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12 questions
A 65-year-old man with hypertension presents with sudden severe chest pain radiating to his back and asymmetric blood pressures in the arms. Initial ECG is non-diagnostic. Which diagnostic test most rapidly confirms the suspected diagnosis?
A young woman presents with pleuritic chest pain and sudden dyspnea after a long flight. Exam shows tachycardia and low-grade fever. Which combination of tests best establishes the diagnosis and assesses clot burden?
A patient presents with fever, productive cough, and focal crackles on lung exam. Lab shows leukocytosis with left shift. Which finding most strongly favors bacterial lobar pneumonia over viral bronchitis?
An elderly patient with chronic atrial fibrillation on warfarin presents with sudden left leg pain, pallor, and absent distal pulses. Which immediate diagnostic step most directly confirms arterial occlusion?
A 28-year-old presents with polyuria, polydipsia, weight loss, and ketonuria. Serum glucose is 420 mg/dL. Which test most reliably distinguishes type 1 from type 2 diabetes in this acute presentation?
A patient with progressive proximal muscle weakness and elevated creatine kinase undergoes evaluation. Which finding most supports inflammatory myopathy (polymyositis) over a neurogenic cause?
A normal chest x-ray reliably excludes pulmonary embolism in a patient with high clinical pretest probability.
In suspected acute bacterial meningitis, delaying lumbar puncture to administer empiric antibiotics reduces mortality compared with waiting for imaging in patients with signs of increased intracranial pressure.
An isolated elevated alkaline phosphatase with normal gamma-glutamyl transferase (GGT) is more suggestive of bone disease than cholestatic liver disease.
A 54-year-old smoker presents with 3 months of progressive cough, weight loss, and left-sided shoulder pain. Chest x-ray shows a left apical mass. Describe your stepwise diagnostic approach linking history, exam, labs, and imaging to reach a differential and next diagnostic steps.
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Match each physical exam finding with the most likely associated diagnosis: