Adult-Gerontology Acute Care Practice Exam Quiz
What is the primary goal of restorative care in adult-gerontology acute care practice?
Stabilization of vital signs
B. Improvement in patient functionality and quality of life
C. Prevention of recurrent infections
D. Minimization of hospital costs
Which of the following laboratory tests is most indicative of acute kidney injury?
Decreased hemoglobin
B. Elevated creatinine and BUN
C. Low albumin levels
D. Elevated white blood cell count
A 72-year-old patient presents with acute shortness of breath and wheezing. What is the most appropriate first intervention?
Order a chest X-ray
B. Administer a bronchodilator
C. Start IV fluids
D. Obtain an arterial blood gas
Which condition is commonly associated with delirium in hospitalized older adults?
Hyperthyroidism
B. Infection
C. Hypoglycemia
D. All of the above
What is a key feature of geriatric syndromes?
They affect only the cardiovascular system.
B. They have a single identifiable cause.
C. They involve multiple organ systems and require interdisciplinary care.
D. They are always irreversible.
When performing a health assessment in an elderly patient, what factor most influences the accuracy of findings?
Use of diagnostic imaging
B. Effective communication and active listening
C. Laboratory test results
D. Family member input
Which is the first-line treatment for acute heart failure with pulmonary edema?
Beta-blockers
B. IV diuretics
C. Digoxin
D. Vasodilators
In older adults, what is a common side effect of polypharmacy?
Improved medication adherence
B. Increased risk of falls
C. Reduced efficacy of medications
D. Resistance to antibiotics
A 65-year-old patient with sepsis is hypotensive despite fluid resuscitation. What is the next best step in management?
Increase IV fluid rate
B. Administer norepinephrine
C. Perform blood cultures
D. Start antibiotics
Which diagnostic imaging is most appropriate for evaluating suspected acute ischemic stroke?
CT scan without contrast
B. MRI with gadolinium
C. Ultrasound
D. Chest X-ray
What is the most likely diagnosis for a patient with sudden onset of chest pain relieved by leaning forward?
Myocardial infarction
B. Pericarditis
C. Pulmonary embolism
D. Pneumothorax
What is a major psychosocial concern in patients recovering from a critical illness?
Persistent depression
B. Risk of reinfection
C. Malnutrition
D. Reduced social support
A patient with COPD exacerbation is found to have respiratory acidosis. What is the best initial treatment?
Increase oxygen flow to 100%
B. Non-invasive positive pressure ventilation (NIPPV)
C. Begin IV antibiotics
D. Administer diuretics
What is the hallmark symptom of delirium?
Gradual memory loss
B. Acute onset of confusion
C. Persistent sadness
D. Personality changes
Which is the preferred treatment for atrial fibrillation with rapid ventricular response?
IV amiodarone
B. IV calcium gluconate
C. IV metoprolol
D. IV dopamine
What is the recommended vaccination for preventing pneumonia in patients aged 65 and older?
Influenza vaccine
B. Pneumococcal conjugate vaccine (PCV13 or PCV15)
C. MMR vaccine
D. Hepatitis B vaccine
A 70-year-old patient with diabetes is found unconscious with a blood glucose of 40 mg/dL. What is the immediate treatment?
Administer 10 units of insulin
B. Administer IV dextrose 50%
C. Perform CT imaging of the head
D. Provide oral glucose tablets
What is the most common cause of acute abdomen in the elderly?
Appendicitis
B. Diverticulitis
C. Pancreatitis
D. Cholecystitis
Which is a common complication in mechanically ventilated patients?
Acute renal failure
B. Ventilator-associated pneumonia
C. Stroke
D. Deep vein thrombosis
What is the gold standard for diagnosing pulmonary embolism?
CT pulmonary angiography
B. Chest X-ray
C. Arterial blood gas
D. Echocardiogram
Which electrolyte imbalance is commonly seen in acute pancreatitis?
Hypercalcemia
B. Hypocalcemia
C. Hyperkalemia
D. Hyponatremia
What is the main goal in the initial treatment of septic shock?
Reducing inflammation
B. Restoring perfusion with fluids and vasopressors
C. Normalizing white blood cell count
D. Minimizing antibiotic use
A 75-year-old patient presents with unilateral leg swelling and tenderness. What is the most likely diagnosis?
Cellulitis
B. Deep vein thrombosis
C. Lymphedema
D. Peripheral arterial disease
Which drug is contraindicated in elderly patients with acute glaucoma?
Beta-blockers
B. Anticholinergics
C. Carbonic anhydrase inhibitors
D. Prostaglandin analogs
What is the most common cause of hospital-acquired infections?
Catheter-associated urinary tract infections
B. Surgical site infections
C. Ventilator-associated pneumonia
D. Bloodstream infections
Which intervention best addresses caregiver burnout?
Psychotherapy for the patient
B. Referral to respite care services
C. Encouraging caregiver medication use
D. Hospitalization of the patient
What is the most important consideration in the management of a frail elderly patient?
Prescribing all indicated medications
B. Minimizing functional decline
C. Frequent laboratory monitoring
D. Optimizing nutrition
Which condition presents with sudden unilateral vision loss and headache?
Retinal detachment
B. Giant cell arteritis
C. Glaucoma
D. Cataract
What is the first-line treatment for a hypertensive emergency in older adults?
IV labetalol
B. Oral nifedipine
C. IV furosemide
D. IV hydrocortisone
Which intervention is most effective in preventing pressure ulcers in immobilized patients?
Increasing caloric intake
B. Regular repositioning every 2 hours
C. Applying prophylactic antibiotics
D. Using anticoagulants
A 68-year-old patient with a history of atrial fibrillation presents with acute-onset slurred speech and right-sided weakness. What is the priority diagnostic test?
ECG
B. CT scan of the brain without contrast
C. MRI of the brain
D. Carotid ultrasound
Which medication is most appropriate for initial management of acute hyperkalemia with ECG changes?
Sodium bicarbonate
B. Calcium gluconate
C. Loop diuretics
D. Sodium polystyrene sulfonate
What is the most common cause of acute confusion in older adults admitted to the hospital?
Electrolyte imbalance
B. Hypoxia
C. Infection
D. Polypharmacy
A 75-year-old patient with a history of diabetes presents with severe chest pain radiating to the back. Blood pressure is significantly different between the arms. What is the most likely diagnosis?
Myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pericarditis
Which intervention is most effective for preventing deep vein thrombosis (DVT) in hospitalized older adults?
Prophylactic anticoagulation
B. Frequent ambulation
C. Compression stockings
D. Hydration therapy
A 70-year-old patient with COPD is experiencing an acute exacerbation. Which of the following is the most likely trigger?
Allergic reaction
B. Viral or bacterial infection
C. Physical overexertion
D. Medication nonadherence
What is the most common cause of syncope in older adults?
Orthostatic hypotension
B. Seizures
C. Stroke
D. Dehydration
Which symptom is a hallmark of acute decompensated heart failure?
