A 58-year-old male with a history of hypertension, smoking, and recent hip replacement surgery presents with sudden-onset dyspnea, pleuritic chest pain, and tachycardia. His oxygen saturation is 88% on room air. A CT pulmonary angiogram (CTPA) is performed and shows a large embolus in the right pulmonary artery. Which of the following is the most appropriate initial management?

A 22-year-old male presents to the ER with sudden sharp chest pain, tachypnea, and decreased breath sounds on the right side. He has no significant past medical history. On physical examination, the trachea is midline, and breath sounds are absent on the right hemithorax. A chest x-ray reveals a large right-sided pneumothorax. What is the most appropriate next step in management?

A 45-year-old woman with systemic lupus erythematosus (SLE) on immunosuppressive therapy presents with fever, cough, and shortness of breath. A chest x-ray shows multiple infiltrates. A sputum culture grows Histoplasma capsulatum. What is the most likely risk factor for this patient’s fungal pneumonia?

A 30-year-old woman presents with acute epigastric pain radiating to her back, nausea, and vomiting. Laboratory tests reveal an elevated amylase and lipase level (5 times the normal limit). Abdominal ultrasound shows a normal gallbladder. What is the most likely etiology of her acute pancreatitis?

A 55-year-old man presents with hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI). He has a recent history of diarrhea. Laboratory results show schistocytes on peripheral smear and a positive stool culture for Shiga toxin-producing Escherichia coli (STEC). What is the most likely diagnosis?

A 58-year-old man with acute kidney injury (AKI) secondary to septic shock is not responding to medical management with fluids and vasopressors. He is oliguric with rising creatinine levels, and his acid base status is worsening. Which of the following is the most appropriate treatment option for this patient?

A 45-year-old woman with acute respiratory distress syndrome (ARDS) due to severe pneumonia is being mechanically ventilated but is not responding to conventional therapies. Her oxygenation remains poor despite high levels of PEEP and FiO2. Her physicians decide to initiate ECMO. Which of the following is the most likely indication for starting ECMO in this patient?

A 30-year-old man with a recent diagnosis of systemic lupus erythematosus (SLE) develops worsening renal failure, hematuria, and hypertension. His laboratory results show low complement levels, elevated anti-dsDNA antibodies, and proteinuria. Despite treatment with steroids and immunosuppressants, his condition deteriorates. What is the most appropriate next step in management?

A 35-year-old woman presents with recurrent venous thromboembolic events despite being on warfarin therapy. Her family history is significant for multiple relatives with deep vein thrombosis (DVT) and pulmonary embolism (PE). Which of the following genetic disorders is most likely responsible for her recurrent clotting?

A 60-year-old woman is admitted for heart failure exacerbation. She is receiving furosemide for diuresis. Her electrolytes are as follows: Sodium 134 mEq/L, Potassium 2.6 mEq/L, Chloride 98 mEq/L, Bicarbonate 28 mEq/L. She is complaining of muscle weakness, palpitations, and constipation. What is the most likely cause of her symptoms?

A 70-year-old woman with a history of atrial fibrillation on warfarin presents with sudden shortness of breath and pleuritic chest pain. A CT pulmonary angiogram reveals a large embolus in the right lower lobe. Her INR is 2.0. Which of the following is the next step in management?

A 70-year-old man with chronic obstructive pulmonary disease (COPD) and a history of corticosteroid use presents with cough, fever, and shortness of breath. A chest CT scan reveals multiple nodules and a cavity in the right upper lobe. Sputum culture grows Aspergillus fumigatus. What is the most appropriate next step in management?

A 45-year-old man presents with fatigue, pallor, and abdominal pain. Laboratory findings include hemolytic anemia (elevated LDH, decreased haptoglobin), thrombocytopenia, and acute kidney injury (creatinine 2.5 mg/dL). Peripheral blood smear shows schistocytes. His recent history includes a gastrointestinal illness with diarrhea. What is the most likely diagnosis?

A 30-year-old woman presents with heavy menstrual bleeding and a history of easy bruising. Lab results show a prolonged activated partial thromboplastin time (aPTT), normal prothrombin time (PT), and normal platelet count. Mixing studies show no correction of the aPTT. Which of the following is the most likely diagnosis?

A 60-year-old woman with heart failure and chronic kidney disease is admitted for an exacerbation of her symptoms. She is on furosemide and an ACE inhibitor. Laboratory results show:  Sodium 135 mEq/L  Potassium 5.6 mEq/L  Bicarbonate 20 mEq/L  Creatinine 2.4 mg/dL (baseline 1.8 mg/dL) She complains of generalized weakness and palpitations. Which of the following is the most likely cause of her symptoms?

