Medicine
Infectious Disease
A patient with infective endocarditis has persistent Staphylococcus aureus bacteremia and a new murmur. Which diagnostic test is especially useful for detecting valvular vegetations when transthoracic echo is nondiagnostic?
A. Transesophageal echocardiography
B. Exercise ECG
C. Abdominal X-ray
D. Spirometry
Correct Answer: A
TEE has higher sensitivity than transthoracic echo for vegetations, abscesses and prosthetic-valve endocarditis.
Medicine
Infectious Disease
A patient with HIV has CD4 count 80 cells/mm3, dyspnea, dry cough and bilateral diffuse ground-glass infiltrates. What is the most likely diagnosis?
A. Pneumocystis jirovecii pneumonia
B. Lobar pneumococcal pneumonia
C. Pulmonary embolism
D. Aspergilloma
Correct Answer: A
Pneumocystis pneumonia classically occurs with advanced cellular immunosuppression and presents subacutely with dry cough, dyspnea and diffuse interstitial infiltrates.
Medicine
Infectious Disease
A hospitalized patient develops profuse watery diarrhea after clindamycin. Which organism is most likely?
A. Clostridioides difficile
B. Vibrio cholerae only
C. Giardia lamblia
D. Entamoeba histolytica
Correct Answer: A
Recent antibiotic exposure followed by healthcare-associated watery diarrhea strongly suggests C. difficile infection.
Medicine
Infectious Disease
A patient with fever, neck stiffness and altered mental status is suspected of bacterial meningitis. What should happen if lumbar puncture will be delayed for brain imaging?
A. Delay all treatment until LP
B. Obtain blood cultures and start empiric antibiotics promptly
C. Give only antipyretics
D. Start antifungal therapy only
Correct Answer: B
When bacterial meningitis is suspected, antimicrobial treatment should not be delayed for imaging or lumbar puncture after blood cultures are obtained when feasible.
Medicine
Endocrinology
A patient with a pituitary macroadenoma develops bitemporal hemianopia. Which structure is compressed?
A. Optic chiasm
B. Optic nerve within orbit only
C. Occipital cortex
D. Oculomotor nucleus
Correct Answer: A
A superiorly expanding pituitary mass can compress the optic chiasm, causing loss of temporal visual fields.
Medicine
Endocrinology
A patient with severe thyrotoxicosis has fever, agitation, tachyarrhythmia and heart failure. What life-threatening condition is this?
A. Thyroid storm
B. Myxedema coma
C. Addisonian crisis
D. Hyperosmolar state
Correct Answer: A
Decompensated thyrotoxicosis with hyperthermia, CNS disturbance and cardiovascular dysfunction is thyroid storm.
Medicine
Endocrinology
A diabetic patient has albuminuria and established cardiovascular disease. Which glucose-lowering class has important cardiorenal benefits in many such patients?
A. SGLT2 inhibitor
B. Short-acting sulfonylurea only
C. Acarbose only
D. Meglitinide only
Correct Answer: A
SGLT2 inhibitors reduce heart-failure and kidney outcomes in appropriate patients with diabetes, CKD and cardiovascular risk.
Medicine
Endocrinology
A patient taking long-term high-dose glucocorticoids should not stop them abruptly mainly because of risk of:
A. Adrenal crisis from HPA-axis suppression
B. Thyroid storm
C. Hyperparathyroidism
D. SIADH
Correct Answer: A
Chronic exogenous glucocorticoids suppress ACTH and adrenal cortisol production, so abrupt withdrawal can precipitate adrenal insufficiency.
Medicine
Endocrinology
A 19-year-old with type 1 diabetes becomes confused during exercise. Capillary glucose is 42 mg/dL and he can swallow safely. What is the immediate treatment?
A. Fast-acting oral carbohydrate
B. Long-acting insulin
C. Fluid restriction
D. Metformin
Correct Answer: A
Conscious hypoglycemic patients who can swallow should receive rapidly absorbed oral carbohydrate and have glucose rechecked.
Medicine
Endocrinology
A patient has hypercalcemia, low phosphate and elevated PTH. What is the most likely diagnosis?
A. Primary hyperparathyroidism
B. Hypoparathyroidism
C. Vitamin D deficiency alone
D. Acute pancreatitis
Correct Answer: A
PTH-mediated hypercalcemia with phosphate wasting is typical of primary hyperparathyroidism.
