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Question 1. A 62-year-old male is admitted to the hospital with complaints of fatigue, nausea, vomiting, low-grade fever and decreased urine output over the past few days. On physical examination, he is a febrile with a normal white blood cell count. He appears pale and dehydrated. Laboratory results show elevated serum creatinine and blood urea nitrogen (BUN) levels. His urine output is minimal, and urinalysis reveals muddy brown casts. A renal ultrasound is normal. Based on the clinical presentation and diagnostic findings, which of the following is the most likely diagnosis?
A) Kidney stones
B) Renal cancer
C) Acute kidney injury (AKI)
D) Sepsis
E) Pancreatitis
Explanation: The clinical presentation and diagnostic findings in this patient are suggestive of acute kidney injury (AKI). Key indicators include fatigue, nausea, decreased urine output, elevated serum creatinine and BUN levels, and urinalysis findings of muddy brown casts. AKI often occurs due to ischemia or nephrotoxic drugs. Renal Questions
A 45-year-old male presents with diarrhea, fever, and abdominal pain. Laboratory tests show leukocytosis and stool studies reveal the presence of fecal leukocytes. What is the most likely diagnosis?
A) Salmonella enterica
B) Vibrio cholerae
C) Giardia lamblia
D) Shigella species
Explanation: The clinical presentation of diarrhea, fever, abdominal pain, leukocytosis, and the presence of fecal leukocytes on stool studies is suggestive of Shigella infection. Shigella species are known to cause bacillary dysentery, characterized by these symptoms. GI Questions
A 40-year-old male presents with a persistent cough, purulent sputum production, and a fever of 101.5°F (38.6°C). Chest X-ray reveals patchy infiltrates in the right lower lobe. What is the most appropriate treatment for this patient’s respiratory infection?
A) Antiviral medications
B) Oral corticosteroids
C) Antibiotics
D) Nebulized bronchodilators
Explanation: The clinical presentation of a persistent cough, purulent sputum production, fever, and patchy infiltrates on chest X-ray suggests a bacterial lower respiratory tract infection. The most appropriate treatment is antibiotics targeting the likely bacterial pathogen. Respiratory Questions
A 50-year-old male presents with a sudden-onset high fever, chills, and pleuritic chest pain on the right side. Physical examination reveals decreased breath sounds and dullness to percussion over the right lower lung field. What diagnostic test should be considered to confirm the diagnosis, and what is the likely treatment for this patient’s condition?
A) Sputum culture; antiviral medications
B) Blood culture; oral antibiotics
C) Chest X-ray; antibiotics and drainage if necessary
D) Skin test for allergies; antihistamines
Explanation: The patient’s symptoms of fever, chills, pleuritic chest pain, decreased breath sounds, and dullness to percussion are indicative of a possible pleural effusion or pneumonia. The initial diagnostic test should be a chest X-ray, and treatment may involve antibiotics and drainage if necessary, depending on the underlying cause. Respiratory Questions
A 25-year-old male presents with watery diarrhea, abdominal cramps, and a low-grade fever after attending a picnic. Stool samples reveal leukocytes and fecal lactoferrin. What is the most likely cause of his gastroenteritis, and what treatment should be considered?
A) Bacterial gastroenteritis; oral rehydration therapy
B) Viral gastroenteritis; antibiotics
C) Parasitic gastroenteritis; antiviral medications
D) Fungal gastroenteritis; antifungal therapy
Explanation: The clinical presentation of watery diarrhea, abdominal cramps, and leukocytes in stool samples suggests bacterial gastroenteritis. The mainstay of treatment for bacterial gastroenteritis is oral rehydration therapy to prevent dehydration. GI Questions
A 30-year-old female presents with diarrhea, vomiting, and abdominal pain after consuming undercooked chicken. Stool cultures confirm the presence of Salmonella species. What is the appropriate treatment for her Salmonella gastroenteritis?
A) Antibiotics
B) Antiviral medications
C) Antipyretics
D) Oral rehydration therapy
Explanation: In uncomplicated cases of Salmonella gastroenteritis, treatment typically involves supportive care and oral rehydration therapy to manage symptoms and prevent dehydration. Antibiotics are reserved for severe or systemic infections. GI Questions
A 40-year-old male presents with diarrhea, nausea, and abdominal cramps after eating contaminated seafood at a restaurant. He experiences rapid-onset diarrhea with mucus and blood. Stool samples show curved, gram-negative bacteria. What is the likely causative organism, and what treatment should be considered?
