Emergency Medicine Final Exam Questions
and Answers Latest 2025 A+
What charachteristic do you expect the vital signs to be for
someone in hypovolemic shock?
(+) Orthostatic vitals (they pass out when they stand up or a
change of 20mmHg or 20 BPM with position change)
In what order do you take orthostatic vitals?
a. Sitting-lying-standing
b. Lying-sitting-standing
c. Standing-sitting-lying
d. Lying-standing-sitting
b. Lying-sitting-standing
What signifies the changes between compensated and
decompensated shock?
Urine output decreased
Respiratory Rate Increase
Blood pressure dropping
How do you manage shock?
-1-2L Normal saline (unless elderly or they cannot tolerate it)
-Correct electrolyte imbalances
-Stop vomiting: Zofran
-Treat fever: Tylenol (?)
-Treat underlying cause
-Ensure patient can tolerate oral fluids prior to discharge
Intravascular volume depletion due to marker system
vasodilation. Results in reduction of afterload.
Distributive Shock
(33-50% of the time)
What types of shock are commonly seen with Distrubutive
shock?
,Septic Shock
Anaphylaxis
Neurogenic shock
IgE mediated response that results in systemic vasodilation
and is commonly caused by:
-Food
-Medications
-Insect stings
-Immunotherapy injections
Any sunstance or agent that can cause a sudden
degranulation of mast cells or basophils can cause
anaphylaxis
Anaphylaxis
What are the S & S of anaphylaxis?
-Pruritus
-Skin Flushing
-Hives or urticaria
-Fullness in the throat and -Hoarseness (laryngeal edema)
-Anxiety
-Chest tightness
What are the MAJOR symptoms of Distributive shock?
-Abdominal pain or cramps
-Nausea/Vomiting/Diarrhea
-Bronchospasm
-Rhinorrhea
-Conjunctivitis
-Hypotension
What is the cascade flow of Distributive shock if you had to
draw it as a diagram?
Respiratory distress--> Decreased LOC-->
Circulatory Collapse-->
Complete LOC & Cardiac Arrest
,How long can symptoms of distributive shock be delayed?
What is the peak time for recurrence?
1. 60 minutes
2. 8-11 hours
How many body systems must be involed to consider a DX of
Anaphylaxis?
a. 1
b. 2
c. 3
d. 4
e. All of the above
f. None of the above
b. 2
T/F Anaphylaxis can mimic other conditions such as
syncope, gastroenteritis and anxiety.
True
How is a diagnosis made for distributive shock?
Clinically
1st line treatment of Distributive Shock?
a. Initiate IV
b. Cardiac EKG
c. Decontamination (remove stinger)
d. Primary Survey & ABC
d. Primary Survey & ABC
T/F You should intubate early in distributive shock due to
potential for airway obstruction.
True
Which of the following is not involved in 1st line therapy of
shock:
a. ABC's
b. Primary survey
c. Vital signs
, d. Initiate IV access
e. Provide supplemental O2
f. Cardiac monitoring
d. Decontamination if probable
g. Call the OR
g. Call of OR
What is the treatment of choice for anaphylaxis?
a. Adenosine
b. Noncrystalline
c. Epinephrine
d. Dobutamine
c. Epinephrine
What is the EMERGENT dose of Epinephrine for
anaphylaxis?
Epinephrine IM 0.3-0.5 of the 1:1000 dilution
If a patient is refractory to the initial dose of Epi what do you
do?
1mcg/min then titrate to effect (improve hypotension)
What do you give for the hypotension associated with
anaphylaxis that is due to the distributive shock?
IV crystalloids 1-2L
Which of the following is NOT a second line therapy for
distributive shock.
a. Diphenhydramine 25-50, IV, IM or PO
b. Ranitidine 150mg IV
c. Famotidine 40mg IV
d. Loratadine/ Pseudophedrine 40mg IV
e. Prenisone 40-60mg PO
f. Solu-medrol 125mg IV
g. Albuterol nebulizer
h. Magnesium 2mg IV over 20 minutes
and Answers Latest 2025 A+
What charachteristic do you expect the vital signs to be for
someone in hypovolemic shock?
(+) Orthostatic vitals (they pass out when they stand up or a
change of 20mmHg or 20 BPM with position change)
In what order do you take orthostatic vitals?
a. Sitting-lying-standing
b. Lying-sitting-standing
c. Standing-sitting-lying
d. Lying-standing-sitting
b. Lying-sitting-standing
What signifies the changes between compensated and
decompensated shock?
Urine output decreased
Respiratory Rate Increase
Blood pressure dropping
How do you manage shock?
-1-2L Normal saline (unless elderly or they cannot tolerate it)
-Correct electrolyte imbalances
-Stop vomiting: Zofran
-Treat fever: Tylenol (?)
-Treat underlying cause
-Ensure patient can tolerate oral fluids prior to discharge
Intravascular volume depletion due to marker system
vasodilation. Results in reduction of afterload.
Distributive Shock
(33-50% of the time)
What types of shock are commonly seen with Distrubutive
shock?
,Septic Shock
Anaphylaxis
Neurogenic shock
IgE mediated response that results in systemic vasodilation
and is commonly caused by:
-Food
-Medications
-Insect stings
-Immunotherapy injections
Any sunstance or agent that can cause a sudden
degranulation of mast cells or basophils can cause
anaphylaxis
Anaphylaxis
What are the S & S of anaphylaxis?
-Pruritus
-Skin Flushing
-Hives or urticaria
-Fullness in the throat and -Hoarseness (laryngeal edema)
-Anxiety
-Chest tightness
What are the MAJOR symptoms of Distributive shock?
-Abdominal pain or cramps
-Nausea/Vomiting/Diarrhea
-Bronchospasm
-Rhinorrhea
-Conjunctivitis
-Hypotension
What is the cascade flow of Distributive shock if you had to
draw it as a diagram?
Respiratory distress--> Decreased LOC-->
Circulatory Collapse-->
Complete LOC & Cardiac Arrest
,How long can symptoms of distributive shock be delayed?
What is the peak time for recurrence?
1. 60 minutes
2. 8-11 hours
How many body systems must be involed to consider a DX of
Anaphylaxis?
a. 1
b. 2
c. 3
d. 4
e. All of the above
f. None of the above
b. 2
T/F Anaphylaxis can mimic other conditions such as
syncope, gastroenteritis and anxiety.
True
How is a diagnosis made for distributive shock?
Clinically
1st line treatment of Distributive Shock?
a. Initiate IV
b. Cardiac EKG
c. Decontamination (remove stinger)
d. Primary Survey & ABC
d. Primary Survey & ABC
T/F You should intubate early in distributive shock due to
potential for airway obstruction.
True
Which of the following is not involved in 1st line therapy of
shock:
a. ABC's
b. Primary survey
c. Vital signs
, d. Initiate IV access
e. Provide supplemental O2
f. Cardiac monitoring
d. Decontamination if probable
g. Call the OR
g. Call of OR
What is the treatment of choice for anaphylaxis?
a. Adenosine
b. Noncrystalline
c. Epinephrine
d. Dobutamine
c. Epinephrine
What is the EMERGENT dose of Epinephrine for
anaphylaxis?
Epinephrine IM 0.3-0.5 of the 1:1000 dilution
If a patient is refractory to the initial dose of Epi what do you
do?
1mcg/min then titrate to effect (improve hypotension)
What do you give for the hypotension associated with
anaphylaxis that is due to the distributive shock?
IV crystalloids 1-2L
Which of the following is NOT a second line therapy for
distributive shock.
a. Diphenhydramine 25-50, IV, IM or PO
b. Ranitidine 150mg IV
c. Famotidine 40mg IV
d. Loratadine/ Pseudophedrine 40mg IV
e. Prenisone 40-60mg PO
f. Solu-medrol 125mg IV
g. Albuterol nebulizer
h. Magnesium 2mg IV over 20 minutes
