UWorld UWorld High-Yield Clinical Vignettes

Question 1

A 55-year-old male with chest pain radiating to the left arm, diaphoresis, and ST elevation in leads II, III, and aVF presents to the ER. What is the most likely diagnosis?

Accepted Answer

Inferior STEMI

Answer

Stable angina

Answer

Pulmonary embolism

Answer

Aortic dissection

Question 2

A 28-year-old woman presents with fatigue, cold intolerance, weight gain, constipation, and a TSH of 12 mIU/L with low free T4. What is the most appropriate next step?

Accepted Answer

Start levothyroxine therapy

Answer

Order a thyroid ultrasound immediately

Answer

Refer for thyroid surgery

Answer

Prescribe propylthiouracil

Question 3

A 70-year-old male smoker with a 50 pack-year history presents with hemoptysis, weight loss, and a central lung mass on chest X-ray. Biopsy shows small cells with necrosis. What is the most likely diagnosis?

Accepted Answer

Small cell lung carcinoma

Answer

Squamous cell carcinoma

Answer

Adenocarcinoma of the lung

Answer

Pulmonary carcinoid tumor

Question 4

A 35-year-old woman presents with a butterfly rash, joint pain, fatigue, and a positive ANA with anti-dsDNA antibodies. Urinalysis shows hematuria and proteinuria. What is the most likely diagnosis?

Accepted Answer

Systemic lupus erythematosus with lupus nephritis

Answer

Rheumatoid arthritis with renal involvement

Answer

Sjögren syndrome

Answer

Dermatomyositis

Question 5

An 8-year-old boy presents with sudden onset periorbital edema, proteinuria (>3.5g/day), hypoalbuminemia, and hyperlipidemia. Kidney biopsy shows normal light microscopy with effacement of podocyte foot processes on electron microscopy. What is the diagnosis?

Accepted Answer

Minimal change disease

Answer

Focal segmental glomerulosclerosis

Answer

IgA nephropathy

Answer

Membranous nephropathy

Question 6

A 45-year-old male presents with severe epigastric pain radiating to the back, nausea, vomiting, and a serum lipase three times the upper limit of normal after a weekend of heavy alcohol use. What is the most appropriate initial management?

Accepted Answer

IV fluid resuscitation, bowel rest (NPO), and pain management

Answer

Emergency ERCP

Answer

Immediate surgical consultation for pancreatectomy

Answer

Oral pancreatic enzyme replacement