Emergency Medicine Exam 3 | Actual Questions and Answers
Latest Updated 2026/2027 (Graded A+)
• Question
Which patients raise concern about harm to self or others and must be
supervised/cannot leave the ER?
Correct Answer: patients with psychoses, agitated or expressing suicidal or homicidal
ideation
• Question
What is included in the medical evaluation for patients with mental health disorders?
Correct Answer: -Vital signs -Focused history & physical exam -Assess if medical
component of mental health illness that must be addressed -Assess if patient needs
psychiatric consult or hospitalization [suicidality, homicidality, mania, hallucinations,
delusions, mental status change, agitation]
• Question
Loose associations, derailment, and word salad are examples of what aspect of
psychoses?
Correct Answer: disorganized thinking
• Question
List some examples of negative symptoms seen in psychoses?
Correct Answer: anhedonia, decreased motivation/movement, emotional expression
• Question
What is the most common type of mood disorder?
Correct Answer: major depressive disorder *FYI no anti-depressants prescribed in ED
(filled by PCP or psychiatrist under guidance & follow up)
• Question
What do many anxiety symptoms often mimic in the ER?
Correct Answer: life-threatening conditions (i.e. chest pain, palpitations, chest tightness,
SOB, etc.)
• Question
An acute change in cognition that fluctuates rapidly over time and is often reversible is
best known as which condition?
Correct Answer: delirium
,• Question
In order to rule out all other causes of what seems to be something psychiatric, what
must you do as a practitioner?
Correct Answer: "DELIRIUM"
D= drugs E= electrolyte disturbances L= lack of drugs (withdrawal) I= infection R=
reduced sensory input I= intracranial U= urinary/fecal M= myocardial/pulmonary
*Before you admit the patient make sure you order blood glucose (check if glycemic),
regular labs, head CT to look for bleed, etc.
• Question
Which 2 conditions are often associated with majority of the cases of delirium?
Correct Answer: 1) UTI 2) Pneumonia
• Question
How is delirium treated?
Correct Answer: treat the underlying cause and/or remove the medications that might
be responsible
• Question
Which meds should be avoided when treating elderly patient with delirium?
Correct Answer: *DONT= Benzodiazepine, anti-histamines (will worsen anti-cholingeric
effects & can induce delirium) *DO use anti-psychotics
• Question
In treating a patient with delirium, what is the order of treatment (i.e. what should be
done first)?
Correct Answer: consider non-pharmacologic treatment first [try to calm them down
with water, food, blankets, etc.]
• Question
In defining dementia, a patient must have memory impairment and at least one of which
of the following?
a) aphasia
b) apraxia
c) agnosia
d) disturbance in executive functioning
e) all of the above
Correct Answer: e) all of the above
,• Question
What is recommended to be evaluated prior to inducing sedation of patients & why?
Correct Answer: QTc interval because all anti-psychotic agents carry a black box
warning for altered cardiac conduction & risk of fatal arrhythmias
~Men: QTc > 450 Ms ~Women QTc > 460 Ms
• Question
Which Benzodiazepine has the most literature support for use & is first-line treatment in
undifferentiated agitation? Who should it NOT be used in?
Correct Answer: Lorazepam [initial dose= 2mg IV, IM and repeated dosing to desired
effect] *Consider alternative agent for elderly because it can cause respiratory
depression, hypotension, paradoxical agitation, worsening of confusion (especially in
patients with delirium)
• Question
What is the adverse effect of the typical anti-psychotics and what is used to manage
that?
Correct Answer: strongly associated with extrapyramidal symptoms [use Benadryl 25mg
or Benzotropine 2mg to treat]
• Question
Which atypical anti-psychotic has shown benefits for agitation associated with delirium
in critical care population?
Correct Answer: Quetiapine [adverse effects= somnolence & hypotension]
• Question
What are risk factors for otitis externa? What are the common organisms?
Correct Answer: I. Risk Factors:
II. frequent contact with water (swimming, hot tub, pools, lakes)
III. -scratching of ear
IV. -no cerumen
• Question
Organisms: -pseudomonas aruginosa, Staphyloccocus areua, Proteus What is malignant
otitis externa & how is it treated?
Correct Answer: I. starts as simple otitis externa & spreads to
II. deeper tissues [skull base, pinna, soft tissues]
III. *Tx= IV Abx [Ceftriaxone + Ciprofloxacin]
, • Question
Most otitis media infections coincide with what?
Correct Answer: viral URI infection (RSV, CMV, adenovirus)
*Middle ear infection [infancy/childhood] *Tx: Amoxicillin 500mg PO TID x 7-10 days
• Question
How is tympanic membrane perforation treated?
Correct Answer: most will heal on its own [NSAIDs prn for pain]
• Question
What can be used to confirm the diagnosis of acute mastoditis and how is it treated?
Correct Answer: I. CT with IV
II. contrast
III. *Tx= admission with IV Abx (Ceftriaxone 1g q24 hours)
• Question
What is cauliflower ear and how might it form?
Correct Answer: new cartilaginous growth forming where hematoma collects causing
this deformity of ear [caused by ear hematoma]
• Question
How are ear hematomas treated?
Correct Answer: aspiration of blood to prevent ischemia to ear *Abx if
immunocompromised [Ciprofloxacin 500mg BID]
• Question
What are the instruments of choice for removing ear foreign body?
Correct Answer: alligator forceps *For insects use butterfly tubing connected to syringe
• Question
What is used for live objects that are in the ear as topical anesthesia and to paralyze the
insect?
