All practice questions

A physician is evaluating five patients presenting with distinct bleeding or thrombotic profiles across different clinical settings. Match each patient's clinical vignette and initial screening results with the most appropriate targeted laboratory test to establish the definitive diagnosis.

A 54-year-old man presents to the emergency department complaining of severe lower back pain that began abruptly 48 hours ago after lifting a heavy piece of furniture. He reports that the pain radiates down the posterior aspect of both legs. Today, he noticed that he was unable to feel toilet paper when wiping and experienced an unexpected episode of urinary incontinence. Which of the following physical examination findings are highly consistent with the most likely diagnosis? (Select all that apply)

A $34$-year-old woman presents to the clinic with new-onset headaches, palpitations, and severe muscle cramps. Her blood pressure is $172/106$ mmHg. A basic metabolic panel reveals a serum sodium of $144$ mEq/L and a serum potassium of $2.8$ mEq/L. She is not taking any medications and has no family history of early-onset hypertension. The physician suspects an endocrine etiology for her secondary hypertension. Assuming each investigative step confirms the indication for the next and the patient is a candidate for surgical management, arrange the following diagnostic steps in the correct, guideline-directed chronological sequence from initial workup to preoperative planning.

Match each set of laboratory findings with the most likely hematologic diagnosis.

An evaluation is requested for a 30-year-old female patient complaining of progressive shortness of breath over the past two months. She notes that she feels increasingly weak towards the evening, to the point where her vision occasionally becomes double. A plain chest radiograph reveals a widened mediastinum, and a subsequent contrast-enhanced computed tomography (CT) scan of the chest localizes a well-circumscribed, lobulated mass to the anterior mediastinal compartment. Arrange the following differential diagnoses for this anterior mediastinal mass in order of their pre-test probability, from highest (most likely) to lowest (least likely), based on her demographic profile and clinical syndrome.

A $28$-year-old woman comes to the clinic complaining of intermittent, crampy abdominal pain, bloating, and loose, foul-smelling stools for the past $4$ months. She also reports progressive fatigue and an unintentional weight loss of $3$ kg ($6.6$ lbs) during this time. Her past medical history is significant for autoimmune thyroiditis, for which she takes levothyroxine. Vital signs are within normal limits. Physical examination reveals mild abdominal distension without tenderness. Laboratory studies show a hemoglobin concentration of $10.2$ g/dL and a mean corpuscular volume of $74$ fL.

Which of the following is the most appropriate next step in laboratory evaluation?

A retired teacher with a history of severe alcohol use disorder and biopsy-proven hepatic cirrhosis is admitted to the inpatient medical service for management of new-onset hepatic encephalopathy and tense ascites. On physical examination, the patient appears chronically ill, with scleral icterus and significant peripheral edema.

A comprehensive metabolic panel is obtained to assess the patient's baseline metabolic status. The relevant laboratory results are reported as follows:

Based on the provided laboratory data, what is the patient's corrected serum calcium concentration? (Provide the final numerical value in mg/dL)

A physician is evaluating several adult patients presenting to the occupational medicine and pulmonology clinic with progressive respiratory symptoms. A detailed medical and occupational history is critical for establishing the etiology of their conditions. Match each patient's distinct occupational history profile to the most appropriate respiratory diagnostic consideration.

A 48-year-old man presents to the ambulatory care clinic with a 2-day history of right leg swelling and calf pain. He recently returned from a 12-hour international flight. His temperature is 37.1°C (98.8°F), blood pressure is 128/82 mmHg, pulse is 76/min, and respiratory rate is 14/min. Physical examination reveals pitting edema and tenderness in the right lower extremity below the knee. Point-of-care compression ultrasonography demonstrates a noncompressible right popliteal vein. Laboratory testing shows a serum creatinine of 0.9 mg/dL and normal liver function tests. The patient is hemodynamically stable, ambulatory, and has reliable access to outpatient follow-up. Which of the following is the most appropriate initial pharmacologic intervention for this patient?

A $42$-year-old female high school teacher presents to the clinic reporting progressive weight gain of $12$ kg over the past $1$ year, easy bruising, and new-onset facial hair growth. She also reports worsening fatigue and difficulty climbing stairs due to proximal muscle weakness. On examination, her blood pressure is $164/96$ mmHg. She exhibits prominent supraclavicular fat pads, facial plethora, and wide, purplish abdominal striae. A diagnostic evaluation for suspected hypercortisolism is initiated.

