- | Page
MCGRAW-HILL EMERGENC Y
MEDICINE EXAM REVIEW
(TINTINALLI'S) TEST BANK
Question : Which of the following methods is NOT an
appropriate way to decrease the pain of infiltration from a local anesthetic?A Buffering the anesthetic solution with sodium bicarbonate prior to infiltration B Injecting through the wound margins instead of through intact skin C Rapid injection to minimize the duration of pain D Using 1 mL of sodium bicarbonate 8.4% to buffer 29 mL of bupivacaine 0.25% E Warming the solution to body temperature before injecting
Correct answer: C. Rapid injection to minimize the
duration of pain
Explanation: There are multiple ways to reduce pain of
infiltration of a local anesthetic. They include slow (not fast) injection, warming the solution to body temperature, and injecting through the margins of the wound.
- | Page
Bupivacaine can be buffered as described. Buffering the anesthetic solution with sodium bicarbonate will decrease the pain of injection.
Question : What is the MOST common cause of
cardiogenic shock?A Acute aortic insufficiency B Aortic stenosis C Hypertrophic cardiomyopathy D Acute myocardial infarction (AMI) E Pericardial tamponade
Correct answer: D. Acute myocardial infarction (AMI)
Explanation: Cardiogenic shock is mostly commonly due
to extensive MI with suppressed myocardial contractility.Pump failure is the underlying factor in most causes of cardiogenic shock (Table 54-2). Hypoperfusion, with or without hypotension, is the unifying feature of cardiogenic shock, regardless of etiology. During an AMI, several mechanical complications can precipitate cardiogenic shock, including acute myocardial regurgitation due to papillary muscle rupture, ventricular
- | Page
septal defect (VSD), and free-wall rupture. Mechanical complications cause one-fourth of the cardiogenic shock following AMI. Right ventricular infarction can also cause cardiogenic shock due to loss of preload. Cardiac contractility can also be severely depressed due to sepsis, myocarditis, myocardial contusion, and cardiomyopathy.Mechanical obstruction to forward blood flow can also lead to cardiogenic shock, including aortic stenosis, HCM, mitral stenosis, left atrial myxoma, and pericardial tamponade. Regurgitation of LV output due to chordal rupture or aortic insufficiency can cause profound cardiogenic shock.85% of users answered correctly.
Question : Which is TRUE about chronic pain?
A Chronic pain is more common in elderly patients.B Less than 25% of patients whose pain lasts 3 months will continue to have chronic pain for several years.C The goal of emergency treatment should be complete relief of pain.D The head is the most common location of chronic pain.
- | Page
E Patients presenting to the emergency department because of chronic pain are best helped by hospital admission.
Correct answer: A. Chronic pain is more common in
elderly patients.
Explanation: Chronic pain is more common in elderly
patients and the most common site of chronic pain is the back. Complete pain relief is an unrealistic goal for chronic pain patients who present to the emergency department. Chronic pain patients who present to the emergency department may be best helped by referral to a pain clinic or specialists; hospital admission is seldom indicated.
Question : What is the significance of a third heart sound
(S3) in the diagnosis of CHF?A Absence suggests increased 90-day mortality B Absence suggests worse outcome C Presence suggests an elevated pulmonary capillary wedge pressure D Presence suggests improved outcome