ChadGBT Questions Flashcards
A 65-year-old man presents to the clinic with chest pain described as pressure-like, located in the center of the chest, and radiating to the left arm. The pain started 30 minutes ago while he was gardening. He has a history of hypertension, hyperlipidemia, and smoking. An electrocardiogram (ECG) shows ST-segment elevation in leads II, III, and aVF.
Which of the following is the most appropriate next step in management?
A. Administration of sublingual nitroglycerin
B. Immediate cardiac catheterization
C. Oral administration of aspirin and a statin
D. Start of an ACE inhibitor
B. Immediate cardiac catheterization
The patient’s presentation is indicative of an ST-elevation myocardial infarction (STEMI), particularly involving the inferior wall given the ECG findings. Immediate cardiac catheterization is recommended as part of reperfusion therapy to restore blood flow to the affected myocardium, which is critical for reducing mortality and improving outcomes in STEMI patients.
A 72-year-old woman with a history of chronic obstructive pulmonary disease (COPD) presents with increased shortness of breath, wheezing, and a productive cough with green sputum for the past two days. She is afebrile, with an oxygen saturation of 89% on room air, and has diffuse wheezes on lung auscultation.
What is the most appropriate initial treatment?
A. Oral antibiotics
B. Inhaled short-acting beta-agonists and anticholinergics
C. Systemic corticosteroids
D. Oxygen therapy and mechanical ventilation
B. Inhaled short-acting beta-agonists and anticholinergics
This patient’s presentation is consistent with an acute exacerbation of COPD. The initial treatment should focus on bronchodilation, which is effectively achieved with inhaled short-acting beta-agonists (e.g., albuterol) and anticholinergics (e.g., ipratropium), to relieve symptoms and improve lung function.
A 50-year-old man presents with melena, light-headedness, and a history of peptic ulcer disease. His blood pressure is 100/70 mmHg, and heart rate is 110 bpm. Laboratory tests reveal a hemoglobin of 8 g/dL.
What is the most appropriate initial diagnostic procedure?
A. Colonoscopy
B. Esophagogastroduodenoscopy (EGD)
C. Abdominal ultrasonography
D. CT scan of the abdomen
B. Esophagogastroduodenoscopy (EGD)
Given the patient’s history of peptic ulcer disease and presentation with melena, the most appropriate initial diagnostic procedure is EGD. This allows for direct visualization of the upper gastrointestinal tract to identify and possibly treat the source of bleeding.
A 34-year-old woman presents with fatigue, weight gain, and cold intolerance. Physical examination reveals dry skin, bradycardia, and delayed reflexes. Laboratory tests show an elevated TSH and low free T4.
Which of the following is the most likely diagnosis?
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing syndrome
D. Pheochromocytoma
B. Hypothyroidism
The patient’s clinical presentation and laboratory findings of elevated thyroid-stimulating hormone (TSH) and low free T4 are indicative of hypothyroidism. This condition is characterized by insufficient thyroid hormone production, leading to symptoms such as fatigue, weight gain, and cold intolerance.
A 28-year-old man presents with fatigue, pallor, and petechiae. Laboratory tests reveal a hemoglobin of 7.2 g/dL, platelet count of 20,000/μL, and a normal white blood cell count. Bone marrow biopsy shows decreased megakaryocytes.
What is the most appropriate initial treatment?
A. High-dose corticosteroids
B. Platelet transfusion
C. Iron supplementation
D. Hematopoietic stem cell transplantation
A. High-dose corticosteroids
The patient’s presentation is consistent with immune thrombocytopenic purpura (ITP), which is characterized by an autoimmune destruction of platelets leading to low platelet counts and increased bleeding risk. High-dose corticosteroids are the first-line treatment to suppress the immune system and increase platelet count, reducing the risk of bleeding.
A 58-year-old man with diabetes mellitus presents with fever, right flank pain, and dysuria. His vital signs reveal a fever of 38.6°C (101.5°F), a heart rate of 102 bpm, and blood pressure of 130/85 mmHg. Physical examination shows costovertebral angle tenderness on the right side. Urinalysis is positive for leukocyte esterase and nitrites.
Which of the following is the most appropriate treatment?
A. Oral ciprofloxacin
B. Intravenous ceftriaxone
C. Oral amoxicillin-clavulanate
D. Intravenous vancomycin
B. Intravenous ceftriaxone
The patient’s presentation is consistent with acute pyelonephritis, particularly in the context of diabetes mellitus, which is a risk factor for severe infections. Intravenous antibiotics such as ceftriaxone are recommended for initial treatment to ensure rapid and effective bacterial clearance, especially in patients who may have complicated infections due to underlying conditions.
A 30-year-old woman presents with morning stiffness in her hands lasting more than 1 hour, symmetrical joint swelling, and tenderness in her wrists and fingers for the past three months. Laboratory tests show elevated erythrocyte sedimentation rate (ESR) and positive rheumatoid factor (RF).
What is the most appropriate initial medication?
A. Oral prednisone
B. Methotrexate
C. Ibuprofen
D. Hydroxychloroquine
B. Methotexate
The patient’s symptoms and laboratory findings are indicative of rheumatoid arthritis (RA). Methotrexate is the cornerstone of treatment for RA, serving as a disease-modifying antirheumatic drug (DMARD) that can slow disease progression and decrease joint damage and disability.
A 70-year-old man with chronic kidney disease presents with nausea, vomiting, and lethargy. His blood pressure is 150/90 mmHg. Laboratory tests reveal a serum creatinine of 4.0 mg/dL (baseline 2.2 mg/dL) and a potassium level of 6.5 mEq/L.
What is the most appropriate immediate treatment for hyperkalemia?
A. Oral sodium polystyrene sulfonate
B. Intravenous calcium gluconate
C. Intravenous insulin and glucose
D. Oral loop diuretics
C. Intravenous insulin and glucose
The patient has significant hyperkalemia, which is a potentially life-threatening condition. Intravenous insulin, along with glucose to prevent hypoglycemia, is a rapid and effective treatment to lower serum potassium levels by shifting potassium intracellularly.
A 45-year-old woman with a history of mitral valve prolapse presents with palpitations, lightheadedness, and a brief episode of syncope. An ECG demonstrates episodes of rapid, irregular heartbeats.
What is the most likely diagnosis?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Supraventricular tachycardia
D. Sinus bradycardia
C. Supraventricular tachycardia
Given the patient’s history of mitral valve prolapse and presentation with palpitations and syncope, supraventricular tachycardia (SVT) is the most likely diagnosis. SVT is often associated with structural heart conditions like mitral valve prolapse and can cause rapid, irregular heartbeats that may lead to symptoms such as lightheadedness or syncope.
A 55-year-old man presents with progressive difficulty swallowing both solids and liquids, weight loss, and regurgitation of undigested food. He has a history of long-standing heartburn. A barium swallow shows a dilated esophagus with a bird’s beak appearance at the distal end.
What is the most likely diagnosis?
A. Gastroesophageal reflux disease (GERD)
B. Achalasia
C. Esophageal cancer
D. Peptic stricture
B. Achalasia
The patient’s symptoms of dysphagia to both solids and liquids, weight loss, and regurgitation, combined with the characteristic “bird’s beak” appearance on barium swallow, are indicative of ach
A 60-year-old woman presents with sudden onset of left-sided weakness and slurred speech that began two hours ago. She has a history of atrial fibrillation for which she is not on anticoagulation. Her blood pressure on presentation is 170/95 mmHg.
Which of the following is the most appropriate initial management?
A. Intravenous thrombolysis
B. Immediate anticoagulation with heparin
C. High-dose aspirin therapy
D. Blood pressure reduction with intravenous medication
A. Intravenous thrombolysis
The patient’s symptoms are suggestive of an acute ischemic stroke, and given the onset of symptoms was within a 4.5-hour window, she is a candidate for intravenous thrombolysis, which can significantly improve outcomes by dissolving the clot and restoring blood flow to the affected area of the brain.
A 25-year-old man presents with a painful rash on his lower back that appeared two days ago. The rash consists of clustered vesicles on an erythematous base. He also reports headache and malaise.
Which of the following is the most likely diagnosis?
A. Herpes zoster
B. Psoriasis
C. Contact dermatitis
D. Impetigo
A. Herpes Zoster
The description of clustered vesicles on an erythematous base, along with systemic symptoms such as headache and malaise, is characteristic of herpes zoster (shingles), which results from the reactivation of the varicella-zoster virus.
A 40-year-old man presents with complaints of feeling persistently sad, loss of interest in activities, significant weight loss, and insomnia for the past six weeks. He also expresses feelings of worthlessness and recurrent thoughts of death.
Which of the following is the most appropriate initial treatment?
A. Cognitive-behavioral therapy
B. A selective serotonin reuptake inhibitor (SSRI)
C. Immediate hospitalization
D. Electroconvulsive therapy (ECT)
B. A selective serotonin reuptake inhibitor (SSRI)
The patient’s symptoms are consistent with major depressive disorder. The first-line treatment for moderate to severe depression includes the use of SSRIs, which are effective in improving mood, sleep, and appetite, and decreasing suicidal ideation.
A 68-year-old woman presents with a 2-month history of progressive fatigue and a palpable mass in her left breast. Mammography shows a 2 cm irregular mass in the left breast with microcalcifications. A biopsy confirms invasive ductal carcinoma.
What is the most appropriate next step in management?
A. Total mastectomy
B. Chemotherapy
C. Radiation therapy
D. Hormonal therapy
A. Total mastectomy
Given the diagnosis of invasive ductal carcinoma, the most appropriate next step is surgical management, which may include total mastectomy or breast-conserving surgery (lumpectomy), depending on the stage of the disease and patient preference, followed by adjuvant therapy as indicated.
A 55-year-old man with a history of type 2 diabetes mellitus presents with numbness, tingling, and burning pain in his feet that worsens at night. His diabetes has been poorly controlled.
Which of the following is the most appropriate management for his symptoms?
A. Glycemic control
B. Oral prednisone
C. Gabapentin
D. Topical capsaicin
C. Gabapentin
The patient’s symptoms are indicative of diabetic neuropathy, a common complication of poorly controlled diabetes. Gabapentin is effective in managing the neuropathic pain associated with diabetic neuropathy. Glycemic control is crucial for preventing progression but may not immediately alleviate symptoms.
A 32-year-old male presents with fever, headache, stiff neck, and photophobia. He has no significant past medical history. Lumbar puncture results show increased white blood cells, predominantly lymphocytes, elevated protein, and normal glucose levels.
Which of the following is the most appropriate treatment?
A. Vancomycin plus ceftriaxone
B. Acyclovir
C. Doxycycline
D. Amphotericin B
B. Acyclovir
The patient’s presentation is suggestive of viral (aseptic) meningitis, with lumbar puncture findings supporting this diagnosis. Acyclovir is appropriate for the treatment of viral meningitis, especially if herpes simplex virus (HSV) is a suspected cause.