Bilateral leg pain
B. Persistent cough with pink, frothy sputum
C. Hypotension with bradycardia
D. Severe abdominal pain
A 78-year-old patient presents with a non-healing ulcer on the foot. What is the most likely underlying condition?
Peripheral artery disease
B. Deep vein thrombosis
C. Cellulitis
D. Venous insufficiency
Which clinical finding most strongly suggests sepsis in an older adult?
Leukocytosis
B. Elevated lactate levels
C. Hypokalemia
D. Hyperglycemia
A patient develops sudden dyspnea and pleuritic chest pain post-surgery. What is the next step in diagnosis?
Echocardiogram
B. D-dimer test
C. CT pulmonary angiography
D. Chest X-ray
What is the most important initial step in managing a patient with status epilepticus?
Administer IV lorazepam
B. Perform a lumbar puncture
C. Order an EEG
D. Initiate mechanical ventilation
A 65-year-old patient with diabetes presents with fever and severe back pain. What is the most likely diagnosis?
Spinal stenosis
B. Osteomyelitis
C. Disc herniation
D. Muscle strain
Which condition is most associated with an increased risk of falls in older adults?
Vision impairment
B. Osteoporosis
C. Sarcopenia
D. All of the above
What is the recommended diagnostic test for suspected bacterial meningitis in an older adult?
Lumbar puncture
B. CT scan of the head
C. Blood culture
D. MRI of the brain
A 76-year-old patient presents with new-onset, progressive weight loss, and difficulty swallowing. What is the most likely diagnosis?
Gastroesophageal reflux disease (GERD)
B. Esophageal cancer
C. Achalasia
D. Peptic ulcer disease
Which clinical intervention is most effective for managing acute exacerbation of chronic heart failure?
Beta-blockers
B. IV furosemide and oxygen therapy
C. ACE inhibitors
D. Calcium channel blockers
What is the most common pathogen causing pneumonia in older adults?
Streptococcus pneumoniae
B. Staphylococcus aureus
C. Mycoplasma pneumoniae
D. Pseudomonas aeruginosa
Which medication is used for managing hyperactive delirium in an older adult?
Lorazepam
B. Haloperidol
C. Diphenhydramine
D. Morphine
What is the first-line treatment for acute bacterial pyelonephritis in a stable elderly patient?
Oral fluoroquinolone
B. IV vancomycin
C. Oral macrolide
D. IV aminoglycoside
A 70-year-old patient presents with acute confusion, fever, and a productive cough. What is the most appropriate next step in management?
Administer antipsychotics
B. Start empirical antibiotics
C. Order a CT scan of the head
D. Perform a lumbar puncture
What is the best initial treatment for a patient with suspected acute ischemic stroke within 4.5 hours of symptom onset?
IV alteplase
B. Aspirin therapy
C. Thrombectomy
D. Heparin infusion
A 68-year-old patient is diagnosed with acute kidney injury. Which lab finding is most consistent with prerenal azotemia?
BUN/Creatinine ratio > 20:1
B. Hyperkalemia
C. Low urine sodium concentration
D. Elevated urine protein levels
What is the most common electrolyte imbalance seen in older adults taking loop diuretics?
Hypernatremia
B. Hypokalemia
C. Hypercalcemia
D. Hypermagnesemia
A 72-year-old patient presents with an acute gout flare. Which medication is the most appropriate for initial management?
Allopurinol
B. Colchicine
C. Probenecid
D. Febuxostat
What is the preferred imaging modality for diagnosing acute mesenteric ischemia in a hemodynamically stable patient?
Abdominal X-ray
B. CT angiography
C. MRI
D. Ultrasound
A patient presents with fever, tachypnea, and a productive cough with rust-colored sputum. Which pathogen is most likely responsible?
Streptococcus pneumoniae
B. Klebsiella pneumoniae
C. Haemophilus influenzae
D. Mycoplasma pneumoniae
Which of the following is a hallmark sign of hypovolemic shock in older adults?
Increased urine output
B. Hypotension with tachycardia
C. Bradycardia with confusion
D. Warm and flushed skin
A 75-year-old patient presents with acute abdominal pain and a pulsatile mass in the abdomen. What is the most likely diagnosis?
Acute pancreatitis
B. Abdominal aortic aneurysm rupture
C. Small bowel obstruction
D. Peritonitis
Which medication is contraindicated in patients with systolic heart failure?
ACE inhibitors
B. Calcium channel blockers (non-dihydropyridines)
C. Beta-blockers
D. Diuretics
A patient with sepsis develops acute respiratory distress syndrome (ARDS). What is the primary goal of mechanical ventilation in ARDS?
Reduce cardiac output
B. Maintain high oxygen levels
C. Prevent ventilator-associated pneumonia
D. Minimize lung injury through low tidal volumes
A 74-year-old patient on warfarin therapy presents with significant hematuria. What is the most important lab test to evaluate?
Platelet count
B. PT/INR
C. PTT
D. Hemoglobin
A patient with chronic obstructive pulmonary disease (COPD) develops sudden pleuritic chest pain and dyspnea. What is the most likely diagnosis?
Acute bronchitis
B. Pneumothorax
C. Pulmonary embolism
D. Pneumonia
Which medication is most appropriate for acute pain management in an elderly patient with renal impairment?
Ibuprofen
B. Morphine
C. Acetaminophen
D. Naproxen
A 70-year-old patient with chronic liver disease develops acute confusion and asterixis. What is the most likely diagnosis?
Hepatic encephalopathy
B. Stroke
C. Alcohol withdrawal
D. Hypoglycemia
Which clinical finding is most indicative of tension pneumothorax?
Bilateral crackles on auscultation
B. Tracheal deviation
C. Dullness to percussion
D. Bradycardia
A patient presents with acute unilateral vision loss and pain with eye movement. What is the most likely diagnosis?
Glaucoma
B. Optic neuritis
C. Retinal detachment
D. Conjunctivitis
What is the primary goal of management in hypertensive emergencies?
Normalize blood pressure immediately
B. Reduce blood pressure gradually to prevent end-organ damage
C. Administer beta-blockers only
D. Avoid treatment to prevent hypotension
A 68-year-old patient with diabetes develops acute onset of severe epigastric pain radiating to the back. Serum lipase is elevated. What is the most likely diagnosis?
Gastric ulcer
B. Acute pancreatitis
C. Cholecystitis
D. Myocardial infarction
A 76-year-old patient presents with confusion, lethargy, and a sodium level of 118 mEq/L. What is the first step in management?
Start hypertonic saline
B. Administer oral sodium supplements
C. Restrict fluid intake
D. Administer loop diuretics
Which medication is first-line therapy for acute atrial fibrillation with rapid ventricular response in a hemodynamically stable patient?
Amiodarone
B. Adenosine
C. Beta-blocker
D. Digoxin
A 75-year-old patient presents with acute abdominal pain, fever, and rebound tenderness in the right lower quadrant. What is the most likely diagnosis?
