ABEM Cardiovascular & Respiratory Emergencies 3 — Questions and Answers
Question 1: A 55-year-old man with hypertension presents with acute pulmonary edema. His BP is 220/130 mmHg. Which vasodilator acts primarily as a venodilator to rapidly reduce preload?
- Hydralazine
- Nitroglycerin (Correct answer)
- Nicardipine
- Labetalol
Correct answer: Nitroglycerin
Nitroglycerin at low doses acts primarily as a venodilator, rapidly reducing preload and relieving acute pulmonary congestion.
Question 2: Which of the following is the MOST common cause of massive hemoptysis requiring emergency intervention?
- Pulmonary embolism
- Bronchogenic carcinoma
- Bronchiectasis (Correct answer)
- Goodpasture syndrome
Correct answer: Bronchiectasis
Bronchiectasis is the most common cause of massive hemoptysis due to hypertrophied bronchial arteries and recurrent infections.
Question 3: A patient presents in wide-complex tachycardia at 180 bpm, is hemodynamically stable. The rhythm is regular and the QRS morphology is LBBB pattern. The SAFEST initial pharmacologic treatment is:
- Verapamil
- Adenosine
- Procainamide (Correct answer)
- Metoprolol
Correct answer: Procainamide
Procainamide is the preferred agent for stable wide-complex tachycardia of uncertain origin; verapamil and other AV nodal blockers can cause deterioration in VT.
Question 4: In a patient with suspected tension pneumothorax, what is the IMMEDIATE management?
- Obtain chest X-ray first
- Needle decompression at 2nd ICS midclavicular line (Correct answer)
- Chest CT scan
- Intubate and ventilate
Correct answer: Needle decompression at 2nd ICS midclavicular line
Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression without waiting for imaging to prevent cardiac arrest.
Question 5: A 62-year-old female presents with acute dyspnea, pleuritic chest pain, and leg swelling after a 10-hour flight. D-dimer is elevated. The MOST appropriate next step is:
- Empiric anticoagulation and discharge
- CT pulmonary angiography (Correct answer)
- V/Q scan
- Lower extremity venous duplex only
Correct answer: CT pulmonary angiography
CT pulmonary angiography (CTPA) is the gold standard imaging study for diagnosing pulmonary embolism in patients with intermediate-to-high clinical probability.
Question 6: Which arrhythmia is MOST commonly associated with Wolff-Parkinson-White syndrome presenting as a wide-complex tachycardia?
- Atrial fibrillation with accessory pathway conduction (Correct answer)
- Atrial flutter with 2:1 block
- Ventricular tachycardia
- Junctional tachycardia
Correct answer: Atrial fibrillation with accessory pathway conduction
Atrial fibrillation conducting rapidly down an accessory pathway in WPW produces a wide, irregular, potentially life-threatening tachycardia.
Question 7: A patient with acute STEMI develops cardiogenic shock. After PCI, which medication should be AVOIDED as it may worsen outcomes in this setting?
- Aspirin
- Heparin
- Intra-aortic balloon pump support
- High-dose vasopressors as primary treatment without PCI (Correct answer)
Correct answer: High-dose vasopressors as primary treatment without PCI
High-dose vasopressors increase afterload and myocardial oxygen demand; early revascularization with PCI is the priority in cardiogenic shock from STEMI.
ABEM Cardiovascular & Respiratory Emergencies 3
A 55-year-old man with hypertension presents with acute pulmonary edema.
His BP is 220/130 mmHg.
Which vasodilator acts primarily as a venodilator to rapidly reduce preload?