PANRE Emergency Medicine 3 — Questions and Answers
Question 1: A 60-year-old female presents with acute onset atrial fibrillation with rapid ventricular response and hypotension (BP 80/50). What is the immediate treatment?
- IV diltiazem for rate control
- Oral metoprolol for rate control
- Synchronized DC cardioversion (Correct answer)
- IV amiodarone infusion
Correct answer: Synchronized DC cardioversion
Unstable atrial fibrillation with hemodynamic compromise requires immediate synchronized cardioversion regardless of duration.
Question 2: A 3-year-old child is brought in unresponsive after being found in a backyard pool. After 2 minutes of CPR, a pulse is restored. Temperature is 32°C. What management is critical?
- Active external rewarming only
- Therapeutic hypothermia to 33°C
- Passive rewarming and supportive care with close neurologic monitoring (Correct answer)
- Immediate defibrillation
Correct answer: Passive rewarming and supportive care with close neurologic monitoring
In pediatric drowning with restored circulation and mild hypothermia, passive rewarming and supportive care with neurologic monitoring is appropriate; active cooling is not indicated.
Question 3: A 50-year-old diabetic presents with right lower quadrant pain, fever, and nausea for 2 days. CT shows a perforated appendix with localized abscess. What is the best initial management?
- Emergent appendectomy
- IV antibiotics and interventional radiology drainage (Correct answer)
- Oral antibiotics and outpatient follow-up
- Colonoscopy to evaluate the area
Correct answer: IV antibiotics and interventional radiology drainage
A walled-off periappendiceal abscess is best managed initially with IV antibiotics and percutaneous drainage, with interval appendectomy planned later.
Question 4: A 35-year-old presents after a bee sting with urticaria, hypotension, and stridor. After IM epinephrine, blood pressure improves but stridor persists. What is the next step?
- Repeat epinephrine and prepare for definitive airway management (Correct answer)
- Administer IV diphenhydramine only
- Discharge with an EpiPen prescription
- Apply oxygen by mask and observe for 15 minutes
Correct answer: Repeat epinephrine and prepare for definitive airway management
Persistent stridor after epinephrine in anaphylaxis signals imminent airway obstruction; repeat epinephrine and prepare for intubation or surgical airway.
Question 5: A 28-year-old male presents with a painful, tender, fluctuant perirectal mass. He has no fever or signs of systemic infection. What is the appropriate ED treatment?
- IV antibiotics and admission
- Incision and drainage in the ED (Correct answer)
- Sitz baths and outpatient surgical referral
- MRI pelvis to delineate extent before any intervention
Correct answer: Incision and drainage in the ED
A simple perirectal abscess without systemic involvement should be incised and drained in the ED without delay.
Question 6: A 22-year-old presents with perioral tingling, carpopedal spasm, and a positive Trousseau's sign after hyperventilating due to anxiety. What is the most likely electrolyte abnormality?
- Hyperkalemia
- Hypocalcemia (Correct answer)
- Hypomagnesemia
- Hypernatremia
Correct answer: Hypocalcemia
Hyperventilation causes respiratory alkalosis, which increases protein binding of calcium, leading to symptomatic hypocalcemia with tetany and a positive Trousseau's sign.
Question 7: A 68-year-old man presents with acute onset painless monocular vision loss described as a 'curtain coming down.' Fundoscopic exam shows a pale retina with a cherry-red spot. What is the diagnosis?
- Central retinal vein occlusion
- Central retinal artery occlusion (Correct answer)
- Retinal detachment
- Acute angle-closure glaucoma
Correct answer: Central retinal artery occlusion
A pale retina with a cherry-red spot at the macula is pathognomonic of central retinal artery occlusion, an ophthalmic emergency.
PANRE Emergency Medicine 3
A 60-year-old female presents with acute onset atrial fibrillation with rapid ventricular response and hypotension (BP 80/50).
What is the immediate treatment?