Page 1 of 241
McGraw HILL EMERGENCY MEDICINE EXAM ACTUAL
EXAM ALL 500 QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE THIS YEAR
ANSWER STARTS THEN QUESTION
The correct answer is C. Presence suggests an elevated pulmonary capillary wedge pressure
Explanation:
The presence of third heart sound, or ventricular filling gallop, has a specificity of 99% and
highly suggests increased pulmonary capillary wedge pressure and helps rule in CHF.
Detection by stethoscope can be challenging and has a sensitivity of only 20%. Use of digital
microphone detection during ECG testing improves sensitivity to 40.2%; specificity is 88.5%.
The presence of an S3 is associated with notably worse outcomes, including a doubling of 90-
day mortality. JVD is another excellent physical finding for an elevated pulmonary capillary
wedge pressure, with a specificity of 94% and a sensitivity of 39%.
87% of users answered correctly.
What is the significance of a third heart sound (S3) in the diagnosis of CHF?
A
Absence suggests increased 90-day mortality
B
Absence suggests worse outcome
1
, Page 2 of 241
C
Presence suggests an elevated pulmonary capillary wedge pressure
D
Presence suggests improved outcome
E
Presence rules out CHF
The correct answer is D. Minimal sedation
Explanation:
Moderate sedation patients generally have their eyes closed and respond slowly to vocal
commands. Dissociative sedation is a type of moderate sedation where cortical centers do
not receive sensory stimuli. Deep sedation is characterized by a profoundly depressed level of
consciousness, with a purposeful motor response elicited only after repeated or painful
stimuli. Minimal sedation is characterized by anxiolysis but with normal arousal to verbal
stimuli. With general anesthesia, the patient is unarousable.
An anxious 50-year-old female drug user with a 10-cm thigh abscess from skin-popping is given
midazolam (Versed) to facilitate incision and drainage. She remains calm but with her eyes
open and cooperative and verbal throughout the procedure. What type of sedation is this
called?
A
Deep sedation
B
Dissociation
2
, Page 3 of 241
C
General anesthesia
D
Minimal sedation
E
Moderate sedation
The correct answer is E. Rescue PCI
Explanation:
Rescue PCI is indicated in patients in the following groups after thrombolysis: patients who
are in cardiogenic shock and younger than 75 years, patients with severe heart failure or
pulmonary edema, patients with hemodynamically compromising ventricular arrhythmias,
patients with a large area of myocardium at risk, and for whom fibrinolytic therapy has failed.
There is no role for repeat thrombolytic administration in this type of patient. A balloon
pump might help temporarily, but rescue PCI is the procedure of choice. Nitroglycerin is a
poor choice as the patient’s BP is too low. Dopamine infusion will increase myocardial oxygen
demand.
75% of users answered correctly.
A 65-year-old male presents with 2 hours of chest pain. He has ST elevations across his
precordial leads and is diagnosed with an AMI. He is given thrombolytics in the ED. One hour
after administration, he is still having chest pain and his BP is 80/60. The next best course of
action would be
A
Dopamine infusion
3
, Page 4 of 241
B
Nitroglycerin drip
C
Placement of an aortic balloon pump
D
Repeat thrombolytic administration
E
Rescue PCI
The correct answer is B. NSAIDs are an appropriate long-term treatment for chronic low back
pain in patients at low risk of side effects.
Explanation:
Administration of steroids for acute sciatica significantly reduces pain scores, but the benefit
appears to last only about 24 hours. A systematic meta-analysis of opioids for chronic back
pain found no significant long-term benefit. Despite some lack of long-term studies, it is
considered reasonable to use NSAIDs in patients with chronic back pain provided that side
effects are anticipated when the decision is made to prescribe them. Cyclobenzaprine
(Flexeril) appears to have little benefit beyond that of placebo in chronic back pain. Tricyclic
antidepressants have been shown to improve mild to moderate chronic back pain.
Which of the following is the BEST answer regarding medication for back pain and sciatica?
A
Cyclobenzaprine (Flexeril) is an appropriate long-term medication for chronic back pain.
