©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
Emergency Medicine Practice Questions
with 100% Verified Answers | Rated A+
A 68-year-old female presents to the emergency department with signs and
symptoms of an acute ischemic stroke. The initial CT scan is normal. Her
blood pressure is 164/105. What is the most appropriate treatment for the
blood pressure of this patient?
A Atenolol PO
B Clonidine PO
C Close monitoring
D Labetolol IV
E Nicardipine IV - ✔✔*The Correct Answer is: C
Aggressively lowering blood pressure may decrease blood flow to the
ischemic tissue, thus decreasing the chances of recovery or increasing the
risk of further infarction. In the setting of an acute ischemic stroke, blood
pressure elevation should be monitored closely, with some elevation
expected.* This elevation is expected to decline without medication in the
first few hours to days, but if elevation continues to a systolic blood
,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
pressure greater than 220mmHg, or mean arterial pressure greater than
120mmHg, medication is advised. Medications may include intravenous
labetolol or nicardipine, with close monitoring of the patient. After the acute
phase following a stroke, appropriate oral medications may be considered
for outpatient hypertension management.
You are evaluating a 67-year-old male with known cirrhosis of the liver
secondary to alcoholic liver disease, although he has been sober for the
past year. He is brought in to the emergency department by his daughter,
who notes that for the past few days he has seemed to be more confused.
On examination you note the patient to be mildly confused but alert to
person and place. He has noticeable asterixis. He is not currently taking
any medications and his blood alcohol level is undetectable. What is the
treatment of choice in this case based on your physical examination
findings?
A amoxicillin
B prednisone
C lactulose
D folic acid
E thiamine - ✔✔*The correct answer is (C). *
,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
This patient most likely has hepatic encephalopathy due to end-stage liver
disease. *Asterixis indicates an increase in serum ammonia. The treatment
of choice is lactulose. Both folic acid and thiamine are used in the treatment
of alcoholic liver disease, but do not treat elevated ammonia levels.*
Antibiotics may be used secondarily in patients nonresponsive to lactulose,
but amoxicillin is not preferred. Prednisone is not a treatment for hepatic
encephalopathy.
A 76-year-old man, is brought to the emergency department by his niece
after she found him wandering around his yard in the cold wearing only a
tee shirt and jeans. When she set up his pill container about 36 hours
earlier, he seemed his usual self but, in retrospect, possibly a little more
confused than usual. The niece says that he has "high blood," treated with
a "white fluid pill," "sugar diabetes," treated with an oral medication, and
early "old timer's" dementia treated with "a memory pill." Vital signs include
an oral temperature of 100.8F, pulse 100 beats per minute, respirations 24
and somewhat shallow, and blood pressure of 88/52. Initial examination
reveals a slightly dehydrated, stuporous man appearing older than his
stated age, who smells strongly of urine. He has no lateralizing signs. What
is the most likely cause of the mental status changes?
A hyperglycemic hyperosmolar state
, ©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
B lactic acidosis
C st - ✔✔*The Correct Answer is: A
The combination of confusion and dehydration in a patient with diabetes
type 2 who is taking a diuretic strongly suggest hyperosmolar state.*
Patients with lactic acidosis (B) have marked hyperventilation and, usually,
signs and symptoms of a serious illness. The lack of lateralizing signs
makes a stroke (C) less likely. Urinary tract infection (D) could certainly
cause confusion and incontinence in an elderly man and should be
investigated. Alzheimer dementia (E) progresses slowly; sudden
decompensation is usually due to delirium.
A 66-year-old man with a history of HTN and diabetes mellitus, type 2,
presents to the emergency department with complaints of palpitations for
over 2 weeks, tachypnea, and chest pain. He denies history of CAD,
stroke, TIA, or congestive heart failure. He is afebrile, with vital signs as
follows: BP 145/98, HR 138, and RR 22. His EKG is shown (Figure 1).
Troponins are negative X 3. Which of the following choices is the most
appropriate next diagnostic study for this patient?
