SMLE Complete Review Guide 2026–2027

4. A patient with prediabetes weighs 100 kg. A prevention plan uses the 5–7% initial-weight reduction demonstrated in the Diabetes Prevention Program. What weight loss corresponds to that range? — 5–7 kg. 100 multiplied by 0.05–0.07 gives 5–7 kg. [NIDDK, Insulin Resistance & Prediabetes, Blood tests and Managing your weight (reviewed March 2025).]
5. An adult with established prediabetes asks when to repeat testing for progression to type 2 diabetes. What interval does NIDDK describe? — Every year. Annual testing detects asymptomatic progression. [NIDDK, Insulin Resistance & Prediabetes, Blood tests and Managing your weight (reviewed March 2025).]
6. An alert adult with diabetes can swallow safely and has glucose 62 mg/dL. What initial self-treatment follows the CDC 15-15 approach? — 15 g fast carbohydrate, then recheck in 15 minutes. This corrects the low and provides a prompt reassessment. [CDC, Treatment of Low Blood Sugar, The 15-15 rule and Treating severely low blood sugar (May 2024).]
7. A conscious adult treating hypoglycemia asks why glucose tablets are preferred over chocolate for rapid correction. What is the best explanation? — Chocolate fat slows absorption of its sugar. Rapid carbohydrate availability matters during a low. [CDC, Treatment of Low Blood Sugar, The 15-15 rule and Treating severely low blood sugar (May 2024).]
8. At home, a person with diabetes loses consciousness from hypoglycemia. A trained caregiver has the prescribed glucagon kit. Which action is appropriate while obtaining emergency help? — Give prescribed glucagon and obtain emergency help. The trained caregiver can deliver rescue treatment while help is obtained. [CDC, Treatment of Low Blood Sugar, The 15-15 rule and Treating severely low blood sugar (May 2024).]
9. A patient using an insulin pump develops vomiting, deep breathing, high glucose, and ketones after the infusion tubing becomes blocked. What best explains this deterioration? — Insulin interruption with ketone generation. Blocked delivery explains the hyperglycemia and ketosis with deep breathing. [CDC, Diabetic Ketoacidosis, Overview, Causes and Treatment (May 2024).]
10. A patient with confirmed DKA reaches hospital. Which overall treatment plan addresses the major abnormalities and cause? — Monitored fluids, electrolytes, insulin and precipitant treatment. The treatment package addresses the main deficits and cause. [CDC, Diabetic Ketoacidosis, Overview, Causes and Treatment (May 2024).]
11. A patient has fatigue, weight gain, cold intolerance, and a slow pulse. What is needed before attributing all symptoms to hypothyroidism? — Appropriate thyroid blood testing. Biochemical testing supports the diagnosis and cause assessment. [NIDDK, Hypothyroidism, Causes, Diagnosis and Treatment.]
12. A stable adult begins levothyroxine for hypothyroidism. When does NIDDK describe the first blood-test reassessment to guide dose adjustment? — About 6–8 weeks. The cited interval permits meaningful replacement reassessment. [NIDDK, Hypothyroidism, Causes, Diagnosis and Treatment.]
13. A patient treated for hypothyroidism takes excess thyroid hormone without supervision. Which adverse outcome is a recognized concern? — Atrial fibrillation and osteoporosis. Overreplacement can harm the heart and skeleton. [NIDDK, Hypothyroidism, Causes, Diagnosis and Treatment.]
14. A patient with hyperthyroidism has tremor and palpitations. A beta-blocker is added while definitive treatment takes effect. What does the beta-blocker primarily achieve? — Relieve adrenergic symptoms while disease therapy acts. Heart rate and tremor can improve without fixing the synthesis problem. [NIDDK, Hyperthyroidism, Causes and Treatment options.]
15. A patient taking an antithyroid drug develops fever and a persistent sore throat. What is the safest response? — Withhold antithyroid medicine and obtain urgent clinical assessment and blood count. Potential agranulocytosis requires stopping exposure and urgent testing. [NIDDK, Hyperthyroidism, Causes and Treatment options. ATA Clinical Thyroidology for Patients, Implications for the patient (2014)]
16. A patient’s thyrotoxicosis is caused by release of stored hormone during thyroiditis. Which statement about usual antithyroid medicines is accurate? — They do not treat the release of previously stored hormone. Thyroiditis leakage differs from excess synthesis. [NIDDK, Hyperthyroidism, Causes and Treatment options.]
17. A patient with untreated Graves hyperthyroidism asks about noncardiac complications. Which is a recognized complication? — Osteoporosis. Thyroid hormone excess can cause loss of bone mass. [NIDDK, Hyperthyroidism, Causes and Treatment options.]
18. A patient with primary adrenal insufficiency has inadequate aldosterone as well as cortisol. Which medicine replaces the mineralocorticoid deficit? — Fludrocortisone. It provides mineralocorticoid replacement for sodium/fluid balance. [NIDDK, Treatment for Adrenal Insufficiency, Hormone replacement and Treatment in special situations (reviewed September 2018).]
19. A patient with known adrenal insufficiency has repeated vomiting and cannot retain oral corticosteroids. What is the safest action? — Immediate care for parenteral glucocorticoid treatment. Failed absorption risks crisis and needs an effective route. [NIDDK, Treatment for Adrenal Insufficiency, Hormone replacement and Treatment in special situations (reviewed September 2018).]
20. A patient with adrenal insufficiency is scheduled for surgery under general anesthesia. Which perioperative principle is appropriate? — Arrange stress-dose corticosteroid coverage and fluid management. Surgery raises replacement requirements and may prevent oral dosing. [NIDDK, Treatment for Adrenal Insufficiency, Hormone replacement and Treatment in special situations (reviewed September 2018).]
21. A bystander witnesses a generalized convulsive seizure. Which action reduces injury risk? — Clear nearby hazards and cushion the head. Protective positioning reduces injury. [CDC, First Aid for Seizures (May 2024), When to call for help and What to avoid.]
22. A convulsive seizure continues for six minutes. What is the appropriate community response? — Activate emergency medical services now. Six minutes exceeds the five-minute emergency threshold. [CDC, First Aid for Seizures (May 2024), When to call for help and What to avoid.]
23. A seizure has stopped, but the patient remains drowsy and cannot swallow safely. Which first-aid approach is appropriate? — Keep on the side, monitor breathing, and withhold oral intake. The recovery position supports airway protection during drowsiness. [CDC, First Aid for Seizures (May 2024), When to call for help and What to avoid.]
24. During a consultation, a patient suddenly develops one-sided facial weakness and slurred speech. What is the best immediate disposition? — Activate emergency stroke assessment. Urgent transport enables time-sensitive evaluation and treatment. [CDC, Signs and Symptoms of Stroke (May 2026), When to seek emergency help and TIA.]
25. A patient’s arm weakness and speech difficulty resolved after several minutes. What is the most appropriate interpretation? — Possible TIA needing urgent assessment. Resolution does not remove the vascular warning. [CDC, Signs and Symptoms of Stroke (May 2026), When to seek emergency help and TIA.]
26. A witness saw a previously normal person suddenly develop stroke symptoms and calls emergency services. Which timing information is particularly useful for treatment decisions? — The witnessed exact time symptoms began. In this witnessed event, record onset; also document when last known normal. [Joint Commission, Stroke Symptoms—Activation of Stroke Response: onset or last known well.]
27. A patient has an acutely swollen painful joint and gout is suspected. Which investigation can directly identify the relevant crystal? — Microscopy of aspirated joint fluid. Joint-fluid microscopy can demonstrate urate crystals. [NIAMS, Gout: Diagnosis, Treatment and Steps to Take (December 2023).]
28. A patient with frequent gout attacks and tophi wants to rely only on dietary changes. What is the most accurate counseling? — Urate-lowering treatment remains central with lifestyle changes. Tophi and recurrent flares require a long-term urate strategy. [NIAMS, Gout: Diagnosis, Treatment and Steps to Take (December 2023).]
29. A gout medicine is described as a xanthine oxidase inhibitor. Which therapeutic effect explains its role? — Reduces urate production. This enzyme pathway contributes to urate formation. [NIAMS, Gout: Diagnosis, Treatment and Steps to Take (December 2023).]
30. A patient has persistent inflammatory polyarthritis, but rheumatoid factor is negative. Which conclusion is correct? — RA remains possible; continue clinical assessment. Seronegative RA occurs and diagnosis integrates the full pattern. [NIAMS, Rheumatoid Arthritis: Diagnosis and Treatment (November 2022), Laboratory tests and Treatment.]
31. A patient with newly suspected RA has normal plain radiographs. Which statement best interprets the imaging? — Early RA can have normal plain radiographs. Inflammation can precede radiographic structural damage. [NIAMS, Rheumatoid Arthritis: Diagnosis and Treatment (November 2022), Laboratory tests and Treatment.]
32. A patient with RA is offered a DMARD rather than only intermittent analgesia. What is the main additional goal? — Slow disease progression and joint damage. This distinguishes disease modification from analgesia alone. [NIAMS, Rheumatoid Arthritis: Diagnosis and Treatment (November 2022), Laboratory tests and Treatment.]
33. A person has recurrent unexpected panic attacks followed by six weeks of worry about further attacks. Medical and substance causes have been assessed. Which diagnosis best fits? — Panic disorder. The recurrent unexpected attacks and six weeks of concern meet the described pattern. [NIMH, Panic Disorder: What You Need to Know (2025), Diagnosis and Treatment.]
34. After physical causes are assessed, a patient with panic disorder chooses a structured psychological treatment that changes responses to feared bodily sensations. Which approach fits? — CBT with interoceptive exposure. This directly targets the feared sensations and reactions. [NIMH, Panic Disorder: What You Need to Know (2025), Diagnosis and Treatment.]
35. A patient asks why benzodiazepines are not automatically prescribed indefinitely for panic symptoms. Which concern is relevant? — Tolerance and dependence with continued exposure. These concerns favor cautious prescribing and review. [NIMH, Panic Disorder: What You Need to Know (2025), Diagnosis and Treatment.]
36. A patient repeatedly experiences unwanted contamination thoughts and washes for hours to relieve anxiety. What are the unwanted thoughts called? — Obsessions. Obsessions are intrusive unwanted thoughts or urges. [NIMH, Obsessive-Compulsive Disorder (2023), Symptoms and Treatment.]
