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Egyptian Board Emergency Medicine study materials
Egyptian Board Emergency Medicine study resources

Egyptian Board Emergency Medicine practice questions

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Question 1Resuscitation and Cardiovascular Emergencies

A 58-year-old man collapses in the emergency department waiting area. He is unresponsive, not breathing normally, and has no palpable carotid pulse. Chest compressions are started immediately. According to current adult basic life support guidance, what compression-to-ventilation ratio should be used once an advanced airway is not yet in place and two rescuers are available?

  1. Continuous compressions with asynchronous ventilation at 10 breaths per minute
  2. 30 compressions to 2 ventilations Correct answer.
  3. 5 compressions to 1 ventilation
  4. 15 compressions to 2 ventilations

Explanation

For adult cardiac arrest without an advanced airway, both single-rescuer and two-rescuer CPR use a ratio of 30 compressions to 2 ventilations. Once an advanced airway is placed, compressions become continuous and ventilations are delivered asynchronously at about 10 per minute. The 30:2 ratio preserves coronary perfusion pressure during the pause for breaths.

Question 2Resuscitation and Cardiovascular Emergencies

A 64-year-old woman with sudden-onset palpitations is alert but diaphoretic. Her ECG shows a regular narrow-complex tachycardia at 190 beats per minute. Blood pressure is 118/74 mmHg and she has no chest pain or heart failure signs. Synchronised cardioversion is being prepared. Which finding is the strongest indication to proceed with immediate synchronised cardioversion rather than attempting vagal manoeuvres or adenosine first?

  1. A narrow QRS duration of less than 120 milliseconds
  2. Patient preference for a rapid electrical approach
  3. Haemodynamic instability, ongoing ischaemic chest pain, or acute heart failure attributable to the tachycardia Correct answer.
  4. Heart rate greater than 150 beats per minute

Explanation

Synchronised cardioversion is indicated urgently when a tachyarrhythmia causes haemodynamic instability, ischaemic chest pain, acute heart failure, or shock. A stable patient with a regular narrow-complex tachycardia should first receive vagal manoeuvres and then adenosine. Rate and QRS width alone do not mandate electrical therapy in a stable patient.

Question 3Resuscitation and Cardiovascular Emergencies

A 70-year-old man is brought in after an out-of-hospital cardiac arrest with return of spontaneous circulation. He remains comatose and is intubated. Which post-arrest intervention has the strongest evidence for improving neurological outcome?

  1. Targeted temperature management with avoidance of fever Correct answer.
  2. Prophylactic anticonvulsant therapy in all comatose survivors
  3. Routine prophylactic antibiotics for 48 hours
  4. Immediate extubation to allow neurological assessment

Explanation

For comatose survivors of cardiac arrest, controlled temperature management and strict avoidance of fever are recommended because hyperthermia worsens neurological injury. Routine prophylactic antibiotics and universal anticonvulsants are not supported. Early extubation is inappropriate in a comatose patient who cannot protect the airway.

Question 4Resuscitation and Cardiovascular Emergencies

A 45-year-old man presents with crushing central chest pain. His ECG shows 3 mm ST elevation in leads II, III, and aVF with reciprocal depression in I and aVL. The nearest percutaneous coronary intervention centre is 150 minutes away by road, and a fibrinolytic-capable hospital is 20 minutes away with no contraindications to lysis. Which reperfusion strategy is most appropriate?

  1. Immediate transfer for primary percutaneous coronary intervention regardless of delay
  2. Coronary CT angiography before any reperfusion decision
  3. Fibrinolysis now with transfer for angiography after reperfusion Correct answer.
  4. Aspirin and heparin alone with admission for observation

Explanation

When primary percutaneous coronary intervention cannot be delivered within about 120 minutes of first medical contact, and the patient has no contraindications, fibrinolysis should be given promptly with subsequent transfer for angiography. Delay for percutaneous intervention beyond the acceptable window worsens myocardial salvage. Antithrombotic therapy alone is not reperfusion.

Question 5Resuscitation and Cardiovascular Emergencies

A 30-year-old woman is found unresponsive with a witnessed collapse during a marathon. Bystander CPR is ongoing. The rhythm on the monitor is ventricular fibrillation. Defibrillation has been attempted once with no change. After resuming compressions for two minutes, the rhythm remains ventricular fibrillation. What is the recommended next step in advanced life support?

  1. Perform immediate synchronised cardioversion at 50 joules
  2. Withhold further shocks and give amiodarone alone
  3. Give adrenaline 1 mg intravenously and immediately defibrillate again
  4. Deliver a further shock, then resume compressions and give adrenaline 1 mg after the third shock Correct answer.

Explanation

In refractory ventricular fibrillation, shocks are repeated every two cycles of CPR, and adrenaline 1 mg is given after the third shock, then every three to five minutes. Amiodarone is added after the third shock. Synchronised cardioversion is not used for ventricular fibrillation because there is no organised rhythm to synchronise with.

Question 6Resuscitation and Cardiovascular Emergencies

A 68-year-old woman with a history of hypertension presents with sudden severe dyspnoea. She is sitting upright, has bibasal crackles, an S3 gallop, and a blood pressure of 186/104 mmHg. Chest radiograph shows pulmonary oedema. Which initial pharmacological approach is most appropriate?

  1. Intravenous beta-blocker to control blood pressure
  2. Intravenous furosemide plus nitroglycerin with non-invasive ventilation Correct answer.
  3. Immediate intravenous calcium channel blocker bolus to lower blood pressure
  4. Rapid intravenous bolus of 1 litre normal saline

Explanation

Hypertensive acute pulmonary oedema is managed with oxygen or non-invasive ventilation, intravenous loop diuretic, and vasodilators such as nitroglycerin to reduce preload and afterload. Fluid bolus would worsen congestion. Beta-blockers and rapid calcium channel blocker boluses can precipitate decompensation and are not first-line in acute pulmonary oedema.

Question 7Resuscitation and Cardiovascular Emergencies

A 72-year-old man is admitted with an inferior ST-elevation myocardial infarction. He becomes bradycardic at 38 beats per minute, hypotensive at 82/50 mmHg, and confused. Intravenous atropine 0.5 mg has produced no response. Which intervention is the most appropriate next step?

  1. Transcutaneous pacing while preparing for transvenous pacing Correct answer.
  2. Synchronised cardioversion at 100 joules
  3. Sublingual nitroglycerin to relieve ischaemia
  4. Intravenous adenosine 6 mg

Explanation

Symptomatic bradycardia unresponsive to atropine should be managed with transcutaneous pacing, with preparation for transvenous pacing. Atropine is often ineffective in high-degree atrioventricular block complicating inferior infarction. Adenosine and cardioversion treat tachyarrhythmias, and nitroglycerin can worsen hypotension.

Question 8Resuscitation and Cardiovascular Emergencies

A 55-year-old man is in cardiac arrest with an initial rhythm of asystole. After two minutes of CPR and intravenous adrenaline, the rhythm remains asystole on the monitor. Which action is correct?

  1. Deliver an unsynchronised shock at 200 joules
  2. Continue CPR, give adrenaline every 3 to 5 minutes, and search for reversible causes Correct answer.
  3. Give atropine 3 mg intravenously
  4. Terminate resuscitation immediately because asystole is present

Explanation

Asystole is a non-shockable rhythm, so defibrillation is not performed. Management is high-quality CPR, adrenaline every three to five minutes, and systematic identification of reversible causes such as hypoxia, hypovolaemia, and electrolyte disturbance. Atropine is no longer recommended in cardiac arrest.

Question 9Resuscitation and Cardiovascular Emergencies

A 24-year-old man develops sudden sharp chest pain and breathlessness two days after a long-haul flight. He is tachycardic at 118 beats per minute, saturations are 88% on room air, and blood pressure is 96/62 mmHg. Which finding would most strongly support a diagnosis of massive pulmonary embolism requiring thrombolysis?

  1. A normal alveolar-arterial oxygen gradient
  2. Elevated D-dimer level
  3. Persistent hypotension with echocardiographic right ventricular strain Correct answer.
  4. Bilateral basal crackles on auscultation

Explanation

Massive, or high-risk, pulmonary embolism is defined by haemodynamic instability, often with right ventricular dysfunction on echocardiography. Thrombolysis is indicated in this setting. D-dimer is sensitive but non-specific, and a normal alveolar-arterial gradient does not exclude embolism.

Question 10Resuscitation and Cardiovascular Emergencies

A 36-year-old woman is brought in after a bee sting with facial swelling, stridor, and a blood pressure of 78/40 mmHg. Which medication should be given first intramuscularly?

  1. Chlorphenamine 10 mg
  2. Nebulised salbutamol 5 mg
  3. Adrenaline 0.5 mg into the anterolateral thigh Correct answer.
  4. Hydrocortisone 200 mg

Explanation

Intramuscular adrenaline into the anterolateral thigh is the first-line treatment for anaphylaxis with airway compromise and hypotension. It reverses vasodilation and bronchospasm within minutes. Antihistamines and corticosteroids are adjuncts and do not treat the acute airway or circulatory collapse.

Question 11Resuscitation and Cardiovascular Emergencies

A 60-year-old man with a history of heart failure presents with a regular narrow-complex tachycardia at 160 beats per minute. He is alert, blood pressure is 124/78 mmHg, and he has no chest pain or breathlessness. Vagal manoeuvres have failed. Which drug is the most appropriate next step?

  1. Intravenous digoxin 0.5 mg
  2. Intravenous amiodarone 300 mg
  3. Intravenous metoprolol 5 mg
  4. Intravenous adenosine 6 mg rapid bolus Correct answer.

Explanation

For a stable regular narrow-complex tachycardia, adenosine given as a rapid bolus after failed vagal manoeuvres is the recommended next step. It briefly blocks the atrioventricular node and often terminates atrioventricular nodal re-entry. Amiodarone, beta-blockers, and digoxin are used in other contexts or when adenosine fails.

Question 12Resuscitation and Cardiovascular Emergencies

A 78-year-old woman is admitted with a hip fracture. On the second postoperative day she becomes hypotensive at 84/56 mmHg with a heart rate of 112 beats per minute, cool peripheries, and a lactate of 4.2 mmol/L. Which type of shock is most likely, and what is the appropriate initial fluid strategy?

  1. Obstructive shock; perform immediate pericardiocentesis
  2. Hypovolaemic or distributive shock; give a balanced crystalloid bolus and reassess Correct answer.
  3. Neurogenic shock; give atropine and withhold fluids
  4. Cardiogenic shock; restrict fluids and start inotropes

Explanation

Postoperative hypotension with tachycardia, cool peripheries, and raised lactate suggests hypovolaemia or an early distributive component such as sepsis. Initial management is a balanced crystalloid bolus with reassessment of response. Inotropes are reserved for confirmed cardiogenic shock, and pericardiocentesis requires evidence of tamponade.

Question 13Resuscitation and Cardiovascular Emergencies

A 62-year-old man in ventricular fibrillation has received three shocks, adrenaline, and amiodarone but remains in ventricular fibrillation. Which reversible cause should be specifically considered given a history of dialysis-dependent renal failure and a widened QRS before arrest?

  1. Hyperkalaemia Correct answer.
  2. Hypothermia
  3. Tension pneumothorax
  4. Hypoglycaemia

Explanation

In dialysis-dependent patients with a widened QRS before arrest, hyperkalaemia is a likely reversible cause of refractory ventricular fibrillation. Treatment includes intravenous calcium, insulin with glucose, and consideration of urgent dialysis. Hypoglycaemia and hypothermia do not typically produce a widened QRS.

Question 14Resuscitation and Cardiovascular Emergencies

A 50-year-old man presents with a tearing interscapular pain and a blood pressure difference of 30 mmHg between arms. Which immediate management priority is most appropriate while awaiting definitive imaging?

  1. Immediate thrombolysis to dissolve the presumed intimal flap
  2. Rapid intravenous fluid loading to raise blood pressure
  3. Aggressive blood pressure and heart rate control to reduce aortic wall stress Correct answer.
  4. Immediate anticoagulation with therapeutic heparin

Explanation

In suspected acute aortic dissection, the priority is prompt control of heart rate and blood pressure to reduce shear stress on the aortic wall and limit propagation. Thrombolysis and anticoagulation are contraindicated because they promote bleeding into the false lumen. Fluid loading to raise pressure would worsen wall stress.

Question 15Resuscitation and Cardiovascular Emergencies

A 19-year-old athlete collapses during a football match and is unresponsive. Which single action most improves survival in out-of-hospital cardiac arrest when performed immediately by a bystander?

  1. Elevating the legs to improve venous return
  2. Starting chest compressions with minimal interruption Correct answer.
  3. Checking the pupils for reactivity
  4. Placing the patient in the recovery position

Explanation

Immediate, high-quality chest compressions with minimal interruption maintain coronary and cerebral perfusion and are the most important bystander action in cardiac arrest. The recovery position is used only for breathing patients. Pupillary checks and leg elevation do not improve outcomes.

Question 16Resuscitation and Cardiovascular Emergencies

A 66-year-old woman with a permanent pacemaker presents with palpitations. Her ECG shows a tachyarrhythmia at 150 beats per minute with a regular rhythm and a QRS that follows a paced spike. Which consideration is most important before applying a magnet or reprogramming?

  1. Adenosine is contraindicated in all paced rhythms
  2. Pacemaker-mediated tachycardia should be suspected and the device interrogated Correct answer.
  3. Immediate defibrillation should be delivered regardless of stability
  4. The pacemaker guarantees protection against ventricular fibrillation

Explanation

A regular tachycardia in a paced patient may represent pacemaker-mediated tachycardia or a tracking arrhythmia, and device interrogation is needed to confirm the mechanism. Defibrillation is reserved for unstable ventricular arrhythmias. Adenosine is not universally contraindicated and may help terminate some supraventricular tachycardias.

Question 17Resuscitation and Cardiovascular Emergencies

A 40-year-old man is resuscitated after a heroin overdose with respiratory depression and subsequent cardiac arrest. Return of spontaneous circulation is achieved. Which antidote should be given to reverse the underlying cause?

  1. N-acetylcysteine
  2. Physostigmine
  3. Naloxone Correct answer.
  4. Flumazenil

Explanation

Naloxone is a competitive opioid antagonist that reverses opioid-induced respiratory depression, the precipitant of arrest in this case. Flumazenil reverses benzodiazepines and is avoided in mixed overdose because it can precipitate seizures. N-acetylcysteine treats paracetamol toxicity, and physostigmine is used for anticholinergic toxicity.

Question 18Resuscitation and Cardiovascular Emergencies

A 58-year-old woman with ST-elevation myocardial infarction receives fibrinolysis at a rural hospital. Ninety minutes later she remains chest pain free but the ST segments have not resolved by more than 50%, and she develops recurrent pain with new hypotension. What is the most appropriate management?

  1. Discharge home if troponin is only mildly elevated
  2. Urgent transfer for rescue percutaneous coronary intervention Correct answer.
  3. Observe for another 90 minutes before deciding
  4. Repeat the full dose of fibrinolytic agent

Explanation

Failure of ST-segment resolution with recurrent ischaemic symptoms after fibrinolysis indicates failed reperfusion and is an indication for urgent rescue percutaneous coronary intervention. Repeating the fibrinolytic dose increases bleeding risk without proven benefit. Observation or discharge would leave the occluded artery untreated.

Question 19Resuscitation and Cardiovascular Emergencies

A 74-year-old man has a heart rate of 46 beats per minute, blood pressure of 136/80 mmHg, and is asymptomatic while awaiting discharge. Which management is most appropriate?

  1. Intravenous atropine 1 mg
  2. Immediate transcutaneous pacing
  3. Observation with review of rate-limiting medications Correct answer.
  4. Urgent transvenous pacing

Explanation

Asymptomatic bradycardia with adequate blood pressure does not require pacing or atropine. Management is observation and review of drugs that slow conduction, such as beta-blockers or rate-limiting calcium channel blockers. Pacing is reserved for symptomatic or haemodynamically compromising bradycardia.

Question 20Resuscitation and Cardiovascular Emergencies

A 48-year-old woman develops sudden severe headache, and imaging confirms subarachnoid haemorrhage. She is alert with a blood pressure of 168/96 mmHg. Which medication is most appropriate to prevent rebleeding while awaiting aneurysm securing?

  1. Oral or intravenous nimodipine Correct answer.
  2. Intravenous thrombolysis
  3. Intravenous nitroprusside titrated to a systolic pressure below 100 mmHg
  4. Intravenous norepinephrine to raise blood pressure

Explanation

Nimodipine is given to reduce delayed cerebral ischaemia after subarachnoid haemorrhage, and blood pressure is controlled to prevent rebleeding while avoiding excessive hypotension. Thrombolysis is contraindicated in haemorrhagic stroke. Norepinephrine would raise pressure and increase rebleeding risk.

Question 21Resuscitation and Cardiovascular Emergencies

A 65-year-old man with known heart failure presents with hypotension at 80/50 mmHg, cool extremities, raised jugular venous pressure, and bilateral crackles. Bedside echocardiography shows a severely dilated left ventricle with poor contractility. Which inotrope is most appropriate for initial haemodynamic support?

  1. Phenylephrine
  2. Nitroglycerin infusion
  3. Adenosine
  4. Dobutamine Correct answer.

Explanation

Dobutamine is an inotrope that increases contractility and cardiac output in cardiogenic shock due to poor left ventricular function. Phenylephrine is a pure vasoconstrictor that raises afterload without improving contractility. Adenosine is antiarrhythmic, and nitroglycerin reduces preload and worsens hypotension in this setting.

Question 22Resuscitation and Cardiovascular Emergencies

A 28-year-old woman with a history of asthma presents with sudden breathlessness, tachycardia, and hypotension after a severe asthma exacerbation. She has no fever. Which finding would most suggest a diagnosis of tension pneumothorax requiring immediate needle decompression?

  1. Elevated white cell count
  2. Unilateral absent breath sounds with tracheal deviation and worsening hypotension Correct answer.
  3. Bilateral basal crepitations
  4. Bilateral expiratory wheeze

Explanation

Tension pneumothorax presents with unilateral absent breath sounds, tracheal deviation away from the affected side, and obstructive shock. Immediate needle decompression precedes confirmatory imaging. Bilateral wheeze and crepitations suggest asthma or pulmonary oedema rather than pneumothorax.

Question 23Resuscitation and Cardiovascular Emergencies

A 70-year-old man is found in pulseless electrical activity. After intubation and confirmation of tube position, capnography shows a sudden drop in end-tidal carbon dioxide from 25 to 8 mmHg. Which action is most appropriate?

  1. Increase ventilation rate to 20 breaths per minute
  2. Check tube position and compressions, and consider reversible causes Correct answer.
  3. Defibrillate at 360 joules
  4. Give a further 1 mg of adrenaline immediately

Explanation

A sudden fall in end-tidal carbon dioxide during CPR suggests loss of airway, tube displacement, or poor compression quality, and reversible causes should be reconsidered. Hyperventilation raises intrathoracic pressure and reduces venous return. Defibrillation is not indicated for pulseless electrical activity.

Question 24Resuscitation and Cardiovascular Emergencies

A 62-year-old man with a history of hypertension is found unresponsive at home. Blood pressure is 210/110 mmHg, and CT shows an intracerebral haemorrhage. Which blood pressure target is generally recommended in the first hours after intracerebral haemorrhage?

  1. Leave blood pressure untreated regardless of level
  2. Raise blood pressure to improve cerebral perfusion
  3. Reduce systolic pressure to below 90 mmHg as rapidly as possible
  4. Smoothly lower systolic pressure to around 140 mmHg while avoiding abrupt drops Correct answer.

Explanation

In acute intracerebral haemorrhage, guidelines support smooth lowering of systolic pressure to around 140 mmHg to limit haematoma expansion while avoiding abrupt or excessive reduction. Extreme lowering risks cerebral ischaemia, and leaving severe hypertension untreated promotes rebleeding.

Question 25Resuscitation and Cardiovascular Emergencies

A 55-year-old man in cardiac arrest is receiving CPR. Which technique best ensures high-quality chest compressions?

  1. Compress at least 5 cm deep at 100 to 120 per minute with full recoil Correct answer.
  2. Lean on the chest between compressions to maintain contact
  3. Pause compressions for 20 seconds every minute to check the rhythm
  4. Compress at a depth of 2 to 3 cm at 60 per minute

Explanation

High-quality CPR requires compressions of at least 5 cm but not more than 6 cm, at a rate of 100 to 120 per minute, with complete chest recoil and minimal interruptions. Leaning prevents venous return, and prolonged rhythm checks reduce coronary perfusion.

Question 26Resuscitation and Cardiovascular Emergencies

A 58-year-old man collapses in the emergency department waiting room. He is unresponsive, not breathing normally, and has no palpable carotid pulse. Which single intervention has the greatest impact on his chance of survival?

  1. Opening the airway with a head-tilt chin-lift before any other action
  2. Attaching the defibrillator pads before starting chest compressions
  3. Giving two rescue breaths before starting chest compressions
  4. Beginning high-quality chest compressions immediately Correct answer.

Explanation

For any adult in cardiac arrest, immediate high-quality chest compressions with minimal interruption are the foundation of resuscitation and the strongest determinant of survival. Compressions generate the coronary and cerebral perfusion pressure that preserve the myocardium and brain while definitive therapy is prepared. Other steps such as airway manoeuvres, ventilation, or defibrillation are important but must not delay or interrupt the compression sequence.

Question 27Resuscitation and Cardiovascular Emergencies

A 70-year-old woman with a known anterior myocardial infarction develops acute pulmonary oedema. She is breathless, has bibasal crackles, and a blood pressure of 168/94 mmHg. Which initial pharmacological strategy is most appropriate?

  1. Rapid intravenous fluid bolus of 500 mL crystalloid
  2. Intravenous metoprolol to slow the heart rate immediately
  3. Intravenous furosemide with nitroglycerin and non-invasive ventilatory support Correct answer.
  4. Intravenous adrenaline infusion to support cardiac output

Explanation

Hypertensive acute pulmonary oedema is treated with preload and afterload reduction together with ventilatory support. Intravenous loop diuretics reduce volume, nitrates lower afterload and preload, and non-invasive ventilation improves oxygenation and reduces work of breathing. This combination addresses the underlying haemodynamics rather than simply stimulating the heart.

Question 28Resuscitation and Cardiovascular Emergencies

A 30-year-old man is brought in after a high-voltage electrical injury. He is conscious, has a pulse of 118 beats per minute, and a blood pressure of 104/66 mmHg. Which monitoring step is most important in the first hours of emergency care?

  1. Serial measurement of creatine kinase-MB only
  2. Immediate echocardiography before any monitoring
  3. Repeated measurement of serum amylase
  4. Continuous cardiac monitoring for arrhythmia Correct answer.

Explanation

Electrical injury can cause myocardial injury and dangerous arrhythmias, so continuous cardiac monitoring is standard for any significant electrical exposure. Rhythm disturbances may appear hours after the event, and monitoring detects them early. Other investigations may be useful but do not replace rhythm surveillance in the acute phase.

Question 29Resuscitation and Cardiovascular Emergencies

A 64-year-old man with a permanent pacemaker is found unresponsive. The monitor shows a rate of 30 beats per minute with wide QRS complexes. He remains pulseless after the monitor is checked and the patient is reassessed. Which action is the immediate priority?

  1. Reprogram the pacemaker with a magnet before any other action
  2. Give intravenous atropine and observe the response
  3. Obtain a 12-lead ECG before starting resuscitation
  4. Start chest compressions and follow the bradycardia cardiac arrest pathway Correct answer.

Explanation

A pulseless patient in a bradycardic rhythm is in cardiac arrest, and the priority is immediate chest compressions with progression along the cardiac arrest algorithm. Pacemaker malfunction or failure to capture does not change this because the patient has no output. Reprogramming, atropine, or diagnostic testing must never precede resuscitation in a pulseless patient.

Question 30Resuscitation and Cardiovascular Emergencies

A 45-year-old woman presents with a regular narrow-complex tachycardia at 190 beats per minute and a blood pressure of 132/78 mmHg. She has no chest pain, dyspnoea, or altered consciousness. Which initial manoeuvre is most appropriate?

  1. Intravenous amiodarone infusion
  2. Intravenous adenosine followed by atropine
  3. Vagal manoeuvres such as the modified Valsalva technique Correct answer.
  4. Immediate synchronised cardioversion

Explanation

In a haemodynamically stable patient with a regular narrow-complex tachycardia, vagal manoeuvres are the first-line attempt to terminate a re-entrant supraventricular tachycardia. The modified Valsalva technique has good success and avoids drug or electrical therapy. If it fails, adenosine or other rate-control or antiarrhythmic options can be considered.

Question 31Trauma and Orthopedic Emergencies

A 28-year-old motorcyclist arrives with an open tibial fracture and brisk arterial bleeding from the wound. Which initial maneuver best controls the hemorrhage while awaiting definitive care?

  1. Irrigation of the wound with saline to visualize the bleeding vessel
  2. Direct pressure over the wound with a sterile dressing Correct answer.
  3. Application of a tourniquet proximal to the wound after direct pressure fails
  4. Elevation of the limb above heart level alone

Explanation

Direct pressure over the bleeding point is the first-line method for controlling external hemorrhage from an extremity wound and should be applied immediately. Tourniquets are reserved for life-threatening bleeding that does not respond to direct pressure, and irrigation is not a hemorrhage-control measure.

Question 32Trauma and Orthopedic Emergencies

Which finding most strongly suggests that a patient with a pelvic fracture is developing hemorrhagic shock?

  1. Heart rate of 124 beats/min with cool, clammy skin and narrowed pulse pressure Correct answer.
  2. Pain score of 8 out of 10 at the fracture site
  3. Localized pelvic tenderness with stable vital signs
  4. Systolic blood pressure of 118 mmHg with warm extremities

Explanation

Tachycardia, cool clammy skin, and a narrowed pulse pressure are early compensatory signs of hemorrhagic shock from pelvic bleeding. Stable vital signs with isolated tenderness or pain severity do not indicate shock.

Question 33Trauma and Orthopedic Emergencies

In a patient with a suspected cervical spine injury, which maneuver is correct during airway management?

  1. Routine nasotracheal intubation without preparation
  2. Flexion of the neck to align the airway
  3. Manual in-line stabilization with jaw thrust to open the airway Correct answer.
  4. Hyperextension of the neck to improve visualization

Explanation

Manual in-line stabilization protects the cervical spine while a jaw thrust opens the airway without extending the neck. Hyperextension and flexion risk worsening a spinal cord injury, and blind nasotracheal intubation is not the preferred approach.

