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OMSB Emergency Medicine (OEEM) study materials
OMSB Emergency Medicine (OEEM) study resources

OMSB Emergency Medicine (OEEM) practice questions

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Question 1Emergency Medicine

A 24-year-old man is brought to the emergency department after a high-speed motorcycle collision. His blood pressure is 78/40 mmHg, heart rate 138/min, and he is confused. The FAST examination shows free fluid in Morison's pouch. Which is the most appropriate immediate next step?

  1. Activate massive transfusion protocol and proceed to the operating room for laparotomy Correct answer.
  2. Obtain CT of the abdomen and pelvis with intravenous contrast
  3. Perform diagnostic peritoneal lavage to confirm hemoperitoneum
  4. Place a pelvic binder and repeat the FAST examination in 30 minutes

Explanation

Hemodynamically unstable blunt trauma with a positive FAST indicates likely intra-abdominal hemorrhage and requires immediate operative control, supported by balanced resuscitation. CT and serial reassessment are reserved for stable patients, and DPL is largely superseded by FAST in this setting.

Question 2Emergency Medicine

Which finding is most consistent with tension pneumothorax in a spontaneously breathing patient?

  1. Fine crackles at the lung base with fever and productive cough
  2. Unilateral absent breath sounds with hypotension and distended neck veins Correct answer.
  3. Hyperresonance with bilateral vesicular breath sounds and normal blood pressure
  4. Tracheal deviation toward the affected side with dullness to percussion

Explanation

Tension pneumothorax produces unilateral absent breath sounds, hyperresonance, hypotension, and distended neck veins due to impaired venous return. Tracheal deviation is a late and unreliable sign and shifts away from the affected side. Immediate decompression is required before imaging.

Question 3Emergency Medicine

A 62-year-old woman presents with sudden-onset severe headache described as the worst of her life. Non-contrast head CT is normal. Which is the most appropriate next step?

  1. Obtain MRI of the brain within 24 hours
  2. Reassure and discharge with analgesia
  3. Perform lumbar puncture for xanthochromia after 12 hours from symptom onset Correct answer.
  4. Start antibiotics for presumed bacterial meningitis

Explanation

Subarachnoid hemorrhage can be CT-negative early, especially beyond 6 hours, so lumbar puncture for xanthochromia is the standard next step when CT is nondiagnostic. Xanthochromia is most reliable 12 hours after onset. Discharge or delayed MRI risks missing a sentinel bleed.

Question 4Emergency Medicine

Which is the first-line antidote for a patient with severe organophosphate poisoning presenting with bradycardia, bronchorrhea, and miosis?

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

Explanation

Atropine reverses the muscarinic effects of organophosphate toxicity, including bronchorrhea and bradycardia, and is titrated to drying of secretions. Pralidoxime is added for nicotinic effects but atropine is the initial priority. Naloxone, flumazenil, and N-acetylcysteine target other toxidromes.

Question 5Emergency Medicine

A 58-year-old man with chest pain has ST elevation in leads II, III, and aVF with reciprocal depression in I and aVL. He becomes hypotensive with clear lungs and jugular venous distension. Which intervention is most appropriate?

  1. Beta-blocker administration
  2. Intravenous furosemide
  3. Rapid volume loading with normal saline Correct answer.
  4. Sublingual nitroglycerin

Explanation

Inferior STEMI with hypotension, clear lungs, and elevated jugular venous pressure suggests right ventricular infarction, which is preload dependent. Volume loading with saline is the initial maneuver; nitrates and diuretics can precipitate profound hypotension.

Question 6Emergency Medicine

A 3-year-old child presents with drooling, tripod positioning, and muffled voice after a febrile illness. Which is the most appropriate initial management?

  1. Inspect the oropharynx with a tongue depressor
  2. Obtain lateral neck radiograph before any airway intervention
  3. Administer nebulized epinephrine and discharge if stridor resolves
  4. Keep the child calm in a position of comfort and prepare for controlled airway management Correct answer.

Explanation

The presentation suggests epiglottitis, an airway emergency. The child should be kept calm, and airway control should occur in a controlled setting with anesthesia or ENT backup. Instrumentation of the airway or agitation can precipitate complete obstruction.

Question 7Emergency Medicine

Which electrolyte abnormality most commonly causes peaked T waves, widened QRS, and cardiac arrest?

  1. Hypomagnesemia
  2. Hypercalcemia
  3. Hyperkalemia Correct answer.
  4. Hypokalemia

Explanation

Hyperkalemia classically produces peaked T waves, PR prolongation, QRS widening, and sine-wave pattern progressing to arrest. Treatment includes calcium for membrane stabilization, insulin with glucose, and beta-agonists. Hypokalemia causes U waves and arrhythmias rather than peaked T waves.

Question 8Emergency Medicine

A 70-year-old woman presents with acute dyspnea, hypoxemia, and unilateral leg swelling after hip surgery. She is hemodynamically stable. Which is the most appropriate diagnostic test?

  1. Transthoracic echocardiography
  2. D-dimer assay
  3. Ventilation-perfusion scan
  4. CT pulmonary angiography Correct answer.

Explanation

In a stable patient with high pretest probability of pulmonary embolism, CT pulmonary angiography is the preferred diagnostic study. D-dimer is useful only to exclude PE in low-probability patients. Echocardiography is reserved for unstable patients where it may guide thrombolysis.

Question 9Emergency Medicine

A patient in diabetic ketoacidosis has a potassium of 3.1 mmol/L. Which is the most appropriate next step before starting an insulin infusion?

  1. Give intravenous calcium gluconate
  2. Give intravenous sodium bicarbonate
  3. Give intravenous potassium chloride and hold insulin until potassium is above 3.3 mmol/L Correct answer.
  4. Start insulin immediately and recheck potassium in 2 hours

Explanation

Insulin drives potassium intracellularly, so hypokalemia below 3.3 mmol/L must be corrected with intravenous potassium before starting insulin to avoid life-threatening arrhythmias. Bicarbonate and calcium are not indicated in this scenario.

Question 10Emergency Medicine

Which organism is the most common cause of community-acquired bacterial meningitis in adults?

  1. Haemophilus influenzae type b
  2. Neisseria meningitidis
  3. Listeria monocytogenes
  4. Streptococcus pneumoniae Correct answer.

Explanation

Streptococcus pneumoniae is the leading cause of community-acquired bacterial meningitis in adults. Empiric therapy includes vancomycin plus a third-generation cephalosporin, with ampicillin added for patients older than 50 or immunocompromised to cover Listeria.

Question 11Emergency Medicine

A 45-year-old man presents with generalized tonic-clonic seizure lasting 4 minutes in the emergency department. Which is the most appropriate first-line medication?

  1. Intravenous lorazepam Correct answer.
  2. Intravenous levetiracetam
  3. Intravenous phenytoin
  4. Intravenous propofol

Explanation

Status epilepticus is terminated first with a benzodiazepine such as intravenous lorazepam. Phenytoin or levetiracetam are second-line agents after benzodiazepines. Propofol is used for refractory status requiring airway control and continuous sedation.

Question 12Emergency Medicine

A 28-year-old woman presents with sudden sharp pleuritic chest pain and syncope. She is hypotensive with distended neck veins, clear lungs, and an ECG showing electrical alternans. Which is the most appropriate immediate intervention?

  1. Pericardiocentesis Correct answer.
  2. Fibrinolytic therapy
  3. Emergent pericardiectomy
  4. Needle thoracostomy

Explanation

Electrical alternans with hypotension and elevated jugular venous pressure suggests cardiac tamponade. Emergent pericardiocentesis is diagnostic and therapeutic. Needle thoracostomy treats tension pneumothorax, and thrombolysis treats massive pulmonary embolism.

Question 13Emergency Medicine

Which finding on urinalysis is most suggestive of acute interstitial nephritis?

  1. White blood cell casts with eosinophiluria Correct answer.
  2. Broad waxy casts
  3. Muddy brown casts
  4. Red blood cell casts with dysmorphic red cells

Explanation

Acute interstitial nephritis classically causes sterile pyuria with white blood cell casts and eosinophiluria, often after drug exposure. Red cell casts indicate glomerulonephritis, while muddy brown casts indicate acute tubular necrosis.

Question 14Emergency Medicine

A 55-year-old man presents with severe epigastric pain radiating to the back, hypotension, and a rigid abdomen. Which imaging study is most appropriate for initial evaluation in the emergency department?

  1. CT of the abdomen with intravenous contrast Correct answer.
  2. Magnetic resonance cholangiopancreatography
  3. Upright chest radiograph
  4. Abdominal ultrasound

Explanation

Contrast-enhanced CT of the abdomen is the imaging study of choice for suspected acute pancreatitis and its complications, including necrosis and pseudocyst. Upright chest radiograph may show free air but is insensitive for pancreatitis. Ultrasound is used to assess gallstones.

Question 15Emergency Medicine

Which is the definitive treatment for a patient with acute decompensated heart failure and respiratory distress due to pulmonary edema with adequate blood pressure?

  1. Intravenous fluid bolus
  2. Noninvasive positive pressure ventilation with intravenous nitroglycerin Correct answer.
  3. Immediate cardioversion
  4. Oral beta-blocker initiation

Explanation

Noninvasive positive pressure ventilation reduces work of breathing and improves oxygenation while intravenous nitroglycerin reduces preload and afterload. Fluid bolus worsens pulmonary edema, and cardioversion is reserved for unstable tachyarrhythmias.

Question 16Emergency Medicine

A 19-year-old presents with fever, sore throat, and a diffuse maculopapular rash after taking amoxicillin. Which is the most likely diagnosis?

  1. Infectious mononucleosis Correct answer.
  2. Stevens-Johnson syndrome
  3. Measles
  4. Scarlet fever

Explanation

A rash after amoxicillin in a young patient with pharyngitis suggests infectious mononucleosis, commonly caused by Epstein-Barr virus. Ampicillin and amoxicillin are known to trigger this rash. Scarlet fever responds to penicillin and does not classically follow amoxicillin exposure.

Question 17Emergency Medicine

A patient presents with a deep partial-thickness burn involving 25% of total body surface area. Which is the most appropriate initial fluid resuscitation strategy?

  1. Lactated Ringer's solution using the Parkland formula, with half given in the first 8 hours Correct answer.
  2. Colloid infusion as the initial fluid
  3. Hypertonic saline at 4 mL/kg per percent burn
  4. Restrict fluids to avoid edema

Explanation

The Parkland formula uses 4 mL/kg per percent total body surface area of lactated Ringer's, with half given in the first 8 hours from the time of injury. Colloids are generally avoided initially, and hypertonic saline is not standard first-line resuscitation.

Question 18Emergency Medicine

Which is the most appropriate initial management for a patient with suspected acute compartment syndrome of the lower leg after a tibial fracture?

  1. Apply ice and reassess in 6 hours
  2. Obtain MRI before any intervention
  3. Elevate the limb above heart level and observe
  4. Perform immediate fasciotomy Correct answer.

Explanation

Acute compartment syndrome is a surgical emergency requiring urgent fasciotomy to prevent muscle and nerve necrosis. Elevation above heart level reduces perfusion and should be avoided. Imaging delays definitive treatment.

Question 19Emergency Medicine

Which is the recommended initial dose of epinephrine for adult cardiac arrest due to ventricular fibrillation?

  1. 1 mg intravenous push every 3 to 5 minutes Correct answer.
  2. 0.1 mg intravenous push
  3. 0.5 mg intramuscularly
  4. 3 mg intravenous push once

Explanation

The standard adult cardiac arrest dose of epinephrine is 1 mg intravenously every 3 to 5 minutes during CPR. Higher doses are not recommended because they do not improve neurologic outcomes. Intramuscular administration is used for anaphylaxis, not cardiac arrest.

Question 20Emergency Medicine

A 34-year-old woman presents with severe abdominal pain and vaginal bleeding. Her blood pressure is 82/50 mmHg, and ultrasound shows free fluid in the pelvis. Which is the most appropriate next step?

  1. Discharge with outpatient gynecology follow-up
  2. Perform a pelvic examination and observe
  3. Type and crossmatch, resuscitate, and proceed to the operating room Correct answer.
  4. Obtain CT of the abdomen with contrast

Explanation

A hemodynamically unstable patient with suspected ruptured ectopic pregnancy requires resuscitation with blood products and emergent laparotomy. CT delays definitive hemorrhage control, and observation is unsafe in shock.

