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Which of the following is the gold standard test for diagnosing pulmonary embolism (PE)?
D-dimer
Chest X-ray
T pulmonary angiography
wer: C
anation: The gold standard test for diagnosing pulmonary embolism is onary angiography. This invasive procedure involves injecting contra nto the pulmonary arteries to visualize any blockages. However, due t sive nature, it is typically reserved for cases where other non-invasive nconclusive. D-dimer is a screening test that can help rule out PE, but pecific and cannot definitively diagnose the condition. Chest X-ray m nonspecific findings but is not the primary test for diagnosing PE. C onary angiography is a commonly used non-invasive imaging test tha h sensitivity and specificity for diagnosing PE, making it the preferre
ce in most cases.
Pulmonary angiography
C
Ans Expl
pulm st
dye i o its
inva tests
are i it is
not s ay
show T
pulm t has
a hig d
choi
A patient presents with a rash that is characterized by a "herald patch" followed by the appearance of smaller, oval-shaped lesionson the trunk and extremities. The rash is mildly pruritic. The most likely diagnosis is:
tinea corporis
contact dermatitis
psoriasis
pityriasis rosea Answer: D
corporis (ringworm) typically presents with circular, scaly lesions a ave central clearing. Psoriasis typically presents with well-demarcat ematous plaques with silvery scales. Contact dermatitis is typically acterized by a localized rash in areas of contact with an allergen or irri
ay be associated with itching or burning.
-year-old female presents with complaints of lower abdominal pain, areunia, and abnormal uterine bleeding. On physical examination, the erness on palpation of the adnexal region. A pelvic ultrasound reveals plex adnexal mass with solid and cystic components. Which of the wing would be the most appropriate next step in management?
rdering a CA-125 tumor marker test itiation of oral contraceptive pills dministration of intravenous antibiotics eferral for laparoscopic surgery
Explanation: The presentation of a "herald patch" followed by the appearance of smaller, oval-shaped lesions on the trunk and extremities is characteristic of pityriasis rosea. Pityriasis rosea is a common, self-limited skin condition that typically occurs in young adults and presents with this distinctive rash pattern. Tinea nd
may h ed,
eryth
char tant
and m
A 45
dysp re is
tend a
com follo
O
In
A
R
Answer: D
Explanation: The patient's symptoms, physical examination findings, and pelvic ultrasound results are suggestive of an ovarian mass. Given the complex nature of the adnexal mass and the presence of symptoms, the most appropriate next step in management would be to refer the patient for laparoscopic surgery.
an masses, but it is not the primary next step in management.
tient presents with a history of chronic low back pain that is worsened onged sitting and relieved with walking or changing positions. On phy mination, there is tenderness over the lumbar spine and limited lumbar
of motion. The most appropriate next step in management is:
rder lumbar spine X-rays commend surgical consultation
escribe nonsteroidal anti-inflammatory drugs (NSAIDs) fer to physical therapy for exercise and stretching
wer: D
anation: The history of chronic low back pain worsened with prolong g and relieved with walking or changing positions, along with tender
Laparoscopic surgery allows for direct visualization and possible removal of the ovarian mass, as well as potential biopsy or further intervention if needed. Option B (initiation of oral contraceptive pills) may be considered for the management of certain benign ovarian conditions, but it is not the primary intervention for an ovarian mass with concerning features. Option C (administration of intravenous antibiotics) is not indicated in this case as the symptoms and findings are not consistent with an infectious etiology. Option D (ordering a CA-125 tumor marker test) may be useful in the evaluation of ovari
A pa with
prol sical
exa range
o
re
pr
re Ans
Expl ed
sittin ness
over the lumbar spine and limited lumbar range of motion, is suggestive of mechanical low back pain. The most appropriate next step in management is to refer the patient to physical therapy for exercise and stretching. Physical therapy can help improve strength, flexibility, and posture, which can alleviate symptoms and improve function. Lumbar spine X-rays are typically not necessary in the initial management of mechanical low back pain. NSAIDs may be used for symptomatic relief, but they do not address the underlying cause.
