SPEX SPEX Analysis Exam 5 — Questions and Answers
Question 1: A 40-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation. TSH is 12 mIU/L with a low free T4. What is the most appropriate treatment?
- Liothyronine (T3) supplementation only
- Levothyroxine (T4) replacement (Correct answer)
- Radioactive iodine ablation
- Thyroidectomy
Correct answer: Levothyroxine (T4) replacement
Levothyroxine (synthetic T4) is the standard treatment for hypothyroidism because peripheral conversion to T3 provides adequate hormonal replacement.
Question 2: A 30-year-old man presents with hematuria, flank pain, and a palpable abdominal mass. Urinalysis shows RBCs without casts. What is the most concerning diagnosis?
- IgA nephropathy
- Renal cell carcinoma (Correct answer)
- Nephrolithiasis
- Polycystic kidney disease
Correct answer: Renal cell carcinoma
The classic triad of hematuria, flank pain, and palpable mass strongly suggests renal cell carcinoma and warrants urgent imaging.
Question 3: A patient develops septic shock. After fluid resuscitation fails to maintain MAP ≥ 65 mmHg, what is the first-line vasopressor?
- Epinephrine
- Dopamine
- Norepinephrine (Correct answer)
- Phenylephrine
Correct answer: Norepinephrine
Norepinephrine is the first-line vasopressor for septic shock per Surviving Sepsis Campaign guidelines due to its strong alpha-adrenergic vasoconstrictor activity.
Question 4: A 62-year-old woman with a history of osteoporosis has a T-score of -2.8. She has no prior fractures. Which intervention has the strongest evidence for fracture prevention?
- Calcium and vitamin D supplementation alone
- Bisphosphonate therapy such as alendronate (Correct answer)
- Calcitonin nasal spray
- Estrogen replacement therapy
Correct answer: Bisphosphonate therapy such as alendronate
Bisphosphonates like alendronate have the strongest evidence base for reducing vertebral and hip fracture risk in osteoporosis.
Question 5: Which finding on spirometry is most consistent with obstructive lung disease such as COPD?
- FEV1/FVC ratio > 0.70 with reduced total lung capacity
- FEV1/FVC ratio < 0.70 with normal or increased TLC (Correct answer)
- Reduced FVC with normal FEV1/FVC ratio
- Increased DLCO with normal FEV1
Correct answer: FEV1/FVC ratio < 0.70 with normal or increased TLC
Obstructive disease is characterized by FEV1/FVC < 0.70 post-bronchodilator, with air trapping leading to normal or elevated TLC.
Question 6: A patient with chronic hepatitis C and cirrhosis develops confusion, asterixis, and elevated ammonia. What is the immediate management priority?
- Start broad-spectrum antibiotics empirically
- Administer lactulose and identify precipitating factors (Correct answer)
- Perform immediate liver biopsy
- Begin TIPS procedure planning
Correct answer: Administer lactulose and identify precipitating factors
Hepatic encephalopathy is managed with lactulose to reduce ammonia absorption and identification of precipitating factors such as infection or GI bleeding.
Question 7: A physician treating a patient discovers that a colleague is impaired by substance abuse and is practicing unsafely. What is the physician's obligation?
- Speak privately to the colleague and take no further action
- Report the colleague to the appropriate medical board or hospital authority (Correct answer)
- Cover for the colleague until they seek help voluntarily
- Inform only the hospital administrator, not external authorities
Correct answer: Report the colleague to the appropriate medical board or hospital authority
Physicians have a professional and ethical obligation to report an impaired colleague to protect patient safety, even if it involves reporting to licensing boards.
SPEX SPEX Analysis Exam 5
A 40-year-old woman presents with fatigue, weight gain, cold intolerance, and constipation.
TSH is 12 mIU/L with a low free T4.
What is the most appropriate treatment?