Question 21Emergency Medicine

Which is the most appropriate treatment for a patient with symptomatic bradycardia unresponsive to atropine?

  1. Amiodarone
  2. Diltiazem
  3. Adenosine
  4. Transcutaneous pacing Correct answer.

Explanation

Transcutaneous pacing is indicated for symptomatic bradycardia refractory to atropine, along with dopamine or epinephrine infusions. Adenosine, amiodarone, and diltiazem are used for tachyarrhythmias and would worsen bradycardia.

Question 22Emergency Medicine

A patient with severe asthma exacerbation has silent chest, rising PaCO2, and altered mental status. Which is the most appropriate next step?

  1. Administer oral corticosteroids and discharge
  2. Obtain chest radiograph before treatment
  3. Prepare for endotracheal intubation Correct answer.
  4. Give nebulized ipratropium alone

Explanation

A silent chest with rising PaCO2 and altered mental status indicates impending respiratory failure requiring intubation. Delaying airway management risks cardiac arrest. Corticosteroids and bronchodilators should continue but do not replace airway control.

Question 23Emergency Medicine

A patient presents with hyperthermia, altered mental status, and rigidity after taking a selective serotonin reuptake inhibitor and a monoamine oxidase inhibitor. Which is the most appropriate specific therapy?

  1. Physostigmine
  2. Naloxone
  3. Dantrolene
  4. Cyproheptadine Correct answer.

Explanation

Serotonin syndrome with rigidity and hyperthermia is treated with cyproheptadine, a serotonin antagonist, along with supportive care and discontinuation of the offending agents. Dantrolene is used for neuroleptic malignant syndrome or malignant hyperthermia.

Question 24Emergency Medicine

A patient with a mechanical mitral valve and a subtherapeutic INR presents with acute stroke symptoms 2 hours after onset. Which is the most appropriate management?

  1. Aspirin only
  2. Observation and repeat CT in 24 hours
  3. Mechanical thrombectomy evaluation with imaging Correct answer.
  4. Intravenous alteplase

Explanation

Thrombolysis is contraindicated with a subtherapeutic INR in a patient with a mechanical valve, but mechanical thrombectomy may be performed after imaging confirms a large vessel occlusion. Aspirin alone is insufficient for an acute large vessel occlusion.

Question 25Emergency Medicine

A 60-year-old man presents with a pulsatile abdominal mass and hypotension. Which is the most appropriate immediate management?

  1. Beta-blocker infusion
  2. Immediate operative repair with blood product resuscitation Correct answer.
  3. Bedside ultrasound and observation
  4. Emergent CT angiography

Explanation

A pulsatile abdominal mass with hypotension suggests a ruptured abdominal aortic aneurysm, requiring emergent operative repair and blood product resuscitation. CT delays definitive treatment in an unstable patient, and observation is unsafe.

Question 26Emergency Medicine

A 24-year-old man is brought in after a high-speed motorcycle crash. He is anxious, with a respiratory rate of 34/min, oxygen saturation of 89% on room air, absent breath sounds over the right hemithorax, and distended neck veins. Which is the most appropriate immediate intervention?

  1. Needle decompression of the right second intercostal space Correct answer.
  2. Emergent intubation with positive pressure ventilation
  3. Pericardiocentesis via subxiphoid approach
  4. Chest radiograph before any intervention

Explanation

Tension pneumothorax is a clinical diagnosis; positive pressure ventilation or imaging delays decompression and can worsen hemodynamics. Immediate needle decompression (or finger thoracostomy) relieves the obstructive shock before tube thoracostomy.

Question 27Emergency Medicine

A 62-year-old woman presents with sudden-onset severe headache described as the worst of her life, photophobia, and neck stiffness. Non-contrast head CT is negative. Which is the most appropriate next step?

  1. Lumbar puncture for xanthochromia Correct answer.
  2. MRI of the brain with gadolinium
  3. Start antibiotics for bacterial meningitis
  4. Discharge with analgesia and follow-up

Explanation

Subarachnoid hemorrhage can be missed on CT, especially after 6 hours from onset. Lumbar puncture demonstrating xanthochromia confirms the diagnosis when CT is negative.

Question 28Emergency Medicine

A 3-year-old presents with fever, irritability, and refusal to bear weight on the right leg. He has no preceding trauma. Which is the most likely diagnosis?

