Test Bank for Current Medical Diagnosis and
Treatment (CMDT), 65th Edition – Papadakis,
Rabow, McQuaid, Nadler & Price (ISBN:
9781266135545) – Complete Guide, Latest 2022–
2026 Edition
, 1
A 68-year-old male with a history of COPD presents to the clinic with a 3-day history of
productive cough, rusty sputum, and a fever of 38.9°C. On examination, he is alert and
oriented, his respiratory rate is 24 breaths per minute, and his blood pressure is 112/70
mmHg. Auscultation reveals bronchial breath sounds and crackles in the right lower
lobe. Laboratory studies reveal a blood urea nitrogen (BUN) of 24 mg/dL. According to
the CURB-65 scoring system, what is the most appropriate management setting for this
patient?
A) Safe for outpatient management with oral macrolides.
B) Inpatient admission to a general medical floor.
C) Immediate admission to the intensive care unit (ICU) for vasopressor support.
D) Outpatient management with close monitoring via telehealth within 24 hours.
Correct Answer: B
Rationale: The CURB-65 scoring system awards 1 point each for Confusion, Urea > 19
mg/dL, Respiratory rate ≥ 30, Blood pressure (Systolic < 90 or Diastolic ≤ 60), and Age
≥ 65. This patient scores 2 points (Age ≥ 65 and BUN 24 mg/dL), which places him in
the intermediate-risk category, indicating that inpatient admission to a general medical
floor is the safest and most appropriate action.
Question 2
A 54-year-old male with Stage 3 chronic kidney disease (eGFR 38 mL/min/1.73 m²)
presents with acute, severe pain, swelling, and erythema in his right first
metatarsophalangeal (MTP) joint that woke him from sleep. Arthrocentesis reveals
negatively birefringent, needle-shaped crystals under polarized light microscopy. Which
of the following is the most appropriate first-line treatment for this acute flare?
A) High-dose Oral Indomethacin.
B) Oral Colchicine 1.2 mg followed by 0.6 mg one hour later.
C) Oral Allopurinol 300 mg daily.
D) Intravenous Pegloticase.
, Correct Answer: B
Rationale: Colchicine is highly effective for acute gout flares when administered within
36 hours of onset and can be safely used in moderate renal impairment, though
subsequent maintenance dosing must be adjusted; NSAIDs like indomethacin are
strictly contraindicated in Stage 3 CKD due to the high risk of accelerating acute kidney
injury, while urate-lowering therapies like allopurinol or pegloticase should never be
initiated during an acute flare as sudden shifts in uric acid levels can prolong or worsen
the attack.
Question 3
A 31-year-old female presents with a 4-week history of fatigue, symmetric pain and
morning stiffness lasting over an hour in her proximal interphalangeal (PIP) and
metacarpophalangeal (MCP) joints, and a low-grade fever. Laboratory tests reveal a
positive rheumatoid factor (RF) and highly elevated anti-cyclic citrullinated peptide (anti-
CCP) antibodies. Plain radiographs of the hands demonstrate soft tissue swelling and
periarticular osteopenia. Once the diagnosis of rheumatoid arthritis is established, which
therapeutic strategy should be initiated immediately?
A) Monotherapy with Oral Prednisone 20 mg daily indefinitely.
B) Intermittent scheduled therapy with Naproxen 500 mg twice daily.
C) Disease-modifying antirheumatic drug (DMARD) therapy with Methotrexate.
D) Intravenous Infliximab infusions every 4 weeks.
Correct Answer: C
Rationale: Early initiation of conventional synthetic DMARDs, primarily methotrexate, is
the gold standard of care for rheumatoid arthritis to suppress joint inflammation, prevent
irreversible structural erosions, and preserve function, whereas glucocorticoids and
NSAIDs are purely adjunct therapies for temporary symptom relief, and biologic agents
like infliximab are typically reserved for patients who fail target-dose conventional
DMARD therapy.
