NCCPA CAQ Emergency Medicine

A 58-year-old man presents with crushing substernal chest pain for 45 minutes. ECG shows 3 mm ST elevation in leads II, III, and aVF. The hospital has 24/7 PCI capability. What is the maximum acceptable door-to-balloon time?

• A30 minutes
• B60 minutes
• C90 minutes
• D120 minutes

A 62-year-old woman presents to a non-PCI capable hospital with anterior STEMI. The nearest PCI center is 3 hours away. What is the most appropriate management?

• AAdminister fibrinolytics within 30 minutes
• BTransfer immediately without intervention
• CAdmit for medical management only
• DWait to confirm with troponin before treatment

A 55-year-old man with chest pain has a HEART score of 3. Initial high-sensitivity troponin is below the 99th percentile. What is the most appropriate disposition?

• AAdmit to telemetry
• BDischarge with outpatient stress test
• CCardiac catheterization
• DObservation with serial troponins

A 70-year-old presents with NSTEMI. Which finding most strongly supports an early invasive strategy (within 24 hours)?

• AGRACE score >140
• BSingle elevated troponin
• CAge greater than 65
• DPrior MI history

A 67-year-old with acute decompensated heart failure has BP 90/60, cool extremities, and lactate 4.5. What is the most appropriate initial therapy?

• AAggressive IV fluid bolus
• BInotropic support with dobutamine
• CHigh-dose IV furosemide
• DBeta-blocker initiation

A patient with new-onset atrial fibrillation has heart rate 165, BP 80/50, and altered mental status. What is the most appropriate immediate management?

• AIV diltiazem
• BIV metoprolol
• CSynchronized cardioversion
• DAdenosine 6 mg IV

A 45-year-old with palpitations has a regular narrow-complex tachycardia at 180 bpm, BP 120/70. Vagal maneuvers fail. What is next?

• ASynchronized cardioversion
• BAdenosine 6 mg rapid IV push
• CAmiodarone 150 mg
• DDiltiazem 0.25 mg/kg

Which ECG finding is most consistent with acute pericarditis?

• AST elevation in a single coronary distribution
• BDiffuse ST elevation with PR depression
• CT wave inversions in V1-V4
• DQ waves in inferior leads

A 75-year-old with sudden severe tearing chest pain radiating to the back has BP 200/110 in the right arm and 160/90 in the left. What is the diagnostic test of choice?

• ACT angiography of chest
• BTransthoracic echocardiogram
• CD-dimer
• DCardiac catheterization

A patient with type A aortic dissection requires what initial management?

• AIV beta-blocker to target HR <60 and SBP <120
• BImmediate thrombolytics
• CIV nitroprusside alone
• DAntiplatelet therapy

A patient develops Vfib arrest. After 2 minutes of CPR and one shock, rhythm remains Vfib. What medication is given next?

• AAmiodarone 300 mg IV
• BEpinephrine 1 mg IV
• CLidocaine 1 mg/kg
• DMagnesium 2 g IV

Which troponin pattern best supports acute myocardial infarction using high-sensitivity assay?

• ASingle value above 99th percentile
• BStable elevation over 6 hours
• CRise and fall pattern with at least one value above 99th percentile
• DIsolated elevation with normal ECG

A patient with inferior STEMI develops hypotension after sublingual nitroglycerin. What is the most likely cause?

• AAnaphylaxis
• BRight ventricular infarction
• CAortic dissection
• DCardiac tamponade

A patient with chest pain has ECG showing Wellens syndrome (deep T wave inversions in V2-V3). What does this indicate?

• AAcute STEMI
• BCritical proximal LAD stenosis
• CPericarditis
• DPulmonary embolism

What is the most appropriate initial treatment for a patient with acute pulmonary edema, BP 180/110, and oxygen saturation 88% on room air?

• AIV furosemide and bolus normal saline
• BNoninvasive positive pressure ventilation, IV nitroglycerin, IV furosemide
• CIntubation and mechanical ventilation
• DIV beta-blocker

According to Surviving Sepsis 2021, which interventions must occur within the first hour for septic shock?

• ALactate, blood cultures, broad-spectrum antibiotics, 30 mL/kg crystalloid, vasopressors i…
• BAntibiotics within 6 hours and fluid resuscitation
• CBlood cultures only
• DNorepinephrine before any fluid

What is the first-line vasopressor for septic shock?

• ADopamine
• BPhenylephrine
• CNorepinephrine
• DVasopressin

A patient in septic shock receives 30 mL/kg crystalloid, but MAP remains 55. Norepinephrine is started at 20 mcg/min. Lactate is 6. What is the next best step?

• AAdd vasopressin 0.03 units/min
• BIncrease crystalloid bolus to another 30 mL/kg
• CStart dobutamine immediately
• DStop norepinephrine and start phenylephrine

What lactate threshold defines tissue hypoperfusion meriting aggressive resuscitation per Surviving Sepsis?

• A≥1 mmol/L
• B≥2 mmol/L
• C≥4 mmol/L
• D≥6 mmol/L

A patient has BP 75/40, JVD, distant heart sounds, and pulsus paradoxus. What is the immediate intervention?

• AIV fluid bolus
• BPericardiocentesis
• CFurosemide
• DBeta-blocker

In anaphylactic shock, what is the first-line medication and route?

• ADiphenhydramine 50 mg IV
• BMethylprednisolone 125 mg IV
• CEpinephrine 0.3-0.5 mg IM in lateral thigh
• DAlbuterol nebulizer

During post-cardiac arrest care after ROSC, what is the recommended targeted temperature range?

