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1: A 45-year-old male is brought into the ED with altered mental status and seizures. His family reports that he has a history of diabetes mellitus. His blood glucose is found to be 40 mg/dL. Which of the following is the most immediate management step? A. Start an IV insulin drip B. Administer 50% dextrose IV C. Give subcutaneous glucagon D. Administer intravenous saline Answer: B. Administer 50% dextrose IV Explanation: In a hypoglycemic emergency with altered mental status, the immediate treatment is to raise blood glucose levels using IV dextrose. Insulin administration is contraindicated, glucagon may be used but IV dextrose is faster and more effective in an emergency, and saline will not correct hypoglycemia. 2: A 60-year-old female presents with severe weakness, weight loss, and hyperpigmentation of her skin. Laboratory studies reveal hyponatremia, hyperkalemia, and hypotension. What is the most likely diagnosis? A. Cushing’s syndrome B. Primary adrenal insufficiency C. Secondary adrenal insufficiency D. Pheochromocytoma Answer: B. Primary adrenal insufficiency Explanation: The constellation of hyperpigmentation, hyponatremia, hyperkalemia, and hypotension points to primary adrenal insufficiency (Addison’s disease). Hyperpigmentation results from increased ACTH in primary adrenal insufficiency. Secondary adrenal insufficiency typically lacks hyperpigmentation and hyperkalemia. 3: A 30-year-old woman presents with signs of hyperthyroidism including tachycardia, heat intolerance, and weight loss. Which of the following findings is most characteristic of Graves’ disease? A. Thyroid gland nodules on ultrasound B. Low TSH and high free T4 levels C. Thyroid enlargement without eye involvement D. A history of iodine deficiency Answer: B. Low TSH and high free T4 levels Explanation: Graves’ disease is characterized by low TSH due to negative feedback and high levels of free T4. This distinguishes hyperthyroidism from other causes. Ultrasound may show a diffuse goiter rather than nodules, and Graves’ often has eye involvement (ophthalmopathy), and iodine deficiency causes goiter rather than Graves’. 4: A patient with diabetic ketoacidosis (DKA) is being treated with insulin and IV fluids. Which electrolyte should be closely monitored and supplemented during treatment?
A. Sodium B. Potassium C. Calcium D. Magnesium Answer: B. Potassium Explanation: In DKA, although serum potassium may initially appear normal or high, total body potassium is depleted. Insulin drives potassium into cells, which can cause life- threatening hypokalemia. Thus, potassium levels must be closely monitored and supplemented during treatment. 5: A 25-year-old male patient presents with symptoms of polyuria, polydipsia, and weight loss. Laboratory tests indicate fasting hyperglycemia and the presence of autoantibodies against pancreatic islet cells. What type of diabetes does this patient most likely have? A. Type 1 diabetes mellitus B. Type 2 diabetes mellitus C. Gestational diabetes D. Maturity onset diabetes of the young (MODY) Answer: A. Type 1 diabetes mellitus Explanation: The patient's age, symptoms, and the presence of autoantibodies against pancreatic islet cells suggest Type 1 diabetes mellitus, which is autoimmune in origin. Type 2 diabetes typically occurs later in life and is associated with insulin resistance rather than autoimmunity. 6: A 30-year-old firefighter is brought to the emergency department after exposure to a burning structure. He complains of headache, dizziness, and confusion. His skin appears pink, and he has a bright red coloration. What is the most likely cause of his symptoms? A. Carbon monoxide poisoning B. Cyanide poisoning C. Smoke inhalation with thermal injury D. Carbon dioxide narcosis Answer: A. Carbon monoxide poisoning Explanation: Carbon monoxide (CO) poisoning is common in fires and is characterized by headache, dizziness, confusion, and a characteristic cherry red skin color. CO binds to hemoglobin with higher affinity than oxygen, leading to hypoxia despite normal oxygen levels on pulse oximetry. 7: A 40-year-old man presents with cough, dyspnea, and chest tightness after working in a building with mold contamination. Which of the following is the most likely diagnosis? A. Pneumocystis pneumonia B. Allergic bronchopulmonary aspergillosis (ABPA)
Answer: B. Hypocalcemia due to accidental removal of parathyroid glands Explanation: Hypocalcemia can occur after thyroid surgery if the parathyroid glands are accidentally removed or damaged. This leads to symptoms like muscle cramps, tetany, and a prolonged QT interval. Hyperkalemia, hypokalemia, and hypercalcemia are less consistent with this clinical scenario. 11: A 14-year-old girl is evaluated for delayed puberty. Lab results show low serum cortisol, low aldosterone, and high ACTH. What is the most likely diagnosis? A. Secondary adrenal insufficiency B. Primary adrenal insufficiency (Addison’s disease) C. Congenital adrenal hyperplasia D. Cushing's disease Answer: C. Congenital adrenal hyperplasia Explanation: In congenital adrenal hyperplasia (CAH), enzyme deficiencies result in cortisol and often aldosterone deficiency with increased ACTH. This scenario can also lead to delayed puberty. Addison’s disease is also primary adrenal insufficiency but congenital adrenal hyperplasia is a more specific cause in a younger patient with early signs. 12: A 65-year-old man with a history of type 2 diabetes and chronic kidney disease presents with a fragility fracture of the wrist. What metabolic disorder is most likely associated with his increased fracture risk? A. Osteoporosis B. Osteomalacia C. Paget disease of bone D. Hyperparathyroidism Answer: A. Osteoporosis Explanation: Patients with diabetes and chronic kidney disease are at increased risk for osteoporosis, leading to fragility fractures. Osteomalacia is due to defective mineralization, often from vitamin D deficiency, but the most common explanation in this scenario is osteoporosis. Paget disease leads to abnormal bone remodeling but is not typically associated with fragility fractures as seen in diabetes CKD patients. 13: A 40-year-old male presents with acute confusion and abdominal pain. Labs reveal extremely high calcium levels, low phosphate, and high PTH levels. What is the most likely cause? A. Primary hyperparathyroidism B. Malignancy-associated hypercalcemia C. Familial hypocalciuric hypercalcemia D. Vitamin D intoxication Answer: A. Primary hyperparathyroidism Explanation: Primary hyperparathyroidism presents with hypercalcemia, hypophosphatemia, and elevated PTH. Malignancy-associated hypercalcemia typically has low PTH. Familial
hypocalciuric hypercalcemia has mild hypercalcemia but not usually severe symptoms, and vitamin D intoxication usually presents with high calcium and phosphate. 14: A 22-year-old woman presents with fatigue, weight gain, and cold intolerance. Labs show high TSH and low free T4. What condition is most consistent with these findings? A. Graves’ disease B. Subacute thyroiditis C. Primary hypothyroidism D. Secondary hypothyroidism Answer: C. Primary hypothyroidism Explanation: High TSH and low free T4 indicate primary hypothyroidism, where the thyroid gland fails to produce enough thyroid hormone, prompting increased TSH secretion. Graves’ disease features hyperthyroidism, subacute thyroiditis often has a hyperthyroid phase, and secondary hypothyroidism would have low or normal TSH. 15: A 45-year-old woman presents with chronic cough and dyspnea after years of working in a shipyard. A chest X-ray reveals pleural plaques and interstitial fibrosis. What is the most likely diagnosis? A. Asbestosis B. Silicosis C. Coal worker’s pneumoconiosis D. Hypersensitivity pneumonitis Answer: A. Asbestosis Explanation: Exposure to asbestos, especially in shipyards, can lead to pleural plaques and interstitial pulmonary fibrosis. This radiographic finding and occupational history point toward asbestosis, a common environmental lung disease. 16: A 29-year-old man is brought to the ED after exposure to an unknown chemical spill at his workplace. He presents with bronchospasm, wheezing, and eye irritation. Which of the following is the best immediate management for ocular chemical exposure? A. Apply topical steroids B. Irrigate the eyes with copious amounts of water C. Use antibiotic eye drops D. Administer systemic antihistamines Answer: B. Irrigate the eyes with copious amounts of water Explanation: The immediate treatment for chemical eye exposure is copious irrigation with water to remove the chemical agent and prevent further damage. Topical steroids, antibiotics, or systemic antihistamines are secondary considerations and not first-line immediate responses.
