Page 1 of 245
McGraw-Hill Emergency medicine (Tintinalli's) EXAM
COMPLETE NEWEST 500 QUESTIONS AND VERIFIED
SOLUTIONS LATEST UPDATE THIS YEAR
IN THIS SECTION ANSWER STARTS THEN QUESTION
Analgesia, Anesthesia, and Procedural Sedation
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.
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
1
, Page 2 of 245
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
Cardiovascular Disorders
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 also lead to cardiogenic
shock, including aortic stenosis, HCM, mitral stenosis, left atrial myxoma, and pericardial
tamponade. Regurgitation of LV output due to chordal rupture or aortic insufficiency can
cause profound cardiogenic shock.
2
, Page 3 of 245
85% of users answered correctly.
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
The correct answer is A. Chronic pain is more common in elderly patients.
Explanation:
Chronic pain is more common in elderly patients and the most common site of chronic pain is
the back. Complete pain relief is an unrealistic goal for chronic pain patients who present to
the emergency department. Chronic pain patients who present to the emergency department
may be best helped by referral to a pain clinic or specialists; hospital admission is seldom
indicated.
Which is TRUE about chronic pain?
3
, Page 4 of 245
A
Chronic pain is more common in elderly patients.
B
Less than 25% of patients whose pain lasts 3 months will continue to have chronic pain for
several years.
C
The goal of emergency treatment should be complete relief of pain.
D
The head is the most common location of chronic pain.
E
Patients presenting to the emergency department because of chronic pain are best helped by
hospital admission.
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.
4
McGraw-Hill Emergency medicine (Tintinalli's) EXAM
COMPLETE NEWEST 500 QUESTIONS AND VERIFIED
SOLUTIONS LATEST UPDATE THIS YEAR
IN THIS SECTION ANSWER STARTS THEN QUESTION
Analgesia, Anesthesia, and Procedural Sedation
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.
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
1
, Page 2 of 245
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
Cardiovascular Disorders
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 also lead to cardiogenic
shock, including aortic stenosis, HCM, mitral stenosis, left atrial myxoma, and pericardial
tamponade. Regurgitation of LV output due to chordal rupture or aortic insufficiency can
cause profound cardiogenic shock.
2
, Page 3 of 245
85% of users answered correctly.
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
The correct answer is A. Chronic pain is more common in elderly patients.
Explanation:
Chronic pain is more common in elderly patients and the most common site of chronic pain is
the back. Complete pain relief is an unrealistic goal for chronic pain patients who present to
the emergency department. Chronic pain patients who present to the emergency department
may be best helped by referral to a pain clinic or specialists; hospital admission is seldom
indicated.
Which is TRUE about chronic pain?
3
, Page 4 of 245
A
Chronic pain is more common in elderly patients.
B
Less than 25% of patients whose pain lasts 3 months will continue to have chronic pain for
several years.
C
The goal of emergency treatment should be complete relief of pain.
D
The head is the most common location of chronic pain.
E
Patients presenting to the emergency department because of chronic pain are best helped by
hospital admission.
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.
4