Question 4
A 42-year-old male intravenous drug user presents with a 5-day history of shaking
chills, night sweats, and a new-onset holosystolic murmur loudest at the apex that
radiates to the axilla. His temperature is 39.4°C. Transthoracic echocardiography (TTE)
demonstrates a 1.2 cm mobile vegetation on the mitral valve. Blood cultures grow
, Staphylococcus aureus in 3 out of 3 bottles. According to the Modified Duke Criteria,
how should this patient's clinical state be classified?
A) Possible Infective Endocarditis.
B) Rejected Infective Endocarditis.
C) Definite Infective Endocarditis.
D) Culture-Negative Endocarditis.
Correct Answer: C
Rationale: Under the Modified Duke Criteria, a diagnosis of Definite Infective
Endocarditis requires meeting 2 major criteria, 1 major and 3 minor criteria, or 5 minor
criteria; this patient fulfills 2 major criteria: typical microorganism (Staphylococcus
aureus) isolated from persistent blood cultures and echocardiographic evidence of
endocardial involvement (a mobile mitral valve vegetation).
Question 5
A 61-year-old female with a long history of type 2 diabetes and severe peripheral
arterial disease presents with a deep, non-healing ulcer on her right heel. Over the past
48 hours, the foot has become intensely erythematous, swollen, and warm to the touch.
Plain films of the right foot reveal gas shadows within the soft tissues surrounding the
calcaneus. What is the most critical and immediate collaborative management step?
A) Initiate outpatient oral Amoxicillin-Clavulanate.
B) Arrange for urgent surgical consultation for debridement or amputation.
C) Order a non-urgent MRI of the foot to evaluate for bone marrow edema.
D) Apply a wet-to-dry saline dressing and reassess in 48 hours.
Correct Answer: B
Rationale: The presence of soft-tissue gas on radiographic imaging indicates a
necrotizing, gas-producing soft tissue infection or deep abscess, which is a life-
threatening, limb-threatening emergency requiring immediate surgical consultation for
wide surgical debridement, decompression, and simultaneous broad-spectrum
intravenous antibiotic coverage.
Question 6
A 72-year-old male with a history of ischemic cardiomyopathy and an ejection fraction of
30% presents with sudden-onset shortness of breath, a cough producing pink frothy
Treatment (CMDT), 65th Edition – Papadakis,
Rabow, McQuaid, Nadler & Price (ISBN:
9781266135545) – Complete Guide, Latest 2022–
2026 Edition
, 1
A 68-year-old male with a history of COPD presents to the clinic with a 3-day history of
productive cough, rusty sputum, and a fever of 38.9°C. On examination, he is alert and
oriented, his respiratory rate is 24 breaths per minute, and his blood pressure is 112/70
mmHg. Auscultation reveals bronchial breath sounds and crackles in the right lower
lobe. Laboratory studies reveal a blood urea nitrogen (BUN) of 24 mg/dL. According to
the CURB-65 scoring system, what is the most appropriate management setting for this
patient?
A) Safe for outpatient management with oral macrolides.
B) Inpatient admission to a general medical floor.
C) Immediate admission to the intensive care unit (ICU) for vasopressor support.
D) Outpatient management with close monitoring via telehealth within 24 hours.
Correct Answer: B
Rationale: The CURB-65 scoring system awards 1 point each for Confusion, Urea > 19
mg/dL, Respiratory rate ≥ 30, Blood pressure (Systolic < 90 or Diastolic ≤ 60), and Age
≥ 65. This patient scores 2 points (Age ≥ 65 and BUN 24 mg/dL), which places him in
the intermediate-risk category, indicating that inpatient admission to a general medical
floor is the safest and most appropriate action.
Question 2
A 54-year-old male with Stage 3 chronic kidney disease (eGFR 38 mL/min/1.73 m²)
presents with acute, severe pain, swelling, and erythema in his right first
metatarsophalangeal (MTP) joint that woke him from sleep. Arthrocentesis reveals
negatively birefringent, needle-shaped crystals under polarized light microscopy. Which
of the following is the most appropriate first-line treatment for this acute flare?
A) High-dose Oral Indomethacin.
B) Oral Colchicine 1.2 mg followed by 0.6 mg one hour later.
C) Oral Allopurinol 300 mg daily.
D) Intravenous Pegloticase.