Question 34Trauma and Orthopedic Emergencies

A patient presents with a deformed, painful forearm after a fall and has no palpable radial pulse. What is the most appropriate immediate action?

  1. Order an MRI before any manipulation
  2. Apply ice and prescribe oral analgesia for outpatient follow-up
  3. Perform closed reduction and immobilization with urgent reassessment of distal pulses Correct answer.
  4. Apply a splint and reassess in 24 hours

Explanation

A pulseless deformed limb indicates vascular compromise and requires urgent closed reduction to restore alignment and perfusion. Delaying for imaging or outpatient care risks irreversible ischemia.

Question 35Trauma and Orthopedic Emergencies

Which clinical sign is most consistent with a posterior hip dislocation?

  1. Limb held in abduction and external rotation
  2. Limb held in adduction, internal rotation, and flexion Correct answer.
  3. Painless full range of hip movement
  4. Isolated knee effusion

Explanation

Posterior hip dislocation classically presents with the limb adducted, internally rotated, and flexed. Abduction with external rotation suggests an anterior dislocation.

Question 36Trauma and Orthopedic Emergencies

A 45-year-old presents with a swollen, tense, painful thigh after a femoral shaft fracture. Which complication should be suspected first?

  1. Septic arthritis of the knee
  2. Compartment syndrome of the thigh Correct answer.
  3. Deep vein thrombosis
  4. Femoral artery transection

Explanation

A tense, painful thigh after femoral fracture suggests increased compartment pressure, and thigh compartment syndrome, though less common than in the leg, requires urgent recognition. Deep vein thrombosis is possible but typically less acute and tense.

Question 37Trauma and Orthopedic Emergencies

Which of the following is the most appropriate initial immobilization for a suspected open fracture of the forearm?

  1. Circumferential plaster cast applied immediately
  2. Traction with a weight and pulley
  3. No immobilization until orthopedic review
  4. Splint in the position of function and cover the wound with a sterile dressing Correct answer.

Explanation

Open fractures should be covered with a sterile dressing and splinted to reduce movement and contamination before orthopedic assessment. Circumferential casts are avoided acutely because swelling can cause compartment syndrome.

Question 38Trauma and Orthopedic Emergencies

A patient with blunt chest trauma has paradoxical movement of a segment of the chest wall. What is the immediate priority?

  1. Immediate chest tube insertion
  2. Adequate oxygenation and ventilation with analgesia and stabilization Correct answer.
  3. Immediate surgical fixation of the ribs
  4. Application of a tight circumferential bandage

Explanation

Flail chest causes inefficient ventilation, and the priority is oxygenation, ventilation support, and analgesia. Circumferential banding impairs ventilation, and surgical fixation is not an immediate emergency measure.

Question 39Trauma and Orthopedic Emergencies

Which of these patients requires immediate needle decompression?

  1. A patient with hypotension, distended neck veins, absent breath sounds on one side, and tracheal deviation Correct answer.
  2. A patient with rib tenderness and normal breath sounds
  3. A patient with subcutaneous emphysema but normal oxygenation
  4. A patient with a small isolated pneumothorax and stable vital signs

Explanation

Hypotension, distended neck veins, absent breath sounds, and tracheal deviation indicate tension pneumothorax, which requires immediate needle decompression. Small stable pneumothoraces and isolated tenderness do not require this emergency maneuver.

Question 40Trauma and Orthopedic Emergencies

A 32-year-old has a stab wound to the anterior thigh with expanding hematoma and hypotension. Which is the most appropriate next step?

  1. Observation with serial hemoglobin checks
  2. Direct pressure and urgent surgical consultation for vascular injury Correct answer.
  3. Elevation of the limb with oral fluids
  4. Application of a compression bandage and discharge

Explanation

An expanding thigh hematoma with hypotension suggests major vascular injury requiring direct pressure and urgent surgical evaluation. Observation or discharge would allow continued hemorrhage.

Question 41Trauma and Orthopedic Emergencies

Which finding is most specific for a scaphoid fracture on initial plain radiographs?

  1. Pain on wrist extension
  2. A fracture line through the scaphoid waist on the scaphoid view Correct answer.
  3. Tenderness in the anatomic snuffbox
  4. Wrist swelling

Explanation

A visible fracture line through the scaphoid on dedicated views confirms the diagnosis radiographically. Snuffbox tenderness and swelling are sensitive but not specific clinical signs.

Question 42Trauma and Orthopedic Emergencies

A patient with a posterior knee dislocation has a cold, pulseless foot. Which is the most urgent management priority?

