This is Part 1 of the Emergency Medicine
Fundamentals 10th Edition Comprehensive
Test Bank by Tintinalli, Stapczynski, Ma,
Yealy, Meckler, & Cline.
TABLE OF CONTENTS — PART 1
Chapter 1: Cardiovascular Emergencies — Questions 1–20
Chapter 2: Respiratory Emergencies — Questions 21–40
Chapter 3: Neurological Emergencies — Questions 41–60
Chapter 4: Gastrointestinal and Genitourinary Emergencies — Questions 61–80
Chapter 5: Trauma and Environmental Emergencies — Questions 81–100
Chapter 1: Cardiovascular Emergencies — Questions 1–20
Q1. Which of the following is the most common cause of sudden cardiac death in adults?
A. Ventricular fibrillation
B. Asystole
C. Pulseless electrical activity
D. Complete heart block
Correct Answer: A
Rationale: Ventricular fibrillation is the most common cause of sudden cardiac death in adults
because it produces chaotic electrical activity that results in no effective cardiac output. Option B is
incorrect because asystole is less common and often represents a terminal rhythm. Option C is wrong
because pulseless electrical activity is less common but potentially reversible if the underlying cause
is identified. Option D is incorrect because complete heart block typically causes symptomatic
bradycardia rather than sudden death. Early defibrillation is the definitive treatment for ventricular
fibrillation.
Q2. A 65-year-old man presents with crushing substernal chest pain radiating to the left arm. ECG
shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
,B. Left circumflex artery
C. Left main coronary artery
D. Right coronary artery
Correct Answer: D
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction, which is most commonly caused by occlusion of the right coronary artery. Option A is
incorrect because left anterior descending artery occlusion produces anterior changes in leads V1
through V4. Option B is wrong because left circumflex occlusion affects the lateral wall with changes
in leads I, aVL, V5, and V6. Option C is incorrect because left main occlusion produces widespread
changes and is often fatal. Recognizing the coronary territory associated with each ECG lead guides
emergent reperfusion therapy.
Q3. A 58-year-old woman presents with palpitations and a heart rate of 160 beats per minute. ECG
shows a narrow-complex tachycardia with no visible P waves. She is hemodynamically stable. What is
the most appropriate initial intervention?
A. Synchronized cardioversion
B. Vagal maneuvers
C. Amiodarone infusion
D. Adenosine administration
Correct Answer: B
Rationale: Vagal maneuvers are the first-line intervention for stable narrow-complex
tachycardia such as paroxysmal supraventricular tachycardia because they increase vagal tone and
can terminate the arrhythmia. Option A is incorrect because synchronized cardioversion is reserved
for hemodynamically unstable patients. Option C is wrong because amiodarone is used for
ventricular arrhythmias or refractory cases. Option D is incorrect because adenosine is used when
vagal maneuvers fail and is not the initial step. Following the stepwise approach to tachycardia
management ensures patient safety.
Q4. A 72-year-old man with a history of hypertension presents with a blood pressure of 220/120
mmHg and acute onset of chest pain. ECG shows ST depression and troponin is elevated. What is the
most appropriate diagnosis?
A. Hypertensive urgency
B. Aortic dissection
C. Hypertensive emergency
D. Stable angina
Correct Answer: C
,Rationale: Hypertensive emergency is characterized by severe blood pressure elevation with
evidence of end-organ damage such as acute coronary syndrome, which is present in this patient.
Option A is incorrect because hypertensive urgency lacks end-organ damage. Option B is wrong
because aortic dissection typically presents with tearing pain radiating to the back and pulse deficit.
Option D is incorrect because stable angina does not cause troponin elevation. Recognizing end-
organ damage guides emergent blood pressure reduction.
Q5. A 60-year-old man presents with sudden tearing chest pain radiating to the back. Blood pressure
is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. What is the most appropriate
initial diagnostic test?
A. ECG
B. Chest X-ray
C. Troponin
D. CT angiography
Correct Answer: B
Rationale: Chest X-ray is often the initial test in suspected aortic dissection and may show a
widened mediastinum, although it is not definitive. Option A is incorrect because ECG is used to rule
out myocardial infarction but does not diagnose dissection. Option C is wrong because troponin is
used for myocardial infarction. Option D is incorrect because CT angiography is confirmatory but not
always the first test obtained. Recognizing the diagnostic algorithm for aortic dissection is important
for timely surgical intervention.
Q6. A 55-year-old man with a history of heart failure presents with acute shortness of breath,
bilateral crackles, and an S3 gallop. What is the most appropriate initial medication for symptom
relief?
