ABEM Cardiovascular & Respiratory Emergencies 2 — Questions and Answers
Question 1: A 58-year-old male presents with acute onset tearing chest pain radiating to the back, BP 180/100 in the right arm and 140/85 in the left arm. The most likely diagnosis is:
- STEMI
- Aortic dissection (Correct answer)
- Pulmonary embolism
- Esophageal rupture
Correct answer: Aortic dissection
Aortic dissection classically presents with tearing back pain and a blood pressure differential >20 mmHg between arms.
Question 2: Which of the following ECG findings is MOST specific for right heart strain in pulmonary embolism?
- ST depression in V1-V4
- S1Q3T3 pattern (Correct answer)
- Left bundle branch block
- Diffuse ST elevation
Correct answer: S1Q3T3 pattern
The S1Q3T3 pattern (S wave in lead I, Q wave and T-wave inversion in lead III) is the classic but not sensitive ECG finding in PE suggesting right heart strain.
Question 3: A patient with known COPD presents with acute exacerbation. SpO2 is 82%. What is the target oxygen saturation range for this patient?
- 98-100%
- 94-98%
- 88-92% (Correct answer)
- 80-85%
Correct answer: 88-92%
In COPD patients with chronic hypercapnia, target SpO2 is 88-92% to avoid suppressing the hypoxic drive and worsening hypercapnia.
Question 4: A 45-year-old woman presents with sudden syncope. ECG shows a prolonged QTc of 520ms and polymorphic VT. The first-line treatment is:
- Amiodarone IV
- Magnesium sulfate IV (Correct answer)
- Lidocaine IV
- Synchronized cardioversion
Correct answer: Magnesium sulfate IV
Torsades de pointes (polymorphic VT with prolonged QT) is treated first with IV magnesium sulfate 1-2g regardless of serum magnesium level.
Question 5: In cardiac tamponade, Beck's triad includes hypotension, muffled heart sounds, and:
- Bradycardia
- Pulsus alternans
- Jugular venous distension (Correct answer)
- Tracheal deviation
Correct answer: Jugular venous distension
Beck's triad consists of hypotension, muffled heart sounds, and jugular venous distension (JVD) due to impaired cardiac filling.
Question 6: A 70-year-old diabetic male presents with 2 hours of vague epigastric discomfort and diaphoresis. ECG shows new ST elevation in leads II, III, and aVF. The culprit artery is most likely:
- Left anterior descending
- Left circumflex
- Right coronary artery (Correct answer)
- Left main coronary
Correct answer: Right coronary artery
ST elevation in inferior leads II, III, and aVF indicates inferior STEMI, most commonly caused by right coronary artery (RCA) occlusion.
Question 7: Which finding on bedside ultrasound is MOST diagnostic of pneumothorax?
- B-lines bilaterally
- Absence of lung sliding with A-lines (Correct answer)
- Hepatization of lung tissue
- Mirror image artifact
Correct answer: Absence of lung sliding with A-lines
Absence of lung sliding combined with A-lines (and a lung point) on ultrasound is highly sensitive and specific for pneumothorax.
ABEM Cardiovascular & Respiratory Emergencies 2
A 58-year-old male presents with acute onset tearing chest pain radiating to the back, BP 180/100 in the right arm and 140/85 in the left arm.
The most likely diagnosis is: