Medical Emergency Questions PDF

The most important characteris0c of a disaster is: - The discrepancy between needs and resources - The disaster always involves more than 1000 vic0ms - The response system is unable to cope - If the system is ready, you can cope with any disaster Inclusion criteria for thrombolysis wi...

The most important characteris0c of a disaster is: - The discrepancy between needs and resources - The disaster always involves more than 1000 vic0ms - The response system is unable to cope - If the system is ready, you can cope with any disaster Inclusion criteria for thrombolysis within 3 hours of symptoms onset are: - Age equal or greater than 18 years - Measurable neurologic deficit - Symptoms onset less than 3 hours - All the other answers are correct During the charging process of the defibrillator: - The team leader checks for pulses - Everybody should stay away - CPR should be performed - The team leader analyze the heart rhythm The first seizure in a pa0ent without previous history of known epilepsy: - Should be inves0gated only if the pa0ent has not completely recovered - Should always be treated - Should always be inves>gated - Should always be inves0gated and treated A pa0ent with a suspected anaphylac0c reac0on should be: - rapidly transferred to the ICU for invasive pulmonary artery catheter monitoring, hemodynamic support, invasive ven0la0on, and close metabolic monitoring - Given epinephrine IM or SC, an>histamines and cor>costeroids IV to interrupt his allergic reac>on, with fluids and oxygen - Given IV fluids and norepinephrine to treat severe hypotension - Given cor0costeroids IV to interrupt his allergic reac0on A pa0ent is in cardiac arrest. Which one is a probable reversible cause? - Rhabdomyolysis - Tension pneumothorax - Blood vessels abnormali0es - Cerebral bleeding Hypertensive urgency is defined as: - Any type of hypertensive crisis - Elevated BP levels within presence of end organ damage - SBP > 220 mmHg and/or DBP >130 - None of the other answers is correct Consider the aZached flowchart on cardiac arrest advanced life support. Only one of the following contain the correct ac0on to be performed in the A or B squares. Which one? (CPR: Cardiopulmonary resuscita0on) - A: check rhythm then start CPR if appropriate, minimize interrup0ons - A: immediately resume CPR for 2 minutes, minimize interrup0ons, give epinephrine 1 mg IV as soon as possible - B: immediately resume CPR for 2 minutes, minimize interrup>ons, give epinephrine 1 mg IV as soon as possible - B: check rhythm then start CPR if appropriate, minimize interrup0ons 1 di 19  nv 24-26 Interpret this ABG: pH 7.10 ; PaCO2 38 mmHg ; [HCO3-] 16 mEq/L ; BE -12.6 mEq/L - Combined acidosis - Metabolic acidosis - Metabolic acidosis, par0al compensated - Metabolic alkalosis, full compensated Which is a characteris0c of ventricular fibrilla0on rhythm? - High frequency - Could be raw or fine - Large QRS rhythm - Shape of QRS constant Which is the right diagnosis in this EKG? (ECG Secchi 2) - Atrial fibrilla>on - Atrial fluZer - Normal EKG - Lateral STEMI A 67 years old COPD pa0ent has been admiZed 5 days earlier. His first ABG was pH 7.25, pCO2 60 mmHg, HCO3 25 mEq/L. Today his ABG is pH 7.27, pCO2 60 mmHg, HCO3 28. Which exam would you require first? - Bilirubin - D- Dimer - Chest X ray - Crea>nine 2 di 19  lo shock è definito da necessità di vasopressori per mantenere MAP>65 e ridurre i lattati Consider the aZached flowchart on sepsis diagnos0c workup. What should be considered in the square covered by a “?” - Mean arterial pressure OR serum lactate, BEFORE fluid challenge - Mean arterial pressure OR serum lactate, AFTER fluid challenge - Mean arterial pressure AND serum lactate, BEFORE fluid challenge - Mean arterial pressure AND serum lactate, AFTER fluid challenge When looking at “B-breathing” evalua0on, what should NOT always be immediately looked? - Use of accessory muscles - Respiratory rate - Chest X ray secondary survey - Pulse oxymetry Which are the most commonly used benzodiazepines in the preopera0ve and cri0cal care semng? - Midazolam, lorazepam, diazepam - Lorazepam, Diazepam, remimazolam - Midazolam, diazepam, remifentanyl - Midazolam, lorazepam, fentanyl - Midazolam, lorazepam, remimazolam 78 y.o. woman, with history of diabetes and hypertension, mild cogni0ve impairment and previous unspecified arrhythmia is referred to our ER for localized chest pain. What is the diagnosis according to the ECG? (ECG Calvo 6) - Atrial paced rhythm - Early depolariza0on paZern - Len posterior hemlock - Len anterior hemiblock Which of the following devices is able to support the right ventricle? - VA ECMO - Tandem Heart - Impella CP - LVAD 3 di 19  Which are the early signs of shock? - Hypotension, drop of hematocrit, anuria - The pa>ent is pale, swollen, anxious and confused - Tachycardia, hypotension, loss of consciousness - Confusion, tachicardia, hypertension 68 y.o. woman, with history of smoking and hypertension, is admiZed to the ER: with general discomfort from 5 days. ECG shows atrial fibrilla0on of unknown dura0on with elevated mean ventricular rate, Trans- thoracic echocardiography shows normal biventricular func0on without any valvulopathy. Which is your next step? - Electrical cardio version with DC shock of 200 J - Early start of IV flecauinide (1 mg/kg in 30 minutes) - 4 weeks an0platelet therapy then perform electrical of pharmacological cardio version - Perform trans esophageal echocardiography to exclude leS atrial appendage thrombosis, then perform cardio version In the aZached table which is the right choice for the white box? (erano due immagini ma in entrambe andava bene “arrow up”) NB. SE CI SONO DOPPIE IMMAGINI, LA RISPOSTA PUO’ ESSERE IN UNA DELLE 2 - Arrow up - Equal - 0 - Arrow down Prepara0on to receive a severe trauma pa0ent includes: - Aler>ng the blood bank - Availability of defini0ve site of care (ICU bed) - Severe trauma pa0ents must be refused by hospitals that are not trauma centers - The severe trauma pa0ents has to find all the available specialists in the shock room at his/her arrival 72 y.o. woman, with history of previous myocardial infarc0on with residual len ventricular dysfunc0on (EF 30%) is admiZed to the ER due to palpita0ons from one hour. Which therapy is indicated for pharmacological cardio version according to this ECG? (ECG Calvo 1) - Metoprolol - Flecainide - Digoxin - Amiodarone 4 di 19  In acute adrenal insufficiency it is necessary: IV fluids 0.9% NaCl in the first 12 hours, if - Intravenous fluids administra0on hypoglycemia add dextrose 5%; - All the other answers are correct Dexamethasone 4 mg bolus IV if Addison - Treatment of eventual underlying condi0on - Steroids administra0on What is the incidence of cardiogenic shock in pa0ents with acute coronary syndrome? - 20% - 5% - 1% - 0.5% Consider this arterial blood gas analysis: pH 7.24, pCO2 28 mmHg, HCO3- 14 mEq. Which is your diagnosis? - Simple disorder, respiratory acidosis - Mixed disorder, acidosis - Simple disorder, metabolic acidosis - Mixed disorder, alcalosis Which is the right diagnosis in this EKG (ECG Secchi 5) - Anterior STEMI - Polymorphic ventricular ectopic beats - Atrial ectopic beats - Atrial fibrilla0on 5 di 19  Anaphylac0c shock is generally classified as: - Distribu>ve shock 66% - Hypovolemic shock - Obstruc0ve shock - Cardiogenic shock Assessment of airway potency: which one of the following associa0ons is correct? - Noisy breathing - patent airway - Paradoxical chest movements - par>al airways obstruc>on - No breath sounds - patent airway - Pa0ent able to speak - par0al obstruc0on Opioids intoxica0on is characterized by: - GI bleeding - Respiratory depression - Survival = 100% - Hyperven0la0on - Mydriasis Which kind of meningi0s is this liquor sugges0ng? Limpid liquor: opening pressure 400 mmHg, WBC 300 m3 (lymphocytes and PMN leukocytes); glucose 20 mg/dL (normal blood glucose level), proteins 300 mg/ dL 0.3 g/L - This values are impossible - Normal liquor - Bacterial meningi>s listeria - Viral meningi0s In the aZached flowchart in box A, what would you insert? - EEG as soon as possible - EEG is not mandatory - EEG within 24 hours - EEG within 2 hours (L’immagine a sx è quelle della domanda d’esame. Quella a dx corrisponde all’originale delle slides) 6 di 19 1. Which one is not a cause of acute respiratory acidosis? a. Fever b. Laryngospasm c. Cardiac arrest d. Pneumothorax 2. Fistula (FAV) Thrombosis is a medical emergency because: a. FAV allows to perform life-saving treatments for the pa>ent b. It is inherently dangerous for the pa0ent c. Associated with an increased risk of infec0on d. Associated with increased risk of thromboembolism 3. Orolingual angioedema associated with alteplase should be treated with: a. IV rani0dine b. IV diphenhydramine c. IV methylprednisolone d. All are correct 4. Which treatment for 83yr man referred to ER due to dizziness and confusion with ECG evidence of bradycardic rhythm with HR of 39bpm? a. Noradrenaline 0.05 mcg/kg/min b. 60 mEq of potassium c. Implant urgent cardiac defibrillator d. Trial IV atropine 0.5 mg 5. Defibrillator energy in VF-pVT (Ventricular fibrilla0on, pulseness ventricular tachycardia) should be: a. Different for VF or pVT b. Delayed un0l the correct energy has been chosen c. Strictly according to the instruc0ons of the producer d. If any doubt exist, use maximum energy 6. The pelvic fracture is most associated to massive bleeding: a. Fracture by antero-posterior compression b. Fracture with rupture of the pelvic ring c. Bilateral fracture of the branches d. Fracture with involvement of the acetabulum 7. The first line of treatment of DKA, while wai0ng for electrolytes levels is: a. Hydra0on with hypotonic solu0on b. Hydra>on with isotonic solu>on c. Potassium infusion d. Con0nuous insulin IV 8. Management of AKI does NOT include: a. Providing appropriate nutri0on b. Fluids expansion, urine alkaliniza>on, steroids to reduce kidney inflamma>on c. Maintenance of MBP > 60 mmHg to prevent further kidney damage d. Maintenance of fluids and electrolyte homeostasis 9. The ATLS protocol reduces mortality of the severely-injured trauma pa0ent: a. In the ICU because it reduces the risk to develop MOF and sepsis b. At the scene, because it focuses on the Damage Control Resuscita0on that starts at the scene 7 di 19  c. Along the whole way of the management: scene, ED and ICU d. Inside the hospital, because it prevents the lack of recogni>on & treatment of hemorrhage 10. Sepsis screening in pa0ent with known infec0on: which is correct? a. All pts with qSOFA < 2 haven’t sepsis for sure b. All pts with SOFA >= 2 haven’t sepsis c. All pts with qSOFA >=2 have sepsis d. All pts with qSOFA >=2 should be assessed by SOFA 11. 59 yr man with history of coronary artery disease is referred to the ER with chest discomfort and palpita0ons. Pa0ent unstable with AP 80/40 mmHg. Which is first treatment according to ECG? (Calvo 2) a. An0coagulant therapy with loading dose and proceed with urgent coronary angiography b. Start cardiopulmonary resuscita0on c. Electrical cardioversion with DC shock of 150J d. Pharmacological cardioversion with IV propafenone 12. Epilepsy is: a. a disorder of the brain characterized by an enduring predisposi>on to generate epilep>c seizures, and the biological, cogni>ve, psychological, social consequences of this condi>on b. a group of signs and symptoms that, added together, suggest a par0cular medical condi0on c. a condi0on resul0ng either from the failure of the mechanisms responsible for seizure termina0on or from the ini0a0on of those mechanisms which lead to abnormally prolonged seizures d. symptoms that have a close semeiologic & temporal rela0onship with the epilep0c neuronal firing 13. Correct diagnos0c-therapeu0c algorithm in case of ongoing convulsive Status Epilep0cus is: a. ABC approach – EEG – CT scan – pharmacotherapy – consider e0ology b. ABC approach – pharmacotherapy – consider e>ology c. ABC approach – CT scan – EEG – consider e0ology – pharmacotherapy d. Pharmacotherapy – ABC approach – CT scan – EEG – consider e0ology 14. The correct empiric therapy in a 67yr pa0ent with meningeal syndrome is: a. Aciclovir 10mg/kg x3 daily + ceSriaxone 2g x2 daily + ampicillin 2g x6 daily b. Aciclovir 5mg/kg x2 daily + cenriaxone 1g x2 daily + ampicillin 1g x4 daily c. Aciclovir 10mg/kg x3 daily + cenriaxone 2g x2 daily d. Aciclovir 5mg/kg x3 daily + cenriaxone 1g x2 daily 15. An0dote of