ChatGBT Questions Flashcards
A 68-year-old man with a history of hypertension and hyperlipidemia presents to the emergency department with sudden onset of severe chest pain radiating to his left arm, beginning 30 minutes ago while resting. He appears pale and diaphoretic. His blood pressure is 160/90 mmHg, heart rate 110 bpm, and respiratory rate 22 breaths per minute. An ECG shows ST elevation in leads II, III, and aVF. Which of the following is the most appropriate next step in management?**
- A. Administer sublingual nitroglycerin
- B. Perform immediate coronary angiography
- C. Give aspirin and clopidogrel
- D. Obtain a chest X-ray**
B. Perform immediate coronary angiography
The patient’s symptoms and ECG findings are indicative of an ST-segment elevation myocardial infarction (STEMI), specifically involving the inferior wall given the leads affected. Immediate coronary angiography is crucial as it is part of revascularization therapy, which is the recommended treatment for STEMI patients to restore blood flow and minimize myocardial damage.
A 55-year-old woman presents with shortness of breath and palpitations. She has a history of type 2 diabetes and atrial fibrillation. Her blood pressure is 140/85 mmHg, heart rate is irregularly irregular at 120 bpm, and her lungs are clear. ECG confirms atrial fibrillation with rapid ventricular response. What is the most appropriate initial treatment?**
- A. Metoprolol
- B. Amiodarone
- C. Digoxin
- D. Warfarin
A. Metoprolol
Metoprolol is indicated as it helps in controlling the heart rate by slowing the AV nodal conduction, which is beneficial in atrial fibrillation with rapid ventricular response. This beta-blocker is effective in reducing symptoms and stabilizing the patient’s condition.
A 72-year-old man with a history of chronic heart failure is brought to the ER with worsening dyspnea and ankle swelling. Physical examination reveals jugular venous distention, pulmonary rales, and peripheral edema. Chest X-ray shows cardiomegaly and pulmonary congestion. What is the most appropriate initial management?**
- A. Start IV furosemide
- B. Perform endotracheal intubation
- C. Administer subcutaneous enoxaparin
- D. Give oral prednisone
A. Start IV furosemide
IV furosemide is appropriate for acute decompensated heart failure with signs of fluid overload as evidenced by dyspnea, rales, and peripheral edema. It provides rapid diuresis, reducing fluid congestion and improving symptoms.
A 63-year-old female presents with dizziness and a fainting spell while gardening. She reports no previous cardiac history but has a mild headache. Her pulse is 45 bpm, and blood pressure is 110/70 mmHg. ECG shows a regular, slow rhythm with absent P waves and wide QRS complexes. What is the likely diagnosis?**
- A. Second-degree AV block
- B. Sinus bradycardia
- C. Third-degree AV block
- D. Ventricular tachycardia
C. Third-degree AV block
The ECG findings and clinical presentation suggest a third-degree AV block (complete heart block), where there is no association between P waves and QRS complexes. This condition often requires urgent pacing.
A 58-year-old man presents to the emergency department complaining of sudden, severe back pain and a syncopal episode. His blood pressure is 90/60 mmHg, and he has a pulsatile abdominal mass. His extremities are cool and pale. Which of the following is the most likely diagnosis?**
- A. Acute pancreatitis
- B. Ruptured aortic aneurysm
- C. Myocardial infarction
- D. Pulmonary embolism
B. Ruptured aortic aneurysm
The presence of a pulsatile abdominal mass, hypotension, and the described symptoms are highly suggestive of a ruptured aortic aneurysm, which is a surgical emergency. Immediate imaging and surgical consultation are required.
A 50-year-old man with known peripheral arterial disease presents with sudden onset of cold, painful right leg. The leg appears pale and pulseless. What is the most likely diagnosis, and what is the immediate management step?**
- A. Deep vein thrombosis, start anticoagulation
- B. Acute arterial occlusion, immediate surgical evaluation
- C. Chronic venous insufficiency, prescribe compression stockings
- D. Cellulitis, administer IV antibiotics
B. Acute arterial occlusion, immediate surgical evaluation
Acute arterial occlusion presents with the ‘five Ps’: Pain, Pallor, Pulselessness, Paresthesia, and Paralysis. Immediate surgical evaluation is crucial for possible revascularization to save the limb.
A 45-year-old man presents with crushing chest pain, nausea, and sweating. His ECG shows ST elevations in the anterior leads. His troponin I level returned elevated. Which of the following medications should be administered first?**
- A. Oral aspirin
- B. IV metoprolol
- C. Sublingual nitroglycerin
- D. Oral atorvastatin
A. Oral aspirin
Aspirin is given immediately in cases of suspected myocardial infarction to reduce cardiac event-related mortality by inhibiting platelet aggregation, thus preventing further thrombus formation.
A 70-year-old woman with no significant medical history suddenly collapses while shopping. Bystanders report she was complaining of severe chest pain before collapsing. On arrival, she is pulseless and CPR is initiated. The monitor shows ventricular fibrillation. What is the immediate next step?**
- A. Administer IV amiodarone
- B. Perform defibrillation
- C. Insert an oropharyngeal airway
- D. Administer IV epinephrine
B. Perform defibrillation
Immediate defibrillation is the most effective treatment for ventricular fibrillation, especially in the context of cardiac arrest following a suspected myocardial infarction.
A 60-year-old woman with a history of rheumatic heart disease presents with acute shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea. Her ECG shows atrial fibrillation with rapid ventricular rate. What is the most likely exacerbating factor for her symptoms?**
- A. Chronic obstructive pulmonary disease
- B. Acute decompensated heart failure
- C. Acute renal failure
- D. Thyroid storm
B. Acute decompensated heart failure
Given the history of rheumatic heart disease, her symptoms are indicative of acute decompensated heart failure, likely exacerbated by the onset of atrial fibrillation with rapid ventricular rate, which compromises cardiac efficiency.
A 54-year-old male with a history of smoking and hypertension presents with sudden onset of tearing chest pain radiating to his back. His blood pressure is 180/120 mmHg. A chest X-ray shows a widened mediastinum. What is the most appropriate diagnostic test to confirm the suspected diagnosis?**
- A. Transthoracic echocardiogram
- B. CT scan of the chest with contrast
- C. MRI of the chest
- D. Coronary angiography **
B. CT scan of the chest with contrast
The clinical presentation is suggestive of an aortic dissection. A CT scan of the chest with contrast is the diagnostic test of choice for confirming the presence of an aortic dissection, as it provides detailed images of the aorta and can identify the extent of the dissection.
A 65-year-old male with a history of congestive heart failure and diabetes mellitus presents with progressive shortness of breath, fatigue, and a weight gain of 5 kg over the past week. Physical examination reveals rales halfway up both lung fields, jugular venous distention, and 3+ pitting edema of the lower extremities. Which therapeutic intervention is most appropriate to administer first?**
- A. Oral furosemide
- B. Intravenous furosemide
- C. Intravenous nitroglycerin
- D. Oxygen therapy
B. Intravenous furosemide
The patient presents with acute decompensated heart failure with signs of significant volume overload. Intravenous furosemide is indicated for rapid diuresis to relieve symptoms of fluid congestion and improve respiratory status.
