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Afghanistan Comprehensive Specialization Exam study materials
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Afghanistan Comprehensive Specialization Exam practice questions

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Question 1Basic and Clinical Sciences Foundations

Which layer of the skin contains sweat glands, hair follicles, and most sensory nerve endings?

  1. Epidermis
  2. Dermis Correct answer.
  3. Stratum corneum
  4. Hypodermis

Explanation

The dermis is the connective tissue layer beneath the epidermis and contains skin appendages, blood vessels, and most sensory receptors. The epidermis is avascular epithelium, while the hypodermis is the deeper fatty layer.

Question 2Basic and Clinical Sciences Foundations

The principal physiological role of erythrocytes is to do which of the following?

  1. Transport oxygen from the lungs to tissues Correct answer.
  2. Secrete clotting factors into plasma
  3. Phagocytose bacteria in the bloodstream
  4. Produce antibodies against blood group antigens

Explanation

Erythrocytes are packed with hemoglobin, which binds oxygen in the lungs and releases it in peripheral tissues. They lack a nucleus and cannot produce antibodies or secrete clotting factors.

Question 3Basic and Clinical Sciences Foundations

Which molecule directly transfers chemical energy to most ATP-dependent cellular processes?

  1. Adenosine triphosphate Correct answer.
  2. Creatine phosphate
  3. NADH
  4. Glucose

Explanation

ATP hydrolysis releases free energy that drives ion pumps, biosynthesis, and muscle contraction. Glucose and NADH are energy-rich substrates, but they must be oxidized to generate ATP before most processes use the energy.

Question 4Basic and Clinical Sciences Foundations

Which component of the bacterial cell wall is absent from human cells and is a target of penicillin?

  1. Cholesterol
  2. Cellulose
  3. Peptidoglycan Correct answer.
  4. Chitin

Explanation

Peptidoglycan is a cross-linked polymer that gives bacteria mechanical strength and is the target of beta-lactam antibiotics such as penicillin. Human cells lack peptidoglycan, which contributes to the selective toxicity of these drugs.

Question 5Basic and Clinical Sciences Foundations

A single layer of flattened cells lining the alveoli is classified as which type of epithelium?

  1. Simple cuboidal epithelium
  2. Stratified squamous epithelium
  3. Pseudostratified columnar epithelium
  4. Simple squamous epithelium Correct answer.

Explanation

Simple squamous epithelium consists of one layer of thin, flattened cells and allows rapid gas diffusion in the alveoli. Cuboidal and columnar epithelia are thicker, while stratified epithelium has multiple layers.

Question 6Basic and Clinical Sciences Foundations

Which route is preferred for immediate systemic delivery of a drug in an emergency?

  1. Topical
  2. Subcutaneous
  3. Oral
  4. Intravenous Correct answer.

Explanation

Intravenous administration places the drug directly into the bloodstream, producing an immediate systemic effect and bypassing gastrointestinal absorption and first-pass metabolism. Subcutaneous delivery is systemic but depends on absorption and is slower.

Question 7Basic and Clinical Sciences Foundations

Which antibody class is the first to appear in a primary immune response?

  1. IgG
  2. IgA
  3. IgM Correct answer.
  4. IgE

Explanation

Naive B cells initially produce IgM, which appears early in a primary response. Class switching later produces IgG, IgA, or IgE depending on the immune context.

Question 8Basic and Clinical Sciences Foundations

The embryonic neural tube develops into which structures?

  1. Lungs and trachea
  2. Heart and great vessels
  3. Kidneys and ureters
  4. Brain and spinal cord Correct answer.

Explanation

The neural tube forms the central nervous system, giving rise to the brain and spinal cord. Neural crest cells separate from the tube and form many peripheral structures.

Question 9Basic and Clinical Sciences Foundations

A midshaft fracture of the humerus most commonly injures which nerve?

  1. Ulnar nerve
  2. Radial nerve Correct answer.
  3. Axillary nerve
  4. Median nerve

Explanation

The radial nerve runs in the spiral groove along the midshaft of the humerus and is vulnerable in fractures at this level. Axillary nerve injury is more associated with fractures at the surgical neck.

Question 10Basic and Clinical Sciences Foundations

According to the Frank-Starling mechanism, an increase in ventricular end-diastolic volume normally causes which response?

  1. A decrease in heart rate
  2. An increase in stroke volume Correct answer.
  3. Premature closure of the aortic valve
  4. A decrease in stroke volume

Explanation

Greater end-diastolic volume stretches ventricular myocytes and increases their force of contraction, thereby raising stroke volume. This relationship helps match cardiac output to venous return.

Question 11Basic and Clinical Sciences Foundations

Which enzyme catalyzes the rate-limiting step of glycolysis?

  1. Fructose-1,6-bisphosphatase
  2. Phosphofructokinase-1 Correct answer.
  3. Pyruvate kinase
  4. Hexokinase

Explanation

Phosphofructokinase-1 catalyzes the phosphorylation of fructose-6-phosphate to fructose-1,6-bisphosphate, the committed and rate-limiting step of glycolysis. Hexokinase acts earlier, but its step is not the main rate-controlling step.

Question 12Basic and Clinical Sciences Foundations

Endotoxin is a component of which bacterial structure?

  1. Bacterial flagellum
  2. Gram-negative outer membrane Correct answer.
  3. Gram-positive cytoplasmic membrane
  4. Bacterial capsule

Explanation

Endotoxin is lipopolysaccharide located in the outer membrane of Gram-negative bacteria. Its lipid A portion triggers fever and inflammation when released during infection.

