FREE SPEX Exam Question and Answers

Question 1

Upper and lower endoscopy are performed on the patient, but neither procedure reveals any bleeding lesions or clots. No gastric or duodenal ulcer is visible and the esophageal mucosa appears intact. He has a few minor colonic polyps that were surgically removed and were determined to be benign as well as a few dispersed diverticula. While occult blood in the stool tests continues to be positive, a repeat EGD remains negative.

What should the next diagnostic procedure entail?

Accepted Answer

Capsule endoscopy

Answer

Surgical intraoperative enteroscopy

Answer

Isotopic red blood cell scan

Answer

Angiography

Question 2

The patient mentioned above had a CD4 T-cell count of 400/mL and plasma HIV RNA of 75,000 as the results of the follow-up tests. Although his girlfriend's HIV was not detected, one male sexual contact was revealed to be positive. He was advised to use latex condoms for safe sex and, if at all possible, steer clear of homosexual encounters. Following up after six months revealed a reduction in CD 4 T cells to 340/mL and an increase in viral load to 110,000. He is still symptom-free.

Now, how ought he to be handled?

Accepted Answer

A protease inhibitor and nucleoside reverse transcriptase inhibitor (NRTI)

Answer

A nonnucleoside reverse transcriptase inhibitor (NNRTI) only

Answer

A protease inhibitor (PI) only

Answer

Continued observation and repeat testing

Question 3

A 55-year-old guy visits his doctor because of his sporadic chest problems. It occasionally happens during effort and occasionally at rest, and it typically lasts 5 to 10 minutes. With some radiation to the throat, it is midsternal. He has a history of hypertension. He ceased smoking roughly at age 50. His only prescription is 10 mg of amlodipine daily. His type 2 diabetes and hypertension run in the family and his height is 70 inches, his weight is 210 pounds, and his blood pressure is 135/85. His pulse is also regular at 76. There are no cardiac rubs or murmurs audible, and his chest is clear. The overall evaluation is unfavorable. He has a normal electrocardiogram (ECG).

What logical step would result in the best chance of a diagnosis?

Accepted Answer

Technetium Tc-99m Sestamibi stress test

Answer

Hemoglobin A1c

Answer

Lipid profile

Answer

Coronary angiography

Question 4

The patient mentioned above awakens two days later with excruciating, ongoing chest discomfort. Mild diaphoresis is present, but there is no nausea or vomiting. The paramedics administer him two chewable aspirin tablets and nitroglycerin spray before transporting him to the emergency room. His blood pressure is now 160/90, and his ECG displays sinus tachycardia with some inverted T waves in the lateral precordial leads and some ST depressions.

His chest pain has considerably lessened. What activity would be the next most logical step?

Accepted Answer

Draw blood for a troponin level

Answer

Request a cardiac ultrasound

Answer

Send the patient to the catheterization laboratory immediately

Answer

Obtain a high-resolution CT scan of the chest

Question 5

A significant branch of the left anterior descending artery in the aforementioned patient's angiography reveals a 90% blockage (LAD). It seems like fewer than 30% of the other arteries are blocked. After balloon angioplasty and placement of a drug-eluting stent in the severely blocked artery, the patient reports having pain-free rest and exercise. Since the isotopic stress test revealed no signs of myocardial ischemia, the resting electrocardiogram is now normal.

With the exception of All of the following medications, the patient may be discharged:

Accepted Answer

warfarin

Answer

aspirin

Answer

a statin

Answer

clopidogrel

Question 6

The 65-year-old woman visits her doctor because she has experienced multiple periods of weakness in her right arm and hand, which have been accompanied by slurred speech. No loss of conscience exists. The experiences continue for 5 to 15 minutes, following which she returns to her normal state. She is right-handed, widowed, and independent. She has been taking a diuretic, an angiotensin receptor blocker (ARB), metformin, and other medications for the past 5 years to control her diabetes and high blood pressure. She disputes having heart problems, seizures, vertigo, or any other neurological condition. 6.6% was her most recent hemoglobin A1c. Her pulse is steady, and her blood pressure is 150/80. Over the left carotid artery, a bruit can be heard. At the cardiac base, there is a grade 2/6 mid-systolic murmur but no additional abnormalities. The nerves in her skull are unharmed.

What medical condition most closely resembles her symptoms?

Accepted Answer

Transient ischemic attacks (TIA)

Answer

Left hemispheric stroke

Answer

Aortic stenosis

Answer

Seizure disorder

Question 7

The patient's routine blood tests reveal a normal CBC and platelet count, 150 mg/dL fasting hyperglycemia, and modest transaminase increases. A borderline larger cardiac profile and clean lung fields can be seen on a chest x-ray. When reading an ECG, normal sinus rhythm is identified along with a left hemiblock but not ST change or Q waves.

The subsequent diagnostic step should be:

Accepted Answer

duplex carotid scan

Answer

referral to a vascular surgeon

Answer

MR angiography

Answer

echocardiogram