A. Furosemide
B. Metoprolol
C. Lisinopril
D. Spironolactone
Correct Answer: A
Rationale: Furosemide is a loop diuretic that provides rapid symptomatic relief in acute
decompensated heart failure by reducing preload and pulmonary congestion. Option B is incorrect
because metoprolol is a beta-blocker used for chronic heart failure but may worsen acute
decompensation. Option C is wrong because lisinopril is an ACE inhibitor used for chronic heart
failure. Option D is incorrect because spironolactone is an aldosterone antagonist used for chronic
heart failure. Acute management focuses on decongestion and hemodynamic stabilization.
, Q7. A 45-year-old woman presents with syncope and a heart rate of 35 beats per minute. ECG shows
complete heart block. What is the most appropriate immediate intervention?
A. Atropine
B. Dopamine
C. Transcutaneous pacing
D. Isoproterenol
Correct Answer: C
Rationale: Transcutaneous pacing is the immediate intervention for symptomatic complete
heart block because it provides temporary electrical support until a permanent pacemaker can be
placed. Option A is incorrect because atropine may not be effective in complete heart block due to
the lack of conduction through the AV node. Option B is wrong because dopamine is a temporizing
measure but pacing is more definitive. Option D is incorrect because isoproterenol is rarely used and
may worsen ischemia. Recognizing indications for emergent pacing is essential.
Q8. A 50-year-old man presents with chest pain and ST-segment elevation on ECG. What is the most
appropriate diagnosis?
A. Unstable angina
B. Non-ST-elevation myocardial infarction
C. Pericarditis
D. ST-elevation myocardial infarction
Correct Answer: D
Rationale: ST-segment elevation on ECG in the setting of chest pain is diagnostic of ST-
elevation myocardial infarction, which requires emergent reperfusion therapy. Option A is incorrect
because unstable angina has no biomarker elevation and no ST elevation. Option B is wrong because
non-ST-elevation myocardial infarction does not have ST elevation on ECG. Option C is incorrect
because pericarditis typically causes diffuse ST elevation and PR depression. Rapid recognition of
STEMI is critical for timely intervention.
Q9. A 75-year-old man presents with syncope. ECG shows a prolonged QT interval. Which medication
should be avoided?
A. Sotalol
B. Amiodarone
C. Erythromycin
D. Metoprolol
Correct Answer: A
Fundamentals 10th Edition Comprehensive
Test Bank by Tintinalli, Stapczynski, Ma,
Yealy, Meckler, & Cline.
TABLE OF CONTENTS — PART 1
Chapter 1: Cardiovascular Emergencies — Questions 1–20
Chapter 2: Respiratory Emergencies — Questions 21–40
Chapter 3: Neurological Emergencies — Questions 41–60
Chapter 4: Gastrointestinal and Genitourinary Emergencies — Questions 61–80
Chapter 5: Trauma and Environmental Emergencies — Questions 81–100
Chapter 1: Cardiovascular Emergencies — Questions 1–20
Q1. Which of the following is the most common cause of sudden cardiac death in adults?
A. Ventricular fibrillation
B. Asystole
C. Pulseless electrical activity
D. Complete heart block
Correct Answer: A
Rationale: Ventricular fibrillation is the most common cause of sudden cardiac death in adults
because it produces chaotic electrical activity that results in no effective cardiac output. Option B is
incorrect because asystole is less common and often represents a terminal rhythm. Option C is wrong
because pulseless electrical activity is less common but potentially reversible if the underlying cause
is identified. Option D is incorrect because complete heart block typically causes symptomatic
bradycardia rather than sudden death. Early defibrillation is the definitive treatment for ventricular
fibrillation.
Q2. A 65-year-old man presents with crushing substernal chest pain radiating to the left arm. ECG
shows ST-segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
,B. Left circumflex artery
C. Left main coronary artery
D. Right coronary artery
Correct Answer: D
Rationale: ST-segment elevation in leads II, III, and aVF indicates an inferior wall myocardial
infarction, which is most commonly caused by occlusion of the right coronary artery. Option A is
incorrect because left anterior descending artery occlusion produces anterior changes in leads V1
through V4. Option B is wrong because left circumflex occlusion affects the lateral wall with changes
in leads I, aVL, V5, and V6. Option C is incorrect because left main occlusion produces widespread
changes and is often fatal. Recognizing the coronary territory associated with each ECG lead guides
emergent reperfusion therapy.
Q3. A 58-year-old woman presents with palpitations and a heart rate of 160 beats per minute. ECG
shows a narrow-complex tachycardia with no visible P waves. She is hemodynamically stable. What is
the most appropriate initial intervention?