A 54-year-old female with a 20-pack-year smoking history presents with a persistent cough, weight loss, and hemoptysis. A chest CT scan reveals a 3 cm mass in the right upper lobe of the lung.
What is the most likely diagnosis?
A. Asthma
B. Pulmonary embolism
C. Lung cancer
D. Tuberculosis
C. Lung cancer
The combination of a smoking history, persistent cough, weight loss, hemoptysis, and a lung mass on imaging is highly suggestive of lung cancer. Further diagnostic evaluation, including biopsy, is necessary to confirm the type and stage of cancer.
A 68-year-old male with a history of hypertension and hyperlipidemia presents with sudden onset of palpitations, dizziness, and shortness of breath. An ECG shows a rapid irregular rhythm with no discernible P waves.
What is the most likely diagnosis?
A. Atrial fibrillation
B. Ventricular tachycardia
C. Sinus tachycardia
D. Premature ventricular contractions
A. Atrial fibrillation
The ECG findings of a rapid irregular rhythm without discernible P waves are characteristic of atrial fibrillation, a common arrhythmia, especially in patients with underlying cardiovascular risk factors like hypertension and hyperlipidemia.
A 46-year-old male presents with upper abdominal pain, nausea, and vomiting. He reports that the pain worsens after eating and has a history of alcohol abuse. Laboratory tests show elevated amylase and lipase levels.
What is the most likely diagnosis?
A. Gastric ulcer
B. Acute pancreatitis
C. Cholecystitis
D. Hepatitis
B. Acute pancreatitis
The clinical presentation of upper abdominal pain worsening after eating, along with a history of alcohol abuse and elevated amylase and lipase, strongly suggests acute pancreatitis.
A 29-year-old female presents with easy bruising, heavy menstrual bleeding, and bleeding gums. Laboratory tests reveal a prolonged bleeding time, normal platelet count, and decreased levels of factor VIII activity.
What is the most likely diagnosis?
A. Hemophilia A
B. Von Willebrand disease
C. Thrombocytopenia
D. Disseminated intravascular coagulation (DIC)
B. Von Willebrand disease
The presentation of easy bruising, heavy menstrual bleeding, and prolonged bleeding time, along with decreased factor VIII activity but normal platelet count, is indicative of von Willebrand disease, the most common hereditary bleeding disorder.
A 38-year-old female presents with palpitations, weight loss despite increased appetite, and heat intolerance. On examination, she has a diffusely enlarged thyroid gland and exophthalmos. Thyroid function tests reveal decreased TSH and elevated free T4.
What is the most likely diagnosis?
A. Hashimoto’s thyroiditis
B. Graves’ disease
C. Thyroid nodule
D. Subacute thyroiditis
B. Graves’ disease
The presentation of palpitations, weight loss, heat intolerance, diffuse goiter, and exophthalmos, along with laboratory findings of decreased TSH and elevated free T4, are classic for Graves’ disease, an autoimmune hyperthyroid condition.
A 22-year-old male college student presents with a purulent discharge from the urethra, dysuria, and frequency. He is sexually active with multiple partners and uses condoms occasionally.
What is the most appropriate treatment?
A. Azithromycin
B. Ceftriaxone plus azithromycin
C. Doxycycline
D. Metronidazole
B. Ceftriaxone plus azithromycin
This presentation is suggestive of gonorrhea, possibly co-infected with chlamydia, common in sexually active individuals. The recommended treatment is dual therapy with ceftriaxone and azithromycin to cover both pathogens.
A 75-year-old female with a history of atrial fibrillation and hypertension presents with acute onset of severe chest pain radiating to the back. A CT scan of the chest reveals a dissection of the ascending aorta.
What is the most appropriate initial management?
A. Immediate surgical consultation
B. Beta-blockers
C. Anticoagulation therapy
D. Percutaneous coronary intervention
A. Immediate surgical consultation
An ascending aortic dissection is a life-threatening condition requiring urgent surgical intervention. Immediate consultation with cardiovascular surgery is critical for survival.
A 50-year-old male presents with dark, tarry stools, and lightheadedness. He has a history of chronic NSAID use for arthritis. On examination, his blood pressure is 100/60 mmHg, and heart rate is 110 bpm. Hemoglobin is 8 g/dL.
What is the most appropriate initial diagnostic test?
A. Colonoscopy
B. Esophagogastroduodenoscopy (EGD)
C. Abdominal ultrasound
D. CT angiography
B. Esophagogastroduodenoscopy (EGD)
The presentation is suggestive of an upper gastrointestinal bleed, likely secondary to NSAID-induced ulceration. EGD is the most appropriate initial diagnostic test to identify the source of bleeding and potentially provide therapeutic intervention.
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
A. Antibiotics and oral corticosteroids
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.
A 58-year-old male presents with generalized edema, fatigue, and foamy urine. Laboratory tests reveal proteinuria (>3.5 grams/day), hypoalbuminemia, and hyperlipidemia.
What is the most likely diagnosis?
A. Acute kidney injury
B. Nephrotic syndrome
C. Nephritic syndrome
D. Chronic kidney disease
B. Nephrotic syndrome
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.
A 67-year-old male presents with fatigue, bone pain, and recurrent infections. Laboratory tests show hypercalcemia, renal insufficiency, anemia, and monoclonal protein spike on serum protein electrophoresis.
What is the most appropriate initial treatment?
A. High-dose corticosteroids
B. Chemotherapy
C. Plasma exchange
D. Stem cell transplantation
B. Chemotherapy
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.
A 30-year-old woman presents with a 3-month history of depressed mood, sleep disturbance, feeling of guilt, decreased concentration, and significant weight loss. She has no interest in her daily activities.
What is the most likely diagnosis?
A. Bipolar disorder
B. Major depressive disorder
C. Generalized anxiety disorder
D. Schizophrenia
B. Major depressive disorder
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.
A 45-year-old man presents with a sharply demarcated, red, scaly plaque on his elbow that itches. He mentions that the problem worsens during the winter months.
What is the most likely diagnosis?
A. Atopic dermatitis
B. Psoriasis
C. Seborrheic dermatitis
D. Contact dermatitis
B. Psoriasis
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.
A 55-year-old female presents with morning stiffness in her hands lasting more than an hour, swelling of her finger joints, and fatigue. She has a positive rheumatoid factor and anti-CCP antibodies.
What is the most likely diagnosis?
A. Osteoarthritis
B. Rheumatoid arthritis
C. Gout
D. Fibromyalgia
B. Rheumatoid arthritis
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.
A 29-year-old female presents with weight gain, menstrual irregularity, and hirsutism. Laboratory tests reveal elevated serum testosterone levels.
What is the most likely diagnosis?
A. Cushing’s syndrome
B. Polycystic ovary syndrome (PCOS)
C. Hyperthyroidism
D. Prolactinoma
B. Polycystic ovary syndrome (PCOS)
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.
A 70-year-old man presents with fever, cough, and shortness of breath. Chest X-ray reveals a lobar consolidation. He reports no recent travel or known sick contacts.
What is the most appropriate antibiotic treatment?
A. Azithromycin
B. Amoxicillin-clavulanate
C. Levofloxacin
D. Ceftriaxone
C. Levofloxacin
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.
A 65-year-old woman with a history of hypertension presents with chest pain on exertion that resolves with rest. An exercise stress test shows ST-segment depression.
What is the most likely diagnosis?
A. Stable angina
B. Unstable angina
C. Myocardial infarction
D. Aortic stenosis
A. Stable angina
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.
A 60-year-old male presents with painless jaundice, clay-colored stools, and dark urine. On examination, a palpable, nontender gallbladder is noted (Courvoisier’s sign).
What is the most likely diagnosis?
A. Acute cholecystitis
B. Pancreatic cancer
C. Hepatitis
D. Gallstones
B. Pancreatic cancer
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.
A 55-year-old male with a history of stable angina now presents with chest pain at rest. He describes the pain as more severe than his usual angina. An ECG shows ST-segment depression in leads V2-V4.
What is the most appropriate management?
A. Increase the dose of his current beta-blocker
B. Hospital admission for unstable angina
C. Schedule for elective angiography
D. Prescribe a nitrate preparation for sublingual use
B. Hospital admission for unstable angina
A 42-year-old woman presents with fatigue, constipation, and dry skin. Lab tests reveal high TSH and low free T4.
What is the initial treatment?
A. Levothyroxine
B. Methimazole
C. Radioactive iodine therapy
D. Thyroid surgery
A. Levothyroxine
A 68-year-old male presents with progressive dysphagia to solids followed by liquids, weight loss, and regurgitation of undigested food. A barium swallow shows dilation of the esophagus with a narrowing at the distal end.
What is the most likely diagnosis?
A. Esophageal carcinoma
B. Achalasia
C. Gastroesophageal reflux disease (GERD)
D. Esophageal stricture
B. Achalasia
A 36-year-old male presents with cough, night sweats, fever, and weight loss over the past month. A chest X-ray shows upper lobe infiltrates and cavitary lesions.
What is the most likely diagnosis?
A. Bacterial pneumonia
B. Tuberculosis
C. Lung abscess
D. Fungal infection
B. Tuberculosis
A 30-year-old woman presents with generalized edema, proteinuria, and hypoalbuminemia. She has a history of systemic lupus erythematosus (SLE).
What is the most likely diagnosis?
A. Diabetic nephropathy
B. Lupus nephritis
C. Minimal change disease
D. Membranous nephropathy
B. Lupus nephritis
A 70-year-old male smoker presents with a new cough and a chest X-ray showing a 4 cm mass in the right upper lobe.
What is the next best step in management?
A. Start antibiotic therapy
B. Immediate lobectomy
C. CT-guided biopsy of the mass
D. PET scan
C. CT-guided biopsy of the mass
A 25-year-old female presents with morning stiffness in her fingers and knees lasting more than one hour, along with swelling in the same joints. She also reports fatigue.
What is the most likely diagnosis?
A. Osteoarthritis
B. Rheumatoid arthritis
C. Psoriatic arthritis
D. Gout
B. Rheumatoid arthritis
A 55-year-old male presents with fatigue, night sweats, and weight loss. Physical examination reveals lymphadenopathy. A complete blood count shows lymphocytosis.
What is the most likely diagnosis?
A. Acute lymphoblastic leukemia
B. Chronic lymphocytic leukemia
C. Hodgkin’s lymphoma
D. Non-Hodgkin’s lymphoma
B. Chronic lymphocytic leukemia
A 72-year-old female presents with acute onset of right-sided weakness and aphasia. Her symptoms started two hours ago.
What is the initial step in management?
A. Immediate CT scan of the head without contrast
B. Start IV tPA if within window period
C. Immediate anticoagulation with heparin
D. Schedule for MRI brain
A. Immediate CT scan of the head without contrast
A 33-year-old woman presents with a 6-month history of depressed mood, loss of interest in activities, significant weight gain, excessive sleepiness, and feelings of worthlessness. She has difficulty concentrating and has contemplated suicide but has no plan.
