Emergency Medicine Prometric Mcqs

EMERGENCY MEDICINE PAPER UPDATED VERSION TILL NOVEMER 2016
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I have compiled this MCQs file on EMERGENCY MEDICINE from

different books to get all MCQ on this topic in one place. Up to date till
today, all MCQ from different sources, may be some incorrect answers
please read carefully, and please help to correct it, there are some
MCQs incomplete only one with one option just remember that question
you may get in exam.
Equally benefit for MOH UAE, DHA, AND SLE or OMAN BOARD and
QATAR
Wish you all the best for Exams
Regards
Dr. Imran Asghar
DR. IMRAN ASGHAR November 28, 2016

Drimran823@gmail.com
1.Patient ingested 20 gram of acetaminophen 8 hours ago, what is your

next step?
a. Charcoal
b. N acetylcysteine
c. Gastric lavage
Answer: B
2.Patient ate from a restaurant. 2 days after that started to complain of

diarrhea, vomiting and urti-caria.
a. Food poisoning
b. Food allergy
3. A patient comes to the emergency with sudden dypsnea. X ray picture

was attached showing dark area without vascular marking. What is the
diagnosis?
Pneumonia
Pulmonary edema
Pneumothorax
Pulmonary embolism
Answer: C
4. A guy was standing at a bus stop then fell. No previous history and no
cardiac anomalies. What is the diagnosis?
Cardiac syncope
Fainting??!
Seizure
Vasovagal
Answer: D
5. A guy presents in emergency with decreased oxygen carrying

capacity of blood cells. Suicidal at-tempt is suspected. what is the
culprit?
Carbon monoxide
Cyanide
Answer: A

6. Patient came to the ER with status asthmaticus. What will you use to
intubate him?
Propofol
Ketamine
Midazolam
Answer: B
7. Soldier tries to have an excuse from the military, presented to the ER

with symptoms of tremors, hypoglycemia. What is he using?
Factitious injection of insulin.
Metformin
Answer: A
8. Acute attack of cluster headache, what is the abortive treatment?

Oxygen 100%
Subcutaneous Sumatriptan
Answer: A
Both Oxygen 100% and Subcutaneous Sumatriptan are effective
9. Semiconscious polytrauma patient, has difficulty breathing on bag

ventilator (Ambu bag), pre-pared for intubation. What is the next step?
Go directly and intubate
Cricoid pressure
O2 supplements
Jaw thrust
Answer: C
Rapid-Sequence Intubation*
1. Pre-oxygenate with 100% oxygen
2. Apply cricoid pressure
3. Induction: etomidate (0.3 mg/kg), propofol (0.5–2 mg/kg) or ketamine
(2 mg/kg) IV
10. A patient ate a wild mushroom. Which of the following will be

inhibited?
RNA polymerase I
RNA polymerase II
RNA polymerase III
DNA Gyrase
Answer: B

11. Post-traumatic amnesia, vitally stable but he’s complaining of pain in

all of his 4 extremities. Which type of shock might be developed?
Neuro
Cardiac
Hypovolemic
Reversible
Answer: A
Reference: Toronto Notes
12. 4 members in the family developed nausea and diarrhea 8 hours

after eating at a restaurant. Then after 48 hours they improved. Stool
test showed oxidase positive gram +ve bacilli. What is organism?
Shigella
Salmonella
Answer: ?
Shigella (gram –ve)
Salmonella (gram –ve)
13. Aspirin toxicity resulting in which of the following?

Respiratory alkalosis followed by metabolic acidosis
Answer: A
Phase 1: Respiratory stimulation- hyperventilation and respiratory
alkalosis with alkaluria
Phase 2: Paradoxical aciduria (pH <6) and respiratory alkalosis
Phase 3: Metabolic acidosis & hypokalaemia (± ongoing respiratory
alkalosis)
Reference:
http://www.rch.org.au/clinicalguide/guideline_index/Salicylates_Posionin
g/
14. Which of the following babies needs immediate action?

a. Cough and wheezing.
b. Shallow spinal skin.
c. Absent lower pulse.
d. Yellowish discoloration

15. Male patient presented to the ER after MVA, he has tachycardia,

tachypnea, hypotension and cardiac arrhythmia. What is your most
correct next step is ?
a. FAST to check abdominal hemorrhage
b. Needle decompression
c. Pericardiocentesis
Answer: A
Hypovolemic shock
16. You are working as an emergency doctor and you got a call that
there was an accident at the nu-clear plant and 2 men were exposed to
nuclear radiation. They don’t have any complaints right now. What will
you advise them?
Cover them up with dry thick blankets
Give them aspirin and ask them to keep their legs moving
Isolate them and advise them to stay calm
Give them antibiotics
Answer: C
In hospital casualty will be finally decontaminated and kept in a clean
special ward. The decontamina-tion room must be at the entry of the
hospital and should be sealed off from other premises and should have
a separate ventilation system.
17. Unconscious pt after ingestion of overdose sleep pills, breathing

was reflex response breathing , you give him 2 breathing by mask , then
you check pulse it was rapid and weak , what is next step:
A. wait code blue team
B. put pt in recovery position
C. intubat and ventilation
D. do CPR 5 cycle 30:2
Answer: C
Airway protection – Airway protection by endotracheal intubation should
be performed early in the poi-soned patient with depressed mental
status, unless the cause is easily reversible (eg, opioid intoxication or
hypoglycemia), because of the high risk for aspiration and its associated
complications, particularly when gastric decontamination procedures
need to be undertaken [40]. Tracheal intubation with me-chanical
ventilation is also indicated in the presence of severe acid-base
disturbances or acute respira-tory failure. Particularly when intubating a
severely acidemic patient, it is important to prevent the de-velopment of
a respiratory acidosis through inadequate minute ventilation.
Occasionally, the manage-ment of high-grade physiologic stimulation
may require sedation and/or paralysis with mechanical venti-lation to

limit the extent of complications such as hyperthermia, acidosis, and
rhabdomyolysis. One rare exception to this important principle of
aggressive airway management is salicylate poisoning, in which
mechanical ventilation should be avoided unless absolutely necessary
18. child girl obese try to suicide and eat alot of drug because of her
friend and came to the ER?
A. referral immediate to the psychatry
B. treatmen for acute depression
C. something
D. another something
Answer: A
• ensure patient safety: close observation, remove potentially dangerous
objects from person and room
• assess thoughts (ideation), means, action (preparatory, practice
attempts), previous attempts
• admit if there is evidence of intent and organized plan, access to lethal
means, psychiatric disorder, intoxication (suicidal ideation may resolve
with few days of abstinence)
• patient may require certification if unwilling to stay voluntarily
• do not start long-term medications in the ED
• psychiatry or Crisis Intervention Team consult
19.anterior abdominal stab wound omuntam come through the wound ?