A) Salmonella species; oral rehydration therapy
B) Campylobacter species; antibiotics
C) Norovirus; antiviral medications
D) E. coli O157:H7; antipyretics
Explanation: The clinical presentation of rapid-onset diarrhea with mucus and blood, along with the presence of curved, gram-negative bacteria in stool samples, suggests Campylobacter gastroenteritis. Treatment typically involves antibiotics to shorten the duration of symptoms. GI Questions
A 35-year-old female presents with diarrhea, abdominal cramps, and fever after traveling to a developing country. Stool samples reveal ova and parasites consistent with Giardia lamblia infection. What is the appropriate treatment for her parasitic gastroenteritis?
A) Antibiotics
B) Antiviral medications
C) Antipyretics
D) Antiparasitic medications
Explanation: The appropriate treatment for parasitic gastroenteritis caused by organisms like Giardia lamblia is antiparasitic medications, which target and eliminate the parasites from the digestive tract. GI Questions
A 45-year-old male presents with diarrhea, vomiting, and dehydration after consuming raw oysters. Stool cultures confirm the presence of Vibrio vulnificus. What is the recommended treatment for his gastroenteritis?
A) Antibiotics
B) Antiviral medications
C) Antipyretics
D) Oral rehydration therapy
Explanation: In cases of gastroenteritis caused by Vibrio vulnificus, which can be a severe and systemic infection, treatment with antibiotics is recommended. Antibiotics can help reduce the severity of the illness and prevent complications. GI Questions
A 45-year-old female presents with weight gain, fatigue, constipation, and cold intolerance. Physical examination reveals a diffusely enlarged thyroid gland. Laboratory tests show elevated levels of thyroid-stimulating hormone (TSH) and low levels of free thyroxine (FT4). What is the most likely diagnosis, and what treatment should be considered?
) Hyperthyroidism; radioactive iodine therapy
B) Hypothyroidism; levothyroxine replacement therapy
C) Thyroid cancer; surgical resection
D) Euthyroidism; no treatment needed
Explanation: The clinical presentation of weight gain, fatigue, constipation, cold intolerance, a diffusely enlarged thyroid gland (goiter), elevated TSH, and low FT4 levels is indicative of hypothyroidism. The appropriate treatment is levothyroxine replacement therapy to restore thyroid hormone levels. (Endocrine)
A 35-year-old male presents with unintentional weight loss, tremors, palpitations, and heat intolerance. Physical examination reveals an enlarged, non-tender thyroid gland. Laboratory tests show low TSH and elevated FT4 levels. What is the most likely diagnosis, and what treatment should be considered?
A) Hyperthyroidism; radioactive iodine therapy
B) Hypothyroidism; levothyroxine replacement therapy
C) Thyroid cancer; surgical resection
D) Euthyroidism; no treatment needed
Explanation: The clinical presentation of unintentional weight loss, tremors, palpitations, heat intolerance, an enlarged thyroid gland, low TSH, and elevated FT4 levels is indicative of hyperthyroidism, often caused by conditions like Graves’ disease. Radioactive iodine therapy is a common treatment option to reduce thyroid hormone production. Endocrine Questions
A 50-year-old female presents with a painless, rapidly growing neck mass. Physical examination reveals a hard nodule in the thyroid gland, and ultrasound shows microcalcifications. Fine-needle aspiration (FNA) cytology results suggest papillary thyroid carcinoma. What is the appropriate next step in the management of this patient’s thyroid condition?
A) Surgical resection of the thyroid gland
B) Radioactive iodine therapy
C) Levothyroxine replacement therapy
D) No further intervention is necessary
Explanation: The presence of a rapidly growing, painless thyroid nodule with microcalcifications and FNA cytology suggestive of papillary thyroid carcinoma indicates the need for surgical resection of the thyroid gland. This is the primary treatment for thyroid cancer. Endocrine Questions
A 40-year-old male presents with muscle weakness, fatigue, and an enlarged thyroid gland. Laboratory tests reveal elevated TSH and elevated thyroxine (T4) levels. What is the most likely diagnosis, and what treatment should be considered?
