A COMPREHENSIVE STUDY GUIDE ON CLINICAL SKILLS
READINESS TEST (QUESTIONS AND CORRECT ANSWERS)
FALL SERIES JULY/AUG 2026
1. A 68-year-old male with a history of hypertension and type 2
diabetes presents with acute onset of severe, tearing chest pain
that radiates to his back. His blood pressure is 180/100 mmHg in
the right arm and 140/80 mmHg in the left arm. What is the most
appropriate initial diagnostic imaging study?
A. Chest X-ray
B. Transthoracic Echocardiogram
C. Computed Tomography Angiography (CTA) of the chest
D. Magnetic Resonance Angiography (MRA)
Correct Answer: C
Explanation: An acute aortic dissection is suspected based on the
classic presentation. CTA of the chest is the initial imaging
modality of choice due to its high sensitivity, specificity, and rapid
availability, providing clear visualization of the aortic intimal flap.
A chest X-ray may be abnormal but is not diagnostic. An
echocardiogram, especially transthoracic, has limited sensitivity
for visualizing the thoracic aorta. MRA takes too long and is not
readily available in an acute setting.
2. A 45-year-old female with a history of asthma is brought to the
emergency department in respiratory distress. She is unable to
speak in full sentences and has a silent chest on auscultation. Her
, heart rate is 125 bpm and respiratory rate is 30/min. Which of the
following is the most appropriate immediate management step?
A. Administer high-flow oxygen and nebulized albuterol
B. Start continuous positive airway pressure (CPAP)
C. Prepare for immediate endotracheal intubation
D. Administer intravenous magnesium sulfate
Correct Answer: C
Explanation: A silent chest in a patient with severe asthma
indicates extremely poor air movement and is a sign of impending
respiratory failure. The inability to speak in full sentences and
tachypnea with tachycardia further suggest a life-threatening
exacerbation. Immediate endotracheal intubation is the most
appropriate step to secure the airway and provide ventilatory
support. While nebulized albuterol, magnesium, and CPAP may be
considered, they should not delay intubation in this critical
scenario.
3. In a patient with suspected diabetic ketoacidosis (DKA), which of
the following laboratory findings is most consistent with this
diagnosis?
A. Serum pH 7.32, Bicarbonate 18 mEq/L, Serum osmolality 300
mOsm/kg, Anion gap 8
B. Serum pH 7.25, Bicarbonate 15 mEq/L, Serum osmolality 320
mOsm/kg, Anion gap 22
C. Serum pH 7.38, Bicarbonate 24 mEq/L, Serum osmolality 290
mOsm/kg, Anion gap 12
D. Serum pH 7.45, Bicarbonate 28 mEq/L, Serum osmolality 310
mOsm/kg, Anion gap 5
, Correct Answer: B
Explanation: DKA is characterized by a metabolic acidosis (low pH
and bicarbonate), elevated serum osmolality due to
hyperglycemia, and an elevated anion gap metabolic acidosis
(anion gap >12). Option B shows all these features: low pH and
bicarbonate, high osmolality, and a significantly elevated anion
gap of 22. Option A has a normal anion gap. Option C shows
normal values. Option D shows metabolic alkalosis.
4. A 32-year-old woman at 34 weeks gestation presents with a
history of headache, blurred vision, and right upper quadrant
pain. Her blood pressure is 165/105 mmHg and she has 3+
proteinuria on a urine dipstick. Which of the following is the most
appropriate initial pharmacological therapy?
A. Labetalol
B. Nifedipine
C. Methyldopa
D. Magnesium sulfate
Correct Answer: D
Explanation: The patient is showing signs of severe preeclampsia
(headache, visual changes, epigastric pain, severe hypertension,
and proteinuria). Magnesium sulfate is the agent of choice for
seizure prophylaxis in preeclampsia with severe features and
should be initiated immediately. While antihypertensives like
labetalol, nifedipine, or methyldopa are used to control blood
pressure, preventing eclampsia with magnesium sulfate is the
critical first step.
, 5. A 55-year-old male presents with a 2-hour history of acute onset
of right-sided weakness and difficulty speaking. His last known
normal was 1.5 hours ago. A non-contrast CT head shows no
evidence of hemorrhage. What is the most critical factor in
deciding whether to administer intravenous alteplase (tPA)?
A. The patient's blood pressure is 150/90 mmHg
B. The patient is on an anticoagulant
C. The patient's age
D. The patient's National Institutes of Health Stroke Scale (NIHSS)
score
Correct Answer: B
Explanation: In a patient who is a potential candidate for IV tPA, it
is crucial to rule out absolute contraindications. Being on an
anticoagulant is a major exclusion criterion, as it significantly
increases the risk of intracranial hemorrhage. While blood
pressure, age, and NIHSS are important factors in the overall
assessment and risk-benefit analysis, current anticoagulant use is
an absolute contraindication and is the most critical factor to
determine before proceeding.
6. A 60-year-old male with a 40-pack-year smoking history presents
with a chronic cough, hemoptysis, and weight loss. His chest X-ray
reveals a suspicious mass in the right upper lobe. A biopsy
confirms small cell lung cancer (SCLC). Which of the following
paraneoplastic syndromes is most commonly associated with this
type of lung cancer?
READINESS TEST (QUESTIONS AND CORRECT ANSWERS)
FALL SERIES JULY/AUG 2026
1. A 68-year-old male with a history of hypertension and type 2
diabetes presents with acute onset of severe, tearing chest pain
that radiates to his back. His blood pressure is 180/100 mmHg in
the right arm and 140/80 mmHg in the left arm. What is the most
appropriate initial diagnostic imaging study?
A. Chest X-ray
B. Transthoracic Echocardiogram
C. Computed Tomography Angiography (CTA) of the chest
D. Magnetic Resonance Angiography (MRA)
Correct Answer: C
Explanation: An acute aortic dissection is suspected based on the
classic presentation. CTA of the chest is the initial imaging
modality of choice due to its high sensitivity, specificity, and rapid
availability, providing clear visualization of the aortic intimal flap.
A chest X-ray may be abnormal but is not diagnostic. An
echocardiogram, especially transthoracic, has limited sensitivity
for visualizing the thoracic aorta. MRA takes too long and is not
readily available in an acute setting.
2. A 45-year-old female with a history of asthma is brought to the
emergency department in respiratory distress. She is unable to
speak in full sentences and has a silent chest on auscultation. Her
, heart rate is 125 bpm and respiratory rate is 30/min. Which of the
following is the most appropriate immediate management step?
A. Administer high-flow oxygen and nebulized albuterol
B. Start continuous positive airway pressure (CPAP)
C. Prepare for immediate endotracheal intubation
D. Administer intravenous magnesium sulfate
Correct Answer: C
Explanation: A silent chest in a patient with severe asthma
indicates extremely poor air movement and is a sign of impending
respiratory failure. The inability to speak in full sentences and
tachypnea with tachycardia further suggest a life-threatening
exacerbation. Immediate endotracheal intubation is the most
appropriate step to secure the airway and provide ventilatory
support. While nebulized albuterol, magnesium, and CPAP may be
considered, they should not delay intubation in this critical
scenario.
3. In a patient with suspected diabetic ketoacidosis (DKA), which of
the following laboratory findings is most consistent with this
diagnosis?
A. Serum pH 7.32, Bicarbonate 18 mEq/L, Serum osmolality 300
mOsm/kg, Anion gap 8
B. Serum pH 7.25, Bicarbonate 15 mEq/L, Serum osmolality 320
mOsm/kg, Anion gap 22
C. Serum pH 7.38, Bicarbonate 24 mEq/L, Serum osmolality 290
mOsm/kg, Anion gap 12
D. Serum pH 7.45, Bicarbonate 28 mEq/L, Serum osmolality 310
mOsm/kg, Anion gap 5
, Correct Answer: B
Explanation: DKA is characterized by a metabolic acidosis (low pH
and bicarbonate), elevated serum osmolality due to
hyperglycemia, and an elevated anion gap metabolic acidosis
(anion gap >12). Option B shows all these features: low pH and
bicarbonate, high osmolality, and a significantly elevated anion
gap of 22. Option A has a normal anion gap. Option C shows
normal values. Option D shows metabolic alkalosis.
4. A 32-year-old woman at 34 weeks gestation presents with a
history of headache, blurred vision, and right upper quadrant
pain. Her blood pressure is 165/105 mmHg and she has 3+
proteinuria on a urine dipstick. Which of the following is the most
appropriate initial pharmacological therapy?
A. Labetalol
B. Nifedipine
C. Methyldopa
D. Magnesium sulfate
Correct Answer: D
Explanation: The patient is showing signs of severe preeclampsia
(headache, visual changes, epigastric pain, severe hypertension,
and proteinuria). Magnesium sulfate is the agent of choice for
seizure prophylaxis in preeclampsia with severe features and
should be initiated immediately. While antihypertensives like
labetalol, nifedipine, or methyldopa are used to control blood
pressure, preventing eclampsia with magnesium sulfate is the
critical first step.
, 5. A 55-year-old male presents with a 2-hour history of acute onset
of right-sided weakness and difficulty speaking. His last known
normal was 1.5 hours ago. A non-contrast CT head shows no
evidence of hemorrhage. What is the most critical factor in
deciding whether to administer intravenous alteplase (tPA)?
A. The patient's blood pressure is 150/90 mmHg
B. The patient is on an anticoagulant
C. The patient's age
D. The patient's National Institutes of Health Stroke Scale (NIHSS)
score
Correct Answer: B
Explanation: In a patient who is a potential candidate for IV tPA, it
is crucial to rule out absolute contraindications. Being on an
anticoagulant is a major exclusion criterion, as it significantly
increases the risk of intracranial hemorrhage. While blood
pressure, age, and NIHSS are important factors in the overall
assessment and risk-benefit analysis, current anticoagulant use is
an absolute contraindication and is the most critical factor to
determine before proceeding.
6. A 60-year-old male with a 40-pack-year smoking history presents
with a chronic cough, hemoptysis, and weight loss. His chest X-ray
reveals a suspicious mass in the right upper lobe. A biopsy
confirms small cell lung cancer (SCLC). Which of the following
paraneoplastic syndromes is most commonly associated with this
type of lung cancer?