Arrange the following diagnostic tests in the most appropriate chronological sequence for evaluating this patient, from initial diagnostic screening to the most advanced localization study.

A 42-year-old man presents to the outpatient clinic reporting chronic diffuse joint pain, increasing fatigue, and excessive sweating over the past year. He mentions that he recently had to purchase larger shoes and his wedding ring can no longer be worn. His medical history includes newly diagnosed type 2 diabetes mellitus and hypertension. Vital signs show a blood pressure of $145/90 \text{ mmHg}$, a heart rate of $78\text{/min}$, and a BMI of $29 \text{ kg/m}^2$. Physical examination reveals coarse facial features, a prominent jaw, macroglossia, and enlarged, doughy hands. Initial laboratory testing reveals an elevated serum insulin-like growth factor 1 (IGF-1) concentration for his age and sex. Which of the following is the most appropriate next step in the diagnostic workup?

A 54-year-old right-handed woman is brought to the emergency department by emergency medical services 3 hours after the sudden onset of profound left-sided weakness, facial asymmetry, and slurred speech. On physical examination, her blood pressure is 175/95 mm Hg, and her pulse is 88/min and irregularly irregular. Neurological evaluation reveals a dense left hemiparesis, left-sided sensory loss, and left-sided hemineglect. The clinical team suspects an acute ischemic cerebrovascular event and initiates a rapid stroke code response. Arrange the following diagnostic imaging modalities in the correct chronological sequence utilized to evaluate this patient, establish the diagnosis, and guide acute reperfusion therapies.

A $56$-year-old male with long-standing Crohn's disease and a history of multiple small bowel resections is brought to the emergency department by his wife. She reports that he has been increasingly lethargic and confused over the past $24$ hours. He has had significantly increased, high-volume watery output from his ileostomy for the last three days. Physical examination reveals dry mucous membranes, poor skin turgor, and a blood pressure of $88/54\text{ mmHg}$ with a heart rate of $118\text{ /min}$.

Laboratory studies are obtained and reveal the following:

Assuming a normal serum albumin baseline of $4.0\text{ g/dL}$, what is the patient's albumin-corrected serum anion gap in $\text{mEq/L}$?

A 24-year-old male is brought to the emergency department by his roommates due to severe agitation, confusion, and profuse sweating that began 6 hours ago. The roommates report that for the past three days, he has had a low-grade fever, runny nose, and a dry cough. He also sprained his right ankle two days ago while playing basketball. His past medical history is significant for major depressive disorder and seasonal allergic rhinitis. He underwent an uncomplicated appendectomy at age 12. He does not use tobacco or illicit drugs, and drinks alcohol occasionally. His prescribed daily medications are escitalopram and cetirizine. The roommates mention that to manage his recent symptoms, he has been taking leftover tramadol prescribed for a previous sports injury, along with an over-the-counter cough syrup containing dextromethorphan. On physical examination, his temperature is 39.4°C (102.9°F), blood pressure is 165/95 mmHg, and heart rate is 128/min. The patient is visibly diaphoretic with flushed skin and dilated pupils. Neurologic examination reveals tremor, hyperreflexia, and sustained clonus in the bilateral lower extremities. Based on a thorough evaluation of this patient's history and presentation, which of the following is the most likely diagnosis?

A 68-year-old man presents to the emergency department with acute-onset dyspnea and right-sided pleuritic chest pain that began 2 hours ago. He has a history of hypertension, type 2 diabetes mellitus, and chronic kidney disease. He recently returned from a 12-hour international flight. Vital signs include a blood pressure of 135/85 mm Hg, a heart rate of 112/min, a respiratory rate of 22/min, and an oxygen saturation of 93% on room air. Physical examination reveals clear lungs bilaterally. His right calf is mildly swollen, erythematous, and tender to palpation. Laboratory studies show a serum creatinine level of 2.6 mg/dL (patient's baseline is 2.4 mg/dL). A chest radiograph demonstrates clear lung fields without consolidation, pleural effusion, or pneumothorax. Which of the following is the most appropriate next imaging study to establish the diagnosis?