A) Hyperthyroidism; radioactive iodine therapy
B) Hypothyroidism; levothyroxine replacement therapy
C) Thyroid cancer; surgical resection
D) Euthyroidism; no treatment needed
Explanation: The clinical presentation of muscle weakness, fatigue, an enlarged thyroid gland, elevated TSH, and elevated T4 levels is indicative of hyperthyroidism. Radioactive iodine therapy is a common treatment to reduce thyroid hormone production in hyperthyroidism. Endocrine Questions
A 55-year-old male presents with a painless neck mass and difficulty swallowing. Physical examination reveals a palpable thyroid nodule. Fine-needle aspiration (FNA) cytology results are inconclusive. What is the recommended next step in the evaluation of this patient’s thyroid condition?
A) Thyroid hormone replacement therapy
B) Ultrasound-guided core needle biopsy
C) Radioactive iodine therapy
D) Observation with repeat FNA in 6 months
Explanation: In cases where fine-needle aspiration (FNA) cytology results are inconclusive or indeterminate, the recommended next step is an ultrasound-guided core needle biopsy to obtain a more definitive tissue sample and assess for thyroid cancer. Endocrine Questions
A 35-year-old female presents with central obesity, moon facies, purple striae on her abdomen, and easy bruising. Laboratory tests show elevated cortisol levels and a lack of diurnal variation. What is the most likely diagnosis, and what additional test should be performed?
A) Addison’s disease; 24-hour urine cortisol
B) Cushing’s disease; low-dose dexamethasone suppression test
C) Hypothyroidism; thyroid function tests
D) Pheochromocytoma; 24-hour urine metanephrines
Explanation: The clinical presentation of central obesity, moon facies, purple striae, easy bruising, and elevated cortisol levels without diurnal variation is suggestive of Cushing’s disease. The most appropriate next step is to confirm the diagnosis with a low-dose dexamethasone suppression test. Endocrine Questions
A 40-year-old male presents with fatigue, weight loss, and hyperpigmentation of his skin. Laboratory tests reveal low cortisol levels, elevated adrenocorticotropic hormone (ACTH), and positive anti-adrenal antibodies. What is the most likely diagnosis, and what treatment should be considered?
A) Cushing’s disease; surgical resection of the pituitary adenoma
B) Hypothyroidism; levothyroxine replacement therapy
C) Addison’s disease; glucocorticoid and mineralocorticoid replacement
D) Graves’ disease; radioactive iodine therapy
Explanation: The clinical presentation of fatigue, weight loss, hyperpigmentation, low cortisol levels, elevated ACTH, and positive anti-adrenal antibodies is indicative of Addison’s disease. Treatment involves glucocorticoid and mineralocorticoid replacement therapy.
A 60-year-old female with type 2 diabetes presents with confusion, dry mouth, and excessive thirst. Laboratory tests show hyperglycemia, high serum osmolality, and elevated blood urea nitrogen (BUN). What is the most likely diagnosis, and what is the appropriate treatment?
A) Diabetic ketoacidosis (DKA); insulin and IV fluids
B) Hyperosmolar hyperglycemic state (HHS); insulin and IV fluids
C) Diabetic retinopathy; laser photocoagulation D) Diabetic neuropathy; gabapentin therapy
Explanation: The clinical presentation of confusion, dry mouth, excessive thirst, hyperglycemia, high serum osmolality, and elevated BUN is suggestive of hyperosmolar hyperglycemic state (HHS). The appropriate treatment is insulin and intravenous (IV) fluids to correct hyperglycemia and dehydration. Endocrine Questions
A 35-year-old male presents to the emergency department with severe diarrhea, lethargy, and rapid, shallow breathing. Arterial blood gas analysis reveals a pH of 7.30, PCO2 of 28 mmHg, and HCO3- of 16 mEq/L. What acid-base imbalance does this patient likely have, and what is the underlying cause?
A) Respiratory acidosis; opioid overdose
B) Respiratory alkalosis; anxiety and hyperventilation
C) Metabolic acidosis; diarrhea and bicarbonate loss
D) Metabolic alkalosis; excessive vomiting
Explanation: The arterial blood gas results of a pH of 7.30, PCO2 of 28 mmHg, and HCO3- of 16 mEq/L indicate metabolic acidosis. Diarrhea can lead to bicarbonate loss, causing an accumulation of acid in the body. Acidosis, Alkalosis Questions