  1. Slipped capital femoral epiphysis
  2. Legg-Calvé-Perthes disease
  3. Septic arthritis of the hip Correct answer.
  4. Transient synovitis

Explanation

Fever with a limp and refusal to bear weight in a young child suggests septic arthritis, which is a surgical emergency requiring joint aspiration. Transient synovitis typically lacks high fever.

Question 29Emergency Medicine

A 48-year-old man with alcohol use disorder presents with confusion and ataxia. He has horizontal nystagmus and ophthalmoplegia. Which is the most appropriate initial treatment?

  1. Intravenous glucose alone
  2. Intravenous lorazepam
  3. Intravenous thiamine Correct answer.
  4. Intravenous naloxone

Explanation

Wernicke encephalopathy presents with the triad of confusion, ataxia, and ophthalmoplegia, and is treated with parenteral thiamine. Glucose should be given after thiamine to avoid precipitating or worsening the encephalopathy.

Question 30Emergency Medicine

A 72-year-old woman presents with a painless, pale, pulseless left leg with mottled skin and diminished sensation. She is in atrial fibrillation. Which is the most appropriate management?

  1. Immediate surgical embolectomy or catheter-directed thrombolysis Correct answer.
  2. Duplex ultrasound in 24 hours
  3. Heparin infusion alone with observation
  4. Elevation and compression bandaging

Explanation

Acute limb ischemia with sensory deficit is a threatened limb requiring urgent revascularization, usually surgical embolectomy or catheter-directed thrombolysis. Delay risks irreversible ischemia and amputation.

Question 31Emergency Medicine

A 30-year-old woman presents with a 2-day history of colicky right flank pain radiating to the groin and hematuria. She is afebrile with stable vital signs. Which is the most appropriate initial imaging study?

  1. Retrograde urethrography
  2. Non-contrast CT of the abdomen and pelvis Correct answer.
  3. Abdominal radiograph alone
  4. Intravenous pyelography

Explanation

Non-contrast CT is the imaging modality of choice for suspected ureteral stones, with high sensitivity and specificity and identification of alternative diagnoses.

Question 32Emergency Medicine

A 58-year-old man presents with acute onset of tearing chest pain radiating to the back. Blood pressure is 190/100 mmHg in the right arm and 140/80 mmHg in the left arm. Which is the most appropriate initial diagnostic test?

  1. CT angiography of the chest and abdomen Correct answer.
  2. Troponin and ECG alone
  3. D-dimer
  4. Transthoracic echocardiography

Explanation

Interarm blood pressure differential and tearing pain suggest aortic dissection. CT angiography is the diagnostic study of choice in a stable patient.

Question 33Emergency Medicine

A 19-year-old with type 1 diabetes presents with nausea, vomiting, and abdominal pain. Glucose is 480 mg/dL, pH 7.10, and bicarbonate is 8 mmol/L. Which is the most appropriate initial fluid?

  1. 0.45% sodium chloride
  2. Lactated Ringer's with 5% dextrose
  3. 0.9% sodium chloride Correct answer.
  4. 5% dextrose in water

Explanation

Isotonic 0.9% sodium chloride is the initial fluid for diabetic ketoacidosis to restore intravascular volume. Hypotonic fluids and dextrose-containing fluids are added later once glucose falls and volume is restored.

Question 34Emergency Medicine

A 40-year-old woman presents with a swollen, erythematous, and tender right lower leg. She has a low-grade fever. Which is the most appropriate diagnostic test to confirm deep vein thrombosis?

  1. Duplex ultrasonography of the leg Correct answer.
  2. MRI of the leg
  3. D-dimer
  4. Contrast venography

Explanation

Duplex ultrasonography is the noninvasive test of choice for suspected lower extremity deep vein thrombosis. D-dimer is useful for exclusion in low-risk patients but is not confirmatory.

Question 35Emergency Medicine

A 26-year-old presents with a rapidly spreading, painless, non-tender erythema with crepitus and systemic toxicity after a minor wound. Which is the most important initial step?

  1. Topical antifungal therapy
  2. Oral antibiotics and outpatient follow-up
  3. Immediate surgical debridement and broad-spectrum antibiotics Correct answer.
  4. Warm compresses and elevation

Explanation

Necrotizing fasciitis is a surgical emergency; early debridement combined with broad-spectrum antibiotics improves survival. Crepitus and painless spreading erythema are concerning features.

