AANP Emergency and Urgent Care 1 — Questions and Answers
Question 1: A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' What must be immediately ruled out?
- Tension headache
- Migraine with aura
- Subarachnoid hemorrhage (Correct answer)
- Cluster headache
Correct answer: Subarachnoid hemorrhage
A thunderclap headache (sudden, severe, worst of life) is subarachnoid hemorrhage until proven otherwise; immediate non-contrast CT head is required.
Question 2: A patient with known COPD presents with increased dyspnea, productive cough, and wheezing. Oxygen saturation is 88%. What is the appropriate oxygen target?
- Maintain SpO2 at 98–100%
- Maintain SpO2 at 88–92% (Correct answer)
- Administer high-flow oxygen regardless of SpO2
- Withhold oxygen to avoid CO2 retention
Correct answer: Maintain SpO2 at 88–92%
In COPD exacerbations, oxygen should be titrated to maintain SpO2 at 88–92% to relieve hypoxemia without suppressing the hypoxic respiratory drive and causing hypercapnia.
Question 3: A patient presents with sudden dyspnea, pleuritic chest pain, and hypoxia after a long flight. Which test is most appropriate to confirm the diagnosis?
- Chest X-ray
- ECG
- CT pulmonary angiography (CTPA) (Correct answer)
- D-dimer alone
Correct answer: CT pulmonary angiography (CTPA)
CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism, directly visualizing clots in the pulmonary vasculature.
Question 4: A patient presents with sudden-onset unilateral weakness, facial droop, and slurred speech that resolved in 30 minutes. This presentation is most consistent with:
- Migraine with aura
- Todd's paralysis
- Transient ischemic attack (TIA) (Correct answer)
- Bell's palsy
Correct answer: Transient ischemic attack (TIA)
TIA presents with sudden-onset focal neurological deficits that resolve within 24 hours (typically minutes) and requires urgent evaluation for stroke prevention.
Question 5: Which ECG finding indicates ST-elevation myocardial infarction (STEMI) requiring emergent intervention?
- ST depression in V1–V4
- New ST elevation ≥1 mm in two contiguous leads (Correct answer)
- T-wave inversion in III and aVF
- PR interval prolongation
Correct answer: New ST elevation ≥1 mm in two contiguous leads
STEMI is defined by new ST elevation ≥1 mm in two or more contiguous leads (or ≥2 mm in V1–V3), indicating transmural ischemia requiring emergent PCI or thrombolytics.
Question 6: A patient is found unresponsive with agonal breathing. What is the FIRST action per current AHA guidelines?
- Check blood glucose
- Apply an AED immediately
- Call for help and begin high-quality CPR (Correct answer)
- Administer naloxone
Correct answer: Call for help and begin high-quality CPR
Current AHA guidelines prioritize calling for emergency assistance and initiating high-quality chest compressions immediately for an unresponsive patient with absent or abnormal breathing.
AANP Emergency and Urgent Care 1
A patient presents with sudden-onset severe headache described as 'the worst headache of my life.' What must be immediately ruled out?