EMERGENCY MEDICINE - EXAM 2 | (2025/2026) UPDATED: EXAM QUESTIONS WITH ACCURATE ANSWERS | GET IT RIGHT!!
A 15 y/o pt with a PMH of celiac disease and asthma presents to the ER with cough and chest tightness. The pt states her symptoms beginning
shortly after soccer practice outside in the cold and admits to no relief after administration of her Albuterol inhaler. What do you need to do
first in this patient regarding diagnostics? ✔️pulse oximetry
*make sure you obtain a good waveform
A 73 y/o pt with a 24-pack-year smoking history presents to the ER with dyspnea, cough, and sputum production x 2 weeks. What imaging
should you order in this patient, and what findings would you expect to see? ✔️CXR, hyperinflated lungs and flattening of diaphragm
You suspect a patient that has just presented to your ER is experiencing a COPD exacerbation. Their vitals are as follows:
temp - 100.3 F/37.9 C
bp - 152/91
hr - 101 bpm
rr - 22/min
O2 - 89%
in addition to ABG/VBG, CXR, CBC/CMP, and BNP, what testing should you order given their vitals and suspicion of infection? ✔️EKG and sputum
culture
An adolescent patient presents to the ER with an asthma exacerbation. After completing a physical exam and pulse oximetry, you decide to
administer oxygen via nasal cannula. What else should you administer to this patient besides medication, such as a Duoneb or prednisone?
✔️fluid replacement
A 68 y/o female with a PMH of CHF and aortic stenosis presents to the ER with worsening dyspnea x 3 days. On exam, you note edema of the
lower extremities, rales, and rhonchi. Her oxygen saturation is 88%, BP is 161/87, and respiratory rate is 20 respirations/min. All other vital
signs are WNL and CXR shows bilateral fluffy infiltrates. What diagnosis do you suspect, and should you first administer nitroprusside, oxygen
with a nonrebreather mask, or intubate this patient? ✔️pulmonary edema, oxygen via nonrebreather
A 22 y/o patient presents to the ER via EMS with sudden onset dyspnea and chest pain. You receive report that the pt recently underwent right
ACL repair surgery and is currently taking OCPs. Her respiratory rate is 25/min and heart rate is 111/min. What should you do first with this
patient: a) order a d-dimer, b) get a CXR, c) evaluate her airway, d) V/Q scan ✔️c) evaluate airway
*remember ABCs first
You diagnose a patient in the ER with a PE and administer tPA. What should your disposition include for this patient? ✔️ICU admission
gold standard diagnostic test for pulmonary embolism ✔️CTA
What is a Geneva score used to assess the probability of? ✔️PE
What clinical diagnosis uses the Wells criteria? ✔️pulmonary embolism
A 78 y/o male presents to the ER c/o chest pain, dyspnea, and cough. His PMH is significant for CHF with reduced ejection fraction. On exam,
you notice decreased breath sounds and tactile fremitus over the right lung. What else should be part of the initial evaluation of this patient?
✔️vitals, specifically pulse oximetry to assess for hypoxia
What procedure it typically diagnostic and therapeutic for pleural effusion? ✔️thoracentesis
An 81 y/o female presents to the emergency room from her SNF. Report form nursing staff there reveals that the patient has been febrile x 1
day with a productive cough, rigors, and disorientation to place and time. The patient's blood pressure is 98/58, and respiratory rate is 22/min.
