McGraW- HILL EMERGENCY MEDICINE
EXAM STUDY GUIDE 2026/2027
COMPLETE QUESTIONS WITH
VERIFIED CORRECT ANSWERS ||
100% GUARANTEED PASS
<NEWEST VERSION>
Analgesia, Anesthesia, and Procedural Sedation
1. Which of the following methods is NOT an appropriate way to decrease the
pain of infiltration from a local anesthetic?
A
Buffering the anesthetic solution with sodium bicarbonate prior to
infiltration
B
Injecting through the wound margins instead of through intact skin
C
Rapid injection to minimize the duration of pain
D
Using 1 mL of sodium bicarbonate 8.4% to buffer 29 mL of bupivacaine
0.25%
E
Warming the solution to body temperature before injecting - ANSWER ✔
The correct answer is C. Rapid injection to minimize the duration of pain
, Explanation:
There are multiple ways to reduce pain of infiltration of a local anesthetic.
They include slow (not fast) injection, warming the solution to body
temperature, and injecting through the margins of the wound. Bupivacaine
can be buffered as described. Buffering the anesthetic solution with sodium
bicarbonate will decrease the pain of injection.
Cardiovascular Disorders
2. What is the MOST common cause of cardiogenic shock?
A
Acute aortic insufficiency
B
Aortic stenosis
C
Hypertrophic cardiomyopathy
D
Acute myocardial infarction (AMI)
E
Pericardial tamponade - ANSWER ✔ The correct answer is D. Acute
myocardial infarction (AMI)
Explanation:
Cardiogenic shock is mostly commonly due to extensive MI with suppressed
myocardial contractility. Pump failure is the underlying factor in most
causes of cardiogenic shock (Table 54-2). Hypoperfusion, with or without
hypotension, is the unifying feature of cardiogenic shock, regardless of
etiology. During an AMI, several mechanical complications can precipitate
cardiogenic shock, including acute myocardial regurgitation due to papillary
muscle rupture, ventricular septal defect (VSD), and free-wall rupture.
Mechanical complications cause one-fourth of the cardiogenic shock
following AMI. Right ventricular infarction can also cause cardiogenic
, shock due to loss of preload. Cardiac contractility can also be severely
depressed due to sepsis, myocarditis, myocardial contusion, and
cardiomyopathy. Mechanical obstruction to forward blood flow can als
3. What percentage of patients with a normal ECG will ultimately have a
diagnosis of NSTEMI or unstable angina?
A
5
B
10
C
15
D
20
E
25 - ANSWER ✔ The correct answer is B. 10
Explanation:
Remember that ECG findings alone cannot rule out acute coronary
syndrome. Up to 6% of patients with a normal ECG will ultimately be
proven to have an NSTEMI. Another 4% will be proven to have unstable
angina. Nonspecific changes (T-wave flattening or inversion) can also be
concerning if they reverse when the patient is pain free.
4. A 37-year-old male presents to the ED with altered mental status. He was
found unconscious in the bathroom at work. On exam, he is arousable to
painful stimulus, muttering incoherently. His airway is intact and he has
bilateral breath sounds. His initial vital signs are blood pressure (BP) 95/47,
P 110, respiratory rate (RR) 14, O2% 97% on room air, T 99.4. He has dry
mucus membranes. Fingerstick glucose is 396. Lab work reveals a normal
CBC, 3+ acetone, Na 121, Cl- 97, HCO3 9, K 3.0, Mg 2.9, Phos 1.5, AG 29.
Which of the following is the first priority in caring for this patient?
A
IV bicarbonate
, B
IV lactated ringers
C
IV phosphate
D
IV potassium
E
IV saline - ANSWER ✔ The correct answer is E. IV saline
Explanation:
In patients with diabetes mellitus, it is very important to prioritize
therapeutic interventions. The order of therapeutic priorities is volume
resuscitation first and foremost. Patients often have a fluid deficit of 5-10 L.
Potassium deficits should be addressed next. Diabetic ketoacidosis (DKA)
patients often have profound total-body potassium deficits. For an initial
potassium level between 3.3 and 5.3 mEq/L, with established urine output,
potassium should be replaced at a rate of 10 mEq KCL per hour for 4 hours.
Insulin may be given, but only after volume resuscitation and potassium
deficits have been addressed. It may be administered at a bolus of 0.1
units/kg and followed by a drip of 0.1 units/kg per hour. In general, IV
phosphate therapy should only be initiated if the serum level is <1.0 mg/dL.
Routine use of IV bicarbonate is not recommended in the treatment
Environmental
5. A 30-year-old man presents with hallucinations, tachycardia, and ataxia after
eating some mushrooms his roommate brought home from a camping trip.
What is the most appropriate therapy?