37. A therapist gradually exposes a patient to a feared contaminant in a safe setting while helping them refrain from ritual washing. Which treatment is this? — Exposure and response prevention. ERP combines trigger exposure with resisting the compulsion. [NIMH, Obsessive-Compulsive Disorder (2023), Symptoms and Treatment.]
38. A patient has time-consuming compulsions and asks which medication class is commonly used for OCD. Which is correct? — Selective serotonin reuptake inhibitors. SSRIs are commonly used for OCD. [NIMH, Obsessive-Compulsive Disorder (2023), Symptoms and Treatment.]
39. A patient has a clear manic syndrome with markedly reduced need for sleep, pressured speech, grandiosity, and dangerous behavior requiring hospitalization. Substance and medical causes are excluded. Which bipolar category fits best? — Bipolar I disorder. The described severe manic episode is sufficient for this category. [NIMH, Bipolar Disorder, Types and Medications.]
40. Before prescribing antidepressant monotherapy for depression, a clinician discovers a prior manic episode. What treatment-related concern becomes especially important? — Manic switching or rapid cycling with antidepressant monotherapy. The lifetime history changes the medication strategy. [NIMH, Bipolar Disorder, Types and Medications.]
41. An adult has a reactive HCV antibody screening result. Which test establishes whether infection is currently present? — HCV RNA nucleic acid test. RNA detection identifies current viremia. [CDC, Clinical Screening and Diagnosis for Hepatitis C (November 2026), Recommended tests and Test interpretation.]
42. A patient may have been exposed to HCV three weeks ago. The HCV antibody test is nonreactive. Which approach best addresses the window period? — Test HCV RNA now. RNA can be detectable before seroconversion. [CDC, Clinical Screening and Diagnosis for Hepatitis C (November 2026), Recommended tests and Test interpretation.]
43. HCV antibody is reactive, but HCV RNA is undetectable. There is no recent exposure or other clinical concern. What is the usual interpretation? — No current HCV infection. The antibody can persist without current viremia. [CDC, Clinical Screening and Diagnosis for Hepatitis C (November 2026), Recommended tests and Test interpretation.]
44. A person with a documented completed hepatitis B vaccine series has HBsAg negative, total anti-HBc negative, and anti-HBs positive. What best explains the pattern? — Immunity from vaccination. Vaccine-derived immunity does not generate core antibody. [CDC, Clinical Testing and Diagnosis for Hepatitis B (November 2026), How to interpret test results.]
45. HBsAg is negative, total anti-HBc is positive, and anti-HBs is positive. What is the usual interpretation? — Resolved natural HBV infection. Core antibody signals prior infection and surface antibody supports recovery. [CDC, Clinical Testing and Diagnosis for Hepatitis B (November 2026), How to interpret test results.]
46. A screening panel shows only total anti-HBc positivity; HBsAg and anti-HBs are negative. Which conclusion is safest? — Assess further because multiple explanations are possible. Clinical context and further testing clarify the pattern. [CDC, Clinical Testing and Diagnosis for Hepatitis B (November 2026), How to interpret test results.]
47. An otherwise stable adult with acute hepatitis A asks whether a chronic carrier state is expected. What is accurate? — HAV does not establish chronic infection. An extended or relapsing course differs from chronic infection. [CDC, Clinical Care of Hepatitis A (October 2026), Treatment and Immunocompromised people.]
48. An unvaccinated adult with chronic liver disease was exposed to HAV five days ago. Under CDC postexposure guidance, what is indicated? — Hepatitis A vaccine plus immune globulin promptly. This combines active and immediate passive protection in the high-risk group. [CDC, Clinical Care of Hepatitis A (October 2026), Treatment and Immunocompromised people. ACIP 2020 Table 4]
49. A hospitalized patient develops unexplained diarrhea and CDI is suspected. What infection-control action should begin during evaluation? — Begin contact precautions and appropriate isolation now. Suspected CDI warrants prompt transmission precautions. [CDC, Clinical Guidance for C. diff Infection Prevention (May 2026), Isolation and Confirm CDI.]
50. A patient’s CDI diarrhea has resolved after treatment. A colleague orders repeated stool tests solely to prove cure. What is the appropriate response? — Assess clinical recovery without a routine test of cure. Persistent positivity can outlast symptomatic infection. [CDC, Clinical Guidance for C. diff Infection Prevention (May 2026), Isolation and Confirm CDI.]
51. Which specimen is appropriate for routine C. difficile testing in a patient with suspected infectious diarrhea? — Unformed stool from the symptomatic patient. The specimen should match the active diarrheal syndrome. [CDC, Clinical Guidance for C. diff Infection Prevention (May 2026), Isolation and Confirm CDI.]
52. A nonpregnant adult has detectable HCV RNA and is being evaluated for treatment. Which modern therapeutic class is central? — Oral direct-acting antivirals. These are the modern basis of HCV cure. [CDC, Clinical Care of Hepatitis C (January 2025), Treatment and HBV reactivation.]
53. Why should HBV status be checked before starting HCV direct-acting antivirals? — HBV reactivation may occur during HCV therapy. Baseline status guides monitoring and any HBV treatment needed. [CDC, Clinical Care of Hepatitis C (January 2025), Treatment and HBV reactivation.]
54. A patient with chronic HBV asks whether antiviral suppression removes every need for follow-up. What is the best counseling? — Continue clinical monitoring and risk-appropriate liver-cancer surveillance. Suppression does not remove ongoing liver-care needs. [CDC, Clinical Care of Hepatitis B (January 2025), Treatment options and Helping patients stay well.]
55. A patient with chronic HBV asks to start a concentrated herbal supplement advertised for liver health. What is the appropriate advice? — Review the product with the treating clinician before use. Ingredients and liver toxicity must be considered. [CDC, Clinical Care of Hepatitis B (January 2025), Treatment options and Helping patients stay well.]
56. An otherwise healthy adult has uncomplicated nontyphoidal Salmonella diarrhea without invasive features. What is the usual mainstay of care? — Fluid and electrolyte replacement. Supportive care is usually adequate without invasive or high-risk features. [CDC, Clinical Overview of Salmonellosis (October 2024), Diagnosis and Patient management.]
57. A multiplex stool PCR detects Salmonella and antibiotic treatment may be needed. Why obtain a reflex culture? — Obtain an isolate for susceptibility testing. An isolate permits susceptibility testing and characterization. [CDC, Clinical Overview of Salmonellosis (October 2024), Diagnosis and Patient management.]
58. An immunocompromised adult with Salmonella infection develops bacteremia. How does this change treatment consideration compared with mild uncomplicated diarrhea? — Treat invasive infection with appropriate antibiotics guided by susceptibility. Bloodstream disease differs from self-limited uncomplicated enteritis. [CDC, Clinical Overview of Salmonellosis (October 2024), Diagnosis and Patient management.]
59. A patient develops progressive weakness after laboratory-confirmed Campylobacter diarrhea. Which recognized postinfectious neurological complication should be considered? — Guillain–Barré syndrome. The infection can precede progressive immune-mediated neuropathy. [CDC, Clinical Overview of Campylobacter (August 2026), Treatment and Prognosis.]
60. Severe Campylobacter infection requires antibiotics. What principle helps choose an agent when microbiology results are available? — Use antimicrobial susceptibility results to guide the agent. Resistance can change which agent is appropriate. [CDC, Clinical Overview of Campylobacter (August 2026), Treatment and Prognosis.]
61. An adult with iron-deficiency anemia uses NSAIDs regularly and has no obvious external bleeding. Which potential cause warrants assessment? — Occult gastrointestinal blood loss. NSAIDs can cause GI bleeding without obvious external loss. [NHLBI, Iron-Deficiency Anemia, Causes and Prevention.]
62. A patient develops iron deficiency after gastric bypass surgery. Which mechanism is relevant even without overt bleeding? — Reduced gastrointestinal iron absorption. Gastric and intestinal surgery can reduce absorption. [NHLBI, Iron-Deficiency Anemia, Causes and Prevention.]
63. An adult with anemia has paresthesias, gait difficulty, and a painful smooth tongue. Which deficiency particularly warrants investigation? — Vitamin B12 deficiency. The neurological findings plus anemia and glossitis particularly suggest B12 deficiency. [NHLBI, Vitamin B12–Deficiency Anemia, Symptoms and Causes.]
64. A patient has pernicious anemia. Which gastric abnormality explains impaired vitamin B12 absorption? — Inadequate intrinsic factor. Intrinsic factor is the gastric protein needed for normal B12 absorption. [NHLBI, Vitamin B12–Deficiency Anemia, Symptoms and Causes.]
65. A patient taking metformin long term develops anemia and sensory symptoms. Which additional laboratory assessment is particularly relevant? — Vitamin B12 status. Metformin exposure and these findings warrant B12 assessment. [NHLBI, Vitamin B12–Deficiency Anemia, Symptoms and Causes.]
66. A patient has fatigue, recurrent infections, and easy bruising. Blood counts show reductions in red cells, white cells, and platelets, and marrow is markedly hypocellular. Which mechanism fits aplastic anemia? — Failure of marrow blood-cell production. Stem-cell failure affects multiple blood-cell lineages. [NHLBI, Aplastic Anemia, Symptoms, Diagnosis and Causes.]
67. A stable adult without active bleeding has an established indication for red-cell transfusion. One unit has just finished. Under NICE NG24, what should guide whether a further unit is given? — Clinically reassess and check hemoglobin before deciding on another unit. NICE recommends clinical reassessment and hemoglobin measurement after each single-unit red-cell transfusion, with further units only if needed. [NICE NG24 1.6.1–2,p11 (2026 numbering)]
68. A blood disorder is characterized by red cells being destroyed faster than marrow can replace them. Which category best describes it? — Hemolytic anemia. The defining process is excessive red-cell destruction. [NHLBI, Hemolytic Anemia (March 2022), Definition, Causes and Treatment.]
69. Hemolysis develops soon after introduction of a medicine suspected of causing red-cell destruction. Which management principle is appropriate? — Review and stop or replace the suspected culprit under clinical supervision. Removing an acquired trigger can address ongoing destruction. [NHLBI, Hemolytic Anemia (March 2022), Definition, Causes and Treatment.]
