Quiz Challenge

An elderly man presents with sudden-onset hemiparesis for 90 minutes. Non-contrast CT (NCCT) of the brain shows a hyperdense MCA sign. What is the most likely diagnosis?

A 60-year-old patient underwent total hip replacement surgery. On postoperative day 2, he develops acute confusion, irritability, and starts pulling out his IV line. Which of the following is the most appropriate tool for assessment of this patient?

A 25-year-old man is brought to the emergency department with marked respiratory depression, pinpoint pupils and altered consciousness. Opioid overdose is suspected. Which drug should be administered immediately?

A 25-year-old woman presents with severe, difficult-to-control hypertension. CT angiography demonstrates a characteristic “string-of-beads” appearance of the renal artery. What is the preferred revascularization procedure?

A patient with a midbrain lesion develops ipsilateral third-nerve palsy along with a coarse, irregular tremor that is present at rest and becomes more prominent with voluntary movement. Which structure is most likely involved?

A patient develops right-sided paralysis and loss of proprioception, along with loss of pain and temperature sensation on the left side below the level of the lesion. Where is the most likely spinal cord lesion?

An immunocompetent young adult presents with fever, headache and neck stiffness. CSF shows a lymphocytic pleocytosis, normal glucose and elevated protein. Which of the following viruses is a common cause of viral meningitis?

A 20-year-old woman has recurrent epistaxis and menorrhagia. Laboratory evaluation shows prolonged bleeding time, normal PT and mildly prolonged aPTT. Factor VIII activity is 50%. Which of the following is the most likely diagnosis?

A patient who underwent bariatric surgery develops shortness of breath, pedal edema and elevated JVP. Examination also reveals sensorimotor peripheral neuropathy. Which investigation is most useful for confirming thiamine deficiency?

A young adult presents with sudden hypotension, hypoglycemia and features of acute adrenal insufficiency. He rapidly deteriorates and dies. Post-mortem examination reveals bilateral adrenal gland hemorrhage, and blood culture/skin lesions are positive for Neisseria meningitidis. What is the most likely diagnosis?

A 65-year-old man with chronic HFrEF remains symptomatic despite guideline-directed medical therapy. Vericiguat is added to his treatment regimen. Which of the following best describes the mechanism of action of vericiguat?

A 22-year-old patient is found to have hypocalcemia (serum calcium 6.8 mg/dL) with an elevated PTH level. Despite increased PTH secretion, the target organs show resistance to its action. Which of the following is the most likely diagnosis?

A 28-year-old woman with an inflammatory joint disorder is treated with prednisolone and ibuprofen. These drugs act at different steps of the arachidonic acid pathway. Which of the following correctly describes their sites of action?

A 40-year-old man with hypertension is found to have elevated aldosterone levels that remain unsuppressed after a saline infusion suppression test, confirming primary aldosteronism. What is the next best investigation to identify a possible adrenal cause?

A 55-year-old man with heart failure has been receiving spironolactone for several months. He develops progressive bilateral gynecomastia. Which of the following mechanisms is primarily responsible for this adverse effect?

A 55-year-old patient develops a QT-prolongation–associated ventricular arrhythmia with a serum potassium of 2.0 mEq/L. Despite adequate intravenous potassium replacement, the hypokalemia persists. Which of the following electrolyte abnormalities is the most likely cause of refractory hypokalemia?

A 4-year-old child is brought to the emergency department with irritability and palpitations. His blood pressure is normal and he is hemodynamically stable. ECG shows a regular narrow-complex tachycardia at 250/min, consistent with paroxysmal supraventricular tachycardia (PSVT). What is the most appropriate immediate pharmacological treatment?

A 30-year-old woman presents with severe headache for 2 weeks and a new-onset seizure. MRI brain shows multiple small cystic lesions scattered within the brain parenchyma. Which of the following is the most likely causative organism?

A 62-year-old man presents with sudden-onset tearing chest pain. Examination reveals a significant difference in blood pressure between the two arms, and chest X-ray shows a widened mediastinum. He is hemodynamically stable. Which of the following is the best initial imaging modality to confirm the diagnosis?

A 55-year-old man presents with slowness of movements and cogwheel rigidity. He has been working for several years in a steel plant. Which of the following occupational exposures is most likely responsible for his presentation?

A 25-year-old patient is diagnosed with severe aplastic anemia. He has no suitable donor for hematopoietic stem-cell transplantation. Which of the following is the most appropriate initial treatment?

A pregnant woman develops acute shortness of breath 3 hours after receiving a blood transfusion. Examination and chest imaging reveal bilateral pulmonary infiltrates consistent with non-cardiogenic pulmonary edema. There is no evidence of circulatory overload. What is the most likely diagnosis?

A patient is undergoing total intravenous anesthesia (TIVA) for a short surgical procedure. An opioid with an extremely rapid onset and offset of action is selected, allowing rapid recovery after discontinuation. Which of the following opioids is most likely being used?

A 30-year-old woman taking a combined oral contraceptive pill (OCP) is diagnosed with pulmonary tuberculosis and started on a rifampicin-containing antitubercular regimen. She subsequently develops an unintended pregnancy despite regular OCP use. Which of the following best explains this interaction?