Family Practice Exam Acute Care 4 — Questions and Answers
Question 1: A 25-year-old male is brought in after a motor vehicle accident with BP 80/50, HR 130, and distended neck veins. Breath sounds are equal bilaterally. What is the most likely diagnosis?
- Tension pneumothorax
- Hemothorax
- Cardiac tamponade (Correct answer)
- Aortic laceration
Correct answer: Cardiac tamponade
Beck's triad of hypotension, distended neck veins, and muffled heart sounds suggests cardiac tamponade.
Question 2: A 60-year-old presents with sudden vision loss in one eye described as a 'curtain coming down.' What is the most likely diagnosis?
- Central retinal artery occlusion
- Retinal detachment (Correct answer)
- Acute angle-closure glaucoma
- Vitreous hemorrhage
Correct answer: Retinal detachment
Painless monocular vision loss described as a descending curtain is the classic presentation of retinal detachment.
Question 3: A patient with liver cirrhosis presents with fever, abdominal pain, and ascites with PMN count >250 cells/mm³ on paracentesis. What is the first-line treatment?
- IV vancomycin
- IV cefotaxime (Correct answer)
- Oral metronidazole
- Observation only
Correct answer: IV cefotaxime
Spontaneous bacterial peritonitis is treated with IV cefotaxime (third-generation cephalosporin) as first-line therapy.
Question 4: A 3-year-old is brought to the ED with drooling, high fever, muffled voice, and appears anxious sitting in the 'sniffing position.' What is the most important next step?
- Throat culture
- Lateral neck X-ray only
- Immediate otolaryngology and anesthesia consultation for airway management (Correct answer)
- Administer oral amoxicillin
Correct answer: Immediate otolaryngology and anesthesia consultation for airway management
Epiglottitis is a life-threatening emergency requiring immediate airway securing in a controlled setting with surgical backup.
Question 5: A 68-year-old presents with sudden onset of atrial fibrillation with RVR (HR 145 bpm) and is hemodynamically stable. What is the preferred acute rate-control agent?
- Adenosine IV push
- Diltiazem IV (Correct answer)
- Digoxin IV
- Atropine IV
Correct answer: Diltiazem IV
IV diltiazem (calcium channel blocker) provides rapid rate control in hemodynamically stable atrial fibrillation with rapid ventricular response.
Question 6: A patient presents with high fever, altered mental status, muscle rigidity, and autonomic instability after starting haloperidol. What is the diagnosis?
- Serotonin syndrome
- Neuroleptic malignant syndrome (Correct answer)
- Malignant hyperthermia
- Anticholinergic toxicity
Correct answer: Neuroleptic malignant syndrome
Neuroleptic malignant syndrome (NMS) is caused by antipsychotic agents and presents with hyperthermia, rigidity, altered consciousness, and autonomic instability.
Question 7: Which is the most appropriate management for a patient with acute ischemic stroke who presents within 4.5 hours of symptom onset and has no contraindications?
- Aspirin 325 mg only
- IV alteplase (tPA) (Correct answer)
- Heparin drip
- Clopidogrel loading dose
Correct answer: IV alteplase (tPA)
IV alteplase within 4.5 hours of ischemic stroke onset improves neurological outcomes when no contraindications are present.
Family Practice Exam Acute Care 4
A 25-year-old male is brought in after a motor vehicle accident with BP 80/50, HR 130, and distended neck veins.
Breath sounds are equal bilaterally.
What is the most likely diagnosis?