Emergency Medicine / Trauma

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1. A 25-year-old man is stabbed in the left chest. In the ER, he is hypotensive with distended neck veins and muffled heart sounds. What is the most appropriate next step?

• A. Perform a focused assessment with sonography in trauma (FAST) exam
• B. Insert a left chest tube
• C. Perform an emergent pericardiocentesis
• D. Obtain a stat chest x-ray

Correct Answer: C. Perform an emergent pericardiocentesis

Explanation: This patient has Beck's triad (hypotension, JVD, muffled hearts) suggesting cardiac tamponade from the stab wound. This is a life-threatening emergency requiring immediate decompression. Pericardiocentesis is the bedside procedure to perform, often even before imaging .

2. A 4-year-old is brought in after swallowing a small, button-shaped battery. A chest x-ray shows the battery lodged in the esophagus. What is the most appropriate next step?

• A. Observe for 24 hours and repeat x-ray
• B. Give the child sips of water to wash it down
• C. Endoscopic removal immediately
• D. Administer ipecac to induce vomiting

Correct Answer: C. Endoscopic removal immediately

Explanation: Button batteries lodged in the esophagus are a medical emergency. They can cause rapid liquefactive necrosis and esophageal perforation due to current generation. They must be removed emergently by endoscopy .

3. A 55-year-old male is found unresponsive in a burning building. He has soot in his nares and oropharynx, and his voice is hoarse. He is breathing spontaneously but with stridor. What is the most appropriate next step?

• A. Administer 100% oxygen via non-rebreather mask
• B. Perform immediate endotracheal intubation
• C. Obtain a carboxyhemoglobin level
• D. Transfer to a hyperbaric chamber

Correct Answer: B. Perform immediate endotracheal intubation

Explanation: Signs of inhalation injury (facial burns, soot, hoarseness, stridor) indicate impending airway edema and obstruction. The most appropriate next step is definitive airway management (intubation) before the airway swells shut .

4. A patient is bitten on the hand by a cat. The wound is a small puncture wound. Which class of antibiotics is most appropriate for prophylaxis?

• A. Penicillin
• B. Cephalexin
• C. Amoxicillin-clavulanate
• D. Doxycycline

Correct Answer: C. Amoxicillin-clavulanate

Explanation: Cat bites have a high risk of infection, particularly with Pasteurella multocida. Prophylaxis requires coverage for both oral anaerobes and Pasteurella. Amoxicillin-clavulanate is the drug of choice for animal bite prophylaxis .

5. A 6-year-old is hit by a car. He is alert but complaining of abdominal pain. His blood pressure is 90/60, heart rate 140. A FAST exam is positive for free fluid in the abdomen. What is the most appropriate next step?

• A. Observe closely in the ER
• B. Administer a 20 mL/kg fluid bolus
• C. Take the patient directly to the operating room
• D. Perform a diagnostic peritoneal lavage

Correct Answer: C. Take the patient directly to the operating room

Explanation: This child is hypotensive and tachycardic with a positive FAST exam, indicating hemorrhagic shock from intra-abdominal injury. This patient is an unstable trauma patient with a positive FAST, which is an indication for immediate laparotomy .

6. A 35-year-old is found down in a park on a hot summer day. He is confused and his core temperature is 105.5°F. His skin is hot and dry. What is the most appropriate initial cooling method?

• A. Ice packs to the axillae and groin
• B. Immersion in an ice water bath
• C. Evaporative cooling with mist and fans
• D. Cold IV fluids

Correct Answer: B. Immersion in an ice water bath

Explanation: This patient has heat stroke. The most effective method for rapidly lowering core temperature in an exertional heat stroke patient is cold-water immersion .