A 39-year-old woman with no significant medical history presents with palpitations and light-headedness. Her pulse is 160 bpm, and ECG shows a narrow complex tachycardia without visible P waves. Vagal maneuvers have been attempted without success. What is the most appropriate pharmacologic treatment?**
- A. IV adenosine
- B. Oral beta-blockers
- C. IV amiodarone
- D. Oral digoxin
A. IV adenosine
The patient likely has supraventricular tachycardia (SVT). IV adenosine is the drug of choice for rapid termination of SVT due to its ability to transiently block the AV node.
A 70-year-old female with a history of atrial fibrillation is brought in by ambulance after being found unconscious at home. On examination, she is hypotensive and bradycardic. ECG shows a wide complex bradycardia with no discernible P waves. What is the most appropriate initial management?**
- A. Administer IV atropine
- B. Immediate electrical cardioversion
- C. Placement of a transcutaneous pacemaker
- D. Administer IV dopamine
C. Placement of a transcutaneous pacemaker
The patient presents with symptomatic bradycardia likely due to high-grade AV block or ventricular escape rhythm. The placement of a transcutaneous pacemaker is indicated to provide stable cardiac output until a more permanent solution is implemented.
A 58-year-old male with a history of chronic smoking and chronic obstructive pulmonary disease presents with acute onset of severe chest pain and dyspnea. Examination reveals a hypotensive patient with a loud diastolic murmur best heard over the right sternal border. Which of the following is the most likely diagnosis?**
- A. Acute myocardial infarction
- B. Aortic dissection
- C. Acute pulmonary embolism
- D. Aortic regurgitation
B. Aortic dissection
The combination of severe chest pain, hypotension, and a diastolic murmur suggests an aortic dissection, which may involve the aortic valve leading to acute aortic regurgitation as a complication.
A 55-year-old male is brought to the ER with chest pain and diaphoresis that started while mowing the lawn. His past medical history is significant for hypercholesterolemia. ECG shows ST elevations in leads V2-V4. Which enzyme is most specific for diagnosing an acute myocardial infarction in this setting?**
- A. Creatine kinase-MB
- B. Troponin I
- C. Aspartate transaminase (AST)
- D. Lactate dehydrogenase (LDH)
B. Troponin I
Troponin I is the most specific and sensitive marker for myocardial injury and is essential for the diagnosis of myocardial infarction, especially in patients presenting with classic symptoms and ECG changes.
A 48-year-old woman presents with sudden onset of shortness of breath and right-sided chest pain following a long airplane flight. She is tachycardic and hypoxic. A D-dimer test is markedly elevated. What is the most appropriate next step in management?**
- A. Immediate administration of therapeutic anticoagulation
- B. Perform a ventilation-perfusion (V/Q) scan
- C. Obtain a spiral CT scan of the chest
- D. Administer supplemental oxygen and observe
C. Obtain a spiral CT scan of the chest
The clinical presentation is suggestive of a pulmonary embolism. A spiral CT scan of the chest is the most appropriate diagnostic test to confirm the diagnosis and guide further management, especially in a hemodynamically stable patient.
A 62-year-old male with a known history of aortic stenosis presents complaining of dizziness and syncope. Examination reveals a systolic ejection murmur best heard at the right second intercostal space. Which of the following is the most appropriate diagnostic test to assess the severity of his condition?**
- A. Transthoracic echocardiogram
- B. Cardiac catheterization
- C. Holter monitor
- D. Exercise stress test
A. Transthoracic echocardiogram
A transthoracic echocardiogram is the best initial test to assess the severity of aortic stenosis, evaluate valve anatomy, and measure hemodynamic parameters such as gradient and valve area.
A 50-year-old male with a history of hypertension presents with acute tearing pain radiating to his back and a blood pressure discrepancy between arms. What is the most likely diagnosis and the best initial imaging study to confirm it?**
- A. Acute myocardial infarction, echocardiogram
- B. Aortic dissection, CT angiography
- C. Pulmonary embolism, V/Q scan
- D. Pericarditis, ECG
B. Aortic dissection, CT angiography
The symptoms suggest an aortic dissection. A CT angiography is the most appropriate imaging study to confirm the diagnosis as it provides detailed images of the aorta and can show the presence of a dissection flap and involvement of branch vessels.
A 44-year-old female presents to the emergency department with severe chest pain and a history of systolic heart failure. ECG shows no new changes. BNP levels are elevated. Which of the following is the most likely cause of her chest pain?**
- A. Acute myocardial infarction
- B. Acute coronary syndrome
- C. Acute exacerbation of heart failure
- D. Pulmonary embolism
C. Acute exacerbation of heart failure
In patients with systolic heart failure presenting with chest pain and elevated BNP, acute exacerbation of heart failure should be considered as a probable cause, especially in the absence of new ECG changes.
A 68-year-old male with a history of diabetes and smoking presents with sudden onset of severe abdominal pain and back pain. His blood pressure is 180/110 mmHg. Examination reveals a pulsatile abdominal mass. What is the most likely diagnosis and the immediate step to take?**
- A. Acute pancreatitis, administer IV fluids
- B. Abdominal aortic aneurysm, urgent surgical referral
- C. Diverticulitis, administer antibiotics
- D. Kidney stones, perform a CT scan
B. Abdominal aortic aneurysm, urgent surgical referral
The presence of a pulsatile abdominal mass in a patient with risk factors such as diabetes and smoking, accompanied by severe pain and high blood pressure, strongly suggests an abdominal aortic aneurysm. Urgent surgical referral is necessary as this condition can lead to rupture, which is life-threatening.
A 54-year-old female with a past medical history of rheumatoid arthritis and no known cardiac history presents with new onset chest pain. She describes the pain as sharp and worsening with inspiration. She also reports a recent upper respiratory tract infection. Physical examination shows a friction rub. Which of the following is the most likely diagnosis?**
- A. Acute pericarditis
- B. Myocardial infarction
- C. Pulmonary embolism
- D. Costochondritis
A. Acute pericarditis
the clinical presentation of sharp pain worsening with inspiration and the presence of a pericardial friction rub strongly suggest acute pericarditis, likely precipitated by a recent viral infection.
A 67-year-old man presents with sudden onset of palpitations and light-headedness. His pulse is 200 bpm, and blood pressure is 110/70 mmHg. ECG shows a regular tachycardia with narrow QRS complexes. Vagal maneuvers are ineffective. What is the next best step in management?**
- A. Administer IV adenosine
- B. Immediate electrical cardioversion
- C. Administer oral beta-blockers
- D. Perform carotid sinus massage
A. Administer IV adenosine
The presence of a stable, narrow complex tachycardia unresponsive to vagal maneuvers suggests SVT. IV adenosine is effective for terminating SVT by temporarily blocking the AV node.
A 59-year-old male with a history of diabetes and hypertension presents to the emergency department complaining of sudden, severe left-sided chest pain radiating to the back. His blood pressure is 200/120 mmHg in the right arm and 180/110 mmHg in the left arm. A diastolic murmur is heard on auscultation. Which diagnostic test should be performed immediately?**
- A. Transthoracic echocardiogram
- B. CT angiography of the chest
- C. Coronary angiography
- D. X-ray of the chest
B. CT angiography of the chest
The symptoms of severe chest pain radiating to the back, differential blood pressure readings between arms, and a diastolic murmur suggest aortic dissection. A CT angiography of the chest is crucial for immediate diagnosis.
A 72-year-old woman presents to the ED with fatigue and an irregular heartbeat. She has a history of heart failure. Her ECG shows atrial fibrillation with a rapid ventricular response. Her blood pressure is 100/60 mmHg. Which of the following is the best initial treatment?**
- A. IV digoxin
- B. IV diltiazem
- C. Oral amiodarone
- D. IV metoprolol
B. IV diltiazem
Given her history of heart failure and presentation with atrial fibrillation with rapid ventricular response, IV diltiazem is appropriate for rate control. It helps decrease the ventricular rate without adversely affecting cardiac output.
A 45-year-old man with a history of hyperlipidemia presents with sudden onset of shortness of breath, right-sided chest pain, and hemoptysis. He recently returned from a long car trip. His oxygen saturation is 89% on room air. What is the most appropriate diagnostic test to confirm the suspected condition?**
- A. Chest X-ray
- B. D-dimer assay
- C. CT pulmonary angiography
- D. Echocardiogram
C. CT pulmonary angiography
The clinical scenario is highly suggestive of a pulmonary embolism. CT pulmonary angiography is the gold standard for diagnosing pulmonary embolism and should be performed immediately given the symptoms.
A 63-year-old female with a history of mitral valve prolapse presents to the emergency department with palpitations and a feeling of ‘heart flipping in her chest’. Her ECG shows occasional premature ventricular contractions (PVCs). What is the most appropriate management for this patient?**
- A. Immediate electrical cardioversion
- B. Administer IV beta-blockers
- C. Observation and reassurance
- D. Insert an implantable cardioverter-defibrillator
C. Observation and reassurance
In a patient with mitral valve prolapse who is experiencing occasional PVCs but no other signs of hemodynamic instability, the most appropriate management is observation and reassurance. PVCs are common and often benign.
A 76-year-old man with a history of chronic obstructive pulmonary disease presents with increasing dyspnea, cough, and a new finding of an S3 gallop on examination. His chest X-ray shows an enlarged cardiac silhouette. What is the most likely cause of his symptoms?**
- A. Acute bronchitis
- B. Exacerbation of COPD
- C. Acute decompensated heart failure
- D. Pneumonia
C. Acute decompensated heart failure
The presence of an S3 gallop and an enlarged cardiac silhouette on chest X-ray in a patient presenting with dyspnea and cough suggests acute decompensated heart failure.
A 60-year-old woman with a history of aortic stenosis presents with syncope. She is noted to have a systolic ejection murmur and her ECG shows left ventricular hypertrophy. What is the most appropriate next step in management?**
- A. Immediate surgical valve replacement
- B. Cardiac catheterization
- C. Holter monitoring
- D. Start beta-blockers
B. Cardiac catheterization
Cardiac catheterization can help assess the severity of aortic stenosis and guide decisions about timing for surgical valve replacement, which may be necessary given her symptom of syncope.
A 50-year-old man presents with acute onset of chest pain, dyspnea, and palpitations. He has a history of smoking 1 pack per day for 30 years. His ECG shows new T-wave inversions in leads II, III, and aVF. What is the most likely underlying cause of his presentation?**
- A. Acute myocardial infarction
- B. Chronic obstructive pulmonary disease (COPD)
- C. Acute pericarditis
- D. Pulmonary embolism
A. Acute myocardial infarction
New T-wave inversions in leads II, III, and aVF are suggestive of ischemia in the inferior wall of the heart, indicating an acute myocardial infarction, especially given his significant smoking history.
A 55-year-old man with a known history of hypertension and a previous myocardial infarction is brought to the ED with severe dizziness and weakness. His blood pressure is 80/50 mmHg, pulse is 50 bpm, and he is diaphoretic. His ECG shows a wide QRS complex. What is the most likely diagnosis?**
- A. Ventricular tachycardia
- B. Complete heart block
- C. Sinus bradycardia
- D. Atrial fibrillation with slow ventricular response
B. Complete heart block
the presentation of severe dizziness, weakness, hypotension, bradycardia, and wide QRS complexes is consistent with complete heart block, a serious condition requiring immediate pacing.
A 55-year-old woman with a history of rheumatoid arthritis presents with sudden onset of left knee pain and swelling after falling down stairs. Examination reveals warmth, erythema, and a palpable effusion. Which of the following is the most appropriate next step in management?**
- A) Immediate knee X-ray
- B) Intravenous antibiotics
- C) Oral NSAIDs and rest
- D) Arthrocentesis
D) Arthrocentesis
In a patient with rheumatoid arthritis presenting with acute knee pain, swelling, and signs of inflammation, arthrocentesis is critical to exclude septic arthritis, a potential emergency. An X-ray, while useful, would not provide immediate information regarding potential joint infection.
A 22-year-old male athlete complains of sudden, severe right shoulder pain and inability to move his arm after a collision during a football game. Physical examination shows anterior shoulder fullness and a squared off appearance of the deltoid. What is the most likely diagnosis?**
- A) Acromioclavicular joint injury
- B) Rotator cuff tear
- C) Anterior shoulder dislocation
- D) Clavicle fracture
C) Anterior shoulder dislocation
The description of anterior fullness and a squared-off deltoid contour is classic for an anterior shoulder dislocation, common in contact sports injuries.
A 30-year-old construction worker presents with low back pain after lifting heavy equipment. He reports numbness in his right leg. Straight leg raise test elicits right sciatic pain. Which diagnostic study will most likely confirm the suspected diagnosis?**
- A) X-ray of the lumbar spine
- B) MRI of the lumbar spine
- C) CT scan of the lumbar spine
- D) Electromyography (EMG)
B) MRI of the lumbar spine
MRI is the best choice for visualizing soft tissue details needed to diagnose herniated discs and nerve root impingement, likely in this case given the sciatica symptoms.
A 68-year-old female with a past medical history of osteoporosis falls at home and presents with hip pain. She is unable to bear weight. Physical examination reveals leg shortening and external rotation. Which is the most appropriate initial diagnostic test?**
- A) Pelvic X-ray
- B) Total body bone scan
- C) MRI of the hip
- D) CT scan of the pelvis
A) Pelvic X-ray
Pelvic X-rays are the first-line diagnostic tool for suspected hip fractures, especially after a low-energy trauma in an osteoporotic patient
A 45-year-old male presents with sudden onset of severe right great toe pain and swelling after a night of heavy drinking. On examination, the toe is red, hot, and extremely tender. Which of the following is the most likely diagnosis?**
- A) Septic arthritis
- B) Gout
- C) Fracture
- D) Cellulitis
B) Gout
Acute gouty arthritis is likely given the rapid onset, severe pain, and association with alcohol consumption, commonly affecting the great toe (podagra).
A 36-year-old woman presents complaining of recurrent, painful swelling of her knees and wrists. She has a butterfly rash on her face and reports severe fatigue. What is the most likely diagnosis?**
- A) Rheumatoid arthritis
- B) Systemic lupus erythematosus
- C) Psoriatic arthritis
- D) Osteoarthritis
B) Systemic lupus erythematosus
The combination of joint symptoms, a butterfly rash, and systemic symptoms like fatigue strongly suggests systemic lupus erythematosus.
A 20-year-old college student presents after twisting her ankle during basketball. She has significant swelling and bruising, and pain with weight-bearing. Ottawa ankle rules should be applied to determine the need for which of the following?**
- A) Immediate physiotherapy
- B) Ankle X-ray
- C) MRI of the ankle
- D) No imaging is necessary
B) Ankle X-ray
The Ottawa ankle rules suggest an X-ray is required in cases of ankle pain with bone tenderness and an inability to bear weight immediately after injury and in the emergency department.
A 58-year-old male with a history of back pain presents with new onset of bilateral thigh and groin pain. Physical examination reveals decreased range of motion in his hips. He has a history of smoking and chronic steroid use. Which condition is most likely responsible for his symptoms?**
- A) Osteoarthritis
- B) Avascular necrosis of the femoral heads
- C) Spinal stenosis
- D) Meralgia paresthetica
B) Avascular necrosis of the femoral heads
Chronic steroid use and smoking are risk factors for avascular necrosis, which can present with hip pain and reduced range of motion
A 50-year-old female presents to the emergency department with acute knee pain after a fall, notable for significant swelling. There is no fracture on X-ray. Her knee is aspirated, showing fat globules in the synovial fluid. What does this finding suggest?**
- A) Infection
- B) Rheumatoid arthritis
- C) Gout
- D) Fat embolism syndrome
D) Fat embolism syndrome
Fat globules in synovial fluid following trauma without a visible fracture suggest intra-articular fat, indicative of a bone marrow embolism potentially from a non-displaced bone fracture.
A 28-year-old male presents with a swollen, painful left wrist after falling on an outstretched hand. Examination shows tenderness over the ‘anatomical snuffbox.’ What is the most appropriate diagnostic test to order first?**
- A) Wrist X-ray
- B) MRI of the wrist
- C) Ultrasound of the wrist
- D) CT scan of the wrist
A) Wrist X-ray
Tenderness in the anatomical snuffbox after trauma is highly suggestive of a scaphoid fracture. An initial X-ray is appropriate to evaluate for this common injury.
A 32-year-old female presents to the emergency department with a swollen, painful right ankle after twisting it during a soccer game. Physical examination reveals tenderness over the lateral malleolus but no skin breaks. She is unable to bear weight. What is the most likely diagnosis?**
- A) Ankle sprain
- B) Lateral malleolus fracture
- C) Achilles tendon rupture
- D) Peroneal tendon dislocation
B) Lateral malleolus fracture
Given the tenderness over the lateral malleolus and the inability to bear weight, a fracture is highly probable, particularly in the setting of an acute inversion injury. An X-ray would confirm this diagnosis according to the Ottawa ankle rules.
A 40-year-old male presents with sudden onset of sharp, severe lower back pain after lifting a heavy object at work. He reports a sensation of a ‘pop’ in his back at the time of the injury. Examination reveals paraspinal muscle spasm without neurological deficit. Which of the following is the most appropriate initial management?**
- A) Immediate surgical referral
- B) MRI of the lumbar spine
- C) Prescription NSAIDs and muscle relaxants
- D) Bed rest for one week
C) Prescription NSAIDs and muscle relaxants
This presentation is consistent with acute lumbar strain. Initial management includes NSAIDs and muscle relaxants. Bed rest is discouraged as it may delay recovery, and imaging or surgical referral is not indicated unless neurological deficits are present.
A 70-year-old woman with a known history of osteoarthritis presents to the emergency room complaining of right hip pain that worsens with movement and is relieved by rest. She denies recent trauma. Physical examination shows limited range of motion of the right hip with pain on internal rotation. Which imaging modality is most appropriate for this patient?**
- A) X-ray of the hip
- B) MRI of the hip
- C) CT scan of the hip
- D) Ultrasound of the hip
A) X-ray of the hip
An X-ray is the first-line imaging study in patients presenting with symptoms suggestive of exacerbation of osteoarthritis, as it can reveal joint space narrowing, bone spurs, and other changes associated with the disease
A 24-year-old male complains of severe pain in his right wrist after falling off his skateboard and landing on his hand. Examination reveals tenderness and swelling over the scaphoid bone, but initial X-rays are negative. What is the most appropriate next step in management?**
- A) Discharge with analgesics and wrist brace
- B) Repeat X-rays in 10-14 days
- C) Immediate MRI
- D) Plaster cast immobilization and outpatient follow-up
C) Immediate MRI
With clinical suspicion of a scaphoid fracture and negative initial X-rays, an MRI is indicated as it can detect occult fractures not visible on X-rays. This ensures appropriate management to prevent complications like avascular necrosis.
A 15-year-old female volleyball player presents with anterior knee pain that worsens during activity, particularly when jumping. Physical examination reveals pain at the inferior pole of the patella. What is the most likely diagnosis?**
- A) Patellar tendinitis
- B) Patellar dislocation
- C) Meniscal tear
- D) Osgood-Schlatter disease
A) Patellar tendinitis
Known as ‘jumper’s knee,’ patellar tendinitis is common in athletes and presents with localized pain aggravated by activities that load the knee joint, such as jumping
A 55-year-old male with a history of chronic steroid use presents with sudden onset of severe right shoulder pain after reaching overhead. Physical examination reveals weakness in shoulder abduction. What is the most likely diagnosis?**
- A) Acute rotator cuff tear
- B) Shoulder impingement syndrome
- C) Adhesive capsulitis
- D) Biceps tendinitis
A) Acute rotator cuff tear
Chronic steroid use is a risk factor for tendon degeneration, which can lead to an acute rotator cuff tear, particularly under sudden stress. This diagnosis is supported by weakness in abduction, suggesting a tear involving the supraspinatus tendon.
A 49-year-old female presents with severe right wrist pain immediately following a fall onto her outstretched hand. There is noticeable deformity and swelling of the wrist. What is the most appropriate initial management?**
- A) Closed reduction and splinting
- B) Administer analgesia and order a wrist X-ray
- C) Immediate referral to orthopedics for surgery
- D) CT scan of the wrist
B) Administer analgesia and order a wrist X-ray
Initial management should focus on pain control and diagnostic imaging to assess the extent of the injury, which is critical for determining the appropriate intervention, including potential need for reduction or surgery.
A 29-year-old female reports a painful, swollen left knee after a twisting injury during a soccer game. She is unable to fully extend her knee. What is the most likely diagnosis?**
- A) Meniscal tear
- B) Anterior cruciate ligament (ACL) tear
- C) Patellar dislocation
- D) Medial collateral ligament (MCL) sprain
A) Meniscal tear
The inability to fully extend the knee, often referred to as a ‘locked knee,’ is a classic sign of a meniscal tear, particularly following a twisting injury during sports.
A 36-year-old man presents with neck pain and restricted movement following a rear-end collision while driving. He reports pain radiating down to his right arm. What is the most appropriate diagnostic test to order?**
- A) Neck X-ray
- B) CT scan of the neck
- C) MRI of the cervical spine
- D) Electromyography (EMG)
C) MRI of the cervical spine
An MRI is appropriate given the symptoms of radiating pain, which may indicate nerve root compression or other soft-tissue injuries not visible on X-rays or CT scans
A 60-year-old woman presents with right thigh pain after a minor fall. She has a history of chronic renal failure. Examination reveals pain with any attempt to move the hip, but no external injuries are visible. What is the most likely diagnosis?**
- A) Hip fracture
- B) Muscle strain
- C) Hematoma
- D) Renal osteodystrophy related fracture
A) Hip fracture
Given her age and the mechanism of injury, a hip fracture is highly likely and requires immediate X-ray imaging to confirm the diagnosis and guide further management.
A 19-year-old male presents to the emergency department after injuring his knee during a soccer game. He describes a “popping” sound followed by immediate swelling. Physical examination reveals a positive Lachman test. What is the most likely diagnosis?**
- A) Patellar fracture
- B) Meniscal tear
- C) Anterior cruciate ligament (ACL) tear
- D) Collateral ligament injury
C) Anterior cruciate ligament (ACL) tear
A ‘popping’ sound followed by immediate swelling and a positive Lachman test (which indicates anterior translation of the tibia relative to the femur) are classic indicators of an ACL tear.
