Family Practice Exam Acute Care 2 — Questions and Answers
Question 1: A 55-year-old male presents with sudden-onset tearing chest pain radiating to the back. BP is 180/100 mmHg in the right arm and 150/85 mmHg in the left arm. What is the most likely diagnosis?
- Acute MI
- Aortic dissection (Correct answer)
- Pulmonary embolism
- Esophageal rupture
Correct answer: Aortic dissection
Aortic dissection classically presents with tearing chest pain radiating to the back and BP differential between arms.
Question 2: A patient presents with fever, nuchal rigidity, and photophobia. Lumbar puncture shows CSF with elevated protein, low glucose, and predominantly neutrophils. What is the most appropriate initial antibiotic?
- Vancomycin alone
- Ceftriaxone plus vancomycin (Correct answer)
- Ampicillin alone
- Metronidazole plus gentamicin
Correct answer: Ceftriaxone plus vancomycin
Bacterial meningitis requires broad coverage with ceftriaxone plus vancomycin to cover resistant organisms including S. pneumoniae.
Question 3: A 28-year-old presents with sudden severe headache described as 'the worst headache of my life.' CT head is negative. What is the next best step?
- Discharge with analgesics
- MRI brain with contrast
- Lumbar puncture (Correct answer)
- Neurology referral in 1 week
Correct answer: Lumbar puncture
A negative CT does not rule out subarachnoid hemorrhage; lumbar puncture is required to detect xanthochromia or RBCs.
Question 4: A 70-year-old diabetic presents with confusion, polyuria, and blood glucose of 850 mg/dL. Serum ketones are absent. What is the diagnosis?
- Diabetic ketoacidosis
- Hyperosmolar hyperglycemic state (Correct answer)
- Lactic acidosis
- Hypoglycemia
Correct answer: Hyperosmolar hyperglycemic state
Hyperosmolar hyperglycemic state features markedly elevated glucose without significant ketosis, common in type 2 diabetics.
Question 5: Which medication is CONTRAINDICATED in a patient presenting with acute decompensated heart failure and cardiogenic shock?
- IV furosemide
- Nitroglycerin
- Metoprolol (Correct answer)
- Dobutamine
Correct answer: Metoprolol
Beta-blockers like metoprolol are contraindicated in cardiogenic shock because they reduce cardiac output further.
Question 6: A 40-year-old presents with fever, productive cough, and right lower lobe infiltrate on CXR. She is tachycardic and hypotensive. According to CURB-65, what score warrants ICU admission consideration?
- Score of 1
- Score of 2
- Score of 3 or higher (Correct answer)
- Score of 5 only
Correct answer: Score of 3 or higher
A CURB-65 score of 3 or higher indicates severe community-acquired pneumonia and warrants consideration of ICU-level care.
Question 7: A patient receiving heparin develops a platelet count drop from 280,000 to 85,000 on day 8 of therapy. What is the most appropriate next step?
- Increase heparin dose
- Switch to low-molecular-weight heparin
- Stop heparin and start argatroban (Correct answer)
- Transfuse platelets
Correct answer: Stop heparin and start argatroban
Heparin-induced thrombocytopenia (HIT) requires immediate cessation of all heparin products and initiation of a direct thrombin inhibitor like argatroban.
Family Practice Exam Acute Care 2
A 55-year-old male presents with sudden-onset tearing chest pain radiating to the back.
BP is 180/100 mmHg in the right arm and 150/85 mmHg in the left arm.
What is the most likely diagnosis?