Emergency medicine: reversible causes of arrest: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Emergency medicine: reversible causes of arrest

Sample item

A 30-year-old man with rib fractures after a road traffic collision collapses. The monitor shows an organised rhythm with no pulse. The trachea is deviated to the left, breath sounds are absent on the right and the neck veins are distended. Along with CPR, what is the immediate intervention?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Needle decompression of the right chest, followed by a chest drain

An organised rhythm without a pulse is pulseless electrical activity, a non-shockable rhythm managed with CPR, adrenaline and treatment of the reversible causes (4H and 4T). Deviated trachea, absent breath sounds and distended neck veins after chest trauma indicate tension pneumothorax, which is relieved at once by decompression and a chest drain, without waiting for imaging.

Option by option

  • A. Defibrillation at 200 J

    PEA is non-shockable, so a shock is not indicated and does nothing for the cause.

  • B. Pericardiocentesis

    Pericardiocentesis treats tamponade, but tracheal deviation and absent breath sounds point to the chest.

  • C. Needle decompression of the right chest, followed by a chest drain (correct)

    Correct. Relieving the tension restores venous return and cardiac output.

  • D. Intravenous thrombolysis

    Thrombolysis is for suspected massive PE and would be dangerous in a trauma patient.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Needle decompression of the right chest, followed by a chest drain. An organised rhythm without a pulse is pulseless electrical activity, a non-shockable rhythm managed with CPR, adrenaline and treatment of the reversible causes (4H and 4T).

Why is "Defibrillation at 200 J" not the answer?

PEA is non-shockable, so a shock is not indicated and does nothing for the cause.

Why is "Pericardiocentesis" not the answer?

Pericardiocentesis treats tamponade, but tracheal deviation and absent breath sounds point to the chest.

Why is "Intravenous thrombolysis" not the answer?

Thrombolysis is for suspected massive PE and would be dangerous in a trauma patient.

What concept does this question test?

It tests Emergency medicine: reversible causes of arrest in General Medicine. Deviated trachea, absent breath sounds and distended neck veins after chest trauma indicate tension pneumothorax, which is relieved at once by decompression and a chest drain, without waiting for imaging.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Emergency medicine: reversible causes of arrest?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.