ChadGBT Questions Flashcards

Question

A 63-year-old male with a history of COPD presents with increased dyspnea, purulent sputum production, and a low-grade fever. Chest X-ray shows increased markings and no consolidation. **What is the most appropriate treatment?** A. Antibiotics and oral corticosteroids B. Inhaled corticosteroids C. Oxygen therapy D. Antiviral therapy

Answer 1

A. Antibiotics and oral corticosteroids ## Footnote The patient's symptoms are indicative of an acute exacerbation of COPD, characterized by increased dyspnea, change in sputum character, and possibly infection. Treatment with antibiotics (to cover suspected bacterial infection) and oral corticosteroids (to reduce inflammation) is recommended.

Answer 2

B. Nephrotic syndrome ## Footnote The combination of significant proteinuria, hypoalbuminemia, hyperlipidemia, and edema is characteristic of nephrotic syndrome, a kidney disorder causing your body to excrete too much protein in your urine.

Answer 3

B. Chemotherapy ## Footnote The clinical presentation and laboratory findings suggest multiple myeloma, characterized by bone pain, hypercalcemia, renal insufficiency, anemia, and a monoclonal protein spike. Initial treatment typically involves chemotherapy to target the abnormal plasma cells.

Answer 4

B. Major depressive disorder ## Footnote The patient's symptoms of depressed mood, sleep disturbance, guilt, decreased concentration, weight loss, and loss of interest in activities meet the criteria for major depressive disorder.

Answer 5

B. Psoriasis ## Footnote The description of a sharply demarcated, red, scaly plaque on the elbow that worsens in winter is characteristic of psoriasis, a chronic inflammatory skin condition.

Answer 6

B. Rheumatoid arthritis ## Footnote The presence of morning stiffness lasting more than an hour, joint swelling, fatigue, and positive rheumatoid factor and anti-CCP antibodies are diagnostic for rheumatoid arthritis, an autoimmune disorder.

Answer 7

B. Polycystic ovary syndrome (PCOS) ## Footnote The combination of weight gain, menstrual irregularity, hirsutism, and elevated testosterone levels is highly suggestive of polycystic ovary syndrome, a common endocrine disorder in women of reproductive age.

Answer 8

C. Levofloxacin ## Footnote The patient's symptoms and chest X-ray findings are consistent with community-acquired pneumonia. Levofloxacin, a fluoroquinolone antibiotic, is appropriate for empirical treatment in adults with community-acquired pneumonia.

Answer 9

A. Stable angina ## Footnote The presentation of chest pain on exertion that resolves with rest and ST-segment depression during an exercise stress test is indicative of stable angina, caused by myocardial ischemia.

Answer 10

B. Pancreatic cancer ## Footnote Painless jaundice, clay-colored stools, dark urine, and a palpable, nontender gallbladder (Courvoisier's sign) strongly suggest obstructive jaundice, most commonly caused by pancreatic cancer, especially in the head of the pancreas, which blocks the common bile duct.

Answer 11

B. Hospital admission for unstable angina

Answer 12

A. Levothyroxine

Answer 13

B. Achalasia

Answer 14

B. Tuberculosis

Answer 15

B. Lupus nephritis

Answer 16

C. CT-guided biopsy of the mass

Answer 17

B. Rheumatoid arthritis

Answer 18

B. Chronic lymphocytic leukemia

Answer 19

A. Immediate CT scan of the head without contrast

Answer 20

A. Start an SSRI

Answer 21

C. Hypotension and a systolic murmur ## Footnote Hypotension and a new systolic murmur could indicate complications of AMI such as papillary muscle rupture leading to acute mitral regurgitation, making this the most critical finding suggesting a complicated AMI.

Answer 22

B. Exercise stress test ## Footnote An exercise stress test is appropriate for patients with an intermediate pretest probability of coronary artery disease (CAD) who can exercise and have a normal baseline ECG, to assess for inducible ischemia.

Answer 23

B. Congestive heart failure ## Footnote The patient's symptoms of dyspnea, orthopnea, and edema, combined with findings of atrial fibrillation, are indicative of congestive heart failure.

Answer 24

C. Initiate nicotine replacement therapy ## Footnote Smoking cessation is the single most effective measure for reducing cardiovascular risk in smokers. Nicotine replacement therapy can aid in this process, providing a significant benefit over other interventions listed.

Answer 25

C. Regular echocardiographic monitoring ## Footnote Asymptomatic patients with severe mitral regurgitation and preserved LV function should undergo regular echocardiographic monitoring to assess for changes in LV size or function, indicating the need for intervention.

Answer 26

A. Dabigatran ## Footnote For patients with atrial fibrillation and a moderate to high stroke risk (CHA2DS2-VASc ≥2) who are warfarin intolerant, a direct oral anticoagulant (DOAC) like dabigatran is recommended over aspirin or no anticoagulation.

Answer 27

D. No abnormalities between episodes ## Footnote Patients with stable angina typically have a normal physical examination when not experiencing an episode of chest pain. The symptoms are usually provoked by physical exertion or stress and relieved by rest or nitroglycerin, without persistent physical findings.

Answer 28

A. Exercise stress test ## Footnote In patients with atypical chest pain and risk factors for coronary artery disease whose initial ECG does not show ischemic changes, an exercise stress test is a reasonable next step to evaluate for inducible ischemia.

Answer 29

B. Atrial fibrillation ## Footnote The presence of irregularly irregular rhythm without distinct P waves on ECG, accompanied by symptoms of palpitations and lightheadedness, is indicative of atrial fibrillation.

Answer 30

C. Recommend smoking cessation and regular exercise ## Footnote For individuals with risk factors such as a family history of coronary artery disease, smoking, and a sedentary lifestyle, lifestyle modifications including smoking cessation and regular physical activity are the most effective interventions for reducing cardiovascular risk.

Answer 31

C. Mitral valve repair or replacement ## Footnote In symptomatic patients with severe mitral regurgitation and evidence of left atrial dilation or decreased ejection fraction, mitral valve repair or replacement is indicated to improve symptoms and prevent further cardiac remodeling and deterioration.