  1. Application of a knee brace and elevation
  2. Immediate reduction and vascular assessment with angiography or CT Correct answer.
  3. Non-weight-bearing instructions with outpatient follow-up
  4. Analgesia and observation for six hours

Explanation

Knee dislocation with a cold pulseless foot indicates popliteal artery injury; urgent reduction and vascular imaging are required to save the limb. Delaying for observation risks amputation.

Question 43Trauma and Orthopedic Emergencies

Which is the most reliable early clinical indicator of compartment syndrome in the leg?

  1. Visible swelling of the calf
  2. Absent distal pulses
  3. Pain out of proportion to injury and pain on passive stretch Correct answer.
  4. Rise in creatine kinase

Explanation

Pain out of proportion and pain on passive stretch are the earliest and most reliable clinical indicators of compartment syndrome. Pulselessness is a late finding, and swelling is nonspecific.

Question 44Trauma and Orthopedic Emergencies

A patient with a traumatic amputation of a finger arrives with the severed part. What is the correct handling of the amputated digit?

  1. Place it directly on ice without wrapping
  2. Immerse it in alcohol for sterilization
  3. Keep it at room temperature without cooling
  4. Wrap in saline-moistened gauze, place in a sealed bag, and cool in ice water Correct answer.

Explanation

The amputated part should be wrapped in saline-moistened gauze, sealed in a bag, and cooled indirectly in ice water to preserve tissue without freezing. Direct contact with ice or alcohol damages tissue.

Question 45Trauma and Orthopedic Emergencies

A 60-year-old with a Colles fracture has numbness in the thumb and index finger. Which structure is most likely compressed?

  1. Median nerve in the carpal tunnel Correct answer.
  2. Ulnar nerve at the elbow
  3. Axillary nerve in the shoulder
  4. Radial nerve in the spiral groove

Explanation

Numbness in the thumb and index finger after a distal radius fracture suggests median nerve compression at the wrist. The ulnar, radial, and axillary nerves supply different distributions.

Question 46Trauma and Orthopedic Emergencies

Which of the following patients with a head injury requires immediate neurosurgical consultation?

  1. A patient with a mild headache after a minor bump
  2. A patient with a normal CT and no symptoms
  3. A patient with a small scalp laceration and normal neurological examination
  4. A patient with a fixed dilated pupil and deteriorating consciousness Correct answer.

Explanation

A fixed dilated pupil with deteriorating consciousness suggests expanding intracranial hematoma and herniation, requiring immediate neurosurgical consultation. Minor injuries with normal examinations do not.

Question 47Trauma and Orthopedic Emergencies

A patient with a suspected pelvic fracture and hemodynamic instability has a pelvic binder applied. What is the correct placement?

  1. Around the lower abdomen below the iliac crests
  2. Over the iliac crests
  3. At the level of the greater trochanters Correct answer.
  4. Over the lower rib cage

Explanation

A pelvic binder is most effective when placed at the level of the greater trochanters to compress the pelvic ring. Placement over the iliac crests or lower abdomen reduces effectiveness.

Question 48Trauma and Orthopedic Emergencies

Which of the following is the most appropriate initial management of a patient with a suspected tension pneumothorax during transport?

  1. Administer oral antibiotics
  2. Wait for chest radiography before treatment
  3. Apply a chest binder
  4. Perform immediate needle decompression in the second intercostal space midclavicular line or fifth intercostal space anterior axillary line Correct answer.

Explanation

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression; waiting for imaging risks cardiac arrest. Antibiotics and chest binders do not treat the tension physiology.

Question 49Trauma and Orthopedic Emergencies

A patient with a femoral shaft fracture develops fat embolism syndrome. Which triad is most characteristic?

  1. Fever, jaundice, and hematuria
  2. Bradycardia, hypertension, and hyperreflexia
  3. Polyuria, polydipsia, and weight loss
  4. Hypoxemia, neurological changes, and petechial rash Correct answer.

Explanation

Fat embolism syndrome classically presents with hypoxemia, neurological dysfunction, and a petechial rash, usually after long bone fractures. The other triads describe unrelated conditions.

Question 50Trauma and Orthopedic Emergencies

A patient has a dislocated shoulder that cannot be reduced with standard techniques and has a locked anterior dislocation. Which structure is most likely interposed?

  1. Subscapularis tendon Correct answer.
  2. Long head of the biceps tendon
  3. Deltoid muscle
  4. Supraspinatus tendon

Explanation

Irreducible anterior shoulder dislocation is often caused by interposition of the subscapularis tendon or a buttonhole effect. The other structures are not typical blocks to reduction.