20 Comprehensive MD Medicine Final Exam Questions
The following 20 questions cover key medical knowledge areas essential for physician competency, focusing on critical aspects of cardiovascular medicine, critical care, and clinical reasoning that directly impact patient morbidity and mortality.
Cardiovascular Medicine Questions
A 68-year-old male presents with new-onset atrial fibrillation. His CHA₂DS₂-VASc score is 3. Which of the following is the most appropriate antithrombotic therapy to reduce mortality risk?
- A) Aspirin 81mg daily
- B) Clopidogrel 75mg daily
- C) Direct oral anticoagulant
- D) No antithrombotic therapy
- E) Dual antiplatelet therapy
A 54-year-old woman with heart failure with reduced ejection fraction (EF 30%) remains symptomatic despite optimal doses of an ACE inhibitor and beta-blocker. Which medication would most significantly reduce mortality in this patient?
- A) Digoxin
- B) Spironolactone
- C) Hydralazine
- D) Furosemide
- E) Ranolazine
Which hemodynamic finding is most consistent with cardiogenic shock?
- A) Cardiac index >2.5 L/min/m², PCWP 8 mmHg
- B) Cardiac index <2.2 L/min/m², PCWP >18 mmHg
- C) Cardiac index >3.0 L/min/m², PCWP 12 mmHg
- D) Cardiac index <2.2 L/min/m², PCWP <10 mmHg
- E) Cardiac index 2.5 L/min/m², PCWP 14 mmHg
A 72-year-old male with hypertension is started on lisinopril. Which electrolyte abnormality requires closest monitoring?
- A) Hyponatremia
- B) Hyperkalemia
- C) Hypocalcemia
- D) Hypomagnesemia
- E) Hypophosphatemia
In a patient with acute decompensated heart failure and hypotension (BP 85/50 mmHg), which inotropic agent is most appropriate as initial therapy?
- A) Milrinone
- B) Dobutamine
- C) Dopamine
- D) Epinephrine
- E) Norepinephrine
Critical Care Medicine Questions
A 65-year-old intubated patient has the following arterial blood gas: pH 7.28, PaCO₂ 60 mmHg, PaO₂ 58 mmHg, HCO₃⁻ 28 mEq/L. Which ventilator adjustment is most appropriate?
- A) Increase respiratory rate
- B) Increase tidal volume
- C) Decrease PEEP
- D) Increase FiO₂
- E) Decrease inspiratory pressure
A 58-year-old post-cardiac surgery patient develops hypotension and decreased cardiac output. Bedside echocardiography shows right ventricular dilation and interventricular septal flattening. What is the most likely diagnosis?
- A) Cardiogenic shock
- B) Hypovolemic shock
- C) Right ventricular failure
- D) Left ventricular failure
- E) Distributive shock
A 70-year-old patient with septic shock requires vasopressor support. Which of the following is the first-line vasopressor recommended to improve mortality?
- A) Dopamine
- B) Epinephrine
- C) Norepinephrine
- D) Phenylephrine
- E) Vasopressin
Which of the following findings is most consistent with tamponade physiology?
- A) Elevated JVP, pulsus paradoxus >10 mmHg, electrical alternans
- B) Elevated JVP, narrow pulse pressure, S3 gallop
- C) Elevated JVP, Kussmaul's sign, pericardial knock
- D) Low JVP, pulsus paradoxus >10 mmHg, distant heart sounds
- E) Low JVP, wide pulse pressure, S4 gallop
A 45-year-old patient with ARDS has PaO₂/FiO₂ ratio of 80 mmHg despite optimal ventilator settings. Which intervention has shown mortality benefit in this scenario?
- A) High-frequency oscillatory ventilation
- B) Prone positioning
- C) Inhaled nitric oxide
- D) Surfactant administration
- E) Extracorporeal CO₂ removal
Pharmacology Questions
A patient on warfarin therapy (INR 2.8) requires urgent surgery. Which agent is most appropriate for rapid warfarin reversal?
- A) Fresh frozen plasma
- B) Vitamin K (oral)
- C) Prothrombin complex concentrate
- D) Recombinant factor VIIa
- E) Tranexamic acid
A 62-year-old diabetic patient on lisinopril develops a persistent dry cough. Which antihypertensive medication would be most appropriate to substitute?
- A) Amlodipine
- B) Hydrochlorothiazide
- C) Losartan
- D) Metoprolol
- E) Clonidine
Which medication combination poses the highest risk for hyperkalemia in a patient with chronic kidney disease?
- A) Lisinopril and spironolactone
- B) Amlodipine and hydrochlorothiazide
- C) Metoprolol and hydralazine
- D) Losartan and furosemide
- E) Clonidine and nifedipine
Clinical Reasoning Questions
A 58-year-old male presents with sudden-onset chest pain radiating to the back, blood pressure 210/110 mmHg in right arm and 150/90 mmHg in left arm. Which diagnostic test should be performed first?
- A) Exercise stress test
- B) CT angiography of the chest
- C) Transthoracic echocardiogram
- D) Coronary angiography
- E) V/Q scan
A 72-year-old female with atrial fibrillation on dabigatran presents with acute confusion and right-sided weakness. Her CT head shows an intracerebral hemorrhage. What is the most appropriate next step?
- A) Administer vitamin K
- B) Administer protamine sulfate
- C) Administer idarucizumab
- D) Administer fresh frozen plasma
- E) Immediate neurosurgical intervention
A 45-year-old male with no prior cardiac history presents with acute chest pain, ST-segment elevation in leads II, III, and aVF, and hypotension. Which complication should be immediately ruled out?
- A) Papillary muscle rupture
- B) Right ventricular infarction
- C) Left ventricular aneurysm
- D) Pericarditis
- E) Dressler syndrome
A 60-year-old male with history of MI develops sudden dyspnea, hypotension, and a new holosystolic murmur. Which echocardiographic finding would most likely confirm the diagnosis?
- A) Severe aortic stenosis
- B) Ventricular septal defect
- C) Mitral valve prolapse
- D) Aortic dissection
- E) Pericardial effusion
A 50-year-old female with lupus presents with progressive dyspnea. Echocardiogram shows LVEF 60% and estimated pulmonary artery systolic pressure of 65 mmHg. Right heart catheterization reveals mean pulmonary artery pressure 35 mmHg, PCWP 8 mmHg, and PVR 6 Wood units. What is the most likely diagnosis?
- A) Left heart failure with preserved ejection fraction
- B) Pulmonary arterial hypertension
- C) Chronic thromboembolic pulmonary hypertension
- D) Pulmonary hypertension due to lung disease
- E) Pulmonary veno-occlusive disease
A 68-year-old male with ischemic cardiomyopathy (EF 25%) and NYHA Class III symptoms has a QRS duration of 160 ms with left bundle branch block morphology. Which intervention has been shown to reduce mortality in this patient?
- A) Implantable cardioverter-defibrillator only
- B) Cardiac resynchronization therapy only
- C) Cardiac resynchronization therapy with defibrillator
- D) Permanent pacemaker
- E) Left ventricular assist device
A 55-year-old male with hypertension presents with headache and BP 220/120 mmHg. Fundoscopic exam shows papilledema and flame hemorrhages. Which antihypertensive regimen is most appropriate to reduce end-organ damage and mortality?
- A) Oral clonidine
- B) Intravenous labetalol
- C) Sublingual nifedipine
- D) Oral amlodipine
- E) Intravenous nitroprusside with arterial line monitoring
These questions are designed based on the American College of Cardiology competency guidelines 1 and focus on critical knowledge areas that directly impact patient morbidity and mortality in cardiovascular and critical care medicine.