Acute appendicitis
B. Diverticulitis
C. Crohn’s disease flare
D. Biliary colic
What is the most appropriate initial management for a patient with acute decompensated heart failure and pulmonary edema?
IV diuretics and noninvasive ventilation
B. Oral beta-blockers
C. IV fluids and dopamine
D. Start ACE inhibitors immediately
A 70-year-old patient with Parkinson’s disease develops acute psychosis. Which medication is most appropriate?
Haloperidol
B. Clozapine
C. Risperidone
D. Levodopa
A patient with a history of atrial fibrillation presents with sudden onset of left leg pain, pallor, and loss of pulses. What is the most likely diagnosis?
Deep vein thrombosis
B. Acute arterial occlusion
C. Cellulitis
D. Compartment syndrome
Which condition is characterized by elevated troponin levels without significant coronary artery obstruction?
Myocarditis
B. Takotsubo cardiomyopathy
C. Pulmonary embolism
D. All of the above
A patient with chronic obstructive pulmonary disease (COPD) develops worsening dyspnea, hypoxia, and hypercapnia. What is the most appropriate intervention?
IV corticosteroids
B. Noninvasive positive pressure ventilation
C. Intubation and mechanical ventilation
D. Antibiotics
What is the primary goal of management in acute limb ischemia?
Administer anticoagulation and restore perfusion
B. Perform fasciotomy
C. Administer IV fluids
D. Initiate thrombolysis only if surgery is unavailable
Which electrolyte abnormality is most commonly associated with tumor lysis syndrome?
Hypocalcemia
B. Hyperkalemia
C. Hyperuricemia
D. All of the above
A 68-year-old patient presents with acute epigastric pain after a meal and a positive Murphy’s sign. What is the most likely diagnosis?
Peptic ulcer disease
B. Acute cholecystitis
C. Acute pancreatitis
D. Gastroesophageal reflux disease
A patient presents with sepsis and lactic acidosis. What is the most appropriate first step in management?
Administer vasopressors
B. Initiate fluid resuscitation
C. Administer corticosteroids
D. Obtain blood cultures after antibiotics
Which condition is most likely to cause metabolic acidosis with an elevated anion gap?
Acute renal failure
B. Diabetic ketoacidosis
C. Methanol poisoning
D. All of the above
A patient with liver cirrhosis presents with confusion and flapping tremors. What is the first-line treatment?
Rifaximin
B. Lactulose
C. Neomycin
D. Spironolactone
Which medication is most appropriate for managing hypertensive emergency with end-organ damage?
Oral captopril
B. IV nitroprusside
C. IV labetalol
D. Sublingual nifedipine
A 74-year-old patient presents with sudden chest pain and syncope. ECG shows ST elevation in leads II, III, and aVF. What is the next step?
Administer IV thrombolytics
B. Perform immediate percutaneous coronary intervention (PCI)
C. Start beta-blockers
D. Order a chest X-ray
What is the most common cause of hospital-acquired pneumonia in older adults?
Methicillin-resistant Staphylococcus aureus (MRSA)
B. Pseudomonas aeruginosa
C. Streptococcus pneumoniae
D. Klebsiella pneumoniae
A patient presents with acute onset of confusion, ataxia, and nystagmus. Which condition should be suspected?
Stroke
B. Wernicke’s encephalopathy
C. Multiple sclerosis
D. Parkinson’s disease
A patient with severe sepsis develops acute kidney injury. Which intervention is most likely to improve outcomes?
Continuous renal replacement therapy
B. Early goal-directed fluid resuscitation
C. High-dose diuretics
D. Initiating vasopressors without fluids
Which medication is most appropriate for acute management of pulmonary embolism in a hemodynamically unstable patient?
Subcutaneous enoxaparin
B. IV heparin
C. Thrombolytics
D. Oral rivaroxaban
A 70-year-old patient with chronic atrial fibrillation develops an acute embolic stroke. What is the most appropriate long-term therapy to prevent recurrence?
Aspirin
B. Clopidogrel
C. Warfarin
D. Direct oral anticoagulants (DOACs)
Which imaging study is most appropriate for diagnosing an acute pulmonary embolism in a patient with normal renal function?
Chest X-ray
B. Ventilation-perfusion (V/Q) scan
C. CT pulmonary angiography (CTPA)
D. Echocardiography
What is the primary goal of treatment for a patient presenting with septic shock?
Initiate broad-spectrum antibiotics
B. Restore tissue perfusion and oxygen delivery
C. Administer corticosteroids
D. Correct acidosis with bicarbonate
Which of the following is the hallmark of acute kidney injury (AKI)?
Hypernatremia
B. Decreased glomerular filtration rate (GFR)
C. Metabolic alkalosis
D. Low serum potassium
What is the primary mechanism of action for naloxone in opioid overdose management?
GABA receptor antagonist
B. Competitive opioid receptor antagonist
C. NMDA receptor inhibitor
D. Beta-adrenergic agonist
A 68-year-old patient presents with slurred speech and right-sided weakness. Which diagnostic test should be performed first?
CT scan of the brain without contrast
B. MRI of the brain
C. Carotid Doppler ultrasound
D. Lumbar puncture
Which electrolyte imbalance is commonly seen in a patient with syndrome of inappropriate antidiuretic hormone secretion (SIADH)?
Hyperkalemia
B. Hyponatremia
C. Hypocalcemia
D. Hypermagnesemia
A patient with acute pancreatitis develops a pleural effusion. What is the most likely cause?
Malignancy
B. Infection
C. Leakage of pancreatic enzymes into the pleural cavity
D. Congestive heart failure
A patient is diagnosed with acute respiratory distress syndrome (ARDS). What is the most appropriate ventilation strategy?
High tidal volumes and high PEEP
B. Low tidal volumes and high PEEP
C. Low tidal volumes and low PEEP
D. High tidal volumes and low PEEP
What is the most likely diagnosis for an elderly patient with sudden loss of vision in one eye and a cherry-red spot on fundoscopy?
Retinal detachment
B. Central retinal artery occlusion
C. Central retinal vein occlusion
D. Macular degeneration
Which of the following is the most common cause of hospital-acquired acute kidney injury?
Contrast-induced nephropathy
B. Postrenal obstruction
C. Sepsis
D. Nephrotoxic medications
Which clinical feature is most suggestive of delirium in an elderly patient?
Gradual onset of cognitive decline
B. Acute onset of confusion and fluctuating course
C. Memory loss over months
D. Social withdrawal and apathy
A patient presents with acute chest pain, elevated D-dimer, and clear lung fields on chest X-ray. What is the next step?
CT pulmonary angiography (CTPA)
B. Perform ECG
C. Echocardiography
D. V/Q scan
Which of the following is a clinical sign of cardiac tamponade?
Pulsus paradoxus
B. Hyperresonance to percussion
C. Positive Kernig’s sign
D. Widened pulse pressure
A 70-year-old patient presents with fever, chills, and a new heart murmur. What is the most likely diagnosis?
Pericarditis
B. Myocarditis
C. Infective endocarditis
D. Aortic stenosis
What is the recommended target blood glucose range for critically ill patients in the ICU?
70–110 mg/dL
B. 140–180 mg/dL
C. 100–150 mg/dL
D. <200 mg/dL
What is the most appropriate initial diagnostic test for suspected acute mesenteric ischemia?
Abdominal X-ray
B. Contrast-enhanced CT scan
C. Endoscopy
D. MRI
Which treatment is first-line for hypertrophic cardiomyopathy with symptomatic outflow obstruction?
Beta-blockers
B. Calcium channel blockers
C. ACE inhibitors
D. Diuretics
A patient presents with acute altered mental status and serum glucose of 35 mg/dL. What is the most appropriate initial intervention?
Administer IV dextrose
B. Initiate an insulin infusion
C. Order a CT scan of the head
D. Administer glucagon IM
Which of the following is most likely to cause metabolic alkalosis?
Diuretic use
B. Diarrhea
C. Renal failure
D. Sepsis
What is the preferred initial diagnostic test for suspected aortic dissection in a hemodynamically stable patient?
Chest X-ray
B. CT angiography
C. MRI
D. Transesophageal echocardiography
Which laboratory finding is most indicative of acute liver failure?
Elevated alkaline phosphatase
B. Increased direct bilirubin
C. Prolonged prothrombin time (PT) and INR
D. Elevated serum lipase
A patient with chronic atrial fibrillation is admitted with a stroke. Which medication should be reviewed as part of the management plan?
Beta-blockers
B. Aspirin
C. Warfarin
D. Statins
What is the most common electrolyte abnormality in patients with acute alcohol intoxication?
Hypercalcemia
B. Hypomagnesemia
C. Hyperkalemia
D. Hyponatremia
A 65-year-old patient presents with acute flank pain, hematuria, and nausea. What is the most likely diagnosis?
Acute pyelonephritis
B. Renal artery stenosis
C. Kidney stone
D. Bladder cancer
What is the primary management for a patient with status epilepticus?
Administer IV lorazepam
B. Perform an emergent EEG
C. Start oral phenytoin
D. Intubate immediately
Which diagnostic test is most appropriate for evaluating a suspected thoracic aortic aneurysm?
Transthoracic echocardiography
B. CT angiography
C. Abdominal ultrasound
D. Chest X-ray
A patient presents with fever, a maculopapular rash, eosinophilia, and acute kidney injury after starting a new medication. What is the most likely diagnosis?
Acute glomerulonephritis
B. Drug-induced interstitial nephritis
C. Nephrotic syndrome
D. Renal cell carcinoma
What is the recommended target systolic blood pressure in a patient with acute ischemic stroke eligible for thrombolysis?
<140 mmHg
B. <160 mmHg
C. <185 mmHg
D. <200 mmHg
A 72-year-old patient presents with acute confusion, fever, and neck stiffness. What is the next diagnostic step?
Brain MRI
B. Lumbar puncture
C. CT scan of the head without contrast
D. Blood cultures
Which of the following is the primary cause of acute coronary syndrome (ACS)?
Coronary artery spasm
B. Atherosclerotic plaque rupture and thrombosis
C. Hypotension
D. Myocardial hypertrophy
What is the most common cause of acute respiratory failure in patients with chronic obstructive pulmonary disease (COPD)?
Pulmonary embolism
B. Pneumothorax
C. Acute bacterial or viral infection
D. Aspiration pneumonia
Which treatment is most appropriate for hyperkalemia with ECG changes?
Sodium bicarbonate
B. Intravenous calcium gluconate
C. Loop diuretics
D. Hemodialysis
A patient with advanced heart failure presents with hypotension, elevated jugular venous pressure, and muffled heart sounds. What is the likely diagnosis?
Cardiac tamponade
B. Constrictive pericarditis
C. Cardiogenic shock
D. Pulmonary embolism
What is the gold standard for diagnosing pulmonary hypertension?
Echocardiography
B. Chest CT scan
C. Right heart catheterization
D. Pulmonary function tests
What is the recommended first-line treatment for bacterial meningitis in a 70-year-old patient?
Ceftriaxone and vancomycin
B. Amoxicillin and metronidazole
C. Doxycycline and rifampin
D. Azithromycin and cefazolin
A patient presents with severe epigastric pain radiating to the back, nausea, and vomiting. Elevated lipase confirms the diagnosis of acute pancreatitis. Which scoring system assesses severity?
APACHE II
B. Child-Pugh
C. SOFA
D. MELD
Which condition is characterized by pulsus paradoxus?
Cardiac tamponade
B. Aortic stenosis
C. Mitral regurgitation
D. Pulmonary fibrosis
What is the most appropriate initial step in managing a patient with suspected acute limb ischemia?
Administer heparin
B. Perform Doppler ultrasound
C. Schedule emergency surgery
D. Start IV antibiotics
A patient with cirrhosis presents with confusion and asterixis. What is the most appropriate treatment?
Lactulose
B. Spironolactone
C. Furosemide
D. Vitamin K
What is the hallmark finding on ECG for hyperkalemia?
Prolonged QT interval
B. ST-segment elevation
C. Peaked T waves
D. Inverted P waves
A 70-year-old patient with a history of chronic kidney disease presents with a creatinine level of 3.0 mg/dL and an elevated BUN. What is the most likely cause of the elevated creatinine in this patient?
Acute kidney injury
B. Acute exacerbation of heart failure
C. Chronic kidney disease progression
D. Dehydration
Which of the following is a common complication of acute myocardial infarction?
Acute pancreatitis
B. Atrial fibrillation
C. Deep vein thrombosis
D. Hyperthyroidism
What is the most appropriate treatment for a patient with a confirmed diagnosis of acute ischemic stroke who presents within 3 hours of symptom onset?
Intravenous thrombolysis with alteplase
B. Intravenous aspirin
C. Endovascular thrombectomy
D. Hyperbaric oxygen therapy
Which of the following is the most likely cause of acute lower extremity swelling and pain in a patient with a history of recent orthopedic surgery?
Deep vein thrombosis (DVT)
B. Cellulitis
C. Lymphedema
D. Compartment syndrome
Which of the following laboratory findings is consistent with diabetic ketoacidosis (DKA)?
Low anion gap
B. Elevated blood glucose
C. Hypokalemia
D. Elevated bicarbonate levels
A patient is being treated for acute exacerbation of chronic obstructive pulmonary disease (COPD) with steroids and antibiotics. Which of the following is most likely to improve their outcomes?
Oxygen therapy
B. Diuretics
C. Statins
D. Antitussives
Which condition is most commonly associated with acute respiratory distress syndrome (ARDS)?
Pulmonary embolism
B. Viral pneumonia
C. Acute myocardial infarction
D. Diabetes mellitus
Which intervention is most appropriate for a patient with acute decompensated heart failure and significant volume overload?
Intravenous loop diuretics
B. Intravenous corticosteroids
C. Oral beta-blockers
D. Intravenous inotropes
What is the first-line treatment for a patient with acute anaphylaxis following an insect sting?
Oral antihistamines
B. Subcutaneous epinephrine
C. Oral corticosteroids
D. Intravenous fluids
Which of the following is the primary cause of acute liver failure in a patient with a history of excessive alcohol use?
Hepatitis C
B. Hepatitis B
C. Alcoholic hepatitis
D. Nonalcoholic fatty liver disease
Which of the following diagnostic tests is most useful in confirming a diagnosis of acute pericarditis?
Chest X-ray
B. Echocardiogram
C. Electrocardiogram (ECG)
D. Cardiac biomarkers
What is the recommended first-line treatment for acute gout?
Colchicine
B. Methotrexate
C. Allopurinol
D. Prednisone
Which of the following is the most likely cause of acute confusion and agitation in an elderly patient with no prior history of psychiatric illness?
Dementia
B. Depression
C. Delirium
D. Generalized anxiety disorder
Which diagnostic test is most appropriate for evaluating a suspected pulmonary embolism in a patient with moderate to high clinical probability?
Chest X-ray
B. CT pulmonary angiography (CTPA)
C. V/Q scan
D. D-dimer
What is the first-line treatment for a patient with acute viral bronchitis?
Oral antibiotics
B. Inhaled corticosteroids
C. Bronchodilators
D. Cough suppressants
Which of the following is a key diagnostic feature of acute bacterial endocarditis?
Positive blood cultures
B. Elevated liver enzymes
C. Low white blood cell count
D. Chest pain with pleuritic features
What is the most appropriate initial intervention for a patient with suspected tension pneumothorax?
Needle decompression
B. Chest X-ray
C. Chest tube placement
D. Observation
Which laboratory test is most helpful in diagnosing acute adrenal insufficiency in a critically ill patient?
Serum cortisol level
B. Serum sodium level
C. Serum potassium level
D. Complete blood count (CBC)
What is the most likely cause of acute renal failure in a patient who has received intravenous contrast for imaging?
Contrast-induced nephropathy
B. Acute tubular necrosis
C. Prerenal azotemia
D. Glomerulonephritis
A 75-year-old patient presents with sudden onset of severe headache, nausea, and vomiting. Their blood pressure is elevated, and they have an altered mental status. What is the most likely diagnosis?
Acute hypertensive emergency
B. Subarachnoid hemorrhage
C. Migraine headache
D. Acute glaucoma
A 60-year-old patient presents with sudden-onset chest pain, dyspnea, and syncope. A CT scan reveals a massive pulmonary embolism. What is the first-line treatment for this condition?
Oral anticoagulants
B. Intravenous thrombolytics
C. Low-molecular-weight heparin
D. Oxygen therapy
What is the most likely cause of hypotension in a patient with severe burns and extensive fluid loss?
Hemorrhage
B. Sepsis
C. Cardiogenic shock
D. Hypovolemic shock
A patient presents with hemoptysis, weight loss, and night sweats. Which of the following is the most appropriate initial diagnostic test?
Chest X-ray
B. Sputum culture
C. Chest CT scan
D. Pulmonary function tests
A 68-year-old patient with heart failure presents with sudden-onset dyspnea, orthopnea, and lower extremity edema. What is the most likely diagnosis?
Acute exacerbation of chronic obstructive pulmonary disease (COPD)
B. Acute heart failure
C. Pulmonary embolism
D. Acute myocardial infarction
Which of the following is the first-line treatment for acute pancreatitis?
Antibiotics
B. Intravenous fluids and electrolyte replacement
C. Oral pain management
D. Surgical intervention
What is the most likely cause of acute respiratory failure in a patient with a history of obesity and hypoventilation syndrome?
Sleep apnea
B. Pulmonary embolism
C. Acute asthma exacerbation
D. Chronic obstructive pulmonary disease (COPD)
A 78-year-old patient with chronic hypertension presents with an acute headache, visual changes, and chest pain. What is the most likely diagnosis?
Stroke
B. Acute myocardial infarction
C. Aortic dissection
D. Subarachnoid hemorrhage
A 50-year-old male presents with abdominal pain, jaundice, and elevated liver enzymes. His history includes heavy alcohol use. What is the most likely diagnosis?
Acute alcoholic hepatitis
B. Gallstones
C. Chronic liver disease
D. Pancreatitis
A patient with a history of diabetes presents with confusion, fatigue, and fruity-smelling breath. Blood glucose is 500 mg/dL. What is the most likely diagnosis?
Hypoglycemia
B. Diabetic ketoacidosis (DKA)
C. Hyperosmolar hyperglycemic state (HHS)
D. Hyperthyroidism
Which of the following is the primary goal in the treatment of acute stroke with a suspected large vessel occlusion?
Thrombolysis
B. Blood pressure management
C. Mechanical thrombectomy
D. Antiplatelet therapy
What is the most appropriate first-line treatment for an acute asthma exacerbation?
Inhaled corticosteroids
B. Beta-agonists (e.g., albuterol)
C. Oral corticosteroids
D. Intravenous magnesium sulfate
A 50-year-old patient with a history of chronic alcohol use presents with confusion, asterixis, and jaundice. What is the most likely diagnosis?
Hepatic encephalopathy
B. Acute liver failure
C. Delirium tremens
D. Wernicke’s encephalopathy
What is the most common cause of acute pericarditis?
Bacterial infection
B. Autoimmune disease
C. Viral infection
D. Trauma
A 65-year-old patient presents with acute leg pain, swelling, and redness after prolonged bed rest. What is the most likely diagnosis?
Deep vein thrombosis (DVT)
B. Cellulitis
C. Lymphedema
D. Acute gout
Which of the following is the most important first step in managing a patient with suspected stroke?
Administer aspirin
B. Perform a head CT scan
C. Start intravenous fluids
D. Administer thrombolytics
Which of the following conditions is most likely to cause hypovolemic shock in a patient after gastrointestinal bleeding?
Anemia
B. Hemorrhagic shock
C. Septic shock
D. Cardiogenic shock
What is the most common cause of septic shock in the elderly population?
Urinary tract infection
B. Pneumonia
C. Skin infection
D. Gastrointestinal infection
What is the most appropriate next step in the management of a patient with suspected acute cholecystitis?
Intravenous antibiotics
B. Urgent cholecystectomy
C. Oral cholecystectomy
D. Biliary drainage
Which of the following is the first-line treatment for acute bronchitis?
Oral antibiotics
B. Inhaled bronchodilators
C. Oral corticosteroids
D. Rest and hydration
A 70-year-old patient presents with new-onset weakness, dizziness, and hypotension after starting a new antihypertensive medication. What is the most likely cause?
Orthostatic hypotension
B. Stroke
C. Acute myocardial infarction
D. Hyperglycemia
A 65-year-old patient presents with confusion, lethargy, and muscle weakness. Lab results show a potassium level of 2.9 mEq/L. What is the most appropriate intervention?
Administer potassium chloride intravenously
B. Initiate hemodialysis
C. Administer intravenous sodium bicarbonate
D. Give oral potassium supplements
What is the most common cause of acute exacerbation of chronic obstructive pulmonary disease (COPD)?
Viral respiratory infection
B. Heart failure
C. Pulmonary embolism
D. Pneumothorax
A 45-year-old male presents with abdominal pain, fever, and jaundice. His liver function tests reveal elevated AST, ALT, and alkaline phosphatase. What is the most likely diagnosis?
Hepatitis A
B. Acute cholecystitis
C. Acute pancreatitis
D. Cirrhosis
A 70-year-old patient with a history of heart failure presents with sudden-onset dyspnea and orthopnea. Chest X-ray shows bilateral pulmonary edema. What is the most likely diagnosis?
Acute myocardial infarction
B. Acute heart failure
C. Pulmonary embolism
D. Pneumonia
Which of the following is the most common cause of community-acquired pneumonia in adults?
Staphylococcus aureus
B. Streptococcus pneumoniae
C. Haemophilus influenzae
D. Legionella pneumophila
A patient presents with a sudden-onset severe headache, nausea, vomiting, and altered mental status. They are diagnosed with subarachnoid hemorrhage. What is the most appropriate management?
Surgical clipping or coiling of the aneurysm
B. Administer intravenous corticosteroids
C. Initiate broad-spectrum antibiotics
D. Start intravenous fluids and electrolyte correction
What is the first-line treatment for a patient with acute gout?
Oral allopurinol
B. Intravenous corticosteroids
C. Oral colchicine
D. Oral nonsteroidal anti-inflammatory drugs (NSAIDs)
A 62-year-old male with a history of smoking presents with hemoptysis, weight loss, and chest pain. What is the most appropriate diagnostic test?
Chest X-ray
B. Sputum culture
C. CT scan of the chest
D. Pulmonary function tests
Which of the following is the most common cause of acute kidney injury in hospitalized patients?
Glomerulonephritis
B. Acute tubular necrosis
C. Prerenal azotemia
D. Postrenal obstruction
What is the primary treatment for an acute exacerbation of multiple sclerosis?
Intravenous corticosteroids
B. Disease-modifying therapy
C. Plasmapheresis
D. Immunosuppressive therapy
Which of the following is the most appropriate initial treatment for a patient with suspected acute appendicitis?
Broad-spectrum antibiotics
B. Laparoscopic appendectomy
C. Nonsteroidal anti-inflammatory drugs (NSAIDs)
D. Observation with serial exams
A 50-year-old patient presents with sudden-onset chest pain, shortness of breath, and an ECG showing ST-segment elevation in the anterior leads. What is the most likely diagnosis?
Acute pericarditis
B. Acute coronary syndrome
C. Pulmonary embolism
D. Aortic dissection
Which of the following medications is contraindicated in patients with acute decompensated heart failure and low blood pressure?
Diuretics
B. Beta-blockers
C. Vasodilators
D. Inotropes
A 68-year-old patient with a history of hypertension presents with severe abdominal pain and a pulsatile mass in the abdomen. What is the most likely diagnosis?
Abdominal aortic aneurysm
B. Acute pancreatitis
C. Acute cholecystitis
D. Bowel obstruction
What is the most likely cause of acute dyspnea, hypoxemia, and hypotension in a patient who has recently undergone surgery for a hip fracture?
Pulmonary embolism
B. Acute respiratory distress syndrome (ARDS)
C. Acute myocardial infarction
D. Pneumothorax
Which of the following is the most common cause of acute myocardial infarction?
Coronary artery spasm
B. Thrombosis from a ruptured plaque
C. Aortic dissection
D. Severe anemia
A 72-year-old patient presents with sudden-onset confusion, fever, and cough. Chest X-ray reveals a lobar consolidation. What is the most likely diagnosis?
Acute bronchitis
B. Pneumonia
C. Pulmonary embolism
D. Acute asthma exacerbation
Which of the following is the most appropriate treatment for acute severe asthma exacerbation?
Inhaled corticosteroids
B. Inhaled beta-agonists
C. Oral antibiotics
D. Oxygen therapy alone
A patient with a history of diabetes presents with altered mental status, deep rapid breathing (Kussmaul respirations), and fruity breath odor. What is the most likely diagnosis?
Hyperosmolar hyperglycemic state (HHS)
B. Diabetic ketoacidosis (DKA)
C. Hypoglycemia
D. Hyperthyroid crisis
Which of the following diagnostic tests is most useful in the evaluation of suspected acute myocardial infarction?
Troponin levels
B. Chest X-ray
C. Electrocardiogram (ECG)
D. Echocardiogram
A 56-year-old male with a history of chronic hypertension presents with sudden-onset chest pain, diaphoresis, and shortness of breath. The ECG shows ST-segment elevation in the anterior leads. What is the most likely diagnosis?
Aortic dissection
B. Acute coronary syndrome
C. Pericarditis
D. Pulmonary embolism
Which of the following is the most appropriate initial management for a patient with acute renal failure due to hypovolemia?
Diuretic therapy
B. Intravenous fluid resuscitation
C. Dialysis
D. Administration of vasopressors
A 72-year-old patient with a history of chronic obstructive pulmonary disease (COPD) presents with worsening dyspnea, productive cough, and fever. What is the most likely cause of the exacerbation?
Acute respiratory failure
B. Pulmonary embolism
C. Pneumonia
D. Spontaneous pneumothorax
A 63-year-old patient with a history of diabetes presents with polyuria, polydipsia, weight loss, and a random blood glucose of 450 mg/dL. What is the most likely diagnosis?
Diabetic ketoacidosis (DKA)
B. Hyperosmolar hyperglycemic state (HHS)
C. Acute renal failure
D. Hyperthyroid crisis
A patient presents with fever, night sweats, and weight loss, along with a persistent cough and hemoptysis. Chest X-ray reveals cavitary lesions in the upper lung lobes. What is the most likely diagnosis?
Pneumonia
B. Tuberculosis
C. Lung cancer
D. Sarcoidosis
Which of the following is the most common cause of sepsis in adults?
Escherichia coli
B. Staphylococcus aureus
C. Streptococcus pneumoniae
D. Pseudomonas aeruginosa
A 70-year-old patient with a history of diabetes and hypertension presents with acute-onset left-sided weakness and slurred speech. What is the most appropriate initial diagnostic test?
CT scan of the head
B. MRI of the brain
C. Carotid Doppler ultrasound
D. Echocardiogram
A 78-year-old patient presents with severe back pain after lifting a heavy object. Physical examination reveals tenderness over the lower lumbar spine, but no neurological deficits. What is the most likely diagnosis?
Spinal fracture
B. Acute disc herniation
C. Muscle strain
D. Cauda equina syndrome
A 64-year-old female with a history of rheumatoid arthritis presents with fever, chills, and a swollen, erythematous knee joint. What is the most likely cause of her symptoms?