70. A patient with ITP asks why bleeding occurs despite no major injury. Which explanation is most accurate? — Low platelets impair primary hemostatic plug formation. The platelet deficit explains mucocutaneous bleeding. [NHLBI, Immune Thrombocytopenia, Symptoms, Diagnosis and Causes.]
71. A patient with suspected platelet-related bleeding has petechiae and gum bleeding. Which initial laboratory pair helps assess platelet number and appearance? — CBC and peripheral blood smear. These directly assess count and morphology. [NHLBI, Immune Thrombocytopenia, Symptoms, Diagnosis and Causes.]
72. An adult man has hemarthroses since childhood and affected maternal male relatives. Platelets and VWF testing are normal; factor VIII activity is very low and factor IX is normal. Which diagnosis fits? — Hemophilia A. An inherited isolated factor VIII defect with hemarthroses fits hemophilia A. [CDC, About Hemophilia (March 2025), Types, Diagnosis and Inhibitors.]
73. A person with hemophilia has less bleeding control despite replacement factor treatment. Testing identifies an inhibitor. What is this inhibitor? — An antibody neutralizing clotting-factor activity. Neutralization reduces the effect of factor replacement. [CDC, About Hemophilia (March 2025), Types, Diagnosis and Inhibitors.]
74. A patient has repeated spontaneous bleeding into the knee from hemophilia. Which long-term complication is especially relevant? — Chronic hemophilic arthropathy. Recurrent bleeding damages joints and function. [CDC, About Hemophilia (March 2025), Types, Diagnosis and Inhibitors.]
75. A patient has recurrent epistaxis, heavy menstrual bleeding, and prolonged bleeding after dental work. Testing shows abnormal von Willebrand factor. What role of VWF is impaired? — Platelet adhesion at the damaged vessel. VWF supports primary hemostasis at vascular injury. [CDC, About von Willebrand Disease (May 2024), Types and Treatment.]
76. A patient has type 2 von Willebrand disease. Which feature distinguishes this category from a simple quantitative deficiency? — VWF is functionally abnormal. Type 2 is primarily a qualitative category. [CDC, About von Willebrand Disease (May 2024), Types and Treatment.]
77. Desmopressin is selected for a suitable patient with responsive mild type 1 VWD. What is its hemostatic effect? — Release of stored VWF into the bloodstream. This raises available hemostatic VWF in a responsive patient. [CDC, About von Willebrand Disease (May 2024), Types and Treatment.]
78. An adult with sickle cell disease develops chest pain, fever, and new difficulty breathing. Which potentially life-threatening complication must be urgently considered? — Acute chest syndrome. This acute respiratory cluster is a medical emergency in sickle cell disease. [NHLBI, Sickle Cell Disease: How It May Affect Your Health, Complications.]
79. Why does splenic damage in sickle cell disease increase concern about bacterial infection? — Loss of splenic immune protection raises bacterial infection risk. Splenic dysfunction reduces protection and motivates preventive care. [NHLBI, Sickle Cell Disease: How It May Affect Your Health, Complications.]
80. A patient with sickle cell disease develops persistent hip pain and reduced walking ability. Which ischemic bone complication is recognized in this disease? — Avascular necrosis. Reduced bone perfusion can cause necrosis and joint dysfunction. [NHLBI, Sickle Cell Disease: How It May Affect Your Health, Complications.]
81. A woman requires testing for genital chlamydia but prefers to collect the vaginal specimen herself. Which approach is appropriate? — Validated self-collected vaginal swab for NAAT. Properly collected validated specimens perform comparably. [CDC STI Treatment Guidelines, Chlamydial Infections, Diagnostic Considerations.]
82. A man with suspected urethral chlamydia can provide urine but declines a urethral swab. Which test is appropriate? — NAAT on first-catch urine. Urine provides an accepted alternative to a urethral swab. [CDC STI Treatment Guidelines, Chlamydial Infections, Diagnostic Considerations.]
83. Symptoms and a positive gonorrhea test persist after recommended treatment without sexual re-exposure. What testing best supports evaluation for resistance? — Culture with antimicrobial susceptibility testing. Culture permits susceptibility assessment in suspected treatment failure. [CDC STI Treatment Guidelines, Gonococcal Infections Among Adolescents and Adults, Diagnostic Considerations.]
84. A symptomatic man has purulent urethral discharge. Microscopy shows intracellular gram-negative diplococci in polymorphonuclear leukocytes. What is the best interpretation? — Diagnostic evidence of gonorrhea in this symptomatic male setting. The context gives this Gram-stain finding high diagnostic value. [CDC STI Treatment Guidelines, Gonococcal Infections Among Adolescents and Adults, Diagnostic Considerations.]
85. An asymptomatic man has a negative urethral Gram stain after a gonorrhea exposure. What conclusion is justified? — Gonorrhea remains possible; use an appropriate NAAT. Asymptomatic infection may be missed on Gram stain. [CDC STI Treatment Guidelines, Gonococcal Infections Among Adolescents and Adults, Diagnostic Considerations.]
86. A patient has a reactive RPR during an initial syphilis assessment. Which additional test category is needed for a presumptive serologic diagnosis? — A treponemal test such as TP-PA. The two test categories complement one another. [CDC STI Treatment Guidelines, Syphilis, Diagnostic Considerations.]
87. Using the same RPR method, a treated patient changes from 1:32 to 1:8. How is this change described? — A fourfold decline. Two serial dilution steps represent a fourfold decline. [CDC STI Treatment Guidelines, Syphilis, Diagnostic Considerations.]
88. A patient remains treponemal-antibody positive years after adequate syphilis treatment. Which marker is generally used to assess serologic treatment response? — Serial quantitative nontreponemal titers using the same method. Changes in the same quantitative assay support response assessment. [CDC STI Treatment Guidelines, Syphilis, Diagnostic Considerations.]
89. A patient has active genital vesicles. What is the preferred sensitive method to confirm and type HSV from the lesion? — Type-specific lesion NAAT. Lesion NAAT is highly sensitive and can identify the type. [CDC STI Treatment Guidelines, Genital Herpes, Diagnostic Considerations.]
90. HSV culture from an almost healed genital ulcer is negative. Which explanation should inform counseling? — Healing reduces culture sensitivity, so HSV remains possible. Older lesions can yield false-negative cultures. [CDC STI Treatment Guidelines, Genital Herpes, Diagnostic Considerations.]
91. A clinician proposes HSV IgM to determine whether genital symptoms represent a new infection. Why is this test unsuitable? — It is not type-specific and may be positive during recurrence. These limitations make IgM unsuitable for dating HSV infection. [CDC STI Treatment Guidelines, Genital Herpes, Diagnostic Considerations.]
92. A patient presents 20 hours after a substantial HIV exposure. PEP is indicated, but laboratory results are delayed. What is the best next step? — Start indicated PEP promptly while obtaining baseline assessment. Timely initiation is more useful than avoidable laboratory delay. [CDC HIV Nexus, Clinical Guidance for PEP, October 2026, Initiation and Follow-up.]
93. An adult starts HIV PEP after an eligible exposure. What is the standard course duration? — 28 days. The standard PEP course is 28 days. [CDC HIV Nexus, Clinical Guidance for PEP, October 2026, Initiation and Follow-up.]
94. A patient completes HIV PEP and anticipates continuing substantial exposure risk. What prevention transition should be assessed? — Assess transition to PrEP without a gap when appropriate. PrEP addresses continuing risk after completed PEP. [CDC HIV Nexus, Clinical Guidance for PEP, October 2026, Initiation and Follow-up.]
95. Acute epididymitis is suspected. Which point-of-care test finding can document objective inflammation under CDC guidance? — Positive leukocyte esterase in first-void urine. It is one of the guideline-listed point-of-care criteria. [CDC STI Treatment Guidelines 2021, Epididymitis, Diagnostic Considerations: point-of-care evidence of inflammation.]
96. A man treated for acute epididymitis reports no improvement after 72 hours. What is the recommended action? — Reevaluate the diagnosis and treatment. The guideline distinguishes lack of improvement from slow complete resolution. [CDC STI Treatment Guidelines, Epididymitis, Diagnostic Considerations and Follow-Up.]
97. An asymptomatic patient has reactive treponemal and nontreponemal tests. Documented seroconversion occurred eight months ago, and examination finds no active lesions. How should latent syphilis be classified? — Early latent syphilis. Documented acquisition within the preceding year supports early latent disease. [CDC STI Treatment Guidelines, Latent Syphilis, Classification and Treatment.]
98. An asymptomatic patient has newly discovered syphilis seroreactivity, a high RPR titer, and no reliable dates of exposure or prior testing. What is the best classification? — Latent syphilis of unknown duration. Without evidence of recent acquisition, duration remains unknown. [CDC STI Treatment Guidelines, Latent Syphilis, Classification and Treatment.]
99. A patient with reactive syphilis serology has new cognitive impairment and a cranial nerve palsy. Which investigation is indicated before treatment? — CSF examination. Neurologic signs warrant investigation for CNS involvement. [CDC STI Treatment Guidelines, Neurosyphilis, Ocular Syphilis, and Otosyphilis, Treatment.]
100. A patient has reactive syphilis serology and ophthalmologist-confirmed uveitis, with a normal neurologic examination. What treatment principle applies? — Treat ocular syphilis using a neurosyphilis regimen. Ocular syphilis requires the neurosyphilis regimen even with normal CSF. [CDC STI Treatment Guidelines, Neurosyphilis, Ocular Syphilis, and Otosyphilis, Treatment.]