A. Immediate induction of labor B. Hospital admission for intravenous hydration and antiemetics C. Outpatient management with oral antiemetics D. Prescribe high-carbohydrate diet at home Answer: B. Hospital admission for intravenous hydration and antiemetics Explanation: The presentation suggests hyperemesis gravidarum, especially with ketonuria indicating dehydration and malnutrition. Hospital admission is appropriate for IV fluids, antiemetics, and nutritional support. Outpatient treatment is inadequate in severe cases. 21: A 16-year-old boy is brought to the ED with confusion, muscle pain, and dark- colored urine after a long run. Laboratory tests show elevated creatine kinase (CK) and myoglobin. What metabolic condition can predispose him to this presentation? A. Glycogen storage disease type V (McArdle disease) B. Hypothyroidism C. Addison's disease D. Rhabdomyolysis due to trauma Answer: A. Glycogen storage disease type V (McArdle disease) Explanation: McArdle disease is a glycogen storage disease where muscle phosphorylase deficiency leads to exercise intolerance, muscle pain, and potential rhabdomyolysis. Elevated CK and myoglobin after exertion are consistent with this condition. While hypothyroidism can cause muscle symptoms, it is less likely to precipitate acute rhabdomyolysis after exercise. 22: A 50-year-old diabetic patient complains of numbness and tingling in the feet. What is the most likely diagnosis? A. Diabetic peripheral neuropathy B. Guillain-Barré syndrome C. Multiple sclerosis D. Tarsal tunnel syndrome Answer: A. Diabetic peripheral neuropathy Explanation: Numbness and tingling in the feet in a long-standing diabetic patient are classic features of diabetic peripheral neuropathy, a common complication due to chronic hyperglycemia affecting peripheral nerves. Guillain-Barré syndrome is an acute inflammatory demyelinating polyradiculoneuropathy and less likely in this context. Multiple sclerosis and tarsal tunnel syndrome are less consistent with this presentation. 23: A 35-year-old woman presents with weight gain, muscle weakness, and easy bruising. Labs reveal hyperglycemia, hypokalemia, and metabolic alkalosis. Which of the following is the best explanation? A. Primary hyperaldosteronism B. Cushing's syndrome C. Pheochromocytoma D. Hyperthyroidism
Answer: B. Cushing's syndrome Explanation: Cushing's syndrome presents with weight gain, muscle weakness, easy bruising, hyperglycemia, hypokalemia, and metabolic alkalosis. The combination of these symptoms and laboratory findings points to excess cortisol production. Primary hyperaldosteronism could cause hypokalemia and hypertension but not the Cushingoid features. 24: A 52-year-old man presents with dyspnea and cough. He works in a silica mine. A chest X-ray reveals nodular opacifications in the upper lung fields. Which condition does this most likely represent? A. Silicosis B. Asbestosis C. Coal worker's pneumoconiosis D. Sarcoidosis Answer: A. Silicosis Explanation: Nodular opacifications in the upper lung fields in a worker with silica exposure are classic for silicosis. Asbestosis typically affects the lower lobes and presents with pleural plaques. Coal worker's pneumoconiosis and sarcoidosis have different radiologic patterns and occupational exposures. 25: A 37-year-old woman, an industrial solvent cleaner, presents to the ED with acute onset of headache, nausea, and confusion following exposure to fumes in a poorly ventilated space. What is the most immediate treatment intervention? A. Gastric decontamination B. Initiate hemodialysis C. Provide supplemental oxygen and supportive care D. Administer activated charcoal Answer: C. Provide supplemental oxygen and supportive care Explanation: For inhalational exposure to toxic fumes causing neurological symptoms, the primary treatment is to remove the patient from the source, administer supplemental oxygen, and provide supportive care. Gastric decontamination and activated charcoal are not applicable to inhalational exposures, and hemodialysis is not indicated unless the toxin is dialyzable and causing severe toxicity. 26: A 48-year-old man presents to the emergency department with polyuria, polydipsia, and confusion. His finger-stick blood glucose is 650 mg/dL. He has a history of type 2 diabetes. Which of the following additional findings is most consistent with hyperosmolar hyperglycemic state (HHS)? A. Ketosis B. Kussmaul respirations C. Severe dehydration D. Rapid weight loss
the thyroid hormone deficiency is primary. Oral medications may not be absorbed well in this state. 30: A 45-year-old male is admitted for persistent hypoglycemia. His laboratory values show high insulin and high C-peptide levels during a hypoglycemic episode. Which of the following is the most likely cause? A. Exogenous insulin administration B. Insulinoma C. Factitious hypoglycemia D. Sulfonylurea ingestion Answer: B. Insulinoma Explanation: High insulin and high C-peptide during hypoglycemia suggest an endogenous source of insulin such as an insulinoma. Exogenous insulin would result in high insulin but low C-peptide, and sulfonylurea ingestion typically also shows high insulin and high C- peptide, but the does not indicate such ingestion. However, insulinoma is a more direct cause of endogenous hyperinsulinemic hypoglycemia when no evidence of ingestion is provided. 31: A 34-year-old woman is found to have a thyroid nodule. Fine-needle aspiration biopsy shows papillary carcinoma of the thyroid. What is the most appropriate next step in management? A. Total thyroidectomy B. Radioactive iodine therapy alone C. Observation only D. Partial thyroidectomy Answer: A. Total thyroidectomy Explanation: Papillary thyroid carcinoma typically requires surgical management. A total thyroidectomy is usually recommended, often followed by radioactive iodine therapy depending on staging, because it minimizes recurrence risk and allows for effective follow-up using thyroglobulin levels. Partial thyroidectomy is not generally the first-line treatment for papillary carcinoma. 32: A 29-year-old woman with anorexia nervosa presents with bradycardia, hypothermia, and hypotension. Which of the following metabolic disturbances is she most at risk for? A. Metabolic alkalosis B. Hyperkalemia C. Hypokalemia D. Hypernatremia Answer: C. Hypokalemia Explanation: Patients with anorexia nervosa often experience electrolyte imbalances due to malnutrition, vomiting, and laxative abuse, with hypokalemia being a common disturbance. This can contribute to cardiac arrhythmias and muscle weakness, especially in the context of bradycardia and hypotension.
3 3: A 60-year-old shipyard worker presents with progressive dyspnea and dry cough. He also has clubbing of fingers. His chest X-ray shows interstitial fibrosis and pleural plaques. What is the most likely diagnosis? A. Asbestosis B. Silicosis C. Coal worker's pneumoconiosis D. Hypersensitivity pneumonitis Answer: A. Asbestosis Explanation: The history of asbestos exposure in a shipyard worker, along with interstitial fibrosis, pleural plaques, and clubbing, is characteristic of asbestosis. Silicosis and coal worker's pneumoconiosis have different exposures and radiographic patterns, while hypersensitivity pneumonitis generally presents differently. 34: A 33-year-old painter presents with headache and confusion after chronic exposure to lead-based paints. His blood lead level is elevated. Which of the following is the first- line treatment for symptomatic lead poisoning? A. Succimer chelation therapy B. EDTA chelation therapy C. Penicillamine therapy D. Dimercaprol therapy Answer: A. Succimer chelation therapy Explanation: Succimer (DMSA) is the first-line treatment for mild to moderate lead poisoning, especially in children and adults with elevated blood lead levels who are symptomatic. EDTA, dimercaprol, or penicillamine are used in more severe cases or as alternatives depending on specific circumstances, but succimer is typically preferred first. 35: A 33-year-old woman presents with palpitations, weight loss, and heat intolerance. Physical exam shows a diffusely enlarged thyroid gland and a fine tremor. Which antibody is most likely to be positive in this patient? A. Anti-thyroid peroxidase (anti-TPO) B. Thyroid-stimulating immunoglobulin (TSI) C. Anti-thyroglobulin D. Anti-TSH receptor blocking antibodies Answer: B. Thyroid-stimulating immunoglobulin (TSI) Explanation: The clinical picture is suggestive of Graves’ disease, an autoimmune hyperthyroidism. TSI mimics TSH, leading to overproduction of thyroid hormones. Anti- TPO and anti-thyroglobulin antibodies are associated with autoimmune thyroiditis but are not as specific for Graves’ disease as TSI. 36: A 55-year-old man with a history of type 2 diabetes and chronic renal failure is admitted with altered mental status. His labs reveal a serum sodium of 118 mEq/L and
