COMAT: EM questions with verified
answers graded A+ passed
Phentolamine
-b/c only phentolamine can counteract the effects of epi by alpha-1 adrenergic blockade -
correct answer ✔✔44 yo f presents to ED after suffering a bee sting on her finger. She is allergic
to bees. Hx reveals that she injected her son's epi into her finger. She is an anxious woman w/ a
finger that is pale & cool to the touch. Sensation is ltd. & finger is non-blanching. Most
appropriate tx?
-digital massage
-nitroglycerin
-phentolamine
-phenylephrine
-warm water immersion
LP
-b/c we need to ID the causative organism
Note: fever of unknown origin in children less than 3 yo should always prompt a thorough
workup including cultures of blood, urine, CSF, & chest radiograph - correct answer ✔✔25 yo f
is brought to ED by her parents who report the neonate has been fussy, has fever of 101.5 deg F.
She has difficulty breathing, but has been feeding well. VS: 103 deg F, HR 145, BP 75/35, resp
38, O2 sat 94%. PE reveals a well appearing child w/ inc work of breathing, nasal flaring, &
grunting. Best next step?
-CT scan of chest
-IM lorazepam
,-IV ceftriaxone
-LP
-stool ova & parasites
Heparin/enoxaparin - correct answer ✔✔Tx of stable pt w/ PE?
TPA
-massive PE sx= cardiac arrest, hypotension, R heart strain - correct answer ✔✔Tx of pt w/
massive PE?
Hypothermia
-core temp < 95 deg F or 35 deg C
Note: opioid OD= miosis/pinpoint pupils
Wellens syndrome= stenosis of LAD & ECG abnormalities in leads V1-V6 - correct answer ✔✔42
yo m presents to ED after he was discovered unconscious lying outside on a park bench. VS: HR
52, BP 90/48, resp rate 14. PE reveals a lethargic disheveled m w/ pupils that are 4 mm, equal,
round, & reactive bilat. An ECG showed sinus bradycardia w/ 1st degree AV block & diffuse J
waves. Dx? Tx?
-cocaine OD
-hypothermia
-methanol intoxication
-opioid OD
-Wellens syndrome
Warming blankets - correct answer ✔✔Tx for hypothermia?
,Placement of cervical collar
-must r/o C-spine injury - correct answer ✔✔14 yo f is brought to the ED by her parents after
being struck in the head w/ a baseball bat at her softball game. She is conscious w/ a Glasgow
coma scale of 12/15. VS: HR 95, resp 22, BP 98/50, O2 sat of 99% on room air. She has a 1.5 cm
laceration on the L frontal bone w/ surrounding erythema extending 2 cm above the underlying
skin at its peak. Best next step after ABCs?
-CT scan of head & neck
-IV insertion w/ maintenance fluids
-neuromuscular testing
-observation
-placement of cervical collar
Esophageal varices - correct answer ✔✔67 yo m presents to ED w/ several episodes of
hematemesis. Hx reveals pt has 5-6 ep of blood-tinged emesis throughout the past day. He is a
chronic alcoholic & has not seen a physician in years. VS: HR 95, resp 18, BP 150/96. PE reveals a
disheveled m w/ pink conjunctiva, capillary refill of 2 sec, & abd obesity w/ distended veins
around umbilicus. There is a tender nodule just to the R of the sternum in the 2nd IC space. Dx?
-aorto-esophageal fistula
-Boerhaave syndrome
-esophageal varices
-Mallory-Weiss tear
-peptic ulcer dz
Rapid sequence intubation
-b/c in pts w/ anaphylaxis & resp compromise (hypoxia, stridor, laryngeal edema esp),
intubation is the answer!
, -also, give IV epi - correct answer ✔✔An atopic 34 yo m presents to the ED after abrupt
development of SOB w/ assoc swelling of his hands, feet, & lips. He was stung by multiple wasps
while doing yard work. VS reveals a BP of 110/64, resp rate 22, O2 sat of 96% on 5L nasal
cannula. PE reveals oropharyngeal edema & stridor. Best next step?
-bolus of IV crystalloid solution
-emergent cricothyroidotomy
-IV epi
-IV glucocorticoids & diphenhydramine
-rapid sequence intubation
Fasciotomy - correct answer ✔✔42 yo m w/ R LE pain is found to have a broken tibia. Leg pain
has worsened. R LE is ecchymotic, cool in temp, very hard to palpate, & w/out pulse appreciated
on dorsalis pedis. Definitive management for pt's condition?
-alteplase infusion
-angiography
-angioplasty
-fasciotomy
-heparin infusion
D-dimer test - correct answer ✔✔33 yo f presents to ED c/o SOB & chest pain of 1 day duration.
She denies taking oral contraceptives, hx of DVT/PE, recent trauma or surgery, hemoptysis,
active cancer, or leg swelling. Chest pain is in R ant chest, sharp, & only occurs when she takes a
deep breath. VS: BP 115/75, HR 115, resp rate 18, O2 sat 98%. PE reveals bilat equal & clear
breath sounds, min tachycardia w/out murmurs, rubs, or gallops, & no LE edema. You note
boggy thoracic paravertebral musculature from T2-T6 that is tender to palpation. Most
appropriate test to order?