Medicine
Endocrinology
Which finding best distinguishes central diabetes insipidus from primary polydipsia after specialist water-deprivation testing?
A. Urine concentration improves markedly after desmopressin
B. Urine remains dilute after desmopressin
C. Persistent hyponatremia
D. High urine osmolality at baseline
Correct Answer: A
In central diabetes insipidus, deficient ADH action is corrected by desmopressin, causing a substantial rise in urine osmolality.
Medicine
Endocrinology
A patient with acromegaly should usually be screened for which important comorbidity?
A. Obstructive sleep apnea and cardiometabolic disease
B. Cystic fibrosis
C. Hemophilia A
D. Acute rheumatic fever
Correct Answer: A
Growth-hormone excess is associated with sleep apnea, hypertension, diabetes, cardiomyopathy and other systemic complications.
Medicine
Endocrinology
A patient with primary adrenal insufficiency is expected to have which combination?
A. Hyponatremia, hyperkalemia and hyperpigmentation
B. Hypernatremia and hypokalemia
C. Cushingoid features
D. Suppressed ACTH with hyperpigmentation
Correct Answer: A
Addison disease causes cortisol and aldosterone deficiency with elevated ACTH, producing hyperpigmentation, hyponatremia and hyperkalemia.
Medicine
Endocrinology
A patient has hypertension, hypokalemia, metabolic alkalosis and suppressed renin. What is the most likely diagnosis?
A. Primary hyperaldosteronism
B. Addison disease
C. SIADH
D. Hypoparathyroidism
Correct Answer: A
Autonomous aldosterone secretion causes sodium retention, hypertension, potassium loss, alkalosis and suppressed renin.
Medicine
Endocrinology
A patient with pheochromocytoma is being prepared for surgery. Which drug sequence is correct?
A. Beta-blockade before alpha-blockade
B. Alpha-blockade before beta-blockade if beta-blockade is needed
C. No blood-pressure preparation
D. Start digoxin first
Correct Answer: B
Alpha blockade is established first to prevent unopposed alpha-adrenergic vasoconstriction when beta blockade is added.
Medicine
Endocrinology
A patient with primary hypothyroidism is most likely to have which laboratory pattern?
A. High TSH, low free T4
B. Low TSH, high free T4
C. Low TSH, low free T4 in all cases
D. Normal TSH with high cortisol
Correct Answer: A
Loss of thyroid hormone feedback causes elevated TSH with low free T4 in primary hypothyroidism.
Medicine
Endocrinology
A 32-year-old woman has weight loss, tremor, heat intolerance, diffuse goiter and eye signs. What is the most likely diagnosis?
A. Graves disease
B. Hashimoto thyroiditis
C. Subacute thyroiditis
D. Pituitary adenoma
Correct Answer: A
Hyperthyroidism with diffuse goiter and orbitopathy is characteristic of Graves disease.
Medicine
Endocrinology
During DKA treatment, serum potassium falls to 2.9 mmol/L before insulin is started. What should be done?
A. Start insulin immediately at high dose
B. Replace potassium and delay insulin until potassium is safer
C. Give calcium channel blocker
D. Restrict all fluids
Correct Answer: B
Severe hypokalemia increases arrhythmia risk; potassium must be replaced before insulin because insulin drives potassium into cells.
Medicine
Endocrinology
A patient with DKA has glucose 520 mg/dL, bicarbonate 10 mmol/L and potassium 5.4 mmol/L. What is the first major treatment priority after initial assessment?
A. IV isotonic fluid resuscitation
B. IV bicarbonate in every patient
C. Long-acting insulin only
D. Immediate oral feeding
Correct Answer: A
Volume depletion is a major component of DKA; isotonic IV fluid is a core initial therapy, followed by insulin and potassium-guided management.
Medicine
Nephrology
A patient with advanced CKD has persistent metabolic acidosis. Which chronic complication can acidosis worsen?
A. Bone and muscle catabolism
B. Polycythemia
C. Hypercalcemia from excess calcitriol
D. Respiratory alkalosis only
Correct Answer: A
Chronic metabolic acidosis in CKD contributes to muscle wasting and bone buffering/demineralization.