?What is the top priority in the initial encounter with a patient in the ED .

.Introduce yourself .A
.Order appropriate diagnostic studies .B
.Identify and stabilize the life threat .C
.Obtain a past medical history .D

A 34-year-old woman is brought to the ED from a kitchen fire. She was cooking with a .2
frying pan full of grease that caught fire, and subsequently the ceiling caught on fire. Upon
arrival, her BP is 110/75 mmHg, HR is 155 beats/minute, RR is 18 breaths/minute, and pulse
oxygenation is 98% on room air. She weighs 70 kg. She has tender burns with blisters to her
bilateral forearms, no singed facial hair, and no intraoral edema. Her breathing is
nonlabored without stridor, and her voice is normal. After the primary survey is performed,
a complete examination of this patient reveals partial thickness burns covering both
forearms nearly circumferentially. Approximately what percentage body
?surface area is burned in this patient

1% .A
4.5% .B
9% .C
15% .D
0% .E

After establishing IV access, IV fluids are started. Using the Parkland Formula, .3
approximately how much IV fluid should this patient receive in the first 24 hours following
?her injury

mL 500 .A
mL 1000 .B
mL 2000 .C
mL 2500 .D
mL 3000 .E

A 32-year-old female asthmatic patient G2P1 at 30 weeks’ gestation has had headache .4
and nausea for 2 days with vision that “got funny” when standing up. She has had no
prenatal care. Her BP is 180/120, with a pulse of 108. She appears uncomfortable, and there
is moderate right upper quadrant tenderness present.
?Which medication should be used to treat her BP

Nitroprusside .A
Nitroglycerin .B
Hydralazine .C
Lisinopril .D
 Labetalol .E

What mechanism of shock is present in patients with PE, what are the best therapeutic .5
?approaches

Cardiogenic; dobutamine .A
Obstructive; intravenous fluids and thrombolytics .B
Obstructive; intravenous fluids and pericardiotomy .C
Obstructive; intravenous fluids and norepinephrine .D

A 19-year-old man is brought into the trauma room by EMS after a head-on cycling .6
accident. The patient was not wearing a helmet. Upon presentation his BP is 1 5/75 mm Hg,
HR is 105 beats/minute, RR is 19 breaths/minute, and oxygen saturation is 100% on 10 liters
of oxygen via facemask. His eyes are closed but he opens them to verbal command. He also
moves his arms and legs on command. When you ask him questions, he is disoriented but
?able to converse. What is the patient’s GCS score

11 .A
12 .B
13 .C
14 .D
15 .E

A 7-year-old man is brought to the ED by paramedics after a roll-over MVC. His BP is 85/55 .7
mm Hg, HR is 11 beats/minute, RR is 45 breaths/minute, and oxygen saturation is 89% on 10
liters via facemask. You auscultate his chest and hear decreased breath sounds on the left.
?Which of the following is the most appropriate next step in management

Order a stat chest radiograph .A

Perform an emergent pericardiocentesis .B
Perform a diagnostic peritoneal lavage (DPL) .C
Perform an ED thoracotomy .D
Perform an emergent needle decompression .E

?Which of the following is not a first-line therapy for mild asthma exacerbations .8

β2-Agonists .A
Oxygen .B
Ipratropium .C
Corticosteroids .D

A 25-year-old stockbroker presents to the ED complaining of 6 weeks of daily headaches. .9

Her headaches are band-like in distribution and are not associated with nausea, vomiting,
visual phenomena, or neurologic symptoms. Normally they respond to acetaminophen, but
they have increased in frequency in the past week as she stopped taking a medication that
 had been prescribed to prevent them.
?What type of primary headache syndrome is the patient likely experiencing

Migraine headaches .A
Cluster-type headaches .B
Trigeminal neuralgia .C
Postherpetic neuralgia .D
Tension headache .E

A 5-year-old man fell off his surfboard and landed on a large nearby rock. He was pulled .10
from the water by lifeguards and brought to the ED in full spinal immobilization. He is alert
and oriented to person, place, and time. He is complaining of weakness in all of his
extremities. His BP is 85/50 mm Hg, HR is 54 beats/minute, RR is 10 breaths/minute,
temperature is 98.4°F, and oxygen saturation is 98% on room air. On examination, he has no
external signs of head injury. His heart is bradycardic without murmurs. The lungs are clear
to auscultation and the abdomen is soft and nontender. He has grossly normal peripheral
sensation but no motor strength in all four extremities.
?Which of the following is the most likely diagnosis

Hypovolemic shock .A
Neurogenic shock .B
Cardiogenic shock .C
Anaphylactic shock .D
Septic shock .E

A 68-year-old female arrives at the ED with a headache and jaw claudication. Her .11
symptoms started gradually and have been present for 1 week. Her vital signs are normal.
Her physical examination is notable for tenderness to her right temple. Her neurologic
examination is otherwise normal. Laboratory reports are notable for ESR of 60.
?What is the next best step

.Arrange for an emergent temporal artery biopsy .A

.Initiate treatment with high-dose prednisone .B
.Perform an MRI .C
.Treat her pain with IV narcotics .D

?The ABCDE approach is based upon which of the following principles .12

The ABCDE approach is a method for carrying out a detailed physical assessment .A
The ABCDE approach assumes that all patients have an airway problem .B
The ABCDE approach is a systematic method for identifying patient problems in .C
order of priority
The ABCDE approach is a system of sorting ED patients into order of priority .D
 A 27-year- l w man presents to the ED complaining of an intensely pruritic rash all over .13
her body, abdominal cramping, and chest tightness. She states that 1 hour ago she was at
inner an accidentally ate some shrimp. She has a known anaphylactic allergy t shrimp. Her
BP is 115/75 mm Hg, HR is 95 beats/minute, RR is 20 breaths/minute, temperature is 98.9°F,
and oxygen saturation is 97% on room air. She appears anxious, and her skin is flushes with
urticarial lesions. Auscultation of her lungs reveals scattered wheezes with decrease air
entry.
?Which of the following is the most appropriate next step in management

Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids, and .A
administer methylprednisolone intravenously
Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids, and .B
administer methylprednisolone and diphenhydramine intravenously
Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids, .C
administer methylprednisolone an diphenhydramine intravenously, an give
intramuscular epinephrine
Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids, and .D
start aerosolized albuterol
Administer oxygen via non-rebreather, place a large-bore IV, begin IV fluids, and .E
start aerosolized epinephrine

An 18-year-old woman comes to the office due to recurrent headaches. In the past, the .14
patient has had occasional headaches, especially during term exams or other stressful
situations. However, over the past 3 months, she has had 4 episodes of severe headache.
They are always left sided, throbbing, associated with nausea, and spontaneously resolve
after 12-24 hours. The patient also reports feelings of numbness and tingling in her
extremities prior to the headaches. She has no chronic medical conditions and underwent an
appendectomy several years ago. The patient is sexually active with her boyfriend and began
taking combined oral contraceptives 6 months ago. Vital signs are within normal limits.
Physical examination, including neurological examination, shows no abnormalities.
?Which of the following is the best next step in management of this patient

Begin selective serotonin reuptake inhibitor .A

Discontinue oral contraceptives .B
Measure cerebrospinal fluid pressure .C
Order MRI of the brain .D
Prescribe daily propranolol therapy .E
Reassure and advise nonsteroidal anti-inflammatory drugs as needed .F

:High quality CPR include all of the following except .15

Minimized interruption .A
Allow chest recoil .B
Excessive ventilation .C
 Achieving a rate of 100–120 compressions per minute .D
Compressing the chest to a depth of 2–2.4 inches (5–6 cm) .E

:High quality CPR include all of the following except .1

Minimized interruption .A
Allow chest recoil .B
Excessive ventilation .C
Achieving a rate of 100–120 compressions per minute .D
Compressing the chest to a depth of 2–2.4 inches (5–6 cm) .E

?What physical finding would lead you to suspect a metabolic etiology of coma .2

Asymmetric muscle tone .A

Increased blood pressure and decreased pulse rate .B
Preserved pupillary reflexes .C
When the eyelids are forcibly opened, the eyes flutter upward exposing the sclera .D

For unresponsive traumatic bleeding patient, according to last change in ATLS trauma life .3
support

You start blood products after one litre of colloids .A

you start blood products after one litre of NS .B
you start blood products after 4 litres of NS .C
all of the above .D

A 69-year-old woman with HTN, DM type 1, is brought to (ED) for acting funny over the .4
last hour. The patient did not know where she was despite being in her own house. She also
did not recognize her family and was speaking incomprehensibly. Her (BP) is 150/80 mm Hg,
heart rate (HR) is 90 beats/minute, respiratory rate (RR) is 16 breaths/minute, and
temperature is 98.9°F. On physical examination she is diaphoretic, agitated, and tremulous.
(ECG) is sinus rhythm with normal ST segments and T waves. Which of the following is the
?most appropriate course of action for this patient

Administer a benzodiazepine .A
scan of the head )CT( .B
check glucose level .C
Request a psychiatric .D