-ABG
answers graded A+ passed
Phentolamine
-b/c only phentolamine can counteract the effects of epi by alpha-1 adrenergic blockade -
correct answer ✔✔44 yo f presents to ED after suffering a bee sting on her finger. She is allergic
to bees. Hx reveals that she injected her son's epi into her finger. She is an anxious woman w/ a
finger that is pale & cool to the touch. Sensation is ltd. & finger is non-blanching. Most
appropriate tx?
-digital massage
-nitroglycerin
-phentolamine
-phenylephrine
-warm water immersion
LP
-b/c we need to ID the causative organism
Note: fever of unknown origin in children less than 3 yo should always prompt a thorough
workup including cultures of blood, urine, CSF, & chest radiograph - correct answer ✔✔25 yo f
is brought to ED by her parents who report the neonate has been fussy, has fever of 101.5 deg F.
She has difficulty breathing, but has been feeding well. VS: 103 deg F, HR 145, BP 75/35, resp
38, O2 sat 94%. PE reveals a well appearing child w/ inc work of breathing, nasal flaring, &
grunting. Best next step?
-CT scan of chest
-IM lorazepam
,-IV ceftriaxone
-LP
-stool ova & parasites
Heparin/enoxaparin - correct answer ✔✔Tx of stable pt w/ PE?
TPA
-massive PE sx= cardiac arrest, hypotension, R heart strain - correct answer ✔✔Tx of pt w/
massive PE?
Hypothermia
-core temp < 95 deg F or 35 deg C
Note: opioid OD= miosis/pinpoint pupils
Wellens syndrome= stenosis of LAD & ECG abnormalities in leads V1-V6 - correct answer ✔✔42
yo m presents to ED after he was discovered unconscious lying outside on a park bench. VS: HR
52, BP 90/48, resp rate 14. PE reveals a lethargic disheveled m w/ pupils that are 4 mm, equal,
round, & reactive bilat. An ECG showed sinus bradycardia w/ 1st degree AV block & diffuse J
waves. Dx? Tx?
-cocaine OD
-hypothermia
-methanol intoxication
-opioid OD
-Wellens syndrome
Warming blankets - correct answer ✔✔Tx for hypothermia?
,Placement of cervical collar
-must r/o C-spine injury - correct answer ✔✔14 yo f is brought to the ED by her parents after
being struck in the head w/ a baseball bat at her softball game. She is conscious w/ a Glasgow
coma scale of 12/15. VS: HR 95, resp 22, BP 98/50, O2 sat of 99% on room air. She has a 1.5 cm
laceration on the L frontal bone w/ surrounding erythema extending 2 cm above the underlying
skin at its peak. Best next step after ABCs?
-CT scan of head & neck
-IV insertion w/ maintenance fluids
-neuromuscular testing
-observation
-placement of cervical collar
Esophageal varices - correct answer ✔✔67 yo m presents to ED w/ several episodes of
hematemesis. Hx reveals pt has 5-6 ep of blood-tinged emesis throughout the past day. He is a
chronic alcoholic & has not seen a physician in years. VS: HR 95, resp 18, BP 150/96. PE reveals a
disheveled m w/ pink conjunctiva, capillary refill of 2 sec, & abd obesity w/ distended veins
around umbilicus. There is a tender nodule just to the R of the sternum in the 2nd IC space. Dx?
-aorto-esophageal fistula
-Boerhaave syndrome
-esophageal varices
-Mallory-Weiss tear
-peptic ulcer dz
Rapid sequence intubation
-b/c in pts w/ anaphylaxis & resp compromise (hypoxia, stridor, laryngeal edema esp),
intubation is the answer!
, -also, give IV epi - correct answer ✔✔An atopic 34 yo m presents to the ED after abrupt
development of SOB w/ assoc swelling of his hands, feet, & lips. He was stung by multiple wasps
while doing yard work. VS reveals a BP of 110/64, resp rate 22, O2 sat of 96% on 5L nasal
cannula. PE reveals oropharyngeal edema & stridor. Best next step?
-bolus of IV crystalloid solution
-emergent cricothyroidotomy
-IV epi
-IV glucocorticoids & diphenhydramine
-rapid sequence intubation
Fasciotomy - correct answer ✔✔42 yo m w/ R LE pain is found to have a broken tibia. Leg pain
has worsened. R LE is ecchymotic, cool in temp, very hard to palpate, & w/out pulse appreciated
on dorsalis pedis. Definitive management for pt's condition?
-alteplase infusion
-angiography
-angioplasty
-fasciotomy
-heparin infusion
D-dimer test - correct answer ✔✔33 yo f presents to ED c/o SOB & chest pain of 1 day duration.
She denies taking oral contraceptives, hx of DVT/PE, recent trauma or surgery, hemoptysis,
active cancer, or leg swelling. Chest pain is in R ant chest, sharp, & only occurs when she takes a
deep breath. VS: BP 115/75, HR 115, resp rate 18, O2 sat 98%. PE reveals bilat equal & clear
breath sounds, min tachycardia w/out murmurs, rubs, or gallops, & no LE edema. You note
boggy thoracic paravertebral musculature from T2-T6 that is tender to palpation. Most
appropriate test to order?
-ABG