Answer 32

B. Long-acting nitrate ## Footnote For patients with chronic stable angina who remain symptomatic despite optimal doses of beta-blockers and calcium channel blockers, adding a long-acting nitrate can provide further symptomatic relief by reducing myocardial oxygen demand.

Answer 33

C. Warfarin ## Footnote In patients with atrial fibrillation and a CHADS2 score of 2 or higher, anticoagulation therapy is recommended for stroke prevention. Warfarin has been a traditional choice, especially in the setting of rheumatic heart disease, where DOACs may not have been as extensively studied.

Answer 34

D. Reduced ejection fraction ## Footnote the presentation of dyspnea, orthopnea, S3 heart sound, and bibasilar rales suggests heart failure with reduced ejection fraction (HFrEF), which would be confirmed by an echocardiogram showing a reduced ejection fraction.

Answer 35

D. Receive a yearly influenza vaccination ## Footnote For most patients, including those with risk factors for cardiovascular disease, annual influenza vaccination is recommended as part of health maintenance to prevent respiratory infections that can exacerbate cardiovascular conditions.

Answer 36

B. Transcatheter aortic valve replacement (TAVR) ## Footnote For patients with severe symptomatic aortic stenosis who are high risk for surgical valve replacement, TAVR is an appropriate intervention. TAVR can provide significant symptom relief and improved survival in patients who are not candidates for surgery.

Answer 37

B. Clubbing of the fingers ## Footnote Clubbing of the fingers, a sign of chronic hypoxia, is often associated with lung cancer, especially non-small cell lung cancer. It reflects more advanced disease and can indicate the presence of a malignancy when found in a patient with a history of smoking and unexplained weight loss.

Answer 38

C. Bronchoscopy with biopsy ## Footnote Bronchoscopy with biopsy is the most direct method to obtain tissue for histopathological examination of a lung mass, crucial for confirming the diagnosis of lung cancer and guiding treatment decisions.

Answer 39

D. Pneumoconiosis ## Footnote Pneumoconiosis, a lung disease caused by the inhalation of dust, is common in individuals with a history of working in mining. The chest X-ray findings are characteristic of this condition.

Answer 40

B. Varenicline ## Footnote Varenicline has been shown to be more effective than other options for smoking cessation by acting as a nicotinic receptor partial agonist, reducing craving and withdrawal symptoms.

Answer 41

D. Nebulized short-acting beta agonists and anticholinergics ## Footnote In acute exacerbations of COPD, nebulized short-acting beta agonists and anticholinergics are effective for rapid symptom relief by dilating the airways and reducing bronchospasm.

Answer 42

C. Adding a long-acting beta agonist (LABA) ## Footnote For asthma patients not controlled on low-dose inhaled corticosteroids, adding a LABA is recommended to improve control and reduce the frequency of exacerbations.

Answer 43

B. Asthma ## Footnote Leukotriene inhibitors are effective in managing asthma by reducing inflammation, bronchoconstriction, and mucus production, directly addressing the pathophysiological mechanisms of asthma.

Answer 44

C. Low-dose computed tomography (LDCT) of the chest ## Footnote LDCT of the chest is recommended for lung cancer screening in high-risk individuals, such as those with a significant smoking history and asbestos exposure, to detect tumors at an earlier, more treatable stage.

Answer 45

C. Idiopathic pulmonary fibrosis (IPF) ## Footnote The HRCT findings of bibasilar reticular abnormalities with honeycombing are characteristic of idiopathic pulmonary fibrosis, a chronic, progressive fibrotic interstitial lung disease.

Answer 46

D. All of the above ## Footnote Targeting IL-5 in eosinophilic asthma aims to reduce eosinophilic inflammation, leading to decreased exacerbations, reduced steroid use, and improved lung function, making all listed outcomes relevant measures of effectiveness.

Answer 47

D. Phosphodiesterase-4 inhibitors ## Footnote Phosphodiesterase-4 inhibitors, such as roflumilast, are indicated to decrease the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis, especially those with a history of exacerbations.

Answer 48

C. Bronchoscopy ## Footnote Bronchoscopy allows direct visualization of the airways and is essential for investigating the cause of hemoptysis and recurring pneumonia, including the possibility of an obstructing lesion or tumor.

Answer 49

A. Annual low-dose CT scans ## Footnote Current guidelines recommend annual low-dose CT scans for lung cancer screening in individuals aged 50-80 years with a 20-pack-year smoking history and who currently smoke or have quit within the past 15 years.

Answer 50

D. Blockade of leukotriene receptors ## Footnote Leukotriene receptor antagonists, such as montelukast, work by blocking the action of leukotrienes, which are inflammatory mediators involved in the pathophysiology of asthma, leading to reduced inflammation and bronchoconstriction.

Answer 51

C. Silicosis ## Footnote Silicosis is a lung disease caused by inhalation of crystalline silica dust, commonly seen in occupations such as mining, construction, and sandblasting. It presents with chronic cough and shortness of breath.

Answer 52

B. Use of personal protective equipment (PPE) ## Footnote The primary prevention of occupational lung diseases involves controlling exposure to hazardous materials, with the use of PPE (e.g., respirators) being the most effective strategy to prevent inhalation of harmful substances.

Answer 53

B. Initiate antifibrotic therapy ## Footnote Antifibrotic therapy, such as pirfenidone or nintedanib, can slow the progression of disease and improve symptoms in patients with pulmonary fibrosis by reducing fibroblast proliferation and collagen deposition.

Answer 54

C. Phosphodiesterase-4 inhibitor ## Footnote For patients with severe COPD and chronic bronchitis with a history of exacerbations, adding a phosphodiesterase-4 inhibitor like roflumilast can reduce the frequency of exacerbations by targeting inflammation and smooth muscle relaxation.

Answer 55

A. CT scan of the chest with contrast ## Footnote A CT scan of the chest with contrast is indicated to evaluate for possible pulmonary embolism, especially in the setting of acute onset chest pain and dyspnea with a normal chest X-ray.

Answer 56

B. Influenza vaccine ## Footnote Influenza vaccination is recommended for individuals with chronic respiratory diseases like asthma to reduce the risk of exacerbations triggered by influenza infections.

Answer 57

C. Digital clubbing ## Footnote Digital clubbing, a sign of chronic hypoxia and advanced lung disease, is particularly suggestive of cystic fibrosis in adults when combined with a history of recurrent respiratory and sinus infections.

Answer 58

C. Endothelin receptor antagonists ## Footnote Endothelin receptor antagonists, such as bosentan, are used in the management of PAH to dilate pulmonary vessels and decrease pulmonary vascular resistance, addressing the pathophysiology of PAH directly.

Answer 59

C. It contributes to the uncontrolled growth of malignant cells. ## Footnote EGFR mutations lead to increased growth signaling in lung cancer cells, contributing to their uncontrolled proliferation. Targeted therapies against EGFR can be effective in tumors harboring such mutations.

Answer 60

C. Non-specific interstitial pneumonia (NSIP) ## Footnote Ground-glass opacifications on high-resolution CT, in the absence of honeycombing, suggest a diagnosis of Non-specific interstitial pneumonia (NSIP) rather than Idiopathic Pulmonary Fibrosis (IPF), which typically shows honeycombing. NSIP is characterized by its more uniform interstitial inflammation and fibrosis, leading to such imaging findings and presenting with symptoms of dyspnea and cough.

Answer 61

C. Endoscopic surveillance based on Barrett’s esophagus findings

Answer 62

B. Serologic testing for celiac disease

Answer 63

A. ERCP with sphincterotomy

Answer 64

A. Lubiprostone

Answer 65

C. Beta-cell dysfunction from chronic inflammation

Answer 66

C. Pancreatic cancer

Answer 67

C. Irritable bowel syndrome

Answer 68

B. Biannual colonoscopy after 8 years of disease

Answer 69

D. Triple therapy (PPI, clarithromycin, amoxicillin) ## Footnote For a patient with an active duodenal ulcer, particularly with a history of peptic ulcer disease, the most appropriate treatment is triple therapy, which includes a proton pump inhibitor (to reduce acid production and promote healing), clarithromycin, and amoxicillin (to eradicate Helicobacter pylori, a common causative agent of peptic ulcers). This approach addresses both the underlying infection and the symptoms.

Answer 70

A. Acute cystitis ## Footnote The patient's symptoms of dysuria, urinary frequency, and suprapubic tenderness, along with her history and physical examination, are indicative of acute cystitis, a common urinary tract infection (UTI) in sexually active women.

Answer 71

A. Sputum culture ## Footnote The patient's presentation is suggestive of pulmonary tuberculosis. Sputum culture for Mycobacterium tuberculosis is the gold standard for diagnosing active tuberculosis and allows for drug susceptibility testing.

Answer 72

C. Chikungunya virus infection ## Footnote The combination of fever, rash, headache, and significant joint pain, especially following travel to an endemic area like the Caribbean, strongly suggests Chikungunya virus infection.

Answer 73

C. Pneumococcal vaccine ## Footnote the pneumococcal vaccine is recommended for all adults over 65 years and for younger adults with certain conditions like COPD, which increases their risk for pneumococcal disease.

Answer 74

C. Secure airway and administer IV antibiotics ## Footnote The child's presentation is consistent with epiglottitis, a medical emergency requiring immediate airway management and IV antibiotics to prevent airway obstruction.

Answer 75

B. Fluconazole ## Footnote The patient's symptoms are indicative of vulvovaginal candidiasis. Fluconazole, an antifungal agent, is the treatment of choice for uncomplicated cases.

Answer 76

A. Bacterial conjugation ## Footnote Bacterial conjugation is a major mechanism of horizontal gene transfer among bacteria, contributing to the spread of antibiotic resistance genes, such as those encoding for beta-lactamase enzymes, which inactivate many antibiotics.

Answer 77

C. Erythema migrans ## Footnote The patient's symptoms suggest Lyme disease, which is often preceded by erythema migrans, a characteristic expanding rash at the site of the tick bite.

Answer 78

C. Sputum culture ## Footnote Sputum culture is appropriate to identify the causative organism in patients with symptoms and radiographic findings suggestive of bacterial pneumonia, guiding targeted antibiotic therapy.

Answer 79

B. Recombinant zoster vaccine ## Footnote the recombinant zoster vaccine is recommended for adults aged 50 years and older, including those on low-dose immunosuppressive therapy or those with chronic medical conditions, to prevent herpes zoster (shingles). It is preferred over the live vaccine for immunocompromised patients.

Answer 80

B. Rheumatoid arthritis ## Footnote The presence of morning stiffness lasting more than 1 hour, symmetrical polyarthritis involving the wrists and metacarpophalangeal joints, and a positive squeeze test strongly suggest rheumatoid arthritis. Rheumatoid arthritis is characterized by chronic inflammation leading to joint damage, and these clinical findings are consistent with its diagnosis.

Answer 81

D. Antinuclear antibodies (ANA) and anti-double-stranded DNA (anti-dsDNA) ## Footnote In a patient with SLE presenting with knee effusion, the identification of elevated ANA and anti-dsDNA levels can help confirm a flare of lupus-related arthritis. SLE can cause a wide range of musculoskeletal manifestations, including non-erosive arthritis often involving the knees.

Answer 82

A. Rotator cuff tear ## Footnote The patient's presentation of severe shoulder pain, tenderness, and particularly the inability to actively lift the arm following trauma suggests a rotator cuff tear. This diagnosis is consistent with the mechanism of injury and clinical findings.

Answer 83

D. Regularly monitor bone mineral density ## Footnote For a patient with osteopenia, especially those at risk of progressing to osteoporosis, regular monitoring of bone mineral density (BMD) is crucial for early detection and management. While calcium intake, exercise, and bisphosphonates can be part of the management, BMD monitoring is essential for determining the need for pharmacological intervention.

Answer 84

C. Administer nonsteroidal anti-inflammatory drugs (NSAIDs) ## Footnote For acute gout attacks, NSAIDs are the first-line treatment to quickly reduce inflammation and pain. Allopurinol is used for long-term management to lower uric acid levels and prevent future attacks, not during the acute phase. Aspirin is avoided as it can alter uric acid levels, and colchicine is an alternative when NSAIDs are contraindicated.

Answer 85

B. Add a tumor necrosis factor (TNF) inhibitor ## Footnote In patients with RA who have an inadequate response to methotrexate alone, the addition of a TNF inhibitor is an effective strategy to achieve better disease control. TNF inhibitors target specific pathways in the inflammatory process, offering a targeted approach to reduce joint inflammation and damage.

Answer 86

C. Inflammation of entheses ## Footnote The patient's symptoms and radiographic findings suggest ankylosing spondylitis, a type of spondyloarthritis characterized by inflammation of the entheses, the sites where ligaments or tendons insert into the bone. This inflammation leads to pain and can eventually cause bone fusion.

Answer 87

D. Routine dual-energy X-ray absorptiometry (DEXA) scans ## Footnote For a patient with risk factors for osteoporosis, including family history, routine DEXA scans are appropriate for early detection. While her lifestyle is conducive to bone health, DEXA scans can help monitor bone density and inform the need for pharmacologic intervention.

Answer 88

A. Arthrocentesis ## Footnote Arthrocentesis, the aspiration of joint fluid, is crucial for diagnosing the cause of knee effusion. Analyzing the synovial fluid can help differentiate between inflammatory, infectious, and degenerative joint disorders, guiding appropriate management.

Answer 89

A. Intra-articular corticosteroid injection ## Footnote For patients with osteoarthritis of the shoulder who have not responded to conservative management and are not candidates for surgery, intra-articular corticosteroid injections can provide significant pain relief and reduce inflammation, offering an effective nonsurgical treatment option.

Answer 90

A. Methimazole ## Footnote The patient's symptoms, physical findings, and laboratory results are indicative of Graves' disease, an autoimmune hyperthyroid condition. Methimazole, a thionamide, is the most appropriate initial treatment as it inhibits thyroid hormone synthesis.

Answer 91

B. Type 2 diabetes mellitus ## Footnote A fasting plasma glucose level ≥126 mg/dL on two separate occasions is diagnostic for type 2 diabetes mellitus, especially in the context of obesity and other metabolic syndrome components.

Answer 92

A. Start levothyroxine ## Footnote The patient's clinical presentation and laboratory findings are consistent with primary hypothyroidism. The most appropriate initial intervention is to start levothyroxine to replace deficient thyroid hormone.

Answer 93

A. Oral glucose tolerance test (OGTT) ## Footnote Given the history of gestational diabetes, current symptoms suggestive of diabetes mellitus, and physical findings like acanthosis nigricans, an OGTT is the next best step to assess for diabetes.

Answer 94

A. Testosterone replacement therapy ## Footnote The patient's clinical presentation and consistently low testosterone levels indicate hypogonadism, for which testosterone replacement therapy is the most appropriate treatment to improve symptoms.

Answer 95

B. Glucagon-like peptide-1 (GLP-1) receptor agonist ## Footnote For a patient with type 2 diabetes and an HbA1c significantly above target despite metformin, a GLP-1 receptor agonist is an appropriate choice due to its efficacy in lowering HbA1c and additional benefits on weight loss and cardiovascular risk reduction.

Answer 96

C. ACTH stimulation test ## Footnote The patient's clinical presentation suggests Addison's disease (primary adrenal insufficiency), characterized by weakness, hyperpigmentation, weight loss, hyponatremia, and hyperkalemia. The ACTH stimulation test is the most appropriate diagnostic study to confirm adrenal insufficiency by assessing the adrenal glands' response to ACTH.

Answer 97

A. Thyroid-stimulating hormone (TSH) level ## Footnote Given the family history of thyroid disease, screening with a TSH level is appropriate to identify asymptomatic thyroid disorders early, allowing for timely intervention.

Answer 98

B. Prescribe methimazole ## Footnote The patient exhibits signs of hyperthyroidism. Methimazole is appropriate for decreasing thyroid hormone production, addressing the hyperthyroid state.

Answer 99

B. Decreases glucose reabsorption in the kidneys ## Footnote SGLT2 inhibitors lower blood glucose levels by blocking glucose reabsorption in the kidneys, leading to increased excretion of glucose in the urine. This mechanism is effective in managing type 2 diabetes, especially when combined with other therapies like metformin.

Answer 100

C. Empagliflozin ## Footnote SGLT2 inhibitors, such as empagliflozin, have been shown to offer cardiovascular benefits in patients with type 2 diabetes, including reduced risk of heart failure hospitalization and cardiovascular death.

Answer 101

C. Sestamibi scan ## Footnote A sestamibi scan is a nuclear medicine test that helps localize parathyroid adenomas in patients with primary hyperparathyroidism, indicated by hypercalcemia and elevated PTH.

Answer 102

A. Prednisone ## Footnote Treatment for Addison's disease (primary adrenal insufficiency) involves hormone replacement with glucocorticoids such as prednisone, and may also require mineralocorticoids.

Answer 103

A. Ketoconazole ## Footnote Ketoconazole is an antifungal medication that can inhibit adrenal steroid synthesis, used off-label in the management of Cushing's syndrome to lower cortisol levels.

Answer 104

C. Graves' disease ## Footnote The combination of weight loss, palpitations, tremors, and diffuse goiter is characteristic of Graves' disease, an autoimmune hyperthyroid condition.

Answer 105

C. Insulin deficiency ## Footnote DKA is primarily caused by insulin deficiency, leading to increased lipolysis, ketogenesis, and metabolic acidosis, commonly seen in type 1 diabetes.

Answer 106

B. Ovarian cysts ## Footnote PCOS diagnosis is based on the Rotterdam criteria, which include the presence of ovarian cysts, androgen excess, and menstrual irregularity.

Answer 107

C. Bisphosphonates ## Footnote Bisphosphonates are the first-line treatment for osteoporosis in postmenopausal women, effective in reducing the risk of fractures by inhibiting bone resorption.

