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Topics:
Medical Licensing Examination Step 2
Fundamental Concepts
Understanding of medical terminology, anatomy, physiology, and biochemistry.
Knowledge of basic pharmacology and therapeutics.
Familiarity with medical ethics, professionalism, and legal aspects of healthcare.
Clinical Knowledge
Diagnosis and management of common medical conditions across various specialties:
Internal Medicine
Pediatrics
Surgery
Obstetrics and Gynecology
Psychiatry
Integration of clinical data to formulate differential diagnoses and treatment plans.
Interpretation of diagnostic tests and imaging studies.
Patient Care Skills
History taking and physical examination techniques.
Communication skills with patients, families, and healthcare teams.
Patient counseling, education, and shared decision-making.
Clinical Reasoning and Problem-Solving
Ability to analyze clinical scenarios, identify key issues, and prioritize management steps.
Application of evidence-based medicine in clinical practice.
Critical appraisal of medical literature and research studies.
Ethics, Professionalism, and Legal Aspects
Understanding of medical ethics principles and their application in patient care.
Knowledge of legal responsibilities, informed consent, confidentiality, and patient rights.
Professional behavior, including integrity, empathy, and cultural competence.
Integrated Systems and Multidisciplinary Care
Recognition of multisystem diseases and their impact on patient management.
Coordination of care among different specialties and healthcare providers.
Team-based approaches to patient care and interprofessional collaboration.
Preventive Medicine and Health Promotion
Strategies for disease prevention, health promotion, and patient education.
Screening guidelines for common medical conditions and risk assessment tools.
Lifestyle modifications, immunizations, and health maintenance recommendations.
Clinical Skills Assessment
Performance of clinical skills such as suturing, wound care, and procedural techniques.
Proficiency in medical documentation, including patient histories, progress notes, and discharge summaries.
Time management and organization in clinical settings.
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Question 1 of 30
1. Question
A 65-year-old male presents with sudden-onset severe headache, confusion, and right-sided weakness. CT scan without contrast shows a hyperdense left middle cerebral artery (MCA) sign. What is the most appropriate next step in management?
Correct
The presentation with sudden-onset severe headache, neurological deficits, and hyperdense MCA sign on imaging is consistent with acute ischemic stroke due to MCA occlusion. Immediate thrombolytic therapy with tissue plasminogen activator (tPA) is indicated within the therapeutic window for acute stroke management.
Incorrect
The presentation with sudden-onset severe headache, neurological deficits, and hyperdense MCA sign on imaging is consistent with acute ischemic stroke due to MCA occlusion. Immediate thrombolytic therapy with tissue plasminogen activator (tPA) is indicated within the therapeutic window for acute stroke management.
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Question 2 of 30
2. Question
A 35-year-old female presents with recurrent episodes of upper abdominal pain, nausea, and vomiting, often triggered by fatty meals. Physical examination reveals tenderness in the epigastric region. Which of the following diagnostic tests is most appropriate for confirming the diagnosis?
Correct
The clinical presentation with recurrent upper abdominal pain triggered by fatty meals and tenderness in the epigastric region suggests the possibility of gallstone disease or peptic ulcer disease. Upper endoscopy (EGD) is the most appropriate test for confirming the diagnosis of peptic ulcer disease and evaluating the upper gastrointestinal tract.
Incorrect
The clinical presentation with recurrent upper abdominal pain triggered by fatty meals and tenderness in the epigastric region suggests the possibility of gallstone disease or peptic ulcer disease. Upper endoscopy (EGD) is the most appropriate test for confirming the diagnosis of peptic ulcer disease and evaluating the upper gastrointestinal tract.
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Question 3 of 30
3. Question
A 45-year-old female presents with sudden-onset severe right lower quadrant abdominal pain, fever, and rebound tenderness on physical examination. Laboratory tests show an elevated white blood cell count and neutrophil predominance. What is the most likely diagnosis?
Correct
Incorrect
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Question 4 of 30
4. Question
A 60-year-old male with a history of hypertension presents with acute-onset chest pain, diaphoresis, and dyspnea. ECG shows ST-segment elevation in leads II, III, and aVF. Troponin levels are elevated. What is the most appropriate next step in management?
