Emergency Medicine Exam Study Guide | Actual Questions and
Answers Latest Updated 2026/2027 (Graded A+)
• Question
Acute/subacute bacterial endocarditis
Correct Answer: General
-mitral valve MC valve involved (exception: tricuspid valve MC in IV drug users) -types
I. acute bacterial endocarditis: normal valves; S. aureus
II. subacute bacterial endocarditis: abnormal valves (S. viridans)
III. IV drug-related endocarditis: most commonly due to S. aureus (esp MRSA)
IV. Prosthetic valve endocarditis: early (within 60 days); Staphylococcus epidermis MC
-organisms:
V. Staph. aureus: ACUTE, affects normal valves, IV drug use (esp MRSA)
VI. Strep. viridans: SUBACUTE, affects damaged valves, poor dentition or dental
procedures)
VII. Staph epidermis: prosthetic valve endocarditis
VIII. Enterococcus: GI or GU procedure
IX. HACEK organisms: negative blood cultures
Clinical -persistent fever MC -new onset of murmur -Osler nodes -Janeway lesions:
painless macules -Splinter hemorrhages -Roth spots
Dx -blood cultures (3 sets at least 1 hour apart) -echocardiogram: transesophageal
echocardiogram (TEE) much more sensitive than TTE -Labs
• Major: sustained bacteremia positive blood cultures, endocardial involvement (positive
echocardiogram, new valvular regurgitation)
• Minor: fever, vascular & embolic phenomena, immunologic phenomena
Tx -native valve: anti-staph penicillin (eg. Nafcillin, Oxacillin) plus either Ceftriaxone or
Gentamicin -prosthetic valve: Vancomycin + Gentamicin + Rifampin -fungal:
Amphotericin B -duration of therapy usu 4-6 wks
Prophylaxis indications -cardiac conditions: prosthetic (artificial) heart valves, heart
repairs using prosthetic material (not including stents), prior history of endocarditis,
congenital heart disease -procedures: dental, respiratory, procedures involving infected
skin/musculoskeletal tissues -regimens: amoxicillin 2g 30-60mins before, clindamycin
600mg
• Question
Angina
Correct Answer: General -complication of Coronary artery disease leading to symptoms
Pathophys -inadequate tissue perfusion due to imbalance between increased demand
and decreased coronary artery blood supply -Classes:
,• I: ***angina only with unusually strenuous activity! No limitations of activity.
• II: ***angina with more prolonged or rigorous activity! Slight limitation of physical
activity.
• III: angina with usual daily activity. Marked limitation of physical activity.
• IV: ***angina at rest! Often unable to carry out any physical activity
Clinical -chest pain: classic; substernal, poorly localized, exertional, short in duration
(<30 mins), relieved with rest or Nitroglycerin
Dx -ECG:
• initial test of choice
• ST depression classic finding
• Resting ECG = normal in 50% of cases
-Stress testing: most important noninvasive testing -Coronary angiography: definitive
diagnostic test
Tx -Medical:
• daily Aspirin + Beta blockers (both decrease mortality), sublingual Nitroglycerin as
needed, and daily
Statin -Revascularization: definitive management
• percutaneous transluminal coronary angioplasty
• coronary artery bypass graft - ***left main coronary artery stenosis, 3 vessel disease
• Question
Arrhythmias
Correct Answer: I. Normal sinus: normal rate (60-100) and rhythm; impulse originates in
SA node; p waves upright; regular intervals
II. Sinus tach: HR >100; exercise, excitement, illness
III. Sinus brady: HR 50-60
IV. Atrial fibrillation/flutter: irritable sites in atria fire rapidly (400-600bpm); rapid
pacemaking à atrial quivering; ventricles beat slower bc AV node blocks some atrial
impulses o Sx: Elderly/alcohol use; syncope, dyspnea, palpitations o Dx: EKG: no
discrete p waves; irregularly irregular o Tx: rate - CCB (diltiazem / verapamil) or beta
blocker (metoprolol); rhythm (<48 hrs = cardioversion, amiodarone; >48
hrs = anticoagulare 21 days prior to cardioversion) § CHADS2 score (CHF, HTN, age >75,
