rescuers when an advanced airway is in place?
- 30:2
- 15:2
- Continuous compressions at 100-120/min with 1 breath every 6 seconds (Correct answer)
- 50:2
Correct answer: Continuous compressions at 100-120/min with 1 breath every 6 seconds
Once an advanced airway is placed, compressions are continuous at 100-120/min and ventilations are delivered asynchronously at 10 breaths/min (one every 6 seconds).
Question 7: A patient with suspected opioid overdose has respiratory rate of 4/min and pinpoint pupils. Which treatment is indicated?
- Flumazenil 0.2mg IV
- Naloxone 0.4–2mg IV/IM/IN (Correct answer)
- Activated charcoal via NG tube
- Sodium bicarbonate 1–2 mEq/kg IV
Correct answer: Naloxone 0.4–2mg IV/IM/IN
Naloxone is the opioid antagonist that rapidly reverses opioid-induced respiratory depression and miosis.
OSCE Emergency Assessment 3
A patient presents with sudden onset of unilateral pleuritic chest pain and dyspnea.
Breath sounds are absent on the right.
The trachea is midline.
The MOST likely diagnosis is: