Sample Acute Care Medicine QBank Test

A 47-year-old woman presents to the ED with right upper quadrant pain, nausea, and occasional vomiting that began one week after eating raw oysters. On examination, she has mild right upper quadrant tenderness, and there is no jaundice.  She has a negative Murphy’s sign. Her laboratory values are notable for elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT). Ultrasound is negative for gallstones or cholecystitis.  Which of the following is true regarding her condition?

A 18-year-old girl presents to the ED after twisting her ankle.  Her vital signs are blood pressure 175/75 mm Hg, HR 80, and RR 14. The patient tells you that she has had headaches, chest pain, and fatigue over the previous few months. There is a systolic murmur in the left infraclavicular area and under the left scapula. Which of the following is the most important next step in management?

A 31-year-old man presents with severe lip and tongue swelling due to hereditary angioedema. While you prepare for the possibility of a definitive airway, which of the following treatments will have the most benefit for this condition?

A 10 year old girl presents to the emergency department after ingesting an unknown amount of iron tablets. What sign or symptom predicts significant systemic toxicity in the setting of an iron overdose?

A 61-year-old woman has pain and swelling of the face that began yesterday. Her symptoms began abruptly with a fever and chills. Physical exam reveals bright red, indurated skin in a malar distribution. What is the most likely diagnosis?

A 17-year-old girl presents with the above rash a week after hiking in the woods. She does not report a tick bite. She otherwise has no symptoms. What management is indicated?

A 31-year-old woman presents to minor care complaining of heat intolerance and palpitations.  She has a history of bipolar disorder and says her symptoms started after a recent flu-like illness. She takes lithium. Her vital signs are normal, and on exam you note non-tender thyroid enlargement.  Which of the following is the next best step?

A 29-year-old man with type 2 diabetes and depression had a panic attack at work and presents with acute onset palpitations, numbness and tingling in the hands and feet. When paramedics arrived, his palpitations had improved.  His blood glucose is 146.  On exam, he is anxious, mildy tachycardic and tachypneic. What is the most likely cause of his neurologic symptoms?

A normally healthy 3-year-old boy has been running a fever of 101.5°F to 103.0°F at home for two days, along with a sore throat, runny nose, and lack of appetite. You make a diagnosis of viral pharyngitis and plan to discharge the patient home with follow-up with their family physician if not better in two or three days. What other discharge instructions are appropriate?  

A 64-year-old man presents to the Emergency Department by paramedics after being found down in a neighbor’s yard. He has slurred speech and smells of alcohol. Laboratory tests reveal sodium 148 mmol/L, potassium 5.8 mmol/L, chloride 118 mmol/L, bicarbonate 22 mmol/L, urea nitrogen 40 mg/dL, creatinine 1.6 mg/dL, glucose 225 mg/dL, and creatine kinase 24,400 U/L. Which of the following is indicated at this time? 

A 46-year-old man has had personality changes and confusion for 2 days. On presentation, you discover a weak left leg, speech impairment and low-grade fever. All other neurologic exam findings are normal.  A brain MRI shows right temporal lobe edema. Cerebrospinal fluid analysis has an elevated number of red blood cells and the Gram stain is negative for bacteria. Which of the following is the most likely diagnosis?

A 36-year-old woman is diagnosed with her sixth spontaneous abortion. Which of the following is the most likely underlying diagnosis?

A 19-year-old girl presents to the emergency department with pain and mild itching to an area on her foot.  It is swollen. Earlier in the day, she felt a sting to her foot and quickly noticed some redness to the area. Over the next few hours, the top of her foot became more erythematous and swollen, and a small pustule developed in the center of the injury. She denies other symptoms.  What is the most appropriate treatment of this injury?

A 61 year-old man presents with acute on chronic knee pain and reports a history of arthritis and joint edema.  Exam shows a warm, tender left knee without fever, and full but painful range of motion.  An arthrocentesis is performed and reveals rhomboid shaped, positively birefringent crystals. What is the most likely diagnosis? 

A 7-day-old girl has difficulty feeding. There is resistance when placing an NG tube, and  you cannot advance the tube. Which of the following supports the suspected diagnosis?  

A woman in her third trimester of pregnancy is involved in a motor vehicle collision. She presents to the ED with new onset vaginal bleeding and pelvic pain. Which of the following laboratory abnormalities would you expect to find in this patient?

A 22-year-old was emptying a bottle when a chemical liquid plashed into his right eye. The bottle is not available. Irrigation is started with normal saline. Which of the following is the most proper end point of irrigation?

Which of the following predicts the highest risk of suicide completion?

A 49-year-old woman has respiratory distress and is hypotensive. Her past medical history is significant for systemic lupus erythematosus, interstitial lung disease on 2 L of oxygen chronically, diabetes mellitus, and severe pulmonary hypertension. She was doing well until three days ago when she started having increased work of breathing and developed lightheadedness with exertion. She is now up to 4 L of oxygen at home and experiencing lightheadedness even while seated. She had one episode of syncope this morning. She also reports a productive cough, rhinorrhea, and odynophagia. Vital signs are remarkable for temperature 102.4°F, HR 130, RR 30, BP 90/52, and oxygen saturation of 87% on 4 L of oxygen. You note coarse wheezing and rales on auscultation. The chest X-ray demonstrates a left lower lobe infiltrate with a left-sided parapneumonic effusion. Which of the following treatment options would worsen the patient‘s hemodynamic status?

A 14-day-old boy presents with copious purulent drainage from his left eye. One day after an uneventful vaginal delivery, mom developed vaginal irritation. Which of the following is the most likely etiology of the patient’s conjunctivitis?