#Fast_Five_Quiz #Medscape – QPreTest Medical

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Welcome to your #Fast_Five_Quiz #Medscape

Vitamin D deficiency is a highly prevalent condition, with > 15% of all individuals worldwide having serum 25-hydroxyvitamin D levels in the deficient range. The condition is even more prevalent among those living at high latitudes and during winter-spring compared with summer-autumn. Vitamin D plays several physiologic roles and has been studied for its potential in preventing obesity and averting the adverse effects of cancer therapy, among other preventive interventions.

What is the disadvantage of measuring circulating 1,25-dihydroxyvitamin D for vitamin D status?

1,25-dihydroxyvitamin D has a short half-life of only a few hours

1,25-dihydroxyvitamin D is not a biologically active form of vitamin D

Serum levels of 1,25-dihydroxyvitamin D are tightly regulated by androgens

Serum levels of 1,25-dihydroxyvitamin D are tightly regulated by potassium

None

Which form of vitamin D supplementation is recommended for healthy individuals aged 1-18 years to lower the risk for respiratory tract infections and prevent rickets?

In fortified foods, vitamin formulations, or daily vitamin D supplement pills or drops

In fortified foods only

As daily vitamin D supplement pills or drops only

This group should not receive empiric supplementation

None

What is the reported causal relationship between vitamin D and stress urinary incontinence in women of European ancestry?

Vitamin D deficiency is causally associated with stress urinary incontinence

Vitamin D levels above normal are causally associated with stress urinary incontinence

There is no causal relationship between vitamin D and stress urinary incontinence

Vitamin D supplementation is associated with stress urinary incontinence

None

Which statement about the effect of vitamin D deficiency on cognitive impairment in older adults is most accurate?

There is no known association

Vitamin D deficiency and secondhand smoke have a synergistic effect

Vitamin D deficiency and secondhand smoke have a synergistic effect but only in women

Vitamin D deficiency has a significant effect, but the effect is not compounded by secondhand smoke

None

Which statement about vitamin D deficiency and restless leg syndrome (RLS) is most accurate?

Vitamin D deficiency shows no correlation with RLS severity

Oral vitamin D supplementation is linked to improvements in primary RLS

Serum vitamin D levels are significantly lower in cases of primary RLS only

Serum vitamin D levels are significantly lower in cases of both primary and secondary RLS

None

Fibromyalgia is a complex and often misunderstood condition that affects approximately 2%-8% of the worldwide population. Despite its prevalence, many aspects of fibromyalgia — including its diagnosis, biochemical underpinnings, treatment options, and lifestyle considerations — are still being studied and refined. Advances in research have shed light on its biochemical markers, diagnostic criteria, and effective treatment approaches, but its management remains a challenge.

Which pain history is required to diagnose fibromyalgia?

Pain spreading in at least two body quadrants

Spreading pain for at least 1 month

Centralized and bilateral pain above and below the waist

Pain caused by digital pressure in 9 out of 18 allogenic points (trigger points)

None

Which of these is part of the main biochemical alterations observed in fibromyalgia?

Decreased substance P

Elevated norepinephrine

Elevated glutamate

Elevated serotonin

None

Which nonpharmacologic treatment for fibromyalgia has the strongest evidence of efficacy?

Mindfulness stress reduction

Acupuncture

Cognitive-behavioral therapy

Aerobic and strengthening exercises

None

Which drug class is among the most strongly recommended pharmacologic therapies for fibromyalgia with severe pain?

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Corticosteroids

Opioids

None

What is the approximate Patient Acceptable Symptom State (PASS) threshold for the Revised Fibromyalgia Impact Questionnaire (FIQR)?

< 20

< 40

< 60

< 80

None

Chronic obstructive pulmonary disease (COPD) is an increasingly significant cause of morbidity, disability, and mortality worldwide. Its prevalence is expected to continue to increase owing to the aging population, urbanization, and other risk factors. Treatment is essential to manage symptoms, improve quality of life, and reduce the risk for exacerbations.

Which treatment should generally be avoided in patients with COPD?

Dual combination therapy with a long-acting muscarinic antagonist (LAMA) and long-acting beta-2 agonist (LABA)

Inhaled corticosteroids in conjunction with LAMA/LABA therapy

Maintenance oral systemic corticosteroids

Azithromycin

None

Which is a factor that best favors the addition of ICS to combination LAMA/LABA therapy?

Blood eosinophil levels ≥ 100 cells/μL

Positive COVID test within the past 15 days

History of mycobacterial infection

Recurrent pneumonia

None

Which is recommended for patients with COPD who report moderate to high symptoms of dyspnea or exercise intolerance and impaired lung function?

Monotherapy with a LABA

LABA/LAMA combination therapy

Monotherapy with a LAMA

ICS monotherapy

None

Which is most accurate about triple therapy with ICS/LABA/LAMA for COPD?