A
Activated charcoal and monitoring of liver enzymes
B
Atropine and intravenous fluids
C
Immediate evaluation for liver transplant
EXAM STUDY GUIDE 2026/2027
COMPLETE QUESTIONS WITH
VERIFIED CORRECT ANSWERS ||
100% GUARANTEED PASS
<NEWEST VERSION>
Analgesia, Anesthesia, and Procedural Sedation
1. Which of the following methods is NOT an appropriate way to decrease the
pain of infiltration from a local anesthetic?
A
Buffering the anesthetic solution with sodium bicarbonate prior to
infiltration
B
Injecting through the wound margins instead of through intact skin
C
Rapid injection to minimize the duration of pain
D
Using 1 mL of sodium bicarbonate 8.4% to buffer 29 mL of bupivacaine
0.25%
E
Warming the solution to body temperature before injecting - ANSWER ✔
The correct answer is C. Rapid injection to minimize the duration of pain
, Explanation:
There are multiple ways to reduce pain of infiltration of a local anesthetic.
They include slow (not fast) injection, warming the solution to body
temperature, and injecting through the margins of the wound. Bupivacaine
can be buffered as described. Buffering the anesthetic solution with sodium
bicarbonate will decrease the pain of injection.
Cardiovascular Disorders
2. What is the MOST common cause of cardiogenic shock?
A
Acute aortic insufficiency
B
Aortic stenosis
C
Hypertrophic cardiomyopathy
D
Acute myocardial infarction (AMI)
E
Pericardial tamponade - ANSWER ✔ The correct answer is D. Acute
myocardial infarction (AMI)
Explanation:
Cardiogenic shock is mostly commonly due to extensive MI with suppressed
myocardial contractility. Pump failure is the underlying factor in most
causes of cardiogenic shock (Table 54-2). Hypoperfusion, with or without
hypotension, is the unifying feature of cardiogenic shock, regardless of
etiology. During an AMI, several mechanical complications can precipitate
cardiogenic shock, including acute myocardial regurgitation due to papillary
muscle rupture, ventricular septal defect (VSD), and free-wall rupture.
Mechanical complications cause one-fourth of the cardiogenic shock
following AMI. Right ventricular infarction can also cause cardiogenic
, shock due to loss of preload. Cardiac contractility can also be severely
depressed due to sepsis, myocarditis, myocardial contusion, and
cardiomyopathy. Mechanical obstruction to forward blood flow can als
3. What percentage of patients with a normal ECG will ultimately have a
diagnosis of NSTEMI or unstable angina?
A
5
B
10
C
15
D
20
E
25 - ANSWER ✔ The correct answer is B. 10
Explanation:
Remember that ECG findings alone cannot rule out acute coronary
syndrome. Up to 6% of patients with a normal ECG will ultimately be
proven to have an NSTEMI. Another 4% will be proven to have unstable
angina. Nonspecific changes (T-wave flattening or inversion) can also be
concerning if they reverse when the patient is pain free.
4. A 37-year-old male presents to the ED with altered mental status. He was
found unconscious in the bathroom at work. On exam, he is arousable to
painful stimulus, muttering incoherently. His airway is intact and he has
bilateral breath sounds. His initial vital signs are blood pressure (BP) 95/47,
P 110, respiratory rate (RR) 14, O2% 97% on room air, T 99.4. He has dry
mucus membranes. Fingerstick glucose is 396. Lab work reveals a normal
CBC, 3+ acetone, Na 121, Cl- 97, HCO3 9, K 3.0, Mg 2.9, Phos 1.5, AG 29.
Which of the following is the first priority in caring for this patient?
A
IV bicarbonate
, B
IV lactated ringers
C
IV phosphate
D
IV potassium
E
IV saline - ANSWER ✔ The correct answer is E. IV saline
Explanation:
In patients with diabetes mellitus, it is very important to prioritize
therapeutic interventions. The order of therapeutic priorities is volume
resuscitation first and foremost. Patients often have a fluid deficit of 5-10 L.
Potassium deficits should be addressed next. Diabetic ketoacidosis (DKA)
patients often have profound total-body potassium deficits. For an initial
potassium level between 3.3 and 5.3 mEq/L, with established urine output,
potassium should be replaced at a rate of 10 mEq KCL per hour for 4 hours.
Insulin may be given, but only after volume resuscitation and potassium
deficits have been addressed. It may be administered at a bolus of 0.1
units/kg and followed by a drip of 0.1 units/kg per hour. In general, IV
phosphate therapy should only be initiated if the serum level is <1.0 mg/dL.
Routine use of IV bicarbonate is not recommended in the treatment
Environmental
5. A 30-year-old man presents with hallucinations, tachycardia, and ataxia after
eating some mushrooms his roommate brought home from a camping trip.
What is the most appropriate therapy?
A
Activated charcoal and monitoring of liver enzymes
B
Atropine and intravenous fluids
C
Immediate evaluation for liver transplant