A 38-year-old female presents with severe pain in her right wrist after slipping on ice. On examination, there is significant tenderness over the radial aspect of the wrist. An X-ray shows a fracture through the radial styloid. What is the most likely diagnosis?**
- A) Scaphoid fracture
- B) Distal radius fracture
- C) De Quervain’s tenosynovitis
- D) Ulnar styloid fracture
B) Distal radius fracture
A fracture through the radial styloid typically indicates a distal radius fracture, often referred to as a Chauffeur’s fracture, common in falls on an outstretched hand.
A 56-year-old male presents with acute onset of lower back pain after lifting a heavy object at home. The pain is localized to the lumbar region without radiation. He denies any previous history of similar pain. Physical examination reveals paraspinal tenderness without neurological deficit. What is the most appropriate management?**
- A) NSAIDs and physical therapy
- B) Immediate lumbar spine MRI
- C) Prescription opioids
- D) Epidural steroid injection
A) NSAIDs and physical therapy
This scenario suggests acute nonspecific low back pain, best managed initially with non-opioid analgesics such as NSAIDs and physical therapy to encourage mobility and strengthen the back.
A 24-year-old female runner presents with bilateral knee pain that worsens with running and descending stairs. Physical examination shows pain and swelling over the anterior aspect of both knees. Which condition is most likely responsible for her symptoms?**
- A) Patellar tendinopathy
- B) Patellofemoral pain syndrome
- C) Bursitis
- D) IT band syndrome
B) Patellofemoral pain syndrome
Patellofemoral pain syndrome is common in young athletes, especially females, presenting with pain localized to the anterior knee, exacerbated by activities that increase patellofemoral joint stress, such as running and stair climbing
A 60-year-old male with a history of prostate cancer presents with new onset of severe back pain. Radiographs reveal lytic lesions in the vertebral bodies. What is the most likely cause of his back pain?**
- A) Osteoporotic fractures
- B) Metastatic prostate cancer
- C) Multiple myeloma
- D) Acute herniated disc
B) Metastatic prostate cancer
Patients with a history of prostate cancer presenting with new severe back pain and lytic lesions on radiograph are highly suggestive of metastatic disease to the spine.
A 22-year-old female gymnast presents with acute onset of wrist pain following a fall during a routine. Examination shows tenderness over the scaphoid bone. An X-ray is negative for fracture. What is the next best step in management?**
- A) Discharge with follow-up if pain persists
- B) MRI of the wrist
- C) Splint and follow-up in one week
- D) Immediate referral to orthopedics
C) Splint and follow-up in one week
With clinical suspicion of a scaphoid fracture and an initially negative X-ray, it is appropriate to splint the wrist and arrange for close follow-up. An MRI may be considered if symptoms persist or worsen.
A 45-year-old male presents with shoulder pain after a motor vehicle accident. Examination reveals a dropped shoulder and inability to shrug against resistance. What is the most likely diagnosis?**
- A) Acromioclavicular joint separation
- B) Rotator cuff tear
- C) Brachial plexus injury
- D) Trapezius muscle injury
D) Trapezius muscle injury
Explanation: Inability to shrug the shoulder against resistance with a dropped shoulder appearance typically indicates a trapezius muscle injury, possibly involving the accessory nerve.
A 34-year-old male presents with acute right ankle pain and deformity after a basketball injury. Physical examination reveals tenderness, swelling, and instability of the ankle. What is the most appropriate immediate management?**
- A) Apply a compression wrap and elevate the ankle
- B) Perform a reduction in the emergency department
- C) Send the patient home with crutches and pain medication
- D) Immediate surgical referral
B) Perform a reduction in the emergency department
Clinical signs suggest a dislocated ankle, which requires immediate reduction in the emergency department to restore alignment and minimize vascular compromise.
A 53-year-old female presents with wrist pain following a slip on ice. Physical examination shows tenderness in the ‘anatomical snuffbox.’ The initial X-ray of the wrist is inconclusive. What is the next best step in management?**
- A) CT scan of the wrist
- B) Bone scan
- C) MRI of the wrist
- D) Splint and re-evaluate in 10-14 days
D) Splint and re-evaluate in 10-14 days
With tenderness in the anatomical snuffbox and an inconclusive initial X-ray, it is prudent to splint the wrist and schedule a follow-up, including a repeat X-ray, to rule out a scaphoid fracture, which can often be initially occult.
A 72-year-old male with a history of chronic obstructive pulmonary disease presents with acute right hip pain after a minor fall. He is unable to bear weight. An X-ray reveals no fracture. What is the most likely diagnosis?**
- A) Acute exacerbation of hip osteoarthritis
- B) Muscle strain
- C) Hip dislocation
- D) Insufficiency fracture
D) Insufficiency fracture
In elderly patients, particularly those with underlying conditions that may weaken bone (like COPD with long-term steroid use), an insufficiency fracture may occur even with minimal trauma and can be initially radiographically occult. MRI or CT may be needed to confirm the diagnosis.
A 43-year-old male with a history of alcohol abuse presents to the emergency department complaining of sudden onset of severe epigastric pain radiating to the back, nausea, and vomiting. His vital signs are: BP 110/70 mmHg, HR 120 bpm, T 37.6°C. On examination, he has epigastric tenderness. His serum lipase level is elevated. What is the most likely diagnosis?
- A) Acute cholecystitis
- B) Acute pancreatitis
- C) Peptic ulcer disease
- D) Gastroesophageal reflux disease
B) Acute pancreatitis
The patient’s history of alcohol abuse combined with the classic symptom of epigastric pain radiating to the back and elevated lipase confirms the diagnosis of acute pancreatitis. Acute cholecystitis and peptic ulcer disease typically do not cause pain that radiates to the back, and GERD does not correlate with elevated lipase levels.
A 57-year-old woman presents with a two-day history of right lower quadrant abdominal pain, fever, and leukocytosis. She mentions that the pain worsened with movement and is associated with nausea. On physical examination, you note tenderness and rebound in the right lower quadrant. What is the most appropriate next step in management?
- A) Order an abdominal ultrasound
- B) Perform a CT scan of the abdomen
- C) Administer intravenous fluids and observe
- D) Immediate exploratory laparotomy
B) Perform a CT scan of the abdomen
The clinical presentation is suggestive of acute appendicitis. A CT scan is the diagnostic tool of choice in adults to confirm the diagnosis and rule out other causes of right lower quadrant pain.
A 65-year-old man with a history of hypertension and chronic constipation presents with new-onset left-sided abdominal pain and a change in bowel habits. Physical examination reveals a distended abdomen and hyperactive bowel sounds. Which of the following is the most likely diagnosis?
- A) Diverticular disease
- B) Ischemic bowel disease
- C) Obstructive bowel disease
- D) Inflammatory bowel disease
A) Diverticular disease
Given the patient’s age and history of chronic constipation, diverticular disease with possible acute diverticulitis is likely, presenting with left-sided abdominal pain and altered bowel habits. Ischemic bowel disease typically presents with pain out of proportion to physical findings.
A 22-year-old college student comes to the emergency department with severe cramping abdominal pain, fever, and bloody diarrhea. He recently returned from a camping trip. Stool cultures are pending. Which of the following is the most likely pathogen?