Question 36Emergency Medicine

A 68-year-old with a history of hypertension presents with sudden, painless loss of vision in the left eye. Fundoscopy shows a pale retina with a cherry-red spot at the macula. Which is the most likely diagnosis?

  1. Central retinal vein occlusion
  2. Retinal detachment
  3. Vitreous hemorrhage
  4. Central retinal artery occlusion Correct answer.

Explanation

A pale retina with a cherry-red spot and painless sudden vision loss is characteristic of central retinal artery occlusion. It is an ophthalmologic emergency requiring immediate evaluation.

Question 37Emergency Medicine

A 45-year-old woman presents with palpitations and lightheadedness. ECG shows a narrow-complex tachycardia at 180/min that is irregular with no discernible P waves. She is hemodynamically stable. Which is the most appropriate initial management?

  1. Synchronized cardioversion
  2. Amiodarone infusion
  3. Rate control with a beta-blocker or calcium channel blocker Correct answer.
  4. Adenosine bolus

Explanation

Atrial fibrillation with rapid ventricular response in a stable patient is managed with rate control. Synchronized cardioversion is reserved for instability or failed rate control.

Question 38Emergency Medicine

A 70-year-old man with chronic obstructive pulmonary disease presents with worsening dyspnea. He is drowsy with a respiratory rate of 8/min and an oxygen saturation of 80%. Which is the most appropriate initial oxygen strategy?

  1. Titrate oxygen to a target saturation of 88-92% Correct answer.
  2. Administer high-flow oxygen at 15 L/min
  3. Target a saturation of 100%
  4. Withhold oxygen to avoid worsening hypercapnia

Explanation

In COPD, oxygen should be titrated to a target saturation of 88-92% to avoid worsening hypercapnia while correcting hypoxemia. High-flow oxygen can worsen respiratory acidosis in these patients.

Question 39Emergency Medicine

A 35-year-old presents with a depressed skull fracture and a Glasgow Coma Scale score of 8. Which is the most appropriate airway management?

  1. Oral airway alone
  2. Rapid sequence intubation Correct answer.
  3. Observation with serial GCS
  4. Nasopharyngeal airway

Explanation

A GCS of 8 or less mandates definitive airway protection with rapid sequence intubation. Nasopharyngeal airways are avoided in significant facial or skull base trauma.

Question 40Emergency Medicine

A 55-year-old man presents with sudden-onset severe abdominal pain and distension. He is afebrile with a history of prior abdominal surgery. Abdominal radiograph shows multiple air-fluid levels. Which is the most appropriate initial management?

  1. Colonoscopy
  2. Immediate laparotomy
  3. Oral contrast study
  4. Intravenous fluids and nasogastric decompression Correct answer.

Explanation

Small bowel obstruction is initially managed with intravenous fluids and nasogastric decompression. Surgery is reserved for signs of strangulation, perforation, or failure of conservative management.

Question 41Emergency Medicine

A 28-year-old presents with a painful, swollen knee after a fall. Arthrocentesis yields turbid fluid. Which finding most suggests septic arthritis?

  1. Gram stain positive for organisms Correct answer.
  2. White cell count of 2,000 cells/mm³
  3. Negative Gram stain
  4. Clear yellow fluid

Explanation

A positive Gram stain of synovial fluid strongly supports septic arthritis, which requires urgent joint drainage and antibiotics. Synovial white cell counts above 50,000 cells/mm³ also suggest infection.

Question 42Emergency Medicine

A 65-year-old woman presents with confusion and a urinary tract infection. She is hypotensive with a lactate of 4 mmol/L. Which is the most appropriate initial fluid resuscitation?

  1. 500 mL of colloid
  2. 10 mL/kg of crystalloid
  3. 30 mL/kg of crystalloid Correct answer.
  4. Restrict fluids to 500 mL

Explanation

Early goal-directed therapy for sepsis recommends 30 mL/kg of crystalloid for hypotension or elevated lactate. Colloids are not recommended as first-line resuscitation fluids.

