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

Following carotid endarterectomy for significant carotid stenosis and a history of TIAs, the patient remains at high risk for future cerebrovascular events. Long-term management involves antiplatelet therapy with aspirin to prevent clot formation and a statin. Statins are crucial for managing dyslipidemia and providing pleiotropic vascular protective effects, regardless of baseline lipid levels, thereby reducing the risk of recurrent stroke and other cardiovascular events.

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

For HIV-positive pregnant women, combination antiretroviral therapy (ART) is recommended to prevent mother-to-child transmission. While ART should be initiated, if the mother's HIV disease is stable and her CD4 count is good, deferring initiation until after the first trimester (around 12-14 weeks) is often preferred. This approach minimizes potential teratogenic risks during the critical period of fetal organogenesis, while still effectively reducing viral load before delivery.

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

When investigating occult blood in the stool, the initial diagnostic workup for gastrointestinal bleeding typically involves both an upper gastrointestinal endoscopy (EGD) and a colonoscopy. These procedures allow for direct visualization of the most common sites of bleeding in the upper and lower GI tracts, respectively. This comprehensive approach ensures that potential bleeding lesions are identified or ruled out from both ends of the digestive system.

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

In cases of brain death, the patient is legally and medically deceased. The driver's license indicating organ donation serves as a legally binding advanced directive for organ donation, reflecting the patient's autonomous wishes. The wife, as the legal next of kin, has the authority to make decisions regarding the cessation of life support for a deceased individual, especially when aligned with the patient's expressed wishes. The family's opposition, while emotionally understandable, does not override these legal and medical determinations.

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

Once HIV infection is confirmed by Western blot, the immediate next step is to establish baseline immunological and virological parameters. This involves obtaining a CD4 T-lymphocyte count to assess the immune system's health and a plasma HIV RNA determination (viral load) to measure the amount of virus in the blood. These values are essential for staging the disease, monitoring progression, guiding treatment decisions, and establishing a prognosis for the patient.

SPEX Exam Practice Test

SPEX Exam Practice Test

FREE SPEX Assessment Exam Question and Answers