SPEX Emergency Medicine 4

Question 1

A patient with atrial fibrillation presents with rapid ventricular response (HR 160) and hemodynamic instability. What is the immediate treatment?

Accepted Answer

Synchronized cardioversion

Answer

Hemodynamically unstable tachyarrhythmias require immediate synchronized cardioversion regardless of the rhythm.

Question 2

Which physical exam finding is MOST specific for cardiac tamponade?

Accepted Answer

Pulsus paradoxus >10 mmHg

Answer

Pulsus paradoxus greater than 10 mmHg is the most specific physical exam finding for cardiac tamponade, reflecting impaired ventricular filling with inspiration.

Question 3

A 25-year-old female presents with right lower quadrant pain, missed period, and a positive pregnancy test. The uterus is empty on ultrasound. What is the most concerning diagnosis?

Accepted Answer

Ectopic pregnancy

Answer

A positive pregnancy test with an empty uterus on ultrasound and abdominal pain must be presumed ectopic pregnancy until proven otherwise due to risk of rupture.

Question 4

Which maneuver should be performed when shoulder dystocia is encountered during delivery?

Accepted Answer

McRoberts maneuver and suprapubic pressure

Answer

McRoberts maneuver (hyperflexion of maternal thighs) combined with suprapubic pressure is the first-line intervention for shoulder dystocia.

Question 5

What is the most common cause of distributive shock?

Accepted Answer

Sepsis

Answer

Sepsis is the most common cause of distributive shock, characterized by vasodilation, decreased SVR, and initially elevated cardiac output.

SPEX Exam Practice Test

SPEX Exam Practice Test

SPEX Emergency Medicine 4