Answer 108

D. Salt-loading test ## Footnote The salt-loading test, either oral or intravenous, assesses aldosterone levels after salt loading. Persistence of high aldosterone levels confirms the diagnosis of primary hyperaldosteronism.

Answer 109

A. Total thyroidectomy ## Footnote For confirmed papillary thyroid cancer, especially in nodules larger than 1 cm or in patients with risk factors for disease progression, total thyroidectomy is the initial management to remove the cancerous tissue.

Answer 110

C. Epigastric tenderness ## Footnote Epigastric tenderness on physical examination is consistent with gastritis or peptic ulcer disease, conditions commonly exacerbated by NSAID use due to mucosal irritation and inhibition of prostaglandin synthesis, leading to reduced gastric mucosal protection.

Answer 111

C. Anti-mitochondrial antibody (AMA) test ## Footnote The presence of jaundice, pruritus, dark urine, and chronic fatigue with pruritus suggests primary biliary cholangitis (PBC). The anti-mitochondrial antibody (AMA) test is highly specific for PBC and would most likely confirm the diagnosis.

Answer 112

B. Esophageal varices ## Footnote In the context of alcohol abuse and signs of liver dysfunction (elevated bilirubin, AST:ALT ratio >2 indicating cirrhosis), hematemesis is most likely due to bleeding esophageal varices, a complication of portal hypertension.

Answer 113

A. Gluten-free diet ## Footnote the cornerstone of managing celiac disease is adherence to a strict gluten-free diet, which helps in the healing of the intestinal mucosa, improves symptoms, and prevents disease complications.

Answer 114

B. Endoscopic dilation ## Footnote Dysphagia to solids post-Nissen fundoplication may indicate a too tight or misplaced wrap. Endoscopic dilation is an appropriate intervention to relieve the symptom without the need for immediate repeat surgery.

Answer 115

B. Psyllium fiber supplementation ## Footnote Psyllium fiber supplementation is beneficial in IBS, particularly for symptoms of bloating and diarrhea, by regulating bowel movements and improving stool consistency.

Answer 116

B. Peptic ulcers ## Footnote Zollinger-Ellison syndrome is characterized by excessive gastrin secretion, leading to gastric acid hypersecretion and the development of peptic ulcers, especially in unusual areas of the stomach and duodenum. This condition significantly increases the risk for peptic ulcer disease due to the corrosive effect of the increased gastric acid.

Answer 117

C. CT scan of the abdomen ## Footnote A CT scan of the abdomen provides detailed imaging to assess the liver mass's size, characteristics, and potential spread, guiding further diagnostic and treatment plans.

Answer 118

C. Regular colorectal cancer screening ## Footnote Patients with ulcerative colitis have an increased risk of colorectal cancer. Regular colorectal cancer screening is essential for early detection and management of precancerous lesions or cancer.

Answer 119

A. Spironolactone ## Footnote Spironolactone, a potassium-sparing diuretic, is the first-line treatment for managing ascites in cirrhosis by antagonizing aldosterone, reducing fluid accumulation in the abdomen.

Answer 120

A. MRI of the brain ## Footnote An MRI of the brain is more sensitive than a CT scan for detecting structural changes associated with dementia, including Alzheimer's disease, which the patient's history and presentation suggest. MRI can help rule out other causes of dementia-like symptoms, such as strokes or tumors.

Answer 121

B. CT scan of the head without contrast ## Footnote A CT scan of the head without contrast is the initial diagnostic study of choice for suspected subarachnoid hemorrhage, as indicated by the sudden onset of a "thunderclap" headache, vomiting, and signs of meningeal irritation (e.g., neck stiffness). It quickly identifies bleeding in the brain.

Answer 122

A. Peripheral neuropathy ## Footnote The patient's symptoms are indicative of peripheral neuropathy, commonly seen in diabetes mellitus due to chronic hyperglycemia causing nerve damage. The "glove and stocking" sensory loss pattern is characteristic of this condition.

Answer 123

A. Regular aerobic exercise ## Footnote Regular aerobic exercise has been shown to improve motor function and potentially slow the progression of symptoms in patients with Parkinson's disease. Exercise promotes neuroplasticity and overall health, which is beneficial in managing Parkinson's disease.

Answer 124

A. Intravenous thrombolysis ## Footnote Given the acute onset of ischemic stroke symptoms within a 4.5-hour window, intravenous thrombolysis with alteplase (tPA) is the most appropriate intervention to dissolve the clot and restore blood flow, potentially reducing long-term disability.

Answer 125

B. Add a dopamine agonist ## Footnote Adding a dopamine agonist can provide additional symptomatic control in Parkinson's disease patients who have suboptimal response to levodopa/carbidopa, particularly for controlling tremor and rigidity.

Answer 126

B. Degeneration of the motor neurons in the brain and spinal cord ## Footnote ALS is characterized by the progressive degeneration and death of motor neurons in the brain and spinal cord, which leads to muscle weakness, atrophy, and eventually, respiratory failure. This process impairs voluntary muscle control and physical function.

Answer 127

C. Bacterial meningitis ## Footnote The presentation of fever, neck stiffness, and positive Kernig's and Brudzinski's signs strongly suggests bacterial meningitis, an infection of the protective membranes covering the brain and spinal cord, necessitating immediate empirical antibiotic treatment.

Answer 128

B. Risperidone ## Footnote Risperidone, an atypical antipsychotic, is often used to manage behavioral symptoms such as agitation in Alzheimer's disease patients, especially when non-pharmacological interventions are insufficient.

Answer 129

C. Anticoagulation therapy ## Footnote For patients with a history of stroke, particularly due to atrial fibrillation or other sources of cardioembolism, anticoagulation therapy is critical for secondary prevention to reduce the risk of recurrent stroke.