DM, stroke hx) - 2+ points = heparin à coumadin; 1 = aspirin or coumadin; 0 = no
therapy or aspirin)
• AV block:
o 1st degree: PR >.2 - delay at AV node or bundle of His o 2nd: § 1: longer, longer, drop
à Wenckebach (some impulses are blocked) § 2: some dropped (impulse blocked in
bundle of His) o 3rd: p's and q's have no correlation - no atrial impulses transmitted to
ventricles à complete AV dissociation
• Bundle branch block: QRS > .12sec; possible due to MI
o Left: R and R' (upward bunny ears) V4-V6 o Right: R and R' (upward bunny ears) V1-V3
,• Paroxysmal SVT: HR 150-250
o Paroxysmal SVT - no structural abnormalities; faster than normal HR begins above two
lower chambers in atria, AV or SA node o AV nodal re-entrant tachy o WPW: impulse
travels between atria and ventricles through bundle of kent; § EKG: bundle of kent fibers
and delta wave on EKG; short PR, long QRS, delta wave § Don't give adenosine or CCB o
MAT: irregularly tachy, narrow QRS, abnormal 3 p waves with different morphology; HR
>100 o Tx: stable = Valsalva; symptomatic = adenosine; definitive = radiofrequency
ablation
• Premature beats: usually benign; may cause palpitat
• Question
Cardiac tamponade
Correct Answer: General -pericardial effusion causing significant pressure on the heart,
impeding cardiac filling, leading to decreased cardiac output and shock -rate of
accumulation of fluid is more critical than the volume
-Tachycardia with an elevated JVP and either hypotension or a paradoxical pulse. -Low
voltage or electrical alternans on ECG. -Echocardiography is diagnostic. -can develop
during any of the acute pericarditis processes -characterized by elevated
intrapericardial pressure (greater than 15 mm Hg), which restricts venous return and
ventricular filling. As a result, the stroke volume and arterial pulse pressure fall, and the
heart rate and venous pressure rise. Shock and death may result.
Clinical -***Beck's triad: distant (muffled) heart sounds, increased JVP, and systemic
hypotension! -pulse paradoxus (decline of greater than 10 mm Hg in systolic pressure
during inspiration) -Kussmaul's signs: increased JVP c inspiration -Dyspnea and cough;
tachycardia, hypotension, pulsus paradoxicus, raised JVP, muffled heart sounds, and
decreased ECG voltage or electrical alternan
Dx -Echocardiogram: pericardial effusion + ***diastolic collapse of cardiac chambers!
hemodynamic compromise -ECG: low voltage QRS complexes
Tx -pericardiocentesis (immediate) or cardiac surgery is required
• Question
Chest pain
Correct Answer: o Key physical exam: vital signs + BP in both arms; complete
cardiovascular exam (JVD, PMI, chest wall tenderness to palpation, heart sounds, pulses,
edema); lung and abdominal exams; lower extremity exam (inspection for signs of DVT)
Cardiac • Myocardial infarction: o Hx: hypertension, hyperlipidemia, smoking
• Question
, o Sx: sudden onset substernal heavy chest pain, radiation to left arm, dyspnea,
diaphoresis, nausea o Labs: ECG, CPK-MB, troponin x3, CXR, CBC, electrolytes, helical
CT, echo, cardiac catheterization • Angina: ECG changes o Sx: retrostenal squeezing
pain that lasts for 2 minutes and occurs with exercise; relieved with rest; not related to
food intake o Labs: ECG, CPK-MB, CXR, CBC, electroylates, exercise stress test (easiest /
most affordable), upper endoscopy / pH monitoring, cardiac catheterization (coronary
angiography = gold standard)
• Aortic dissection
o Hx: uncontrolled hypertension o Sx: sudden onset severe chest pain that radiates to
back o Labs: TTE, ECG, CPK-MB, troponin, CXR, CBC, amylase, lipase, CTA (chest with
contrast), MRI/MRA (aorta), aortic angiography, upper endoscopy
• Pericarditis
o Hx: viral infection o Sx: retrosternal stabbing, chest pain that improves when leaning
forward, worsens with deep inspiration o Labs: ECG, CPK-MB, troponin, CXR, echo, CBC,
upper endoscopy, ESR
• CHF