You suspect the patient may have pneumonia. What is their CURB-65 score, and what is the associated disposition for this patient? What
should you do before giving antibiotics? ✔️CURB-65 = 3 (confusion, blood pressure, and age over 65); admit to hospital for management; obtain
blood cultures before giving antibiotics to determine pathogen and susceptibility
, An 8 y/o boy is brought to the ER by his father who states his son has had a fever x 2 days with a cough and has been making "loud sounds
when he is breathing." On exam, you appreciate rhonchi and dullness to percussion over the right lower lobe. Aside from a fever, the patient's
vital signs are WNL. You order a CXR, which reveals an infiltrate in the right lower lobe. What diagnosis do you suspect, should you send this
patient home, and what treatment options do you have to offer? ✔️CAP; discharge home; amoxicillin/Augmentin or azithromycin + Tylenol for
fever
*note: Current doesn't list amoxicillin/Augmentin as a treatment for CAP
A 65 y/o female with a 22-pack-year smoking history presents to the ER with a fever, cough, and a "burning" in her chest x 3 days. Her vital signs
are WNL. You notice that the patient has rhonchi that clear with cough. You ordered an EKG d/t to the chest pain, which does not reveal any ST
elevations or abnormalities. Should you order a CXR in this patient? ✔️no - likely acute bronchitis, which would not have an infiltrate
Another provider in the ER just performed a thoracentesis on a patient for a pleural effusion. The patient is now dyspneic, complaining of chest
pain, and has a markedly decreased O2 saturation. The provider asks for your opinion on what may be going with this patient. If you suspected
diagnosis is true, what management should the provider initiate on this patient? ✔️iatrogenic pmeunothorax, chest tube placement connected
to water seal suction due to likelihood of hemothorax given mechanism
A 27 y/o GSW victim presents to the ER with acute onset dyspnea, respiratory distress, decreased breath sounds on the wounded side, and
tracheal deviation. What should be initiated immediately in this patient? ✔️needle decompression
A patient presents to the ER with apnea and pulselessness - what should you initiate? ✔️ACLS pathway
A patient presents to the ER with chest pain and significant hypotension, classifying them as hemodynamically unstable. What is the first
immediate measure you need to take with this patient after assessing the ABCs? ✔️insert 2 large-bore IVs (or IO access)
A patient presents to the ER with chest and epigastric pain. Their blood pressure is 92/60. A CXR is obtained, which shows clear lung fields. Your
team decides to perform an ultrasound, which reveals that the IVC is 1.5cm. The patient denies chest pain, back pain, and EKG does not show
any patterns of infarct. What two steps should be taken to stabilize this patient? ✔️1. type and cross for 6-10 units of packed RBCs
2. administer IV crystalloid solution or blood if unresponsive to fluid (consider central line)
A patient presents to the ER with chest pain, hypotension, and hypervolemia, as noted by distended neck veins. What diagnosis must be made
or ruled out immediately? ✔️tension pneumothorax
True or false: CXR is helpful in diagnosing a patient with cardiac tamponade ✔️false - acute cardiac tamponade rarely causes cardiomegaly
A 42 y/o male presents to the ER c/o of weakness and dizziness. Your EMR shows that this patient was recently at the ER due to being the
victim of a chest stabbing and left AMA. On exam, you appreciate muffled heart sounds and hypotension. EKG reveals low voltage on all leads.
What diagnostic test should you order, and what treatment should be initiated if testing confirms your suspected diagnosis? ✔️ultrasound
(POCUS or echo), pericardiocentesis under ultrasound guidance
You notice diffuse ST elevations on EKG - what diagnosis is this most consistent with? ✔️pericarditis
How would you treat a patient with signs of shock and a tachydysrhythmia? ✔️synchronized cardioversion
An 88y/o female is brought to the ER by her daughter who states that she thinks the patient may have taken too many doses of her metoprolol.
Her vital signs reveal a blood pressure of 87/50 and a heart rate of 37. What treatment should you initiate? ✔️IV glucagon
*IV glucagon also used in CCB overdose
A patient presents to the ER with chest pain and hypotension. Their heart rate is 40bpm. What treatment should be initiated in this patient, and
if refractory, what can you try instead? ✔️atropine, epinephrine
drug of choice for cardiogenic shock due to pump failure ✔️dobutamine
What do you have to rule out before administering aspirin to a patient with cardiogenic shock due to an MI? ✔️aortic dissection
A patient with a PMH of CHF is brought to the ER. They have distended neck veins, bilateral pitting edema, and SOB, but their blood pressure is
normotensive. You have administered nitroglycerin, furosemide, aspirin, and lisinopril, but the patient's O2 sats continue to decline. What next
step can you take to manage this patient while waiting for a bed in the hospital? ✔️BiPAP or CPAP
A 15 y/o pt with a PMH of celiac disease and asthma presents to the ER with cough and chest tightness. The pt states her symptoms beginning
shortly after soccer practice outside in the cold and admits to no relief after administration of her Albuterol inhaler. What do you need to do
first in this patient regarding diagnostics? ✔️pulse oximetry
*make sure you obtain a good waveform
A 73 y/o pt with a 24-pack-year smoking history presents to the ER with dyspnea, cough, and sputum production x 2 weeks. What imaging
should you order in this patient, and what findings would you expect to see? ✔️CXR, hyperinflated lungs and flattening of diaphragm
You suspect a patient that has just presented to your ER is experiencing a COPD exacerbation. Their vitals are as follows:
temp - 100.3 F/37.9 C
bp - 152/91
hr - 101 bpm
rr - 22/min
O2 - 89%
in addition to ABG/VBG, CXR, CBC/CMP, and BNP, what testing should you order given their vitals and suspicion of infection? ✔️EKG and sputum
culture
An adolescent patient presents to the ER with an asthma exacerbation. After completing a physical exam and pulse oximetry, you decide to
administer oxygen via nasal cannula. What else should you administer to this patient besides medication, such as a Duoneb or prednisone?
✔️fluid replacement
A 68 y/o female with a PMH of CHF and aortic stenosis presents to the ER with worsening dyspnea x 3 days. On exam, you note edema of the
lower extremities, rales, and rhonchi. Her oxygen saturation is 88%, BP is 161/87, and respiratory rate is 20 respirations/min. All other vital
signs are WNL and CXR shows bilateral fluffy infiltrates. What diagnosis do you suspect, and should you first administer nitroprusside, oxygen
with a nonrebreather mask, or intubate this patient? ✔️pulmonary edema, oxygen via nonrebreather
A 22 y/o patient presents to the ER via EMS with sudden onset dyspnea and chest pain. You receive report that the pt recently underwent right
ACL repair surgery and is currently taking OCPs. Her respiratory rate is 25/min and heart rate is 111/min. What should you do first with this
patient: a) order a d-dimer, b) get a CXR, c) evaluate her airway, d) V/Q scan ✔️c) evaluate airway
*remember ABCs first
You diagnose a patient in the ER with a PE and administer tPA. What should your disposition include for this patient? ✔️ICU admission
gold standard diagnostic test for pulmonary embolism ✔️CTA
What is a Geneva score used to assess the probability of? ✔️PE
What clinical diagnosis uses the Wells criteria? ✔️pulmonary embolism
A 78 y/o male presents to the ER c/o chest pain, dyspnea, and cough. His PMH is significant for CHF with reduced ejection fraction. On exam,
you notice decreased breath sounds and tactile fremitus over the right lung. What else should be part of the initial evaluation of this patient?
✔️vitals, specifically pulse oximetry to assess for hypoxia
What procedure it typically diagnostic and therapeutic for pleural effusion? ✔️thoracentesis
An 81 y/o female presents to the emergency room from her SNF. Report form nursing staff there reveals that the patient has been febrile x 1
day with a productive cough, rigors, and disorientation to place and time. The patient's blood pressure is 98/58, and respiratory rate is 22/min.