Answer 130

A. Epidural steroid injection

Answer 131

B. Start a weight reduction program

Answer 132

C. Fibromyalgia tender point assessment

Answer 133

A. Patellar tendon rupture

Answer 134

B. Recommend calcium and vitamin D supplementation

Answer 135

A. Apply a compression bandage and recommend RICE

Answer 136

A. Calcific tendinitis

Answer 137

A. Osteoarthritis

Answer 138

A. IT band stretching and strengthening exercises

Answer 139

B. Ankylosing spondylitis

Answer 140

B. Weight loss and reduction of alcohol intake

Answer 141

B. Rheumatoid arthritis

Answer 142

B. NSAIDs and hydroxychloroquine

Answer 143

B. Lumbar disc herniation

Answer 144

C. Lyme disease ## Footnote The presentation of fever, headache, and neurological symptoms, along with a history of camping in New England and CSF findings, suggests Lyme neuroborreliosis, a manifestation of Lyme disease caused by Borrelia burgdorferi.

Answer 145

A. Ciprofloxacin ## Footnote For uncomplicated urinary tract infections (UTIs) caused by E. coli, fluoroquinolones like ciprofloxacin are effective due to their bactericidal activity and urinary excretion.

Answer 146

B. Meningococcal vaccine ## Footnote Meningococcal vaccine is recommended for adolescents and young adults, especially those living in close quarters like dormitories, to protect against meningococcal disease.

Answer 147

C. PCR assay ## Footnote PCR assay is a rapid and sensitive method for detecting Mycoplasma pneumoniae DNA, suitable for diagnosing atypical pneumonia.

Answer 148

B. IV hydration and antimalarials ## Footnote The symptoms suggest malaria, likely caused by Plasmodium falciparum. Immediate treatment with IV hydration and antimalarials is critical to prevent complications.

Answer 149

B. Antigenic shift ## Footnote Antigenic shift is a process by which two or more different strains of a virus, or strains of two different viruses, combine to form a new subtype having a mixture of the surface antigens of the two or more original strains.

Answer 150

B. Streptococcal ## Footnote The presence of fever, tonsillar exudates, and cervical lymphadenopathy strongly suggests streptococcal pharyngitis, which requires antibiotic treatment.

Answer 151

B. Trimethoprim-sulfamethoxazole ## Footnote Trimethoprim-sulfamethoxazole (TMP-SMX) is the first-line treatment for Pneumocystis jirovecii pneumonia (PCP), offering broad-spectrum antibacterial activity and effectiveness against PCP in patients with HIV/AIDS.

Answer 152

C. Hepatic abscess ## Footnote Given the travel history, clinical presentation, and ultrasound findings, a hepatic abscess, potentially amoebic due to Entamoeba histolytica acquired in an endemic area, is the most likely diagnosis.

Answer 153

A. Isoniazid for 9 months ## Footnote Isoniazid for 9 months is the standard regimen for treating latent tuberculosis infection (LTBI) to prevent the development of active TB disease, offering a balance between efficacy and safety.

Answer 154

C. Vitamin B12 and folate levels ## Footnote Macrocytic anemia, indicated by an MCV >100 fL, is most commonly due to vitamin B12 or folate deficiency, especially with a low reticulocyte count indicating ineffective erythropoiesis. Assessing vitamin B12 and folate levels is crucial for diagnosis.

Answer 155

B. Pneumococcal vaccine ## Footnote Patients with sickle cell disease are at increased risk for invasive pneumococcal infections due to asplenia or functional asplenia. Pneumococcal vaccination is crucial for preventing these potentially life-threatening infections.

Answer 156

B. Aspirin ## Footnote In essential thrombocythemia, low-dose aspirin is effective in reducing microvascular symptoms and thrombotic events, particularly in patients with a history of thrombosis or those at high risk.

Answer 157

B. Impaired synthesis of beta-globin chains ## Footnote Beta-thalassemia major is characterized by a genetic defect leading to reduced or absent synthesis of beta-globin chains, resulting in severe anemia and requiring regular blood transfusions.

Answer 158

A. All-trans retinoic acid (ATRA) ## Footnote ATRA is the treatment of choice for APL, a subtype of acute myeloid leukemia, as it induces differentiation of promyelocytes and rapidly reverses the coagulopathy associated with APL.

Answer 159

A. Chronic myeloid leukemia (CML) ## Footnote The presence of the Philadelphia chromosome is characteristic of CML, a myeloproliferative disorder that often presents with leukocytosis and constitutional symptoms.

Answer 160

B. Granulocyte colony-stimulating factor (G-CSF) ## Footnote G-CSF is used to stimulate the production of neutrophils and reduce the duration of chemotherapy-induced neutropenia, decreasing the risk of infection.

Answer 161

A. Family history of bleeding disorders ## Footnote A detailed family history is crucial in patients with symptoms suggestive of a bleeding disorder, as many such conditions are hereditary. This information can guide further diagnostic evaluation and management.

Answer 162

A. Genetic testing for hemochromatosis ## Footnote The combination of elevated serum iron, ferritin, and transferrin saturation suggests iron overload, for which hereditary hemochromatosis is a common cause. Genetic testing can confirm the diagnosis and guide treatment and family screening.

Answer 163

C. Intravenous immunoglobulin (IVIG) ## Footnote In patients with immune thrombocytopenia presenting with severe or life-threatening bleeding, such as intracranial hemorrhage implied by a severe headache, IVIG is used to rapidly increase the platelet count.

Answer 164

B. Chemotherapy ## Footnote In CLL patients with symptomatic anemia due to marrow infiltration, chemotherapy is the primary treatment to reduce leukemic cell burden and improve bone marrow function.

Answer 165

B. Infectious mononucleosis ## Footnote The presence of atypical lymphocytes and a positive heterophile antibody test is characteristic of infectious mononucleosis, commonly caused by the Epstein-Barr virus.

Answer 166

B. Serum protein electrophoresis ## Footnote Serum protein electrophoresis is used to monitor the levels of monoclonal proteins (M-protein), which can indicate disease activity and progression in patients with multiple myeloma.

Answer 167

B. Autoimmune destruction of red blood cells ## Footnote The presence of spherocytes, anemia, jaundice, and splenomegaly suggests autoimmune hemolytic anemia, where the body's immune system mistakenly attacks and destroys its own red blood cells.