A Transthoracic echocardiogram
B Cardiac catheterization
Emergency Medicine Practice Questions
with 100% Verified Answers | Rated A+
A 68-year-old female presents to the emergency department with signs and
symptoms of an acute ischemic stroke. The initial CT scan is normal. Her
blood pressure is 164/105. What is the most appropriate treatment for the
blood pressure of this patient?
A Atenolol PO
B Clonidine PO
C Close monitoring
D Labetolol IV
E Nicardipine IV - ✔✔*The Correct Answer is: C
Aggressively lowering blood pressure may decrease blood flow to the
ischemic tissue, thus decreasing the chances of recovery or increasing the
risk of further infarction. In the setting of an acute ischemic stroke, blood
pressure elevation should be monitored closely, with some elevation
expected.* This elevation is expected to decline without medication in the
first few hours to days, but if elevation continues to a systolic blood
,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
pressure greater than 220mmHg, or mean arterial pressure greater than
120mmHg, medication is advised. Medications may include intravenous
labetolol or nicardipine, with close monitoring of the patient. After the acute
phase following a stroke, appropriate oral medications may be considered
for outpatient hypertension management.
You are evaluating a 67-year-old male with known cirrhosis of the liver
secondary to alcoholic liver disease, although he has been sober for the
past year. He is brought in to the emergency department by his daughter,
who notes that for the past few days he has seemed to be more confused.
On examination you note the patient to be mildly confused but alert to
person and place. He has noticeable asterixis. He is not currently taking
any medications and his blood alcohol level is undetectable. What is the
treatment of choice in this case based on your physical examination
findings?
A amoxicillin
B prednisone
C lactulose
D folic acid
E thiamine - ✔✔*The correct answer is (C). *
,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
This patient most likely has hepatic encephalopathy due to end-stage liver
disease. *Asterixis indicates an increase in serum ammonia. The treatment
of choice is lactulose. Both folic acid and thiamine are used in the treatment
of alcoholic liver disease, but do not treat elevated ammonia levels.*
Antibiotics may be used secondarily in patients nonresponsive to lactulose,
but amoxicillin is not preferred. Prednisone is not a treatment for hepatic
encephalopathy.
A 76-year-old man, is brought to the emergency department by his niece
after she found him wandering around his yard in the cold wearing only a
tee shirt and jeans. When she set up his pill container about 36 hours
earlier, he seemed his usual self but, in retrospect, possibly a little more
confused than usual. The niece says that he has "high blood," treated with
a "white fluid pill," "sugar diabetes," treated with an oral medication, and
early "old timer's" dementia treated with "a memory pill." Vital signs include
an oral temperature of 100.8F, pulse 100 beats per minute, respirations 24
and somewhat shallow, and blood pressure of 88/52. Initial examination
reveals a slightly dehydrated, stuporous man appearing older than his
stated age, who smells strongly of urine. He has no lateralizing signs. What
is the most likely cause of the mental status changes?
A hyperglycemic hyperosmolar state
, ©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
B lactic acidosis
C st - ✔✔*The Correct Answer is: A
The combination of confusion and dehydration in a patient with diabetes
type 2 who is taking a diuretic strongly suggest hyperosmolar state.*
Patients with lactic acidosis (B) have marked hyperventilation and, usually,
signs and symptoms of a serious illness. The lack of lateralizing signs
makes a stroke (C) less likely. Urinary tract infection (D) could certainly
cause confusion and incontinence in an elderly man and should be
investigated. Alzheimer dementia (E) progresses slowly; sudden
decompensation is usually due to delirium.
A 66-year-old man with a history of HTN and diabetes mellitus, type 2,
presents to the emergency department with complaints of palpitations for
over 2 weeks, tachypnea, and chest pain. He denies history of CAD,
stroke, TIA, or congestive heart failure. He is afebrile, with vital signs as
follows: BP 145/98, HR 138, and RR 22. His EKG is shown (Figure 1).
Troponins are negative X 3. Which of the following choices is the most
appropriate next diagnostic study for this patient?
A Transthoracic echocardiogram
B Cardiac catheterization