What is the most appropriate initial treatment?
A. Start an SSRI
B. Refer for cognitive behavioral therapy
C. Prescribe a mood stabilizer
D. Initiate antipsychotic medication
A. Start an SSRI
A 67-year-old male with a history of smoking and controlled hypertension presents with sudden onset of severe chest pain radiating to his left arm, diaphoresis, and nausea. The pain started while he was resting and has not improved with nitroglycerin.
Questions: What key finding on physical examination is most suggestive of acute myocardial infarction (AMI)?
A. Bilateral wheezes on lung auscultation
B. Jugular venous distension
C. Hypotension and a systolic murmur
D. Palpable abdominal mass
C. Hypotension and a systolic murmur
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.
A 58-year-old female with diabetes presents with fatigue and dyspnea on exertion. Her ECG shows no significant ST-T changes, but she has a history of chest discomfort.
Questions: What is the most appropriate diagnostic study to further evaluate her symptoms?
A. Repeat ECG
B. Exercise stress test
C. Right heart catheterization
D. Abdominal ultrasound
B. Exercise stress test
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.
A 72-year-old man presents with shortness of breath, orthopnea, and bilateral lower extremity edema. His ECG shows atrial fibrillation with a rapid ventricular response.
Questions: What is the most likely diagnosis?
A. Acute myocarditis
B. Congestive heart failure
C. Chronic obstructive pulmonary disease (COPD) exacerbation
D. Acute renal failure
B. Congestive heart failure
The patient’s symptoms of dyspnea, orthopnea, and edema, combined with findings of atrial fibrillation, are indicative of congestive heart failure.
A 65-year-old male with a history of CAD is undergoing a routine follow-up. He has a BMI of 29, smokes half a pack of cigarettes per day, and exercises irregularly.
Questions: What is the most effective health maintenance advice to reduce his cardiovascular risk?
A. Start a low-carbohydrate diet
B. Increase physical activity to at least 150 minutes per week
C. Initiate nicotine replacement therapy
D. Prescribe a daily aspirin
C. Initiate nicotine replacement therapy
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.
A 59-year-old woman with severe mitral regurgitation is asymptomatic with normal left ventricular function and size.
Questions: What is the most appropriate clinical intervention at this time?
A. Immediate surgical valve repair
B. Initiation of ACE inhibitors
C. Regular echocardiographic monitoring
D. Start diuretic therapy
C. Regular echocardiographic monitoring
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.
A 75-year-old female with atrial fibrillation and a CHA2DS2-VASc score of 3 is allergic to warfarin.
Questions: What is the most appropriate anticoagulant therapy?
A. Dabigatran
B. Clopidogrel
C. Aspirin
D. No anticoagulation needed
A. Dabigatran
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.
A 55-year-old man with a history of smoking and hypertension presents complaining of intermittent chest discomfort that occurs with exertion and resolves with rest. The pain is described as a squeezing sensation behind the sternum.
Question: What finding would most likely be present on physical examination?
A. Rales at the lung bases
B. A systolic murmur at the right sternal border
C. Jugular venous distension
D. No abnormalities between episodes
D. No abnormalities between episodes
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.
A 60-year-old female with diabetes and hyperlipidemia presents with atypical chest pain. An ECG is non-diagnostic.
Question: What is the most appropriate next step in evaluating this patient?
A. Exercise stress test
B. Coronary angiography
C. 24-hour Holter monitoring
D. High-sensitivity C-reactive protein (hs-CRP)
A. Exercise stress test
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.
A 70-year-old man presents with acute onset of palpitations and lightheadedness. An ECG shows atrial fibrillation with a rapid ventricular response.
Question: What is the most likely diagnosis?
A. Ventricular tachycardia
B. Atrial fibrillation
C. Sinus tachycardia
D. First-degree AV block
B. Atrial fibrillation
The presence of irregularly irregular rhythm without distinct P waves on ECG, accompanied by symptoms of palpitations and lightheadedness, is indicative of atrial fibrillation.
A 45-year-old male with no significant medical history comes in for a check-up. He has a family history of coronary artery disease. He smokes and has a sedentary lifestyle.
Question: Which intervention is most effective for reducing his cardiovascular risk?
A. Prescribe a low-dose statin
B. Initiate aspirin prophylaxis
C. Recommend smoking cessation and regular exercise
D. Start antihypertensive medication
C. Recommend smoking cessation and regular exercise
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.
A 50-year-old woman with severe mitral regurgitation is symptomatic with dyspnea on exertion and fatigue. Echocardiography shows a dilated left atrium and decreased ejection fraction.
Question: What is the most appropriate clinical intervention?
A. Diuretics
B. Percutaneous coronary intervention
C. Mitral valve repair or replacement
D. Beta-blockers
C. Mitral valve repair or replacement
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.
A 65-year-old man with chronic stable angina is on maximal tolerated doses of beta-blockers and calcium channel blockers. He continues to experience angina with minimal exertion.
Question: What medication should be added next?
A. ACE inhibitor
B. Long-acting nitrate
C. Digoxin
D. Thiazide diuretic
B. Long-acting nitrate
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.
A 55-year-old female with rheumatic heart disease presents with atrial fibrillation. She has a
CHADS2 score of 3 due to her age, hypertension, and the presence of rheumatic heart disease.
Question: What is the most appropriate management for stroke prevention?
A. Aspirin
B. Aspirin and clopidogrel
C. Warfarin
D. Direct oral anticoagulant (DOAC)
C. Warfarin
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.
A 75-year-old male presents with dyspnea and orthopnea. Physical examination reveals an S3 heart sound and bibasilar rales. An echocardiogram is ordered.
Question: What is the most likely finding on echocardiography?
A. Mitral valve prolapse
B. Aortic stenosis
C. Left ventricular hypertrophy
D. Reduced ejection fraction
D. Reduced ejection fraction
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.
A 58-year-old man with well-controlled hypertension and a 10-pack-year smoking history (quit 5 years ago) asks about cardiovascular disease prevention.
Question: Which recommendation is most appropriate for this patient?
A. Start aspirin 81 mg daily
B. Initiate statin therapy
C. Undergo annual stress testing
D. Receive a yearly influenza vaccination
D. Receive a yearly influenza vaccination
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.
A 82-year-old female with severe symptomatic aortic stenosis is deemed too high risk for surgical aortic valve replacement due to multiple comorbidities.
Question: What is the most appropriate intervention?
A. Balloon valvuloplasty
B. Transcatheter aortic valve replacement (TAVR)
C. Medical management with diuretics
D. Percutaneous coronary intervention
B. Transcatheter aortic valve replacement (TAVR)
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.
A 58-year-old man with a history of smoking presents with a chronic cough and shortness of breath. He mentions a recent weight loss of 10 pounds over the past two months and intermittent chest pain.
Questions: What finding on physical examination would most suggest a diagnosis of lung cancer?
A. Wheezing
B. Clubbing of the fingers
C. Bilateral rales
D. High-pitched cough
B. Clubbing of the fingers
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.
A 72-year-old female with a 40-pack-year smoking history presents with a persistent cough, weight loss, and hemoptysis. Chest X-ray shows a mass in the right upper lobe.
Questions: What is the most appropriate next diagnostic step?
A. Pulmonary function tests
B. High-resolution CT scan of the chest
C. Bronchoscopy with biopsy
D. PET scan
C. Bronchoscopy with biopsy
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.
A 65-year-old man with chronic cough, dyspnea, and history of coal mining presents with a chest X-ray showing small, rounded opacities throughout the lung fields.
Questions: What is the most likely diagnosis?
A. Chronic obstructive pulmonary disease (COPD)
B. Pneumonia
C. Pulmonary embolism
D. Pneumoconiosis
D. Pneumoconiosis
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.
A 55-year-old woman with a 30-pack-year smoking history is interested in smoking cessation.
Questions: Which intervention is most effective for smoking cessation?
A. Nicotine replacement therapy
B. Varenicline
C. Bupropion
D. Counseling and behavioral therapy
B. Varenicline
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.
A 60-year-old male presents with acute exacerbation of COPD, characterized by increased dyspnea, wheezing, and productive cough.
Questions: What is the most appropriate initial treatment?
A. Oral corticosteroids and antibiotics
B. Long-acting beta agonists
C. Oxygen therapy alone
D. Nebulized short-acting beta agonists and anticholinergics
D. Nebulized short-acting beta agonists and anticholinergics
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.
A 25-year-old female presents with a history of asthma uncontrolled by a low-dose inhaled corticosteroid.
Questions: What is the next best step in her asthma management?
A. Oral corticosteroids
B. Increasing the dose of inhaled corticosteroids
C. Adding a long-acting beta agonist (LABA)
D. Leukotriene receptor antagonist
C. Adding a long-acting beta agonist (LABA)
For asthma patients not controlled on low-dose inhaled corticosteroids, adding a LABA is recommended to improve control and reduce the frequency of exacerbations.
A researcher is studying a new drug that inhibits the formation of leukotrienes.
Questions: What respiratory condition could this drug potentially
be most effective?
A. Chronic bronchitis
B. Asthma
C. Pulmonary fibrosis
D. Pulmonary arterial hypertension
B. Asthma
Leukotriene inhibitors are effective in managing asthma by reducing inflammation, bronchoconstriction, and mucus production, directly addressing the pathophysiological mechanisms of asthma.
A 50-year-old male with a history of smoking and occupational asbestos exposure is concerned about his risk for lung cancer.
Questions: Which screening method is recommended for this patient?
A. Annual chest X-ray
B. Sputum cytology
C. Low-dose computed tomography (LDCT) of the chest
D. Bronchoscopy
C. Low-dose computed tomography (LDCT) of the chest
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.
A 45-year-old woman presents with dyspnea on exertion and a dry cough. High-resolution CT shows bibasilar reticular abnormalities with honeycombing.
Questions: What is the most likely diagnosis?
A. Acute respiratory distress syndrome (ARDS)
B. Chronic obstructive pulmonary disease (COPD)
C. Idiopathic pulmonary fibrosis (IPF)
D. Pulmonary embolism
C. Idiopathic pulmonary fibrosis (IPF)
The HRCT findings of bibasilar reticular abnormalities with honeycombing are characteristic of idiopathic pulmonary fibrosis, a chronic, progressive fibrotic interstitial lung disease.
A study evaluates the efficacy of a novel monoclonal antibody targeting interleukin-5 (IL-5) in severe eosinophilic asthma.
Questions: What outcome would best demonstrate the drug’s effectiveness?
A. Reduced eosinophil counts in blood and sputum
B. Decreased use of oral corticosteroids
C. Improvement in forced expiratory volume in 1 second (FEV1)
D. All of the above
D. All of the above
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.
A 68-year-old woman with severe COPD presents with an acute exacerbation. She has a history of multiple exacerbations requiring hospitalization.