During a comprehensive medical history evaluation, eliciting the use of over-the-counter herbal and dietary supplements is a critical step. These substances frequently cause insidious adverse effects, unexpected organ toxicity, or severe drug-drug interactions that explain a patient's acute presentation. Match each patient's elicited supplement history to the specific clinical complication it is most likely to precipitate.

A 26-year-old man presents to the urgent care clinic complaining of a 5-day history of high fever, severe sore throat, profound fatigue, and a diffuse maculopapular rash on his trunk. He reports having unprotected receptive anal intercourse with a new partner approximately 3 weeks ago. Vital signs are temperature 38.8°C (101.8°F), blood pressure 118/76 mmHg, heart rate 104/min, and respiratory rate 16/min. Physical examination reveals generalized non-tender lymphadenopathy and exudative pharyngitis. The physician strongly suspects acute retroviral syndrome and wishes to initiate the standard diagnostic workup. Arrange the following laboratory investigations in the most appropriate sequential order to establish the diagnosis and direct initial management, assuming typical results for this specific clinical stage.

A 61-year-old man is evaluated in the outpatient clinic for a persistent ulcer on the plantar aspect of his left first metatarsophalangeal joint, which he first noticed six weeks ago. His medical history is significant for type 2 diabetes mellitus complicated by peripheral neuropathy, as well as stage 3 chronic kidney disease. He reports no fevers, chills, or systemic symptoms. Vital signs are within normal limits. Physical examination reveals a $2 \text{ cm} \times 2 \text{ cm}$ ulcer with raised borders and a granulating, mildly exudative base. Surrounding erythema extends $1 \text{ cm}$ from the ulcer margin. Sensation to a 10-gram monofilament is absent in the bilateral distal lower extremities. During the examination, a sterile, blunt stainless-steel probe is introduced into the ulcer and advances seamlessly until a hard, gritty surface is encountered. Laboratory studies show a leukocyte count of $8,500/\text{mm}^3$ and an erythrocyte sedimentation rate of $82 \text{ mm/h}$. A plain radiograph of the left foot reveals soft tissue swelling but no radiopaque foreign bodies, subcutaneous gas, or distinct cortical destruction. Which of the following is the most appropriate next step in the diagnostic workup?

An 81-year-old woman is evaluated for discharge planning on post-operative day 5 following an open reduction and internal fixation of a left intertrochanteric femur fracture. Her hospitalization was complicated by a brief episode of postoperative delirium, which has now completely resolved. She is currently medically stable, alert, and oriented. Her vital signs are within normal limits, and her surgical incision is clean and intact. Prior to her fall, she lived in a single-story home with her 84-year-old husband and ambulated independently without assistive devices. The physical therapy team reports that she currently requires moderate assistance for bed-to-chair transfers and can ambulate approximately 15 feet with a front-wheeled walker. During therapy sessions, she becomes profoundly exhausted after 45 minutes and is unable to participate in further physical or occupational therapy for the remainder of the day. The patient and her husband express a strong desire for her to eventually return home. Which of the following is the most appropriate care setting transition for this patient at this time?

A 42-year-old man is evaluated for discharge planning. Eight weeks ago, he was involved in a high-speed motorcycle collision resulting in a T6 spinal cord transection and complete paraplegia. During his initial prolonged intensive care stay, his course was complicated by a severe stage 4 sacral pressure injury. Ten days ago, he underwent surgical debridement and closure of the ulcer with a gluteal musculocutaneous flap.

His postoperative course has been uncomplicated. The surgical drains were removed yesterday, and the incision is clean, dry, and intact. He is hemodynamically stable, afebrile, and his medications have been transitioned from intravenous to oral routes.

On physical examination, upper extremity strength is 5/5 bilaterally, but he has no sensory or motor function below the T6 level. Per the plastic surgery protocol, he must remain on strict bed rest in prone or alternating lateral decubitus positions for the next 4 weeks to ensure flap viability. He requires assistance from two staff members to turn every 2 hours and must avoid any sitting, shearing forces, or supine positioning. Physical and occupational therapy note that due to these severe positional restrictions, he can currently tolerate a maximum of 45 minutes of recumbent upper-body therapeutic exercise daily. Prior to his injury, he lived alone in a second-floor walk-up apartment.

Which of the following is the most appropriate disposition for this patient at this time?