Acute Care and Urgent Presentations Flashcards

A 19-year-old male presents with right testicular pain and swelling of 3 hours duration. Cremasteric reflex is absent. The immediate next step is:

Answer: Emergent urology consultation for suspected testicular torsion — surgical detorsion is required within 4 to 6 hours to preserve testicular viability

Absent cremasteric reflex with acute onset testicular pain is testicular torsion until proven otherwise. Surgical detorsion within 4-6 hours preserves testicular viability in more than 95% of cases.

A 65-year-old patient on warfarin presents with sudden onset severe headache, left-sided weakness, and confusion. CT head without contrast shows a hyperdense region in the right basal ganglia. The most likely diagnosis and immediate management is:

Answer: Intracerebral hemorrhage — reverse anticoagulation immediately with 4-factor PCC or FFP, and involve neurosurgery

Hyperdense region on non-contrast CT in an anticoagulated patient with acute focal deficits indicates intracerebral hemorrhage. Emergent anticoagulation reversal with 4-factor prothrombin complex concentrate minimizes hematoma expansion.

A 55-year-old patient with known COPD presents in acute respiratory distress with RR 32, SpO2 82%, pursed-lip breathing, and use of accessory muscles. Initial management priority is:

Answer: Supplemental oxygen titrated to SpO2 88 to 92%, short-acting bronchodilators (albuterol plus ipratropium), and systemic corticosteroids

Acute COPD exacerbation management: controlled oxygen targeting SpO2 88-92% (avoid hyperoxia), inhaled bronchodilators (SABA plus SAMA), and systemic corticosteroids. NIV (BiPAP) for persisting hypercapnia before considering intubation.

A 40-year-old female presents with her 5th urinary tract infection in 12 months. Urine cultures consistently grow E. coli. The most appropriate management to prevent recurrent UTIs is:

Answer: Evaluate for structural urinary abnormalities; consider prophylactic antibiotics (TMP-SMX or nitrofurantoin), post-coital antibiotics if coitally related, or patient-initiated therapy

Recurrent UTIs (2 or more in 6 months or 3 or more in 12 months) warrant evaluation for predisposing factors and management with evidence-based prophylactic strategies.

A 10-year-old child presents with high fever, severe odynophagia, uvular deviation, drooling, and a muffled 'hot potato' voice. This presentation is most concerning for:

Answer: Peritonsillar abscess (PTA) requiring drainage and IV antibiotics

Peritonsillar abscess presents with fever, severe throat pain, uvular deviation away from the abscess, drooling, and muffled hot potato voice due to peritonsillar pus collection. Treatment: needle aspiration or incision and drainage plus IV antibiotics.

A 78-year-old nursing home patient presents with fever, altered mental status, and decreased urine output. Vital signs: BP 88/60, HR 118, RR 26, Temp 38.9°C. Suspected source is urinary. Per Sepsis-3 criteria, which finding most strongly suggests septic shock?

Answer: Hypotension requiring vasopressors to maintain MAP of 65 mmHg or higher with elevated lactate above 2 mmol/L despite adequate fluid resuscitation

Sepsis-3 defines septic shock as sepsis with vasopressor requirement to maintain MAP of 65 mmHg or higher and serum lactate above 2 mmol/L despite adequate fluid resuscitation.