Question 43Emergency Medicine

A 22-year-old presents with fever, sore throat, and a greyish-white pseudomembrane on the tonsils. He has recently returned from an endemic area. Which is the most appropriate initial action?

  1. Immediate tonsillectomy
  2. Corticosteroids alone
  3. Oral penicillin and discharge
  4. Airborne isolation and diphtheria antitoxin Correct answer.

Explanation

Diphtheria is treated with antitoxin and antibiotics, and respiratory isolation is required because of the risk of transmission. Airborne precautions are recommended until two cultures are negative.

Question 44Emergency Medicine

A 40-year-old man presents with a painful, swollen, erythematous leg after a minor abrasion. He is febrile and toxic. Crepitus is palpated. Which is the most appropriate imaging study to evaluate for necrotizing soft tissue infection?

  1. MRI without contrast
  2. Ultrasound
  3. Plain radiograph
  4. CT with intravenous contrast Correct answer.

Explanation

CT with contrast can demonstrate gas and fascial involvement in necrotizing soft tissue infection and helps define extent, though surgery should not be delayed for imaging in an unstable patient.

Question 45Emergency Medicine

A 3-day-old neonate presents with poor feeding, lethargy, and a temperature of 38.5°C. Which is the most appropriate initial management?

  1. Antipyretics alone
  2. Oral antibiotics and outpatient follow-up
  3. Full sepsis evaluation and empiric intravenous antibiotics Correct answer.
  4. Observation for 24 hours

Explanation

Fever in a neonate younger than 28 days requires a full sepsis workup including blood, urine, and cerebrospinal fluid cultures, and empiric intravenous antibiotics.

Question 46Emergency Medicine

A 50-year-old presents with a snakebite to the hand with progressive swelling and coagulopathy. Which is the most appropriate initial treatment?

  1. Tourniquet application
  2. Antivenom administration Correct answer.
  3. Incision and suction
  4. Ice application to the wound

Explanation

Antivenom is the definitive treatment for systemic envenomation with coagulopathy or progressive local swelling. Tourniquets, incision, and suction are harmful and not recommended.

Question 47Emergency Medicine

A 60-year-old with end-stage renal disease presents with severe hyperkalemia and ECG changes. Which is the most appropriate initial therapy to stabilize the myocardium?

  1. Nebulized albuterol
  2. Oral sodium polystyrene sulfonate
  3. Intravenous insulin with glucose
  4. Intravenous calcium gluconate Correct answer.

Explanation

Intravenous calcium stabilizes the myocardium in hyperkalemia with ECG changes while other measures shift or remove potassium. Insulin with glucose and albuterol shift potassium intracellularly but do not stabilize the membrane.

Question 48Emergency Medicine

A 25-year-old presents with a deep laceration over the palmar surface of the hand with inability to flex the index finger at the distal interphalangeal joint. Which structure is most likely injured?

  1. Flexor digitorum profundus tendon Correct answer.
  2. Flexor digitorum superficialis tendon
  3. Median nerve
  4. Ulnar artery

Explanation

Inability to flex the distal interphalangeal joint indicates injury to the flexor digitorum profundus tendon. Flexor digitorum superficialis injury impairs proximal interphalangeal joint flexion.

Question 49Emergency Medicine

A 30-year-old presents with a painful, red eye and a fixed, mid-dilated pupil after instilling a mydriatic. Which is the most likely diagnosis?

  1. Corneal abrasion
  2. Anterior uveitis
  3. Conjunctivitis
  4. Acute angle-closure glaucoma Correct answer.

Explanation

A fixed, mid-dilated pupil with a painful red eye and elevated intraocular pressure suggests acute angle-closure glaucoma, an ophthalmologic emergency. Immediate pressure-lowering therapy is required.

Question 50Emergency Medicine

A 55-year-old presents with severe headache, confusion, and a blood pressure of 220/120 mmHg with papilledema. Which is the most appropriate initial management?

  1. Oral antihypertensives and discharge
  2. Observation without treatment
  3. Rapid reduction to normal blood pressure
  4. Gradual blood pressure reduction with intravenous agents Correct answer.

Explanation

Hypertensive emergency with encephalopathy requires controlled blood pressure reduction, typically by 20-25% in the first hour, using titratable intravenous agents. Overly rapid reduction can cause cerebral ischemia.