UWorld UWorld High-Yield Clinical Vignettes 1 — Questions and Answers
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?
- Inferior STEMI (Correct answer)
- Stable angina
- Pulmonary embolism
- Aortic dissection
Correct answer: Inferior STEMI
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?
- Start levothyroxine therapy (Correct answer)
- Order a thyroid ultrasound immediately
- Refer for thyroid surgery
- Prescribe propylthiouracil
Correct answer: Start levothyroxine therapy
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?
- Small cell lung carcinoma (Correct answer)
- Squamous cell carcinoma
- Adenocarcinoma of the lung
- Pulmonary carcinoid tumor
Correct answer: Small cell lung carcinoma
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?
- Systemic lupus erythematosus with lupus nephritis (Correct answer)
- Rheumatoid arthritis with renal involvement
- Sjögren syndrome
- Dermatomyositis
Correct answer: Systemic lupus erythematosus with lupus nephritis
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?
- Minimal change disease (Correct answer)
- Focal segmental glomerulosclerosis
- IgA nephropathy
- Membranous nephropathy
Correct answer: Minimal change disease
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.
Question 6: A 45-year-old male presents with severe epigastric pain radiating to the back, nausea, vomiting, and a serum lipase three times the upper limit of normal after a weekend of heavy alcohol use. What is the most appropriate initial management?
- IV fluid resuscitation, bowel rest (NPO), and pain management (Correct answer)
- Emergency ERCP
- Immediate surgical consultation for pancreatectomy
- Oral pancreatic enzyme replacement
Correct answer: IV fluid resuscitation, bowel rest (NPO), and pain management
Acute pancreatitis is initially managed with aggressive IV fluid resuscitation, NPO status, and analgesics; surgery is reserved for complications such as infected necrosis.
UWorld UWorld High-Yield Clinical Vignettes 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?