101. An irregular pulse is detected in a patient with palpitations. Which test confirms suspected AF under NICE guidance? — 12-lead ECG. ECG documents the rhythm causing the irregular pulse. [NICE NG196 1.1.2]
102. Episodes suggestive of AF occur twice daily, but a resting ECG is normal. Which monitoring strategy fits NICE? — 24-hour ambulatory ECG. Frequent episodes can be captured with a day of continuous recording. [NICE NG196 1.1.3]
103. Suspected AF episodes occur several weeks apart. Which approach is appropriate after a normal resting ECG? — Longer ambulatory ECG or event recorder matched to frequency. Several-week spacing requires a strategy likely to capture an event. [NICE NG196 1.1.3]
104. A patient with AF asks to use aspirin alone solely for stroke prevention. What does NICE advise? — Aspirin alone is not recommended solely for AF stroke prevention. Stroke prevention should follow individual anticoagulation risk assessment. [NICE NG196 1.6.14]
105. Sinus rhythm is present after AF treatment. What should guide a decision to stop anticoagulation under NICE? — Reassess stroke and bleeding risk and preferences. Risk can persist even when sinus rhythm is recorded. [NICE NG196 1.11.1–1.11.2]
106. A stable adult has suspected PE with a two-level Wells score of 6 and no contraindication to contrast. What is the next imaging test under NICE? — CT pulmonary angiography. The likely-probability pathway proceeds directly to appropriate imaging. [NICE NG158 1.1.18]
107. A stable adult has unlikely PE by Wells score. D-dimer testing is available promptly. What is the usual next test under NICE? — D-dimer. D-dimer is the initial exclusion test in this pathway. [NICE NG158 1.1.21]
108. An adult with unlikely PE has a positive D-dimer. What does this result imply? — Proceed to appropriate PE imaging. A positive result triggers the imaging pathway. [NICE NG158 1.1.21]
109. Likely PE requires imaging but the patient has severe contrast allergy. Which alternative may be assessed under NICE? — V/Q SPECT or, if unavailable, planar V/Q. This is an alternative imaging pathway when contrast is unsuitable. [NICE NG158 1.1.18]
110. In a patient older than 50 undergoing D-dimer testing for suspected VTE, which threshold approach may be considered under NICE? — A validated age-adjusted threshold. Age adjustment may improve specificity in older patients. [NICE NG158 1.1.14]
111. An untreated patient has breathlessness and suspected chronic HF. Which blood test is recommended initially? — NT-proBNP. This is the recommended blood marker in the diagnostic pathway. [NICE NG106 1.2.2]
112. An untreated patient has suspected HF and NT-proBNP 250 ng/L. Which interpretation fits NICE? — HF is less likely; assess alternative causes and persistent concern. The low value lowers likelihood but does not override clinical assessment. [NICE NG106 1.2.5–1.2.6]
113. Can an elevated NT-proBNP alone distinguish preserved from reduced ejection fraction HF? — No; imaging characterizes ventricular function. Echocardiography evaluates systolic and diastolic function. [NICE NG106 1.2.5]
114. A patient with renal disease and sepsis has elevated NT-proBNP. Which conclusion is sound? — Renal disease and sepsis can also elevate NT-proBNP. Interpret the result in its clinical context. [NICE NG106 1.2.7]
115. A patient with suspected HF is obese and has a modest natriuretic peptide level. What limitation matters? — Obesity can lower natriuretic peptide levels. A modest result may underestimate the cardiac concern. [NICE NG106 1.2.7]
116. Under NICE NG196, which score is used to assess stroke risk in AF? — CHA2DS2-VASc. This is the stroke-risk score specified by NICE. [NICE NG196, Assessment algorithm.]
117. Under NICE NG196, which tool helps estimate bleeding risk when discussing anticoagulation for AF? — ORBIT. This estimates bleeding risk for the anticoagulation discussion. [NICE NG196, Assessment algorithm.]
118. A woman aged 42 has AF and no stroke risk factors other than sex. Under NICE NG196, is anticoagulation solely for stroke prevention routinely offered? — No routine anticoagulation solely for this very-low-risk profile. Sex alone in this young woman does not meet the threshold. [NICE NG196 1.6.7.]
119. PE is clinically unlikely and an alternative diagnosis is feasible. Which rule may help decide whether further PE testing is needed under NICE? — PERC. PERC can help decide whether further PE testing is necessary in this low-suspicion setting. [NICE NG158 1.1.16.]
120. A likely PE patient cannot undergo immediate CTPA. No contraindication to anticoagulation is present. What interim approach does NICE recommend? — Interim therapeutic anticoagulation. This covers likely PE while appropriate imaging is arranged. [NICE NG158 1.1.18.]
121. An acutely ill adult with vomiting, hypovolaemia and recent NSAID use has reduced urine output. What should be checked to identify AKI? — Serum creatinine compared with baseline. The change from baseline helps identify acute loss of function. [NICE NG148 1.1.1]
122. AKI is suspected in a hospitalised adult. Which bedside urine assessment is recommended promptly? — Dipstick for blood, protein, leucocytes, nitrites and glucose. The panel helps identify renal and infectious clues promptly. [NICE NG148 1.4.2]
123. An adult has unexplained AKI, haematuria and proteinuria, without UTI or catheter trauma. Which possibility requires nephrology consideration? — Acute nephritis. The combined urine pattern suggests intrinsic renal inflammation. [NICE NG148 1.4.3]
124. Pyonephrosis is suspected in an adult with AKI. Under NICE NG148, how urgently should urinary ultrasound be performed? — Immediately, within 6 hours of assessment. Infected obstruction has a more urgent imaging window. [NICE NG148 1.4.5]
125. AKI has no identified cause and urinary obstruction remains possible. Which imaging plan fits NICE NG148? — Urinary ultrasound within 24 hours. Uncertain cause or obstruction risk warrants urgent imaging. [NICE NG148 1.4.6]
126. A solitary functioning kidney is obstructed and renal function is deteriorating. What referral is required? — Immediate urological referral. The sole functioning kidney is at immediate risk. [NICE NG148 1.5.1]
127. Upper-tract obstruction causing AKI is to be treated by nephrostomy or stent. Under NICE NG148, which timing is appropriate? — As soon as possible, within 12 hours of diagnosis. The recommendation specifies prompt decompression within this interval. [NICE NG148 1.5.2]
128. A euvolaemic adult has AKI without fluid overload. Should loop diuretics be routinely prescribed merely to treat AKI? — Do not routinely add a loop diuretic for AKI itself. There is no fluid-overload indication in this patient. [NICE NG148 1.5.3]
129. An adult with AKI has fluid overload while awaiting renal replacement therapy. Which temporary medication approach can be considered? — Consider a loop diuretic for volume control. This is a specified temporary volume-management indication. [NICE NG148 1.5.4–1.5.5]
130. Low-dose dopamine is suggested to improve renal function in AKI. What does NICE NG148 advise? — Do not use low-dose dopamine to treat AKI. The guideline specifically discourages this indication. [NICE NG148 1.5.5]
131. Hyperkalaemia and pulmonary oedema persist despite medical treatment in AKI. What is the priority? — Immediate renal replacement therapy assessment. Refractory life-threatening complications require escalation. [NICE NG148 1.5.8–1.5.9]
132. An adult with AKI develops uraemic encephalopathy that does not respond to medical management. What is required? — Immediate referral for renal replacement therapy. Encephalopathy is a specified uraemic complication. [NICE NG148 1.5.8]
133. A patient has rapidly worsening AKI. Which principle should guide dialysis initiation? — Integrate the overall condition and complications. Volume, electrolytes, uraemia and trajectory all matter. [NICE NG148 1.5.9]
134. An adult with a renal transplant develops AKI. What specialist discussion is appropriate under NICE? — Nephrology discussion as soon as possible, within 24 hours. Acute graft dysfunction merits prompt specialist review. [NICE NG148 1.5.15]
135. After recovery from AKI, an adult has stable eGFR 25 mL/min/1.73 m². Which follow-up step should be considered? — Consider nephrology referral and monitor renal function. This level of residual impairment meets the referral consideration. [NICE NG148 1.5.16]
136. An adult has severe hyperkalaemia with ECG changes. Which treatment primarily protects the myocardium immediately? — Intravenous calcium. Calcium antagonizes the myocardial effects of hyperkalemia. [Resuscitation Council UK 2025, Hyperkalaemia, Protect the heart]
137. Insulin with glucose is given for acute hyperkalaemia. What is its principal potassium-lowering mechanism? — Shift potassium into cells. Insulin temporarily reduces extracellular potassium by redistribution. [Resuscitation Council UK 2025, Hyperkalaemia, Shift potassium into cells]
138. After insulin-glucose treatment for hyperkalaemia, what additional biochemical monitoring is essential alongside potassium? — Blood glucose. Insulin can cause delayed hypoglycemia despite initial glucose administration. [Resuscitation Council UK 2025, Hyperkalaemia, Monitor potassium and glucose;; NHS GGC, Treatment options, insulin-glucose monitoring (reviewed Sep 2024, updated Apr 2025)]
139. An adult without diabetes has CKD with persistent urine ACR 80 mg/mmol and stable eGFR 68 mL/min/1.73m². There is no acute illness or urinary obstruction. Which follow-up plan follows NICE referral criteria? — Refer for nephrology assessment because the albuminuria meets the referral criterion. An ACR of at least 70 mg/mmol is a specialist-referral criterion; the diabetes exception does not apply. [NICE NG203 1.5.5;1.6.7]
140. A person with CKD asks how progression and adverse-outcome risk are classified. Which paired categories are used by NICE? — GFR and urine ACR categories. Together they stratify progression and adverse outcomes. [NICE NG203 Risk assessment using GFR and ACR categories]
141. A diabetic adult taking an SGLT2 inhibitor has vomiting, ketonaemia and metabolic acidosis, but glucose is 180 mg/dL. Which diagnosis remains possible? — Euglycemic DKA. Near-normal glucose does not exclude DKA in an SGLT2-treated diabetic adult. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Special populations: SGLT2 inhibitors]
142. In suspected DKA, which ketone measurement is preferred for diagnosis and monitoring? — Blood beta-hydroxybutyrate. It directly measures the predominant DKA ketoacid. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Diagnostic criteria and ketone assessment]
143. During recovery from DKA, urine ketones remain positive although blood beta-hydroxybutyrate is falling. What explains this discrepancy? — Conversion to acetoacetate sustains urine positivity during recovery. Urine nitroprusside detects acetoacetate, which can remain detectable. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Ketone assessment]
144. DKA presents with potassium 3.1 mmol/L. Under the 2024 consensus, what should precede insulin treatment? — Replace potassium and delay insulin until K exceeds 3.5 mmol/L. Insulin can worsen hypokalemia with arrhythmic and muscle risk. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Potassium]
145. A DKA patient has normal initial serum potassium despite substantial osmotic diuresis. Which interpretation is correct? — Total-body potassium can be depleted despite normal serum K. Extracellular shifts can mask urinary losses. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Potassium]
146. A DKA patient has pH7.20 and is receiving appropriate fluid and insulin therapy. Is routine bicarbonate recommended by the 2024 consensus? — Continue appropriate fluids and insulin without routine bicarbonate. Routine bicarbonate has no established benefit here. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Bicarbonate]
147. Severe DKA has pH6.85. Which statement fits the 2024 consensus on bicarbonate? — Bicarbonate may be considered alongside standard DKA therapy. pH6.85 is below the severe-acidosis threshold in the 2024 report. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Bicarbonate]
148. An adult with severe DKA is stuporous with marked acidosis. What care location is suggested by the 2024 severity framework? — Intensive care assessment. Severe acidosis and altered consciousness require high-acuity care. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Table 2 severity classification]
149. Which patients may be candidates for frequent subcutaneous rapid-acting insulin under the 2024 consensus, where monitoring is adequate? — Selected uncomplicated mild or moderate DKA with adequate monitoring. The alternative requires selection and frequent clinical/biochemical review. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Insulin]
150. An adult taking an SGLT2 inhibitor is admitted with DKA. What should happen to that medicine initially? — Stop the SGLT2 inhibitor on admission. Acute DKA warrants interruption of this contributing medication. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Special populations: SGLT2 inhibitors]
151. A treated DKA patient has persistent normal-anion-gap acidosis after ketones improve. Which treatment-related process may explain this? — Hyperchloremic metabolic acidosis. Chloride-rich fluid and changing anion balance can leave this pattern. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Anion gap interpretation]
152. DKA is suspected with diabetes, hyperglycaemia and acidosis. Which additional feature is required for the DKA diagnostic triad? — Significant ketonaemia. Ketones establish the ketoacidotic component of the triad. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Diagnostic criteria]
153. During DKA treatment, glucose falls to220mg/dL while ketonaemia persists. Under the 2024 consensus, which principle is appropriate? — Add dextrose and continue appropriately adjusted insulin. Glucose can normalize before ketoacidosis; dextrose permits ongoing insulin safely. [ADA/EASD/JBDS/AACE/DTS2024Consensus, Fluid Therapy and Insulin: glucose below250mg/dL before ketonaemia correction.]
154. A diabetic patient in DKA has beta-hydroxybutyrate4mmol/L. Which statement is accurate? — It meets the ketonaemia criterion of at least3mmol/L. 4mmol/L exceeds the diagnostic ketone threshold. [ADA/EASD/JBDS/AACE/DTS 2024 Consensus, Diagnostic criteria]
155. A patient with possible adrenal crisis is hypotensive. Should emergency hydrocortisone await definitive laboratory confirmation? — Give emergency hydrocortisone without awaiting definitive confirmation. Diagnostic uncertainty must not delay treatment of possible adrenal shock. [Society for Endocrinology Adrenal Crisis Guidance, Emergency management]
156. A clinically stable woman taking oral estrogen for hormone replacement is having elective serum cortisol testing for possible adrenal insufficiency. There are no adrenal-crisis features. Under NICE NG243, which preparation is appropriate after discussing her treatment? — Stop oral estrogen for 6 weeks before testing; consider a transdermal HRT alternative. Oral estrogen raises cortisol-binding globulin and may falsely elevate total cortisol; NICE specifies a 6-week pause for elective testing. [NICE NG243 1.2.12–13;Rationale Initial investigations]
157. After initial adrenal-crisis rescue, a patient remains unstable. Which principle applies to glucocorticoid cover? — Continue parenteral glucocorticoid cover until recovery with specialist guidance. Ongoing physiologic stress requires continued replacement and monitoring. [Society for Endocrinology Adrenal Crisis Guidance, Maintenance until recovery]
158. An adult with severe symptomatic hyponatraemia has seizures. What immediate therapy is recommended by Society for Endocrinology guidance? — IV hypertonic sodium chloride with close monitoring. Severe neurologic symptoms require immediate monitored treatment. [Society for Endocrinology 2022 Hyponatraemia Emergency Guidance, Treatment recommendation 1]
159. During correction of hyponatraemia, sodium rises too rapidly. Which serious complication is the main concern? — Osmotic demyelination syndrome. Excessively rapid correction threatens osmotic brain injury. [Society for Endocrinology 2022 Hyponatraemia Emergency Guidance, Correction limits and over-correction]
160. An adult with severe symptomatic hyponatraemia receives monitored hypertonic saline. Under Society for Endocrinology 2022 guidance, what initial sodium rise is targeted within the first hour? — About5mmol/L in the first hour, with reassessment. A limited rise aims to relieve cerebral edema without uncontrolled correction. [Society for Endocrinology 2022 Hyponatraemia Emergency Guidance, Treatment monitoring]
161. An adult has confirmed asthma and uses only a SABA. What treatment principle does BTS/NICE/SIGN NG245 emphasise? — Use an ICS-containing strategy. The strategy addresses inflammation as well as relief. [NG245, SABA prescribing and adult initial treatment]
162. Asthma symptoms persist despite prescribed inhalers. Before escalating, what should be checked at review? — Assess adherence and observe inhaler technique. Poor delivery can mimic pharmacological treatment failure. [NG245, checking adherence and inhaler technique]
163. An adult has asthma-like symptoms but routine objective tests do not confirm asthma. What is an appropriate next diagnostic consideration under NG245? — Refer for consideration of bronchial challenge testing. Challenge may demonstrate airway hyperresponsiveness. [NG245, adult objective diagnostic pathway]
164. An adult is stepping down maintenance asthma therapy after sustained control. Which supporting document should be reviewed and updated? — Personalised asthma action plan. It should reflect the reduced regimen and actions for deterioration. [NG245, decreasing maintenance treatment]
165. A patient reports no daytime wheeze but wakes repeatedly at night from asthma. Does this meet complete control as defined by NG245? — No; nocturnal asthma waking indicates incomplete control. Night symptoms are a separate control domain. [NG245, definition of complete control]
166. A patient admitted with COPD exacerbation remains acidotic and hypercapnic despite optimal medical treatment. Which ventilatory support is the treatment of choice under NG115 if suitable? — Non-invasive ventilation if suitable. NIV is the stated treatment of choice in suitable patients. [NG115 1.3.30]
167. A COPD exacerbation patient reaches hospital on supplemental oxygen. What should be recorded when arterial blood gases are measured? — Inspired oxygen concentration. The current concentration is necessary for interpretation. [NG115 1.3.29]
168. A stable COPD patient is being assessed for long-term oxygen therapy under NICE. Which testing context is appropriate? — ABGs twice at least3weeks apart while stable on optimal therapy. Repeated stable assessment distinguishes chronic from transient hypoxemia. [NG115, assessing long-term oxygen therapy]
169. A COPD patient has recurrent purulent sputum despite treatment. What investigation may identify resistant or unusual organisms? — Sputum culture and susceptibility. Culture can identify resistant or unusual pathogens. [NG115, investigating persistent or recurrent infection]
170. A COPD patient has repeated exacerbations. Which self-management support is recommended? — An individualised exacerbation action plan. The plan guides early recognition and appropriate individualized action. [NG115, self-management and action plans]
171. An acutely breathless asthmatic adult has a silent chest and poor respiratory effort. Which interpretation is safest? — Life-threatening airflow obstruction. Minimal airflow can cause a silent chest despite critical obstruction. [NHS GGC acute asthma, life-threatening features]
172. A severely distressed asthmatic adult has a normal-range PaCO2. Why can this be concerning? — Failing ventilation and fatigue may normalize PaCO2. Compensatory hyperventilation usually lowers CO2 in a severe attack. [NHS GGC acute asthma, blood gas markers]
173. A severely ill asthmatic patient is agitated. Should sedatives be routinely used to calm the attack? — Avoid routine sedatives and assess respiratory deterioration. Agitation can reflect hypoxia and exhaustion; sedatives can depress ventilation. [NHS GGC acute asthma, immediate treatment]
174. A severe asthma patient cannot take oral corticosteroids. Which route is an accepted alternative in the acute pathway? — Intravenous corticosteroid. IV delivery provides systemic treatment when oral dosing is not feasible. [NHS GGC acute asthma, immediate treatment]
175. After initial severe asthma treatment, unilateral chest pain and markedly asymmetric breath sounds appear. What complication warrants chest imaging? — Pneumothorax. Unilateral pain and asymmetric sounds warrant urgent assessment for pneumothorax. [NHS GGC acute asthma, chest radiograph indications]
176. A severe asthma patient has already received bronchodilator treatment but remains hypoxic. What oxygen principle fits the GGC adult acute asthma pathway? — Titrate to94–98%. This is the GGC adult acute asthma target. [NHS GGC acute asthma, oxygen]
177. A COPD patient has respiratory failure and an immediate need for tracheal intubation. Should a trial of NIV delay the required airway intervention? — Proceed with required definitive airway management. NIV should not delay an immediately necessary airway. [NSW ECI COPD clinical tool, August 2026 revision, NIV absolute contraindications.]
178. An older patient with COPD struggles with a new inhaler. What is the appropriate first response? — Observe technique, train and select a suitable device. Ability and demonstrated technique guide the choice. [NG115, inhaler technique and devices]
179. A COPD patient uses several different inhaler types and often confuses their techniques. What prescribing principle may help? — Simplify the number and types of inhalers when feasible. Simplification can reduce errors while maintaining needed treatment. [NG115 1.2.18]
180. A COPD patient has chronic hypercapnic failure and needed assisted ventilation during a recent exacerbation. What specialist option should be considered? — Specialist assessment for long-term NIV. This history meets a specialist referral consideration. [NG115, long-term non-invasive ventilation]
181. A patient with acute stroke has not yet had a swallowing screen. What should precede oral tablets or water? — Swallow screen by an appropriately trained professional. Stroke may impair airway protection despite apparent alertness. [NG128, swallowing screen before oral intake]
182. An acute stroke patient is considered for aspirin. Which imaging exclusion is required first? — Intracerebral hemorrhage. Bleeding changes the acute treatment pathway. [NG128 1.4.9]
183. Imaging excludes haemorrhage in acute ischaemic stroke, but dysphagia is present. Which aspirin route is supported by NICE when treatment is appropriate? — Rectal or enteral-tube aspirin. These routes avoid an unsafe oral swallow. [NG128 1.4.9]
184. An otherwise eligible acute ischemic stroke thrombolysis candidate has BP195/115mmHg after hemorrhage is excluded. Under NICE NG128, what BP approach should be considered before reperfusion? — Consider controlled BP reduction to185/110mmHg or lower. The thrombolysis pathway includes this BP consideration. [NICE NG128,1.5.10 blood pressure in thrombolysis candidates.]