:**The following scenario applies to the following two questions **

A 34-year-old woman is brought to the ED from a kitchen fire. She was cooking with a .5
frying pan full of grease that caught fire, and subsequently the ceiling caught on fire. Upon
arrival, her BP is 110/75 mmHg, HR is 115 beats/minute, RR is 18 breaths/minute, and pulse
oxygenation is 98% on room air. She weighs 70 kg. She has tender burns with blisters to her
bilateral forearms, no singed facial hair, and no intraoral edema. Her breathing is
nonlabored without stridor, and her voice is normal. What classification of burns does this
?patient have

Superficial .A
First degree .B
Partial thickness .C
Full thickness .D
Fourth degree .E

After the primary survey is performed, a complete examination of this patient reveals .6
.partial thickness burns covering both forearms nearly circumferentially
?Approximately, what percentage body surface area is burned in this patient

1% .A
4.5% .B
9% .C
15% .D
0% .E

A patient who opens his eyes to painful stimuli, localizes to pain, and is verbalizing only .7
?incomprehensible sounds, has a Glasgow Coma Scale score of

8 .A
9 .B
10 .C
11 .D

A 68-year-old female arrives at the ED with a headache and jaw claudication. Her .8
symptoms started gradually and have been present for 1 week. Her vital signs are normal.
Her physical examination is notable for tenderness to her right temple. Her neurologic
examination is otherwise normal. Laboratory reports are notable for ESR of 60. What is the
?next best step

.Arrange for an emergent temporal artery biopsy .A

.Initiate treatment with high-dose prednisone .B
.Perform an MRI .C
.Treat her pain with IV narcotics .D

:When formulating a differential diagnosis on an ED patient, one should ask what is .9

The most likely diagnosis .A

The most serious diagnosis .B
The most uncommon diagnosis .C
The most benign diagnosis .D
A 35-year-old man is brought to the emergency department after being involved in a .10
motor vehicle collision. He is unconscious. Blood pressure is 100/50 mm Hg, pulse is
100/min, and respirations are 19/min. Examination shows bilaterally reactive and nondilated
pupils. He does not follow commands and makes inappropriate sounds. A CT scan of the
head shows numerous minute punctate hemorrhages with blurring of the graywhite matter
?interface. Which of the following is the most likely diagnosis

Epidural hematoma .A
Subdural hematoma .B
Diffuse axonal injury .C
Subarachnoid hemorrhage .D
Multiple sclerosis .E

What mechanism of shock is present in patients with PE, and what are the best .11
?therapeutic approaches

Cardiogenic; dobutamine .A
Obstructive; intravenous fluids and thrombolytics .B
Obstructive; intravenous fluids and pericardiotomy .C
Obstructive; intravenous fluids and norepinephrine .D

A 32-year-old female asthmatic patient G2P1 at 30 weeks’ gestation has had headache .12
and nausea for 2 days with vision that “got funny” when standing up. She has had no
prenatal care. Her BP is 180/120, with a pulse of 108. She appears uncomfortable, and there
is moderate right upper quadrant tenderness present. Which medication should be used to
?treat her BP
Nitroprusside .A
Nitroglycerin .B
Hydralazine .C
Lisinopril .D
Labetalol .E

A 65-year-old man presents to the ED with a headache, drowsiness, and confusion. He .13
has a history of long-standing hypertension. His BP is 230/120 mm Hg, pulse is 87
beats/minute, RR is 18 breaths/minute, and oxygen saturation is 97% on room air. On
examination, you note papilledema. A head computed tomography (CT) scan is performed
and there is no evidence of ischemia or hemorrhage. Which of the following is the most
?appropriate method to lower his BP

Administer propofol for rapid reduction in BP .A

Administer mannitol for rapid reduction in BP and intracranial pressure (ICP) .B
Administer a high-dose diuretic to reduce preload .C
Administer labetalol until his BP is 140/80 mm Hg .D
Administer labetalol until his BP is 180/100 mm Hg .E
A 68-year-old man presents to the ED complaining of a daily headache for almost a .14
month. He describes the headache as being dull, difficult to localize, most intense in the
morning, and abating in the early afternoon. He also noticed progressive weakness of his
right upper and lower extremity. Which of the following is most likely responsible for this
?patient’s symptoms

Intracranial neoplasm .A
Cluster headache .B
Tension-type headache .C
Idiopathic intracranial hypertension (IIH) .D
Waking or morning migraine .E

?The ABCDE approach is based upon which of the following principles .15

The ABCDE approach is a method for carrying out a detailed physical assessment .E
The ABCDE approach assumes that all patients have an airway problem .F
The ABCDE approach is a systematic method for identifying patient problems in .G
order of priority
The ABCDE approach is a system of sorting ED patients into order of priority .H

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