- A) Escherichia coli O157:H7
- B) Salmonella
- C) Giardia lamblia
- D) Campylobacter jejuni
D) Campylobacter jejuni
Campylobacter jejuni is a common cause of bacterial enteritis, particularly in young adults and is often associated with consumption of contaminated water or food and recent travel or outdoor activities, such as camping.
A 55-year-old man with a history of peptic ulcer disease presents with vomiting of bright red blood. His BP is 90/60 mmHg and HR is 110 bpm. What is the initial most appropriate action?
- A) Oral administration of a proton pump inhibitor
- B) Endoscopic evaluation
- C) Administration of IV fluids and blood transfusion
- D) Immediate surgery
C) Administration of IV fluids and blood transfusion
This patient is presenting with signs of hypovolemic shock due to upper gastrointestinal bleeding, likely from a peptic ulcer. Immediate resuscitation with IV fluids and blood transfusion is necessary before further diagnostic steps such as endoscopy.
A 48-year-old female presents with jaundice, dark urine, and pruritus. Her liver function tests show elevated direct bilirubin and alkaline phosphatase. Which of the following is the most appropriate diagnostic test to confirm the suspected diagnosis?
- A) Hepatic ultrasound
- B) Liver biopsy
- C) ERCP
- D) Serum acetaminophen level
C) ERCP
The presentation is suggestive of cholestasis, possibly due to a biliary obstruction. ERCP (Endoscopic Retrograde Cholangiopancreatography) is appropriate for visualizing the biliary tree and identifying any obstructive lesion such as stones or tumors.
A 34-year-old male presents with sudden onset of right upper quadrant abdominal pain, fever, and vomiting. Physical examination shows tenderness in the right upper quadrant with a positive Murphy’s sign. What is the most likely diagnosis?
- A) Hepatitis
- B) Peptic ulcer
- C) Gallstones with acute cholecystitis
- D) Pancreatitis
C) Gallstones with acute cholecystitis
This classic presentation of right upper quadrant pain with a positive Murphy’s sign and systemic symptoms such as fever strongly suggests acute cholecystitis, typically associated with gallstones.
A 70-year-old woman presents with non-bloody diarrhea and a history of antibiotic use two weeks ago. Which of the following is the most appropriate treatment?
- A) Initiate loperamide
- B) Prescribe a course of ciprofloxacin
- C) Start metronidazole
- D) Oral vancomycin
D) Oral vancomycin
The patient’s history of recent antibiotic use and symptoms are suggestive of Clostridium difficile infection. Oral vancomycin is the treatment of choice for C. difficile infection.
A 26-year-old woman presents with acute lower abdominal pain and has a positive pregnancy test. She is hemodynamically stable, but her hCG levels are unusually high for the gestational age. What is the most likely diagnosis?
- A) Ectopic pregnancy
- B) Threatened abortion
- C) Normal early pregnancy
- D) Molar pregnancy
D) Molar pregnancy
The unusually high hCG levels and presentation of abdominal pain in a pregnant woman raise the suspicion of a molar pregnancy, which is characterized by abnormal trophoblastic growth.
A 60-year-old man with a history of atrial fibrillation and warfarin therapy presents with melena. His INR is 5.0. What is the most appropriate management to address his current condition?
- A) Increase the dose of warfarin
- B) Administer vitamin K
- C) Discontinue warfarin
- D) Perform a colonoscopy
B) Administer vitamin K
The patient has an elevated INR and symptoms of gastrointestinal bleeding, indicating warfarin over-anticoagulation. Vitamin K is used to reverse the effects of warfarin rapidly to manage the bleeding.
A 50-year-old male with a history of chronic smoking and alcohol use presents with acute onset of severe, sharp epigastric pain that worsens on lying flat and improves upon leaning forward. He also reports nausea without vomiting. Examination reveals epigastric tenderness without rebound. Which of the following is the most likely diagnosis?
- A) Acute myocardial infarction
- B) Acute pancreatitis
- C) Gastroesophageal reflux disease (GERD)
- D) Peptic ulcer disease
B) Acute pancreatitis
The patient’s presentation of severe epigastric pain that improves on leaning forward, along with a history of risk factors such as chronic smoking and alcohol use, strongly suggests acute pancreatitis. This condition often presents with pain that radiates to the back and is alleviated by sitting up and leaning forward.
A 29-year-old man presents with severe diarrhea, abdominal cramping, and fever after returning from a hiking trip in South America. He reports consuming local street food and untreated water. Stool examination is likely to reveal which of the following pathogens?
- A) Clostridium difficile
- B) Giardia lamblia
- C) Campylobacter jejuni
- D) Norovirus
B) Giardia lamblia
Giardia lamblia, a protozoan parasite, is commonly contracted through contaminated water, which fits the patient’s history of drinking untreated water during a trip to South America. It presents with diarrhea, cramps, and sometimes fever.
A 38-year-old female presents with acute right-sided abdominal pain and jaundice. Labs show elevated liver enzymes and bilirubin. Ultrasound reveals multiple gallstones and a dilated common bile duct. What is the most appropriate next step in management?
- A) Schedule for elective cholecystectomy
- B) Initiate broad-spectrum antibiotics
- C) Perform endoscopic retrograde cholangiopancreatography (ERCP)
- D) Provide symptomatic treatment only
C) Perform endoscopic retrograde cholangiopancreatography (ERCP)
Given the findings of gallstones and a dilated common bile duct in a patient presenting with jaundice and right-sided abdominal pain, ERCP is indicated to remove any obstructing stones in the bile duct and alleviate the obstruction.
A 45-year-old woman presents with a one-week history of progressive jaundice, pruritus, and pale stools. She has a history of rheumatoid arthritis and has been taking methotrexate. Which of the following is the most likely diagnosis?
- A) Viral hepatitis
- B) Drug-induced liver injury
- C) Autoimmune hepatitis
- D) Gallstone disease
B) Drug-induced liver injury
Methotrexate is known to potentially cause hepatotoxicity, especially in patients with pre-existing liver conditions or prolonged use, leading to symptoms like jaundice and pruritus. This patient’s symptoms are consistent with a drug-induced liver injury.
A 36-year-old male presents to the ED with lower abdominal pain and rectal bleeding. He reports a recent history of frequent antibiotic use for a skin infection. Colonoscopy shows pseudomembranes on the colon wall. Which treatment is most appropriate?
- A) Intravenous hydration and observation
- B) Oral vancomycin
- C) Initiation of antidiarrheal agents
- D) Broad-spectrum antibiotics
B) Oral vancomycin
The presence of pseudomembranes seen during colonoscopy and a history of recent antibiotic use suggest Clostridium difficile infection. Oral vancomycin is the treatment of choice for moderate to severe cases.
A 24-year-old woman presents with sudden onset of intense, localized left lower quadrant pain. She mentions that she recently had a severe episode of coughing followed by the onset of pain. Physical examination shows localized tenderness in the left lower quadrant with guarding. What is the most likely diagnosis?
- A) Ruptured ovarian cyst
- B) Diverticulitis
- C) Splenic rupture
- D) Ectopic pregnancy
B) Diverticulitis
Diverticulitis often presents with sudden onset of pain in the left lower quadrant, especially in a younger patient without a clear precipitating factor like trauma. The episode of coughing may have increased intra-abdominal pressure, triggering a diverticular rupture or inflammation.