Correct
The presentation with acute-onset chest pain, diaphoresis, dyspnea, ST-segment elevation on ECG, and elevated troponin levels is consistent with acute ST-segment elevation myocardial infarction (STEMI). Emergent reperfusion therapy with PCI is the preferred management to restore coronary blood flow and minimize myocardial damage.
Incorrect
The presentation with acute-onset chest pain, diaphoresis, dyspnea, ST-segment elevation on ECG, and elevated troponin levels is consistent with acute ST-segment elevation myocardial infarction (STEMI). Emergent reperfusion therapy with PCI is the preferred management to restore coronary blood flow and minimize myocardial damage.
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Question 5 of 30
5. Question
A 50-year-old male presents with sudden-onset left-sided facial droop, slurred speech, and weakness of the left arm and leg. CT scan shows no acute intracranial hemorrhage. What is the most appropriate next step in management?
Correct
The presentation with sudden-onset focal neurological deficits and absence of acute intracranial hemorrhage on CT scan suggests acute ischemic stroke. The most appropriate next step is to evaluate the patient’s eligibility for intravenous thrombolysis with tissue plasminogen activator (tPA) within the therapeutic window for stroke management.
Incorrect
The presentation with sudden-onset focal neurological deficits and absence of acute intracranial hemorrhage on CT scan suggests acute ischemic stroke. The most appropriate next step is to evaluate the patient’s eligibility for intravenous thrombolysis with tissue plasminogen activator (tPA) within the therapeutic window for stroke management.
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Question 6 of 30
6. Question
A physician has a conflict of interest involving a pharmaceutical company that sponsors a research project the physician is involved in. The company offers substantial financial incentives for favorable study outcomes. What ethical principle should guide the physician’s decision-making in this situation?
Correct
Integrity is the ethical principle that emphasizes honesty, transparency, and adherence to ethical standards in professional conduct. In situations involving conflicts of interest, maintaining integrity involves prioritizing ethical conduct, avoiding bias or influence from external factors such as financial incentives, and upholding professional and scientific integrity in research and practice.
Incorrect
Integrity is the ethical principle that emphasizes honesty, transparency, and adherence to ethical standards in professional conduct. In situations involving conflicts of interest, maintaining integrity involves prioritizing ethical conduct, avoiding bias or influence from external factors such as financial incentives, and upholding professional and scientific integrity in research and practice.
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Question 7 of 30
7. Question
:A 45-year-old female patient presents to the emergency department with sudden-onset severe abdominal pain, nausea, and vomiting. On examination, she has rebound tenderness in the right lower quadrant. Laboratory tests show an elevated white blood cell count and a CT scan confirms acute appendicitis. What is the most appropriate next step in management?
Correct
Acute appendicitis is a surgical emergency requiring urgent appendectomy to prevent complications like perforation and peritonitis. Immediate surgical intervention is indicated upon diagnosis to avoid potential morbidity and mortality. This approach is supported by guidelines from the American College of Surgeons.
Incorrect
Acute appendicitis is a surgical emergency requiring urgent appendectomy to prevent complications like perforation and peritonitis. Immediate surgical intervention is indicated upon diagnosis to avoid potential morbidity and mortality. This approach is supported by guidelines from the American College of Surgeons.
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Question 8 of 30
8. Question
Dr. Smith, a primary care physician, receives a gift from a pharmaceutical company representative, including tickets to a concert. What action should Dr. Smith take based on ethical guidelines?
Correct
Medical ethics guidelines advise healthcare professionals to avoid accepting gifts that may influence their judgment or create conflicts of interest. Transparency and maintaining professional boundaries are essential in preserving patient trust and ensuring ethical practice.
Incorrect
Medical ethics guidelines advise healthcare professionals to avoid accepting gifts that may influence their judgment or create conflicts of interest. Transparency and maintaining professional boundaries are essential in preserving patient trust and ensuring ethical practice.
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Question 9 of 30
9. Question
A 3-year-old child presents with fever, cough, and difficulty breathing. Examination reveals increased respiratory rate, nasal flaring, and intercostal retractions. Which of the following is the most likely diagnosis?