A. Fast
B. CT
C. Exploratory laparotomy
Answer: C
Reference: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4379793/
20. patient came from RTA and the staff preparing him for intubation he
devolved low ventila-tion on bivalve what to do ? repeated
A.Proceed to intubation
B. jaw thrust
C. More head tilt
D. Cricoid pressure
Answer: A

Indications for intubation: 1) inadequate oxygenation 2) inadequate

ventilation 3) Anticipate develop-ment of inadequate
oxygenation/ventilation 4) protect the airway
21.Pt work outdoor in temp 42 c .. Tired and Complain of crampy

abdominal
pain .. Lower limb pain and fever .. Otherwise normal ,, what to do ?
electrolytes and oral replacement fluid
warming
cooling
Answer: C
Heat Stroke - Rapid reduction of the core body temperature is the
cornerstone of treatment because the duration of hyperthermia is the
primary determinant of outcome. Once heatstroke is suspected, cooling
must begin immediately and must be continued during the patient's
resuscitation.
Reference: http://emedicine.medscape.com/article/166320-treatment
22.Patient is bleeding the baro receptor activated result in increased

tachycardia and decrease of ?
HR
Ventricular rate
Coronary artery flow
Answer: A
Circulatory Reflex Initiated by the Baroreceptors. After the baroreceptor
signals have entered the trac-tus solitarius of the medulla, secondary
signals inhibit the vasoconstrictor center of the medulla and ex-cite the
vagal parasympathetic center. The net effects are (1) vasodilation of the
veins and arterioles throughout the peripheral circulatory system and (2)
decreased heart rate and strength of heart con-traction. Therefore,
excitation of the baroreceptors by high pressure in the arteries reflexly
causes the
arterial pressure to decrease because of both a decrease in peripheral
resistance and a decrease in car-diac output. Conversely, low pressure
has opposite effects, reflexly causing the pressure to rise back to-ward
normal.
Reference: Guyton and Hall Textbook of Medical Physiology 12th Ed

23. .Patient came to you with history of bee sting with light heeded and
shortness of breath what is the Rx ?
Oral histamine reassurance
Fluids and elevate the leg
Sc epinephrine , IV histamine
Answer : C
Acute Severe Systemic Reaction/ Anaphylaxis
ABCs, Epinephrine SC/IV, Antihistamines IV, Corticosteroids
Reference: 5-Minute Emergency Medicine Consult
24.man got a bee sting then his wife trying look for the epinephrine what
it gonna inhibit?
leukotriene release from macrophages
cross reactivity with the cardiac..
inhibit immunocomplex formation
An-swer: A
25.Pt conscious with multiple injuries. How do you maintain airway?

Mask
Oro pharyngeal airway
Nasopharyngeal
Endotracheal Intubation
Answer : A mask
26.Depressed pt with HTN Brought by family to ER for drug overdose

palpitation diaphoresis and ECG shows arrhythmia. What is the possible
drug ?
Ssri
Digoxin
Answer. B or if there is TCA in the choices
27.Old pt with high cholesterol level measured before 4 months and he

is on a diet. Came to ER com-plaining of chest pain. What will concern
you?
Current symptoms
Cholesterol level before 4 m
Answer. A Current symptoms

28.gunshot with wound bowel perforation. What antibiotics you should

give
answer : -
IV antibiotics: Antibiotics with coverage against gram-negative and
anaerobic
organisms: Ampicillin/sulbactam, Cefotetan, Cefoxitin,
Piperacillin/tazobactam, Ticarcillin/clavulanate.
Reference: 5-Minute Emergency Medicine Consult
29.Case of RTA and they found difficulty in intubation what should they
do :
just proceed to intubation whatever.
increase chit tilt .
press on cricoid
answer: c
30. Patient has acute MI. which of the following enzymes will be
elevated?
Creatine kinase.
alanine aminotransferase.
Alkaline phosphatase.
Answer: A
31.Patient had bee sting on the hand yesterday, he is presenting to you

with redness and itching on the bite site. What is the treatment?
Oral steroid.
Antihistamine.
Oral Antibiotic.
Answer: B antihistamines
32.Patient had bee sting and presented to you immediately with

shortness of breath and lightheaded-ness. What is the treatment?
SC epinephrine.
Answer: IM epinephrine

33. Patient with ischemic stroke presented after 6 hours. What is the
treatment?
Tissue plasminogen activator.
Aspirin.
Clopedogril.
answer : B aspirin
Presentation within 3-4.5 h and no contraindication to thrombolysis →

1st line tissue plasminogen acti-vator
Presentation after 4.5 h or contraindication to thrombolysis → 1st line
aspirin
Reference: BMJ
34.Unconscious patient after RTA .. Ventilation with bag mask was

difficult .. What to do ?
exaggerate jaw thrust
increase head tilt
coricoid pressure
intubation
answer : D Intubation
35. Man got bee sting ,, his wife gave him epinephrine .. What is the
Immunologic action of epineph-rine ?
Iterlukine..... Ect
Tryptanase .....ect
Answer A
36. Young healthy guy comes to ER after light headedness nausea and
heavy breathing 20 mins before admission. What most appropriate thing
to do?
a.Alcohol concentration.
b.CT brain.
c. Other choices unrelated.
Answer: B

37.Elderly asthmatic patient comes to regular check up. His wife has
osteoporosis. He's recurrent kid-ney stones.he's taking calcium and
vitamin supplements. Labs show high ca, normal phosphate, PTH high.
Most diagnosis Is:
a- Sarcoidosis.
b- Paget's disease.
c- Vit D intoxication.
d- Hyperparathyroidism.**
Answer: D Hypepararthyroidism
38. Child with traumatic injury to elbow. X-ray will show?

