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

ST elevation in leads II, III, and aVF localizes ischemia to the inferior wall of the left ventricle, most commonly from right coronary artery occlusion.

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

Elevated TSH with low free T4 confirms primary hypothyroidism, and first-line treatment is oral levothyroxine replacement to normalize thyroid hormone levels.

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

Small cell lung carcinoma classically presents as a central mass in a heavy smoker with neuroendocrine features on biopsy and is strongly associated with paraneoplastic syndromes.

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

The combination of butterfly rash, polyarthritis, positive ANA, anti-dsDNA antibodies, and renal involvement is classic for SLE with lupus nephritis.

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

Minimal change disease is the most common cause of nephrotic syndrome in children, characterized by normal light microscopy but diffuse foot process effacement on electron microscopy.

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UWorld UWorld High-Yield Clinical Vignettes