185. A patient with ischemic stroke has symptomatic confirmed proximal DVT. Anticoagulation contraindications have been assessed and none is present. Under NICE, which treatment is preferred for the DVT? — Anticoagulation rather than aspirin alone. The concurrent symptomatic VTE is a separate treatment indication. [NG128, proximal DVT/PE after ischaemic stroke]
186. An adult is in convulsive status with an immediately available individual emergency plan. What should guide rescue medication? — Give rescue medication according to the immediately available plan. The plan supports prompt individualized rescue. [NG217 7.1.2]
187. Convulsive status occurs in hospital with immediate IV access and resuscitation facilities but no personal rescue plan. Which first-line option fits NICE? — Intravenous lorazepam. This is the NICE first-line hospital option in the stated setting. [NG217 7.1.3]
188. Convulsive status occurs in the community without an available emergency plan. Which rescue class is first line under NICE? — An appropriate rescue benzodiazepine route. NICE lists buccal midazolam or rectal diazepam in the community. [NG217 7.1.3]
189. The first benzodiazepine dose has failed to stop convulsive status in hospital. What should accompany further treatment? — Seek expert guidance urgently while continuing the status pathway. Ongoing convulsions require escalation with support. [NG217 7.1.7]
190. An adult with convulsive status has received appropriate benzodiazepine rescue. Which immediate cause-directed bedside assessment should accompany resuscitation rather than waiting for recovery? — Check glucose and treat hypoglycemia if present. A reversible metabolic cause can require treatment alongside seizure rescue. [NICE NG217,7.1.4 underlying causes of status epilepticus.]
191. Headache worsens over4months while a patient uses a triptan 12 days each month. Which diagnosis should be considered? — Medication-overuse headache. Twelve days monthly for four months exceeds the triptan threshold. [CG150 1.2.7]
192. An adult uses only paracetamol for headache 12 days per month for four months and uses no other acute headache medicine. How does this compare with the NICE paracetamol frequency alert for medication-overuse headache? — It is below the paracetamol-specific15-day frequency alert threshold. Drug class affects the frequency threshold; still assess the headache clinically. [CG150 1.2.7]
193. A pregnant patient needs migraine prevention. What does NICE advise before selecting prophylactic treatment? — Seek specialist advice before selecting prophylaxis. Pregnancy changes the benefit-harm assessment of preventive medicines. [CG150 1.3.33]
194. An adult has an acute cluster headache attack. Which non-drug treatment is recommended by NICE? — Oxygen through an appropriate high-flow non-rebreathing system. The recommended system supplies high-concentration oxygen. [CG150 1.3.35–1.3.36]
195. A patient with cluster headache requests an oral triptan for fast relief. What does NICE say about oral triptans in acute cluster attacks? — Oral triptans are not recommended for acute cluster attacks. NICE favors oxygen and/or a subcutaneous or nasal triptan. [CG150 1.3.35–1.3.38]
196. Verapamil prophylaxis is considered during a cluster headache bout. Which safety support is important when the prescriber is unfamiliar with this use? — Specialist advice including ECG monitoring. Verapamil affects cardiac conduction as well as headache prevention. [CG150 1.3.39]
197. A first cluster headache bout is diagnosed. What investigation discussion is recommended by NICE? — Discuss neuroimaging with a headache-experienced GP or neurologist. The first bout warrants consideration of structural mimics. [CG150 1.3.34]
198. A headache diary is used to assess suspected menstrual-related migraine. What duration does NICE recommend for diagnosis? — At least2menstrual cycles. Repeated-cycle timing helps establish the association. [CG150 1.2.6]
199. A patient withdraws overused acute headache medicines. Can preventive treatment for the underlying primary headache also be considered? — Consider suitable prophylaxis alongside withdrawal. Withdrawal and prevention can address different parts of the problem. [CG150, medication-overuse headache management]
200. A patient with headache describes visual symptoms confined to one eye and poor balance. Should these simply be assumed typical aura without further assessment? — Consider further assessment or referral for atypical aura features. The localization and balance symptoms alter the differential. [CG150, migraine aura requiring further investigation]
201. Acute pancreatitis is diagnosed without evidence of infection. Should antibiotics be given solely to prevent infection? — Withhold prophylactic antibiotics; reassess if infection becomes suspected. Antibiotics are not routine prophylaxis; a separate infection indication changes management. [NG104 1.2.3]
202. A patient with acute pancreatitis can tolerate food and has no vomiting or other reason to fast. Which approach fits NICE? — Allow food as tolerated. There is no clear reason to withhold food in this scenario. [NG104 1.2.5]
203. Moderately severe acute pancreatitis requires nutritional support and the gut is usable. Which route is preferred? — Enteral tube nutrition. The functioning gut can provide the recommended nutritional route. [NG104 1.2.6–7]
204. In severe acute pancreatitis, enteral feeding fails or is contraindicated. What nutrition option is appropriate? — Parenteral nutrition. This is the indication for parenteral nutritional support. [NG104 1.2.7]
205. Under NICE, when should enteral nutrition start for severe or moderately severe acute pancreatitis? — Within 72 hours of presentation. This is the NICE start window; aim to meet requirements promptly. [NG104 1.2.6]
206. A person with chronic pancreatitis continues smoking. Which counselling is supported by NICE? — Offer support to stop tobacco smoking. Smoking cessation is specifically advised in chronic pancreatitis. [NG104 1.1.11]
207. An adult with chronic pancreatitis loses weight and develops malabsorptive symptoms. Which complication should be assessed? — Pancreatic exocrine insufficiency with malnutrition. Malabsorption and weight loss require assessment of digestion and nutrition. [NG104 1.3.20]
208. Crohn disease is in remission. Are conventional glucocorticoids recommended as long-term maintenance? — Plan a steroid-sparing maintenance strategy. Neither conventional steroids nor budesonide is recommended to maintain remission. [NG129 1.3.7]
209. Before azathioprine for Crohn disease, TPMT activity is very low or absent. What should be done under NICE? — Avoid azathioprine and mercaptopurine and select an alternative. Very low or absent activity is a contraindication in this NICE pathway. [NG129 1.2.8]
210. A patient taking azathioprine after Crohn surgery has normal TPMT activity. Is neutropenia monitoring still needed? — Continue scheduled blood-count monitoring. Normal TPMT does not exclude treatment-related neutropenia. [NG129 1.4.3;1.2.10]
211. A patient asks whether azathioprine alone is a rapid induction treatment for an active Crohn flare. Which statement fits NICE? — Use an appropriate induction regimen rather than azathioprine alone. NICE advises against these agents as monotherapy for induction. [NG129 1.2.6]
212. An adult is admitted with acute severe ulcerative colitis. What should happen to the assessment of surgical need? — On admission and then daily. Severe colitis requires repeated assessment for deterioration and treatment failure. [NG130 1.2.26]
213. A patient with longstanding ulcerative colitis asks why colonoscopic surveillance is discussed. Which risk is relevant? — Colitis-associated colorectal dysplasia and cancer. Surveillance seeks colonic dysplasia and early colorectal malignancy. [NICE CG118 1.1.1–2,p7]
214. A person with ulcerative colitis is considering elective surgery. Which decision process is appropriate? — Discuss medical and surgical choices, stoma or pouch consequences, and preferences. Informed choice includes short- and long-term consequences relevant to the person. [NG130 1.3.1–5]
215. A patient taking a PPI is scheduled for H pylori breath testing. Which preparation is needed under NICE? — Stop the PPI for 2 weeks before the test. The recommended washout reduces acid-suppression interference. [CG184 1.4.2]
216. An adult has uncomplicated dyspepsia without new alarm features. Which H pylori strategy is offered under NICE? — Test for H pylori and treat a confirmed infection. Test-and-treat identifies patients who can benefit from eradication. [CG184 1.4.4]
217. A patient had previous endoscopy but now develops new alarm symptoms. Should management simply repeat the old reassuring plan? — Reassess the new alarm features and determine current referral needs. The reassurance from prior endoscopy is conditional on no new alarm signs. [CG184 1.3.4]
218. An adult is malnourished, cannot swallow safely, and has a usable gastrointestinal tract. Which nutritional route should be considered? — Enteral tube feeding. The usable gut permits feeding while bypassing the unsafe oral swallow. [CG32 1.7.1]
219. After stroke, an adult cannot swallow safely or meet needs orally. Under NICE CG32, which initial enteral approach is suggested? — An initial 2–4 week nasogastric feeding trial. An initial trial supports nutrition while prognosis and swallowing are assessed. [CG32 1.7.10]
220. A recovering adult previously required oral nutritional supplements. A dietitian confirms sustained adequate energy and nutrient intake from normal food, and swallowing is safe. What should happen to oral nutrition support? — Stop oral nutrition support with ongoing nutritional review. The stopping criterion is established adequate intake from normal food. [CG32 1.6.9]
221. After an injection, an adult suddenly develops wheeze, stridor and hypotension without a rash. Which diagnosis needs immediate treatment? — Anaphylaxis. Sudden combined airway and circulatory compromise after exposure fits anaphylaxis even without rash. [RCUK2025 Anaphylaxis,recognition bullet]
222. An adult has suspected anaphylaxis. Which first-line drug and route is recommended? — Intramuscular adrenaline. Adrenaline treats life-threatening airway, breathing and circulatory effects. [RCUK2025 Anaphylaxis,adrenaline bullet]
223. Anaphylaxis begins during an infusion. What should happen to the suspected trigger if feasible immediately? — Stop the suspected infusion and begin emergency treatment. This limits further exposure while resuscitation begins. [RCUK2025 Anaphylaxis,trigger bullet]
224. An adult remains hypotensive in anaphylaxis after initial adrenaline. What circulatory support should be provided early while monitoring response? — An intravenous crystalloid bolus with reassessment. Early bolus support addresses circulatory compromise; assess response. [RCUK2025 Anaphylaxis,fluid bullet]
225. A collapsed worker has suspected heat stroke. Which measurement guides temperature-directed treatment? — Core temperature measured with an appropriate device. Core temperature guides assessment and temperature-directed treatment. [RCUK2025 Hyperthermia,measurement bullet]