ICS/LABA/LAMA triple therapy is noninferior but not superior to LABA/LAMA dual therapy for controlling COPD exacerbations

A fixed-dose ICS/LABA/LAMA combination inhaler is only available for mild cases

ICS/LABA/LAMA triple therapy should be reserved for patients with severe COPD only

ICS/LABA/LAMA triple therapy has been shown to be superior to LABA/LAMA dual therapy for controlling COPD exacerbations

None

Which is most accurate about maintenance therapy strategies for COPD?

Maintenance systemic corticosteroid therapy is recommended for patients with a history of severe exacerbations despite otherwise optimal therapy

In patients receiving triple therapy with ICS/LABA/LAMA, the ICS can be withdrawn if the patient has had no exacerbations in the past 6 months

Opioid-based therapy should not be considered with advanced refractory dyspnea despite otherwise optimal therapy

Long-term oxygen therapy may improve survival in patients with severe resting chronic hypoxemia

None

Colorectal cancer remains one of the leading causes of cancer-related deaths worldwide, but early detection through effective screening can significantly reduce morbidity and mortality. In recent years, at-home testing options for people at average risk for colorectal cancer have gained traction; accessible, noninvasive tools are aiming to increase screening adherence, especially among populations that face barriers to traditional clinic-based care. Each testing option has its own advantages, limitations, and ideal use cases.

What trend has been observed in colorectal cancer diagnosis rates in recent years?

Stable diagnosis rates across all age groups

Decreasing diagnosis rates in all age groups

Increasing diagnosis rates among those younger than 50 years

Increasing diagnosis rates only in those with family history

None

Which is most accurate regarding multitarget stool DNA (mtsDNA) testing vs fecal immunochemical testing (FIT) for colorectal cancer screening?

FIT has higher sensitivity than mtsDNA

FIT has lower specificity than mtsDNA

mtsDNA has higher specificity than FIT

mtsDNA has higher sensitivity than FIT

None

According to recent data, what is the approximate median time of completion for individuals prescribed mtsDNA or FIT for at-home screening?

2 weeks

1 month

2 months

4 months

None

Which colorectal cancer screening method has the highest sensitivity for advanced precancerous lesions?

FIT

mtsDNA

Septin 9

Septin 9 and mtsDNA

None

What is the recommended testing interval for at-home, high-sensitivity guaiac fecal occult blood testing (HSgFOBT) for people aged 45 years or older?

Every 6 months

Every year

Every 3 years

Every 5 years

None

Chronic obstructive pulmonary disease (COPD) refers to a group of diseases that causes airflow blockage and breathing-related problems, including emphysema and chronic bronchitis. Global estimates suggest that over 380 million individuals currently have COPD. Although no cure exists, treatments are available to slow progression and improve quality of life.

Which criterion best confirms COPD diagnosis?

Postbronchodilator forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio < 0.70

Prebronchodilator FEV1/FVC ratio < 0.70

Prebronchodilator FEV1 < 80% predicted

Postbronchodilator FEV1 < 80% predicted

None

What is the primary pathophysiologic mechanism in emphysema that leads to airway collapse during exhalation?

Increased mucus production

Loss of elastic recoil owing to elastin destruction

Bronchial wall inflammation

Pulmonary vasoconstriction

None

Which clinical manifestation pattern is most characteristic of COPD symptoms?

Symptoms are worse in afternoon and evening

Symptoms are worse during exertion only

Symptoms are constant throughout the day

Symptoms are worse in early morning and evening

None

Which is the most common reason reported by physicians for switching COPD medications within the same therapeutic class?

Adverse effects

Declining lung function

Problems with device handling

Frequent exacerbations

None

How does the global death and disability-adjusted life years (DALY) rate pattern differ between male and female patients with COPD?

Both sexes show decreasing rates after age 85-89 years

Both sexes show increasing rates until age 95+ years

Male patients show peak rates at age 85-89 years, while female patients continue to show increasing rates

Female patients show peak rates at age 85-89 years, while male patients continue to show increasing rates

None

Complement 3 glomerulopathy (C3G) is a group of extremely rare kidney diseases characterized by complement dysregulation in the alternative pathway and is classified into two major subgroups: C3 glomerulonephritis (C3GN) and dense deposit disease (DDD), both of which have overlapping clinical and pathologic features. The disease is largely driven by acquired factors, namely, alterations of regulatory proteins in the complement pathways. All patients with C3G should undergo a comprehensive complement evaluation that includes assessment of overall complement activity, measurements of serum levels of complement proteins and their split products, as well as genetic testing for autoantibodies. Treatment and management vary based on test results.

What therapeutic approaches are currently available to treat C3G?

