FREE SPEX Assessment Exam Question and Answers

Question 1

A successful endarterectomy was performed on this patient after cerebral angiography revealed a 95% blockage of the left carotid artery. The brain MRI revealed no signs of a previous stroke, and the cardiac ultrasound confirmed mild left ventricular hypertrophy but revealed no anomalies in wall motion or potential emboli sources.

The appropriate medication(s) for discharge ought to be:

Accepted Answer

aspirin and a statin

Answer

aspirin and clopidogrel

Answer

warfarin

Answer

aspirin alone

Answer

low molecular weight heparin

Question 2

The young man starts taking an NRTI and a prostate inhibitor. His lover is discovered to be HIV-positive six months later. They acknowledge having multiple instances of unprotected intercourse. She has been referred by her physician for potential therapy and is also five weeks pregnant. She feels fine except for occasional morning sickness and has a basically clean medical background. Her CD4 T-cell count is 500/mL, and she has 20,000 copies of HIV RNA in her blood.

What is the safest course of action for her to take to stop the spread of the infection to the fetus?

Accepted Answer

Combination ART after her first trimester is completed

Answer

Combination ART immediately

Answer

Zidovudine monotherapy

Answer

Defer treatment until just before delivery

Answer

No therapy until her HIV RNA is above 50,000

Question 3

Aspirin and naproxen should be stopped, and the patient should report any visible rectal bleeding. For additional testing, a gastroenterologist is consulted.

What should the following diagnostic process entail?

Accepted Answer

Both EGD and colonoscopy

Answer

Air contrast barium enema

Answer

Angiography

Answer

Upper gastrointestinal endoscopy (EGD)

Answer

Colonoscopy

Question 4

A 33-year-old married guy who suffered severe head injuries in a car accident is brought to the emergency room. He is being kept alive by a ventilator, intravenous hydration, and nutrition while he is in a coma. An electroencephalogram (EEG), neurologic examination, and brain imaging investigations are all consistent with the diagnosis of brain death. He didn't leave a living will or any other instructions for end-of-life treatment, but his driver's license indicated that he wanted to be an organ donor. His parents and brother oppose his wife's request to stop all of his assistance and go forward with organ donation; they want to keep him on life support longer in the hopes of a "miracle" and forbid organ donation. What should the accountable doctor do in these circumstances?

Accepted Answer

Stop all life support per the wife's wishes and proceed with the organ donation

Answer

Stop artificial ventilation but maintain hydration and nutrition

Answer

Add morphine or potassium chloride to his intravenous line to try hasten cardiorespiratory death

Answer

Continue life support and call in clergy or bioethics specialist to make the decision

Answer

Call s transplant surgeon to manage the case

Question 5

A standard pre-employment physical is performed on a 30-year-old single male. His medical history shows he had an appendectomy when he was 16 but no other significant illnesses. He experienced a febrile sickness many months ago that included swollen glands, exhaustion, and a fever, but it went away on its own without the need for medical attention. Further investigation finds that he is bisexual, has had intercourse with both men and women, and currently has a committed partner. About using condoms, he is evasive. He denies having any STDs or using drugs intravenously, although he does snort a little cocaine now and then. Except for the scar from the appendectomy, a physical examination is essentially negative. There are no noticeable oropharyngeal abnormalities, lymphadenopathy, or hepatosplenomegaly. An x-ray of the chest is negative. Each of the tests for hepatitis—CBC, liver function, VDRL, and hepatitis—is negative. Western blot confirmation of an HIV screening test's positive result. Tests using pure protein derivatives (PPD) come up negative.

What should the patient's next course of action be?

Accepted Answer

Obtain CD4 T-lymphocyte count and a plasma HIV RNA determination

Answer

Obtain a CD4 T-lymphocyte count

Answer

Observation only with repeat examination and blood tests in 6 months

Answer

Observation only with HIV testing of his girlfriend

Answer

Begin highly active antiretroviral therapy (HAART)

Question 6

A 101° temperature and a chronic, productive cough are both present in a 24-year-old guy. He claims to have had a "cold" for approximately a week, along with a cough and a temperature between 100° and 101°. He claims not to smoke, use illegal drugs, or be homosexual. He is generally healthy and does not use any prescriptions. A "pneumonia shot" has never been given to him. He experiences a small left-sided pleuritic ache on deep inhalation and feels a little bit out of breath with exercise. Over the left lower lobe, he has some crackles and percussive dullness. Both leg swelling and calf discomfort are absent. There is 93% oxygen saturation.

Which diagnosis is more likely?

Accepted Answer

Streptococcus pneumoniae pneumonia

Answer

Legionnaire disease

Answer

Mycoplasma pneumonia

Answer

Pneumocystis pneumonia

Answer

Pulmonary embolus

Question 7

A 101° temperature and a chronic, productive cough are both present in a 24-year-old guy. He claims to have had a "cold" for approximately a week, along with a cough and a temperature between 100° and 101°. He claims not to smoke, use illegal drugs, or be homosexual. He is generally healthy and does not use any prescriptions. A "pneumonia shot" has never been given to him. He experiences a small left-sided pleuritic ache on deep inhalation and feels a little bit out of breath with exercise. Over the left lower lobe, he has some crackles and percussive dullness. Both leg swelling and calf discomfort are absent. There is 93% oxygen saturation.

Except for the following, all of the following would be suitable for managing this case:

Accepted Answer

Hospitalization for intravenous cephalosporin

Answer

CBC with differential

Answer

Doxycycline 100 mg orally twice daily

Answer

Chest x-ray

Answer

Azithromycin 500 mg as a single dose on the first day followed by 250 mg daily