SPEX Emergency Medicine 5 — Questions and Answers
Question 1: Which antidote is used for acetaminophen overdose and when should it be administered?
- Activated charcoal only if within 1 hour
- N-acetylcysteine (NAC) based on Rumack-Matthew nomogram (Correct answer)
- Flumazenil within 4 hours
- Sodium bicarbonate for all cases
Correct answer: N-acetylcysteine (NAC) based on Rumack-Matthew nomogram
N-acetylcysteine is the antidote for acetaminophen toxicity; the Rumack-Matthew nomogram determines treatment thresholds based on serum level and time since ingestion.
Question 2: A patient presents with acute angle-closure glaucoma. Which symptom combination is classic?
- Gradual bilateral vision loss with cupped disc
- Sudden unilateral eye pain, headache, nausea, and halos around lights (Correct answer)
- Painless unilateral vision loss with a curtain effect
- Bilateral red eyes with purulent discharge
Correct answer: Sudden unilateral eye pain, headache, nausea, and halos around lights
Acute angle-closure glaucoma presents with sudden, severe unilateral eye pain, headache, vomiting, halos around lights, and a mid-dilated non-reactive pupil.
Question 3: In pediatric resuscitation, what is the correct first energy dose for defibrillation?
- 1 J/kg
- 2 J/kg (Correct answer)
- 3 J/kg
- 360 J (same as adult)
Correct answer: 2 J/kg
Per PALS guidelines, initial defibrillation dose in pediatric VF/pVT is 2 J/kg, with subsequent doses at 4 J/kg.
Question 4: A patient presents after a bee sting with urticaria, stridor, and hypotension. What is the FIRST-LINE treatment?
- Diphenhydramine IV
- Methylprednisolone IV
- Epinephrine 0.3mg IM in the lateral thigh (Correct answer)
- Albuterol nebulization
Correct answer: Epinephrine 0.3mg IM in the lateral thigh
Epinephrine IM is the first-line, life-saving treatment for anaphylaxis; antihistamines and steroids are adjuncts only.
Question 5: What is the Cushing's triad and what does it indicate?
- Hypertension, bradycardia, and irregular respirations indicating increased intracranial pressure (Correct answer)
- Tachycardia, hypotension, and tachypnea indicating hemorrhagic shock
- Fever, altered mental status, and seizures indicating meningitis
- Chest pain, dyspnea, and diaphoresis indicating STEMI
Correct answer: Hypertension, bradycardia, and irregular respirations indicating increased intracranial pressure
Cushing's triad (hypertension, bradycardia, irregular respirations) represents the brainstem's response to herniation from elevated ICP and signals impending death.
Question 6: Which of the following is a contraindication to thrombolytics in pulmonary embolism?
- Oxygen saturation of 88%
- Recent intracranial surgery within 3 months (Correct answer)
- Heart rate of 120 bpm
- PaO2 of 55 mmHg
Correct answer: Recent intracranial surgery within 3 months
Recent intracranial surgery or stroke within 3 months is an absolute contraindication to thrombolytics due to the risk of intracranial hemorrhage.
Question 7: A patient presents with hyperthermia >41°C, muscle rigidity, and altered mental status after starting a new antipsychotic. Which diagnosis should be suspected?
- Serotonin syndrome
- Neuroleptic malignant syndrome (NMS) (Correct answer)
- Malignant hyperthermia
- Heat stroke
Correct answer: Neuroleptic malignant syndrome (NMS)
NMS presents with hyperthermia, lead-pipe rigidity, altered consciousness, and autonomic instability following antipsychotic use, developing over days.
SPEX Emergency Medicine 5
Which antidote is used for acetaminophen overdose and when should it be administered?