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Emergency Medicine Practice
Questions and Answers Latest 2026
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 Ans: *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 pressure greater
than 220mmHg, or mean arterial pressure greater than
120mmHg, medication is advised. Medications may
include intravenous labetolol or nicardipine, with close
© 2025 All rights reserved
, 2 | Page
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 Ans: The correct answer is (C).
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
© 2025 All rights reserved
, 3 | Page
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
B lactic acidosis
C st Ans: *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
© 2025 All rights reserved
, 4 | Page
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
C Nuclear stress test
D Holter monitor
E Event recorder Ans: *The Correct Answer is: A
Choice A, transthoracic echocardiogram, is correct, as it
can demonstrate the presence of valvular heart disease.
The presence of valvular heart disease can change the
recommendations for embolism prophylaxis.* Choice B,
cardiac catheterization, is useful in patients suspected to
have unstable angina, or who have sustained a
myocardial infarction. Choice C, nuclear stress test, is
useful in patients suspected to have angina pectoris, and
may be a useful diagnostic study in this patient with
© 2025 All rights reserved
Emergency Medicine Practice
Questions and Answers Latest 2026
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 Ans: *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 pressure greater
than 220mmHg, or mean arterial pressure greater than
120mmHg, medication is advised. Medications may
include intravenous labetolol or nicardipine, with close
© 2025 All rights reserved
, 2 | Page
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 Ans: The correct answer is (C).
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
© 2025 All rights reserved
, 3 | Page
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
B lactic acidosis
C st Ans: *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
© 2025 All rights reserved
, 4 | Page
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
C Nuclear stress test
D Holter monitor
E Event recorder Ans: *The Correct Answer is: A
Choice A, transthoracic echocardiogram, is correct, as it
can demonstrate the presence of valvular heart disease.
The presence of valvular heart disease can change the
recommendations for embolism prophylaxis.* Choice B,
cardiac catheterization, is useful in patients suspected to
have unstable angina, or who have sustained a
myocardial infarction. Choice C, nuclear stress test, is
useful in patients suspected to have angina pectoris, and
may be a useful diagnostic study in this patient with
© 2025 All rights reserved
