SPEX SPEX Analysis Exam 2 — Questions and Answers
Question 1: A 58-year-old man presents with sudden-onset severe headache described as 'the worst headache of my life.' What is the most critical diagnosis to rule out?
- Migraine with aura
- Subarachnoid hemorrhage (Correct answer)
- Cluster headache
- Tension-type headache
Correct answer: Subarachnoid hemorrhage
A sudden, severe 'thunderclap' headache must be presumed to be subarachnoid hemorrhage until proven otherwise by CT and lumbar puncture.
Question 2: Which of the following is the MOST appropriate initial antibiotic choice for community-acquired pneumonia in a healthy outpatient without comorbidities?
- Vancomycin IV
- Azithromycin or amoxicillin (Correct answer)
- Meropenem
- Linezolid
Correct answer: Azithromycin or amoxicillin
Current IDSA/ATS guidelines recommend azithromycin or amoxicillin as first-line therapy for outpatient CAP in patients without comorbidities.
Question 3: A 45-year-old woman with Type 2 diabetes has a blood pressure of 138/88 mmHg on two separate visits. Which antihypertensive drug class is preferred as first-line therapy?
- Beta-blockers
- ACE inhibitors or ARBs (Correct answer)
- Loop diuretics
- Calcium channel blockers only
Correct answer: ACE inhibitors or ARBs
ACE inhibitors and ARBs are preferred in diabetic patients with hypertension due to their renoprotective effects.
Question 4: On a 12-lead ECG, which finding is most consistent with an acute ST-elevation myocardial infarction (STEMI) of the anterior wall?
- ST elevation in leads II, III, aVF
- ST elevation in leads V1–V4 (Correct answer)
- Diffuse ST elevation with PR depression
- ST depression in leads I and aVL
Correct answer: ST elevation in leads V1–V4
ST elevation in the precordial leads V1–V4 indicates anterior STEMI, most commonly due to left anterior descending artery occlusion.
Question 5: A physician is unsure whether a 70-year-old patient with newly diagnosed prostate cancer would benefit from aggressive treatment. What is the most appropriate next step?
- Initiate androgen deprivation therapy immediately
- Obtain a Gleason score and stage the cancer (Correct answer)
- Refer for immediate radical prostatectomy
- Begin watchful waiting without further workup
Correct answer: Obtain a Gleason score and stage the cancer
Risk stratification using Gleason score, PSA level, and clinical stage is essential before deciding on treatment in prostate cancer.
Question 6: Which of the following is a recognized criterion for diagnosing metabolic syndrome according to the ATP III guidelines?
- Fasting glucose ≥ 110 mg/dL (Correct answer)
- Total cholesterol > 200 mg/dL
- BMI > 30 kg/m²
- Resting heart rate > 90 bpm
Correct answer: Fasting glucose ≥ 110 mg/dL
ATP III defines metabolic syndrome as having three or more of five criteria, including fasting glucose ≥ 110 mg/dL (updated to ≥ 100 mg/dL in later revisions).
Question 7: A 32-year-old woman at 28 weeks gestation has a blood pressure of 155/100 mmHg and 2+ proteinuria on two occasions. What is the most likely diagnosis?
- Gestational hypertension
- Preeclampsia (Correct answer)
- Chronic hypertension
- HELLP syndrome
Correct answer: Preeclampsia
Preeclampsia is defined as hypertension ≥ 140/90 mmHg plus proteinuria occurring after 20 weeks of gestation.
SPEX SPEX Analysis Exam 2
A 58-year-old man presents with sudden-onset severe headache described as 'the worst headache of my life.' What is the most critical diagnosis to rule out?