15 free questions from the CinnaEMS medical and obstetrics/gynecology bank (533 in the app). Tap an answer to check it. The rationale opens right away.
A patient with a prolonged QT has recurring runs of polymorphic ventricular tachycardia that twist around the baseline. Between runs she has a pulse and is alert. Which drug is first-line?
Answer: A. Magnesium sulfate, which suppresses the triggering afterdepolarizations
Torsades de pointes arises from a prolonged QT and early afterdepolarizations; magnesium sulfate suppresses the triggers and is first-line even when the serum magnesium is normal. Amiodarone is the tempting answer because it treats monomorphic VT, but it prolongs the QT further. Adenosine does not treat ventricular rhythms, and class IA drugs also lengthen the QT.
Parents call because their 3-month-old is "fussy." You notice a small bruise on the infant's cheek; they say he "must have hit himself with his hand." He is otherwise well. What is the significance?
Answer: A. Any bruise in a non-mobile infant may be a sentinel injury that signals abuse
Infants who cannot yet roll or crawl rarely bruise accidentally — "those who don't cruise rarely bruise." A small bruise in a young infant can be a sentinel injury that precedes more serious abuse, so it should be documented and reported per mandated reporter law and the infant transported for evaluation. Self-inflicted bruising at this age is implausible.
A thin patient with long-term heavy alcohol use is unresponsive with a glucose of 38 mg/dL. You cannot obtain IV or IO access, give IM glucagon, and 15 minutes later the glucose is unchanged. What best explains the failure?
Answer: A. Glucagon works by releasing liver glycogen, and his stores are depleted
Glucagon raises blood glucose by stimulating the liver to break down stored glycogen. Malnourished and chronically alcohol-dependent patients have little glycogen, so glucagon may do almost nothing; vascular access for dextrose becomes the priority. Alcohol does not block glucagon receptors, and glucagon does not require food — that is exactly why it is used in patients who cannot swallow.
A patient who recently started an antipsychotic has a temperature of 105 degrees Fahrenheit, 'lead-pipe' muscle rigidity, confusion and a swinging blood pressure. This most suggests:
Answer: A. Neuroleptic malignant syndrome
Neuroleptic malignant syndrome follows dopamine blockade and develops over days: high fever, generalized lead-pipe rigidity, altered mental status and autonomic instability. Serotonin syndrome is the tempting look-alike, but it comes on within hours with clonus and hyperreflexia rather than rigidity. Cooling and supportive care are the priorities.
Lightning strikes a group of hikers. One is in cardiac arrest, one is confused with burns, and one is crying with a painful leg. Whom do you treat first?
Answer: A. The patient in cardiac arrest, since recovery is often possible
Lightning can stop the heart and breathing at the same moment; the heart often restarts but breathing may not, so prompt ventilation and CPR save many victims. Lightning triage therefore reverses the usual approach and treats the apparently dead first. Using standard triage and writing off the arrest is the tempting but wrong application of mass-casualty rules.
A young adult has pain that began around the umbilicus and has since settled in the right lower quadrant, with nausea and a low fever. The most likely cause is:
Answer: A. Appendicitis
Visceral pain from a hollow organ begins vague and central, then localizes once the inflammation reaches the parietal peritoneum above it — periumbilical pain migrating to the right lower quadrant is the classic sequence. Biliary pain sits in the right upper quadrant and radiates to the shoulder, and a stone travels from flank to groin rather than settling in one tender spot.
A septic patient with a history of heart failure is hypotensive. After the first isotonic bolus, his blood pressure improves slightly and new crackles appear at both bases. What is the best next step?
Answer: A. Stop the bolus, raise the head and notify ALS or the receiving team
Fluid for sepsis is given in boluses with reassessment after each one; new crackles mean the heart cannot handle more volume and further fluid will cause pulmonary edema. Stop, position upright and escalate for vasopressor support. Continuing a fixed volume regardless of response is the error, and new bilateral crackles after fluid should not be dismissed as pneumonia.
After using a topical anesthetic spray, a patient has an SpO2 of 85% that does not rise on high-flow oxygen, and her blood looks chocolate-brown. Which antidote class is indicated?