o Sx: cough exacerbated by lying down at night and improved by propping with pillows,
exertional dyspnea o Labs: CBC, CXR, ECG, echo, PFTs, BNP, CT-chest
• Lung cancer
o Hx: heavy smoker o sx: 6 mo worsening cough, hemoptysis, dyspnea, weakness,
weight loss o labs: CBC, sputum gram stain, culture, cytology, CXR, CT-chest
• asthma:
o sx: SOB, cough, wheezing worse in cold air o labs: CBC, CXR, peak flow measurement,
PFTs Pulmonary
• Costochondritis
o Hx: viral infection o Sx: stabbing chest pain that worsens with deep Conduction
disorders (atrial fibrillation/flutter, supraventricular tachycardia, bundle branch block,
ventricular tachycardia/fibrillation, premature beats)
Correct Answer: I. Clinical significance depends on how much
it impairs cardiac output / how likely it is to deteriorate into more serious disturbance
II. Presentation ranges: asymptomatic hemodynamic instability, shock, death
III. Unstable: chest pain, dyspnea, altered mental status, hypotension
IV. Diagnostic studies: ECG monitoring, event recording, measurement of HR variability,
signal-averaged ECG, exercise stress testing, electrophysiologic testing, autonomic
testing
V. Tx: antiarrythmic drugs
o Stable = treated with medications; unstable = treat with electricity
VI. Supraventricular arrhythmias
o Types:
VII. Sinus brady: <60 - well conditioned athletes / sinus node pathology with increased
risk ectopic rhythm
VIII. Unstable - give vagolytic (atropine) or positive chronotropic (epinephrine,
dopamine)
IX. Transcutaneous / transvenous pacing indicated / may need permanent pacing
X. Sinus tach: >100 - fever, exercise, pain, emotion, shock, thyrotoxicosis, anemia, HF,
drugs - causes symptoms when >150
XI. Unstable - synchronized cardioversion
Answers Latest Updated 2026/2027 (Graded A+)
• Question
Acute/subacute bacterial endocarditis
Correct Answer: General
-mitral valve MC valve involved (exception: tricuspid valve MC in IV drug users) -types
I. acute bacterial endocarditis: normal valves; S. aureus
II. subacute bacterial endocarditis: abnormal valves (S. viridans)
III. IV drug-related endocarditis: most commonly due to S. aureus (esp MRSA)
IV. Prosthetic valve endocarditis: early (within 60 days); Staphylococcus epidermis MC
-organisms:
V. Staph. aureus: ACUTE, affects normal valves, IV drug use (esp MRSA)
VI. Strep. viridans: SUBACUTE, affects damaged valves, poor dentition or dental
procedures)
VII. Staph epidermis: prosthetic valve endocarditis
VIII. Enterococcus: GI or GU procedure
IX. HACEK organisms: negative blood cultures
Clinical -persistent fever MC -new onset of murmur -Osler nodes -Janeway lesions:
painless macules -Splinter hemorrhages -Roth spots
Dx -blood cultures (3 sets at least 1 hour apart) -echocardiogram: transesophageal
echocardiogram (TEE) much more sensitive than TTE -Labs
• Major: sustained bacteremia positive blood cultures, endocardial involvement (positive
echocardiogram, new valvular regurgitation)
• Minor: fever, vascular & embolic phenomena, immunologic phenomena
Tx -native valve: anti-staph penicillin (eg. Nafcillin, Oxacillin) plus either Ceftriaxone or
Gentamicin -prosthetic valve: Vancomycin + Gentamicin + Rifampin -fungal:
Amphotericin B -duration of therapy usu 4-6 wks
Prophylaxis indications -cardiac conditions: prosthetic (artificial) heart valves, heart
repairs using prosthetic material (not including stents), prior history of endocarditis,
congenital heart disease -procedures: dental, respiratory, procedures involving infected
skin/musculoskeletal tissues -regimens: amoxicillin 2g 30-60mins before, clindamycin
600mg
• Question
Angina
Correct Answer: General -complication of Coronary artery disease leading to symptoms
Pathophys -inadequate tissue perfusion due to imbalance between increased demand
and decreased coronary artery blood supply -Classes:
,• I: ***angina only with unusually strenuous activity! No limitations of activity.