226. Heat stroke is diagnosed after exertional collapse. What is the treatment priority alongside resuscitative assessment? — Begin rapid active cooling alongside resuscitative care. Heat stroke needs immediate effective heat removal. [RCUK2025 Hyperthermia,heatstroke bullet]
227. A person has heat exhaustion without heat-stroke features. Which immediate environmental measure is appropriate? — Move to a cool place, use simple external cooling and provide fluids. These measures are appropriate for uncomplicated heat exhaustion. [RCUK2025 Hyperthermia,heatexhaustion bullet]
228. A hypothermic patient in ventricular fibrillation has a core temperature 27°C. VF persists after three shocks. Under RCUK2025, what should happen to further defibrillation attempts? — Defer further shocks until the core temperature exceeds 30°C while continuing appropriate resuscitation and rewarming. RCUK specifies this temperature-dependent modification after three unsuccessful shocks. [RCUK2025 Accidentalhypothermia,defibrillation bullet]
229. An unconscious hypothermic adult may have very slow vital signs. How long should vital signs be checked under RCUK guidance? — Up to1 minute. Profoundly slowed vital signs may need the extended check. [RCUK2025 Accidentalhypothermia,vitals bullet]
230. An adult with accidental hypothermia needs a reliable temperature measurement. Which instrument is appropriate? — A core thermometer validated for low temperatures. The device must measure the clinically relevant low range. [RCUK2025 Accidentalhypothermia,temperature bullet]
231. A conscious cold-exposed adult is shivering. If core temperature cannot be measured, which Swiss-stage pattern fits? — StageI. Consciousness with shivering fits the mild-stage pattern. [RCUK2025 Accidentalhypothermia,Swissstaging bullets]
232. A severely hypothermic patient has core temperature 28°C and ventricular arrhythmia. What destination capability is important under RCUK? — An ECPR centre with extracorporeal rewarming capability. These are risk factors for imminent arrest requiring specialist destination planning. [RCUK2025 Accidentalhypothermia,ECPRtransfer bullets]
233. A person is drowning in hazardous water. What is the first principle for rescuers? — Use the safest rescue method within training, with rescue aids and help. Rescuer safety prevents additional casualties. [RCUK2025 Drowning,safety bullets]
234. A drowning casualty needs resuscitation. Should in-water spinal immobilisation delay removal for resuscitation? — Remove promptly for required resuscitation with practical spinal precautions. Spinal precautions must not delay lifesaving removal and resuscitation. [RCUK2025 Drowning,spine bullet]
235. A trained first responder begins resuscitation after drowning. What initial breathing step does RCUK specify? — Give 5 initial ventilations, then follow standard CPR. Use 100% oxygen when available; drowning has a major hypoxic component. [RCUK2025 Drowning,initialventilation bullet]
236. Bag-mask ventilation is provided after drowning. Why should ventilation pressure be minimised while achieving ventilation? — Reduce gastric inflation. Excess pressure promotes stomach inflation; maintain effective ventilation. [RCUK2025 Drowning,BVM bullet]
237. A cardiac-arrest patient may have toxic exposure. What should the resuscitation team actively assess? — Assess poisoning as a potentially reversible cause while continuing ALS. Clinical context and exposure assessment guide parallel cause-specific care. [RCUK2025 Toxins,assessment bullet]
238. A specific antidote is available for a suspected life-threatening poisoning during resuscitation. Which principle fits RCUK? — Give the indicated antidote promptly alongside resuscitation. Specific treatment addresses the cause while supportive care continues. [RCUK2025 Toxins,antidote bullet]
239. Resuscitation continues in severe poisoning. Why may prolonged efforts sometimes be appropriate? — Support can maintain perfusion while the toxin is metabolised or eliminated. This reversibility may justify extended efforts, assessed individually. [RCUK2025 Toxins,prolongedresuscitation bullet]
240. The team needs advice on a complex poisoning and enhanced elimination. Which resource is appropriate? — A regional or national poison information centre. Poison centres provide case-specific antidote and enhanced-elimination advice. [RCUK2025 Toxins,poisoncentre bullet]
241. An older ward patient develops acute inattention and fluctuating confusion. Which screening tool is recommended by NICE outside critical care? — 4AT. 4AT is the specified delirium assessment tool in this setting. [CG103 1.6.1]
242. Delirium is suspected in an intensive-care patient. Which assessment tool fits NICE critical-care guidance? — CAM-ICU or ICDSC. NICE specifies these ICU-appropriate instruments instead of4AT. [CG103 1.6.1]
243. Over 24 hours an older inpatient develops fluctuating inattention, withdrawal, slow responses and reduced mobility without agitation. Which diagnosis is most important to assess? — Hypoactive delirium. An acute fluctuating change with inattention can be hypoactive rather than agitated. [CG103 1.3.2]
244. Acute confusion occurs in a patient with baseline dementia. When delirium and dementia are difficult to distinguish, what should be managed first? — Identify and manage delirium first. This prioritises potentially reversible acute illness. [CG103 1.6.3]
245. An older resident develops sudden confusion after a medication change. Which history step is particularly useful? — Reconcile recent additions and withdrawals, including sedatives and anticholinergics. Both toxicity and withdrawal can contribute to acute confusion. [Queensland Practicepoint2,Medications row]
246. A confused older adult has suprapubic discomfort and cannot void. Which reversible trigger should be assessed? — Urinary retention. Suprapubic discomfort and inability to void warrant prompt retention assessment. [Queensland Practicepoint2,head-to-toe/pain row]
247. A delirious resident has unstable vital signs. What is the priority? — Urgently assess physiological instability and escalate according to goals of care. Instability is a red flag and needs an acute response. [Queensland Practicepoints 2–4]
248. A confused patient cannot provide a reliable baseline history. What information source helps identify the acute change? — Obtain collateral history from a familiar carer or family member. Informants can describe usual function and the timing of change. [Queensland Practicepoint2,history bullet]
249. A delirious patient has poor hearing and normally wears hearing aids. Which environmental intervention is appropriate? — Check and provide the patient’s working hearing aids. Correcting sensory deprivation assists orientation and communication. [FICM Non-pharmacological paragraph 2;CG103 1.4.12]
250. Night-time noise and repeated unnecessary interruptions disturb a patient at delirium risk. Which measure helps? — Cluster nonessential care and reduce noise during sleep periods. Protecting the sleep-wake cycle is part of supportive care. [FICM Non-pharmacological paragraph 2;CG103 1.4.13]
251. A delirious patient is disoriented to time and place. Which supportive communication approach is suitable? — Give calm repeated orientation, introductions and visible time cues. Reassurance and familiar cues improve the care environment. [FICM Non-pharmacological paragraphs 1–2;CG103 1.7.2]
252. Before diagnosing dementia, which contributors should be investigated? — Delirium, depression, sensory impairment and adverse medication effects. These can mimic or worsen cognitive decline and need investigation. [NG97 1.2.6,1.2.9]
253. An older adult taking several anticholinergic medicines develops cognitive decline. What prescribing review is appropriate? — Review indications and consider alternatives with lower anticholinergic burden. Individual safe deprescribing or substitution may reduce cognitive adverse effects. [NG97 1.6.1–2]
254. A patient with Lewy-body dementia develops distressing hallucinations. What special antipsychotic risk matters? — Worsening parkinsonism with potentially severe antipsychotic sensitivity. NG97 warns of motor deterioration and sometimes severe sensitivity in Lewy-body or Parkinson dementia. [NG97 1.7.4]
255. A person with dementia becomes agitated. What should be assessed before attributing it solely to dementia? — Assess pain, delirium, unmet needs and environmental factors. Treatable contributors can drive apparent behavioral deterioration. [NG97 1.7.1]
256. An antipsychotic is justified for severe dementia-related distress after assessment. Which dosing principle fits NICE? — Lowest effective dose for the shortest possible time. Limit exposure and reassess benefit and harm. [NG97 1.7.6]
257. A dementia patient is receiving an antipsychotic for behavioural distress. What does NICE recommend about ongoing need? — At least every 6 weeks. Check whether medication remains necessary at least this often. [NG97 1.7.6]
258. Antipsychotic treatment is started for a dementia patient. Should psychosocial and environmental support stop? — Continue individualized psychosocial and environmental interventions. Support remains accessible during and after drug treatment. [NG97 1.7.8]
259. A person with dementia has coughing and difficulty while eating. Which assessment support should be considered? — Speech and language therapist with swallowing expertise. The symptoms raise swallowing and aspiration-safety concerns. [NG97 1.10.7]
260. An agitated dementia patient has no severe distress or harm risk after assessment. Is routine antipsychotic prescribing appropriate solely for staff convenience? — Use individualized psychosocial/environmental measures and review needs. The stated presentation does not meet the restricted antipsychotic indications. [NG97 1.7.2–3]
261. An adult presents3hours after STEMI onset. Primary PCI can be delivered within 120 minutes of when fibrinolysis could be given. Under NICE, which reperfusion strategy is preferred? — Coronary angiography with primary PCI if indicated. This is the preferred NICE reperfusion strategy in the stated timeframe. [NG185 1.1.6]
262. A STEMI patient presents within 12 hours. PCI cannot be delivered within 120 minutes of when fibrinolysis could be given. No fibrinolysis contraindication exists. What does NICE advise? — Offer fibrinolysis promptly. The patient meets the stated NICE alternative reperfusion conditions. [NG185 1.1.19]
263. STEMI is complicated by cardiogenic shock within 12 hours of symptom onset. What invasive strategy does NICE recommend? — Urgent coronary angiography with PCI if indicated. Shock complicating recent STEMI requires this invasive pathway. [NG185 1.1.7]
264. A patient has clinical cardiovascular disease after MI. What lipid-management principle is supported by NICE? — Offer an appropriate secondary-prevention statin regimen. Clinical cardiovascular disease supports secondary prevention. [NG185 1.4.42]
265. An older adult recovers from MI. Is age alone a reason not to offer exercise-based cardiac rehabilitation? — Offer rehabilitation and individualize the exercise component to clinical status. Age alone is not a restriction; clinical risks may require adaptation. [NG185 1.8.1–4]
266. A clinician proposes routine ACE inhibitor plus ARB after MI without another indication. What does NICE advise? — Use a single appropriate renin–angiotensin agent rather than routine dual blockade. The recommendation excludes routine combination for this purpose. [NG185 1.4.8–10]
