PANRE Emergency Medicine 5

Question 1

A 58-year-old male with known COPD presents with increasing dyspnea, pursed-lip breathing, and SpO2 of 82% on room air. His PCO2 is 68 mmHg. What is the preferred initial ventilatory support?

Accepted Answer

Non-invasive positive pressure ventilation (BiPAP)

Answer

BiPAP reduces the work of breathing in COPD exacerbation and has been shown to decrease intubation rates and mortality compared to standard oxygen therapy.

Question 2

A 45-year-old construction worker presents with a nail embedded in the plantar surface of his foot through his boot. He is not up to date on tetanus. What is appropriate tetanus management?

Accepted Answer

Both tetanus toxoid and tetanus immune globulin (TIG)

Answer

A contaminated, deep puncture wound in an unvaccinated or incompletely vaccinated patient requires both tetanus toxoid and TIG for passive and active immunization.

Question 3

A 33-year-old female at 32 weeks gestation presents with severe headache, BP 168/110, and 3+ proteinuria. She then develops a generalized tonic-clonic seizure. What drug is given to prevent further seizures?

Accepted Answer

IV magnesium sulfate

Answer

Eclampsia (seizures in a preeclamptic patient) is treated and prevented with IV magnesium sulfate, which is superior to other anticonvulsants in this setting.

Question 4

A 17-year-old presents after a motor vehicle collision with distended neck veins, tracheal deviation to the right, absent breath sounds on the left, and hypotension. What is the immediate intervention?

Accepted Answer

Needle thoracostomy on the left at the second intercostal space, midclavicular line

Answer

Tension pneumothorax presents with tracheal deviation away from the affected side, absent breath sounds, distended neck veins, and shock — immediate needle decompression is lifesaving.

Question 5

A 62-year-old presents to the ED with confusion, fever of 38.8°C, and jaundice. She reports right upper quadrant pain for 3 days. BP is 90/60. What is the diagnosis?

Accepted Answer

Ascending cholangitis (Reynold's pentad)

Answer

Charcot's triad (fever, jaundice, RUQ pain) with added hypotension and confusion constitutes Reynold's pentad, diagnostic of severe ascending cholangitis requiring urgent biliary decompression.

PANRE Test Practice Test

PANRE Test Practice Test

PANRE Emergency Medicine 5