A 70-year-old male with a history of NSAID use for chronic knee pain presents with melena and dizziness. His hemoglobin is 9.2 g/dL, down from 13.4 g/dL three months ago. Which of the following is the most appropriate initial diagnostic test?
- A) Colonoscopy
- B) Esophagogastroduodenoscopy (EGD)
- C) Abdominal CT scan
- D) Barium enema
B) Esophagogastroduodenoscopy (EGD)
EGD is indicated for an elderly patient presenting with melena and a history of NSAID use, as it is the best initial diagnostic test to evaluate for upper gastrointestinal bleeding, likely caused by peptic ulcer disease.
A 55-year-old male presents with severe upper abdominal pain that began after eating a fatty meal. His physical examination shows a positive Murphy’s sign. Which of the following is the most likely cause of his symptoms?
- A) Acute pancreatitis
- B) Acute hepatitis
- C) Acute cholecystitis
- D) Peptic ulcer disease
C) Acute cholecystitis
The patient’s symptoms of severe pain after a fatty meal and a positive Murphy’s sign are classic for acute cholecystitis, an inflammation of the gallbladder often caused by gallstones.
A 32-year-old male presents with non-bloody diarrhea and a cramping abdominal pain for two weeks. He recently started a gluten-free diet after a diagnosis of celiac disease but has not seen improvement. Which of the following is the most appropriate next step?
- A) Refer to a dietitian to review dietary compliance
- B) Prescribe a course of antibiotics for presumed bacterial overgrowth
- C) Perform a colonoscopy with biopsy to evaluate for microscopic colitis
- D) Recommend an over-the-counter antidiarrheal
A) Refer to a dietitian to review dietary compliance
Before considering further invasive testing or treatments, it is crucial to ensure that the patient is strictly adhering to a gluten-free diet as non-compliance is a common reason for lack of improvement in symptoms of celiac disease.
A 28-year-old female presents to the emergency department with acute epigastric pain, nausea, and vomiting. She has a history of similar episodes, and previous workups including abdominal ultrasound and CT scan were unremarkable. Family history is significant for hyperparathyroidism. What is the most likely diagnosis?
- A) Peptic ulcer disease
- B) Pancreatic cancer
- C) Biliary dyskinesia
- D) Medullary thyroid cancer
C) Biliary dyskinesia
Biliary dyskinesia can present with symptoms similar to gallstone disease but without visible stones on imaging studies. It should be considered especially when other common causes have been ruled out and there is a recurrent pattern of symptoms.
A 68-year-old male with a history of atrial fibrillation on warfarin therapy presents with coffee-ground emesis and light-headedness. His vital signs include a BP of 100/60 mmHg, HR 110 bpm, and RR 20/min. Which of the following is the most immediate management step?
- A) Administer intravenous proton pump inhibitors
- B) Perform an urgent upper gastrointestinal endoscopy
- C) Administer intravenous fluids and packed red blood cells
- D) Reverse anticoagulation with vitamin K and fresh frozen plasma
C) Administer intravenous fluids and packed red blood cells
The patient presents with signs of an upper gastrointestinal bleed and hemodynamic instability, indicated by coffee-ground emesis and hypotension. Immediate fluid resuscitation with IV fluids and blood transfusion is critical to stabilize the patient before further diagnostic and therapeutic measures.
A 30-year-old female presents with acute abdominal pain, fever, and a rigid abdomen. She has a history of multiple abdominal surgeries. Her last meal was 10 hours ago. Which of the following is the most likely diagnosis?
- A) Acute appendicitis
- B) Bowel obstruction
- C) Gastroenteritis
- D) Cholecystitis
B) Bowel obstruction
The presentation of acute abdominal pain, fever, and a rigid abdomen in a patient with a history of multiple abdominal surgeries strongly suggests a bowel obstruction, possibly due to adhesions. The lack of recent food intake is consistent with an obstruction.
A 44-year-old male with a history of alcoholism presents with black, tarry stools and mild abdominal discomfort. Lab results show a low hemoglobin level. Which of the following is the most appropriate initial diagnostic test?
- A) Colonoscopy
- B) Esophagogastroduodenoscopy (EGD)
- C) Abdominal ultrasound
- D) CT scan of the abdomen
B) Esophagogastroduodenoscopy (EGD)
The patient’s history of alcoholism and presentation with melena (black, tarry stools) suggest an upper gastrointestinal source of bleeding, most likely related to gastropathy or esophageal varices. EGD is the appropriate initial diagnostic test to visualize the upper gastrointestinal tract.
A 53-year-old woman with no significant medical history presents with right upper quadrant pain, fever, and leukocytosis. Ultrasound shows gallstones and a thickened gallbladder wall. Which of the following is the most appropriate treatment?
- A) Intravenous antibiotics and urgent cholecystectomy
- B) Oral antibiotics and outpatient follow-up
- C) Pain management with NSAIDs
- D) Immediate ERCP
A) Intravenous antibiotics and urgent cholecystectomy
This patient’s symptoms and ultrasound findings are indicative of acute cholecystitis. The appropriate management is intravenous antibiotics to cover potential bacterial infection and an urgent cholecystectomy to remove the inflamed gallbladder.
A 40-year-old male presents with diffuse abdominal pain, watery diarrhea, and a recent weight loss of 10 pounds over the past month. He mentions that the symptoms worsen after meals. Which condition is most consistent with this presentation?
- A) Lactose intolerance
- B) Celiac disease
- C) Irritable bowel syndrome (IBS)
- D) Peptic ulcer disease
B) Celiac disease
The symptoms of diffuse abdominal pain, diarrhea, and weight loss worsening after meals suggest a malabsorptive disorder like celiac disease, where ingestion of gluten leads to intestinal inflammation and nutrient malabsorption.
A 22-year-old female presents to the emergency department with severe lower abdominal pain. She has a known history of irritable bowel syndrome but states that the pain is different and more severe than usual. On examination, she has a temperature of 38.3°C and rebound tenderness. What is the most likely diagnosis?
- A) Exacerbation of IBS
- B) Acute appendicitis
- C) Pelvic inflammatory disease
- D) Urinary tract infection
B) Acute appendicitis
Although the patient has a history of IBS, the presence of fever and rebound tenderness is suggestive of a more acute inflammatory process, such as appendicitis, which requires immediate surgical evaluation.
A 55-year-old male with a history of hypertension and smoking presents with sudden onset of sharp back pain and vomiting. His blood pressure is 180/100 mmHg. Abdominal examination reveals a pulsatile mass. What is the most appropriate initial management?
- A) Immediate surgical consultation
- B) CT scan of the abdomen with contrast
- C) Administration of a beta-blocker
- D) Esophagogastroduodenoscopy (EGD)
A) Immediate surgical consultation
The presence of a pulsatile abdominal mass with hypertension and severe pain suggests an abdominal aortic aneurysm (AAA), possibly ruptured. This is a surgical emergency requiring immediate consultation and intervention.
A 47-year-old male with a history of type 2 diabetes presents with nausea, vomiting, and sharp pain radiating to his back. He has a fever and elevated white blood cell count. His lipase is significantly elevated. What is the most likely diagnosis?
- A) Diabetic ketoacidosis
- B) Acute pancreatitis
- C) Myocardial infarction
- D) Cholecystitis
B) Acute pancreatitis
The patient’s symptoms of nausea, vomiting, back pain, fever, leukocytosis, and elevated lipase are highly indicative of acute pancreatitis, which can be exacerbated by factors like hyperglycemia in diabetics.