Answer 168

A. Antiphospholipid antibody testing ## Footnote The presentation of recurrent thrombosis and miscarriages suggests antiphospholipid syndrome, an autoimmune disorder characterized by the presence of antiphospholipid antibodies. Testing for these antibodies (lupus anticoagulant, anticardiolipin antibodies, and anti-β2 glycoprotein I) is essential for diagnosis.

Answer 169

B. Perform a bone marrow biopsy ## Footnote The combination of cytopenias and splenomegaly raises concern for a hematologic malignancy or marrow infiltration process. A bone marrow biopsy is crucial for diagnosis, allowing for histological examination and the identification of specific abnormalities.

Answer 170

C. Von Willebrand disease ## Footnote Von Willebrand disease is the most common inherited bleeding disorder and often presents with mucocutaneous bleeding, such as easy bruising and menorrhagia. Prolonged PTT that corrects with mixing studies suggests a factor deficiency or inhibitor, common in von Willebrand disease due to its role in factor VIII stabilization.

Answer 171

B. Thrombotic thrombocytopenic purpura (TTP) ## Footnote The presentation of neurological symptoms, microangiopathic hemolytic anemia (MAHA), and thrombocytopenia strongly suggests TTP. TTP is characterized by a pentad of MAHA, thrombocytopenia, neurological symptoms, renal dysfunction, and fever, although not all components need to be present for diagnosis.

Answer 172

C. Transferrin saturation ## Footnote For individuals at risk of hereditary hemochromatosis, transferrin saturation is an effective initial screening test. It measures the percentage of transferrin that is bound with iron. Elevated levels may indicate iron overload and warrant further investigation with serum ferritin levels and genetic testing.

Answer 173

C. Discontinue anticoagulation and start a different anticoagulant ## Footnote This patient likely has heparin-induced thrombocytopenia (HIT), a prothrombotic disorder caused by heparin therapy. The best management is discontinuation of heparin and initiation of a non-heparin anticoagulant, such as a direct thrombin inhibitor or factor Xa inhibitor.

Answer 174

B. Oral corticosteroids ## Footnote For patients with SLE presenting with thrombocytopenia, oral corticosteroids are often considered first-line therapy. They work by reducing autoantibody production and inflammation, thereby increasing platelet count. Hydroxychloroquine may be used for SLE management, but corticosteroids are specifically effective for thrombocytopenia.

Answer 175

A. Viral infection of B lymphocytes ## Footnote The presentation is consistent with infectious mononucleosis, typically caused by the Epstein-Barr virus (EBV), which infects B lymphocytes. The atypical lymphocytes seen in peripheral blood smears are activated T lymphocytes responding to the infected B cells.

Answer 176

A. Polycythemia vera ## Footnote Polycythemia vera is a myeloproliferative disorder characterized by increased red cell mass, splenomegaly, and symptoms such as pruritus (especially after a hot bath), weight loss, and night sweats. The elevated hematocrit confirms the diagnosis.

Answer 177

B. Erythropoiesis-stimulating agents ## Footnote In patients with chronic kidney disease, anemia is often due to erythropoietin deficiency. Erythropoiesis-stimulating agents (ESAs) are used to stimulate the bone marrow to produce more red blood cells, improving anemia and reducing the need for transfusions.

Answer 178

C. Oral prednisone ## Footnote The presentation is suggestive of immune thrombocytopenia (ITP), characterized by low platelet count and increased megakaryocytes in the bone marrow. Oral prednisone is the initial treatment of choice to suppress the immune-mediated destruction of platelets. Platelet transfusions are generally reserved for severe bleeding or before surgical procedures in patients with ITP.

Answer 179

B. Congestive heart failure exacerbation

Answer 180

B. Blood cultures before antibiotic administration

Answer 181

A. Staphylococcal toxic shock syndrome

Answer 182

B. Elevating the head of the bed to 30-45 degrees

Answer 183

B. Apply positive end-expiratory pressure (PEEP) to improve oxygenation

Answer 184

B. Norepinephrine

Answer 185

B. Ventilation-perfusion mismatch

Answer 186

C. Pharmacologic prophylaxis with low molecular weight heparin

Answer 187

B. CT scan of the abdomen with contrast

Answer 188

A. Continuous renal replacement therapy (CRRT)

Answer 189

B. Perform a CT pulmonary angiogram.

Answer 190

C. Start vasopressin.

Answer 191

B. Low tidal volume ventilation

Answer 192

B. Hypovolemic shock due to fluid loss

Answer 193

B. Lumbar puncture

Answer 194

B. Maintaining adequate hydration and perfusion

Answer 195

B. Spinal cord injury

Answer 196

A. Liver transplantation

Answer 197

B. Intravenous immunoglobulin (IVIG)

Answer 198

A. Hypercoagulability due to systemic inflammation

Answer 199

C. Non-contrast CT of the abdomen and pelvis ## Footnote A non-contrast CT of the abdomen and pelvis is the diagnostic study of choice for suspected nephrolithiasis, as it can quickly identify the presence, size, and location of kidney stones.

Answer 200

D. Foley catheter placement ## Footnote Acute urinary retention requires immediate relief of bladder outlet obstruction, best achieved through Foley catheter placement. This intervention provides immediate symptom relief and prevents renal damage from back pressure.

Answer 201

B. Cinacalcet ## Footnote Cinacalcet is effective in managing secondary hyperparathyroidism by increasing the sensitivity of the calcium-sensing receptor on the parathyroid gland, thus reducing parathyroid hormone (PTH) levels.

Answer 202

B. Avoid NSAIDs ## Footnote NSAIDs can cause renal damage, particularly in patients with reduced renal mass or function. Avoiding NSAIDs helps maintain renal health by preventing potential nephrotoxic effects.

Answer 203

B. Palpable abdominal mass ## Footnote Polycystic kidney disease often leads to enlarged, palpable kidneys due to the presence of numerous cysts, making this finding supportive of the diagnosis.

Answer 204

B. Microalbuminuria ## Footnote Microalbuminuria is the earliest sign of diabetic nephropathy, indicating the onset of kidney damage in patients with diabetes before more severe manifestations occur.