a- Posterior fat pad.**
b- Anterior fat pad.
c-Others epicondylar injuries I forgot.
Answer: A
Supracondylar fracture over 60% of all paediatric elbow injuries
Posterior fat pad sign indicates effusion/injury: In children, it implies
supracondylar fracture.
Anterior fat pad can found in normal xrays
Reference:5-Minute Emergency Medicine Consult,
http://radiopaedia.org/articles/paediatric-elbow-radiograph-an-approach
39. Pt brought to ER with multiple injuries in head . Chest , abdomen ,

proximal upper limb is amputated blood profuse , hypotensive , on o2
face mask 6L , what to do?
Tourniquet ,
clamp vessels ,
OR ,
mantain airway
Answer : D Three goals exist in the emergency department treatment of
the patient with hypovolemic shock as fol-lows: (1) maximize oxygen
delivery - completed by ensuring adequacy of ventilation, increasing
oxygen saturation of the blood, and restoring blood flow, (2) control
further blood loss, and (3) fluid resuscita-tion.

40. asprin toxicity with ABG : show low CO2 and low HCO3 ?
with acidic PH ?. cause ?
resp. alkalosis followed by metabolic acidosis
metabolic acidosis followed by resp. alkalosis
metabolic acidosis
Answer: A
Respiratory alkalosis progressing to metabolic acidosis is the key for
aspirin overdose diagnosis. Aspirin interferes with oxidative
phosphorylation increasing lactate levels. Reference: Master the board
page: 604
41. bee sting treatment?

answer: - For local reactions: Provide supplemental oxygen
Diphenhydramine limits the size of the local reaction. Clean the wound
and remove the stinger if present. Apply ice or cool packs. Elevate the
extremity to limit edema. if generalized reactions developed; Treatment
should include an initial intravenous (IV) bolus of 10-20 mL/kg isotonic
crystalloids in addition to diphenhydramine and epinephrine. Reference:
http://emedicine.medscape.com/article/768764-treatment#d9
42. child ingested iron what is treatment:

Answer: - Deferoxamine is the iron-chelating agent of choice.
Deferoxamine binds absorbed iron, and the iron-deferoxamine complex
is excreted in the urine. Reference: Medscape
43. in emergency department pt come with close head truma and loss
of consciousness what is the first thing to do:
intubation and hyperventalition
asses airway
pupalliry responce
glascow coma scale
Answer: B Assess Airway. Establishing and maintaining airway patency
takes precedence over all other treatment. Reference: First Aid Step 2
page 466

44. An alcoholic comes to you with symptoms of alcohol withdrawal. Last

drink he consumed was 2 days back. What drug will you give?
a. Naloxone
b. Diazepam
c. Nicotine
d. Disulfiram
Answer : B Diazepam. Basic protocol for alcohol withdrawal treatment is
diazepam 20mg PO every 2hrs til regression of severe withdrawal
symptoms + Thiamine 100 mg IM then 100 mg PO OD for 3 days in
addition to hydration.
Reference: Toronto notes.
45. Young female stayed out in sun at 42 degree .. she came to ER

later tired.. muscle cramp.. vitally stable except T: 38 how to manage? A.
Normal sline B. Cold pack
Answer: B
Heat Stroke - Rapid reduction of the core body temperature is the
cornerstone of treatment because the duration of hyperthermia is the
primary determinant of outcome. Once heatstroke is suspected, cooling
must begin immediately and must be continued during the patient's
resuscitation.
Reference: http://emedicine.medscape.com/article/166320-treatment
46. elderly patient had motor vehicle accident, there is problem with
ventilation. what is next step:
exaggerated jaw thrust
more head tilt
intubate immediately
answer : C. Failure of ventilation is an indication for endotracheal
intubation. Reference: Medscape.
47. Dog bite infections?

Gram negative bacillus bacterua
virals
parasite
answer : A. The most common pathogens in dog bites are Pasteurella
spp. (both Pasteurella multocida and Pas-teurella canis),
Staphylococcus and Streptococcus spp., and the fastidious Gram-

negative rod Capno-cytophaga canimorsus (previously known as the

CDC and Prevention Group Dysgonic Fermenter-2).
Treatment:is amoxicillin/clavulanate plus tetanus vaccination booster if
more 5 years since last injection. Reference: Master the board.
Reference: http://www.medscape.com/viewarticle/739023_4
48. patient presented to ER with history of drug overdose and coma for
the last 8 hours on examina-tion absent gag reflex best management is :
A.iv naloxone
B.gastric lavage
C.immediate endotracheal intubation
D. charcoal
Answer: C
Airway protection – Airway protection by endotracheal intubation should
be performed early in the poi-soned patient with depressed mental
status, unless the cause is easily reversible (eg, opioid intoxication or
hypoglycemia), because of the high risk for aspiration and its associated
complications, particularly when gastric decontamination procedures
need to be undertaken
http://www.uptodate.com/contents/general-approach-to-drug-poisoning-
in-adults
49. case head trauma on parietal lobe subdural hematoma which artery
is injured?
a-superficial temporal .
b- mid cerebral
c- Rt.cerebral
answer: C
Middle cerebral artery supplies parietal lobe. however, subdural
hematomas are most commonly caused by tearing of the bridging veins
that drain from the surface of the brain to the dural sinuses. Ar-terial
rupture can also result in Subdural Hematoma and most of them were
caused by injuries to small cortical arteries. Reference:

50. Patient is eating at a restaurant with his friend; he choked with a

piece of meat, his friend who was an emergency assistant performed
Heimlich maneuver but without benefit. He then decided to perform a
tracheostomy, during tracheostomy which of the following structures will
be cut?
Cricoid cartilage
Thyroid cartilage
Cricothyroid membrane
Answer: C.
51. young man close the door on his nail color become blue under nail
what will u do ?
evacuate hematoma
remove nail
reassure
Answer: C A painless and small subungual hematoma usually requires
no treatment and its according to the nail edges status. evacuation is
indicated in the presence of a painful subungual hematoma with the nail
edges intact.
Reference: http://www.webmd.com/skin-problems-and-
treatments/bleeding-under-nail?page=2 ,
http://emedicine.medscape.com/article/82926-overview#a2
52. pt involved in MVA the impact especially in forehead examination

forehead laceration & fx ,dis-charge from nose clear positive glucose
test ( I think mean CSF leak ) Which cranial n affected :
Optic
Olfactory
Ophthalmic
Oculomotor
Answer: D
Cerebrospinal fluid rhinorrhea in the acute phase after trauma has been
reported in as many as 39% of the patients with skull base
fractures.[104] Patients present with a variety of symptoms depending
on the acuteness of the event. In the acute phase following the traumatic
event, patients may present with epistaxis, nasal discharge, periorbital
ecchymosis, chemosis, oculomotor impairment, anosmia, motor deficit,
open-head injury with CSF leakage, loss of vision, cranial nerve deficits
(most frequently, first–third and fifth–seventh cranial nerve injuries),
meningitis, and pneumocephalus Reference:
http://www.medscape.com/viewarticle/765460_3

53. What is the treatment of Aspirin toxicity?

Alkalinization of urine.
Gastric lavage.
Activated charcoal.
Answer: A. Alkalinization of urine. Reference: First Aid step 2 page 482
54. Which of the following substance ingestion is a contraindication to

gastric lavage?
Aspirin.
Benzodiazepine.
Some kind of bleach or cleaning products.
Maybe hydrocarbons.
Answer: C
Caustics ingestion (drain cleaners) is a contraindication to Gastric
lavage.
Reference: Master the board page: 602
55. child girl obese try to suicide and eat alot of drug because of her
friend, came to ER:
immediate referral to psychiatry.
treatment of acute depression.
Answer: A
• ensure patient safety: close observation, remove potentially dangerous
objects from person and room
• assess thoughts (ideation), means, action (preparatory, practice
attempts), previous attempts
• admit if there is evidence of intent and organized plan, access to lethal
means, psychiatric disorder, intoxication (suicidal ideation may resolve
with few days of abstinence)
• patient may require certification if unwilling to stay voluntarily
• do not start long-term medications in the ED
• psychiatry or Crisis Intervention Team consult

56. Pt with shock & Cherry red skin;

Bacteremia
Septicemia
Carbon monoxidemia
Answer : c
57. Old man came to ER with SOB cough, fever, what is the next step of
management
. a.Put him in negative pressure room
b.Xray
c-Antibiotics
answer: B X- Ray ,cough and fever with respiratory infection order CXR
to notes any interstitial changes .
58. Child on picnic with family, presented to the ER with high suspicion
of foreign body inhalation. The most common location in the chest will be
in?
a- Right Main Bronchus
b- Left Main Bronchus
c- Carina of Trachea
d- Inlet of Larynx
Answer: A Right Main Bronchus 52% of cases

Reference: uptodate
59.Child swallowed battery, now it is lodged in esophagus Ttt ?

a-Endoscopic removal
b-Wait ..
Answer:A Endoscopic removal
Reference: http://www.poison.org/battery/guideline
60. Man have 41 c temp with muscle spasm mangment?

a-core cooling
b- syprying warm
c- warm iv
Answer: A

61. Healthy baby was in picnic with his family .. Sudenly he get SOB
..come to ER the chest oscultation :RT wheezing in rt hemithorax, What
you will find in the CXR (foreign body),?!
RT lower consolidation
Hyperinflation with midline shift.
RT Atlectasis
ANSWER: B
Children will more often display
signs of air-trapping while adults will more often show atelectasis
80% of aspirated foreign bodies will be non-opaque on conventional
radiography
62. CPR in child according to American heart association in presence of

02 rescuer:
a.15 compression and 2 ventilation
b.30 compression and 2 ventilation
Answer : B
63. case about someone stabbed in the 4th right intercostal space, what
the structure behind it?
right horizontal fissure
right apical lung
answer : A
1) Horizontal Fissure: 4th Intercostal Space OR inferior border of 4th Rib
2) Oblique Fissure: 6th Intercostal Space OR inferior border of the 6th
Rib
Reference: https://quizlet.com/7143345/lungs-pleura-mediastinum-flash-
cards/
64. basal skull fracture cavernous sinus affected>>not sure, which

muscle is intact?
trapezius
Sternocliedmastoid
Answer: -
More often, oculomotor palsy occurs together with that of other ocular
motor nerves contained in the cavernous sinus in case of skull base
fracture.
Reference: http://medind.nic.in/icf/t07/i2/icft07i2p89.pdf

65. man make RTA he was conscious, oriented, alert , but his extremity
type of shock ?
irreversable
neuro
cardio
hemorrhagic
answer: D hemorrhagic
66. Child ate a number of iron tablets presented with severe symptoms
including constipation and bloody stool nausea and vomiting and
drowsiness how would you treat him:
IV deferoxamie.
Dialysis
Answer: A Deferoxamine is the iron-chelating agent of choice.

67. Pt with Digoxin toxicity, what will order ?

lidocaine
Fb immunoglbulin
Answer: B
Decontaminate (activated charcoal) - Digoxin-specific Ab fragments
68. ptn came to ER with multiple fracture no loss of conscious with Low
bp , tachycardia , normal RR , O2 saturation = 95% ?
IV fluid
Save airway
Answer: B
All resuscitations should be performed using Advanced Trauma Life
Support (ATLS) guidelines.For the individual physician, assessment of
the polytraumatized patient is performed using a stepwise longitudi-nal
approach, in which the airway is handled first and no procedures are
initiated until the airway is se-cured. Then, breathing and circulation are
addressed

69-Pt eat multiple drug what do (not give time)