Correct
Bronchiolitis is a common viral lower respiratory tract infection in young children, characterized by cough, wheezing, and respiratory distress. Clinical features such as tachypnea, nasal flaring, and intercostal retractions are typical findings. Management includes supportive care, hydration, and monitoring for respiratory distress.
Incorrect
Bronchiolitis is a common viral lower respiratory tract infection in young children, characterized by cough, wheezing, and respiratory distress. Clinical features such as tachypnea, nasal flaring, and intercostal retractions are typical findings. Management includes supportive care, hydration, and monitoring for respiratory distress.
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Question 10 of 30
10. Question
A 60-year-old male patient presents with complaints of progressive weakness in his lower extremities, urinary incontinence, and difficulty walking. On examination, you note decreased muscle strength in the legs, exaggerated deep tendon reflexes, and a positive Babinski reflex. Which of the following is the most likely diagnosis?
Correct
This patient’s symptoms, including progressive weakness, urinary incontinence, and exaggerated reflexes, are indicative of spinal cord compression. This condition can result from various causes, such as metastatic cancer, spinal trauma, or degenerative changes. It leads to neurological deficits due to compression of the spinal cord, requiring urgent evaluation and management to prevent permanent damage.
Incorrect
This patient’s symptoms, including progressive weakness, urinary incontinence, and exaggerated reflexes, are indicative of spinal cord compression. This condition can result from various causes, such as metastatic cancer, spinal trauma, or degenerative changes. It leads to neurological deficits due to compression of the spinal cord, requiring urgent evaluation and management to prevent permanent damage.
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Question 11 of 30
11. Question
Ms. Anderson, a 45-year-old woman, visits your clinic with a history of chronic lower back pain. She mentions using over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) regularly for pain relief. On further inquiry, she reveals that she consumes alcohol daily and smokes half a pack of cigarettes per day. What is the most appropriate initial step in managing her chronic pain?
Correct
In managing chronic pain, especially in patients with risk factors such as alcohol consumption and smoking, a comprehensive approach is necessary. This includes non-pharmacological interventions like physical therapy to improve mobility and function, along with lifestyle modifications such as smoking cessation and alcohol reduction. These measures aim to address the underlying causes of pain and improve long-term outcomes while minimizing reliance on medications with potential adverse effects.
Incorrect
In managing chronic pain, especially in patients with risk factors such as alcohol consumption and smoking, a comprehensive approach is necessary. This includes non-pharmacological interventions like physical therapy to improve mobility and function, along with lifestyle modifications such as smoking cessation and alcohol reduction. These measures aim to address the underlying causes of pain and improve long-term outcomes while minimizing reliance on medications with potential adverse effects.
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Question 12 of 30
12. Question
A 55-year-old male with a history of hypertension and type 2 diabetes mellitus presents to the emergency department with sudden-onset severe chest pain radiating to his left arm. He appears diaphoretic and anxious. Vital signs show tachycardia and elevated blood pressure. An electrocardiogram (ECG) reveals ST-segment elevation in leads II, III, and aVF. What is the most appropriate initial management?
Correct
The clinical presentation, ECG findings of ST-segment elevation myocardial infarction (STEMI), and the patient’s risk factors indicate an acute coronary syndrome requiring immediate intervention. PCI is the preferred reperfusion strategy in STEMI if available within a timely manner, as it offers better outcomes compared to fibrinolytic therapy.
Incorrect
The clinical presentation, ECG findings of ST-segment elevation myocardial infarction (STEMI), and the patient’s risk factors indicate an acute coronary syndrome requiring immediate intervention. PCI is the preferred reperfusion strategy in STEMI if available within a timely manner, as it offers better outcomes compared to fibrinolytic therapy.
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Question 13 of 30
13. Question
Mr. Thompson, a 65-year-old man, is admitted to the hospital for community-acquired pneumonia. He has a history of chronic obstructive pulmonary disease (COPD) and is a former smoker. During his hospital stay, he develops worsening dyspnea, increased sputum production, and fever. Chest auscultation reveals diffuse crackles bilaterally. What is the most likely diagnosis, and what initial management is indicated?
Correct
Mr. Thompson’s history of COPD, along with worsening dyspnea and increased sputum production, suggests an acute exacerbation of COPD. Management includes systemic corticosteroids to reduce airway inflammation and bronchodilators to improve airflow. Antibiotics may be added if there are signs of bacterial infection.
Incorrect
Mr. Thompson’s history of COPD, along with worsening dyspnea and increased sputum production, suggests an acute exacerbation of COPD. Management includes systemic corticosteroids to reduce airway inflammation and bronchodilators to improve airflow. Antibiotics may be added if there are signs of bacterial infection.
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Question 14 of 30
14. Question
A 25-year-old female presents with recurrent episodes of abdominal pain, bloating, and diarrhea, particularly after meals. She reports that these symptoms have been ongoing for several months and are exacerbated by certain foods. Physical examination is unremarkable. Stool studies are negative for infectious pathogens. What is the most likely diagnosis, and what dietary advice should be given?
Correct
The patient’s symptoms of abdominal pain, bloating, and diarrhea, especially triggered by certain foods, are characteristic of IBS. A low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet is often effective in managing IBS symptoms by reducing fermentable carbohydrates that can contribute to gut symptoms.
Incorrect
The patient’s symptoms of abdominal pain, bloating, and diarrhea, especially triggered by certain foods, are characteristic of IBS. A low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet is often effective in managing IBS symptoms by reducing fermentable carbohydrates that can contribute to gut symptoms.
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Question 15 of 30
15. Question
A 35-year-old female presents with a sudden-onset severe headache, nausea, and photophobia. On examination, she has nuchal rigidity, positive Kernig’s and Brudzinski’s signs, and petechial rash on her trunk. Her cerebrospinal fluid (CSF) analysis shows elevated white blood cells and protein with decreased glucose levels. Which of the following is the most likely diagnosis?
Correct
The patient’s clinical presentation with sudden-onset severe headache, signs of meningeal irritation, petechial rash (suggestive of meningococcal infection), and abnormal CSF findings (elevated white blood cells, protein, and decreased glucose) are consistent with bacterial meningitis. Prompt initiation of empiric antibiotic therapy is crucial to prevent complications and improve outcomes.
Incorrect
The patient’s clinical presentation with sudden-onset severe headache, signs of meningeal irritation, petechial rash (suggestive of meningococcal infection), and abnormal CSF findings (elevated white blood cells, protein, and decreased glucose) are consistent with bacterial meningitis. Prompt initiation of empiric antibiotic therapy is crucial to prevent complications and improve outcomes.
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Question 16 of 30
16. Question
Mrs. Garcia, a 50-year-old woman, presents with a history of rheumatoid arthritis (RA) and complains of bilateral hand pain, swelling, and morning stiffness lasting more than an hour. She reports limited range of motion in her hands and difficulty performing activities of daily living. On examination, there are tender, swollen metacarpophalangeal and proximal interphalangeal joints with ulnar deviation of fingers. What is the most appropriate next step in management?
Correct
Mrs. Garcia’s clinical presentation of symmetric polyarthritis involving small joints, morning stiffness, and functional impairment is consistent with RA. Early initiation of DMARDs, such as methotrexate, is crucial to control disease activity, prevent joint damage, and improve long-term outcomes in RA patients.
Incorrect
Mrs. Garcia’s clinical presentation of symmetric polyarthritis involving small joints, morning stiffness, and functional impairment is consistent with RA. Early initiation of DMARDs, such as methotrexate, is crucial to control disease activity, prevent joint damage, and improve long-term outcomes in RA patients.
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Question 17 of 30
17. Question
A 60-year-old male with a history of chronic kidney disease presents with progressive fatigue, anorexia, and difficulty concentrating. Laboratory tests reveal hemoglobin of 9 g/dL, mean corpuscular volume (MCV) of 110 fL, and serum creatinine elevated at 2.5 mg/dL. Peripheral blood smear shows macrocytic red blood cells with hypersegmented neutrophils. What is the most likely diagnosis?