Answer 205

B. 24-hour urine collection for protein ## Footnote A 24-hour urine collection for protein is the gold standard to accurately quantify proteinuria and assess the severity of kidney damage.

Answer 206

C. Increase fluid intake ## Footnote Increasing fluid intake is recommended to prevent recurrent calcium oxalate stones by diluting the urine and reducing the concentration of calcium oxalate in the urine, a risk factor for stone formation.

Answer 207

B. Intravenous glucose and insulin ## Footnote Intravenous glucose and insulin is an immediate treatment for severe hyperkalemia, as insulin facilitates the cellular uptake of potassium, rapidly lowering serum potassium levels.

Answer 208

A. Oral ciprofloxacin ## Footnote For a complicated urinary tract infection, especially in the outpatient setting, oral ciprofloxacin is effective due to its broad-spectrum activity against common uropathogens and good penetration into the urinary tract.

Answer 209

C. Purulent urethral discharge ## Footnote Gonococcal urethritis, caused by Neisseria gonorrhoeae, typically presents with a purulent (pus-like) urethral discharge and dysuria. This symptom distinguishes it from non-gonococcal urethritis, which may present with clearer discharge.

Answer 210

C. Kidney biopsy ## Footnote In a patient presenting with clinical signs of nephrotic syndrome, such as significant proteinuria, hypoalbuminemia, and edema, a kidney biopsy is crucial for determining the exact cause and guiding treatment.

Answer 211

A. Acute kidney injury ## Footnote The sudden decrease in urine output and elevated serum creatinine suggest acute kidney injury (AKI). This condition may be precipitated by diabetes mellitus, hypertension, and potentially nephrotoxic medications like lisinopril.

Answer 212

B. Increased fluid intake ## Footnote Increased fluid intake is the most effective lifestyle modification for preventing kidney stones. It dilutes the urine, decreasing the concentration of stone-forming minerals.

Answer 213

B. Initiate hemodialysis ## Footnote In patients with chronic kidney disease presenting with uremic pericarditis, the initiation of hemodialysis is critical. This intervention helps manage the underlying uremia, which is likely contributing to the pericarditis.

Answer 214

B. Oxalate ## Footnote Calcium oxalate stones are the most common type of kidney stones. Reducing dietary oxalate, found in foods like nuts, tea, and spinach, can help prevent the formation of these stones.

Answer 215

A. Decreased renal phosphate excretion ## Footnote In end-stage renal disease, the kidneys' ability to excrete phosphate is significantly impaired, leading to hyperphosphatemia. Despite dialysis helping remove some phosphate, the reduced renal excretion is the primary mechanism contributing to elevated phosphorus levels in these patients.

Answer 216

B. Family history of diabetes ## Footnote Given the symptoms of polyuria, nocturia, weight loss, and signs of dehydration, a family history of diabetes is crucial. These are classic symptoms of poorly controlled diabetes mellitus, potentially indicating diabetes insipidus or uncontrolled diabetes mellitus.

Answer 217

A. Renal ultrasound ## Footnote A renal ultrasound is a non-invasive test that can evaluate the size, shape, and presence of obstructions or abnormalities in the kidneys, making it an essential first step in assessing renal dysfunction.

Answer 218

C. Phosphate binders ## Footnote in CKD, impaired phosphate excretion leads to hyperphosphatemia, contributing to secondary hyperparathyroidism and renal bone disease. Phosphate binders reduce intestinal phosphate absorption, helping to manage serum phosphate levels and maintain bone health.

Answer 219

A. Nerve conduction studies and electromyography (EMG) ## Footnote Nerve conduction studies and EMG can help diagnose Guillain-Barré syndrome (GBS) by showing typical patterns of demyelination and nerve conduction abnormalities, consistent with the patient's clinical presentation of ascending weakness post-infection.

Answer 220

C. Refer to physical therapy for balance training ## Footnote Physical therapy focusing on balance and strength training is crucial for patients with Parkinson's disease to improve mobility, reduce fall risk, and enhance quality of life, addressing the progressive nature of the disease.

Answer 221

C. Intravenous methylprednisolone ## Footnote Intravenous methylprednisolone is the treatment of choice for acute MS exacerbations, including optic neuritis, to reduce inflammation and potentially hasten recovery of neurological function.

Answer 222

B. Ischemic stroke ## Footnote The patient's history of atrial fibrillation, a known risk factor for clot formation, combined with sudden onset of neurological deficits, strongly suggests an ischemic stroke due to embolic occlusion of a cerebral artery.

Answer 223

B. Altered ion channel function ## Footnote Seizures often result from altered ion channel function leading to abnormal neuronal excitability and synchronization. This disruption in ion flow across neuronal membranes can generate excessive electrical discharges, manifesting as seizures.

Answer 224

A. Administer broad-spectrum antibiotics ## Footnote The patient's presentation suggests acute bacterial meningitis, a medical emergency. Immediate administration of broad-spectrum antibiotics, even before lumbar puncture confirmation if necessary, is critical to reduce morbidity and mortality.

Answer 225

A. Regular physical exercise ## Footnote Regular physical exercise has been shown to slow cognitive decline in Alzheimer's disease through various mechanisms, including improved blood flow and neurogenesis, and reducing inflammation. It promotes overall brain health and can delay the progression of Alzheimer's symptoms.

Answer 226

A. Brain MRI with angiography ## Footnote An MRI with angiography is crucial for diagnosing conditions like an aneurysm or arteriovenous malformation, which could cause the patient's symptoms through compression of cranial nerves or intracranial hemorrhage.

Answer 227

B. Botulinum toxin injections ## Footnote For chronic migraine patients who do not respond adequately to oral prophylactic medications, botulinum toxin injections have been approved and shown to be effective in reducing the frequency and severity of headache days.

Answer 228

A. The impact of autoimmune responses on myelin sheath degradation ## Footnote Multiple sclerosis is characterized by an autoimmune response against the central nervous system, leading to inflammation and damage to the myelin sheath. The study aims to understand how neuroinflammation contributes to this process and identifies potential therapeutic targets.

ChadGBT Questions Flashcards

(253 cards)