C. Vitamin D D. Vitamin K Answer: C. Vitamin D Explanation: Patients with celiac disease can have malabsorption of fat-soluble vitamins, including vitamin D, even on a gluten-free diet due to ongoing malabsorption issues or damage to the small intestine. Vitamin B12 may also be affected, but fat-soluble vitamin deficiencies like vitamin D are common due to malabsorption. 40: A 60-year-old man presents with confusion and seizures. Laboratory tests reveal serum sodium of 122 mEq/L, serum osmolality of 260 mOsm/kg, urine osmolality of 500 mOsm/kg, and urine sodium of 45 mEq/L. Which is the most likely cause of his hyponatremia? A. SIADH due to small cell lung carcinoma B. Psychogenic polydipsia C. Hypovolemic hyponatremia D. Hyperglycemia-induced hyponatremia Answer: A. SIADH due to small cell lung carcinoma Explanation: The labs reveal hypotonic hyponatremia with inappropriately concentrated urine and high urine sodium, which is characteristic of SIADH. In this context, SIADH is often associated with a paraneoplastic syndrome from small cell lung carcinoma. Psychogenic polydipsia would yield dilute urine, hypovolemia would have low urine sodium, and hyperglycemia wouldn't match these urine findings. 41: A 38-year-old female presents with episodes of dizziness, palpitations, and sweating. During an episode, her blood glucose is measured at 40 mg/dL. She denies any diabetes medication use. Which of the following tests would be most helpful in diagnosing the cause of her hypoglycemia? A. Serum insulin, C-peptide, and proinsulin levels during a fasting state B. Oral glucose tolerance test C. Hemoglobin A1c D. Continuous glucose monitoring Answer: A. Serum insulin, C-peptide, and proinsulin levels during a fasting state Explanation: For a patient with unexplained hypoglycemia, especially with symptoms consistent with an insulinoma or endogenous hyperinsulinism, measuring insulin, C-peptide, and proinsulin during a hypoglycemic episode or fasting state is key to diagnosis. An oral glucose tolerance test or Hemoglobin A1c isn’t helpful here, and while continuous glucose monitoring provides data, it doesn’t determine the underlying cause. 42: A 28 - year-old man presents to the ED with headache, nausea, and confusion after working in a poorly ventilated area with gasoline fumes. Which of the following is the most appropriate initial evaluation? A. Serum lead level B. Carboxyhemoglobin level
C. Serum methemoglobin level D. Arterial blood gas analysis Answer: D. Arterial blood gas analysis Explanation: Exposure to gasoline fumes can lead to inhalation of various toxic substances. While carboxyhemoglobin level is important for carbon monoxide poisoning, gasoline fumes are more associated with volatile organic compounds that could affect respiratory function. An arterial blood gas (ABG) can provide immediate information on oxygenation, ventilation, and acid-base status, which is critical in acute toxic exposures and guides further management. 43: A 45-year-old woman presents with chronic cough and shortness of breath. She has a history of exposure to bird droppings at home. A chest X-ray shows diffuse reticulonodular patterns. Which condition is most likely? A. Bird fancier's lung (Hypersensitivity pneumonitis) B. Asbestosis C. Sarcoidosis D. Tuberculosis Answer: A. Bird fancier's lung (Hypersensitivity pneumonitis) Explanation: Hypersensitivity pneumonitis can be caused by inhalation of organic antigens, such as bird proteins from droppings. The patient's exposure history and diffuse lung findings align with bird fancier's lung. Asbestosis, sarcoidosis, and tuberculosis have different exposure histories and radiographic patterns. 44: A 50-year-old man presents with progressive memory loss, ataxia, and neuropathy. He has a known history of chronic mercury exposure from working in a thermometer factory. Which finding is most consistent with mercury poisoning? A. Blue line along the gingiva B. Burton's line C. Tremor and erethism D. Koplik spots Answer: C. Tremor and erethism Explanation: Chronic mercury poisoning often presents with neurological symptoms such as tremor, erethism (irritability, excitability), memory loss, and neuropathy. A blue line along the gingiva (lead line) and Burton's line (lead exposure) are associated with lead poisoning, not mercury. Koplik spots are related to measles. 45: A 34-year-old woman presents with palpitations, heat intolerance, and weight loss. On exam, she has a fine tremor and warm, moist skin. Laboratory results show suppressed TSH and elevated free T4. Which medication is most appropriate for acute symptom control? A. Propylthiouracil (PTU) B. Methimazole
Answer: A. Primary hyperparathyroidism due to a parathyroid adenoma Explanation: The patient's high calcium, low phosphate, and high PTH levels point to primary hyperparathyroidism, commonly due to a parathyroid adenoma. Secondary hyperparathyroidism typically presents with low calcium, and familial hypocalciuric hypercalcemia is usually less severe. Malignancy-related hypercalcemia often has suppressed PTH. 49: A 22-year-old woman presents to the ED with severe abdominal pain, nausea, and vomiting. She has a history of gallstones. Lab tests reveal elevated serum amylase and lipase. What is the most likely diagnosis? A. Acute cholecystitis B. Acute pancreatitis C. Peptic ulcer disease D. Gastroenteritis Answer: B. Acute pancreatitis Explanation: The combination of severe abdominal pain, nausea, vomiting, history of gallstones, and elevated amylase and lipase strongly suggests acute pancreatitis. Gallstones are a common cause of pancreatitis due to obstruction of the pancreatic duct. 50: A 40-year-old man with a history of obesity and hyperlipidemia presents with yellowish plaques over his eyelids. What are these lesions most likely? A. Xanthelasma B. Neurofibromas C. Milia D. Seborrheic keratoses Answer: A. Xanthelasma Explanation: Yellowish plaques on the eyelids, especially in the context of hyperlipidemia, are most consistent with xanthelasma, which are cholesterol-rich deposits. They often correlate with underlying lipid abnormalities. 51: A 55-year-old woman complains of fatigue and weight gain. Lab results reveal high TSH and high cholesterol levels. What is the next best step in management? A. Start levothyroxine B. Initiate statin therapy C. Order a thyroid ultrasound D. Recommend lifestyle modifications only Answer: A. Start levothyroxine Explanation: The patient exhibits signs of hypothyroidism (elevated TSH, high cholesterol). Starting levothyroxine to correct hypothyroidism is the most appropriate next step, which will also likely improve her cholesterol levels. Statin therapy may be secondary after thyroid issues are addressed, and imaging isn’t indicated without a suspicion of structural pathology.
52: A 40 - year-old man presents with progressive shortness of breath and dry cough. He has a history of working in ship construction. A high-resolution CT scan reveals subpleural fibrosis and pleural plaques. What is the most likely diagnosis? A. Silicosis B. Asbestosis C. Hypersensitivity pneumonitis D. Sarcoidosis Answer: B. Asbestosis Explanation: The patient’s occupational exposure to asbestos in ship construction, combined with HRCT findings of subpleural fibrosis and pleural plaques, is characteristic of asbestosis. 53: A 55-year-old man is admitted with severe headache, vomiting, and blurred vision after prolonged exposure to high altitude. What condition should be considered first? A. High-altitude cerebral edema (HACE) B. Decompression sickness C. Carbon monoxide poisoning D. Hypoglycemia Answer: A. High-altitude cerebral edema (HACE) Explanation: Prolonged exposure to high altitude can lead to HACE, characterized by headache, vomiting, and neurological symptoms such as confusion and blurred vision. It's a life-threatening condition that requires immediate descent and oxygen therapy. 54: A 32-year-old woman working in a nail salon presents with symptoms of dizziness, fatigue, and irritability. She reports chronic use of solvents without proper ventilation. Which toxic exposure should be considered? A. Carbon monoxide B. Benzene C. Asbestos D. Silica Answer: B. Benzene Explanation: Nail salon workers are often exposed to organic solvents like benzene, which can cause neurological symptoms (dizziness, fatigue, irritability) with chronic exposure. Carbon monoxide typically presents more acutely and is not common in this setting, while asbestos and silica exposures are more related to respiratory conditions over long durations. 55: A 48-year-old woman with known hypothyroidism presents with severe lethargy, hoarseness, and hypothermia. Lab results show a TSH level markedly elevated above her baseline, and extremely low free T4. What life-threatening complication should you be most concerned about in this patient? A. Myxedema coma B. Thyroid storm
C. Intravenous fluids D. Intravenous insulin and glucose Answer: A. High-dose intravenous hydrocortisone Explanation: The laboratory findings suggest an adrenal crisis likely due to primary adrenal insufficiency (Addison's disease). The urgent treatment involves high-dose IV hydrocortisone, along with IV fluids to stabilize blood pressure and electrolyte imbalances. Oral prednisone is not suitable for acute crisis, and insulin/glucose is used for hyperglycemia, not adrenal crisis. 59: A 35-year-old woman with known anorexia nervosa presents with bradycardia, hypotension, and amenorrhea. What electrolyte abnormality is she most likely to have? A. Hyperkalemia B. Hypokalemia C. Hypernatremia D. Hypercalcemia Answer: B. Hypokalemia Explanation: In anorexia nervosa, especially if accompanied by purging behaviors (vomiting, laxative abuse), hypokalemia is common due to losses of potassium. This electrolyte disturbance can cause bradycardia and hypotension. Hypernatremia and hypercalcemia are less typical, and hyperkalemia would not align with these behaviors. 60: A 50-year-old man presents with severe epigastric pain radiating to the back, nausea, and vomiting. Lab work indicates serum calcium of 13 mg/dL and elevated serum PTH levels. What is the most likely etiology of his symptoms? A. Acute pancreatitis from hypercalcemia B. Peptic ulcer disease C. Gastroesophageal reflux disease D. Cholelithiasis Answer: A. Acute pancreatitis from hypercalcemia Explanation: Severe hypercalcemia can precipitate acute pancreatitis, which presents as epigastric pain radiating to the back, nausea, and vomiting. The lab findings of high calcium and PTH suggest primary hyperparathyroidism causing hypercalcemia, which then may lead to pancreatitis. Other options do not explain the lab findings. 61: A 68-year-old female with longstanding type 2 diabetes presents with burning pain in her feet that is worse at night. Which of the following is the most likely diagnosis? A. Diabetic peripheral neuropathy B. Restless legs syndrome C. Vitamin B12 deficiency D. Tarsal tunnel syndrome Answer: A. Diabetic peripheral neuropathy Explanation: Burning pain in the feet in a diabetic patient, particularly worse at night, is
characteristic of diabetic peripheral neuropathy. Restless legs syndrome typically causes an urge to move the legs, vitamin B12 deficiency would likely present with additional neurological deficits, and tarsal tunnel syndrome is focal rather than diffuse. 62: A 57-year-old man presents with progressive dyspnea and cough. He has a 30-year history of working in an asbestos factory. A chest radiograph shows bilateral irregular opacities at the lung bases and pleural thickening. Which of the following conditions is he at increased risk for? A. Mesothelioma B. Silicosis C. Sarcoidosis D. Emphysema Answer: A. Mesothelioma Explanation: Asbestos exposure significantly increases the risk of mesothelioma, a malignant tumor of the pleura. The patient's occupational history and radiograph findings of pleural thickening raise suspicion for asbestos-related disease, including mesothelioma. Silicosis, sarcoidosis, and emphysema have different risk factors and imaging patterns. 63: A 39-year-old woman presents to the ED with headache, confusion, and a metallic taste after renovating an old house with lead paint. Which of the following is the best initial step in her evaluation? A. Serum lead level testing B. Brain CT scan C. Measurement of zinc protoporphyrin D. Chelation therapy with EDTA Answer: A. Serum lead level testing Explanation: Given her symptoms and history of lead paint exposure, the best initial step is to confirm lead poisoning by measuring her serum lead level. While brain CT scans could be helpful later for complications, they are not the first step. Measurement of zinc protoporphyrin can be supportive but serum lead level is more direct. Chelation therapy is based on confirmed high lead levels. 64: A 45-year-old woman presents with chronic cough and exertional dyspnea. She has a long history of working in a fiberglass factory. Which pulmonary function test finding is most consistent with her likely diagnosis? A. Obstructive pattern with reduced FEV1/FVC B. Restrictive pattern with decreased lung volumes C. Mixed obstructive-restrictive pattern D. Normal lung function tests Answer: B. Restrictive pattern with decreased lung volumes Explanation: Chronic exposure to fiberglass dust can lead to interstitial lung disease, which typically presents with a restrictive pattern on pulmonary function testing—characterized by decreased total lung capacity (TLC), forced vital capacity (FVC), and preserved or increased
