APEA Acute Care and Urgent Presentations

Question 1

A 60-year-old patient presents with sudden-onset severe headache described as the worst headache of their life. What is the priority diagnosis to rule out?

Accepted Answer

Subarachnoid hemorrhage (SAH) — a neurological emergency requiring immediate CT head without contrast

Answer

Tension-type headache requiring NSAIDs

Answer

Migraine with aura requiring triptan therapy

Answer

Cluster headache requiring oxygen therapy

Question 2

A 55-year-old male presents to primary care with right-sided facial droop, arm weakness, and slurred speech of 45-minute duration. The most appropriate immediate action is:

Accepted Answer

Activate emergency medical services immediately — potential ischemic stroke within tPA administration window

Answer

Schedule an MRI for next week as symptoms may resolve

Answer

Administer aspirin 325mg and observe in clinic for 2 hours

Answer

Order outpatient carotid ultrasound and neurology referral

Question 3

A 35-year-old female presents with sudden-onset dyspnea, pleuritic chest pain, and leg swelling after a 12-hour flight. D-dimer is elevated. What is the most appropriate next diagnostic step?

Accepted Answer

CT pulmonary angiography (CTPA) to confirm or exclude pulmonary embolism

Answer

Chest X-ray alone to rule out pneumonia

Answer

Echocardiogram as the initial definitive test

Answer

Arterial blood gas only

Question 4

A 72-year-old diabetic patient presents with a red, hot, swollen knee joint with fever and WBC of 18,000. Joint aspiration reveals WBC of 75,000 with 90% PMNs and gram-positive cocci on Gram stain. The diagnosis is:

Accepted Answer

Septic arthritis — a medical emergency requiring immediate joint irrigation and IV antibiotics

Answer

Pseudogout (calcium pyrophosphate crystal arthropathy)

Answer

Rheumatoid arthritis acute flare

Answer

Gout with secondary infection

Question 5

A 45-year-old male presents with tearing chest pain radiating to the back, unequal blood pressures between arms, and a widened mediastinum on CXR. The most critical diagnosis to evaluate for is:

Accepted Answer

Aortic dissection — a vascular emergency requiring emergent CT aortography and immediate blood pressure control

Answer

Acute STEMI requiring immediate cardiac catheterization

Answer

Costochondritis with referred back pain

Answer

Pulmonary embolism requiring anticoagulation

Question 6

A 28-year-old female presents with severe right lower quadrant pain, fever, and vaginal discharge. Pelvic exam reveals cervical motion tenderness, uterine tenderness, and adnexal tenderness. The most likely diagnosis is:

Accepted Answer

Pelvic inflammatory disease (PID) — treat empirically without waiting for culture results

Answer

Appendicitis requiring immediate surgical consultation

Answer

Ovarian torsion requiring only analgesics

Answer

Urinary tract infection causing referred pain