Medicine
Respiratory Medicine
A tall young man develops sudden dyspnea and unilateral absent breath sounds. He is hypotensive with tracheal deviation. What should be done immediately?
A. Wait for chest X-ray
B. Needle/finger decompression followed by chest tube
C. Give oral steroids only
D. Perform spirometry
Correct Answer: B
Tension pneumothorax is a clinical emergency requiring immediate decompression without waiting for imaging.
Medicine
Respiratory Medicine
A patient with sudden pleuritic chest pain, tachycardia and hypoxemia has high clinical probability of pulmonary embolism and is stable. What is the preferred diagnostic imaging test?
A. CT pulmonary angiography
B. Routine chest X-ray only
C. Bronchoscopy
D. Echocardiography alone
Correct Answer: A
CT pulmonary angiography is the standard imaging test for most hemodynamically stable patients with suspected pulmonary embolism and high clinical probability.
Medicine
Respiratory Medicine
A COPD patient has worsening dyspnea, increased sputum volume and purulent sputum. Which feature most strongly supports adding antibiotics?
A. Bradycardia
B. Purulent sputum with increased respiratory symptoms
C. Mild ankle edema only
D. Stable chronic cough
Correct Answer: B
Antibiotics are most useful in COPD exacerbations when bacterial features such as sputum purulence accompany increased dyspnea or sputum volume.
Medicine
Respiratory Medicine
A 22-year-old with asthma has symptoms most days and wakes at night twice weekly. Which controller principle is preferred over SABA-only treatment?
A. Use SABA alone as needed
B. Use an inhaled corticosteroid-containing regimen
C. Use oral antibiotics daily
D. Use theophylline as sole first-line therapy
Correct Answer: B
Current asthma strategy recommends ICS-containing treatment because SABA-only therapy does not address airway inflammation and is associated with higher exacerbation risk.
Medicine
Cardiology
A 58-year-old man with stable ischemic heart disease has LDL cholesterol well above target despite maximal tolerated high-intensity statin. What is the usual next lipid-lowering step?
A. Stop statin and use niacin alone
B. Add ezetimibe
C. Add digoxin
D. Add hydrochlorothiazide
Correct Answer: B
Ezetimibe is commonly added when LDL remains above goal despite maximally tolerated statin therapy, with PCSK9-directed therapy considered thereafter in appropriate high-risk patients.
Medicine
Cardiology
Which feature favors constrictive pericarditis over cardiac tamponade?
A. Kussmaul sign
B. Pulsus paradoxus
C. Electrical alternans
D. Marked respiratory variation in mitral inflow only
Correct Answer: A
A rise or failure of JVP to fall with inspiration, Kussmaul sign, is characteristic of constrictive physiology and is usually absent in classic tamponade.
Medicine
Cardiology
A patient with acute decompensated heart failure has severe dyspnea, bilateral crackles and peripheral edema but preserved blood pressure. Which initial therapy most directly treats congestion?
A. IV loop diuretic
B. Large IV saline bolus
C. Verapamil
D. Thrombolysis
Correct Answer: A
Intravenous loop diuretics are used to rapidly relieve volume overload and congestion in acute decompensated heart failure.
Medicine
Cardiology
A 60-year-old smoker has calf pain after walking 100 meters that resolves with rest. What bedside test is most useful to support the diagnosis of peripheral arterial disease?
A. Allen test
B. Ankle-brachial index
C. D-dimer
D. Tilt-table test
Correct Answer: B
The ankle-brachial index is a simple noninvasive test for lower-extremity peripheral arterial disease.
Medicine
Cardiology
A patient taking warfarin for a mechanical mitral valve has an INR of 1.4. Why is a direct oral anticoagulant generally not substituted?
A. DOACs cause universal hepatotoxicity
B. DOACs are not recommended for mechanical prosthetic valves
C. DOACs cannot be taken orally
D. Warfarin has no drug interactions
Correct Answer: B
Vitamin K antagonists remain standard anticoagulation for mechanical prosthetic valves; DOACs are not recommended in this setting.
Medicine
Cardiology
Which finding most strongly supports cardiac tamponade?
A. Wide pulse pressure
B. Pulsus paradoxus with elevated JVP
C. Bounding peripheral pulses
D. Fixed split S2
Correct Answer: B
Tamponade impairs ventricular filling, producing elevated venous pressure and exaggerated inspiratory fall in systolic blood pressure.
Medicine
Cardiology
A 30-year-old woman has recurrent palpitations. ECG during symptoms shows a regular narrow-complex tachycardia at 190/min. Vagal maneuvers fail. What is the next best treatment in a stable patient?
A. Adenosine
B. Atropine
C. Lidocaine
D. Magnesium sulfate
Correct Answer: A
Adenosine is first-line acute pharmacologic therapy for stable regular narrow-complex re-entrant supraventricular tachycardia after vagal maneuvers fail.
Medicine
Cardiology
A patient 3 days after MI suddenly develops acute pulmonary edema and a new loud holosystolic murmur at the apex radiating to the axilla. What is most likely?
A. Dressler syndrome
B. Papillary muscle rupture causing acute mitral regurgitation
C. Ventricular aneurysm
D. Right ventricular infarction
Correct Answer: B
Papillary muscle rupture typically occurs several days after MI and causes abrupt severe mitral regurgitation with pulmonary edema.
Medicine
Cardiology
A 72-year-old woman with severe aortic stenosis develops exertional dyspnea, angina and syncope. What is the definitive treatment?
A. Long-term nitrates alone
B. Aortic valve replacement
C. Digoxin
D. Permanent anticoagulation only
Correct Answer: B
Symptomatic severe aortic stenosis has a poor prognosis without valve replacement; transcatheter or surgical replacement is selected according to patient factors.
Medicine
Cardiology
Which ECG finding is most characteristic of acute pericarditis?
A. Localized ST elevation with reciprocal depression
B. Diffuse concave ST elevation with PR depression
C. ST depression only in V1-V3
D. Pathologic Q waves in contiguous leads
Correct Answer: B
Acute pericarditis classically causes diffuse concave ST elevation and PR-segment depression rather than a territorial infarction pattern.
Medicine
Cardiology
A 24-year-old athlete has exertional syncope and a harsh systolic murmur that becomes louder with Valsalva. What is the most likely diagnosis?
A. Aortic stenosis
B. Hypertrophic obstructive cardiomyopathy
C. Mitral stenosis
D. Atrial septal defect
Correct Answer: B
Dynamic LV outflow obstruction in hypertrophic cardiomyopathy increases when preload falls, such as during Valsalva.
Medicine
Cardiology
A patient with HFrEF remains symptomatic despite ACE inhibitor/ARNI, evidence-based beta-blocker and mineralocorticoid receptor antagonist. Which drug class also reduces heart-failure hospitalization and cardiovascular death even without diabetes?
A. DPP-4 inhibitor
B. SGLT2 inhibitor
C. Sulfonylurea
D. Alpha-glucosidase inhibitor
Correct Answer: B
SGLT2 inhibitors are foundational therapy in HFrEF and provide benefit irrespective of diabetes status.
Medicine
Cardiology
A 55-year-old man has tearing chest pain radiating to the back and unequal arm blood pressures. What is the best initial imaging test if he is hemodynamically stable?
A. Exercise ECG
B. CT angiography of the aorta
C. Coronary calcium score
D. Chest ultrasound only
Correct Answer: B
Stable suspected acute aortic syndrome is rapidly assessed with CT angiography; unstable patients may require bedside transesophageal echocardiography.
Medicine
Cardiology
A patient with acute inferior STEMI becomes hypotensive with raised JVP and clear lungs. Which complication is most likely?
A. Left ventricular free-wall rupture
B. Right ventricular infarction
C. Papillary muscle rupture
D. Ventricular septal rupture
Correct Answer: B
Hypotension, elevated JVP and clear lung fields after inferior MI strongly suggest right ventricular infarction.
Medicine
Cardiology
A 68-year-old man with atrial fibrillation presents with hypotension, chest pain and pulmonary edema. What is the most appropriate immediate management?
A. IV amiodarone
B. Synchronized electrical cardioversion
C. Oral beta-blocker
D. Digoxin
Correct Answer: B
Hemodynamic instability due to atrial fibrillation requires urgent synchronized electrical cardioversion rather than delayed pharmacologic rate control.
Medicine
Rheumatology
Which infection-risk screening is commonly considered before substantial immunosuppression in rheumatology, depending on drug and patient factors?
A. Only throat swab
B. Hepatitis B status
C. Only stool culture
D. Only malaria smear
Correct Answer: B
Hepatitis B screening is important before several immunosuppressive regimens because reactivation can occur, particularly with B-cell-depleting and other potent therapies.