AOA Patient Care and Management 2 — Questions and Answers
Question 1: A healthy 40-year-old with community-acquired pneumonia, no comorbidities, and a CURB-65 score of 0 should be managed with which regimen?
- Outpatient oral amoxicillin (Correct answer)
- Inpatient IV ceftriaxone plus azithromycin
- Outpatient oral levofloxacin plus amoxicillin-clavulanate
- ICU admission with vancomycin and piperacillin-tazobactam
Correct answer: Outpatient oral amoxicillin
ATS/IDSA guidelines recommend outpatient amoxicillin for healthy adults with low-severity CAP and no comorbidities.
Question 2: A patient with type 2 diabetes and established atherosclerotic cardiovascular disease has an A1c of 8.2% on metformin. Which add-on agent is most appropriate?
- Sulfonylurea
- GLP-1 receptor agonist with proven cardiovascular benefit (Correct answer)
- DPP-4 inhibitor
- Thiazolidinedione
Correct answer: GLP-1 receptor agonist with proven cardiovascular benefit
GLP-1 receptor agonists such as liraglutide lower major adverse cardiovascular events in patients with ASCVD.
Question 3: A 35-year-old presents with 5 days of acute low back pain without red flags. What is the most appropriate initial management?
- Lumbar MRI
- Strict bed rest for one week
- Staying active, NSAIDs, and OMT as indicated (Correct answer)
- Scheduled opioid analgesics
Correct answer: Staying active, NSAIDs, and OMT as indicated
Imaging is not indicated for acute low back pain without red flags, and staying active with NSAIDs and manipulation is first-line.
Question 4: In which patient is cervical HVLA most clearly contraindicated?
- A 30-year-old with acute torticollis
- A 55-year-old with rheumatoid arthritis (Correct answer)
- A 25-year-old with tension headache
- A 45-year-old with a cervical somatic dysfunction after a long drive
Correct answer: A 55-year-old with rheumatoid arthritis
Rheumatoid arthritis can cause atlantoaxial instability, which makes cervical HVLA dangerous.
Question 5: A patient with a potassium of 7.1 mEq/L has peaked T waves and a widened QRS. What is the first treatment?
- Sodium polystyrene sulfonate
- IV calcium gluconate (Correct answer)
- Furosemide
- Oral potassium restriction
Correct answer: IV calcium gluconate
IV calcium stabilizes the cardiac membrane right away, while other therapies shift or remove potassium.
Question 6: In a patient with diabetic ketoacidosis, insulin infusion should be held until potassium is at least what level?
- 2.5 mEq/L
- 3.3 mEq/L (Correct answer)
- 4.5 mEq/L
- 5.2 mEq/L
Correct answer: 3.3 mEq/L
Insulin shifts potassium into cells, so it is held when K is below 3.3 mEq/L until potassium is replaced.
Question 7: What is the correct initial treatment for an adult with anaphylaxis?
- IV diphenhydramine 50 mg
- Epinephrine 0.3–0.5 mg IM (1 mg/mL) in the anterolateral thigh (Correct answer)
- Methylprednisolone 125 mg IV
- Epinephrine 1 mg IV push (0.1 mg/mL)
Correct answer: Epinephrine 0.3–0.5 mg IM (1 mg/mL) in the anterolateral thigh
IM epinephrine in the anterolateral thigh is first-line for anaphylaxis, and antihistamines and steroids are only adjuncts.