Answer: A. Methylene blue, which restores hemoglobin's normal iron
Methemoglobinemia oxidizes hemoglobin iron to a form that cannot carry oxygen, producing cyanosis, chocolate-colored blood and an oximeter reading stuck near 85% regardless of oxygen. Methylene blue reduces it back to functional hemoglobin. Hydroxocobalamin is the cyanide antidote, and local anesthetics are not opioids.
A hospice patient with a skin patch that delivers an opioid has become hard to rouse, breathing 6 times a minute. She was placed under a heating blanket for chills two hours ago. What explains this and what should you do along with ventilating?
Answer: A. Heat sped absorption from the patch; remove it and remove the heat
Warming the skin increases blood flow under a transdermal patch, so fever, heating pads, blankets or hot baths can release a surge of opioid and cause respiratory depression. Support ventilation, remove the patch with gloves, fold it sticky-side in, stop the heat source, and consider naloxone titrated to breathing. Withdrawal produces agitation and fast breathing, the opposite picture.
A patient took a large overdose of an over-the-counter antihistamine. She is hot, flushed and dry with dilated pupils, has had a seizure, and her QRS is 0.13 seconds. What explains the wide QRS and what does it call for?
Answer: A. Sodium-channel blockade; consider sodium bicarbonate
In massive overdose, first-generation antihistamines add sodium-channel blockade to their anticholinergic toxidrome, so the QRS widens and seizures and dysrhythmias follow, much like a tricyclic; sodium bicarbonate is the treatment. The anticholinergic signs are real but atropine is itself anticholinergic and would worsen them, and the other two options misread the mechanism.
A 2-year-old may have swallowed one of her grandfather's oral diabetes pills an hour ago. She is playful and her glucose is normal. What is the best plan?
Answer: A. Transport for observation, since low glucose can be delayed for many hours
Some oral diabetes medications, such as sulfonylureas, are among the drugs that can seriously harm a toddler in a single tablet, and the resulting hypoglycemia may not appear for many hours. A normal glucose now is falsely reassuring, so she needs transport and prolonged monitoring. Inducing vomiting is not recommended, and preventive glucose does not replace observation.
A patient using methamphetamine is agitated, hot to the touch at 105.8 °F and fighting the crew. Which management approach best addresses the life threat?
Answer: A. A benzodiazepine for agitation with aggressive active cooling
Sympathomimetic hyperthermia comes from muscle activity and agitation, so sedating with a benzodiazepine and cooling aggressively treats the cause. Prone restraint increases heat production and risks asphyxial arrest, antipyretics do nothing because the hypothalamic set point is not raised, and unopposed alpha stimulation makes a beta-blocker alone a poor choice.
A 72-year-old man has sudden severe back and abdominal pain, a pulsatile mass, and a blood pressure of 78/50. He is alert. How should the AEMT manage IV fluid?
Answer: A. Titrate small boluses to mentation and a radial pulse, not to normal BP
A leaking abdominal aortic aneurysm is managed with permissive hypotension: enough fluid to keep the patient perfusing the brain and a radial pulse, without raising pressure enough to blow out the clot. Driving to a normal pressure worsens bleeding and dilutes clotting factors, while withholding fluid from a patient losing mentation risks arrest. Dextrose is not volume.
A drinker who stopped a week-long binge two days ago has abdominal pain, repeated vomiting and deep rapid breathing. His glucose is 88 mg/dL. Which condition fits best?
Answer: A. Alcoholic ketoacidosis from starvation and alcohol metabolism
Alcoholic ketoacidosis follows a binge, a period of poor intake and vomiting, and produces a ketoacidosis with Kussmaul-type breathing while the glucose is normal or low. Diabetic ketoacidosis would be expected to show a high glucose. Deep breathing here is compensation for a metabolic acid, not anxiety, and methanol typically adds visual complaints.
Three members of one household all have a dull headache and nausea that ease when they go outside. The pulse oximeter shows 99% on each. The most likely cause is:
Answer: A. Carbon monoxide exposure that the oximeter cannot detect
Clusters of headache in one building that improve away from it point to carbon monoxide, and a standard pulse oximeter reads carboxyhemoglobin as oxyhemoglobin, so a normal SpO2 is falsely reassuring. A virus would not reliably improve simply by stepping outdoors.
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