Family Practice Exam Acute Care 2

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?

Accepted Answer

Aortic dissection

Answer

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?

Accepted Answer

Ceftriaxone plus vancomycin

Answer

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?

Accepted Answer

Lumbar puncture

Answer

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?

Accepted Answer

Hyperosmolar hyperglycemic state

Answer

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?

Accepted Answer

Metoprolol

Answer

Beta-blockers like metoprolol are contraindicated in cardiogenic shock because they reduce cardiac output further.

Family Practice Exam Practice Test

Family Practice Exam Practice Test

Family Practice Exam Acute Care 2