AANP Emergency and Urgent Care 2 — Questions and Answers
Question 1: A patient with type 1 diabetes presents with Kussmaul respirations, fruity breath, nausea, and blood glucose of 480 mg/dL. What is the most likely diagnosis?
- Hyperosmolar hyperglycemic state
- Diabetic ketoacidosis (DKA) (Correct answer)
- Lactic acidosis
- Hyperglycemic hyperosmolar syndrome
Correct answer: Diabetic ketoacidosis (DKA)
DKA presents with hyperglycemia, Kussmaul breathing (compensating for metabolic acidosis), fruity breath from ketones, and is more common in type 1 diabetes.
Question 2: Which analgesic is contraindicated in a patient with known G6PD deficiency presenting with pain?
- Acetaminophen
- Ibuprofen
- Primaquine (not an analgesic; which NSAID triggers hemolysis)
- Aspirin in high doses causing oxidative hemolysis (Correct answer)
Correct answer: Aspirin in high doses causing oxidative hemolysis
High-dose aspirin can cause oxidative hemolysis in G6PD-deficient patients because it increases oxidative stress that G6PD normally protects against; acetaminophen is generally safe.
Question 3: A patient with a bee sting develops urticaria, throat tightness, and hypotension. What is the first-line treatment?
- IV diphenhydramine
- Oral corticosteroids
- Epinephrine 0.3 mg IM in the anterolateral thigh (Correct answer)
- Albuterol nebulizer treatment
Correct answer: Epinephrine 0.3 mg IM in the anterolateral thigh
IM epinephrine is the life-saving first-line treatment for anaphylaxis; it reverses bronchoconstriction and vasodilation and prevents progression to cardiovascular collapse.
Question 4: In a patient with suspected sepsis, what intervention should be initiated within the first hour per Surviving Sepsis guidelines?
- Broad-spectrum antibiotics and 30 mL/kg IV crystalloid (Correct answer)
- Vasopressors immediately without fluids
- Blood cultures and wait for results before antibiotics
- CT scan before any treatment
Correct answer: Broad-spectrum antibiotics and 30 mL/kg IV crystalloid
The 1-hour sepsis bundle includes blood cultures, broad-spectrum antibiotics, and 30 mL/kg IV crystalloid for hypotension or lactate ≥4, with reassessment for vasopressors.
Question 5: A patient presents with confusion, fever, neck stiffness, and photophobia. Lumbar puncture is planned. Which action should precede the LP?
- Start antibiotics only after LP results
- Obtain CT head to rule out mass effect if indicated, and do not delay antibiotics (Correct answer)
- Perform LP immediately without any imaging
- Observe for 6 hours before any intervention
Correct answer: Obtain CT head to rule out mass effect if indicated, and do not delay antibiotics
If bacterial meningitis is suspected, antibiotics must NOT be delayed for LP or CT; CT is obtained first only if there is concern for increased ICP (focal deficits, papilledema), and antibiotics should be started immediately.
Question 6: A patient is brought in after intentional overdose of tricyclic antidepressants (TCAs). Which ECG finding is most concerning for cardiac toxicity?
- Sinus bradycardia
- QRS widening greater than 100 ms (Correct answer)
- Peaked T waves
- Short QT interval
Correct answer: QRS widening greater than 100 ms
TCA overdose causes sodium channel blockade leading to QRS widening; a QRS >100 ms predicts ventricular arrhythmias and >160 ms predicts ventricular fibrillation.
AANP Emergency and Urgent Care 2
A patient with type 1 diabetes presents with Kussmaul respirations, fruity breath, nausea, and blood glucose of 480 mg/dL.
What is the most likely diagnosis?