Family Practice Exam Acute Care 5 — Questions and Answers
Question 1: A 50-year-old with a history of alcohol use presents with tremors, diaphoresis, and visual hallucinations 36 hours after his last drink. What is the treatment of choice?
- Haloperidol
- Benzodiazepines (Correct answer)
- Propranolol
- Phenobarbital alone
Correct answer: Benzodiazepines
Benzodiazepines are first-line for alcohol withdrawal delirium and seizure prevention by cross-reacting at GABA receptors.
Question 2: A 22-year-old presents with fever, purpuric rash, neck stiffness, and shock. What organism is most likely responsible?
- Streptococcus pneumoniae
- Listeria monocytogenes
- Neisseria meningitidis (Correct answer)
- Haemophilus influenzae
Correct answer: Neisseria meningitidis
Neisseria meningitidis causes meningococcemia, characterized by purpuric/petechial rash, meningitis, and septic shock.
Question 3: A patient with a serum acetaminophen level of 250 mcg/mL at 4 hours post-ingestion plots above the Rumack-Matthew nomogram treatment line. What is the antidote?
- Activated charcoal only
- N-acetylcysteine (NAC) (Correct answer)
- Flumazenil
- Naloxone
Correct answer: N-acetylcysteine (NAC)
N-acetylcysteine replenishes glutathione and is the antidote for acetaminophen toxicity when levels exceed the treatment threshold.
Question 4: A 75-year-old on warfarin for AFib presents to the ED with an intracerebral hemorrhage. INR is 4.2. What is the most appropriate reversal strategy?
- Vitamin K alone
- Fresh frozen plasma alone
- 4-factor prothrombin complex concentrate (PCC) plus vitamin K (Correct answer)
- Protamine sulfate
Correct answer: 4-factor prothrombin complex concentrate (PCC) plus vitamin K
4-factor PCC provides rapid, complete reversal of warfarin with smaller volume than FFP, combined with vitamin K for sustained effect.
Question 5: A 38-year-old female presents with pleuritic chest pain, dyspnea, and unilateral leg swelling after a long flight. D-dimer is elevated. What imaging is the gold standard for diagnosis?
- Chest X-ray
- V/Q scan
- CT pulmonary angiography (Correct answer)
- Doppler ultrasound of the leg
Correct answer: CT pulmonary angiography
CT pulmonary angiography (CTPA) is the gold standard for diagnosing pulmonary embolism, offering high sensitivity and specificity.
Question 6: Which of the following best describes the management of anaphylaxis as the first-line treatment?
- IV diphenhydramine
- IM epinephrine to the lateral thigh (Correct answer)
- IV corticosteroids
- Inhaled albuterol
Correct answer: IM epinephrine to the lateral thigh
IM epinephrine to the lateral thigh is the first and most critical intervention in anaphylaxis due to its rapid onset and dual alpha/beta effects.
Question 7: A 45-year-old presents with abdominal pain, vomiting, and serum lipase of 1,200 U/L. CT shows peripancreatic fat stranding. Which finding would indicate severe acute pancreatitis requiring ICU care?
- Serum lipase >3x normal
- Persistent organ failure for >48 hours (Correct answer)
- BMI >30
- Fever >38.5°C on day 1
Correct answer: Persistent organ failure for >48 hours
Persistent (>48 hours) single or multi-organ failure defines severe acute pancreatitis with high morbidity and mortality requiring ICU-level care.
Family Practice Exam Acute Care 5
A 50-year-old with a history of alcohol use presents with tremors, diaphoresis, and visual hallucinations 36 hours after his last drink.
What is the treatment of choice?