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COMAT EM Exam with Verified Answers, Exams of Nursing

Premiere Career CollegeNursing

A series of multiple-choice questions related to emergency medicine (em) scenarios, covering various clinical presentations and treatment options. Each question is followed by a brief explanation of the correct answer, providing insights into the rationale behind the chosen treatment approach. Designed to test knowledge and understanding of em concepts and procedures.

Typology: Exams

2024/2025

Available from 01/19/2025

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COMAT EM exam with verified answers
1. Phentolamine
-b/c |only |phentolamine |can |counteract |the |effects |of |epi |by |alpha-1 |adrenergic |blockade:
|44 |yo |f |presents |to |ED |after |suffering |a |bee |sting |on |her |finger. |She |is
|allergic |to |bees. |Hx |reveals |that |she |injected |her |son's |epi |into |her |finger.
|She |is |an |anxious |woman |w/ |a |finger |that |is |pale |& |cool |to |the
|touch. |Sensation |is |lmtd |& |finger |is |non-blanching. |Most |appropriate |tx?
-digital |massage
-nitroglycerin
-phentolamine
-phenylephrine
-warm |water |immersion
2. LP
-b/c |we |need |to |ID |the |causative |organism
Note: |fever |of |unknown |origin |in |children |less |than |3 |yo |should |always |prompt |a |thorough
|workup |including |cultures |of |blood, |urine, |CSF, |& |chest |radiograph-
: |25 |yo |f |is |brought |to |ED |by |her |parents |who |report |the |neonate |has |been
|fussy, |has |fever |of |101.5 |deg |F. |She |has |difficulty |breathing, |but |has |been
|feeding |well. |VS: |103 |deg |F, |HR |145, |BP |75/35, |resp |38, |O2 |sat |94%. |PE
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COMAT EM exam with verified answers

1. Phentolamine

-b/c|only|phentolamine |can|counteract|the|effects|of|epi|by|alpha-1|adrenergic |blockade:

| 44 |yo |f |presents |to |ED |after |suffering |a |bee |sting |on |her |finger. |She |is

|allergic |to |bees.|Hx |reveals |that |she |injected |her |son's |epi |into |her |finger.

|She |is |an |anxious|woman|w/|a|finger|that |is|pale|&|cool|to|the

|touch.|Sensation|is|lmtd|&|finger |is |non-blanching. |Most |appropriate |tx?

-digital |massage

-nitroglycerin

-phentolamine

-phenylephrine

-warm |water |immersion

2. LP

-b/c |we |need |to |ID |the |causative |organism

Note:|fever|of|unknown |origin|in|children|less |than| 3 |yo|should|always |prompt |a |thorough

|workup |including |cultures |of |blood,|urine,|CSF,|& |chest |radiograph-

: | 25 |yo |f |is |brought |to |ED |by |her |parents |who |report |the |neonate |has |been

|fussy, |has|fever|of|101.5|deg|F.|She|has|difficulty|breathing, |but|has|been

|feeding|well.|VS: | 103 |deg |F, |HR |145, |BP |75/35, |resp |38, |O2 |sat |94%. |PE

|reveals |a |well |appearing |child |w/ |inc |work |of |breathing, |nasal |flaring, |&

|grunting. |Best |next |step?

-CT |scan |of |chest

-IM |lorazepam

-IV |ceftriaxone

-LP

-stool |ova |& |parasites

  1. Heparin/enoxaparin: |Tx |of |stable |pt |w/ |PE?
  2. TPA

-massive|PE|sx=|cardiac|arrest,|hypotension,|R|heart |strain:|Tx|of|pt|w/|massive |PE?

  1. Hypothermia

-core |temp |< | 95 |deg |F |or | 35 |deg |C

Note: |opioid |OD= |miosis/pinpoint |pupils

Wellens |syndrome= |stenosis |of |LAD |& |ECG |abnormalities |in |leads |V1-V6: | 42 |yo |m

|presents |to |ED |after |he |was |discovered |unconscious |lying |outside |on |a

|park |bench. |VS: |HR |52, |BP |90/48, |resp |rate |14. |PE |reveals |a |lethargic

|disheveled |m

|reveals |pt |has |5-6 |ep |of |blood-tinged |emesis |throughout |the |past |day. |He

is |a |chronic |alcoholic |& |has |not |seen |a |physician |in |years.|VS: |HR |95, |resp |18, |BP

|150/96.|PE|reveals|a|disheveled|m|w/|pink|conjunctiva,|capillary|refill|of| 2 |sec,|&|abd |obesity |w/

|distended |veins |around |umbilicus.|There |is |a |tender |nodule |just |to |the |R |of |the |sternum |in

|the |2nd |IC |space. |Dx?

-aorto-esophageal | fistula

-Boerhaave |syndrome

-esophageal |varices

-Mallory-Weiss |tear

-peptic |ulcer |dz

  1. Rapid |sequence |intubation

-b/c |in |pts |w/ |anaphylaxis |& |resp |compromise |(hypoxia, |stridor, |laryngeal |edema |esp), |intubation |is |the

|answer!

-also, |give |IV |epi: |An |atopic | 34 |yo |m |presents |to |the |ED |after |abrupt |development |of |SOB |w/

|assoc |swelling |of |his |hands, |feet, |& |lips. |He |was |stung |by |multiple |wasps |while |doing |yard

|work.|VS |reveals |a |BP |of |110/64, |resp |rate |22, |O2 |sat |of |96% |on

5L |nasal |cannula.|PE |reveals |oropharyngeal |edema |& |stridor.|Best |next |step?

-bolus |of |IV |crystalloid |solution

-emergent |cricothyroidotomy

-IV |epi

-IV |glucocorticoids |& |diphenhydramine

-rapid |sequence |intubation

  1. Fasciotomy: | 42 |yo |m |w/ |R |LE |pain |is |found |to |have |a |broken |tibia.|Leg |pain |has |worsened. |R

|LE |is |ecchymotic, |cool |in |temp, |very |hard |to |palpate, |& |w/out |pulse |appreciated |on

|dorsalis |pedis. |Definitive |management |for |pt's |condition?

-alteplase |infusion

-angiography

-angioplasty

-fasciotomy

-heparin |infusion

  1. D-dimer |test: | 33 |yo |f |presents |to |ED |c/o |SOB |& |chest |pain |of | 1 |day |duration. |She |denies

|taking |oral |contraceptives, |hx |of |DVT/PE, |recent |trauma |or |surgery, |hemoptysis, |active

|cancer, |or |leg |swelling. |Chest |pain |is |in |R |ant |chest, |sharp, |& |only |occurs |when |she |takes

|a |deep |breath.|VS: |BP |115/75, |HR |115, |resp |rate |18, |O2 |sat |98%. |PE |reveals |bilat |equal |&

|clear |breath |sounds, |min |tachycardia |w/out |murmurs, |rubs, |or |gallops, |& |no |LE

|edema.|You |note |boggy |thoracic |paravertebral |musculature |from |T2-T6 |that |is |tender |to

  1. Inf: |Where |is |the |infarct?

II, |III, |& |aVF

  1. Inferolat: |Where |is |the |infarct?

V4-V6, |II, |III, |aVF

  1. Pancreatitis

-think|pancreatitis |when |you |have |a |pt |w/ |N,|V,|epigastric |pain,|Cullen's |sign,|& |Grey|Turner |sign: | 39 |yo |f

|presents |to |ED |w/ |chief |complaint |of |abd |pain, |N |&|V.|VS:

98.8|deg|F,|BP|101/77,|pulse|105, |resp|rate|18,|O2|sat|of|98%|on | 2 |L|nasal|cannula. |PE |reveals |a

|pt |in |moderate |discomfort.|The |rest |of |PE |is |normal |except |for |tender |to |palpation |in

|epigastric |region |w/ |an |associated |Cullen's |sign. |Most |likely |dx?

-acute |cholecystitis

-appendicitis

-GERD

-ruptured |ectopic |pregnancy

-pancreatitis

  1. Assess |ABC

-note: |ABCDE= |airway, |breathing, |circulation, |disability, |& |exposure: | 28 |yo |m |presents|to|ED|after|an

|MVA.|Hx|reveals|pt|was|rear-ended|from|behind|&|sustained |a |whiplash |injury, |hitting |the

|back |of |his |head |against |the |headrest. |He |smells |of |alcohol |& |is |currently |c/o |N |& |HA. |Best

|next |step?

-assess |ABC

-apply |cervical |collar |for |immobilization

-elicit |hx |& |perform |a |PE

-obtain |head |CT

-obtain |plain |film |radiographs |of |head

  1. Countrecoup |forces

=force |opp |side |of |intracerebral |contusion;|caused |by|indirect |rotational |shear |forces |on |the |brain |during |a

|closed |head |injury

Coup= |occipital |lobe |affected: | 28 |yo |m |presents |to |ED |after |an |MVA. |Hx |reveals |pt |was |rear-

ended |from |behind |& |sustained |a |whiplash |injury, |hitting |the |back |of |his |head |against |the

|headrest. |He |smells |of |alcohol |& |is |currently |c/o |N |& |HA. |A |CT |scan |of |his |head |is |obtained

|& |revealed |an |area |of |inc |intensity |of |the |frontal |lobe. |This |is |most |likely |due |to:

|missed |her |period |last |month |& |assumed |she |was |starting |her |period |yesterday, |but |the

|flow |is |worse |than |normal. |Hx |reveals |she |is |G1P1, |has |an |IUD, |& |has |a |hx |of |prior |PID.|VS:

|BP |90/53, |HR |115.|PE |reveals |moderate |amt |of |vaginal |bleeding |through |a |closed |cervical

|os |& |suprapubic |tenderness |w/ |palpation. |Lab |work |reveals |that |a |hCG |level |of |10,000 |& |a

|transvag |US |is |unremarkable. |Best |course |of |action?

-abd |CT |scan

-KUB |(kidney |stone |w/ |uterine |bleeding)

-reassurance |that |a |pregnancy |is |not |large |enough |to |be |seen |@ |this |time

-repeat |hCG |level |in | 48 |hrs

-salpingectomy

  1. IV |glucagon |@ |0.07 |mg/kg: |A | 2 |yo |f |is |brought |into |the |ED |via |ambulance |services |after

|ingesting |an |unknown |quantity |of |her |father's |atenolol. |Her |parents |believe |this |may |have

|happened | 2 |hrs |prior |to |their |arrival |in |the |ED.|VS:|BP |95/60,

HR |65, |resp |rate |25, |O2 |sat |98%. |PE |reveals |a |well |appearing |child |who |appears |fatigued.

|Auscultation |of |the |<3 |is |- |for |murmurs |& |lungs |are |clear |bilat.|You |note |m. |Paravertebral

|spasms |from |T1-4. |Best |next |step?

-activated |charcoal

-IV |D50 |& |sterile |water

-IV |flumazenil |at |0.01 |mg/kg

-IV |glucagon |at |0.07 |mg/kg

-IV |maintenance |fluids

  1. Rhabdomyolysis/myopathy: |Most |common |complication |w/ |succhinylcholine?
  2. III: | 27 |yo |m |presents |to |ED |after |a |MVA. |Emergency |personnel |report |the |pt |admits|to

|severe |abd |pain |& |has |periumbilical |ecchymosis.|VS:|98.2 |deg |F, |HR |136, |BP |67/43, |resp |rate

|32, |O2 |sat |95% |on |2L |nasal |cannula. |A |urinary |catheter |is |inserted |revealing |a |urine |output

|of | 10 |mL/hr.|What |class |of |hemorrhagic |shock |is |this?

