COMBANK EM Exam Questions with Correct Answers Verified by Experts| Latest Update
what is the lowest GCS? 3 - you still get 1 point for LACK of response
ex - no eye opening = 1
no verbal response = 1
no motor response to pain = 1
what is a significant finding to distinguish btwn esophageal rupture and aortic dissection?
esophageal rupture = subcutaneous emphysema
- usually due to blunt chest trauma
what is the diagnostic test for CO poisoning? arterial blood gas (ABG)
>15% in smokers
>3% in non-smokers
signs of basilar skull fracture 1) periorbital ecchymosis
2) otorrhea (ear discharge)
3) rhinorrhea (nasal discharge - leaking CSF fluid)
4) Battle's signs
Battle's signs Bruising behind the ears (over the mastoid process); a very late sign of skull
fracture.
ECG findings for posterior MI tall R waves in precordial leads V1-V3
,*AND*
ST segment DEPRESSIONS in V1-V3
what is early shock characterized by? increased cardiac index, increased stroke volume
- warm, flushed skin
- tachycardia
- widened PP
- bounding peripheral pulses
**VASODILATION --> hypotension due to decreased SVR**
tx for organophosphate poisoning (causes cholinergic toxicity)? atropine and pralidoxime
sx = bradycardia, lacrimation, wheezing/bronchospasm, salivation, diarrhea, miosis, emesis
atropine = anticholinergic (reduces parasympathetic activation)
pralidoxime (after atropine) = reactivates acetylchonlinesterase
what is physostigmine? acetylcholinesterase inhibitor --> increases ACh levels
used for tx in *ANTI*cholinergic toxicity --> dizziness, dry mouth, urinary retention, constipation
cholinergic toxicity acronym DUMBBELLS
,D = diarrhea
U = urinary incontinence
M = miosis
B = bradycardia
B = bronchospasm
E = emesis
L = lacrimation
L = lethargy
S = salivation
Motor response GCS scale 1 = NO purposeful response to noxious stimuli
2 = extends all extrem. in resp to pain
3 = flexes UE/extends LE in response to pain
4 = makes NONPURPOSEFUL movements in resp to noxious stimuli
5 = makes localized movement in resp to painful stimulation
6 = follows commands for motor movements
If a pt is a Jehovah's Witness, lacks decision making capacity, and does NOT have an advanced
directive, and surrgoate decision maker is not readily available, can you still give lifesaving
blood transfusions if needed? yes
what is a classic finding in methanol toxicity? CNS depression + afferent pupillary defect
, vitals = tachycardia, TACHYPNEA (RR > 20) --> exhaled CO2
what are common sources of methanol toxicity? - commercial solvents
- wood alcohol
- FUELS
- **WINDSHIELD WASHER FLUID
how does ethylene glycol taste? SWEET taste --> used for SI attempts
**NO visual disturbances in ethylene glycol toxicity**
methanol toxicity = decreased pupillary response to light (afferent pupillary defect)
common ethylene glycol sources? - antifreeze/coolants, brake fluids, de-icing fluids
- heat transfer fluids
- some household cleaning agents
where is capacity vs competency evaluted? capacity - by physician
competency - by legal system (court)
what is Cheyne-Stokes breathing assoc w? increased ICP
- SAH --> increased ICP --> bradycardia, widened PP, Cheyne-Strokes breathing
irregular respirations --> periods of apnea followed by hyperventilation
what is the lowest GCS? 3 - you still get 1 point for LACK of response
ex - no eye opening = 1
no verbal response = 1
no motor response to pain = 1
what is a significant finding to distinguish btwn esophageal rupture and aortic dissection?
esophageal rupture = subcutaneous emphysema
- usually due to blunt chest trauma
what is the diagnostic test for CO poisoning? arterial blood gas (ABG)
>15% in smokers
>3% in non-smokers
signs of basilar skull fracture 1) periorbital ecchymosis
2) otorrhea (ear discharge)
3) rhinorrhea (nasal discharge - leaking CSF fluid)
4) Battle's signs
Battle's signs Bruising behind the ears (over the mastoid process); a very late sign of skull
fracture.
ECG findings for posterior MI tall R waves in precordial leads V1-V3
,*AND*
ST segment DEPRESSIONS in V1-V3
what is early shock characterized by? increased cardiac index, increased stroke volume
- warm, flushed skin
- tachycardia
- widened PP
- bounding peripheral pulses
**VASODILATION --> hypotension due to decreased SVR**
tx for organophosphate poisoning (causes cholinergic toxicity)? atropine and pralidoxime
sx = bradycardia, lacrimation, wheezing/bronchospasm, salivation, diarrhea, miosis, emesis
atropine = anticholinergic (reduces parasympathetic activation)
pralidoxime (after atropine) = reactivates acetylchonlinesterase
what is physostigmine? acetylcholinesterase inhibitor --> increases ACh levels
used for tx in *ANTI*cholinergic toxicity --> dizziness, dry mouth, urinary retention, constipation
cholinergic toxicity acronym DUMBBELLS
,D = diarrhea
U = urinary incontinence
M = miosis
B = bradycardia
B = bronchospasm
E = emesis
L = lacrimation
L = lethargy
S = salivation
Motor response GCS scale 1 = NO purposeful response to noxious stimuli
2 = extends all extrem. in resp to pain
3 = flexes UE/extends LE in response to pain
4 = makes NONPURPOSEFUL movements in resp to noxious stimuli
5 = makes localized movement in resp to painful stimulation
6 = follows commands for motor movements
If a pt is a Jehovah's Witness, lacks decision making capacity, and does NOT have an advanced
directive, and surrgoate decision maker is not readily available, can you still give lifesaving
blood transfusions if needed? yes
what is a classic finding in methanol toxicity? CNS depression + afferent pupillary defect
, vitals = tachycardia, TACHYPNEA (RR > 20) --> exhaled CO2
what are common sources of methanol toxicity? - commercial solvents
- wood alcohol
- FUELS
- **WINDSHIELD WASHER FLUID
how does ethylene glycol taste? SWEET taste --> used for SI attempts
**NO visual disturbances in ethylene glycol toxicity**
methanol toxicity = decreased pupillary response to light (afferent pupillary defect)
common ethylene glycol sources? - antifreeze/coolants, brake fluids, de-icing fluids
- heat transfer fluids
- some household cleaning agents
where is capacity vs competency evaluted? capacity - by physician
competency - by legal system (court)
what is Cheyne-Stokes breathing assoc w? increased ICP
- SAH --> increased ICP --> bradycardia, widened PP, Cheyne-Strokes breathing
irregular respirations --> periods of apnea followed by hyperventilation