Surgical consultation is not indicated unless there are specific indications, such as progressive neurological deficits or failed conservative management.
cise. The most appropriate initial pharmacologic treatment for this pati
ng-acting beta-agonist (LABA) haled corticosteroid (ICS)
ukotriene receptor antagonist (LTRA) haled short-acting beta-agonist (SABA)
wer: D
anation: The history of recurrent episodes of wheezing, coughing, and ness of breath that are exacerbated by exposure to allergens and exerc y suggestive of asthma. The most appropriate initial pharmacologic ment for asthma is an inhaled short-acting beta-agonist (SABA), such erol. SABAs provide quick relief of acute symptoms by relaxing the oth muscles in the airways. Inhaled corticosteroids (ICS) are typically ng-term controller medications for asthma. Leukotriene receptor gonists (LTRA) may be used as adjunctive therapy in some cases. Lon
A patient presents with a history of recurrent episodes of wheezing, coughing, and shortness of breath that are exacerbated by exposure to allergens and
exer ent
is:
lo
in
le
in Ans
Expl
short ise is
highl
treat as
albut
smo used
as lo
anta g-
acting beta-agonists (LABA) are typically used in combination with ICS for long-term control of asthma symptoms.
A 45-year-old male patient presents with a history of recurrent episodes of abdominal pain associated with diarrhea, urgency, and tenesmus. The most
appropriate diagnostic test to confirm the suspected diagnosis is:
abdominal ultrasound
colonoscopy
stool culture
serum C-reactive protein (CRP) level
wer: B
anation: The history of recurrent episodes of abdominal pain associate iarrhea, urgency, and tenesmus is suggestive of inflammatory bowel se (IBD), such as Crohn's disease or ulcerative colitis. The most opriate diagnostic test to confirm the suspected diagnosis is colonosco h allows direct visualization and biopsy of the gastrointestinal mucos ominal ultrasound may be useful in evaluating other abdominal condit
not specific for diagnosing IBD. Stool culture is primarily used to ify infectious causes of diarrhea. Serum C-reactive protein (CRP) lev er of inflammation but is not diagnostic for IBD.
-year-old male with a history of chronic obstructive pulmonary diseas PD) presents with increasing dyspnea, cough, and production of purul um. On physical examination, the patient has decreased breath sounds onged expiratory phase. Chest X-ray reveals hyperinflation and flatten
Ans
Expl d
with d disea
appr py,
whic a.
Abd ions
but is
ident el is a
mark
A 65 e
(CO ent
sput and
prol ed
diaphragms. Which of the following is the most appropriate initial pharmacologic treatment for this patient?
Systemic corticosteroid (prednisone)
Inhaled corticosteroid (fluticasone)
Long-acting muscarinic antagonist (tiotropium)
Short-acting bronchodilator (albuterol)
Answer: D
costeroids (option B) are more commonly used for maintenance thera nts with moderate to severe COPD, but they are not the initial treatme
acute exacerbation. Long-acting muscarinic antagonists (option C) m e used as maintenance therapy in COPD, but they are not the first-li
ment for an acute exacerbation. Systemic corticosteroids (option D), s ednisone, may be added to the treatment regimen for acute exacerbati OPD to reduce airway inflammation and improve lung function, but th ot the initial pharmacologic treatment.
-year-old male presents with complaints of progressive shortness of b xertion, orthopnea, and bilateral lower extremity edema. On physical mination, there are crackles heard bilaterally on lung auscultation, jugu us distention, and an enlarged liver. Echocardiography reveals decreas
entricular ejection fraction (LVEF) and dilated left ventricle. Which o wing medications would be most appropriate to initiate in this patient
Explanation: The patient's symptoms, physical examination findings, and chest X-ray results are consistent with an acute exacerbation of COPD. The most appropriate initial pharmacologic treatment for this patient would be a short- acting bronchodilator, such as albuterol. Short-acting bronchodilators provide rapid relief of bronchospasm and help improve symptoms of dyspnea. Inhaled corti py in
patie nt
for an ay
also b ne
treat uch
as pr ons
of C ey
are n
A 70 reath
on e
exa lar
veno ed
left v f the
follo ?
Furosemide
Metoprolol
Digoxin
Lisinopril Answer: D
on B (metoprolol) is a beta-blocker that is also commonly used in the agement of heart failure, but ACE inhibitors are typically initiated first on D (digoxin) may be considered in certain cases of heart failure to ove symptoms, but it is not the initial medication of choice and is ofte as an adjunctive therapy.
