SPEX Emergency Medicine 2 — Questions and Answers
Question 1: A 45-year-old male presents with sudden onset tearing chest pain radiating to the back. BP is 180/100 in the right arm and 150/90 in the left arm. What is the most likely diagnosis?
- Acute MI
- Aortic dissection (Correct answer)
- Pulmonary embolism
- Esophageal rupture
Correct answer: Aortic dissection
Aortic dissection classically presents with tearing/ripping chest pain radiating to the back and blood pressure differential between arms.
Question 2: Which of the following is the FIRST priority in managing a patient with tension pneumothorax?
- Chest X-ray confirmation
- Needle decompression (Correct answer)
- Chest tube insertion
- IV fluid resuscitation
Correct answer: Needle decompression
Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression at the 2nd intercostal space, midclavicular line without waiting for imaging.
Question 3: A 70-year-old on warfarin presents with INR of 8 and active GI bleeding. Which is the most appropriate reversal agent?
- Vitamin K alone
- Fresh frozen plasma
- 4-factor prothrombin complex concentrate (4F-PCC) (Correct answer)
- Protamine sulfate
Correct answer: 4-factor prothrombin complex concentrate (4F-PCC)
4F-PCC provides rapid, complete warfarin reversal with lower volume than FFP and is preferred for life-threatening bleeding.
Question 4: A patient presents with bradycardia (HR 38), hypotension, and QRS prolongation after ingesting unknown medications. Which toxidrome is most consistent?
- Opioid toxidrome
- Cholinergic toxidrome
- Calcium channel blocker toxicity (Correct answer)
- Serotonin syndrome
Correct answer: Calcium channel blocker toxicity
Calcium channel blocker toxicity causes bradycardia, hypotension, and can cause QRS widening, distinguishing it from other toxidromes.
Question 5: Which ECG finding in a patient with chest pain indicates immediate catheterization lab activation, even without ST elevation?
- Left bundle branch block (new or presumed new) (Correct answer)
- Sinus tachycardia
- Prolonged QTc
- Right axis deviation
Correct answer: Left bundle branch block (new or presumed new)
New or presumed new LBBB in the setting of chest pain is a STEMI-equivalent and warrants immediate cath lab activation per ACC/AHA guidelines.
Question 6: A child presents with drooling, stridor, and a preference for the tripod position. What condition should be suspected and what should be avoided?
- Croup; avoid steroids
- Epiglottitis; avoid throat examination (Correct answer)
- Foreign body; avoid sedation
- Anaphylaxis; avoid epinephrine
Correct answer: Epiglottitis; avoid throat examination
Epiglottitis presents with drooling, stridor, and tripod positioning; oropharyngeal examination can precipitate complete airway obstruction.
Question 7: In suspected carbon monoxide poisoning, which treatment is most critical regardless of pulse oximetry reading?
- Hyperbaric oxygen
- 100% non-rebreather oxygen (Correct answer)
- Sodium bicarbonate
- N-acetylcysteine
Correct answer: 100% non-rebreather oxygen
100% oxygen via non-rebreather mask should be given immediately because pulse oximetry is unreliable in CO poisoning (CO-oxyhemoglobin reads as oxyhemoglobin).
SPEX Emergency Medicine 2
A 45-year-old male presents with sudden onset tearing chest pain radiating to the back.
BP is 180/100 in the right arm and 150/90 in the left arm.
What is the most likely diagnosis?