Medicine — Advanced Clinical Scenarios and Named Trials MCQs

Medicine · 14 free questions with answers & explanations.

1. The COMPASS trial studied rivaroxaban in stable coronary artery disease or peripheral artery disease. Its key finding was:
2. A 60-year-old man has a 3-month history of proximal muscle weakness (difficulty rising from chair, climbing stairs), elevated CK 4200 U/L, positive anti-Jo-1 antibody, and HRCT chest showing bilateral basal ground-glass opacities. The MOST likely diagnosis and the MOST important systemic association to screen for is:
3. A 55-year-old woman has episodic flushing, diarrhoea, and right-sided heart murmur. 24-hour urine 5-HIAA is 48 mg (normal <8 mg). CT abdomen shows a 1.5 cm ileal mass with multiple liver metastases. The PRIMARY mechanism of carcinoid heart disease and the PREFERRED initial treatment for symptomatic tumour control is:
4. Concerning therapeutic hypothermia (targeted temperature management, TTM) post-cardiac arrest, the landmark TTM2 trial (2021) changed practice by showing:
5. A 45-year-old man has serum sodium 122 mEq/L found incidentally. He has no symptoms. BP 128/80 mmHg, no oedema, skin turgor normal, urine osmolality 520 mOsm/kg, urine sodium 55 mEq/L, serum osmolality 258 mOsm/kg. He takes no diuretics and has no history of cardiac, renal, or liver disease. The MOST likely diagnosis and the CORRECT approach to correction is:
6. The SENIOR POISE trial showed that perioperative metoprolol in non-cardiac surgery patients at cardiovascular risk increased the rate of stroke. The presumed mechanism of this adverse outcome was:
7. A 68-year-old man is diagnosed with localised small-cell lung cancer (SCLC), limited-stage (disease confined to one hemithorax, encompassable in a radiation field). The CURRENT standard of care for limited-stage SCLC is:
8. A 30-year-old woman with SLE has been on hydroxychloroquine for 3 years. She develops new-onset seizures and psychosis despite normal anti-dsDNA and complement. MRI brain shows areas of cortical and white matter signal change. The MOST likely diagnosis and the specific antibody to test is:
9. Immune checkpoint inhibitors (PD-1/PD-L1 inhibitors) can cause immune-related adverse events (irAEs). A patient on pembrolizumab for melanoma develops new-onset severe diarrhoea (Grade 3, >7 stools/day above baseline). The CORRECT management is:
10. In the management of septic shock (Sepsis-3 definition), the SURVIVING SEPSIS CAMPAIGN (SSC) 2021 HOUR-1 BUNDLE requires completion of which actions within 1 hour of recognition?
11. A 70-year-old man with COPD and type 2 DM is admitted for community-acquired pneumonia (CAP). PSI/PORT score puts him in Class IV. Blood cultures and sputum are sent. Urine Legionella antigen and Streptococcus pneumoniae antigen tests are negative. Procalcitonin is 4.8 ng/mL. The MOST appropriate empirical antibiotic regimen for hospitalised non-ICU CAP per IDSA/ATS 2019 guidelines is:
12. A 62-year-old woman with type 2 diabetes mellitus presents with a 3-week history of low-grade fever, weight loss, and a right-sided pleural effusion. Thoracentesis shows exudative effusion (protein 5.4 g/dL, LDH 420 IU/L), lymphocyte predominance (85% lymphocytes), ADA (adenosine deaminase) 72 U/L. Pleural fluid AFB smear is negative. The MOST likely diagnosis and diagnostic test to confirm it is:
13. The RECOVER trial investigating long COVID (post-acute sequelae of SARS-CoV-2) identified the MOST common symptom cluster defining long COVID. Among the following, which symptom triad is MOST characteristic of post-COVID syndrome as per current WHO/CDC definitions?
14. A 55-year-old man has bilateral lower limb weakness progressing over 6 months, upper motor neuron signs (brisk reflexes, Babinski), lower motor neuron signs in the upper limbs (wasting, fasciculations), and dysarthria, but intact sensation and sphincters. MRI brain and spine show no compressive lesion. EMG shows widespread denervation. The MOST appropriate disease-modifying drug with proven survival benefit in this condition is: