FREE SPEX Analysis Exam Question and Answers

Question 1

A mole on the student's back has changed in size and color, and he is a 24-year-old medical student. He has no family history of skin cancer and is in good health. Although he has fair skin and served as a lifeguard for two summers while in college, he cannot recall ever getting a bad sunburn. Recently, the mole has occasionally itched, which has drawn his attention to it. The 0.8 cm-long lesion has an uneven border and is located on the left upper back, slightly below the shoulder. No nodule is palpable, however, there are minor color variations. On examination with a magnifying lens, no ulceration was found. Except for a few benign-looking skin nevi, the rest of his physical evaluation is ordinary. Lymphadenopathy is not seen in the cervical, supraclavicular, or axillary areas. There is a wide excisional biopsy of the mole.

Which of the following pathologies and clinical findings is most crucial for determining prognosis?

Accepted Answer

Tumor thickness

Answer

Age of patient

Answer

Location of the melanoma

Answer

Sex of the patient

Answer

Depth of penetration

Question 2

Prednisone 40 mg/day was prescribed to the patient, and during the following two weeks, his symptoms significantly improved. But when the dosage is reduced to 20 mg per day, the illness worsens.

What will happen with this patient's care after that?

Accepted Answer

Temporarily increase the steroid, and then add an immunosuppressant such as 6-mercaptopurine (6-MP) or azathioprine

Answer

Segmental resection of the terminal ileum

Answer

Begin a 5-aminosalicylic acid-containing drug

Answer

Increase the steroid and maintain him on this indefinitely

Answer

Add powdered opium and belladonna along with a nonsteroid anti-inflammatory drug (NSAID)

Question 3

The patient is given bed rest and is under strict observation, but her blood pressure remains high and at 32 weeks, her urine still reveals 1+ to 2+ proteinuria.

What do you suggest right now?

Accepted Answer

Antihypertensive treatment with methyldopa

Answer

Magnesium sulfate intravenously

Answer

Calcium supplements and low-dose aspirin

Answer

Antihypertensive treatment with an angiotensin-converting enzyme (ACE) inhibitor

Question 4

A 35-year-old married woman contacts you since her older sister recently received a breast cancer diagnosis and her mother passed away from the disease in her 40s. She is Jewish, and her Polish-born grandparents are. She is interested in learning what she may do to reduce her risk of contracting the illness. She has a child who is 5 years old, is in good health, and plans to have one or two more children in the future. It's normal to examine your breasts. She tested positive for the BRCA2 gene, according to genetic testing. Though it is brought up, she declines to consider a bilateral mastectomy.

What would be the most effective strategy for handling her case?

Accepted Answer

Schedule an MRI of the breast and if negative, start tamoxifen

Answer

Schedule an MRI of the breast and if negative, annual examination only

Answer

Refer to a radiation therapist for prophylactic radiation treatment to both breasts

Answer

Schedule a mammogram and if negative, order an annual mammogram

Question 5

A 20-year-old woman comes to see you for menorrhagia and easy bruising. Her gynecologist notes that the pelvic exam was normal. Additional medical history includes bruises from minor childhood injuries, sporadic spontaneous epistaxis, and heavy periods ever since menarche at age 13. She hasn't undergone surgery, but the dentist suggested a workup for a bleeding issue because she had chronic bleeding following dental extraction. She hasn't experienced any joint or deep intramuscular hemorrhage. She doesn't use any medications that affect platelet function, such as aspirin. Her family history is missing because she was adopted. Other than a few bruises on her extremities, her physical examination was normal. There is a slight iron deficient anemia.

Which of the subsequent laboratory tests has the greatest chance of supporting the clinical diagnosis?

Accepted Answer

Ristocetin-induced platelet aggregation (RIPA)

Answer

Platelet count

Answer

Activated partial thromboplastin time (aPTT)

Answer

Factor VIII assay

Answer

Prothrombin time (PT)

Question 6

A 75-year-old woman who has been experiencing palpitations and shortness of breath for the past day is examined in the emergency room. She is discovered to be in atrial fibrillation (AF), with 100 ventricular beats per minute and a 100/70 millimeter-Hg blood pressure. Heparin is used to prevent clotting, and intravenous diltiazem is used to restore her heartbeat to a normal sinus rhythm. There are no signs of severe coronary artery disease, heart failure, or left atrial thrombi in the clinical, imaging, or laboratory data.

Which of the following drugs would be appropriate for discharge?

Accepted Answer

Any of the above

Answer

Amiodarone

Answer

Digoxin

Answer

Sotalol

Answer

Warfarin

Question 7

A 72-year-old guy seeks your advice due to fatigue and sleep issues. He has trouble going to sleep, and he frequently wakes up early. He claims that since his wife passed away from cancer two years ago, he has been in a depressed mood and has trouble concentrating. She is constantly on his mind. He no longer finds enjoyment in activities he formerly did, such as swimming, hiking, and hanging out with friends. Although he had fleeting suicidal thoughts, he never actually tried to end his life. He also didn't have any delusions, hallucinations, or sporadic mood changes. He avoids using other illicit drugs and lives alone. He consumes two to three alcoholic drinks every day. He has two adult children, but since they reside out of state, he rarely sees them. He uses the alpha-adrenergic blocker tamsulosin to treat his benign prostatic hypertrophy and moderate hypertension (Flomax).

What type of treatment should be started and what is the most likely diagnosis?

Accepted Answer

Major depression; refer to a psychiatrist

Answer

Major depression; start sertraline (Zoloft)

Answer

Dysthymia; start trazodone

Answer

Bipolar disorder; start lithium

Answer

Drug-induced depression; stop Flomax