, Correct Answer: B
Rationale: Colchicine is highly effective for acute gout flares when administered within
36 hours of onset and can be safely used in moderate renal impairment, though
subsequent maintenance dosing must be adjusted; NSAIDs like indomethacin are
strictly contraindicated in Stage 3 CKD due to the high risk of accelerating acute kidney
injury, while urate-lowering therapies like allopurinol or pegloticase should never be
initiated during an acute flare as sudden shifts in uric acid levels can prolong or worsen
the attack.
Question 3
A 31-year-old female presents with a 4-week history of fatigue, symmetric pain and
morning stiffness lasting over an hour in her proximal interphalangeal (PIP) and
metacarpophalangeal (MCP) joints, and a low-grade fever. Laboratory tests reveal a
positive rheumatoid factor (RF) and highly elevated anti-cyclic citrullinated peptide (anti-
CCP) antibodies. Plain radiographs of the hands demonstrate soft tissue swelling and
periarticular osteopenia. Once the diagnosis of rheumatoid arthritis is established, which
therapeutic strategy should be initiated immediately?
A) Monotherapy with Oral Prednisone 20 mg daily indefinitely.
B) Intermittent scheduled therapy with Naproxen 500 mg twice daily.
C) Disease-modifying antirheumatic drug (DMARD) therapy with Methotrexate.
D) Intravenous Infliximab infusions every 4 weeks.
Correct Answer: C
Rationale: Early initiation of conventional synthetic DMARDs, primarily methotrexate, is
the gold standard of care for rheumatoid arthritis to suppress joint inflammation, prevent
irreversible structural erosions, and preserve function, whereas glucocorticoids and
NSAIDs are purely adjunct therapies for temporary symptom relief, and biologic agents
like infliximab are typically reserved for patients who fail target-dose conventional
DMARD therapy.
Question 4
A 42-year-old male intravenous drug user presents with a 5-day history of shaking
chills, night sweats, and a new-onset holosystolic murmur loudest at the apex that
radiates to the axilla. His temperature is 39.4°C. Transthoracic echocardiography (TTE)
demonstrates a 1.2 cm mobile vegetation on the mitral valve. Blood cultures grow
, Staphylococcus aureus in 3 out of 3 bottles. According to the Modified Duke Criteria,
how should this patient's clinical state be classified?
A) Possible Infective Endocarditis.
B) Rejected Infective Endocarditis.
C) Definite Infective Endocarditis.
D) Culture-Negative Endocarditis.
Correct Answer: C
Rationale: Under the Modified Duke Criteria, a diagnosis of Definite Infective
Endocarditis requires meeting 2 major criteria, 1 major and 3 minor criteria, or 5 minor
criteria; this patient fulfills 2 major criteria: typical microorganism (Staphylococcus
aureus) isolated from persistent blood cultures and echocardiographic evidence of
endocardial involvement (a mobile mitral valve vegetation).
Question 5
A 61-year-old female with a long history of type 2 diabetes and severe peripheral
arterial disease presents with a deep, non-healing ulcer on her right heel. Over the past
48 hours, the foot has become intensely erythematous, swollen, and warm to the touch.
Plain films of the right foot reveal gas shadows within the soft tissues surrounding the
calcaneus. What is the most critical and immediate collaborative management step?
A) Initiate outpatient oral Amoxicillin-Clavulanate.
B) Arrange for urgent surgical consultation for debridement or amputation.
C) Order a non-urgent MRI of the foot to evaluate for bone marrow edema.
D) Apply a wet-to-dry saline dressing and reassess in 48 hours.
Correct Answer: B
Rationale: The presence of soft-tissue gas on radiographic imaging indicates a
necrotizing, gas-producing soft tissue infection or deep abscess, which is a life-
threatening, limb-threatening emergency requiring immediate surgical consultation for
wide surgical debridement, decompression, and simultaneous broad-spectrum
intravenous antibiotic coverage.
Question 6
A 72-year-old male with a history of ischemic cardiomyopathy and an ejection fraction of
30% presents with sudden-onset shortness of breath, a cough producing pink frothy