• II: ***angina with more prolonged or rigorous activity! Slight limitation of physical
activity.
• III: angina with usual daily activity. Marked limitation of physical activity.
• IV: ***angina at rest! Often unable to carry out any physical activity
Clinical -chest pain: classic; substernal, poorly localized, exertional, short in duration
(<30 mins), relieved with rest or Nitroglycerin
Dx -ECG:
• initial test of choice
• ST depression classic finding
• Resting ECG = normal in 50% of cases
-Stress testing: most important noninvasive testing -Coronary angiography: definitive
diagnostic test
Tx -Medical:
• daily Aspirin + Beta blockers (both decrease mortality), sublingual Nitroglycerin as
needed, and daily
Statin -Revascularization: definitive management
• percutaneous transluminal coronary angioplasty
• coronary artery bypass graft - ***left main coronary artery stenosis, 3 vessel disease
• Question
Arrhythmias
Correct Answer: I. Normal sinus: normal rate (60-100) and rhythm; impulse originates in
SA node; p waves upright; regular intervals
II. Sinus tach: HR >100; exercise, excitement, illness
III. Sinus brady: HR 50-60
IV. Atrial fibrillation/flutter: irritable sites in atria fire rapidly (400-600bpm); rapid
pacemaking à atrial quivering; ventricles beat slower bc AV node blocks some atrial
impulses o Sx: Elderly/alcohol use; syncope, dyspnea, palpitations o Dx: EKG: no
discrete p waves; irregularly irregular o Tx: rate - CCB (diltiazem / verapamil) or beta
blocker (metoprolol); rhythm (<48 hrs = cardioversion, amiodarone; >48
hrs = anticoagulare 21 days prior to cardioversion) § CHADS2 score (CHF, HTN, age >75,
DM, stroke hx) - 2+ points = heparin à coumadin; 1 = aspirin or coumadin; 0 = no
therapy or aspirin)
• AV block:
o 1st degree: PR >.2 - delay at AV node or bundle of His o 2nd: § 1: longer, longer, drop
à Wenckebach (some impulses are blocked) § 2: some dropped (impulse blocked in
bundle of His) o 3rd: p's and q's have no correlation - no atrial impulses transmitted to
ventricles à complete AV dissociation
• Bundle branch block: QRS > .12sec; possible due to MI
o Left: R and R' (upward bunny ears) V4-V6 o Right: R and R' (upward bunny ears) V1-V3
,• Paroxysmal SVT: HR 150-250
o Paroxysmal SVT - no structural abnormalities; faster than normal HR begins above two
lower chambers in atria, AV or SA node o AV nodal re-entrant tachy o WPW: impulse
travels between atria and ventricles through bundle of kent; § EKG: bundle of kent fibers
and delta wave on EKG; short PR, long QRS, delta wave § Don't give adenosine or CCB o
MAT: irregularly tachy, narrow QRS, abnormal 3 p waves with different morphology; HR
>100 o Tx: stable = Valsalva; symptomatic = adenosine; definitive = radiofrequency
ablation
• Premature beats: usually benign; may cause palpitat
• Question
Cardiac tamponade
Correct Answer: General -pericardial effusion causing significant pressure on the heart,
impeding cardiac filling, leading to decreased cardiac output and shock -rate of
accumulation of fluid is more critical than the volume
-Tachycardia with an elevated JVP and either hypotension or a paradoxical pulse. -Low
voltage or electrical alternans on ECG. -Echocardiography is diagnostic. -can develop
during any of the acute pericarditis processes -characterized by elevated
intrapericardial pressure (greater than 15 mm Hg), which restricts venous return and
ventricular filling. As a result, the stroke volume and arterial pulse pressure fall, and the
heart rate and venous pressure rise. Shock and death may result.