Gout
B. Osteoarthritis
C. Septic arthritis
D. Rheumatoid arthritis flare
Which of the following is the most common cause of a non-ST elevation myocardial infarction (NSTEMI)?
Atherosclerotic plaque rupture with thrombosis
B. Coronary artery spasm
C. Vasculitis
D. Myocardial contusion
A 50-year-old male with a history of smoking presents with persistent cough, weight loss, and hemoptysis. Chest X-ray shows a central mass in the right lung. What is the most likely diagnosis?
Small cell lung cancer
B. Squamous cell carcinoma
C. Pulmonary embolism
D. Tuberculosis
A 70-year-old male with a history of congestive heart failure (CHF) presents with worsening shortness of breath, orthopnea, and lower extremity edema. What is the most appropriate initial treatment?
Oral diuretics
B. Intravenous diuretics
C. Beta-blockers
D. Vasopressors
What is the first-line treatment for an acute asthma exacerbation?
Oral corticosteroids
B. Inhaled beta-agonists
C. Anticholinergic agents
D. Oxygen therapy
A patient with a history of hypertension and diabetes presents with a sudden-onset severe headache, nausea, and vomiting. Blood pressure is 210/130 mmHg. What is the most likely diagnosis?
Acute migraine
B. Hypertensive emergency
C. Subarachnoid hemorrhage
D. Acute angle-closure glaucoma
Which of the following is the most appropriate management for a patient diagnosed with acute pancreatitis?
Broad-spectrum antibiotics
B. Intravenous fluids and bowel rest
C. Oral corticosteroids
D. Endoscopic retrograde cholangiopancreatography (ERCP)
A 65-year-old patient presents with chest pain, dyspnea, and hemoptysis. A CT scan reveals a filling defect in the right pulmonary artery. What is the most likely diagnosis?
Pulmonary embolism
B. Aortic dissection
C. Acute myocardial infarction
D. Pneumothorax
A 75-year-old male with a history of coronary artery disease presents with severe chest pain and diaphoresis. His ECG shows ST-segment elevation in the anterior leads. What is the most appropriate treatment?
Thrombolytics
B. Coronary artery bypass grafting (CABG)
C. Pericardiocentesis
D. Oral nitroglycerin
A 66-year-old female with a history of heart failure presents with shortness of breath, fatigue, and peripheral edema. What is the most appropriate diagnostic test to evaluate for acute decompensated heart failure?
Chest X-ray
B. Echocardiogram
C. BNP levels
D. Electrocardiogram (ECG)
A 50-year-old patient presents with sudden-onset severe chest pain, radiating to the back. His blood pressure is markedly different in both arms. What is the most likely diagnosis?
Acute myocardial infarction
B. Aortic dissection
C. Pulmonary embolism
D. Pneumothorax
A 68-year-old patient with a history of diabetes mellitus and hypertension presents with confusion, tremors, and sweating. His blood glucose is 40 mg/dL. What is the most appropriate initial treatment?
Intravenous glucose
B. Oral glucose tablets
C. Glucagon injection
D. Insulin therapy
A 72-year-old male with a history of coronary artery disease presents with progressive shortness of breath, orthopnea, and lower extremity edema. What is the most likely diagnosis?
Pneumonia
B. Acute myocardial infarction
C. Congestive heart failure
D. Chronic obstructive pulmonary disease
A 45-year-old female presents with fever, malaise, and a sore throat. Her physical examination reveals a tender, swollen lymph node in the left axilla. What is the most likely diagnosis?
Bacterial lymphadenitis
B. Mononucleosis
C. Tuberculosis
D. Acute lymphoblastic leukemia
A 60-year-old female with a history of osteoarthritis presents with a painful, red, and swollen knee joint. Synovial fluid analysis reveals needle-shaped crystals. What is the most likely diagnosis?
Gout
B. Pseudogout
C. Septic arthritis
D. Osteoarthritis flare
A 55-year-old male with a history of hypertension and hyperlipidemia presents with sudden-onset, severe chest pain and diaphoresis. An ECG shows ST-segment elevation in the anterior leads. What is the first-line treatment?
Oral nitroglycerin
B. Thrombolytics
C. Coronary angioplasty
D. Beta-blockers
A 60-year-old female presents with complaints of fatigue, unexplained weight loss, and night sweats. Physical examination reveals painless lymphadenopathy. What is the most appropriate next step in management?
Chest X-ray
B. Lymph node biopsy
C. Complete blood count (CBC)
D. MRI of the abdomen
A 72-year-old male with a history of diabetes mellitus presents with a sudden-onset headache, nausea, and blurred vision. His blood pressure is 220/130 mmHg. What is the most likely diagnosis?
Acute migraine
B. Hypertensive emergency
C. Subarachnoid hemorrhage
D. Acute angle-closure glaucoma
A 48-year-old female presents with left-sided chest pain that worsens with deep breathing. She is tachypneic and has a pleuritic rub on examination. What is the most likely diagnosis?
Myocardial infarction
B. Pulmonary embolism
C. Pericarditis
D. Pneumonia
A 55-year-old male with a history of smoking presents with a cough, weight loss, and hemoptysis. Chest X-ray reveals a mass in the right lung. What is the most likely diagnosis?
Small cell lung cancer
B. Non-small cell lung cancer
C. Pulmonary embolism
D. Pneumonia
A 70-year-old patient with a history of congestive heart failure (CHF) presents with acute-onset dyspnea, orthopnea, and bilateral lower extremity edema. What is the most appropriate treatment?
Oral diuretics
B. Intravenous diuretics
C. Digoxin
D. Beta-blockers
A 45-year-old female presents with a sudden-onset, severe headache, photophobia, and a stiff neck. What is the most likely diagnosis?
Migraine headache
B. Tension headache
C. Meningitis
D. Subarachnoid hemorrhage
A 68-year-old female with a history of diabetes mellitus presents with weakness, dry mouth, and deep, rapid breathing. Her blood glucose is 480 mg/dL, and her urine is positive for ketones. What is the most likely diagnosis?
Diabetic ketoacidosis (DKA)
B. Hyperosmolar hyperglycemic state (HHS)
C. Hyperglycemic hyperosmolar state (HHS)
D. Acute renal failure
A 50-year-old male with a history of alcoholism presents with confusion, tremors, and agitation. What is the most likely diagnosis?
Alcohol withdrawal syndrome
B. Acute alcohol intoxication
C. Hypoglycemia
D. Delirium tremens
A 72-year-old patient presents with right-sided weakness, dysphagia, and facial droop. CT scan of the head shows a left middle cerebral artery stroke. What is the most appropriate initial treatment?
Thrombolytics
B. Intravenous fluids
C. Antiplatelet therapy
D. Anticoagulation therapy
A 60-year-old female presents with chest pain and dyspnea. A CT scan reveals a pulmonary embolism. What is the most appropriate treatment?
Intravenous heparin
B. Oral anticoagulants
C. Thrombolytics
D. Inferior vena cava filter placement
A 75-year-old patient with a history of hypertension and diabetes presents with sudden-onset severe back pain, hypotension, and a pulsatile abdominal mass. What is the most likely diagnosis?