B
4
McGraw HILL EMERGENCY MEDICINE EXAM ACTUAL
EXAM ALL 500 QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE THIS YEAR
ANSWER STARTS THEN QUESTION
The correct answer is C. Presence suggests an elevated pulmonary capillary wedge pressure
Explanation:
The presence of third heart sound, or ventricular filling gallop, has a specificity of 99% and
highly suggests increased pulmonary capillary wedge pressure and helps rule in CHF.
Detection by stethoscope can be challenging and has a sensitivity of only 20%. Use of digital
microphone detection during ECG testing improves sensitivity to 40.2%; specificity is 88.5%.
The presence of an S3 is associated with notably worse outcomes, including a doubling of 90-
day mortality. JVD is another excellent physical finding for an elevated pulmonary capillary
wedge pressure, with a specificity of 94% and a sensitivity of 39%.
87% of users answered correctly.
What is the significance of a third heart sound (S3) in the diagnosis of CHF?
A
Absence suggests increased 90-day mortality
B
Absence suggests worse outcome
1
, Page 2 of 241
C
Presence suggests an elevated pulmonary capillary wedge pressure
D
Presence suggests improved outcome
E
Presence rules out CHF
The correct answer is D. Minimal sedation
Explanation:
Moderate sedation patients generally have their eyes closed and respond slowly to vocal
commands. Dissociative sedation is a type of moderate sedation where cortical centers do
not receive sensory stimuli. Deep sedation is characterized by a profoundly depressed level of
consciousness, with a purposeful motor response elicited only after repeated or painful
stimuli. Minimal sedation is characterized by anxiolysis but with normal arousal to verbal
stimuli. With general anesthesia, the patient is unarousable.
An anxious 50-year-old female drug user with a 10-cm thigh abscess from skin-popping is given
midazolam (Versed) to facilitate incision and drainage. She remains calm but with her eyes
open and cooperative and verbal throughout the procedure. What type of sedation is this
called?
A
Deep sedation
B
Dissociation
2
, Page 3 of 241
C
General anesthesia
D
Minimal sedation
E
Moderate sedation
The correct answer is E. Rescue PCI
Explanation:
Rescue PCI is indicated in patients in the following groups after thrombolysis: patients who
are in cardiogenic shock and younger than 75 years, patients with severe heart failure or
pulmonary edema, patients with hemodynamically compromising ventricular arrhythmias,
patients with a large area of myocardium at risk, and for whom fibrinolytic therapy has failed.
There is no role for repeat thrombolytic administration in this type of patient. A balloon
pump might help temporarily, but rescue PCI is the procedure of choice. Nitroglycerin is a
poor choice as the patient’s BP is too low. Dopamine infusion will increase myocardial oxygen
demand.
75% of users answered correctly.
A 65-year-old male presents with 2 hours of chest pain. He has ST elevations across his
precordial leads and is diagnosed with an AMI. He is given thrombolytics in the ED. One hour
after administration, he is still having chest pain and his BP is 80/60. The next best course of
action would be
A
Dopamine infusion
3
, Page 4 of 241
B
Nitroglycerin drip
C
Placement of an aortic balloon pump
D
Repeat thrombolytic administration
E
Rescue PCI
The correct answer is B. NSAIDs are an appropriate long-term treatment for chronic low back
pain in patients at low risk of side effects.
Explanation:
Administration of steroids for acute sciatica significantly reduces pain scores, but the benefit
appears to last only about 24 hours. A systematic meta-analysis of opioids for chronic back
pain found no significant long-term benefit. Despite some lack of long-term studies, it is
considered reasonable to use NSAIDs in patients with chronic back pain provided that side
effects are anticipated when the decision is made to prescribe them. Cyclobenzaprine
(Flexeril) appears to have little benefit beyond that of placebo in chronic back pain. Tricyclic
antidepressants have been shown to improve mild to moderate chronic back pain.
Which of the following is the BEST answer regarding medication for back pain and sciatica?
A
Cyclobenzaprine (Flexeril) is an appropriate long-term medication for chronic back pain.
B
4