Questions: Which medication is most likely to reduce the risk of future exacerbations in this patient?
A. Oral corticosteroids
B. Inhaled corticosteroids combined with long-acting beta agonists
C. Anticholinergic inhalers
D. Phosphodiesterase-4 inhibitors
D. Phosphodiesterase-4 inhibitors
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.
A 50-year-old male smoker presents with hemoptysis and a recent history of recurring pneumonia in the same lung segment.
Questions: What diagnostic study is most appropriate to evaluate for a potential underlying cause?
A. Chest X-ray
B. High-resolution computed tomography (HRCT) of the chest
C. Bronchoscopy
D. Pulmonary function tests
C. Bronchoscopy
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.
For a 55-year-old patient with a 20-pack-year smoking history who quit smoking 5 years ago, which recommendation is most appropriate for lung cancer screening?
A. Annual low-dose CT scans
B. Biennial chest X-rays
C. Sputum cytology annually
D. No screening recommended
A. Annual low-dose CT scans
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.
A 35-year-old female with asthma presents with difficulty controlling her symptoms despite using a high-dose inhaled corticosteroid and a long-acting beta agonist.
Questions: What pathophysiological mechanism is primarily targeted by adding a leukotriene receptor antagonist?
A. Inhibition of cyclic AMP
B. Blockade of muscarinic receptors
C. Inhibition of phosphodiesterase
D. Blockade of leukotriene receptors
D. Blockade of leukotriene receptors
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.
A 45-year-old construction worker presents with shortness of breath, chronic cough, and a history of significant dust exposure.
Questions: Based on occupational history and symptoms, what is the most likely diagnosis?
A. Bronchial asthma
B. Chronic bronchitis
C. Silicosis
D. Allergic rhinitis
C. Silicosis
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.
What is the most effective strategy to prevent occupational lung diseases in workers exposed to hazardous materials?
A. Regular pulmonary function testing
B. Use of personal protective equipment (PPE)
C. Annual influenza vaccination
D. Prophylactic antibiotics
B. Use of personal protective equipment (PPE)
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.
A patient with pulmonary fibrosis is experiencing progressive worsening of dyspnea and cough. What is the most appropriate clinical intervention?
A. Increase oxygen supplementation
B. Initiate antifibrotic therapy
C. Start broad-spectrum antibiotics
D. Prescribe cough suppressants
B. Initiate antifibrotic therapy
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.
A 70-year-old male with advanced COPD is on a regimen of inhaled corticosteroids, long-acting muscarinic antagonists, and long-acting beta agonists. He experiences two exacerbations requiring hospitalization in the past year. What addition to his regimen could potentially reduce the frequency of exacerbations?
A. Antibiotic prophylaxis
B. Systemic corticosteroids
C. Phosphodiesterase-4 inhibitor
D. Short-acting beta agonist as needed
C. Phosphodiesterase-4 inhibitor
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.
A 33-year-old woman with no significant past medical history presents with sudden onset of sharp, right-sided chest pain and shortness of breath. A chest X-ray is unremarkable. What is the most appropriate next step in the diagnostic evaluation?
A. CT scan of the chest with contrast
B. Repeat chest X-ray in 24 hours
C. Pulmonary function tests
D. Echocardiogram
A. CT scan of the chest with contrast
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.
A 30-year-old female with asthma. What is the recommended vaccination to reduce her risk of exacerbations?
A. Pneumococcal vaccine
B. Influenza vaccine
C. Hepatitis B vaccine
D. Human papillomavirus vaccine
B. Influenza vaccine
Influenza vaccination is recommended for individuals with chronic respiratory diseases like asthma to reduce the risk of exacerbations triggered by influenza infections.
A 29-year-old male presents with a history of recurrent sinus infections, bronchitis, and a productive cough with copious amounts of sputum. On physical examination, you note digital clubbing and crackles at both lung bases.
Questions: What historical or physical finding is most suggestive of cystic fibrosis in an adult?
A. Recurrent sinus infections
B. Productive cough with copious sputum
C. Digital clubbing
D. Recurrent bronchitis
C. Digital clubbing
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.
A 40-year-old woman with a diagnosis of pulmonary arterial hypertension (PAH) is being evaluated for treatment.
Questions: Which class of medication is primarily used to manage PAH?
A. Beta-blockers
B. Calcium channel blockers
C. Endothelin receptor antagonists
D. Corticosteroids
C. Endothelin receptor antagonists
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.
In the development of lung cancer, what role does the mutation of the epidermal growth factor receptor (EGFR) gene play?
A. It is a protective factor against lung cancer.
B. It promotes the apoptosis of malignant cells.
C. It contributes to the uncontrolled growth of malignant cells.
D. It enhances the immune system’s ability to detect lung cancer cells.
C. It contributes to the uncontrolled growth of malignant cells.
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.
A 55-year-old man presents with exertional dyspnea and a dry cough. High-resolution CT shows ground-glass opacifications without honeycombing.
Questions: What is the most likely diagnosis?
A. Chronic obstructive pulmonary disease (COPD)
B. Idiopathic pulmonary fibrosis (IPF)
C. Non-specific interstitial pneumonia (NSIP)
D. Acute respiratory distress syndrome (ARDS)
C. Non-specific interstitial pneumonia (NSIP)
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.
A 67-year-old male with a history of smoking and chronic GERD is concerned about his risk for esophageal cancer. What is the most appropriate recommendation?