  1. 6: |Lacerations |greater |than | hours |from |the |time |of |incident |may |NOT

|undergo |primary |closure

  1. Yes, |his |last |tetanus |was |more |than | 10 |yrs |ago

For |minor |wounds:

-give |if |last |vaccination |was |> | 10 |yrs |ago |or |if |< | 3 |doses |of |tetanus |toxoid |vaccination |previously

For |all |other |wounds:

-give |if |last |vaccination |was |> | 5 |yrs |ago |or |if |< | 3 |doses |of |tetanus |toxoid |vaccination |previously

Eye-opening: | 1

Verbal |response: | 2

Motor |response: |4: | 52 |yo |f |presents |to |ED |w/ |a |CC |of |AMS. |Pt |was |found |by |her |bf |in |an |apt

|lying |on |the |floor |next |to |a |suicide |note |& |multiple |empty |pill |bottles.|Per |EMS, |the |pt |had |a

|blood |glucose |of | 112 |@ |the |scene.|VS: |BP |92/44, |HR |128, |resp |8,|O2 |sat |89%|on |100%|non-

rebreather.|PE |reveals |she |now |only|w/draws |to |painful |stimulation, |is |not |opening |her |eyes

|to |pain, |& |is |groaning |incomprehensible |words. |She |is |provided |naloxone, |but |this |has |no

|effect |on |her |mental |status.|What |is |the |pt's |Glasgow |coma |scale |score?

  1. Rimantadine

-rmr: |rimAntAdine |& |AmAntAdine

Note: |influenza |vaccine |is |used |for |influenza |A |& |B; |note: |rimantadine |& |amantadine |cover |influenza |A

|ONLY! |Other |meds |cover |A |& |B: | 35 |yo |presents |w/|fever, |cough, |& |SOB.|Pt |of |care |testing |is |+ |for

|influenza |B.|Which |of |the |following |would |NOT |provide |appropriate |coverage |against |this

|organism?

-influenza |vaccine

-oseltamavir

-peramivir

-rimantadine

-zanamivir

  1. CT |scan |of |head

-b/c|you|MUST |r/o|life|threatening|etiologies: | 36 |yo|m|has|a|seizure|while|at|work |& |is |transported |to

|the |ED. |A |fellow |employee |is |present |& |he |describes |that |the

pt |slumped |to |the |ground |& |had |a | 30 |sec |ep |of |"whole |body |shaking." |After |this |occurred,

|the |pt |appeared |to |be |alert |& |was |able |to |answer |questions, |however |the |pt |states |that |he

|does |not |rmr |the |ep |nor |the |ambulance |ride. |He |denies |a |hx |of |epilepsy |or |other |significant

|PMHx |& |denies |taking |any |rec |drugs.|PE |is |interrupted |when |the |pt |slumps |back |into |the

|bed |& |starts |shaking |his |upper |& |LE. |During |the |ep,|his|eyes|are|open, |eh|is|yelling

|profanities.|This |occurs|for|~| 2 |min.|Afterward, |he |is |alert |& |oriented |to |person, |place, |& |time,

|& |he |is |at |his |baseline |mental |status |per |his |fellow |employee. |Pt |denies |loss |of |bowel |or

|bladder |incontinence |during |these |ep. |Most |appropriate |management?

-CT |scan |of |head

-EEG

-lorazepam

|reveals |that |she |was |about |to |board |a |cruise |ship |for |a |weekend |getaway |w/ |her |husband,

|but |had |to |come |to |the |hospital |b/c |of |her |discomfort.|VS: |155/89,|HR |121, | 103 |deg |F.|Abd

|exam |reveals |a |distended |bladder |w/out |peritoneal |signs |noted. |Skin |is |flushed |& |dry. |Most

|likely |causative |agent?

-anticholinergic

-CO

-cholinergic

-opioids

-serotonin

  1. US |of |abd

-b/c |safest |& |least |expensive

CT |is |useful |& |should |be |performed |if |U/S |does |not |r/o |acute |appendicitis: | 13

yo |m |presents |w/ |N, |V, |abd |pain |around |belly |button, |& |RLQ. |PE |reveals |tenderness |w/

|rebound |in |the |RLQ |w/ |assoc |guarding, |approx |a |third |of |the |distance |b/w |the |R |iliac |crest

|& |umbilicus. |Lab |studies |reveal |a |WBC |of | 20 |x |10^3/L. |Best |next |step?

