Emergency Medicine Question Bank

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1. A 17-year-old man is pulled from the bottom of a neighbor's swimming pool where he was submerged for an unknown period. Although initially pulseless and in respiratory arrest, his vital signs are now: heart rate 110/min; blood pressure 134/88 mmHg; respiratory rate 4/min. His Glasgow Coma Score is eyes, 1; verbal, 1 (intubated); motor, 2. His pupils are fixed and dilated. You know that

The Ames test detects mutagenesis using bacteria (Salmonella strains), serving as a screen for potential mutagens/carcinogens. It is a bacterial reverse-mutation assay.

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2. A 42-year-old, 70-kg man attempts suicide by drenching himself in gasoline and setting himself on fire. He presents screaming in pain with extensive burns to the head and neck, anterior and posterior torso, entire right upper and lower extremity, and the genitals. Using the rule of nines, estimate the total percentage burn:

Nicotinic receptor sites include autonomic ganglia (including parasympathetic ganglia), adrenal medullary cells, and skeletal muscle. Bronchial smooth muscle is controlled by muscarinic receptors, so it is the exception.

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3. Rovsing's sign is:

Heparin and protamine illustrate chemical antagonism: positively charged protamine binds and neutralizes negatively charged heparin directly. This is a direct chemical interaction, not receptor-based.

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4. A 32-year-old man sustained an electric shock while working on a highvoltage power line. He is awake, alert, and oriented and has normal vital signs but complains of paresthesias in the affected arm. Your management includes

This item asks for a prodrug far less toxic in mammals than insects; among the options the keyed answer is acetylcholine, though malathion is the classic example. The intended teaching is selective toxicity via differential metabolism. [REVIEW: none of the listed options is the classic insect-selective prodrug (malathion); the keyed answer (acetylcholine) does not fit well, suggesting a flawed item.]

Sample

5. You are caring for a patient with severe COPD who will require intubation and mechanical ventilation. To limit or prevent the development of dynamic hyperinflation, your next step should be:

Phenylephrine is a selective alpha-1 agonist that constricts vessels, including nasal mucosal vessels (decongestant effect) and causes mydriasis. The keyed answer reflects its vasoconstrictive action.

Sample

6. Two weeks ago, a 54-year-old man developed a cold sore, which resolved uneventfully. He now complains of a nonpruritic skin rash. Examination reveals raised red lesions resembling hives, some with clear fluid bullae. They are located on his hands, including the palms, and his forearms and anterior tibia. The best way to confirm your suspected diagnosis is by:

Propranolol, a beta-blocker, blocks beta-1-mediated cardiac effects; among the options it would block a reflex/cholinergic-mediated tachycardia involving beta receptors. [REVIEW: methacholine causes bradycardia, not tachycardia—the stem appears flawed; propranolol classically blocks beta-mediated responses.]

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7. Choose the correct radiographic descriptions of bone and joint diseases:

Most drug receptors are proteins located on cell membranes or within the cytosol/nucleus. They are not lipids, DNA, or small molecules in general.

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8. Choose the most likely scenario in the setting of mesenteric ischemia:

Drug distribution from blood into tissues depends on tissue blood flow, the drug's tissue solubility, and the blood drug concentration; thus all of the above are important determinants.

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9. A 70-year-old man is diagnosed with pneumonia, but is otherwise stable. He is being admitted to the hospital, but the nurse tells you she and two other nurses have been unable to establish an intravenous line for antibiotic administration. Your next step should be:

pH is defined as the negative logarithm of the hydrogen ion (H+) concentration. This is the standard definition.

Sample

10. Choose the correct statement about these laboratory results: sodium, 136 mEq/L; potassium, 4.1 mEq/L; chloride, 108 mEq/L; sodium bicarbonate, 12 mEq/L; glucose, 600 mg/dL; venous pH, 7.10

Osmotic pressure is a colligative property, depending on the number of solute particles rather than their identity. Solubility, pH, and dissociation are not colligative.