Sensory
A patient reports sudden severe eye pain, blurred vision, and halos around lights. What is the priority concern?
Acute angle-closure glaucoma (with acutely increased IOP). Sudden painful vision changes with halos indicate increased intraocular pressure, which is an emergency.
A patient with a femur fracture becomes acutely confused and short of breath. What is the priority concern?
Fat embolism syndrome that results in hypoxia and requires intensive treatment. Early neurologic changes and hypoxia after fracture indicate fat embolism.
$100 BONUS: What other sign might be present?
A patient with lupus reports foamy urine and swelling. What lab (s) should be checked and what should be assessed?
Creatinine, BUN; edema and urinary output. Lupus nephritis is likely present.
A patient with BPH reports difficulty starting urination and weak stream. What is the underlying cause?
Urethral obstruction from prostate enlargement. BPH symptoms result from compression of the urethra.
A patient has a mole with irregular borders and color variation. What is the priority concern?
Melanoma. ABCDE changes indicate possible malignant melanoma.
$100 BONUS: What if they had a lesion with rolled borders and induration within the center of the lesion? What would you anticipate it is and is it likely to metastasis?
A patient with vertigo reports tinnitus and hearing loss in one ear. What condition is most likely?
Ménière’s disease, which presents with vertigo plus hearing loss, unlike BPPV.
A patient reports severe pain unrelieved by opioids after a fracture. What is the priority concern and thus what will be the priority assessment?
Compartment syndrome. Pain out of proportion is the earliest and most critical sign. Neurovascular assessment is a priority.
A patient with autoimmune disease develops fever while on steroids. What is the priority concern?
Infection. Immunosuppression increases infection risk.
A post-TURP patient has bright red urine with clots. What is the priority action?
Increase irrigation rate. Clots indicate bleeding and risk of obstruction requiring increased CBI flow.
A patient develops widespread blistering after starting a new medication. What is the priority action?
Stop the medication. Stevens-Johnson syndrome requires immediate discontinuation of the offending drug.
A patient presents with sudden severe dizziness, imbalance, and difficulty walking. What is the priority action?
Activate stroke evaluation/call stroke alert. Acute vestibular symptoms with gait instability may indicate posterior stroke.
A patient in traction has weights resting on the floor but denies pain. Is intervention required or is documentation sufficient?
Intervention is required. Traction is not maintained - the weights should be hanging freely. Traction must be continuous to maintain alignment and prevent complications.
A patient has symmetric joint pain and morning stiffness lasting over 1 hour. What condition is most likely?
Rheumatoid arthritis. RA presents with prolonged morning stiffness and symmetric joint involvement.
A patient’s CBI output is less than the input. What is the priority concern?
Catheter obstruction. Output must exceed input; decreased output indicates blockage.
$200 BONUS: What are is the first action you will take, the second action you will take, and the third action you will take if this situation persists?
For patients with scabies or lice - what are key points for patient teaching/instruction?
Use topical medications as directed, treat the whole household, wash belongings in hot, soapy water and dry them on high heat, put belongings in sealed plastic bags for several days.
A patient using contact lenses develops eye redness, pain, and photophobia. What is the priority concern?
Keratitis which requires immediate treatment. Contact lens use increases risk for corneal infection and ulceration that can lead to vision loss.
A patient being discharged after posterior hip replacement is preparing to get dressed. What is an aspect of getting dressed that may be contraindicated?
Putting on socks and shoes. Adduction and crossing legs can dislocate a posterior hip prosthesis.
A patient with lupus reports new visual changes while on medication. What is the priority concern?
Retinal toxicity. Hydroxychloroquine can cause retinal toxicity requiring immediate evaluation. Regular eye exams are important those taking hydroxchlorquine.
A patient arrives to the ED reporting severe scrotal pain which is not alleviated with elevation. What is the priority concern?
Testicular torsion - immediate ultrasound is required to identify this, because this is a medical emergency and requires emergency surgery to restore blood flow to the testicles.
A patient with HIV develops white plaques in the mouth. What is the likely condition and what is the treatment?
This is likely candidiasis, an AIDS-related opportunistic infection, and is treated with oral nystatin.