FMCLA Acute Care and Emergency Medicine 2 — Questions and Answers
Question 1: Which clinical feature best differentiates bacterial sinusitis from viral upper respiratory infection?
- Nasal congestion lasting 3 days
- Symptoms worsening after initial improvement (double sickening) (Correct answer)
- Low-grade fever
- Clear nasal discharge
Correct answer: Symptoms worsening after initial improvement (double sickening)
Double sickening — initial improvement followed by worsening — is a hallmark feature suggesting bacterial superinfection in sinusitis.
Question 2: A patient presents with suspected deep vein thrombosis. Which scoring system should be applied before ordering imaging?
- CHADS2 score
- Wells criteria (Correct answer)
- CURB-65 score
- Ottawa rules
Correct answer: Wells criteria
The Wells criteria stratify pretest probability for DVT and guide the decision to perform D-dimer testing or duplex ultrasound.
Question 3: Which of the following is the most appropriate initial management for a simple febrile seizure in a 2-year-old?
- Immediate CT head
- Lumbar puncture
- Supportive care and fever management (Correct answer)
- Initiate anticonvulsant therapy
Correct answer: Supportive care and fever management
Simple febrile seizures are self-limiting and benign; supportive care and antipyretics are appropriate without neuroimaging or anticonvulsants.
Question 4: A patient with known COPD presents in acute exacerbation with SpO2 of 84%. What oxygen delivery target is appropriate?
- SpO2 > 98%
- SpO2 88–92% (Correct answer)
- SpO2 > 95%
- No supplemental oxygen needed
Correct answer: SpO2 88–92%
COPD patients should be targeted to SpO2 88–92% to avoid hypercapnia worsening due to blunted hypoxic drive.
Question 5: Which test is most sensitive for detecting acute pulmonary embolism?
- D-dimer
- CT pulmonary angiography (CTPA) (Correct answer)
- V/Q scan
- Chest X-ray
Correct answer: CT pulmonary angiography (CTPA)
CT pulmonary angiography is the gold-standard imaging modality for diagnosing PE with high sensitivity and specificity.
Question 6: A 60-year-old male presents with sudden painless vision loss in one eye. Which diagnosis must be ruled out immediately?
- Open-angle glaucoma
- Central retinal artery occlusion (Correct answer)
- Diabetic macular edema
- Refractive error
Correct answer: Central retinal artery occlusion
Central retinal artery occlusion is an ophthalmic emergency requiring immediate treatment within hours to restore vision.
FMCLA Acute Care and Emergency Medicine 2
Which clinical feature best differentiates bacterial sinusitis from viral upper respiratory infection?