Correct
The patient’s clinical presentation of macrocytic anemia (elevated MCV), neurological symptoms (difficulty concentrating), and underlying chronic kidney disease (which can lead to impaired absorption of vitamin B12) are consistent with vitamin B12 deficiency anemia. Treatment involves vitamin B12 supplementation and addressing the underlying cause.
Incorrect
The patient’s clinical presentation of macrocytic anemia (elevated MCV), neurological symptoms (difficulty concentrating), and underlying chronic kidney disease (which can lead to impaired absorption of vitamin B12) are consistent with vitamin B12 deficiency anemia. Treatment involves vitamin B12 supplementation and addressing the underlying cause.
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Question 18 of 30
18. Question
Mr. Thompson, a 55-year-old man, presents to the emergency department with acute onset dyspnea, chest pain, and hemoptysis. He has a history of smoking and recently underwent surgery for a hip fracture. On examination, he is tachypneic and has decreased breath sounds over the right lung base. Chest X-ray reveals a wedge-shaped opacity in the right lower lobe. What is the most likely diagnosis?
Correct
Given the patient’s history of recent surgery, acute onset dyspnea, hemoptysis, and chest X-ray findings of a wedge-shaped opacity consistent with pulmonary infarction, this diagnosis is most likely. Pulmonary infarction can occur as a complication of pulmonary embolism, leading to localized lung tissue necrosis and infarction.
Incorrect
Given the patient’s history of recent surgery, acute onset dyspnea, hemoptysis, and chest X-ray findings of a wedge-shaped opacity consistent with pulmonary infarction, this diagnosis is most likely. Pulmonary infarction can occur as a complication of pulmonary embolism, leading to localized lung tissue necrosis and infarction.
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Question 19 of 30
19. Question
A 40-year-old female presents with episodic palpitations, chest discomfort, and lightheadedness. She reports these symptoms occurring during stressful situations or physical exertion and resolves with rest. Her physical exam and routine laboratory tests are unremarkable. An electrocardiogram (ECG) during symptoms shows transient ST-segment elevation with normal coronary arteries on angiography. What is the most likely diagnosis?
Correct
This condition presents with transient ST-segment elevation on ECG during episodes of vasospasm, typically not related to exertion and often occurring at rest. Normal coronary angiography distinguishes it from CAD. Management includes calcium channel blockers to prevent vasospasm.
Incorrect
This condition presents with transient ST-segment elevation on ECG during episodes of vasospasm, typically not related to exertion and often occurring at rest. Normal coronary angiography distinguishes it from CAD. Management includes calcium channel blockers to prevent vasospasm.
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Question 20 of 30
20. Question
Ms. Rodriguez is a 30-year-old woman seeking advice on contraception. She has no significant medical history and is in a monogamous relationship. She is concerned about the side effects of hormonal contraceptives. What is the most appropriate contraceptive method to recommend?
Correct
Given Ms. Rodriguez’s concerns about hormonal contraceptive side effects and her stable relationship, recommending condoms is appropriate. Condoms offer dual protection against pregnancy and sexually transmitted infections (STIs) and are non-hormonal, making them suitable for individuals seeking non-hormonal contraceptive options.
Incorrect
Given Ms. Rodriguez’s concerns about hormonal contraceptive side effects and her stable relationship, recommending condoms is appropriate. Condoms offer dual protection against pregnancy and sexually transmitted infections (STIs) and are non-hormonal, making them suitable for individuals seeking non-hormonal contraceptive options.
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Question 21 of 30
21. Question
A 60-year-old male presents with progressive dysphagia to solids, unintentional weight loss, and occasional regurgitation of undigested food. He has a history of gastroesophageal reflux disease (GERD) treated with proton pump inhibitors (PPIs). Upper endoscopy reveals a narrowing at the distal esophagus with biopsy showing squamous cell carcinoma. What is the most appropriate initial management?
Correct
he patient’s presentation with dysphagia, weight loss, and biopsy-proven esophageal squamous cell carcinoma indicates advanced disease. The initial management involves a multidisciplinary approach with chemotherapy and radiation therapy to reduce tumor burden and improve symptoms and outcomes.
