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Emergency Medicine Practice Questions with 100% Verified Answers | Rated A+
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Emergency Medicine Practice Questions with 100% Verified Answers | Rated A+ A 68-year-old female presents to the emergency department with signs and symptoms of an acute ischemic stroke. The initial CT scan is normal. Her blood pressure is 164/105. What is the most appropriate treatment for the...

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  • November 15, 2024
  • 239
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers

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  • Emergency Medicine
  • Emergency Medicine

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©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
Emergency Medicine Practice Questions

with 100% Verified Answers | Rated A+


A 68-year-old female presents to the emergency department with signs and

symptoms of an acute ischemic stroke. The initial CT scan is normal. Her

blood pressure is 164/105. What is the most appropriate treatment for the

blood pressure of this patient?

A Atenolol PO

B Clonidine PO

C Close monitoring

D Labetolol IV

E Nicardipine IV - ✔✔*The Correct Answer is: C

Aggressively lowering blood pressure may decrease blood flow to the

ischemic tissue, thus decreasing the chances of recovery or increasing the

risk of further infarction. In the setting of an acute ischemic stroke, blood

pressure elevation should be monitored closely, with some elevation

expected.* This elevation is expected to decline without medication in the

first few hours to days, but if elevation continues to a systolic blood

,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
pressure greater than 220mmHg, or mean arterial pressure greater than

120mmHg, medication is advised. Medications may include intravenous

labetolol or nicardipine, with close monitoring of the patient. After the acute

phase following a stroke, appropriate oral medications may be considered

for outpatient hypertension management.

You are evaluating a 67-year-old male with known cirrhosis of the liver

secondary to alcoholic liver disease, although he has been sober for the

past year. He is brought in to the emergency department by his daughter,

who notes that for the past few days he has seemed to be more confused.

On examination you note the patient to be mildly confused but alert to

person and place. He has noticeable asterixis. He is not currently taking

any medications and his blood alcohol level is undetectable. What is the

treatment of choice in this case based on your physical examination

findings?

A amoxicillin

B prednisone

C lactulose

D folic acid

E thiamine - ✔✔*The correct answer is (C). *

,©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
This patient most likely has hepatic encephalopathy due to end-stage liver

disease. *Asterixis indicates an increase in serum ammonia. The treatment

of choice is lactulose. Both folic acid and thiamine are used in the treatment

of alcoholic liver disease, but do not treat elevated ammonia levels.*

Antibiotics may be used secondarily in patients nonresponsive to lactulose,

but amoxicillin is not preferred. Prednisone is not a treatment for hepatic

encephalopathy.

A 76-year-old man, is brought to the emergency department by his niece

after she found him wandering around his yard in the cold wearing only a

tee shirt and jeans. When she set up his pill container about 36 hours

earlier, he seemed his usual self but, in retrospect, possibly a little more

confused than usual. The niece says that he has "high blood," treated with

a "white fluid pill," "sugar diabetes," treated with an oral medication, and

early "old timer's" dementia treated with "a memory pill." Vital signs include

an oral temperature of 100.8F, pulse 100 beats per minute, respirations 24

and somewhat shallow, and blood pressure of 88/52. Initial examination

reveals a slightly dehydrated, stuporous man appearing older than his

stated age, who smells strongly of urine. He has no lateralizing signs. What

is the most likely cause of the mental status changes?

A hyperglycemic hyperosmolar state

, ©JOSHCLAY 2024/2025. YEAR PUBLISHED 2024.
B lactic acidosis

C st - ✔✔*The Correct Answer is: A

The combination of confusion and dehydration in a patient with diabetes

type 2 who is taking a diuretic strongly suggest hyperosmolar state.*

Patients with lactic acidosis (B) have marked hyperventilation and, usually,

signs and symptoms of a serious illness. The lack of lateralizing signs

makes a stroke (C) less likely. Urinary tract infection (D) could certainly

cause confusion and incontinence in an elderly man and should be

investigated. Alzheimer dementia (E) progresses slowly; sudden

decompensation is usually due to delirium.

A 66-year-old man with a history of HTN and diabetes mellitus, type 2,

presents to the emergency department with complaints of palpitations for

over 2 weeks, tachypnea, and chest pain. He denies history of CAD,

stroke, TIA, or congestive heart failure. He is afebrile, with vital signs as

follows: BP 145/98, HR 138, and RR 22. His EKG is shown (Figure 1).

Troponins are negative X 3. Which of the following choices is the most

appropriate next diagnostic study for this patient?



A Transthoracic echocardiogram

B Cardiac catheterization

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