-year-old female presents with complaints of a sore throat, fever, and len tonsils. On physical examination, her temperature is 101°F, and nlarged and erythematous tonsils with white exudates. The patient's cal lymph nodes are also enlarged and tender. Which of the following ost appropriate next step in management?
hroat culture
apid antigen streptococcal test mpiric antibiotic therapy
ymptomatic management with analgesics and fluids
Explanation: The patient's symptoms, physical examination findings, and echocardiography results are indicative of heart failure with reduced ejection fraction (HFrEF). The most appropriate medication toinitiate in this patient would be an angiotensin-converting enzyme (ACE) inhibitor, such as lisinopril. ACE inhibitors have been shown to improve symptoms, reduce hospitalizations, and improve survival in patients with HFrEF. Option A (furosemide) is a loop diuretic that can be used to manage fluid overload in heart failure but does not directly address the underlying pathophysiology.
Opti
man .
Opti
impr n
used
A 25
swol there
are e
cervi is
the m
T
R
E
S
Answer: B
Explanation: The patient's symptoms and physical examination findings are suggestive of acute pharyngitis, and the most likely etiology is group A streptococcal infection (strep throat). The most appropriate next step in
mplemented to provide relief of symptoms while awaiting test results.
-year-old female presents with a chief complaint of persistent fatigue ht gain over the past few months. She reports feeling cold all the time tipation, and dry skin. On physical examination, her heart rate is 60 b pressure is 130/80 mmHg, and there is diffuse hair loss. Laboratory
al an elevated thyroid-stimulating hormone (TSH) level and a low free oxine (FT4) level. What is the most likely diagnosis?
ypothyroidism yperthyroidism ushing's syndrome ddison's disease
wer: A
management would be to perform a rapid antigen streptococcal test. This test provides rapid results, usually within minutes, and has a high specificity for detecting group A streptococcal infection. A positive test result would support the diagnosis of strep throat and indicate the need for antibiotic therapy. If the rapid antigen test is negative, a throat culture (option B) may be considered to confirm the diagnosis in certain cases. Empiric antibiotic therapy (option C) should only be initiated if the rapid antigen test or throat culture results are positive. Symptomatic management with analgesics and fluids (option D) can be i
A 35 and
weig ,
cons pm,
blood tests
reve thyr
H
H
C
A
Ans
Explanation: The patient's symptoms of fatigue, weight gain, feeling cold, constipation, dry skin, and diffuse hair loss, in addition to the laboratory findings of elevated TSH and low FT4 levels, are consistent with hypothyroidism. Hypothyroidism is a condition in which the thyroid gland does not produce enough thyroid hormones. This can lead to a slowing down of bodily functions, resulting in the symptoms described. Option B
(hyperthyroidism) would present with different symptoms such as weight loss, anxiety, heat intolerance, and increased heart rate. Options C (Cushing's syndrome) and D (Addison's disease) are unrelated conditions that would present with different clinical features and laboratory findings.
xertion and improves with rest. He has a history of smoking, rtension, and dyslipidemia. On physical examination, his blood pressu 90 mmHg, heart rate is 80 bpm, and there are no abnormal cardiac sou ch of the following diagnostic tests would be most appropriate to conf uspected diagnosis?
2-lead electrocardiogram (ECG) hest X-ray
xercise stress test oronary angiography
wer: C
anation: Given the patient's symptoms of exertional chest pain and ris rs for cardiovascular disease, the most appropriate next step to confir ected diagnosis of coronary artery disease (CAD) would be an exercis
test. An exercise stress test is a non-invasive diagnostic test that
A 50-year-old male patient presents with complaints of chest pain that worsens with e
hype re is
150/ nds.
Whi irm
the s
1
C
E
C
Ans
Expl k
facto m the
susp e
stress
evaluates the heart's response to increased workload and can help identify any exercise-induced abnormalities in cardiac function or blood flow. This test is commonly used as an initial screening tool for suspected CAD. Options A and B (12-lead ECG and chest X-ray) may provide useful information but are not specific for diagnosing CAD. Option D (coronary angiography) is an invasive procedure and is typically reserved for cases where non-invasive testing results are inconclusive or when intervention such as angioplasty or stenting is being
considered.
verticulitis holecystitis
cute appendicitis astritis
wer: C
anation: The presence of rebound tenderness in the right lower quadra y indicative of acute appendicitis. This is a classic finding associated mmation of the appendix. Cholecystitis typically presents with right u rant tenderness and is associated with gallbladder inflammation. rticulitis commonly presents with left lower quadrant pain. Gastritis m
abdominal pain, but it does not typically present with rebound erness.