A. Gastric leavage
B. Activite charcoal
Answer: B *in Acute situation*
70. A patient presented to ER with ingestion of multiple iron tablets.
What is your next step?
A. Induce emesis
B. Ipecac syrup
C. Gastric lavage
D. Wait and monitor
Answer: D
if asymptomatic wait 6 h then discharge
71- female with right upper abdomen pain and fever no jaundice.. what
is the
management :
Emergent surgery.
Iv fluid and antibiotics.
Discharge
Answer: B
Mild cholangitis may present with abdominal pain, jaundice, and fever.
When transporting these pa-tients to the hospital, place the patient on a
monitor and insert an intravenous (IV) line.
Provide fluid resuscitation with IV crystalloid solution (eg, 0.9% normal
saline).
Administer parenteral antibiotics empirically after blood cultures are
drawn.
Reference: Medscape
72-MTX toxicity what to give:

A- folic acid
B- folnelic acid (something like that)
C- steroid
Answer: -
73-RTA with hypovolemic shock signs , Hg low , what to give initially

A- rengar lactate
B- packed RBC
C- whole blood transfusion
Answer: A “If there is no NS in options “

74-male paient came to ER with stap wound and hypotension what is

your next step?
fresh frozen plasm
Iv ringer lactate
Packed RBC
Answer: B
2 large-bore IV lines with crystalloid infusion
If no response to 2 L of crystalloid, infuse 2–4 units packed red blood
cells:
75 pt with ECG showing bradycardia, what should you give?

A- atropine.
B- cardioversion.
answer: A
(check the ACLS Algorithm) .
76.long case about adult come to er complaing of diarrhea , have

weekness in body and fatigue , sud-denly he fall down , BP when he
come was 120 / 80 Now it is 90 / 60 , What is the cause ?
A- Extracelular voluim loss
B- Intracellular fluid loss !?
C- Intracellular glocse loss
Answer: A
Reference: http://chemistry.elmhurst.edu/vchembook/255fluiddeficit.html
77.Why we use CT scan in trauma pt ?

a. Can detect retropretoinum hemorrhage
b. You can see the hemorrhage with contrast
Answer: A
CT scans of the abdomen and pelvis usually are performed together,
using both IV and oral contrast. Use this study to identify injuries to
abdominal and pelvic organs and to identify bleeding in the retroperito-
neum and pelvis
Reference: Medscape

78. boy play basket ball he came with abdominal pain without any injury
in match physical exam was tenderness in paramblicus what you next :
a. Chest xray
b .abdominal CT
c. 24 recheck
d. kidney US
Answer: C
Exercise Related Transient Abdominal Pain
1. Diagnosis based
primarily on hx Transient abdominal pain during exercise - relieved
w/cessation of activity
Pain described as well localized, commonly in lumbar region of
abdomen Usually on right side
2. Physical exam: Normal abdominal exam
Abnormal abdominal exam suggests different etiology of pain during
exercise
3. Diagnostic testing :
None recommended unless physical exam or hx suggests etiology other
than ETAP
Reference:
https://mospace.umsystem.edu/xmlui/bitstream/handle/10355/13721/Ex
erciseRelated-TransientAbdominalPain.pdf?sequence=1
79.-Pt came to ER , airway pt gasping ,, u gave 2 breath by mask , pulse

is rapid & wee What to do?!
Waiting code team
Put pt in recovery position
Do CPR
intubation
Answer: C
80.Dm pt e - DKA what to give?

1 L of normal saline
Dextrose 50% followed by insulin
Answer: A
104- Comatosed patient with respiratory depression and pinpointed
pupil, drug abuse suspected what is the cause ?
Cocaine
Opiates
answer: B

81 post RTA in ICU presnt with significant blood losse Hypotension Now
in Multi Organ failure what Is the most Organ causing other organ failure
?
heart
lung
kidney
liver
Answer:
82. Present to ER with severe headache and LP showed blood :

ruptured berry aneurysm,
epidural hematoma
Answer: A
Reference: Medscape * subarachnoid hemorrhage *
83. Pt. Overdosed a medication and presented Comatose, dilated pupil,

hyperreflexia, what is the meds:
Erdophnium
SSRI
TCA
answer: B
84. Drug addicted .. Unconsious Came with no gag reflex, What would
you do?
Intubation
Gastric lavage
give nalexone
answer: A
Airway protection by endotracheal intubation should be performed early
in the poisoned patient with depressed mental status, unless the cause
is easily reversible (eg, opioid intoxication or hypoglycemia), because of
the high risk for aspiration and its associated complications, particularly
when gastric decon-tamination procedures need to be undertaken
http://www.uptodate.com/contents/general-approach-to-drug-poisoning-
in-adults

85-RTA pt came to ER after 30 mins o/e chest there's sound bilateral +

distended neck, Dx?!
A- Hemothorax
B- Pneumothorax
C- Cardiac tamponade
Answer: C
86-MI patient presented to ER after resuscitation he developed coma

and then died, what postmor-tem change you will find:
A- interventricular hemorrhage
B- brown coloured area supplied by middle menengieal artey
Answer: -
O n completion of the staining the infracted myocardium will show up as
pale pink colored area as against the bright red colored normal
myocardium. Even old infarcts and scars get delineated. In ab-sence of
infarction, both the surface of the slice will show uniform bright red
coloration
87-Road accedint presented with paralsis of 4 limb and extremity pink

and hot what is the type of shock?
Irreversable
Nurogenic
Hypotensive
Answer: B
88. girl come to ER complaing of RT hypochondrial pain , vomiting ,

fever with similer attacks Before On examination splenomegaly and Mild
jaundice US show gallstones...your dx?
thalacemia
SCA
answer: -
Both are right , Reference: Introduction To Pathology For The Physical
Therapist Assistant
89. drug .. Came with eye dilatation What does he takes:

TCA.
Organophosphorus .
Answer:A

90-A 6-year-old girl, brought by parents to ER with history of falling from

height...
Not talking but crying, withdrawal from pain, open her eye only in
response to Doctor talking…,Calcu-late GCS.
9
10
11
12
Answer: B
91-Male with abdominal stab wound, vital signs ( hypotension,

tachycardia) ,What to give him first:
A. Ringer lactate
B. Fresh frozen plasma
C. Whole blood
D. Packed RBCs
Answer: A
92. 5 year old with blunt abdominal trauma, Upper GI series showed coil
spin in 2nd 3rd duodenal and high amylase, How to manage:
aparotomy and hematoma evacuation
gastroenterostomy
bowel rest
CT guided needle for hematoma extraction
Answer: C *Not sure*
93-Pts playing tennis, something bites him (birds I think) after few
minutes he has respiratory dis-tress and he was collapsed what is the
immediate tratment for this patient?
Antihistamine
Epinephrine
Answer: B
Anaphylaxis
94. Case scenario about patient who had injury in his right knee, the
doctor applied a valgus stress to examine which ligament:
A. Anterior cruciate ligament
B. Posterior cruciate ligament
C. Fibular collateral
D. Tibial collateral
Answer: D
medial collateral (tibial collateral) ligament
95- ptn came to ER with multiple fracture no loss of conscious with Low
bp , tachycardia , normal RR , O2 saturation = 95% ?
IV fluid
Save airway
answer: B
All resuscitations should be performed using Advanced Trauma Life
Support (ATLS) guidelines.For the individual physician, assessment of
the polytraumatized patient is performed using a stepwise longitudi-nal
approach, in which the airway is handled first and no procedures are
initiated until the airway is se-cured. Then, breathing and circulation are
addressed
96. Why CT is best in blunt trauma

is best in unstable patient
Better to detect on retero-peritoneum bleeding
answer: B
CT scans of the abdomen and pelvis usually are performed together,
using both IV and oral contrast. Use this study to identify injuries to
abdominal and pelvic organs and to identify bleeding in the retroperito-
neum and pelvis
Reference: Medscape
97.patient come to ER unconscious :

check pulse
examine pupils
IV fluid infusion
clear airway
Answer: D
98. MVA with weak heart sounds and silent right side of the chest, dis-
tended neck veins, next?
Needle decompression
cardiac window
Pericardiocentesis
answer: A

99. MVA victim presented to ER with hypotension, given crystolloid his

BP return to normal, and chest tube was inserted. what to do next?
Re-examine the chest
ABG
Answer: A
100.The fastest way to clean child stomach with iron over dose after 4
hours?
gastric lavage
serup something
enema something
other option .
Answer: - Deferoxamine is the iron-chelating agent of choice.
101- a case of heat stroke?

warm
fluid
core
cooling whole body
electrolytes replacement
Answer : D
Heatstroke is a medical emergency and continues to be one of the
leading causes of preventable death in sports.[4] Rapid reduction of the
core body temperature is the cornerstone of treatment because the
duration of hyperthermia is the primary
determinant of outcome.
Reference: medscape
102-The effectiveness of ventilation during CPR measured by:

a. Chest rise
b. Pulse oximetry
c. Pulse acceleration
Answer: A

103-Trauma Or depressed skull fracture what immediate thing to do

(ER) Intubate O2 supplement* IV fluid Answer: A
Management
- ABCs
- ensure oxygen delivery to brain through intubation and prevent
hypercarbia
- maintain BP (sBP >90)
- treat other injuries
• early neurosurgical consultation for acute and subsequent patient
management
Reference: Toronto notes.
104 A lady brought to you after she ingested high dose of

paracetamol tablets 8 hours back, Rx:
a. N-acytylcystine
105.. Baby brought to you after he ingested drug tablets from his
relative's house, initial management:
a. gastric lavage
b. charcoal
106. A child swallowed his relative's medication. What is the best

way of gastric decontamination?
a. Gastric lavage
b. Total bowel irrigation (whole bowel wash)
c. Syrup ipecac
d. Activated charcoal
107 A child was brought by his mother due to bleeding per nose; by
examination you found many bruises in his body, over his back,
abdomen and thigh, what is your diagnosis:
a. Child abuse
108. A patient comes with metabolic acidosis, an overdose with

which of the following drugs will cause such an abnormality?
a. Salicylate
Other drugs include: ethanol, isoniazid, iron, metformin, and
acetazolamide.
109. Burn involved 3 layers of the skin called:

a. Partial thickness
b. Full thickness
c. Superficial
d. Deep
110. Cherry red skin found in:
a. Polycythema
b. CO poisoning
111. Most serious symptom of CO poisoning is:

a. Hypotension
b. Arrhythmia??
c. Cyanosis
d. Seizure
112. A patient presented to the ER with diarrhea, nausea, vomiting,

salivation, lacrimation and abdominal cramps. What do you
suspect?
a. Organophosphate poisoning
113. Patient developed lightheadedness and SOB after bee sting.

You should treat him with the following:
a. Epinephrine injection, antihistamine and IV fluid
b. Antihistamine alone
114. Patient present with high blood pressure (systolic 200),

tachycardia, mydriasis, and sweating. What is the toxicity?
a. Anticholinergic
b. Sympathomimetic
c. Tricyclic antidepressant
d. Organophosphorous compounds
(a) causes dry skin, (c) causes hypotension, and (d) causes miosis.

115. Female after sexual attack on exam hymen tear in

a. a-2 o'clock
b. b-4
c. c-6
d. d-8
Most likely answers, I am not sure 100 %.
116. Using gastric lavage

a. Useless after 8 hours of ASA ingestion
b. No benefit after 6 hours of TCA ingestion
c. Patient should be in the right lateral position
117. Massive overdose of aspirin 50 tabs 6 hours before, asking for

the best management:
a. Urine alkalization and dialysis
118.. What is the metabolic disturbance seen with aspirin toxicity?

a. Respiratory alkalosis with metabolic acidosis
119 Opioids antidote:

a. Naloxone
120. In battered women which is true:

a. Mostly they come from poor socioeconomic area
b. Usually they marry a second violent man
c. Mostly they come to the E/R c/o from other symptoms?
d. Mostly they think that the husband responds like this because
they still have strong feeling for them
121. After accident patient with tachycardia, hypotension, what

will be your initial step:
a. Rapid IVF crystalloid
b. CT

122. A patient with mushroom toxicity will present with

a. Constipation
b. Hallucination
c. Anhydrosis
123. Child ate overdose of iron, best immediate management

a. Gastric lavage
b. Induce vomiting manually
c. Emetic drugs
d. Ipecac
e. Activated charcoal
124. . An alcoholic patient complains of headache, dilated pupil

hyperactivity, agitation. He had history of alcohol withdrawal
last weak so ttt is
a. a-diazepam
b. b-naxtrol
c. c-haloperidol
d. d?????????
125. A child came to ER with fever, stridor, x-ray showed swollen

epiglottis, in addition to oxygen, what u will do?
a. Throat examination.
b. An emergency tracheostomy.
c. Endotracheal intubation.
d. Nasopharyngeal intubation.
126. Arterial injury is characterized by :

a. Dark in color and steady .
b. Dark in color and spurting .
c. Bright red and steady .
d. Bright red and spurting .
127. The most common cause of death on site in a burn patient is?
a. Inhalational injury.

