OSCE Treatment Protocols & Interventions 4 — Questions and Answers
Question 1: A patient in acute alcohol withdrawal develops generalized tonic-clonic seizures. What is the first-line pharmacologic treatment?
- Phenytoin 1g IV load
- Lorazepam 2mg IV (Correct answer)
- Haloperidol 5mg IM
- Propofol infusion
Correct answer: Lorazepam 2mg IV
Benzodiazepines such as lorazepam are the first-line treatment for alcohol withdrawal seizures by enhancing GABA inhibition.
Question 2: When performing CPR, what is the recommended compression-to-ventilation ratio for a single rescuer treating an adult in cardiac arrest?
- 15:2
- 30:2 (Correct answer)
- 5:1
- Compressions only, no ventilations
Correct answer: 30:2
Current AHA guidelines recommend a 30:2 compression-to-ventilation ratio for adult single-rescuer CPR to minimize interruptions.
Question 3: A patient with severe sepsis has received 30 mL/kg of IV crystalloid. BP remains at 80/50 mmHg. What is the next intervention?
- Administer another 30 mL/kg bolus of normal saline
- Start norepinephrine as a vasopressor (Correct answer)
- Transfuse 2 units of packed red blood cells
- Administer hydrocortisone 100mg IV immediately
Correct answer: Start norepinephrine as a vasopressor
After adequate fluid resuscitation, norepinephrine is the first-line vasopressor for septic shock to restore mean arterial pressure.
Question 4: You are managing a patient with a suspected opioid overdose. Naloxone is administered but the patient re-sedates after 30 minutes. What should you do?
- Administer another dose of naloxone and observe
- Discharge with close follow-up instructions
- Start a naloxone infusion at 2/3 of the effective bolus dose per hour (Correct answer)
- Switch to flumazenil
Correct answer: Start a naloxone infusion at 2/3 of the effective bolus dose per hour
Long-acting opioids can outlast naloxone bolus duration; a continuous infusion at 2/3 of the effective bolus dose per hour maintains reversal.
Question 5: During an arterial blood gas collection from the radial artery, the patient complains of severe pain and the site turns white. What does this indicate?
- Successful arterial puncture with hematoma
- Arterial spasm — withdraw the needle and apply pressure (Correct answer)
- Venous puncture requiring redirection
- Air embolism from the procedure
Correct answer: Arterial spasm — withdraw the needle and apply pressure
Blanching and severe pain during radial artery puncture indicate arterial spasm; withdraw the needle and apply firm pressure.
Question 6: A patient with atrial fibrillation and rapid ventricular rate (150 bpm) is hemodynamically stable. Which is the preferred initial rate-control strategy?
- Synchronized cardioversion at 200J
- IV metoprolol or diltiazem (Correct answer)
- Oral digoxin loading
- Amiodarone 300mg IV push
Correct answer: IV metoprolol or diltiazem
IV beta-blockers (metoprolol) or non-dihydropyridine calcium channel blockers (diltiazem) are first-line for rate control in hemodynamically stable AF.
Question 7: A child weighing 20 kg requires IV fluid resuscitation. Using the Holliday-Segar method, what is the maintenance fluid rate?
- 40 mL/hr
- 60 mL/hr (Correct answer)
- 80 mL/hr
- 100 mL/hr
Correct answer: 60 mL/hr
Holliday-Segar: 100 mL/kg for first 10 kg + 50 mL/kg for next 10 kg = 1500 mL/day ÷ 24 = 62.5 mL/hr, rounded to 60 mL/hr.
OSCE Treatment Protocols & Interventions 4
A patient in acute alcohol withdrawal develops generalized tonic-clonic seizures.
What is the first-line pharmacologic treatment?