Acute Care and Urgent Presentations Flashcards

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?

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

A thunderclap headache is subarachnoid hemorrhage until proven otherwise. Immediate non-contrast CT head is required; if negative but SAH still suspected, lumbar puncture for xanthochromia is indicated.

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:

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

Acute focal neurological deficits consistent with stroke require immediate EMS activation. The tPA administration window is 3-4.5 hours from symptom onset. Any delay reduces treatment eligibility.

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?

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

Elevated D-dimer in the context of high clinical suspicion for PE requires CT pulmonary angiography as the gold standard imaging study to confirm or exclude PE.

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:

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

Synovial fluid WBC above 50,000 with PMN predominance and organisms on Gram stain is diagnostic of septic arthritis, a medical emergency. Untreated septic arthritis causes joint destruction within 24-48 hours.

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:

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

Tearing pain radiating to the back, unequal arm blood pressures, and widened mediastinum is the classic triad of aortic dissection — a surgical emergency with mortality of approximately 1-2% per hour without treatment.

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:

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

The clinical triad of cervical motion tenderness plus uterine tenderness plus adnexal tenderness meets minimum CDC diagnostic criteria for PID. Treatment should begin empirically to prevent tubal scarring and infertility.