-acute |abd |series

-CT |scan |of |abd |w/out |contrast

-KUB

-stool |guaiac

-US |of |abd

  1. Rapid |sequence |intubation

-b/c |most |imp |step |at |this |time |is |this |b/c |pt |is |choking |on |his |own |blood!: | 62 |yo |m |presents |to |ED

|after |vomiting |a |large |amt |of |bright |red |blood |twice |just |prior |to |arrival.|Hx |is |significant |for

|end-stage |liver |dz |secondary|to |chronic |alcohol |abuse |w/ |MELD |score |of |32.|He |reports |his

|only |complaint |at |this |time |is |nausea |& |cough |b/c |he |is |gagging |on |vomitus. |He |suddenly

|leans |forward |& |vomits | 500 |cc |of |bright |red |blood. |Best |next |step?

-IV |octreotide

-IV |fluids

-emergent |EGD

-NG |tube |placement

-rapid |sequence |intubation

  1. Lithium

-phenobarbital

-theophylline

  1. 5

Pt |gets | 1 |pt |if:

-ASA |used |in |the |last | 7 |days

-ST |changes |of |@ |least |0.5 |mm |on |EKG

-elevated |serum |cardiac |biomarkers

-age |> | 65

-known |CAD

-at |least | 2 |angina |ep |w/in |the |last | 24 |hrs

-at|least| 3 |risk |factors:|HTN,|diabetes,|smoker,|FHx |of |premature |coronary|a.|Dz |(CAD |in |m |< | 55 |yo |or |f |< | 65 |yo): | 74

|yo |m |presents|to |ED |w/|CC |of |chest |pain.|Chest |pain |started |earlier |today |& |is |located |in |his |L

|chest |w/ |radiation |to |the |L |side |of |the |neck |& |shoulder.|It |is |described |as |moderate, |dull

|pressure.|He |gets |similar |pain |w/ |heavy|exertion|when|going|upstairs;|however,|he|dev|it

|today|by|just|walking|around |the |1st |floor |of |his |home.|This |pain |recurred | 4 |x |& |was |relieved

|by |rest.|He |does |not |currently |have |any |pain, |however |he |did |have |assoc |N, |SOB,

|lightheadedness, |& |diaphoresis.|Later, |he |called | 911 |b/c |he |was |concerned |that |his |chest

|pain |occurred |multiple |times |today |w/ |min |exertion. |He |takes |aspirin |on |a |daily |basis |due

|to |hx |of |coronary |a.|Dz |status |post | 2 |stents.|PMHx |is |significant |for |HTN, |hyperlipidemia, |&

|type |II |diabetes. |FHx |reveals |that |his |father |died |@ |age | 64 |secondary |to |a |heart |attack. |Pt's

|TIMI |score?

  1. Azithromycin: |Tx |for |bartonella |henslae |from |cat |bite?
  1. Axillary |n. |Over |lat |deltoid |m.: |What's |the |most |commonly |injured |structure |assoc |w/

|shoulder |dislocations?

  1. Prolongation |of |QRS |segment

Note: |give |sodium |bicarb |w/ |QRS |prolongation |> | 100 |msesc |to |prevent |the |effects |from |occurring: |Pt

|OD'd |on |amitriptyline.|What |add'l |finding |is |present?

-AST |of | 868 |IU |& |ALT |of | 967 |IU

-diarrhea,|V, |lacrimation, |diaphoresis, |& |miosis

-formation |of |NAPQI |metabolite

-prolongation |of |QRS |segment

-sedation, |anxiolysis, |m.|Relaxation

  1. SIADH

Note: |psychogenic |polydispia |usually |has |dry |mouth |sx: | 27 |yo |f |had |seizure.