• A32-34°C
• B33-36°C
• C36-37°C
• DNormothermia only

Which finding distinguishes neurogenic shock from hypovolemic shock?

• AHypotension
• BTachycardia
• CBradycardia
• DCool extremities

A trauma patient is hypotensive with muffled heart sounds and JVD. FAST shows pericardial fluid. What is the most appropriate next step?

• AEmergency thoracotomy or pericardial window
• BCT chest
• CObservation and serial echo
• DIV beta-blocker

What is the recommended initial fluid for septic resuscitation?

• A0.45% saline
• BBalanced crystalloid (LR or Plasma-Lyte)
• C5% dextrose
• DHydroxyethyl starch

A burn patient has 30% TBSA partial thickness burns. Using Parkland formula, what is the 24-hour fluid requirement for an 80 kg patient?

• A4,800 mL
• B9,600 mL
• C12,000 mL
• D19,200 mL

What is the appropriate ratio for massive transfusion protocol?

• A1:1:1 (PRBC:FFP:platelets)
• B2:1:1
• C4:1:1
• DPRBCs only

In ATLS primary survey, which represents the correct order?

• AAirway, Breathing, Circulation, Disability, Exposure
• BBreathing, Airway, Circulation, Disability, Exposure
• CCirculation, Airway, Breathing, Disability, Exposure
• DDisability, Airway, Breathing, Circulation, Exposure

A trauma patient has SBP 75 from suspected hemorrhage. What is the recommended permissive hypotension target before definitive hemorrhage control (no head injury)?

• ASBP 80-90 mmHg
• BSBP 100-110 mmHg
• CSBP 120-130 mmHg
• DMAP >85 mmHg

What is the time window for tranexamic acid (TXA) in trauma?

• AWithin 1 hour
• BWithin 3 hours
• CWithin 6 hours
• DWithin 24 hours

A trauma patient has unstable pelvic fracture with hypotension. What is the immediate intervention?

• AExternal pelvic binder
• BOpen surgical repair
• CCT scan first
• DFoley catheter

What is the most sensitive FAST exam window for detecting hemoperitoneum?

• APericardial
• BRight upper quadrant (Morison's pouch)
• CLeft upper quadrant
• DPelvic

A patient with blunt chest trauma has decreased breath sounds, hyperresonance, and tracheal deviation away from the affected side. What is the immediate management?

• ACT chest
• BChest x-ray
• CNeedle decompression at 2nd intercostal space midclavicular line
• DTube thoracostomy after CT

What is the threshold for tube thoracostomy output that warrants thoracotomy after blunt chest trauma?

• A500 mL initial or 100 mL/hr
• B1500 mL initial or 200 mL/hr for 4 hours
• C2500 mL initial
• DAny blood output

A patient with penetrating abdominal trauma has hemodynamic instability. What is the appropriate management?

• AImmediate exploratory laparotomy
• BCT abdomen first
• CDiagnostic peritoneal lavage
• DObservation

Which Glasgow Coma Scale score defines severe traumatic brain injury?

• A≤8
• B9-12
• C13-15
• D≤12

A patient with severe TBI develops Cushing's reflex (hypertension, bradycardia, irregular respirations). What does this indicate?

• AAdequate cerebral perfusion
• BImpending herniation
• CSpinal shock
• DHypovolemia

What is the target cerebral perfusion pressure (CPP) in TBI?

• A>30 mmHg
• B60-70 mmHg
• C>90 mmHg
• D>120 mmHg

Which Canadian Head CT rule criterion mandates CT in mild TBI?

• AAny LOC
• BHeadache only
• CGCS <15 at 2 hours post injury
• DAge >40

A patient is found with acetaminophen ingestion 6 hours ago. Level is plotted above the treatment line on Rumack-Matthew nomogram. What is the antidote?

• AN-acetylcysteine
• BActivated charcoal only
• CNaloxone
• DFlumazenil

A patient with TCA overdose has ECG showing QRS 130 ms. What is the appropriate treatment?

• AIV sodium bicarbonate
• BIV magnesium
• CIV calcium chloride
• DSynchronized cardioversion

What is the indication for hyperbaric oxygen therapy in carbon monoxide poisoning?

• AAny elevated COHb
• BCOHb >25%, pregnancy, altered mental status, cardiac ischemia, or syncope
• CCOHb >5%
• DHeadache only

A patient is found unresponsive with pinpoint pupils, RR 6, and track marks. What is the initial treatment?

• ANaloxone 0.4 mg IV/IM/IN
• BActivated charcoal
• CFlumazenil
• DGlucose IV

A patient with salicylate overdose has pH 7.30, salicylate 80 mg/dL, and altered mental status. What is the most appropriate treatment?

• AHemodialysis
• BActivated charcoal alone
• CSodium bicarbonate alone
• DObservation

A patient with beta-blocker overdose has HR 35, BP 70/40, unresponsive to atropine. What is next?

• AGlucagon 5-10 mg IV
• BPhenylephrine
• CNaloxone
• DNorepinephrine alone

Cyanide poisoning from smoke inhalation is best treated with:

• AHydroxocobalamin
• BMethylene blue
• CAtropine
• DNaloxone

What is the antidote for digoxin toxicity with hyperkalemia and ventricular arrhythmia?

• ADigoxin-specific Fab fragments (Digibind)
• BCalcium gluconate
• CAtropine
• DLidocaine