Correct Answer: 2% lidocaine or viscous lidocaine
Latest Updated 2026/2027 (Graded A+)
• Question
Which patients raise concern about harm to self or others and must be
supervised/cannot leave the ER?
Correct Answer: patients with psychoses, agitated or expressing suicidal or homicidal
ideation
• Question
What is included in the medical evaluation for patients with mental health disorders?
Correct Answer: -Vital signs -Focused history & physical exam -Assess if medical
component of mental health illness that must be addressed -Assess if patient needs
psychiatric consult or hospitalization [suicidality, homicidality, mania, hallucinations,
delusions, mental status change, agitation]
• Question
Loose associations, derailment, and word salad are examples of what aspect of
psychoses?
Correct Answer: disorganized thinking
• Question
List some examples of negative symptoms seen in psychoses?
Correct Answer: anhedonia, decreased motivation/movement, emotional expression
• Question
What is the most common type of mood disorder?
Correct Answer: major depressive disorder *FYI no anti-depressants prescribed in ED
(filled by PCP or psychiatrist under guidance & follow up)
• Question
What do many anxiety symptoms often mimic in the ER?
Correct Answer: life-threatening conditions (i.e. chest pain, palpitations, chest tightness,
SOB, etc.)
• Question
An acute change in cognition that fluctuates rapidly over time and is often reversible is
best known as which condition?
Correct Answer: delirium
,• Question
In order to rule out all other causes of what seems to be something psychiatric, what
must you do as a practitioner?
Correct Answer: "DELIRIUM"
D= drugs E= electrolyte disturbances L= lack of drugs (withdrawal) I= infection R=
reduced sensory input I= intracranial U= urinary/fecal M= myocardial/pulmonary
*Before you admit the patient make sure you order blood glucose (check if glycemic),
regular labs, head CT to look for bleed, etc.
• Question
Which 2 conditions are often associated with majority of the cases of delirium?
Correct Answer: 1) UTI 2) Pneumonia
• Question
How is delirium treated?
Correct Answer: treat the underlying cause and/or remove the medications that might
be responsible
• Question
Which meds should be avoided when treating elderly patient with delirium?
Correct Answer: *DONT= Benzodiazepine, anti-histamines (will worsen anti-cholingeric
effects & can induce delirium) *DO use anti-psychotics
• Question
In treating a patient with delirium, what is the order of treatment (i.e. what should be
done first)?
Correct Answer: consider non-pharmacologic treatment first [try to calm them down
with water, food, blankets, etc.]
• Question
In defining dementia, a patient must have memory impairment and at least one of which
of the following?
a) aphasia
b) apraxia
c) agnosia
d) disturbance in executive functioning
e) all of the above
Correct Answer: e) all of the above
,• Question
What is recommended to be evaluated prior to inducing sedation of patients & why?
Correct Answer: QTc interval because all anti-psychotic agents carry a black box
warning for altered cardiac conduction & risk of fatal arrhythmias
~Men: QTc > 450 Ms ~Women QTc > 460 Ms
• Question
Which Benzodiazepine has the most literature support for use & is first-line treatment in
undifferentiated agitation? Who should it NOT be used in?
Correct Answer: Lorazepam [initial dose= 2mg IV, IM and repeated dosing to desired
effect] *Consider alternative agent for elderly because it can cause respiratory
depression, hypotension, paradoxical agitation, worsening of confusion (especially in
patients with delirium)
• Question
What is the adverse effect of the typical anti-psychotics and what is used to manage
that?
Correct Answer: strongly associated with extrapyramidal symptoms [use Benadryl 25mg
or Benzotropine 2mg to treat]
• Question
Which atypical anti-psychotic has shown benefits for agitation associated with delirium
in critical care population?
Correct Answer: Quetiapine [adverse effects= somnolence & hypotension]
• Question
What are risk factors for otitis externa? What are the common organisms?
Correct Answer: I. Risk Factors:
II. frequent contact with water (swimming, hot tub, pools, lakes)
III. -scratching of ear
IV. -no cerumen
• Question
Organisms: -pseudomonas aruginosa, Staphyloccocus areua, Proteus What is malignant
otitis externa & how is it treated?
Correct Answer: I. starts as simple otitis externa & spreads to
II. deeper tissues [skull base, pinna, soft tissues]
III. *Tx= IV Abx [Ceftriaxone + Ciprofloxacin]
, • Question
Most otitis media infections coincide with what?
Correct Answer: viral URI infection (RSV, CMV, adenovirus)
*Middle ear infection [infancy/childhood] *Tx: Amoxicillin 500mg PO TID x 7-10 days
• Question
How is tympanic membrane perforation treated?
Correct Answer: most will heal on its own [NSAIDs prn for pain]
• Question
What can be used to confirm the diagnosis of acute mastoditis and how is it treated?
Correct Answer: I. CT with IV
II. contrast
III. *Tx= admission with IV Abx (Ceftriaxone 1g q24 hours)
• Question
What is cauliflower ear and how might it form?
Correct Answer: new cartilaginous growth forming where hematoma collects causing
this deformity of ear [caused by ear hematoma]
• Question
How are ear hematomas treated?
Correct Answer: aspiration of blood to prevent ischemia to ear *Abx if
immunocompromised [Ciprofloxacin 500mg BID]
• Question
What are the instruments of choice for removing ear foreign body?
Correct Answer: alligator forceps *For insects use butterfly tubing connected to syringe
• Question
What is used for live objects that are in the ear as topical anesthesia and to paralyze the
insect?
Correct Answer: 2% lidocaine or viscous lidocaine