A patient presents with a chief complaint of abdominal pain. On physical examination, rebound tenderness is noted in the right lower quadrant. The most likely diagnosis is:
di
c
a
g
Ans
Expl nt is
highl with
infla pper
quad
Dive ay
cause tend
A patient presents with fatigue, weight gain, constipation, and cold intolerance. Physical examination reveals dry skin, bradycardia, and delayed deep tendon reflexes. The most likely diagnosis is:
hyperthyroidism
diabetes mellitus
hypothyroidism
Cushing's syndrome
Answer: C
xes, is highly suggestive of hypothyroidism. Hypothyroidism is acterized by decreased thyroid hormone production, leading to a slowi
of the body's metabolism. Hyperthyroidism, on the other hand, is acterized by increased thyroid hormone production and typically prese
ymptoms such as weight loss, heat intolerance, and tachycardia. Dia tus and Cushing's syndrome are not associated with the specific symp hysical examination findings mentioned in the question stem.
tient presents with sudden onset severe chest pain radiating to the bac hysical examination, blood pressure in the right arm is significantly h n the left arm, and absent femoral pulses are noted. The most likely nosis is:
cute myocardial infarction ortic dissection
ulmonary embolism
Explanation: The constellation of symptoms, including fatigue, weight gain, constipation, cold intolerance, dry skin, bradycardia, and delayed deep tendon refle
char ng
down
char nts
with s betes
melli toms
and p
A pa k.
On p igher
than i diag
a
a
p
tension pneumothorax
Answer: B
Explanation: The presentation of sudden onset severe chest pain radiating to the back, significant blood pressure difference between the arms, and absent
pressure differences or absent pulses.
-year-old male patient presents with complaints of frequent urination, ased thirst, and unexplained weight loss. On physical examination, hi pressure is 150/90 mmHg, heart rate is 90 bpm, and there are no
rmal findings on cardiovascular examination. Laboratory tests reveal ng blood glucose level of 200 mg/dL [normal = 70-99 mg/dL]. What i likely diagnosis?
ype 1 diabetes mellitus ype 2 diabetes mellitus estational diabetes ushing's syndrome
wer: B
femoral pulses is highly indicative of aortic dissection. Aortic dissection occurs when there is a tear in the inner layer of the aorta, leading to the separation of the layers and potentially compromising blood flow to vital organs. Acute myocardial infarction typically presents with chest pain but does not typically cause significant blood pressure differences or absent pulses. Pulmonary embolism may cause chest pain, but it does not typically radiate to the back or cause differences in blood pressure. Tension pneumothorax presents with sudden-onset chest pain and respiratory distress but does not cause significant blood
A 60
incre s
blood
abno a
fasti s the
most
T
T
G
C
Ans
Explanation: The patient's symptoms of frequent urination, increased thirst, unexplained weight loss, and the laboratory findings of an elevated fasting blood glucose level are indicative of diabetes mellitus. Given the patient's age and the absence of other specific factors suggesting an alternative diagnosis, the most likely diagnosis is type 2 diabetes mellitus. Type 1 diabetes mellitus (option A) typically presents at a younger age and is characterized by the
autoimmune destruction of pancreatic beta cells, leading to insulin deficiency. Gestational diabetes (option C) occurs during pregnancy and is not applicable to this patient. Option D (Cushing's syndrome) is unrelated to the symptoms and laboratory findings described.
ophobia. On physical examination, nuchal rigidity is noted. The most opriate next step in management is:
erform a lumbar puncture
der a head CT scan without contrast dminister intravenous fluids
art empiric treatment with antibiotics
wer: A
anation: The presentation of sudden-onset severe headache, nausea, ting, photophobia, and nuchal rigidity is highly suggestive of meningi ost appropriate next step in management is to perform a lumbar pun tain cerebrospinal fluid (CSF) for analysis. CSF analysis can help con iagnosis and determine the specific etiology of meningitis. Administe venous fluids may be necessary but does not address the underlying c ring a head CT scan without contrast may be considered if there are
A patient presents with sudden-onset severe headache, nausea, vomiting, and phot
appr
p
or
a
st
Ans Expl
vomi tis.
The m cture
to ob firm
the d ring
intra ause.
Orde
contraindications to lumbar puncture or if there is concern for increased intracranial pressure. Starting empiric treatment with antibiotics may be considered after obtaining CSF samples but should not be the initial step.