1:
A 45-year-old male with a history of hypertension presents to the emergency department with severe chest pain. The pain is crushing in nature and radiates to his left arm. He is diaphoretic and nauseous. His blood pressure is 180/110 mmHg, heart rate is 100 bpm, and respiratory rate is 20 breaths per minute. An ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate initial management?
A) Aspirin and nitroglycerin
B) Morphine and oxygen supplementation
C) Intravenous beta-blocker
D) Immediate percutaneous coronary intervention (PCI)
2:
A 28-year-old female presents with recurrent episodes of pain and swelling in her right big toe joint. She mentions that these episodes have been occurring for the past year and usually resolve spontaneously. She denies any trauma or fever. On examination, the affected joint is red, tender, and warm to touch. Laboratory tests reveal elevated serum uric acid levels. What is the most likely diagnosis?
A) Gout
B) Osteoarthritis
C) Rheumatoid arthritis
D) Septic arthritis
3:
A 5-year-old child presents with a sudden onset of high fever, drooling, and difficulty swallowing. The child leans forward and refuses to lie down. On examination, the child is tachycardic, and the throat is red and edematous with a white membrane covering the tonsils and uvula. What is the most likely diagnosis?
A) Bacterial pharyngitis (Streptococcal)
B) Viral pharyngitis (Adenovirus)
C) Epiglottitis (Haemophilus influenzae type B)
D) Peritonsillar abscess
4:
A 60-year-old male with a long history of alcohol abuse presents with confusion and tremors. His vitals are stable. On examination, he has bilateral hand tremors, and his gait is wide-based. Laboratory tests show an elevated blood alcohol level. What is the most appropriate management at this time?
A) Thiamine and folic acid supplementation
B) Naloxone administration
C) Benzodiazepines for alcohol withdrawal
D) Disulfiram to deter further alcohol consumption
5:
A 35-year-old pregnant woman presents with vaginal bleeding and abdominal cramps. She is 10 weeks pregnant by her last menstrual period. Transabdominal ultrasound reveals an empty uterus with a thickened endometrial lining and no gestational sac. The cervix is closed. What is the most likely diagnosis?
A) Threatened abortion
B) Inevitable abortion
C) Complete abortion
D) Missed abortion
1. Clinical Scenario: A 56-year-old male presents with crushing chest pain and diaphoresis. He has a past medical history of hypertension and hyperlipidemia. His ECG shows ST-segment elevation in leads II, III, and aVF. What is the most appropriate immediate management?
A) Administer fibrinolytic therapy
B) Perform percutaneous coronary intervention (PCI)
C) Initiate dual antiplatelet therapy
D) Administer oxygen therapy
2. Clinical Scenario: A 24-year-old female presents with urinary urgency, frequency, and dysuria. Urinalysis shows pyuria, bacteriuria, and positive leukocyte esterase. The patient is sexually active and denies any vaginal symptoms. What is the most likely diagnosis?
A) Acute cystitis
B) Urethritis
C) Pyelonephritis
D) Interstitial cystitis
3. Clinical Scenario: A 45-year-old male smoker presents with progressive dyspnea, chronic cough, and unintentional weight loss. Physical examination reveals decreased breath sounds and dullness to percussion over the right lower lung field. Chest X-ray shows a large cavitary lesion with fluid level in the right lower lobe. What is the most likely diagnosis?
A) Tuberculosis
B) Lung abscess
C) Pulmonary embolism
D) Empyema
4. Clinical Scenario: A 32-year-old pregnant woman at 20 weeks’ gestation presents with intense pruritus and generalized rash. Physical examination shows excoriated papules on the abdomen and flexural surfaces. What is the most appropriate treatment for this condition?
A) Oral antihistamines
B) Topical corticosteroids
C) Oral corticosteroids
D) Phototherapy
5. Clinical Scenario: A 68-year-old male with a history of type 2 diabetes and hypertension presents with a painful, red, swollen right foot. On examination, there is warmth and tenderness over the first metatarsophalangeal joint. Lab results show elevated uric acid levels. What is the most likely diagnosis?