opioid overdose: a. Flumazenil b. Naloxone c. Dantrolene d. ABCD(E) e. Protamine 16. You are asked to evaluate a pa0ent in shock in the Emergency Room, where he just arrived from home. Which are the first 3 things you do? a. Call the ICU to plan an early admission, give him an0bio0cs, and non-invasive ven0la0on b. Check his vital signs, give him oxygen with reservoir, place an IV access to start IV fluids c. Ask for arterial blood gas, EKG, and thoracic X-ray 8 di 19  d. Ask for an EKG, blood test, and thoracic X-ray 17. Point of care (POC) tes0ng for “B” Breathing evalua0on in the ABCDE evalua0on DO NOT include: a. CO2 waveform monitoring b. Spirometry and Diffusion lung capacity of carbon monoxide c. Arterial Blood Gas Analysis d. Pulmonary ultrasonography 18. The first dose of epinephrine, should be given: a. Immediately if the HR is not shockable b. Immediately if the heart is not bea0ng c. Immediately if the heart rhythm is shockable d. Immediately aner the first shock 19. Which of the following arrhythmias detected at EKG might cause cardiogenic shock? a. Ventricular tachycardia b. Complete AV block c. Atrial fibrilla0on d. All are correct 20. Which of the following INTERMACS status capture the pa0ent in cardiogenic shock? a. 1 b. 2 c. 3 d. 5 21. Which is the right diagnosis in this EKG? (Secchi 2) a. Atrial fibrilla>on b. Atrial fluZer c. Lateral STEMI d. Normal EKG 22. Which one of the following is NOT an underlying principle of the ABCDE approach? a. Do not treat any problems without having completed a full examina>on b. Assess the effects of treatment c. Do a complete ini0al assessment and re-assess regularly d. Treat life-threatening problems before moving to the next part of the assessment 23. Consider this Arterial Blood Gas analysis: Ph 7.62 pCO2 28mmHg HCO3- 34mEq a. Simple disorder, metabolic alkalosis b. Simple disorder, respiratory alkalosis↑↓ c. Mixed disorder, alkalosis d. Mixed disorder, acidosis 24. Which one of the following associa0ons is WRONG? a. Shockable – Ventricular Fibrilla0on b. Shockable – Pulseless electric ac>vity c. Shockable – Ventricular tachycardia without pulse d. Not Shockable – Asystole 25. Right diagnosis in this EKG? (Secchi 6) a. Sinus tachycardia 9 di 19  b. Normal EKG c. Atrial fibrilla>on d. Right Bundle Branch Block Temperatura da traZare in emergenza: - SoZo 34.5 °C Terapia prima linea SE: - Diazepam 10 mg Cardiogenic shock: - Revascularize one artery Hypoglycemia more frequent in - Insulin Epilepsy par0al neurological recovery: etiology diagnosis, then eeg asap, then undertsand if ongoing se or - CT scan, EEG (as soon as possible), therapy not; if yes->therapy;if no->evaluate therapy ATLS protocol: - In the hospital ABCDE circula0on assessment does not include: - Echocardio ECG Secchi 6: - Atrial Fibrilla0on 10 di 19  Not a nephrological emergency: - AKI Ventricular tachycardia 80/40 mmHg unstable: - Electrical DC cardio version 150 J ECG Calvo 4: - Weckenbach ECG Secchi 1: - LBBB 11 di 19  The best way to be prepared for disasters is: - To invest in the educa0on of all the personnel poten0ally involved in the response - To prepare and keep few experts in disaster management always available - To make live exercises simula>ng disasters every month - To prepare and stock extra equipment Indica0ons for renal replacement therapy (RRT) in emergency does not include: - Inges0on of drugs poten0ally removed by dialysis treatment - High plasma>c crea>ne levels (sCrea > 10 mg/dL) - Pulmonary edema - Severe hyperkaliemia Which oral inhibitor of P2Y12 receptor is preferred in a 78 y.o. man with NSTEMI and chronic kidney disease that we decide to treat conserva0vely without coronary angiography? - Ticagrelor - Prasugrel (slides dicono “only if angiography is performed”) - Cardioaspirin - Tirofiban Basic technique of airway treatment includes all of the following except: - Supraglojc devices - Jaw trust - Nasopharyngeal cannula - Head 0lt and chin lin Which one is an acceptable PaO2 value in room air for a 80 year old man (in mmHg)? - > 80 - >60 - >50 - >70 For symptoma0c intracranial bleeding occurring within 24 hours aner thrombolysis for acute ischemic