A 26-year-old female presents with acute onset of left-sided abdominal pain and vomiting. She reports using oral contraceptives. Ultrasound reveals a complex mass in the left ovary with free fluid in the pelvis. What is the most likely diagnosis?
- A) Ovarian torsion
- B) Ectopic pregnancy
- C) Ovarian cyst rupture
- D) Pelvic inflammatory disease
A) Ovarian torsion
The acute onset of severe, localized pain and ultrasound findings of a complex ovarian mass with free fluid suggest ovarian torsion, a gynecological emergency caused by the rotation of the ovary, potentially compromising blood supply.
A 59-year-old male presents with abdominal pain, jaundice, and clay-colored stools. His past medical history is significant for coronary artery disease and hyperlipidemia. Laboratory tests reveal elevated bilirubin and alkaline phosphatase. What is the most likely diagnosis?
- A) Acute hepatitis
- B) Pancreatic cancer
- C) Choledocholithiasis
- D) Alcoholic liver disease
C) Choledocholithiasis
The triad of abdominal pain, jaundice, and pale stools (acholic stools) along with the lab findings suggests an obstruction in the biliary tract, most likely due to stones (choledocholithiasis), commonly seen in patients with a history of gallstones.
A 65-year-old man with a history of smoking presents to the emergency department with acute onset of dyspnea and pleuritic chest pain following a prolonged flight. On examination, his oxygen saturation is 88% on room air, and he appears tachypneic. A D-dimer test is elevated. What is the most appropriate next step in management?**
- A) Administer high-flow oxygen and prepare for intubation.
- B) Start broad-spectrum antibiotics.
- C) Perform a CT pulmonary angiogram.
- D) Initiate nebulized bronchodilator therapy.
C) Perform a CT pulmonary angiogram.
The presentation suggests a high probability of pulmonary embolism (PE), given the risk factors (smoking, prolonged flight) and symptoms (dyspnea, pleuritic pain). An elevated D-dimer supports this suspicion. A CT pulmonary angiogram is indicated to confirm diagnosis and guide treatment.
A 28-year-old female with asthma presents to the ED with wheezing and shortness of breath that began after exposure to pollen during a hiking trip. She is using accessory muscles to breathe and her peak expiratory flow is 60% of her predicted normal. What is the most appropriate initial treatment?**
- A) Oral corticosteroids.
- B) Intravenous magnesium sulfate.
- C) High-dose inhaled corticosteroids.
- D) High-dose inhaled bronchodilators.
D) High-dose inhaled bronchodilators.
The patient is experiencing an acute asthma exacerbation triggered by allergen exposure. Immediate treatment with high-dose inhaled bronchodilators is indicated to relieve bronchoconstriction. Inhaled corticosteroids and oral corticosteroids may be considered as part of ongoing management, but the initial focus should be on reversing the acute obstruction.
A 72-year-old man with COPD presents with a two-day history of increased sputum production and a change in sputum color from clear to green, accompanied by an increased cough and subjective fever. What is the most likely diagnosis?**
- A) Acute bronchitis.
- B) COPD exacerbation.
- C) Pulmonary embolism.
- D) Lung cancer.
B) COPD exacerbation.
This patient’s symptoms are consistent with an acute exacerbation of COPD, characterized by an increase in baseline dyspnea, cough, and/or sputum production. The change in sputum color and presence of fever suggest a possible infectious cause.
A 55-year-old woman with no significant medical history presents to the ED complaining of sudden onset of sharp, left-sided chest pain and shortness of breath after a severe coughing episode. On examination, her breath sounds are diminished on the left side. What is the most likely diagnosis?**
- A) Left-sided pneumothorax.
- B) Acute myocardial infarction.
- C) Pulmonary embolism.
- D) Pneumonia.
A) Left-sided pneumothorax.
The sudden onset of sharp, unilateral chest pain and dyspnea following a coughing spell, along with diminished breath sounds on one side, strongly suggests a pneumothorax, likely due to the rupture of a subpleural bleb during coughing.
A 23-year-old man presents to the emergency department with acute onset of fever, dyspnea, and a productive cough with rusty sputum. Physical examination reveals crackles at the right lung base. What is the most appropriate diagnostic test to confirm the suspected diagnosis?**
- A) Chest X-ray.
- B) Complete blood count.
- C) Sputum culture.
- D) Pulmonary function tests.
A) Chest X-ray.
The patient’s symptoms and physical findings suggest community-acquired pneumonia, particularly given the description of rusty sputum. A chest X-ray is essential to confirm the presence of an infiltrate indicative of pneumonia.
A 40-year-old female with a history of systemic lupus erythematosus presents with acute onset of hemoptysis and shortness of breath. She is hypoxic with an oxygen saturation of 89% on room air. Which of the following is the most likely underlying cause?**
- A) Bronchitis.
- B) Pulmonary embolism.
- C) Lupus pneumonitis.
- D) Pneumonia.
C) Lupus pneumonitis.
Given her history of lupus, the acute presentation with hemoptysis and hypoxia may indicate lupus pneumonitis, an inflammation of the lung tissue associated with systemic lupus erythematosus, though pulmonary embolism should also be considered due to overlapping symptoms.
A 58-year-old man presents with acute onset of right-sided chest pain and shortness of breath. He has a past medical history of hypertension and hyperlipidemia. A chest X-ray shows a large right-sided pleural effusion. What is the most appropriate next step in management?**
- A) Therapeutic thoracentesis.
- B) Administer a diuretic.
- C) Immediate chest tube placement.
- D) Initiate antibiotics.
A) Therapeutic thoracentesis.
Therapeutic thoracentesis is indicated to relieve symptoms and to analyze pleural fluid, helping to determine the cause of the effusion (e.g., parapneumonic, malignant, heart failure).
A 50-year-old smoker presents to the ED with sudden onset of confusion, fever, and a productive cough. Chest X-ray reveals right lower lobe consolidation. What is the most likely organism causing this presentation?**
- A) Mycoplasma pneumoniae.
- B) Legionella pneumophila.
- C) Streptococcus pneumoniae.
- D) Haemophilus influenzae.
C) Streptococcus pneumoniae.
Streptococcus pneumoniae is the most common cause of community-acquired pneumonia, presenting with symptoms like fever, productive cough, and consolidation on imaging, especially in a smoker.
A 19-year-old college student presents with sudden onset of sharp chest pain and shortness of breath after a minor trauma. On examination, you note subcutaneous emphysema. What is the most likely diagnosis?**
- A) Asthma exacerbation.
- B) Pneumothorax.
- C) Rib fracture.
- D) Pneumomediastinum.
D) Pneumomediastinum.
The presence of subcutaneous emphysema, particularly after trauma, suggests pneumomediastinum, where air leaks into the mediastinal area, a condition that can occur independently or alongside a pneumothorax.
A 34-year-old man presents to the ED with worsening dyspnea, low-grade fever, and a dry cough that has persisted for 3 weeks. He recently emigrated from a country with a high prevalence of tuberculosis. What is the most appropriate initial diagnostic test?**
- A) Sputum acid-fast bacilli (AFB) stain.
- B) Tuberculin skin test.
- C) Chest X-ray.
- D) CT scan of the chest.
A) Sputum acid-fast bacilli (AFB) stain.
Given the clinical presentation and epidemiological risk factors, testing for tuberculosis with a sputum AFB stain is crucial for rapid identification and confirmation of active tuberculosis, which is necessary to initiate appropriate isolation and treatment.
