SPEX Emergency Medicine 3

Question 1

A 30-year-old female presents with sudden severe headache described as 'the worst of my life.' CT head is negative. What is the next step?

Accepted Answer

Lumbar puncture

Answer

A negative CT does not rule out subarachnoid hemorrhage; lumbar puncture looking for xanthochromia is required when CT is negative and clinical suspicion is high.

Question 2

Which is the preferred vasopressor for septic shock when adequate fluid resuscitation has failed?

Accepted Answer

Norepinephrine

Answer

Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Campaign guidelines due to its alpha-adrenergic properties with less tachycardia risk.

Question 3

A patient is found unresponsive with pinpoint pupils and slow respirations. Which medication should be administered?

Accepted Answer

Naloxone

Answer

Pinpoint pupils with respiratory depression is the classic opioid toxidrome; naloxone is the specific reversal agent.

Question 4

What is the Parkland formula used for in emergency medicine?

Accepted Answer

Estimating fluid resuscitation in burn patients

Answer

The Parkland formula (4 mL × weight in kg × % TBSA burned) estimates the lactated Ringer's solution needed in the first 24 hours post-burn.

Question 5

A patient with known epilepsy presents in status epilepticus still seizing after two doses of benzodiazepines. What is the next preferred agent?

Accepted Answer

Levetiracetam or fosphenytoin

Answer

After benzodiazepine failure, levetiracetam, fosphenytoin, or valproate are second-line agents for established status epilepticus per current guidelines.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Emergency Medicine 3