Barkley Review Post-Test Practice Exam 2
Question and Answers with Rationales Top
rated Latest Version
Question 1
A 62-year-old man with hypertension, type 2 diabetes, and hyperlipidemia presents with
crushing substernal chest pain radiating to the left arm for 45 minutes. ECG demonstrates ST-
segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Correct Answer: C. Right coronary artery
Rationale
Inferior STEMI is identified by ST-segment elevation in leads II, III, and aVF. In most patients,
it results from right coronary artery (RCA) occlusion. Patients should also be evaluated for
right ventricular infarction, which can influence management.
Question 2
A 58-year-old woman has an A1C of 9.4% despite treatment with metformin. She has obesity
(BMI 36 kg/m²), established cardiovascular disease, and normal renal function. Which
medication is most appropriate to add?
A. Glyburide
B. Pioglitazone
C. Semaglutide
D. NPH insulin
,Correct Answer: C. Semaglutide
Rationale
GLP-1 receptor agonists such as semaglutide:
• Lower A1C substantially
• Promote significant weight loss
• Reduce cardiovascular events in patients with established ASCVD
Question 3
A 70-year-old woman with osteoporosis sustained a vertebral compression fracture two years
ago. She asks which intervention has been shown to reduce future fracture risk.
A. Bed rest
B. Alendronate therapy
C. High-dose vitamin C
D. Long-term calcitonin alone
Correct Answer: B. Alendronate therapy
Rationale
Oral bisphosphonates are first-line therapy for most patients at high fracture risk and
significantly reduce vertebral and hip fractures.
Question 4
A patient presents with sudden onset of palpitations. ECG reveals a narrow-complex tachycardia
at 180 beats/min without clearly visible P waves. Vagal maneuvers are unsuccessful, and the
patient is hemodynamically stable. Which medication is recommended next?
A. Epinephrine
B. Adenosine
C. Atropine
,D. Digoxin
Correct Answer: B. Adenosine
Rationale
Stable paroxysmal supraventricular tachycardia (PSVT) should be treated with:
1. Vagal maneuvers
2. IV adenosine if vagal maneuvers fail
3. Calcium channel blockers or beta-blockers if needed
Question 5
A 67-year-old smoker presents with chronic cough and unintentional weight loss. Chest CT
demonstrates a solitary pulmonary nodule. Which diagnosis must be excluded first?
A. Tuberculosis
B. Lung cancer
C. Sarcoidosis
D. COPD
Correct Answer: B. Lung cancer
Rationale
In older adults with a significant smoking history, a pulmonary nodule should be considered
malignant until proven otherwise.
Question 6
A patient with cirrhosis develops increasing abdominal distention. Diagnostic paracentesis
reveals a serum-ascites albumin gradient (SAAG) of 1.5 g/dL. What is the most likely cause of
the ascites?
A. Peritoneal carcinomatosis
B. Portal hypertension
, C. Tuberculous peritonitis
D. Pancreatitis
Correct Answer: B. Portal hypertension
Rationale
A SAAG ≥1.1 g/dL strongly suggests portal hypertension as the cause of ascites, commonly due
to cirrhosis.
Question 7
A 73-year-old man presents with fatigue. CBC demonstrates macrocytic anemia, and laboratory
testing reveals low vitamin B12 levels. Which neurologic finding is most characteristic?
A. Resting tremor
B. Loss of vibration and position sense
C. Facial paralysis
D. Intention tremor
Correct Answer: B. Loss of vibration and position sense
Rationale
Vitamin B12 deficiency can cause:
• Peripheral neuropathy
• Loss of vibration and proprioception
• Ataxia
• Cognitive changes
Neurologic deficits may become irreversible if treatment is delayed.
Question 8
A patient taking chronic prednisone develops hip pain. Which complication should be suspected?
A. Septic arthritis
Question and Answers with Rationales Top
rated Latest Version
Question 1
A 62-year-old man with hypertension, type 2 diabetes, and hyperlipidemia presents with
crushing substernal chest pain radiating to the left arm for 45 minutes. ECG demonstrates ST-
segment elevation in leads II, III, and aVF. Which coronary artery is most likely occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Left main coronary artery
Correct Answer: C. Right coronary artery
Rationale
Inferior STEMI is identified by ST-segment elevation in leads II, III, and aVF. In most patients,
it results from right coronary artery (RCA) occlusion. Patients should also be evaluated for
right ventricular infarction, which can influence management.
Question 2
A 58-year-old woman has an A1C of 9.4% despite treatment with metformin. She has obesity
(BMI 36 kg/m²), established cardiovascular disease, and normal renal function. Which
medication is most appropriate to add?
A. Glyburide
B. Pioglitazone
C. Semaglutide
D. NPH insulin
,Correct Answer: C. Semaglutide
Rationale
GLP-1 receptor agonists such as semaglutide:
• Lower A1C substantially
• Promote significant weight loss
• Reduce cardiovascular events in patients with established ASCVD
Question 3
A 70-year-old woman with osteoporosis sustained a vertebral compression fracture two years
ago. She asks which intervention has been shown to reduce future fracture risk.
A. Bed rest
B. Alendronate therapy
C. High-dose vitamin C
D. Long-term calcitonin alone
Correct Answer: B. Alendronate therapy
Rationale
Oral bisphosphonates are first-line therapy for most patients at high fracture risk and
significantly reduce vertebral and hip fractures.
Question 4
A patient presents with sudden onset of palpitations. ECG reveals a narrow-complex tachycardia
at 180 beats/min without clearly visible P waves. Vagal maneuvers are unsuccessful, and the
patient is hemodynamically stable. Which medication is recommended next?
A. Epinephrine
B. Adenosine
C. Atropine
,D. Digoxin
Correct Answer: B. Adenosine
Rationale
Stable paroxysmal supraventricular tachycardia (PSVT) should be treated with:
1. Vagal maneuvers
2. IV adenosine if vagal maneuvers fail
3. Calcium channel blockers or beta-blockers if needed
Question 5
A 67-year-old smoker presents with chronic cough and unintentional weight loss. Chest CT
demonstrates a solitary pulmonary nodule. Which diagnosis must be excluded first?
A. Tuberculosis
B. Lung cancer
C. Sarcoidosis
D. COPD
Correct Answer: B. Lung cancer
Rationale
In older adults with a significant smoking history, a pulmonary nodule should be considered
malignant until proven otherwise.
Question 6
A patient with cirrhosis develops increasing abdominal distention. Diagnostic paracentesis
reveals a serum-ascites albumin gradient (SAAG) of 1.5 g/dL. What is the most likely cause of
the ascites?
A. Peritoneal carcinomatosis
B. Portal hypertension
, C. Tuberculous peritonitis
D. Pancreatitis
Correct Answer: B. Portal hypertension
Rationale
A SAAG ≥1.1 g/dL strongly suggests portal hypertension as the cause of ascites, commonly due
to cirrhosis.
Question 7
A 73-year-old man presents with fatigue. CBC demonstrates macrocytic anemia, and laboratory
testing reveals low vitamin B12 levels. Which neurologic finding is most characteristic?
A. Resting tremor
B. Loss of vibration and position sense
C. Facial paralysis
D. Intention tremor
Correct Answer: B. Loss of vibration and position sense
Rationale
Vitamin B12 deficiency can cause:
• Peripheral neuropathy
• Loss of vibration and proprioception
• Ataxia
• Cognitive changes
Neurologic deficits may become irreversible if treatment is delayed.
Question 8
A patient taking chronic prednisone develops hip pain. Which complication should be suspected?
A. Septic arthritis