A) Osteoarthritis
B) Gout
C) Septic arthritis
D) Rheumatoid arthritis
6. Clinical Scenario: A 52-year-old female with a history of depression presents with low mood, fatigue, and difficulty sleeping for the past 3 months. She reports loss of interest in activities she once enjoyed. There is no history of substance abuse. What is the most appropriate initial management?
A) Selective serotonin reuptake inhibitor (SSRI) therapy
B) Cognitive-behavioral therapy (CBT)
C) Electroconvulsive therapy (ECT)
D) Supportive counseling
7. Clinical Scenario: A 35-year-old male presents with painful genital ulcers and inguinal lymphadenopathy. He reports multiple sexual partners and inconsistent condom use. Physical examination reveals shallow, painful ulcers with a clean base. Serologic testing is positive for Treponema pallidum. What is the most appropriate next step in management?
A) Start ceftriaxone and azithromycin
B) Start doxycycline
C) Start penicillin G benzathine
D) Start acyclovir
8. Clinical Scenario: A 60-year-old female with a history of chronic kidney disease presents with progressive anemia, hypertension, and proteinuria. Renal biopsy shows thickened glomerular basement membranes and “spike and dome” appearance on electron microscopy. What is the most likely diagnosis?
A) IgA nephropathy (Berger’s disease)
B) Membranous nephropathy
C) Focal segmental glomerulosclerosis (FSGS)
D) Alport syndrome
9. Clinical Scenario: A 28-year-old male with no significant medical history presents with a 1-week history of painless, bilateral vision loss. On examination, he has reduced visual acuity, afferent pupillary defect, and pale optic discs. MRI of the brain shows multiple periventricular lesions. What is the most likely diagnosis?
A) Optic neuritis
B) Central retinal artery occlusion
C) Open-angle glaucoma
D) Multiple sclerosis
10. Clinical Scenario: A 20-year-old female presents with irregular menstrual periods, weight gain, hirsutism, and acne. Her serum testosterone levels are elevated, and pelvic ultrasound reveals multiple ovarian cysts. What is the most appropriate next step in management?
A) Start combined oral contraceptive pills
B) Start metformin
C) Start spironolactone
D) Perform laparoscopic ovarian drilling
1. A 55-year-old male with a history of hypertension presents with sudden-onset severe headache, nausea, and vomiting. On examination, his blood pressure is 180/100 mmHg, and he has nuchal rigidity. What is the most appropriate initial step in management?
a) CT scan of the head without contrast
b) Lumbar puncture
c) Start intravenous antihypertensive medications
d) MRI of the brain with contrast
2. A 32-year-old female complains of bilateral wrist pain and stiffness that worsens in the morning. She also reports fatigue and weight loss over the past few months. On examination, you notice symmetric swelling of the metacarpophalangeal and proximal interphalangeal joints. Which of the following tests is most likely to confirm the diagnosis?
a) Rheumatoid factor (RF)
b) C-reactive protein (CRP)
c) Antinuclear antibodies (ANA)
d) Anti-cyclic citrullinated peptide (anti-CCP) antibodies
3. A 6-year-old boy presents with a rash consisting of erythematous papules with a “sandpaper-like” texture. He has a fever, sore throat, and a strawberry tongue. What is the most appropriate initial treatment?
a) Intravenous penicillin
b) Oral amoxicillin
c) Intramuscular ceftriaxone
d) Supportive care with acetaminophen
4. A 65-year-old man with a past medical history of chronic obstructive pulmonary disease (COPD) and hypertension presents with increasing shortness of breath and peripheral edema. On examination, he has elevated jugular venous pressure, bilateral crackles on lung auscultation, and pitting edema in his lower extremities. Which of the following is the most likely diagnosis?
a) Acute respiratory distress syndrome (ARDS)
b) Pulmonary embolism
c) Congestive heart failure (CHF)
d) Pneumonia
5. A 40-year-old woman with a history of systemic lupus erythematosus (SLE) presents with chest pain and shortness of breath. An electrocardiogram (ECG) shows diffuse ST-segment elevations and PR depressions. What is the most likely diagnosis?
a) Myocardial infarction
b) Pericarditis
c) Pulmonary embolism
d) Aortic dissection
6. A 25-year-old sexually active female presents with lower abdominal pain, dysuria, and vaginal discharge. On examination, she has cervical motion tenderness and purulent cervical discharge. What is the most likely causative organism in this patient?
a) Neisseria gonorrhoeae
b) Chlamydia trachomatis
c) Treponema pallidum
d) Haemophilus ducreyi
7. A 70-year-old man presents with pain and stiffness in his shoulders and hips, especially in the morning. On examination, you notice decreased range of motion in both shoulders and hips. Laboratory findings show elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Which of the following is the most appropriate next step in management?
a) Start high-dose glucocorticoids
b) Obtain a chest X-ray
c) Order magnetic resonance imaging (MRI) of the shoulders and hips
d) Begin disease-modifying antirheumatic drugs (DMARDs)
8. A 35-year-old pregnant woman presents with a sudden-onset severe headache, visual disturbances, and epigastric pain. Her blood pressure is elevated at 160/100 mmHg. Laboratory tests show thrombocytopenia and elevated liver enzymes. What is the most likely diagnosis?
a) Migraine headache
b) Preeclampsia
c) Subarachnoid hemorrhage
d) HELLP syndrome
9. A 55-year-old male presents with recurrent episodes of abdominal pain, diarrhea, and weight loss. He also mentions that he’s been experiencing joint pain and redness in his eyes. On examination, you notice oral ulcers and tender, swollen joints. What is the most likely diagnosis?
a) Crohn’s disease
b) Ulcerative colitis
c) Ankylosing spondylitis
d) Behçet’s disease
10. A 6-month-old infant presents with persistent regurgitation and vomiting after feeds. On examination, you notice failure to thrive and a palpable “olive-shaped” mass in the epigastric region. What is the most likely diagnosis?
a) Gastroesophageal reflux disease (GERD)
b) Pyloric stenosis
c) Intussusception
d) Hirschsprung’s disease
1. Scenario: A 34-year-old male presents with sudden-onset severe chest pain, radiating to the back. He has a history of hypertension and smoking. Vital signs show a blood pressure of 180/110 mmHg, heart rate of 100 bpm, and respiratory rate of 20 breaths per minute. On auscultation, a systolic murmur is heard over the aortic area.
Question: What is the most likely diagnosis in this patient?
a) Acute myocardial infarction
b) Aortic dissection
c) Pulmonary embolism
d) Pericarditis
e) Gastroesophageal reflux disease
2. Scenario: A 52-year-old female with type 2 diabetes presents with a 3-day history of frequent urination, increased thirst, and unintentional weight loss. Physical examination reveals dry mucous membranes and tachycardia. Laboratory results show a serum glucose level of 360 mg/dL (20 mmol/L).
Question: What is the most likely diagnosis in this patient?
a) Diabetic ketoacidosis
b) Hyperosmolar hyperglycemic state
c) Type 2 diabetes exacerbation
d) Hypoglycemic shock
e) Diabetic nephropathy
3. Scenario: A 25-year-old sexually active female presents with lower abdominal pain, dysuria, and increased urinary frequency. Pelvic examination reveals cervical motion tenderness, and laboratory tests show leukocytosis and an elevated erythrocyte sedimentation rate.
Question: What is the most likely diagnosis in this patient?
a) Urinary tract infection
b) Pelvic inflammatory disease
c) Ovarian cyst torsion
d) Endometriosis
e) Ectopic pregnancy
4. Scenario: A 65-year-old male with a past medical history of alcohol abuse presents with confusion, jaundice, and ascites. Laboratory tests show elevated liver enzymes and prolonged prothrombin time.
Question: What is the most likely diagnosis in this patient?
a) Alcoholic hepatitis
b) Cirrhosis
c) Acute pancreatitis
d) Cholecystitis
e) Gastric ulcer
- A 50-year-old woman presents with a 3-day history of fever, cough, and shortness of breath. She has a history of asthma. On physical exam, she is febrile to 102 degrees Fahrenheit and has a respiratory rate of 24 breaths per minute. Her lungs are clear to auscultation. Which of the following is the most likely diagnosis?
- A. Community-acquired pneumonia
- B. Acute exacerbation of asthma
- C. Acute bronchitis
- D. Pneumonia due to Pneumocystis jirovecii
- E. Tuberculosis
- A 25-year-old woman presents with a 2-day history of abdominal pain, nausea, and vomiting. She has a history of endometriosis. On physical exam, she is tender in the right lower quadrant. Her white blood cell count is 12,000 cells/µL. Which of the following is the most likely diagnosis?
- A. Appendicitis
- B. Ectopic pregnancy
- C. Diverticulitis
- D. Inflammatory bowel disease
- E. Gastroenteritis
- A 70-year-old man presents with a 1-day history of chest pain. The pain is sharp and stabbing, and it is located in the left chest. The pain is worse when he breathes deeply. He has a history of coronary artery disease. On physical exam, his heart rate is 100 beats per minute and his blood pressure is 140/90 mmHg. His electrocardiogram shows ST-segment elevation in the anterior leads. Which of the following is the most likely diagnosis?
- A. Myocardial infarction
- B. Aortic dissection
- C. Pericarditis
- D. Pneumonia
- E. Pulmonary embolism
- A 35-year-old woman presents with a 2-week history of fatigue, weight loss, and night sweats. She has a history of Hashimoto’s thyroiditis. On physical exam, she is afebrile and her weight is 100 pounds. Her thyroid is enlarged. Her laboratory tests show a decreased thyroid-stimulating hormone level and an increased free thyroxine level. Which of the following is the most likely diagnosis?
- A. Graves’ disease
- B. Hashimoto’s thyroiditis
- C. Thyroid cancer
- D. Subacute thyroiditis
- E. Multinodular goiter
- A 65-year-old man presents with a 3-month history of progressive weakness. He has a history of hypertension. On physical exam, he has muscle atrophy and weakness. His laboratory tests show an increased creatine kinase level and an increased lactate dehydrogenase level. Which of the following is the most likely diagnosis?
- A. Amyotrophic lateral sclerosis
- B. Myasthenia gravis
- C. Polymyositis
- D. Dermatomyositis
- E. Inclusion body myositis
- A 55-year-old man presents with a 3-day history of fever, cough, and shortness of breath. His chest X-ray shows patchy infiltrates. Which of the following is the most likely diagnosis?
- Pneumonia
- Tuberculosis
- Heart failure
- Acute respiratory distress syndrome
- Asthma
- A 25-year-old woman presents with a 1-week history of fatigue, weight loss, and night sweats. Her physical examination is notable for a low-grade fever, generalized lymphadenopathy, and hepatosplenomegaly. Which of the following is the most likely diagnosis?
- HIV infection
- Lymphoma
- Tuberculosis
- Mononucleosis
- Sarcoidosis
- A 70-year-old woman presents with a 2-day history of headache, nausea, and vomiting. Her physical examination is notable for a stiff neck and photophobia. Which of the following is the most likely diagnosis?
- Meningitis
- Encephalitis
- Stroke
- Subarachnoid hemorrhage
- Brain tumor
- A 35-year-old man presents with a 1-month history of abdominal pain, diarrhea, and weight loss. His physical examination is notable for hepatomegaly and jaundice. Which of the following is the most likely diagnosis?
- Hepatitis B
- Hepatitis C
- Cirrhosis
- Pancreatitis
- Inflammatory bowel disease
- A 60-year-old woman presents with a 2-week history of chest pain. Her physical examination is notable for a murmur. An electrocardiogram shows ST-segment elevation in the anterior leads. Which of the following is the most likely diagnosis?
- Myocardial infarction
- Aortic dissection
- Pericarditis
- Mitral valve prolapse
- Hypertrophic cardiomyopathy
- A 45-year-old man presents with a 1-week history of blurry vision. His physical examination is notable for an enlarged optic disk. Which of the following is the most likely diagnosis?
- Glaucoma
- Cataracts
- Retinal detachment
- Diabetic retinopathy
- Optic neuritis
- A 20-year-old woman presents with a 1-month history of fatigue, weight loss, and night sweats. Her physical examination is notable for a rash on her trunk. Which of the following is the most likely diagnosis?
- Systemic lupus erythematosus
- Rheumatoid arthritis
- Sjögren syndrome
- Polymyositis
- Dermatomyositis
- A 50-year-old man presents with a 2-week history of shortness of breath. His physical examination is notable for a decreased breath sounds in the right lower lobe. Which of the following is the most likely diagnosis?
- Pneumonia
- Atelectasis
- Pleural effusion
- Pneumothorax
- Lung cancer
- A 75-year-old woman presents with a 1-day history of confusion. Her physical examination is notable for a fever, altered mental status, and a rash on her trunk. Which of the following is the most likely diagnosis?
- Sepsis
- Meningitis
- Encephalitis
- Stroke
- Subarachnoid hemorrhage
- A 30-year-old woman presents with a 1-month history of fatigue, weight loss, and night sweats. Her physical examination is notable for hepatosplenomegaly and lymphadenopathy. Which of the following is the most likely diagnosis?
- Lymphoma
- HIV infection
- Tuberculosis
- Mononucleosis
- Sarcoidosis
1. A 35-year-old woman presents with a 6-month history of progressive right knee pain. She reports that her symptoms worsen with activity and improve with rest. Physical examination reveals swelling, warmth, and erythema over the affected joint. Which of the following is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Meniscal tear
D) Ligament sprain
E) Bursitis
2. A 45-year-old man is brought to the emergency department after suffering a head injury during a motor vehicle accident. He is conscious but disoriented, and has a severe left frontal scalp laceration. Which of the following is the most appropriate next step in management?
A) CT scan of the brain without contrast
B) MRI of the brain with contrast
C) lumbar puncture
D) EEG monitoring
E) Observation only
3. A 70-year-old woman is admitted to the hospital for evaluation of shortness of breath and fatigue. Her medical history includes hypertension, hyperlipidemia, and obesity. On physical examination, her blood pressure is 180/90 mmHg, heart rate is 110 bpm, and respiratory rate is 28 breaths per minute. Which of the following is the most likely diagnosis?
A) Heart failure
B) Chronic obstructive pulmonary disease (COPD)
C) Pneumonia
D) Asthma
E) Pulmonary embolism
4. A 30-year-old man presents with a 2-day history of fever, chills, and productive cough. He recently returned from a trip to Mexico and has been experiencing worsening symptoms since his return. Which of the following is the most likely diagnosis?
A) Tuberculosis
B) Influenza
C) Pertussis
D) Malaria
E) Bronchitis
5. A 65-year-old woman is referred to the neurology clinic for evaluation of progressive weakness and numbness in her arms and legs. She denies any recent travel or exposures. On physical examination, she has decreased muscle strength and sensation in all four limbs. Which of the following is the most likely diagnosis?
A) Multiple sclerosis
B) Parkinson’s disease
C) Amyotrophic lateral sclerosis (ALS)
D) Peripheral neuropathy
E) Stroke
6. A 25-year-old woman is seen in the urgent care clinic for evaluation of vaginal bleeding. She reports that she had unprotected sexual intercourse 2 days ago and has been experiencing spotting ever since. Which of the following is the most appropriate next step in management?
A) Emergency contraception
B) STI testing
C) Pelvic ultrasound
D) Endometrial biopsy
E) Antibiotics for pelvic inflammatory disease (PID)