1|Page
McGraw-Hill Emergency medicine Exam Review
(Tintinalli's), Major Field Test: Political Science
Actual Exam Newest 2026-2027 With 350 Questions
And Correct Answers| Already Graded A+
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
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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.
- ANSWER-Cardiovascular Disorders
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)
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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
Which is TRUE about chronic pain?
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
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Patients presenting to the emergency department because of chronic pain
are best helped by hospital admission. - ANSWER-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.
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
C
Presence suggests an elevated pulmonary capillary wedge pressure
D
Presence suggests improved outcome
E
McGraw-Hill Emergency medicine Exam Review
(Tintinalli's), Major Field Test: Political Science
Actual Exam Newest 2026-2027 With 350 Questions
And Correct Answers| Already Graded A+
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
,2|Page
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.
- ANSWER-Cardiovascular Disorders
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)
,3|Page
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
Which is TRUE about chronic pain?
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
, 4|Page
Patients presenting to the emergency department because of chronic pain
are best helped by hospital admission. - ANSWER-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.
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
C
Presence suggests an elevated pulmonary capillary wedge pressure
D
Presence suggests improved outcome
E