128. A burn patient is treated with Silver Sulfadiazine, the toxicity

of this drug can cause:
a. Leukocytosis
b. Neutropenia
c. Electrolyte disturbance
d. Hypokalemia
129.. Charcoal doesn't bind to the following toxins except:

a. CN
b. ETOH
c. Lithium
d. Cocaine
e. Chloral hydrate
It doesn’t bind to CN, ETOH, or Lithium. However, it binds to both
cocaine and chloral hydrate.
130.. All the followings are expected with IV NAC except:

a. Anaphylactoid reaction
b. Hyponatremia
c. Higher portal vein concentration than PO NAC
d. Fetal toxicity
e. Hyperglycemia
131. In corrosive injury, all are true except:

a. Acids cause coagulant necrosis
b. Alkali cause liquefactive necrosis
c. Acids don’t penetrate deeply
d. Hydrofluoric acid causes coagulative necrosis
e. Alkali injury is more serious
132. All are criteria for a toxin to be dialyzable except:

a. Low VD
b. Low protein binding
c. Low molecular weight
d. Low endogenous clearance
e. Low H2O solubility

133. All are dialyzable toxins except:

a. Methanol
b. Lithium
c. ASA
d. ETOH
e. Amitriptyline
134. Regarding button battery; all are true except:

a. High risk for lead/ mercury toxicity
b. Can lead to nasal septal perforation
c. Can be treated conservatively if passed Gastroesophageal
junction
d. Endoscopy should be done A.S.A.P if lodged in the esophagus.
135. All the followings indicate poisonous snakes except:

a. Heat-Sensitive pits
b. Red on yellow strips
c. Anterior fangs
d. Elliptical pupil
e. Triangular head
All of the characters mentioned indicate poisonous snakes (red-black
strips indicate non-poisonous).
136. Saline diuresis increases clearance of all these toxins except:
a. Lithium X
b. ASA
c. Iodide
d. Meprobamate X
e. Cyclophosphamide
137. Alkaline diuresis increases clearance of all the following

toxins except:
a. ASA
b. Fluoride
c. Phenobarbital
d. TCA
e. Chlorpropamide

138. All are hepatotoxins except:

a. ETOH
b. CCL4
c. Jimson weed
d. APAP
e. Amanita phalloides
?? All are considered toxic to the liver
139. Regarding use of Atropine in Organophosphate OD, all are

true except:
a. The goal is to restore muscle activity
b. Binds to muscarinic receptors
c. Can cause CNS agitation
d. The end point is to dry all secretions
e. No maximum dose
140. All the following are indications for IV NAC in chronic APAP
OD except:
a. APAP Level › 10
b. › 7.5g in 24h in adult
c. › 100 mg/kg in 24h in healthy kids
d. APAP Level ‹ 10 + normal AST + RUQ pain/vomiting
e. APAP Level ‹ 10 + AST X2
It should be > 150 mg/kg in children.
141.. All could be life -threatening envenomations except:

a. Bees
b. Fire ants
c. Scorpions
d. Brown recluse spider
e. Black widow spider
142 .All are accepted mechanisms of CO toxicity except:

a. Cytochrome oxidase inhibition
b. Lipid peroxidation
c. Binding to cardiac myoglobin
d. Uncoupler
e. Binding to skeletal myoglobin

143. What OD mimics Organophosphate OD:

a. Theophylline
b. Caffeine
c. Nicotine
d. Cocaine
e. TCA
144. Human bite to the hand greatest risk of infection in which

position?
a. dependent
b. clenched
c. finger extended
145. Cat bites
Mostly occur in the upper limb, and usually result in puncture wound,
thus they are very difficult to evaluate and result in higher rate of
infection than dog bites. Cat scratch disease (by Bartonella henselae) is
a possible complication of cat bites.
146. 30 year old psychiatric patient presented to ER after 5 hours

of ingestion of two safety pins, X-Ray shown it in small bowel,
What I your action:
a. Admit for surgery
b. Discharge if he is stable
c. Admit for repetitive X-Ray and abdominal exam
d. Give him tetanus toxoid
147. Which organ is affected in ingestion of overdose of

acetaminophen?
a. Liver
b. Kidney
c. Intestine
d. Stomach
148. Long scenario for a pt came to ER after RTA, splenic rupture

was clear, accurate sentence describe long term management:
Pneumococcal and meningococcal vaccines are required for capsulated
organisms.

149. A child swallowed a battery that is shown to be in the

esophagus, what is next step?
a. a-observe for 12 hrs
b. b-surgical removal
c. c-use foley catheter to remove
d. d- remove by endoscope
150. Young aged male presented to ER after blunt trauma to

Abdomen, CT scan shows intramural hematoma, your
management is?
a. Lapratomy with evacuation of the hematoma
b. Dissection of duodenum
c. Observation
151. The CPR for child is

a. 30 chest compression-2 ventilation (1-rescuer)
b. 15 chest compressions-2 ventilation (2-rescuers)
c. 15 chest compression 1 ventilation
152. Child over-consumed a prescribed nutritional supplement

and developed abdominal pain, black vomiting, and diarrhea.
What is it?
a. Iron
b. Multivitamins
153. A child came to the ER after ingestion of multiple iron tablet

of his relative & iron concentration in his blood is 700ml what is
the best intervention
a. Gastric lavage
b. Charcoal oil
c. IV deferoxamine
154.. Patient complaining of torso pain after using tan bed, on

examination skin on the chest was red, reblenchable and
painful:
a. 1st degree burn
b. 2nd degree burn
c. 3rd degree burn
155.. Which of the following is contraindication for nasogastric

lavage:
a. quinine
b. erosive material
156. A patient with mixed 1st & 2nd degree burns in head & neck
region, what is the most appropriate management?
a. Apply silver sulfadiazine and cream to all burned areas, cover
them and admit to hospital
b. Apply cream to 2nd degree burns and cover them, give IV fluids
c. Debridement of 2nd degree burns and …
d. Apply silver sulfadiazine then Vaseline ointment to all areas then
discharge the patient
As long as the face is involved the patient should be admitted.
157. Patient with lacrimation, salivation, diarrhea, what is the

antidote:
a. Atropine
55. Organophosphorus poisoning, what is the antidote?
a. Atropine
b. Physostigmine
c. Neostigmine
d. Pilocarpine
e. Endrophonium
158. Besides IV fluids, what is the most important drug to be given

in anaphylaxis?
a. Epinephrine
b. Steroids
c. ??? Other choices
159 About head & neck injury, which is true?

