OSCE Emergency Assessment 4 — Questions and Answers
Question 1: A patient presents with ST-elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
- Left anterior descending artery
- Left circumflex artery
- Right coronary artery (Correct answer)
- Left main coronary artery
Correct answer: Right coronary artery
ST elevation in the inferior leads (II, III, aVF) indicates an inferior STEMI, most commonly caused by right coronary artery occlusion.
Question 2: During a secondary survey, a patient reports flank pain, gross hematuria, and you note a seatbelt sign across the abdomen. Which organ injury is MOST suspected?
- Splenic laceration
- Renal injury (Correct answer)
- Bladder rupture
- Mesenteric tear
Correct answer: Renal injury
Flank pain combined with hematuria strongly suggests renal injury, which is common with deceleration trauma and lateral compression.
Question 3: Which rhythm requires immediate unsynchronized defibrillation?
- Ventricular tachycardia with a pulse
- Atrial fibrillation with rapid ventricular response
- Ventricular fibrillation (Correct answer)
- Supraventricular tachycardia
Correct answer: Ventricular fibrillation
Ventricular fibrillation is a pulseless, chaotic rhythm with no organized activity, requiring immediate unsynchronized defibrillation.
Question 4: In a pediatric patient, which formula is used to estimate the correct endotracheal tube size (uncuffed)?
- Age/4 + 3.5
- (Age/4) + 4 (Correct answer)
- Weight in kg / 10
- Age + 16 divided by 4
Correct answer: (Age/4) + 4
The formula (Age/4) + 4 estimates uncuffed ETT size in mm for pediatric patients, a standard PALS teaching point.
Question 5: A patient presents with hypotension, distended neck veins, and muffled heart sounds after a stab wound to the chest. This is MOST consistent with:
- Tension pneumothorax
- Cardiac tamponade (Correct answer)
- Massive hemothorax
- Aortic transection
Correct answer: Cardiac tamponade
Beck's triad — hypotension, JVD, and muffled heart sounds — is classic for cardiac tamponade caused by blood accumulating in the pericardial sac.
Question 6: Which of the following BEST describes the 'E' component (Exposure/Environment) in the primary ABCDE survey?
- Checking for pupillary response
- Fully undressing the patient and preventing hypothermia (Correct answer)
- Evaluating extremity pulses
- Estimating blood loss volume
Correct answer: Fully undressing the patient and preventing hypothermia
Exposure involves completely undressing the patient to find all injuries, while the environment component means preventing hypothermia with warm blankets.
Question 7: A patient with seizures has not responded to two doses of benzodiazepines. What is the next pharmacological step in status epilepticus management?
- Additional lorazepam at double the dose
- Levetiracetam, valproate, or fosphenytoin IV (Correct answer)
- Propofol infusion for sedation
- Oral carbamazepine via NG tube
Correct answer: Levetiracetam, valproate, or fosphenytoin IV
After failed benzodiazepine therapy, second-line agents including levetiracetam, valproate, or fosphenytoin are indicated for refractory status epilepticus.
OSCE Emergency Assessment 4
A patient presents with ST-elevation in leads II, III, and aVF.
Which coronary artery is most likely occluded?