A 55-year-old male with a history of diabetes and chronic corticosteroid use presents with fever, cough, and weight loss. Chest CT reveals multiple, asymmetric, cavitary lesions with surrounding consolidation. Sputum culture grows Aspergillus fumigatus. Which of the following is the most appropriate treatment for this patient?

A 70-year-old woman is admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD). On day 2 of hospitalization, she develops sudden-onset dyspnea and pleuritic chest pain. A chest CT shows a pulmonary embolism in the left lower lobe. She is not hypotensive or in shock. What is the most appropriate next step in management?

A 25-year-old woman with no significant past medical history presents with a history of spontaneous deep vein thrombosis (DVT) at the age of 20. Laboratory workup shows an elevated homocysteine level and a normal Factor V Leiden mutation test. Which of the following is the most likely underlying cause?

A 40-year-old man presents with weakness, confusion, and vomiting. He has a history of chronic alcohol use and is admitted for acute pancreatitis. His electrolytes are as follows: Sodium 120 mEq/L, Potassium 3.2 mEq/L, Chloride 85 mEq/L, Bicarbonate 16 mEq/L. What is the most likely cause of his hyponatremia?

A 40-year-old woman with a history of obesity, recent oral contraceptive use, and smoking presents with pleuritic chest pain and shortness of breath. A CT pulmonary angiogram confirms a pulmonary embolism in the right lower lobe. What is the most appropriate long-term management strategy for this patient?

A 25-year-old male with no significant medical history presents to the emergency department with sudden-onset pleuritic chest pain and shortness of breath. He has a history of smoking and reports no recent trauma. Physical examination reveals decreased breath sounds on the left side, and a chest X-ray shows a large left-sided pneumothorax. What is the next step in management?

A 45-year-old male with no significant medical history presents with deep vein thrombosis (DVT) despite no obvious risk factors. Lab results reveal an elevated homocysteine level. What is the most appropriate management for this patient?

A 55-year-old male with a history of heavy alcohol use presents with severe upper abdominal pain radiating to the back. His labs reveal elevated lipase, amylase, and liver enzymes. His abdominal CT shows diffuse pancreatic inflammation without pancreatic necrosis. What is the most appropriate initial treatment for this patient?

A 45-year-old woman with a history of obesity and a recent cesarean section presents with sudden-onset dyspnea and pleuritic chest pain. A chest CT angiogram confirms a large pulmonary embolism in the right lower lobe. Her vital signs are stable, and she is not hypotensive. What is the most appropriate management?

A 60-year-old woman with a history of heart failure and chronic kidney disease presents with confusion and weakness. Her labs reveal:  Sodium 118 mEq/L  Potassium 3.1 mEq/L  Creatinine 3.0 mg/dL (baseline 1.5 mg/dL)  Bicarbonate 23 mEq/L What is the most likely cause of her hyponatremia?

A 25-year-old woman presents with recurrent pregnancy losses. Lab work reveals the following:  Positive lupus anticoagulant  Positive anti-cardiolipin antibody  Normal prothrombin time (PT)  Normal activated partial thromboplastin time (aPTT) What is the most likely diagnosis?

A 45-year-old man with HIV presents with a 3-week history of cough, fever, and weight loss. His CD4 count is 100 cells/µL. A chest X-ray shows bilateral infiltrates. A bronchoscopy with lavage grows Histoplasma capsulatum. What is the most appropriate treatment for this patient?

A 60-year-old man presents with severe epigastric pain, nausea, and vomiting. His amylase and lipase levels are significantly elevated. A CT scan shows pancreatic edema without necrosis. What is the most appropriate next step in management?

A 38-year-old woman with severe acute respiratory distress syndrome (ARDS) is intubated and mechanically ventilated, but her oxygenation continues to deteriorate despite optimal ventilator settings. The decision is made to initiate extracorporeal membrane oxygenation (ECMO). What is the most important consideration before starting ECMO?

A 70-year-old male with acute kidney injury secondary to septic shock is being considered for continuous renal replacement therapy (CRRT). What is the most important factor to consider when deciding to initiate CRRT?

A 62-year-old man with a history of atrial fibrillation, hypertension, and recent hip surgery presents with sudden-onset pleuritic chest pain, shortness of breath, and tachypnea. His vital signs are as follows: blood pressure 120/80 mmHg, heart rate 110 bpm, respiratory rate 24/min, and oxygen saturation 92%. A CT pulmonary angiogram confirms a pulmonary embolism (PE) in the right main pulmonary artery. Which of the following is the best initial treatment?

A 34-year-old male with no significant medical history presents to the emergency department with sudden chest pain and dyspnea. He is a smoker and reports a prior episode of spontaneous pneumothorax 2 years ago. On examination, he is tachypneic with decreased breath sounds on the right side. A chest X-ray confirms a small, right-sided pneumothorax. What is the most appropriate management?

A 28-year-old woman with a history of recurrent miscarriage and a positive lupus anticoagulant test presents for evaluation of her thrombophilia risk. She is also positive for anti-cardiolipin antibodies. What is the most appropriate management to reduce her risk of thrombosis and pregnancy loss?

A 58-year-old man with a history of poorly controlled diabetes presents with fever, cough, and hemoptysis. His chest X-ray shows a right upper lobe mass with cavitation. Sputum culture grows Aspergillus fumigatus. What is the most appropriate treatment?

A 50-year-old male with a history of heavy alcohol use presents with sudden-onset epigastric pain radiating to the back. His labs reveal elevated serum lipase and amylase. A CT scan of the abdomen shows diffuse pancreatic inflammation. What is the most important initial step in management?

A 65-year-old woman with a history of heart failure is admitted with worsening dyspnea. Her electrolytes are as follows:  Sodium 128 mEq/L  Potassium 3.5 mEq/L  Bicarbonate 21 mEq/L  Creatinine 2.2 mg/dL What is the most likely cause of her hyponatremia?

A 72-year-old man with septic shock and acute kidney injury is started on continuous renal replacement therapy (CRRT). His blood pressure is difficult to control, and he is oliguric despite aggressive fluid resuscitation. Which of the following is the most common complication of CRRT?

A 28-year-old woman with acute respiratory distress syndrome (ARDS) from pneumonia is being considered for extracorporeal membrane oxygenation (ECMO) due to worsening hypoxia despite maximal ventilatory support. What is the most appropriate next step in management?

A 50-year-old man presents with acute-onset muscle weakness, periorbital edema, and respiratory distress. His labs reveal:  Creatine kinase (CK) 12,000 U/L  Positive anti-acetylcholine receptor antibodies What is the most appropriate next step in management?

A 35-year-old woman presents with recurrent deep vein thrombosis (DVT) and a positive factor V Leiden mutation test. What is the most appropriate long-term management for this patient?

A 22-year-old male presents to the emergency department with acute left-sided chest pain and dyspnea following a soccer match. He is a smoker and has no history of trauma. On examination, his breath sounds are decreased on the left side. A chest X-ray confirms a small pneumothorax. What is the appropriate next step in management?

A 24-year-old female with a history of recurrent miscarriage is diagnosed with antiphospholipid syndrome (APS). What is the most appropriate management for preventing future pregnancy loss?

A 42-year-old male presents with severe epigastric pain and vomiting after a heavy meal. He has a history of alcohol use disorder. His labs show elevated amylase and lipase levels. A CT scan reveals pancreatic enlargement without necrosis. What is the most important aspect of initial management?

A 60-year-old immunocompromised male with a history of chronic granulomatous disease presents with fever, cough, and purulent sputum. A chest CT shows multiple nodules with surrounding ground-glass opacities. What is the most likely pathogen responsible for his pneumonia?

A 32-year-old woman with a history of deep vein thrombosis (DVT) presents with a positive factor V Leiden mutation test. What is the most appropriate long-term anticoagulation therapy for her?

A 36-year-old female with severe ARDS secondary to viral pneumonia is not improving despite maximal ventilator support. Her oxygenation remains poor, and she is in severe respiratory distress. What is the next best step in management?

A 74-year-old male with heart failure presents with altered mental status, weakness, and nausea. His labs show:  Sodium 130 mEq/L  Potassium 5.8 mEq/L  Creatinine 2.4 mg/dL  Bicarbonate 24 mEq/L What is the most likely cause of his hyponatremia and hyperkalemia?

A 42-year-old female presents with a history of recurrent deep vein thrombosis (DVT) and is found to have antithrombin III deficiency. What is the most appropriate management for her?

A 70-year-old man with chronic obstructive pulmonary disease (COPD) presents with fever, cough, and hemoptysis. His chest CT scan shows consolidation with a cavitary lesion in the right upper lobe. Sputum culture is positive for Aspergillus. What is the best next step in treatment?

A 40-year-old woman presents to the emergency department with shortness of breath, pleuritic chest pain, and tachycardia. She has a history of oral contraceptive use and recent travel. A CT pulmonary angiogram confirms a pulmonary embolism (PE). What is the next step in management?