Supportive therapy, immunosuppression, and anticomplement therapy

Kidney transplantation

Dietary and fluid restrictions (lowering sodium and protein intake) alone

Pharmacologic therapy with antibiotics, loop diuretics, and glucocorticoids

None

Which is the most appropriate initial therapy for proteinuria and hypertension in patients with C3G?

Lipid-lowering agent only

Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers

Supportive care

Plasma therapy

None

Which statement regarding general (nonspecific) immunosuppressive therapy for C3G is most accurate?

Comprehensive genetic testing and complement data are required to determine which subgroup of patients will benefit from immunosuppressive therapy

C3G is usually associated with monoclonal gammopathy and warrants immunosuppressive treatment to achieve hematologic response

C3 nephritic factors only affect response rates to mycophenolate mofetil in patients who test negative

Immunosuppression is helpful in altering the disease course in most patients with C3G

None

Which treatment targets the pathogenesis of C3G?

Antimicrobials (eg, antibiotics)

Nonspecific immunomodulatory therapies (eg, rituximab or cyclophosphamide)

Complement-targeting therapies (eg, eculizumab)

Corticosteroids (eg, prednisone)

None

Which statement regarding kidney transplantation in patients with C3G is most accurate?

Only the current status of complement dysregulation affects transplantation outcomes

There is a high risk for recurrence of C3G in renal allografts in patients with both DDD and C3GN

Current recommendations on transplantation are based on C3G treatment guidelines

Only genotype at transplantation has significant effect on graft survival

None

A 30-year-old man of Japanese descent presents to the emergency department (ED) after experiencing a syncopal event at home. His wife, who has accompanied him to the ED, witnessed the event. She states that they had been talking in the kitchen when her husband complained of feeling dizzy. He then became nauseous and slumped over onto the table; before she could get up and help him, he fell out of his chair and hit his head on the floor. After some time lying on the floor, he regained consciousness. The wife did not notice any seizure-like activity (including no jerky body movements, tongue biting, or incontinence) while her husband was unconscious. When he regained consciousness, he was immediately fully awake, alert, and conversant; no period of confusion or garbled speech was noted.

The patient reports that he has had many similar episodes in the past several years, but he has never sought medical evaluation for them. At the time of presentation, the patient has no specific complaints other than a bruise on his forehead and mild embarrassment. The patient's family history is significant for an uncle who died in his 30s without apparent cause.

Which of the following tests would be most important to conduct for this patient?

Lumbar puncture

Carotid ultrasonography

Electrocardiography (ECG)

Routine EEG

None

Upon physical examination, the patient is awake and alert. His vital signs are stable, with a heart rate of 82 beats/min and a blood pressure of 135/85 mm Hg. His respirations are 12 breaths/min, and an oxygen reading on room air is 100%. He has a 3-cm area of ecchymosis on his left forehead, with no underlying hematoma or tenderness to palpation. No laceration is noted over the area of bruising. The cardiac examination reveals a regular rhythm with no significant murmurs or gallops. The chest examination demonstrates easy, nonlabored respirations, with no abnormal breath sounds. The neurologic examination is also unremarkable, including a normal cranial nerve inspection, normal gross motor and sensory function, no pronator drift, and normal speech. He is able to walk without difficulty.

A panel of laboratory investigative blood work is drawn. An ECG is ordered (see Figure 1). The results of the complete blood cell (CBC) count as well as a basic metabolic panel and other laboratory findings are unremarkable.

Based only on this information, which is the most likely diagnosis?

Brugada syndrome

ST-segment elevation myocardial infarction

Wolff-Parkinson-White syndrome

Ventricular tachycardia

None

Which of the following treatments has been proven effective for the treatment of Brugada syndrome?

Beta-blocker therapy

Automatic implantable cardioverter defibrillator (AICD)

Calcium channel blocker therapy

ACE inhibitor therapy

Class IC antiarrhythmic therapy

None

The patient in this case was admitted to an inpatient monitored setting after consultation with an electrophysiologist. Given the clinical presentation, including the positive family history of SCD and the characteristic changes of the Brugada pattern noted on the ECG, the decision was made to place an AICD without a formal EPS. The patient was discharged to home on postprocedure day 2 with follow-up. He was also advised to contact his family members to alert them to his diagnosis and treatment.

Which of the following ECG abnormalities is typically associated with the Brugada pattern?

Prolonged QT interval

QRS morphology resembling a left bundle branch block

Positive deflection of the T-wave in the affected precordial leads

Downsloping ST-segment elevations in V1-V3

None

Which of the following associated features is required to define Brugada syndrome?

History of palpitations

Family history of hypertension in individuals younger than 45 years

Evidence of ST segment depression in family members

History of syncopal episodes

Previously documented atrial fibrillation

None

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