267. Under NICE NG185, which patient should not be offered a newly started beta-blocker solely because of a previous MI? — MI18 months ago, normal LVEF, no heart failure, angina or other beta-blocker indication. This is the specific no-additional-indication group described in1.4.33. [NICE NG1851.4.27,1.4.31–33]
268. A post-MI patient has a separate indication for oral anticoagulation. What should guide the antiplatelet combination and duration? — Balance bleeding, thromboembolic and cardiovascular risks with preferences. Combination and duration require an individualized plan. [NG185 1.4.21–26]
269. At a hypertension assessment, repeated bilateral measurements show right-arm systolic BP 158 mmHg and left-arm systolic BP 138 mmHg. The difference persists on the second set. Which arm should be used for subsequent BP measurements under NICE? — The right arm, which has the higher repeat reading. The persistent 20 mmHg difference exceeds 15; subsequent readings use the higher arm. [NICE NG136 1.2.1]
270. A patient cannot tolerate ABPM for hypertension confirmation. What alternative does NICE allow? — Validated home blood-pressure monitoring. HBPM is the recommended alternative confirmation pathway. [NG136 1.2.4]
271. An irregular pulse is found before BP measurement. Which method does NICE recommend? — Manual auscultation over the brachial artery. Irregularity can impair automated accuracy; NICE specifies manual auscultation. [NG136 1.1.2]
272. A patient reports postural dizziness. What positional BP assessment is appropriate under NICE? — Measure supine, then after standing for at least 1 minute. This tests the postural change; a seated baseline is an alternative if supine is inconvenient. [NG136 1.1.5]
273. Standing BP falls25mmHg systolic after1minute and dizziness occurs. Which next consideration fits NICE? — Review likely causes and medicines, and use standing BP for subsequent measurements. The25mmHg fall exceeds the systolic threshold and warrants management. [NG136 1.1.6]
274. A patient has repeat clinic BP 192/124 mmHg and papilledema on examination. Under NICE NG136, what is the appropriate referral timing? — Specialist assessment on the same day. Severe hypertension with papilledema meets the same-day referral criterion. [NICE NG136 1.5.2; contrast 1.5.1]
275. An adult has acute HF with congestion. Which pharmacological route is recommended for diuresis under NICE? — Intravenous loop diuretic with response assessment. An intravenous bolus or infusion is recommended for acute HF. [CG187 1.3.3]
276. An acute HF patient receives IV diuretics. Which monitoring set is important? — Renal function, body weight and urine output. Together these track decongestion and renal safety. [CG187 1.3.5]
277. Routine morphine is proposed for every acute HF presentation. What does NICE advise? — Do not prescribe morphine routinely for acute HF. An individual analgesic or palliative indication is distinct from routine HF treatment. [CG187 1.3.2]
278. A patient with acute HF is haemodynamically stable without shock. Should inotropes be routine? — Do not use inotropes routinely in this stable presentation. The selected shock indication is absent. [CG187 1.3.10–11]
279. Potentially reversible cardiogenic shock complicates acute HF. If an inotrope is used, what care setting is needed under NICE? — Cardiac care or high-dependency care, or another setting providing at least level 2 care. The treatment requires detailed observation and appropriate organ support. [CG187 1.3.11]
280. IV nitrates are selected for acute HF with severe hypertension. Which safety measure is required? — Close BP monitoring where at least level 2 care is available. Nitrates can cause hypotension and require supported monitoring. [CG187 1.3.7–8]
281. A 46-year-old asymptomatic man has elevated blood pressure at two clinic visits. There is no evidence of an acute hypertensive emergency. Under the USPSTF screening approach, what should precede long-term treatment? — Confirm with ABPM or validated HBPM. Out-of-office confirmation reduces white-coat misclassification. [USPSTF, Hypertension in Adults: Screening (2021), Clinician Summary.]
282. A nurse is preparing a routine screening blood pressure measurement. Which setup best follows the USPSTF measurement advice? — Seated after five minutes’ rest, validated upper-arm device. This follows the stated standardized screening method. [USPSTF, Hypertension in Adults: Screening (2021), Clinician Summary.]
283. A healthy 27-year-old has a normal previous blood pressure, normal weight, and no increased hypertension risk. Under USPSTF guidance, which repeat screening interval is reasonable? — Every 3–5 years. This is reasonable for a normal prior BP and low-risk age 18–39. [USPSTF, Hypertension in Adults: Screening (2021), Clinician Summary.]
284. A 67-year-old without cardiovascular disease asks to start daily aspirin solely to prevent a first cardiovascular event. According to the USPSTF, what is the best advice? — Do not initiate aspirin for primary prevention. USPSTF recommends against initiating at age ≥60 for a first-event prevention indication. [USPSTF, Aspirin Use to Prevent Cardiovascular Disease (2022), Recommendation Summary.]
285. A 52-year-old has no cardiovascular disease, a calculated 10-year CVD risk of 12%, and no increased bleeding risk. How does USPSTF guidance approach initiating aspirin? — Use shared decision-making about small net benefit. For age 40–59 and risk ≥10%, the decision is individualized. [USPSTF, Aspirin Use to Prevent Cardiovascular Disease (2022), Recommendation Summary.]
286. A 58-year-old smoker without known CVD has LDL cholesterol of 130 mg/dL and a 10-year CVD risk of 13%. There is no contraindication to statins. What does USPSTF recommend after discussion and agreement? — Initiate a moderate-intensity statin. Age 40–75, smoking and ≥10% risk meet this recommendation. [USPSTF, Statin Use for Primary Prevention (2022), Clinician Summary.]
287. An otherwise eligible 79-year-old without known CVD asks whether USPSTF evidence establishes that everyone his age should start a statin for primary prevention. Which response is accurate? — Evidence is insufficient to recommend for or against initiation at this age. An I statement denotes insufficient evidence, not a universal prohibition. [USPSTF, Statin Use for Primary Prevention (2022), Clinician Summary.]
288. A patient with a positive TB blood test reports weight loss and persistent cough. Before prescribing a latent-TB regimen, what is essential? — Assess for active TB before preventive treatment. CDC requires excluding TB disease before LTBI treatment. [CDC, Treatment for Latent Tuberculosis Infection (2025), Treatment Considerations and Recommendations.]
289. A woman starts a rifampin-based latent-TB regimen and uses hormonal contraception. Which counseling point is most relevant? — Add or switch to a barrier contraceptive method. CDC advises adding or switching to a barrier method with rifamycins. [CDC, Treatment for Latent Tuberculosis Infection (2025), Treatment Considerations and Recommendations.]
290. A 35-year-old HIV-negative adult has latent TB after active disease is excluded. She cannot tolerate isoniazid and has no rifampin interaction or resistance concern. Which CDC-listed regimen fits? — Daily rifampin for four months. 4R is CDC-listed for HIV-negative people and isoniazid intolerance. [CDC, Treatment for Latent Tuberculosis Infection (2025), Treatment Considerations and Recommendations.]
291. A BCG-vaccinated adult requires testing for TB infection. Which test does CDC prefer in this situation? — Interferon-gamma release assay. IGRA is unaffected by BCG and preferred in vaccinated adults. [CDC, Interferon Gamma Release Assay (2024), Determining an approach and Interpretation.]
292. An immunocompromised patient has cough and imaging concerning for TB, but an IGRA is negative. What is the best interpretation? — Investigate further despite the negative IGRA. Symptoms and immunosuppression limit the reassurance of a negative result. [CDC, Interferon Gamma Release Assay (2024), Determining an approach and Interpretation.]
293. An adult has an indeterminate IGRA result. What is an appropriate next approach under CDC guidance? — Repeat the blood test or use a tuberculin skin test. An indeterminate test provides no useful infection classification. [CDC, Interferon Gamma Release Assay (2024), Determining an approach and Interpretation.]
294. During influenza circulation, a hospitalized patient has a compatible severe respiratory illness. PCR is pending. What is the best influenza-specific action? — Start oseltamivir while testing proceeds. Hospitalized suspected influenza warrants prompt oral/enteric oseltamivir. [CDC, Influenza Antiviral Medications (2026), Priority Groups and Co-circulation.]
295. A high-risk outpatient presents with progressive influenza-associated pneumonia four days after symptom onset. Which statement is correct? — Start oseltamivir promptly despite day-four presentation. Progressive or complicated influenza remains an indication beyond two days. [CDC, Influenza Antiviral Medications (2026), Priority Groups and Co-circulation.]
296. A hospitalized patient tests positive for SARS-CoV-2 during influenza co-circulation. Which interpretation is correct? — Influenza coinfection is still possible. CDC specifically cautions that one positive virus does not exclude the other. [CDC, Influenza Antiviral Medications (2026), Priority Groups and Co-circulation.]
297. A healthy adult with an acute cough has normal vital signs, no focal lung findings, and green sputum. Uncomplicated acute bronchitis is diagnosed. What is appropriate? — Symptomatic care without routine antibiotics. Uncomplicated bronchitis does not routinely benefit from antibiotics. [CDC, Outpatient Clinical Care for Adults (2024), Adult Treatment Recommendations.]
298. A patient has nasal symptoms that improve after a viral upper respiratory infection, then worsen with new fever and facial pain. Which pattern supports acute bacterial rhinosinusitis? — New worsening after initial improvement. Double worsening supports a bacterial pattern. [CDC, Outpatient Clinical Care for Adults (2024), Adult Treatment Recommendations.]
299. An adult with uncomplicated sore throat has a negative rapid group A streptococcal antigen test. According to CDC outpatient guidance, what is appropriate? — Do not give antibiotics for presumed GAS. CDC does not recommend antibiotics for adult negative RADT in this uncomplicated setting. [CDC, Outpatient Clinical Care for Adults (2024), Adult Treatment Recommendations.]
300. A nonpregnant premenopausal woman has uncomplicated cystitis. She can take usual first-line agents. Which antibiotic stewardship approach is appropriate? — Use suitable first-line therapy before a fluoroquinolone. CDC reserves fluoroquinolones when other appropriate agents cannot be used. [CDC, Outpatient Clinical Care for Adults (2024), Adult Treatment Recommendations.]

Common mistakes in this chapter

• ✕ A normal screening snapshot may miss intermittent disease.
• ✕ A concentration or symptom alone may not establish full recovery.
• ✕ Treatment and follow-up should reflect individual contraindications and risks.