stroke is indicated to administer/perform: - Stop alteplase infusion - emergent head CT scan - Tranexamic acid 1 g IV infused over 10 minutes followed by 1 g IV un>l bleeding is controlled (sbobine dicono che prima fai CT e poi se c’è emorragia dai acido tranexamico) - All the other answers are correct Inotropes are appropriate therapy for all of the following scenarios of cardiogenic shock, except: - Tamponade - Pulmonary embolism - Decompensated chronic cardiomyopathy - Postcardiotomy Which of the following sentences is false about CO intoxica0on? - O2 administra0on is indicated for treatment - Heart and brain are affected the most - Cherry red skin is a typical sign - Hyperbaric treatment is considered for the most serious cases - It causes acute intoxica>on only 12 di 19  The ATLS protocol reduces mortality of severely injured trauma pa0ent: - In the ICU because it reduces the risk to develop MOF and sepsis - Along the whole way of management: scene, ED, and ICU - At the scene, because focuses on the Damage Control Resuscita0on that starts at the scene - Inside the hospital, because it prevents the lack of recogni>on and treatment of hemorrhage Which one of the following heart-rhythm can be associated with pulseless electrical ac0vity? - All the other answers are correct - Synus rhythm with 180 bpm - Synus rhythm with 50 bpm - Synus rhythm with 70 bpm Which is the an0dote for benzodiazepines intoxica0on? - Naloxone - Flumazenil - There is no an0dote for benzodiazepine intoxica0on - N-acetylcysteine - Dantrolene Sodium How much fluids should a sep0c shock pa0ent receive in the first 3 hours of resuscita0on if he or she con0nues o be hypotensive? - 30 ml/kg - 10 ml/kg - 20 ml/kg - 40 ml/kg Usually, immediately aner a shock has been delivered: - If the heart rhythm is shockable, another shock should be done - The team leader analyzes the heart rhythm - CPR should be performed - The team leader check for pulses The correct diagnos0c-therapeu0c algorithm for a pa0ent with previous single seizures and only par0al neurological recovery is: - CT scan - EEG (within 24 hours) - eventual pharmacotherapy - ABC approach - pharmacotherapy - CT scan - EEG - CT scan - EEG (as soon as possible) - eventual pharmacotherapy - EEG (as soon as possible) - CT scan - eventual pharmacotherapy The nurse calls you to evaluate a pa0ent that is worsening. He is a 65 y.o. pa0ent admiZed for appendici0s, and he has just started his IV an0bio0cs while wai0ng for surgery. You find him in laying bed, drowsy. He opens his eyes when s0mulated, but he does not answer your ques0ons nor execute any order. His BP is 60/30 and his HR is 130. His wife tells you that he was well, fully awake and speaking with her just some minutes before, and that she does not understand why his skin is somewhat reddening. What do you think: - He needs an EKG, serum cardiac markers, a cardiology evalua0on with cardiac ultrasound to rule out myocardial infarc0on/cardiogenic shock or pulmonary embolism - He needs to be immediately admiZed to the ICU - You ask a complete blood count, CPR, a contrast CT scan of the abdomen and increases an0bio0cs, as this is probably a sep0c shock caused by his appendici0s - That may be an anaphylac>c shock. We need to stop the IV an>bio>c now, give him IV fluids, epinephrine IM, an>histamine, cor>costeroids, and oxygen 13 di 19  The op0mal diagnos0c-therapeu0c sequence for a pa0ent with meningeal syndrome (choose the best answer) - Collect medical history - Neurological examina>on - Blood tests - CT scan - Lumbar puncture - Empiric therapy - Collect medical history - Neurological examina0on - Lumbar puncture - Empiric therapy - Blood tests - CT scan - Collect medical history - Neurological examina0on - Empiric therapy - Blood tests - CT scan - Lumbar puncture - Specific therapy - Collect medical history - Neurological examina0on - Blood tests - CT scan - Lumbar puncture Pa0ents with acute cerebral ischemic symptoms that have not yet resolved: - All the other answers are correct - Noninvasive imaging of the cervical vessels should be performed rou0nely as part of the evalua0on of pa0ents with suspected TIAs - Noninvasive imaging by means of CTA or MRA of the intracranial vasculature is recommended to exclude the presence of stenosis and/or occlusion - Pa0ents with TIA should undergo neuroimaging evalua0on within 24 hours of onset or as soon as possible in pa0ents with delayed presenta0ons ABCDE circula0on assessment will require at least all the following, except: - Colour of the pa0ent - Heart rate - Non invasive blood pressure - Echocardiography Treatment of severe metabolic acidosis should include: - Dialysis treatment - None of the other answers is correct - Dialysis treatment and sodium bicarbonate infusion - Sodium bicarbonate infusion If a pa0ent suffers from type 1 diabetes and Addison disease (treated with hydrocor0sone), in case of acute infec0on with fever, he must: - Augment dosage of hydrocor>sone tablets - Reduce dosage of hydrocor0sone tablets - Suspend hydrocor0sone tablets to avoid hyperglycemia - Maintain the same dosage of hydrocor0sone Why should I treat metabolic acidosis with bicarbonates? - Because treatment should always be done to keep pH within the normal range - Because it will fix the cause of metabolic acidosis - Because respiratory elimina0on of CO2 produc0on due to HCO3 therapy will always fix alcali treatment side effects 14 di 19 - Because of reduc>on of cardiac func>on can occur when pH is less than 7.2 and this could cause an important risk factor for pa>ent survival In a cri0cally Ill pa0ent with AKI: - The iden0fica0on of AKI leading cause is necessary to treat the condi0on - A good glycemic control (DTX 110-150 mg/dL) should be reached - All the other answers are correct - Reduce amount of protein to avoid further increase of Urea/BUN or delay RRT is not recommended According the ALS 2015 guidelines defini0on of “quality chest compression”, which one is NOT true? - Con>nuous compressions even without a defini>ve airway - Posi0on is in the center of the thorax - Complete return of the chest aner compression - About 2 compressions every second A pa0ent is in cardiac arrest because of hypovolemia. Which one solu0on shouldn’t never be used for fluid replacement? - Crystalloids - Blood - Colloids - Plasma Why is is advised to reduce at the minimum the pause between last chest compressions and delivery of shock during resuscita0on of a cardiac arrest pa0ent? - To allow charging of the defibrillator - To enhance probability of success of defibrilla>on - To get 0me for epinephrine administra0on - To increase safety of the rescuer To talk to the pa0ent means: - To receive important informa0on about the mechanism of injury - To know the allergic anamnesy, without which no treatment can be started - To perform a fast and simple ABCD assessment - To collect all the personal data to enter the pa0ent in the hospital informa0cs system This is essen0al in every educa0onal program on disaster response: - Use simula>on as a training tool - Training on job during a disaster - At least one year of formal educa0on - Distance learning + residen0al course + par0cipa0on to disasters A pa0ent in cardiac arrest with reduc0on of respiratory sounds, lateraliza0on of trachea, and full jugular veins should receive, as ini0al treatment: - Chest X ray - Chest tube - Needle puncture in 2nd intercostal space - Fluid challenge The ATLS philosophy says: - You must complete the ABCDE evalua0on before star0ng any treatment - Defini>ve diagnosis is not immediately important: treat the greatest threats to life first 15 di 19 - ABCDE protocol is useful for the severely injured trauma pa0ents, while the mildly injured ones can be manages by the classical “head to toe” examina0on - Do not make any treatment before making a defini0ve diagnosis to not further harm The vasopressor of choice in sep0c shock is: - Dopamine - Dobutamine - Norepinephrine - Epinephrine 45 y.o. man without previous history is admiZed to your hospital due to epigastric pain aner a huge meal. Cardiac troponins are within the normal range. What is the diagnosis? (ECG Calvo 4) - Len bundle branch block - Mobitz I second degree atrioventricular block (Luciani-Wenkeback) - First degree atrioventricular block - Mobitz II second degree