66 yo woman presents to the emergency room with 3 hours of right-sided face and arm numbness and weakness. In the ER, her examination confirms both a sensory and motor deficit involving the right face and arm.

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Question 1 of 5

66 yo woman presents to the emergency room with 3 hours of right-sided face and arm numbness and weakness. In the ER, her examination confirms both a sensory and motor deficit involving the right face and arm.

Correct Answer: D

Rationale: tPA is the first-line treatment for acute ischemic stroke within the appropriate time window.

Question 2 of 5

Which of the following is a common clinical feature of community-acquired pneumonia?

Correct Answer: D

Rationale: Cough, fever, and pleuritic chest pain are all common clinical features of community-acquired pneumonia, making 'All of the above' the correct answer.

Question 3 of 5

A 30-year-old woman is admitted to the ICU for management of respiratory failure due to influenza A. She is intubated and mechanically ventilated. Ventilator settings are in the volume control continuous mandatory ventilation (assist control) with a respiratory rate of 18, tidal volume of 360 mL (6 cc/kg of ideal body weight) and an FiO2 of 0.9, and a positive end-expiratory pressure of 14 cmH2O. Her plateau pressure is 28 cmH2O. Because of difficulty with oxygenation, she is paralyzed and appropriately monitored for depth of paralytic and sedation. Medical history is otherwise unremarkable. On physical examination, the temperature is 101.8°F; blood pressure is 112/64 mmHg, pulse rate is 85 b/min, respiratory rate is 18. BMI is 29. There is no jugular venous distention. Coarse breath sounds noted bilaterally. No other physical exam findings noted. Chest radiograph shows appropriate placed endotracheal tube with diffuse patchy infiltrates throughout both lung fields. Arterial blood gas study showed pH 7.41, PaCO2 of 38 mmHg, PaO2 of 55 mmHg. Which of the following is the most appropriate next step in the management of this patient?

Correct Answer: C

Rationale: The patient has severe hypoxemia (PaO2 of 55 mmHg) despite high FiO2 (0.9) and PEEP (14 cmH2O), indicative of acute respiratory distress syndrome (ARDS) due to influenza A. Prone positioning is a well-established intervention in ARDS to improve oxygenation by enhancing ventilation-perfusion matching, supported by clinical guidelines and trials like the PROSEVA study.

Question 4 of 5

The common denominator in all forms of heart failure is

Correct Answer: B

Rationale: The common manifestation of all forms of heart failure is the failure of the heart to pump blood adequately. The clinical presentation may differ depending on which ventricle fails (left or right, or both). Poor diastolic filling is not seen in all forms of heart failure. Pulmonary edema is seen in left-sided failure. Tissue ischemia is directly related to myocardial infarction, which may induce heart failure.

Question 5 of 5

The most common causes of heart failure are

Correct Answer: A

Rationale: The most common causes of heart failure are myocardial ischemia from coronary artery disease, followed by hypertension. Dilated cardiomyopathy is less common cause of heart failure. A high-fat diet can contribute to coronary artery disease, which is a contributor to heart failure, but a high-fat diet is not one of the most common causes of heart failure.

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