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Free notes, MCQs, tables & flowcharts for USMLE Step 1 Physiology
A 50-year-old man presents to the urgent care clinic for 3 hours of worsening cough, shortness of breath, and dyspnea. He works as a long-haul truck driver, and he informs you that he recently returned to the west coast from a trip to Arkansas. His medical history is significant for gout, hypertension, hypercholesterolemia, diabetes mellitus type 2, chronic obstructive pulmonary disease (COPD), and mild intellectual disability. He currently smokes 1 pack of cigarettes/day, drinks a 6-pack of beer/day, and he endorses a past history of injection drug use but currently denies any illicit drug use. The vital signs include: temperature 36.7°C (98.0°F), blood pressure 126/74 mm Hg, heart rate 87/min, and respiratory rate 23/min. His physical examination shows mild, bilateral, coarse rhonchi, but otherwise clear lungs on auscultation, grade 2/6 holosystolic murmur, and a benign abdominal physical examination. He states that he ran out of his albuterol inhaler 6 days ago and has been meaning to follow-up with his primary care physician (PCP) for a refill. Complete blood count (CBC) and complete metabolic panel are within normal limits. He also has a D-dimer result within normal limits. Which of the following is the most appropriate next step in evaluation?
AChest computed tomography (CT) with contrast
BChest radiographs
CPulmonary function tests
DSputum gram stain and culture
EArterial blood gas
A 55-year-old man with a 60 pack-year smoking history is referred by his primary care physician for a pulmonary function test (PFT). A previously obtained chest x-ray is shown below. Which of the following will most likely appear in his PFT report?
AResidual volume increased, total lung capacity decreased
BResidual volume normal, total lung capacity decreased
CResidual volume normal, total lung capacity normal
DResidual volume decreased, total lung capacity increased
EResidual volume increased, total lung capacity increased
A 60-year-old male is admitted to the ICU for severe hypertension complicated by a headache. The patient has a past medical history of insulin-controlled diabetes, hypertension, and hyperlipidemia. He smokes 2 packs of cigarettes per day. He states that he forgot to take his medications yesterday and started getting a headache about one hour ago. His vitals on admission are the following: blood pressure of 160/110 mmHg, pulse 95/min, temperature 98.6 deg F (37.2 deg C), and respirations 20/min. On exam, the patient has an audible abdominal bruit. After administration of antihypertensive medications, the patient has a blood pressure of 178/120 mmHg. The patient reports his headache has increased to a 10/10 pain level, that he has trouble seeing, and he can't move his extremities. After stabilizing the patient, what is the best next step to diagnose the patient's condition?
ADoppler ultrasound of the carotids
BCT head with intravenous contrast
CMRI head without intravenous contrast
DCT head without intravenous contrast
EMRI head with intravenous contrast
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