- A. Annual CT scan of the chest
- B. Biannual endoscopy
- C. Endoscopic surveillance based on Barrett’s esophagus findings
- D. No screening recommended
C. Endoscopic surveillance based on Barrett’s esophagus findings
A 30-year-old female presents with diarrhea, abdominal pain, and bloating. She mentions that her symptoms improve when avoiding bread and pasta. What is the initial diagnostic test of choice?
- A. Colonoscopy
- B. Serologic testing for celiac disease
- C. Hydrogen breath test
- D. Stool analysis for ova and parasites
B. Serologic testing for celiac disease
A 55-year-old male presents with acute cholangitis. What is the most appropriate initial clinical intervention?
- A. ERCP with sphincterotomy
- B. Oral antibiotics alone
- C. Laparoscopic cholecystectomy
- D. Percutaneous transhepatic cholangiography
A. ERCP with sphincterotomy
A 42-year-old female with irritable bowel syndrome with constipation (IBS-C) has had inadequate response to fiber supplements. What is the next best step?
- A. Lubiprostone
- B. Loperamide
- C. Rifaximin
- D. Amitriptyline
A. Lubiprostone
A patient with chronic pancreatitis develops diabetes mellitus. What is the underlying mechanism?
- A. Autoimmune destruction of islet cells
- B. Insulin resistance due to obesity
- C. Beta-cell dysfunction from chronic inflammation
- D. Amyloid deposition in islets
C. Beta-cell dysfunction from chronic inflammation
A 70-year-old male with unintentional weight loss, jaundice, and palpable non-tender gallbladder. What is the most likely diagnosis?
- A. Acute hepatitis
- B. Cholangiocarcinoma
- C. Pancreatic cancer
- D. Gallstones
C. Pancreatic cancer
A 25-year-old female presents with recurrent abdominal pain, bloating, and alternating diarrhea and constipation. No significant findings on endoscopy. What is the likely diagnosis?
- A. Crohn’s disease
- B. Ulcerative colitis
- C. Irritable bowel syndrome
- D. Celiac disease
C. Irritable bowel syndrome
A 45-year-old male with GERD unresponsive to OTC antacids undergoes 24-hour pH monitoring. What does this test help confirm?
- A. Esophageal motility disorder
- B. Gastric ulcer
- C. GERD
- D. Hiatal hernia
C. GERD
For a patient with newly diagnosed ulcerative colitis, what is an important health maintenance measure?
- A. Annual influenza vaccination
- B. Biannual colonoscopy after 8 years of disease
- C. Genetic testing for colorectal cancer
- D. Low-fat diet
B. Biannual colonoscopy after 8 years of disease
A 50-year-old male with a history of peptic ulcer disease presents with recurrent epigastric pain. Endoscopy shows an active duodenal ulcer. What is the most appropriate treatment?
- A. Proton pump inhibitor
- B. Antacid
- C. Sucralfate
- D. Triple therapy (PPI, clarithromycin, amoxicillin)
D. Triple therapy (PPI, clarithromycin, amoxicillin)
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.
A 25-year-old female presents with a three-day history of painful, burning urination, increased urinary frequency, and lower abdominal pain. She is sexually active with one partner and uses oral contraceptives for birth control. Her temperature is 37.8°C (100°F), and physical examination reveals suprapubic tenderness.
What is the most likely diagnosis?
A. Acute cystitis
B. Pyelonephritis
C. Urethritis
D. Pelvic inflammatory disease
A. Acute cystitis
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.
A 45-year-old male presents with fever, night sweats, productive cough, and weight loss over the past month. A chest X-ray reveals cavitary lesions in the upper lobes. What is the most appropriate diagnostic study to confirm the suspected diagnosis?
A. Sputum culture
B. Blood culture
C. CT chest
D. Tuberculin skin test
A. Sputum culture
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.
A 30-year-old male presents with a maculopapular rash, fever, headache, and joint pain. He recently returned from a trip to the Caribbean. Which of the following is the most likely diagnosis?
A. Zika virus infection
B. Dengue fever
C. Chikungunya virus infection
D. Malaria
C. Chikungunya virus infection
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.
A 60-year-old male with chronic obstructive pulmonary disease (COPD) asks about vaccinations. Which of the following vaccines should be routinely recommended?
A. HPV vaccine
B. Varicella vaccine
C. Pneumococcal vaccine
D. MMR vaccine
C. Pneumococcal vaccine
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.
A 4-year-old boy presents with high fever, drooling, and a muffled voice. He appears anxious and is sitting upright, leaning forward. What is the most appropriate immediate clinical intervention?
A. Oral antibiotics
B. Nebulized epinephrine
C. Secure airway and administer IV antibiotics
D. Corticosteroids orally
C. Secure airway and administer IV antibiotics
The child’s presentation is consistent with epiglottitis, a medical emergency requiring immediate airway management and IV antibiotics to prevent airway obstruction.
A 28-year-old female with no significant medical history presents with a vaginal discharge that is white, thick, and odorless, along with vulvar itching and irritation. What is the most appropriate treatment?
A. Metronidazole
B. Fluconazole
C. Azithromycin
D. Doxycycline
B. Fluconazole
The patient’s symptoms are indicative of vulvovaginal candidiasis. Fluconazole, an antifungal agent, is the treatment of choice for uncomplicated cases.
A patient is diagnosed with a bacterial infection resistant to multiple antibiotics. Which mechanism is most likely responsible for this resistance?
A. Bacterial conjugation
B. Viral recombination
C. Fungal sporulation
D. Parasitic mutation
A. Bacterial conjugation
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.