A. Synchronized cardioversion
B. Vagal maneuvers
C. Amiodarone infusion
D. Adenosine administration
Correct Answer: B
Rationale: Vagal maneuvers are the first-line intervention for stable narrow-complex
tachycardia such as paroxysmal supraventricular tachycardia because they increase vagal tone and
can terminate the arrhythmia. Option A is incorrect because synchronized cardioversion is reserved
for hemodynamically unstable patients. Option C is wrong because amiodarone is used for
ventricular arrhythmias or refractory cases. Option D is incorrect because adenosine is used when
vagal maneuvers fail and is not the initial step. Following the stepwise approach to tachycardia
management ensures patient safety.
Q4. A 72-year-old man with a history of hypertension presents with a blood pressure of 220/120
mmHg and acute onset of chest pain. ECG shows ST depression and troponin is elevated. What is the
most appropriate diagnosis?
A. Hypertensive urgency
B. Aortic dissection
C. Hypertensive emergency
D. Stable angina
Correct Answer: C
,Rationale: Hypertensive emergency is characterized by severe blood pressure elevation with
evidence of end-organ damage such as acute coronary syndrome, which is present in this patient.
Option A is incorrect because hypertensive urgency lacks end-organ damage. Option B is wrong
because aortic dissection typically presents with tearing pain radiating to the back and pulse deficit.
Option D is incorrect because stable angina does not cause troponin elevation. Recognizing end-
organ damage guides emergent blood pressure reduction.
Q5. A 60-year-old man presents with sudden tearing chest pain radiating to the back. Blood pressure
is 180/100 mmHg in the right arm and 140/80 mmHg in the left arm. What is the most appropriate
initial diagnostic test?
A. ECG
B. Chest X-ray
C. Troponin
D. CT angiography
Correct Answer: B
Rationale: Chest X-ray is often the initial test in suspected aortic dissection and may show a
widened mediastinum, although it is not definitive. Option A is incorrect because ECG is used to rule
out myocardial infarction but does not diagnose dissection. Option C is wrong because troponin is
used for myocardial infarction. Option D is incorrect because CT angiography is confirmatory but not
always the first test obtained. Recognizing the diagnostic algorithm for aortic dissection is important
for timely surgical intervention.
Q6. A 55-year-old man with a history of heart failure presents with acute shortness of breath,
bilateral crackles, and an S3 gallop. What is the most appropriate initial medication for symptom
relief?
A. Furosemide
B. Metoprolol
C. Lisinopril
D. Spironolactone
Correct Answer: A
Rationale: Furosemide is a loop diuretic that provides rapid symptomatic relief in acute
decompensated heart failure by reducing preload and pulmonary congestion. Option B is incorrect
because metoprolol is a beta-blocker used for chronic heart failure but may worsen acute
decompensation. Option C is wrong because lisinopril is an ACE inhibitor used for chronic heart
failure. Option D is incorrect because spironolactone is an aldosterone antagonist used for chronic
heart failure. Acute management focuses on decongestion and hemodynamic stabilization.
, Q7. A 45-year-old woman presents with syncope and a heart rate of 35 beats per minute. ECG shows
complete heart block. What is the most appropriate immediate intervention?
A. Atropine
B. Dopamine
C. Transcutaneous pacing
D. Isoproterenol
Correct Answer: C
Rationale: Transcutaneous pacing is the immediate intervention for symptomatic complete
heart block because it provides temporary electrical support until a permanent pacemaker can be
placed. Option A is incorrect because atropine may not be effective in complete heart block due to
the lack of conduction through the AV node. Option B is wrong because dopamine is a temporizing
measure but pacing is more definitive. Option D is incorrect because isoproterenol is rarely used and
may worsen ischemia. Recognizing indications for emergent pacing is essential.
Q8. A 50-year-old man presents with chest pain and ST-segment elevation on ECG. What is the most
appropriate diagnosis?
A. Unstable angina
B. Non-ST-elevation myocardial infarction
C. Pericarditis
D. ST-elevation myocardial infarction
Correct Answer: D
Rationale: ST-segment elevation on ECG in the setting of chest pain is diagnostic of ST-
elevation myocardial infarction, which requires emergent reperfusion therapy. Option A is incorrect
because unstable angina has no biomarker elevation and no ST elevation. Option B is wrong because
non-ST-elevation myocardial infarction does not have ST elevation on ECG. Option C is incorrect
because pericarditis typically causes diffuse ST elevation and PR depression. Rapid recognition of
STEMI is critical for timely intervention.
Q9. A 75-year-old man presents with syncope. ECG shows a prolonged QT interval. Which medication
should be avoided?
A. Sotalol
B. Amiodarone
C. Erythromycin
D. Metoprolol
Correct Answer: A