You suspect the patient may have pneumonia. What is their CURB-65 score, and what is the associated disposition for this patient? What
should you do before giving antibiotics? ✔️CURB-65 = 3 (confusion, blood pressure, and age over 65); admit to hospital for management; obtain
blood cultures before giving antibiotics to determine pathogen and susceptibility
, An 8 y/o boy is brought to the ER by his father who states his son has had a fever x 2 days with a cough and has been making "loud sounds
when he is breathing." On exam, you appreciate rhonchi and dullness to percussion over the right lower lobe. Aside from a fever, the patient's
vital signs are WNL. You order a CXR, which reveals an infiltrate in the right lower lobe. What diagnosis do you suspect, should you send this
patient home, and what treatment options do you have to offer? ✔️CAP; discharge home; amoxicillin/Augmentin or azithromycin + Tylenol for
fever
*note: Current doesn't list amoxicillin/Augmentin as a treatment for CAP
A 65 y/o female with a 22-pack-year smoking history presents to the ER with a fever, cough, and a "burning" in her chest x 3 days. Her vital signs
are WNL. You notice that the patient has rhonchi that clear with cough. You ordered an EKG d/t to the chest pain, which does not reveal any ST
elevations or abnormalities. Should you order a CXR in this patient? ✔️no - likely acute bronchitis, which would not have an infiltrate
Another provider in the ER just performed a thoracentesis on a patient for a pleural effusion. The patient is now dyspneic, complaining of chest
pain, and has a markedly decreased O2 saturation. The provider asks for your opinion on what may be going with this patient. If you suspected
diagnosis is true, what management should the provider initiate on this patient? ✔️iatrogenic pmeunothorax, chest tube placement connected
to water seal suction due to likelihood of hemothorax given mechanism
A 27 y/o GSW victim presents to the ER with acute onset dyspnea, respiratory distress, decreased breath sounds on the wounded side, and
tracheal deviation. What should be initiated immediately in this patient? ✔️needle decompression
A patient presents to the ER with apnea and pulselessness - what should you initiate? ✔️ACLS pathway
A patient presents to the ER with chest pain and significant hypotension, classifying them as hemodynamically unstable. What is the first
immediate measure you need to take with this patient after assessing the ABCs? ✔️insert 2 large-bore IVs (or IO access)
A patient presents to the ER with chest and epigastric pain. Their blood pressure is 92/60. A CXR is obtained, which shows clear lung fields. Your
team decides to perform an ultrasound, which reveals that the IVC is 1.5cm. The patient denies chest pain, back pain, and EKG does not show
any patterns of infarct. What two steps should be taken to stabilize this patient? ✔️1. type and cross for 6-10 units of packed RBCs
2. administer IV crystalloid solution or blood if unresponsive to fluid (consider central line)
A patient presents to the ER with chest pain, hypotension, and hypervolemia, as noted by distended neck veins. What diagnosis must be made
or ruled out immediately? ✔️tension pneumothorax
True or false: CXR is helpful in diagnosing a patient with cardiac tamponade ✔️false - acute cardiac tamponade rarely causes cardiomegaly
A 42 y/o male presents to the ER c/o of weakness and dizziness. Your EMR shows that this patient was recently at the ER due to being the
victim of a chest stabbing and left AMA. On exam, you appreciate muffled heart sounds and hypotension. EKG reveals low voltage on all leads.
What diagnostic test should you order, and what treatment should be initiated if testing confirms your suspected diagnosis? ✔️ultrasound
(POCUS or echo), pericardiocentesis under ultrasound guidance
You notice diffuse ST elevations on EKG - what diagnosis is this most consistent with? ✔️pericarditis
How would you treat a patient with signs of shock and a tachydysrhythmia? ✔️synchronized cardioversion
An 88y/o female is brought to the ER by her daughter who states that she thinks the patient may have taken too many doses of her metoprolol.
Her vital signs reveal a blood pressure of 87/50 and a heart rate of 37. What treatment should you initiate? ✔️IV glucagon
*IV glucagon also used in CCB overdose
A patient presents to the ER with chest pain and hypotension. Their heart rate is 40bpm. What treatment should be initiated in this patient, and
if refractory, what can you try instead? ✔️atropine, epinephrine
drug of choice for cardiogenic shock due to pump failure ✔️dobutamine
What do you have to rule out before administering aspirin to a patient with cardiogenic shock due to an MI? ✔️aortic dissection
A patient with a PMH of CHF is brought to the ER. They have distended neck veins, bilateral pitting edema, and SOB, but their blood pressure is
normotensive. You have administered nitroglycerin, furosemide, aspirin, and lisinopril, but the patient's O2 sats continue to decline. What next
step can you take to manage this patient while waiting for a bed in the hospital? ✔️BiPAP or CPAP
