EM COMAT ACTUAL EXAM WITH 250+
QUESTIONS WITH VERY ELABORATED
ANSWERS CORRECTRY WELL ORGANIZED
LATEST 2024 – 2025 ALREADY GRADED A+
A 45-year-old female presents to the emergency room with altered mental status.
History reveals that the patient ingested an unknown substance approximately
three hours prior to arrival. The patient is nauseous, has vomited, and has been
defecating and urinating almost continuously since presentation. Vital signs reveal
a heart rate of 98/min, respiratory rate 24/min and blood pressure of 115/89
mmHg. Physical examination reveals an obese, diaphoretic female who appears
delirious with a Glasgow coma score of 12. Activated charcoal, 50 grams by
mouth, is promptly provided without response. This initial intervention was
unsuccessful because the most likely offending agent is
A. carbamazepine
B. glipizide
C. lithium
D.phenobarbital
,E. theophylline - ANSWERS-The correct answer is: C
This patient is suffering from acute lithium toxicity. Lithium is commonly used in
psychiatric disorders such as bipolar disorder and acute episodes of mania.
Activated charcoal in many instances works well for adsorption of an ingested
toxin. However, activated charcoal does not adsorb certain compounds.
Absorption by the intestines of these compounds are not impeded and will diffuse
across the intestinal lining to make it into the body's circulation. The drugs that
activated charcoal does not work for are as follows:
Ionic compounds: lithium, calcium, potassium, sodium, magnesium, fluoride and
iodide
Heavy metals: arsenic, lead, mercury, iron and zinc cadmium
Acids/Bases
Hydrocarbons: alkenes, alkanes, alkyl halides, and aromatic compounds
Essential oils
Alcohols: acetone, ethanol, ethylene glycol, methanol and isopropanol
Activated charcoal is otherwise relatively safe but caution should always be used
if a perforation of the gut is suspected. In addition, if endoscopy is a possibility
charcoal should not be used as it will coat the lining of the GI tract and make
seeing any pathology impossible.
Answer A: Carbamazepine is a medication commonly used in the treatment of
seizures, bipolar disorder and trigeminal neuralgia. The mechanism of action of
this drug is unknown for bipolar disorder and trigeminal neuralgia, however it
works for preventing seizures by reducing post-tetanic potentiation and
decreasing seizure spread. As this drug is a tricyclic derivative an overdose of this
medication would present with an anticholinergic toxidrome. The molecule itself
,is large enough (activated charcoal works best for molecules between 100-1000
Da) and would readily be absorbed by activated charcoal and thus this treatment
would be effective in aiding elimination.
Answer B: Glipizide is an oral hy
A 28-year-old female is brought into the emergency department by her family for
reported seizure activity. The family reports the patient was walking across the
floor at home, stopped, fell to the ground, and began shaking violently. They
estimate this lasted 2-3 minutes total. History reveals a patient with known
seizure disorder who has run out of her levertiracetam. Vital signs are a heart rate
of 98/min, respiratory rate of 22/min, and a blood pressure 115/74 mmHg.
Physical examination reveals an obese female who is alert and oriented to person,
place, and time. The remainder of the examination cannot be completed because
the patient begins seizing again. What is the next most important step in
management at this time?
A. CT of the head with contrast
B. left lateral decubitus position
C. rectal diazepam
D.serum prolactin level
E. start an IV catheter - ANSWERS-The correct answer is: B
Rolling the patient into the left lateral decubitus position is also known as the
recovery position. This position is used in many instances including seizures,
, pregnant patients with unstable vitals and after successful CPR in the field. The
purpose of doing this maneuver prior to any other interventions is to prevent the
patient from aspirating. Many patients may vomit before, during or after a seizure
and therefore may aspirate on the vomitus. Rolling them to the left lateral
position allows the patient to expel their stomach contents without gravity and
inhalation pulling the secretions into the oropharynx and the trachea. For this
patient and many patients the seizure may only last a few minutes. Not rolling the
patient could cause them to aspirate and potentially leaving them alone to either
get supplies or medications would not be in their best interest. The patient could
aspirate, roll of the bed and potentially hurt themselves. Some emergency
departement's are staffed with several other people and calling out for help to
get the necessary supplies would be appropriate.
Answer A: CT scan of the head with contrast would be indicated in the patient
with a first time seizure or an alteration in their normal seizure activity. This
would be to rule out any intracranial causes for the seizure such as infection or
mass. This patient has a known seizure disorder with a known cause, a lapse in
her treatment, so a CT of the head would not be indicated for her. If this were a
new onset seizure she would need be first a glucometer reading, then electrolyte
studies, a CT of the head and toxicologic profile.
Answer C: Benzodiazepines are indicated for the treatment of seizures. In this
scenario however the ABC's still apply. The patient must have their airway
protected first and this is done so b
A 4-year-old male is brought into the emergency department by his parents after
reportedly falling off of a couch and landing on his side. The child is holding his
right forearm and will not allow it to be examined. After calming him and
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