Free SPEX Exam Question and Answers — Questions 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. <br> <br> What should the next diagnostic procedure entail?
- Surgical intraoperative enteroscopy
- Capsule endoscopy (Correct answer)
- Isotopic red blood cell scan
- Angiography
Correct answer: Capsule endoscopy
When occult blood in the stool persists despite negative upper and lower endoscopies, the bleeding source is most likely located in the small intestine, which is beyond the reach of conventional scopes. Capsule endoscopy is the gold standard for evaluating the small bowel for obscure gastrointestinal bleeding. This non-invasive procedure allows for visualization of the jejunum and ileum, where lesions like angioectasias or small ulcers might be found.
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.<br> <br> Now, how ought he to be handled?
- A nonnucleoside reverse transcriptase inhibitor (NNRTI) only
- A protease inhibitor (PI) only
- A protease inhibitor and nucleoside reverse transcriptase inhibitor (NRTI) (Correct answer)
- Continued observation and repeat testing
Correct answer: A protease inhibitor and nucleoside reverse transcriptase inhibitor (NRTI)
The patient's declining CD4 count and increasing viral load indicate active HIV disease progression, even in the absence of symptoms. Current guidelines recommend initiating antiretroviral therapy (ART) for all HIV-infected individuals to prevent disease progression and reduce transmission risk. A standard initial ART regimen typically involves a combination of drugs from different classes, such as two nucleoside reverse transcriptase inhibitors (NRTIs) plus a third agent like a protease inhibitor, to effectively suppress the virus.
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). <br> <br> What logical step would result in the best chance of a diagnosis?
- Hemoglobin A1c
- Lipid profile
- Coronary angiography
- Technetium Tc-99m Sestamibi stress test (Correct answer)
Correct answer: Technetium Tc-99m Sestamibi stress test
The patient's sporadic chest pain, occurring both at rest and with exertion, radiating to the throat, and his significant risk factors (hypertension, former smoker, obesity, family history) strongly suggest angina due to coronary artery disease. Despite a normal resting ECG, a Technetium Tc-99m Sestamibi stress test is the most appropriate next step. This non-invasive test assesses for inducible myocardial ischemia, helping to confirm the diagnosis and determine the extent of coronary artery disease.
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. <br> <br> His chest pain has considerably lessened. What activity would be the next most logical step?
- Draw blood for a troponin level (Correct answer)
- Request a cardiac ultrasound
- Send the patient to the catheterization laboratory immediately
- Obtain a high-resolution CT scan of the chest
Correct answer: Draw blood for a troponin level
The patient's new onset of excruciating, ongoing chest discomfort, diaphoresis, and ECG changes (ST depressions, inverted T waves) are highly concerning for an acute coronary syndrome, specifically a non-ST elevation myocardial infarction (NSTEMI). While his pain has lessened, it is crucial to assess for myocardial injury. Drawing blood for a troponin level is the most logical next step, as troponin is a highly sensitive and specific biomarker for myocardial necrosis.
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. <br> <br> With the exception of All of the following medications, the patient may be discharged:
- aspirin
- a statin
- clopidogrel
- warfarin (Correct answer)
Correct answer: warfarin
After percutaneous coronary intervention (PCI) with drug-eluting stent placement for an acute coronary syndrome, patients are typically discharged on dual antiplatelet therapy (aspirin and clopidogrel) to prevent stent thrombosis. Additionally, a high-intensity statin is prescribed for lipid management and secondary cardiovascular prevention. Warfarin, an anticoagulant, is not routinely indicated in this scenario unless there is another specific indication for anticoagulation, which is not mentioned in the patient's case.
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. <br> <br> What medical condition most closely resembles her symptoms?
- Left hemispheric stroke
- Aortic stenosis
- Transient ischemic attacks (TIA) (Correct answer)
- Seizure disorder
Correct answer: Transient ischemic attacks (TIA)
The patient's recurrent, transient episodes of right arm/hand weakness and slurred speech, lasting 5-15 minutes and resolving completely, are classic symptoms of transient ischemic attacks (TIAs). The presence of a carotid bruit further suggests carotid artery stenosis as a potential underlying cause. TIAs are critical warning signs of impending stroke and require prompt investigation and management.
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. <br> <br> The subsequent diagnostic step should be:
- referral to a vascular surgeon
- duplex carotid scan (Correct answer)
- MR angiography
- echocardiogram
Correct answer: duplex carotid scan
Given the strong clinical suspicion of Transient Ischemic Attacks (TIAs) and the presence of a carotid bruit, the next most logical diagnostic step is a duplex carotid scan. This non-invasive ultrasound technique is highly effective in evaluating the carotid arteries for stenosis. Identifying significant carotid stenosis is crucial as it is a treatable risk factor for stroke and can guide further management decisions.
Free SPEX Exam Question and Answers
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?