Renal colic
B. Aortic aneurysm rupture
C. Acute pancreatitis
D. Spinal fracture
A 60-year-old male with a history of COPD presents with increased shortness of breath, wheezing, and cough. What is the most appropriate first-line treatment?
Inhaled corticosteroids
B. Oral corticosteroids
C. Inhaled beta-agonists
D. Antibiotics
A 40-year-old female presents with a rapid heart rate, tremors, and heat intolerance. Lab tests reveal elevated thyroid-stimulating hormone (TSH) and free T4. What is the most likely diagnosis?
Hypothyroidism
B. Hyperthyroidism
C. Thyroid storm
D. Graves’ disease
A 55-year-old male with a history of hypertension and diabetes presents with severe chest pain radiating to his back, along with hypotension and a widening mediastinum on chest X-ray. What is the most likely diagnosis?
Aortic dissection
B. Acute myocardial infarction
C. Pulmonary embolism
D. Esophageal rupture
A 45-year-old male presents with shortness of breath, chest pain, and a recent history of deep vein thrombosis. What is the most likely diagnosis?
Pulmonary embolism
B. Myocardial infarction
C. Pneumonia
D. Pleuritis
A 70-year-old female presents with new-onset confusion, fever, and dysuria. Urinalysis reveals leukocyte esterase and nitrites. What is the most likely diagnosis?
Urinary tract infection (UTI)
B. Delirium
C. Acute pyelonephritis
D. Sepsis
A 55-year-old male with a history of chronic kidney disease presents with nausea, vomiting, and confusion. His potassium is 6.8 mEq/L. What is the most appropriate next step in management?
Administer sodium bicarbonate
B. Start hemodialysis
C. Administer calcium gluconate
D. Monitor potassium levels closely
A 68-year-old male presents with sudden-onset, severe chest pain radiating to his left arm and jaw. His ECG shows ST-segment elevation. What is the most appropriate treatment?
Thrombolytics
B. Nitroglycerin infusion
C. Coronary angioplasty
D. Aspirin
A 62-year-old female with a history of breast cancer presents with severe back pain and lower extremity weakness. An MRI reveals a spinal metastasis. What is the most appropriate initial treatment?
Oral corticosteroids
B. Radiation therapy
C. Surgical decompression
D. Intravenous chemotherapy
A 70-year-old male with a history of chronic obstructive pulmonary disease (COPD) presents with increased shortness of breath, a productive cough, and fever. What is the most appropriate next step in management?
Administer antibiotics
B. Start corticosteroids
C. Increase oxygen therapy
D. Perform chest X-ray
A 55-year-old male with a history of atrial fibrillation presents with sudden-onset dizziness, lightheadedness, and palpitations. What is the most likely diagnosis?
Atrial flutter
B. Acute myocardial infarction
C. Atrial fibrillation with rapid ventricular response
D. Stroke
A 60-year-old female presents with fatigue, weight gain, and constipation. Her TSH is elevated, and free T4 is low. What is the most likely diagnosis?
Hyperthyroidism
B. Hypothyroidism
C. Thyroid storm
D. Goiter
A 72-year-old male presents with a productive cough, fever, and dyspnea. His chest X-ray shows consolidation in the right lower lobe. What is the most likely diagnosis?
Pulmonary embolism
B. Pneumonia
C. Acute bronchitis
D. Lung cancer
A 68-year-old female with a history of hypertension and diabetes presents with sudden-onset vision loss in her right eye. Fundoscopic examination reveals a cherry-red spot in the macula. What is the most likely diagnosis?
Diabetic retinopathy
B. Retinal artery occlusion
C. Retinal vein occlusion
D. Age-related macular degeneration
A 75-year-old male presents with a history of progressive difficulty swallowing, weight loss, and hoarseness. What is the most likely diagnosis?
Gastroesophageal reflux disease (GERD)
B. Esophageal cancer
C. Achalasia
D. Stroke
A 60-year-old male with a history of alcohol use disorder presents with confusion, ataxia, and nystagmus. What is the most likely diagnosis?
Wernicke’s encephalopathy
B. Stroke
C. Delirium tremens
D. Hypoglycemia
A 70-year-old female presents with acute-onset shortness of breath, tachypnea, and a history of prolonged immobility. What is the most likely diagnosis?
Pulmonary embolism
B. Pneumonia
C. Acute myocardial infarction
D. Asthma exacerbation
A 64-year-old male presents with severe pain and swelling in the right knee. Physical examination reveals warmth and erythema. Synovial fluid analysis reveals negatively birefringent crystals. What is the most likely diagnosis?
Gout
B. Pseudogout
C. Rheumatoid arthritis
D. Osteoarthritis
A 72-year-old male with a history of diabetes presents with sudden-onset weakness, slurred speech, and right-sided facial droop. What is the most likely diagnosis?
Transient ischemic attack (TIA)
B. Stroke
C. Hypoglycemia
D. Bell’s palsy
A 58-year-old male presents with severe back pain, difficulty urinating, and bilateral leg weakness. MRI shows a herniated disc at L4-L5. What is the most appropriate next step in management?
Oral corticosteroids
B. Surgery
C. Physical therapy
D. Intravenous antibiotics
A 65-year-old female presents with sudden-onset right-sided weakness, dysphagia, and aphasia. CT scan of the brain shows an ischemic stroke in the left middle cerebral artery territory. What is the most appropriate next step?
Intravenous tissue plasminogen activator (tPA)
B. Antiplatelet therapy
C. Heparin infusion
D. Endovascular thrombectomy
A 50-year-old female presents with fatigue, excessive thirst, and frequent urination. Her blood glucose is 350 mg/dL, and her urine is positive for ketones. What is the most likely diagnosis?
Diabetic ketoacidosis (DKA)
B. Hyperosmolar hyperglycemic state (HHS)
C. Diabetic nephropathy
D. Hypoglycemia
A 65-year-old male with a history of chronic heart failure presents with worsening edema, ascites, and shortness of breath. What is the most likely cause of these symptoms?
Exacerbation of heart failure
B. Pulmonary embolism
C. Acute myocardial infarction
D. Renal failure
A 58-year-old female presents with abdominal pain, jaundice, and dark urine. Her liver function tests show elevated AST and ALT. What is the most likely diagnosis?
Acute pancreatitis
B. Hepatitis
C. Gallstones
D. Cirrhosis
A 70-year-old male presents with dizziness and syncope. His ECG shows a slow, irregular rhythm with a rate of 40 beats per minute. What is the most appropriate treatment?
Atropine
B. Pacemaker implantation
C. Beta-blockers
D. Amiodarone
A 60-year-old female presents with a productive cough, shortness of breath, and wheezing. She has a 40-pack-year smoking history. What is the most likely diagnosis?
Chronic obstructive pulmonary disease (COPD)
B. Asthma
C. Pulmonary embolism
D. Pneumonia