SPEX Emergency Medicine 2

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?

Accepted Answer

Aortic dissection

Answer

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?

Accepted Answer

Needle decompression

Answer

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?

Accepted Answer

4-factor prothrombin complex concentrate (4F-PCC)

Answer

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?

Accepted Answer

Calcium channel blocker toxicity

Answer

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?

Accepted Answer

Left bundle branch block (new or presumed new)

Answer

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.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Emergency Medicine 2