a. Hoarsness of voice & Stridor can occur with midfacial injury
b. Upper airway injury commonly occurs with midfacial injury
c. Tracheostomy is contraindicated

160. A patient presented to the ER after a cat bite with greenish

discharge which organism:
a. staph aureus
b. pseudomonas aurgenosa
c. bacteriodes
d. strept. Viridans
161. pt come in emergency with complaint of HCL burn on her,

the skin of the pt is burnt, now emergency treatment is
a. NAHCO3
b. DEBRIDGEMENT
c. WATER IRRIGATION
d. ???
162. pt come in emergency with frozen foot, FIRST AID treatment

is
a. HEAT AND WARM AIR
b. IN WARM WATER
c. GIVE COFFE AND TEA
d. RUBBING THE FOOT
163. A child took an unknown medicine and presented in the

emergency with decreased level of consciousness, pinpoint
pupil, urination, diarrhea, diaphoresis, lacrimation, excitation,
and salivation. The treatment is
a. gastric lavage
b. activated charcoal
c. atropine
d. naloxone
164.. A young fireman come to ER complain of headache and

dizziness after some activity (they mention something I couldn’t
remember) ABG show, normal partial pressure of oxygen what is
the first step in this patient?
a. O2 therapy
b. C-xray
c. Caboxyhemoglobin level
d. Anemia evaluation
Query CO poisoning CO levels must be checked to guide our
management.
165. Which role used to calculate burn surface area in case of

burn:
a. Nine
b. Seven
166. pt came to ER decreased level of consciousness and pinpoint

pupil?
a. opiate over dose
167. A baby fell down from stairs and came with multiple
contusions some of them were old and X-ray show fracture in
radius how to manage?
a. Splinter for his hand
b. Hospitalization and call social worker


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EMERGENCY MEDICINE PAPER UPDATED VERSION TILL NOVEMER 2016

I have compiled this MCQs file on EMERGENCY MEDICINE from

Wish you all the best for Exams

Dr. Imran Asghar

DR. IMRAN ASGHAR November 28, 2016

1.Patient ingested 20 gram of acetaminophen 8 hours ago, what is your

2.Patient ate from a restaurant. 2 days after that started to complain of

3. A patient comes to the emergency with sudden dypsnea. X ray picture

5. A guy presents in emergency with decreased oxygen carrying

DR. IMRAN ASGHAR November 28, 2016

7. Soldier tries to have an excuse from the military, presented to the ER

8. Acute attack of cluster headache, what is the abortive treatment?

9. Semiconscious polytrauma patient, has difficulty breathing on bag

10. A patient ate a wild mushroom. Which of the following will be

DR. IMRAN ASGHAR November 28, 2016

11. Post-traumatic amnesia, vitally stable but he’s complaining of pain in

12. 4 members in the family developed nausea and diarrhea 8 hours

13. Aspirin toxicity resulting in which of the following?

14. Which of the following babies needs immediate action?

DR. IMRAN ASGHAR November 28, 2016

15. Male patient presented to the ER after MVA, he has tachycardia,

17. Unconscious pt after ingestion of overdose sleep pills, breathing

may require sedation and/or paralysis with mechanical venti-lation to

19.anterior abdominal stab wound omuntam come through the wound ?

DR. IMRAN ASGHAR November 28, 2016

Indications for intubation: 1) inadequate oxygenation 2) inadequate

21.Pt work outdoor in temp 42 c .. Tired and Complain of crampy

22.Patient is bleeding the baro receptor activated result in increased

DR. IMRAN ASGHAR November 28, 2016

25.Pt conscious with multiple injuries. How do you maintain airway?

26.Depressed pt with HTN Brought by family to ER for drug overdose

27.Old pt with high cholesterol level measured before 4 months and he

DR. IMRAN ASGHAR November 28, 2016

28.gunshot with wound bowel perforation. What antibiotics you should

31.Patient had bee sting on the hand yesterday, he is presenting to you

32.Patient had bee sting and presented to you immediately with

DR. IMRAN ASGHAR November 28, 2016

Presentation within 3-4.5 h and no contraindication to thrombolysis →

34.Unconscious patient after RTA .. Ventilation with bag mask was

DR. IMRAN ASGHAR November 28, 2016

38. Child with traumatic injury to elbow. X-ray will show?

39. Pt brought to ER with multiple injuries in head . Chest , abdomen ,

DR. IMRAN ASGHAR November 28, 2016

41. bee sting treatment?

42. child ingested iron what is treatment:

DR. IMRAN ASGHAR November 28, 2016

44. An alcoholic comes to you with symptoms of alcohol withdrawal. Last

45. Young female stayed out in sun at 42 degree .. she came to ER

47. Dog bite infections?

DR. IMRAN ASGHAR November 28, 2016

negative rod Capno-cytophaga canimorsus (previously known as the

DR. IMRAN ASGHAR November 28, 2016

50. Patient is eating at a restaurant with his friend; he choked with a

52. pt involved in MVA the impact especially in forehead examination

DR. IMRAN ASGHAR November 28, 2016

53. What is the treatment of Aspirin toxicity?

54. Which of the following substance ingestion is a contraindication to

DR. IMRAN ASGHAR November 28, 2016

56. Pt with shock & Cherry red skin;

Answer: A Right Main Bronchus 52% of cases