Incorrect
he patient’s presentation with dysphagia, weight loss, and biopsy-proven esophageal squamous cell carcinoma indicates advanced disease. The initial management involves a multidisciplinary approach with chemotherapy and radiation therapy to reduce tumor burden and improve symptoms and outcomes.
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Question 22 of 30
22. Question
Mrs. Smith, a 35-year-old woman, visits your clinic for preconception counseling. She has a history of epilepsy well-controlled with antiepileptic drugs (AEDs) and is planning to become pregnant. What is the most appropriate recommendation regarding AED management during pregnancy?
Correct
Managing epilepsy during pregnancy requires balancing seizure control with minimizing fetal risks. Each case should be evaluated individually by a neurologist familiar with managing epilepsy in pregnancy to optimize AED selection and dosing based on seizure control and potential teratogenic effects.
Incorrect
Managing epilepsy during pregnancy requires balancing seizure control with minimizing fetal risks. Each case should be evaluated individually by a neurologist familiar with managing epilepsy in pregnancy to optimize AED selection and dosing based on seizure control and potential teratogenic effects.
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Question 23 of 30
23. Question
A 50-year-old male with a history of chronic kidney disease (CKD) presents with worsening lower extremity edema, fatigue, and decreased urine output. Laboratory tests show elevated serum creatinine and potassium levels. His medications include an angiotensin-converting enzyme inhibitor (ACEI) for hypertension. What is the most likely cause of his current presentation?
Correct
ACEIs can cause hyperkalemia, especially in patients with CKD, due to reduced aldosterone-mediated potassium excretion. This can manifest as worsening renal function, electrolyte disturbances, and symptoms like edema and fatigue. Monitoring serum potassium levels is essential in patients on ACEIs, and dose adjustments may be necessary to manage hyperkalemia.
Incorrect
ACEIs can cause hyperkalemia, especially in patients with CKD, due to reduced aldosterone-mediated potassium excretion. This can manifest as worsening renal function, electrolyte disturbances, and symptoms like edema and fatigue. Monitoring serum potassium levels is essential in patients on ACEIs, and dose adjustments may be necessary to manage hyperkalemia.
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Question 24 of 30
24. Question
A 45-year-old female presents with a 2-week history of progressive bilateral lower extremity weakness and numbness. On examination, she has decreased strength in the hip flexors and knee extensors, along with decreased sensation below the knees in a “saddle distribution.” An MRI of the lumbar spine shows a large herniated disc at the L4-L5 level compressing the cauda equina. What is the most appropriate initial management?
Correct
The patient’s symptoms, including bilateral lower extremity weakness and saddle anesthesia, along with imaging findings of a large herniated disc compressing the cauda equina, indicate cauda equina syndrome. Urgent surgical decompression is necessary to prevent permanent neurological deficits.
Incorrect
The patient’s symptoms, including bilateral lower extremity weakness and saddle anesthesia, along with imaging findings of a large herniated disc compressing the cauda equina, indicate cauda equina syndrome. Urgent surgical decompression is necessary to prevent permanent neurological deficits.
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Question 25 of 30
25. Question
Mr. Davis, a 55-year-old man with a history of type 2 diabetes and hypertension, presents with acute-onset severe chest pain radiating to his back. He is diaphoretic and hypotensive. An ECG shows ST-segment elevation in leads V1-V4. Initial laboratory tests reveal elevated cardiac enzymes. What is the most likely diagnosis?
Correct
Mr. Davis’s presentation of sudden-onset severe chest pain radiating to the back, hypotension, and ECG findings of ST-segment elevation in anterior leads are concerning for acute aortic dissection. This is a life-threatening emergency requiring immediate surgical intervention to prevent aortic rupture and mortality.
Incorrect
Mr. Davis’s presentation of sudden-onset severe chest pain radiating to the back, hypotension, and ECG findings of ST-segment elevation in anterior leads are concerning for acute aortic dissection. This is a life-threatening emergency requiring immediate surgical intervention to prevent aortic rupture and mortality.
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Question 26 of 30
26. Question
A 65-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea and productive cough with purulent sputum. He reports increased frequency and severity of exacerbations over the past few months. Chest auscultation reveals coarse crackles bilaterally. What is the most appropriate initial management?