atrioventricular block You are asked to evaluate a pa0ent in shock in the Emergency Room, where he is just arrived from home. Which are the first 3 things you do? - Check his vital signs, give him oxygen with reservoir, place an IV access to start IV fluids - Ask for an EKG, blood tests, and thoracic X-ray - Ask for arterial blood gas, EKG and thoracic X-ray - Call the ICU to plan an early admission, give him an0bio0cs and noninvasive ven0la0on Inclusion criteria for thrombectomy is: - Age equal or greater than 18 years - All the other answers are correct - NIHSS score greater than 6 and ASPECTS greater than 6 - Treatment can be ini0ated (groin puncture) within 6 hours of symptom onset What is malignant hyperthermia and do we have an an0dote? - It is a gene>cally inherited syndrome presen>ng mainly with hyperthermia and hyperkalemia in response to certain anesthe>c drugs. Yes, the an>dote is Dantrolene Sodium 16 di 19 - It is an aquired syndrome presen0ng as a hyper metabolic response to certain drugs. Yes, the an0dote is Dantrolene Sodium - It is an immune-mediated adverse reac0on to certain drugs. Yes, the an0dote is dantrolene sodium - It is a gene0cally inherited syndrome presen0ng as a hyper metabolic response to certain drugs. Yes, the an0dote is Flumazenil - It is an immune mediated adverse reac0on to certain drugs. No, we do not have an an0dote What is the best revasculariza0on strategy in cardiogenic shock pa0ents due to acute myocardial infarc0on: - Revascularize all coronary arteries with atherosclerosis damage - There is no need for revasculariza0on - Revascularize only the culprit artery - Wait hemodynamic stabiliza0on and then revascularize Consider this arterial blood gas analysis: pH 7.31, pCO2 54 mmHg, HCO3- 25 mEq. Which is your diagnosis? - Simple disorder, respiratory acidosis - Mixed disorder, acidosis - Mixed disorder, alkalosis - Simple disorder, metabolic acidosis The applica0on of an0-seismic regula0ons means: - Preven>on or at least mi>ga>on of the damage due to an earthquake - Management of the consequences of an earthquake - A fu0le exper0se if the earthquake is very severe - A way to beZer recover aner an earthquake Neurogenic shock is a form of: - Obstruc0ve shock - Cardiogenic shock - Distribu>ve shock - Hypovolemic shock General management of a pa0ent with AKI: - Do not reduce the amount of protein to avoid or delay RRT - If possible, avoid further kidney damage while renal repair mechanisms operate to restore the glomerular filtrate - All the other answers are correct - A good glycemic control (DTX 110-150 mg/dl) should be reached Impact of ATLS program: which one is wrong? - Reten0on of organiza0onal and procedural skills - Documented improvements in care of injured pa0ents aner implementa0on of the program - Organized trauma care reduces injury mortality - Preven>on of major injuries Which is the right diagnosis in this EKG? (ECG Secchi 3) - Monomorphic ventricular ectopic beats - Polymorphic ventricular ectopic beats - Normal EKG - Atrial ectopic beats 17 di 19  In the aZached flowchart in box A, what would you insert? - EEG as soon as possible - EEG is not mandatory - EEG within 24 hours - EEG within 2 hours FIRST SEIZURE or SE Seizure or SE Seizure or SE with partial neurological recovery or Ongoing SE completely recovered supposed SE Etiologic diagnosis Therapy Etiologic diagnosis EEG (as soon as possible) Etiologic diagnosis aA 24h) EEG (within Not SE Ongoing SE Prolonged EEG monitoring Evaluate therapy Evaluate Therapy to assess AED efficacy therapy If a peripheral vascular access can’t be obtained during resuscita0on of a cardiac arrest vic0m, it is correct to: - Administer drugs into the tracheal tube - Put a intra-bone line omero, tibia prossimale o distale, sterno - Put a central venous line - Avoid any drugs administra0on Which is the an0dote of heparin? - Tranexamic acid - Vitamin K - Protamine - Fresh frozen plasma - Recombinant factor VIIIa 18 di 19  Among the ATLS program goals, which one is wrong? - Reduce hospitaliza>on - Resuscitate and stabilize by priority - Rapid and accurate assessment - Arrange for transfer to defini0ve care 19 di 19