OSCE Emergency Assessment 5 — Questions and Answers
Question 1: A 55-year-old diabetic patient presents with diaphoresis, nausea, and jaw pain but denies chest pain. What should be your HIGHEST suspicion?
- Acute gastroenteritis
- Acute myocardial infarction (Correct answer)
- Diabetic gastroparesis
- Panic attack
Correct answer: Acute myocardial infarction
Diabetic patients frequently present with atypical MI symptoms such as jaw pain, nausea, and diaphoresis without classic chest pain due to autonomic neuropathy.
Question 2: When assessing capillary refill time in an adult, what duration is considered abnormal?
- Greater than 1 second
- Greater than 2 seconds (Correct answer)
- Greater than 4 seconds
- Greater than 5 seconds
Correct answer: Greater than 2 seconds
A capillary refill time greater than 2 seconds in adults indicates impaired peripheral perfusion and possible shock.
Question 3: A patient with acute pulmonary edema is sitting upright, using accessory muscles, and has pink frothy sputum. After oxygen, which drug should be given FIRST?
- Furosemide 80mg IV
- Nitroglycerin sublingual or IV (Correct answer)
- Morphine 4mg IV
- Dobutamine infusion
Correct answer: Nitroglycerin sublingual or IV
Nitroglycerin is the fastest-acting preload and afterload reducer in acute pulmonary edema, providing immediate symptom relief before diuresis begins.
Question 4: In the SBAR communication tool used during emergency handoffs, what does the 'R' stand for?
- Review of medications
- Recommendation (Correct answer)
- Respiratory assessment
- Response to treatment
Correct answer: Recommendation
SBAR stands for Situation, Background, Assessment, and Recommendation — with R being the clinician's specific request or recommendation.
Question 5: A patient who was submerged in cold water is found pulseless. Which statement BEST guides resuscitation?
- Withhold CPR if the patient has been submerged more than 30 minutes
- Continue full resuscitation because the cold may be protective; 'not dead until warm and dead' (Correct answer)
- Defibrillate immediately before warming
- Administer epinephrine only after the patient's temperature exceeds 30°C
Correct answer: Continue full resuscitation because the cold may be protective; 'not dead until warm and dead'
Hypothermia is protective against anoxic brain injury, and the principle 'not dead until warm and dead' guides full resuscitation until core temperature is restored.
Question 6: Which finding on a FAST (Focused Assessment with Sonography in Trauma) examination would indicate free fluid in the abdomen?
- Hyperechoic (bright white) area between organs
- Anechoic (black) area in the hepatorenal space (Morrison's pouch) (Correct answer)
- Increased echogenicity of the liver parenchyma
- Shadowing artifact posterior to the gallbladder
Correct answer: Anechoic (black) area in the hepatorenal space (Morrison's pouch)
Free fluid (blood) appears anechoic (black) on ultrasound; its presence in Morrison's pouch between the liver and kidney indicates hemoperitoneum.
Question 7: A patient presents after a high-voltage electrical injury. Beyond the entry and exit wounds, what is the MOST critical hidden injury to assess for?
- Corneal burns from arc flash
- Rhabdomyolysis and cardiac arrhythmias (Correct answer)
- Ruptured tympanic membranes
- Peripheral neuropathy
Correct answer: Rhabdomyolysis and cardiac arrhythmias
High-voltage electrical injury causes deep tissue destruction along the current path, leading to rhabdomyolysis and potentially fatal cardiac arrhythmias that must be monitored.
OSCE Emergency Assessment 5
A 55-year-old diabetic patient presents with diaphoresis, nausea, and jaw pain but denies chest pain.
What should be your HIGHEST suspicion?