Correct
The patient’s history of COPD exacerbations with worsening symptoms, purulent sputum, and crackles on examination indicate an acute exacerbation of COPD (AECOPD). Management includes systemic corticosteroids to reduce airway inflammation and antibiotics targeting respiratory pathogens to treat bacterial exacerbation.
Incorrect
The patient’s history of COPD exacerbations with worsening symptoms, purulent sputum, and crackles on examination indicate an acute exacerbation of COPD (AECOPD). Management includes systemic corticosteroids to reduce airway inflammation and antibiotics targeting respiratory pathogens to treat bacterial exacerbation.
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Question 27 of 30
27. Question
Mr. Anderson, a 60-year-old man with a history of chronic obstructive pulmonary disease (COPD), presents with worsening dyspnea and productive cough. His oxygen saturation is 88% on room air. Which of the following is the most appropriate initial management?
Correct
In patients with COPD exacerbation and hypoxemia (oxygen saturation < 90%), supplemental oxygen therapy is crucial to improve oxygenation and reduce the risk of complications. Arterial blood gas analysis may be performed later to assess acid-base status and guide further management, but oxygen supplementation should not be delayed.
Incorrect
In patients with COPD exacerbation and hypoxemia (oxygen saturation < 90%), supplemental oxygen therapy is crucial to improve oxygenation and reduce the risk of complications. Arterial blood gas analysis may be performed later to assess acid-base status and guide further management, but oxygen supplementation should not be delayed.
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Question 28 of 30
28. Question
Ms. Brown, a 35-year-old woman, presents to the emergency department with severe abdominal pain, nausea, and vomiting. She has a history of heavy alcohol use. On examination, she appears jaundiced, and her abdomen is tender in the right upper quadrant. Laboratory tests show elevated liver enzymes and total bilirubin. What is the most likely diagnosis?
Correct
Ms. Brown’s presentation with severe abdominal pain, jaundice, elevated liver enzymes, and a history of heavy alcohol use is consistent with alcoholic hepatitis. This condition requires prompt management, including supportive care, abstinence from alcohol, and potentially corticosteroid therapy in severe cases.
Incorrect
Ms. Brown’s presentation with severe abdominal pain, jaundice, elevated liver enzymes, and a history of heavy alcohol use is consistent with alcoholic hepatitis. This condition requires prompt management, including supportive care, abstinence from alcohol, and potentially corticosteroid therapy in severe cases.
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Question 29 of 30
29. Question
A 50-year-old female presents with recurrent episodes of palpitations, sweating, and anxiety. She has no significant medical history and is not taking any medications. Cardiac examination and routine laboratory tests are unremarkable. Which of the following is the most appropriate next step in evaluation?
Correct
The patient’s presentation with recurrent palpitations and anxiety suggests possible paroxysmal arrhythmias. Performing an ECG during symptoms can capture the arrhythmia and provide diagnostic information. Holter monitoring may be considered if symptoms occur intermittently over a longer duration.
Incorrect
The patient’s presentation with recurrent palpitations and anxiety suggests possible paroxysmal arrhythmias. Performing an ECG during symptoms can capture the arrhythmia and provide diagnostic information. Holter monitoring may be considered if symptoms occur intermittently over a longer duration.
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Question 30 of 30
30. Question
Dr. Roberts is treating a 28-year-old female with a history of rheumatoid arthritis (RA) who presents with fatigue, weight loss, and low-grade fever. Laboratory tests reveal anemia, thrombocytosis, and elevated inflammatory markers. What is the most likely diagnosis?
Correct
Felty syndrome is characterized by the triad of RA, splenomegaly, and neutropenia. Patients may present with constitutional symptoms, anemia, thrombocytosis, and elevated inflammatory markers. Recognizing Felty syndrome is important for appropriate management, including addressing neutropenia-related complications.
Incorrect
Felty syndrome is characterized by the triad of RA, splenomegaly, and neutropenia. Patients may present with constitutional symptoms, anemia, thrombocytosis, and elevated inflammatory markers. Recognizing Felty syndrome is important for appropriate management, including addressing neutropenia-related complications.