Clinical -***Beck's triad: distant (muffled) heart sounds, increased JVP, and systemic
hypotension! -pulse paradoxus (decline of greater than 10 mm Hg in systolic pressure
during inspiration) -Kussmaul's signs: increased JVP c inspiration -Dyspnea and cough;
tachycardia, hypotension, pulsus paradoxicus, raised JVP, muffled heart sounds, and
decreased ECG voltage or electrical alternan
Dx -Echocardiogram: pericardial effusion + ***diastolic collapse of cardiac chambers!
hemodynamic compromise -ECG: low voltage QRS complexes
Tx -pericardiocentesis (immediate) or cardiac surgery is required
• Question
Chest pain
Correct Answer: o Key physical exam: vital signs + BP in both arms; complete
cardiovascular exam (JVD, PMI, chest wall tenderness to palpation, heart sounds, pulses,
edema); lung and abdominal exams; lower extremity exam (inspection for signs of DVT)
Cardiac • Myocardial infarction: o Hx: hypertension, hyperlipidemia, smoking
• Question
, o Sx: sudden onset substernal heavy chest pain, radiation to left arm, dyspnea,
diaphoresis, nausea o Labs: ECG, CPK-MB, troponin x3, CXR, CBC, electrolytes, helical
CT, echo, cardiac catheterization • Angina: ECG changes o Sx: retrostenal squeezing
pain that lasts for 2 minutes and occurs with exercise; relieved with rest; not related to
food intake o Labs: ECG, CPK-MB, CXR, CBC, electroylates, exercise stress test (easiest /
most affordable), upper endoscopy / pH monitoring, cardiac catheterization (coronary
angiography = gold standard)
• Aortic dissection
o Hx: uncontrolled hypertension o Sx: sudden onset severe chest pain that radiates to
back o Labs: TTE, ECG, CPK-MB, troponin, CXR, CBC, amylase, lipase, CTA (chest with
contrast), MRI/MRA (aorta), aortic angiography, upper endoscopy
• Pericarditis
o Hx: viral infection o Sx: retrosternal stabbing, chest pain that improves when leaning
forward, worsens with deep inspiration o Labs: ECG, CPK-MB, troponin, CXR, echo, CBC,
upper endoscopy, ESR
• CHF
o Sx: cough exacerbated by lying down at night and improved by propping with pillows,
exertional dyspnea o Labs: CBC, CXR, ECG, echo, PFTs, BNP, CT-chest
• Lung cancer
o Hx: heavy smoker o sx: 6 mo worsening cough, hemoptysis, dyspnea, weakness,
weight loss o labs: CBC, sputum gram stain, culture, cytology, CXR, CT-chest
• asthma:
o sx: SOB, cough, wheezing worse in cold air o labs: CBC, CXR, peak flow measurement,
PFTs Pulmonary
• Costochondritis
o Hx: viral infection o Sx: stabbing chest pain that worsens with deep Conduction
disorders (atrial fibrillation/flutter, supraventricular tachycardia, bundle branch block,
ventricular tachycardia/fibrillation, premature beats)
Correct Answer: I. Clinical significance depends on how much
it impairs cardiac output / how likely it is to deteriorate into more serious disturbance
II. Presentation ranges: asymptomatic hemodynamic instability, shock, death
III. Unstable: chest pain, dyspnea, altered mental status, hypotension
IV. Diagnostic studies: ECG monitoring, event recording, measurement of HR variability,
signal-averaged ECG, exercise stress testing, electrophysiologic testing, autonomic
testing
V. Tx: antiarrythmic drugs
o Stable = treated with medications; unstable = treat with electricity
VI. Supraventricular arrhythmias
o Types:
VII. Sinus brady: <60 - well conditioned athletes / sinus node pathology with increased
risk ectopic rhythm
VIII. Unstable - give vagolytic (atropine) or positive chronotropic (epinephrine,
dopamine)
IX. Transcutaneous / transvenous pacing indicated / may need permanent pacing
X. Sinus tach: >100 - fever, exercise, pain, emotion, shock, thyrotoxicosis, anemia, HF,
drugs - causes symptoms when >150
XI. Unstable - synchronized cardioversion