Question 13Basic and Clinical Sciences Foundations

Which feature best distinguishes apoptosis from necrosis?

  1. Formation of apoptotic bodies Correct answer.
  2. Random DNA degradation
  3. Extensive inflammation in surrounding tissue
  4. Cellular swelling and lysis

Explanation

Apoptosis is an energy-dependent form of programmed cell death in which cells shrink and break into membrane-bound apoptotic bodies without provoking inflammation. Necrosis typically involves cell swelling, membrane rupture, and an inflammatory response.

Question 14Basic and Clinical Sciences Foundations

A competitive antagonist at a receptor typically produces which effect?

  1. Irreversible binding to the receptor
  2. An increase in agonist potency
  3. A rightward shift of the agonist dose-response curve Correct answer.
  4. Reduction of the maximal agonist response

Explanation

A competitive antagonist competes with the agonist for the same binding site, so higher agonist concentrations are needed to achieve the same response. This shifts the dose-response curve to the right without reducing the maximal response.

Question 15Basic and Clinical Sciences Foundations

MHC class I molecules present endogenous peptides primarily to which cells?

  1. Natural killer cells
  2. CD8+ cytotoxic T cells Correct answer.
  3. CD4+ helper T cells
  4. B lymphocytes

Explanation

MHC class I molecules display peptides derived from intracellular proteins to CD8+ cytotoxic T cells. This allows the immune system to detect viral infection or abnormal protein production within a cell.

Question 16Basic and Clinical Sciences Foundations

Two healthy carriers of an autosomal recessive disease have a child. What is the probability that the child is affected?

  1. 25% Correct answer.
  2. 75%
  3. 50%
  4. 0%

Explanation

Each carrier parent has one mutant and one normal allele, so each child has a one-in-four chance of inheriting two mutant alleles. That genotype produces the autosomal recessive phenotype.

Question 17Basic and Clinical Sciences Foundations

Sensitivity of a diagnostic test is calculated as which ratio?

  1. TN divided by all nondiseased persons
  2. TN divided by all persons tested
  3. TP divided by all persons tested
  4. TP divided by all diseased persons Correct answer.

Explanation

Sensitivity is the proportion of people with disease who test positive, calculated as true positives divided by true positives plus false negatives. It reflects the test's ability to detect disease when disease is present.

Question 18Basic and Clinical Sciences Foundations

Aldosterone acts on the distal nephron chiefly to produce which effect?

  1. Increased sodium reabsorption and potassium secretion Correct answer.
  2. Blockade of hydrogen ion secretion
  3. Decreased sodium reabsorption and potassium retention
  4. Increased water permeability without changing sodium

Explanation

Aldosterone increases sodium reabsorption through epithelial sodium channels and promotes potassium secretion in the distal nephron. Water follows sodium retention, expanding extracellular fluid volume.

Question 19Basic and Clinical Sciences Foundations

Which structure passes through the porta hepatis along with the portal vein and hepatic artery?

  1. Common bile duct Correct answer.
  2. Falciform ligament
  3. Inferior vena cava
  4. Thoracic duct

Explanation

The porta hepatis transmits the portal triad: portal vein, hepatic artery proper, and common bile duct. These structures enter or leave the liver at its inferior surface.

Question 20Basic and Clinical Sciences Foundations

The third pharyngeal pouch gives rise to which structures?

  1. Superior parathyroid glands
  2. Thymus and inferior parathyroid glands Correct answer.
  3. Palatine tonsils
  4. Thyroid gland

Explanation

The third pharyngeal pouch forms the thymus and the inferior parathyroid glands. The fourth pouch forms the superior parathyroid glands, while the second pouch contributes to the palatine tonsils.

Question 21Basic and Clinical Sciences Foundations

A substance is freely filtered at the glomerulus and is neither secreted nor reabsorbed by the tubules. Its renal clearance equals which value?

  1. Renal plasma flow
  2. Urine flow rate
  3. Glomerular filtration rate Correct answer.
  4. Tubular maximum for glucose

Explanation

For a freely filtered substance with no tubular transport, the amount excreted in urine equals the amount filtered, so clearance equals glomerular filtration rate. Inulin is the classic reference substance for this measurement.

Question 22Basic and Clinical Sciences Foundations

In chronic respiratory alkalosis, the kidneys compensate mainly by doing which of the following?

  1. Decreasing bicarbonate reabsorption Correct answer.
  2. Retaining carbon dioxide
  3. Increasing hydrogen ion secretion
  4. Increasing bicarbonate reabsorption

Explanation

Chronic respiratory alkalosis lowers PaCO2, so the kidneys compensate by reducing bicarbonate reabsorption and allowing plasma bicarbonate to fall. This helps return the bicarbonate-to-carbon dioxide ratio toward normal.

Question 23Basic and Clinical Sciences Foundations

The retinoblastoma gene illustrates the two-hit hypothesis because which statement applies?

  1. It promotes apoptosis when overexpressed
  2. A single activating mutation is sufficient for tumor formation
  3. Both alleles must be inactivated for loss of function Correct answer.
  4. The gene is amplified in all tumors

Explanation

Retinoblastoma is a tumor suppressor gene, so tumor formation requires loss of function in both alleles. A person who inherits one mutant allele needs only one additional somatic mutation to eliminate the remaining normal copy.

Question 24Basic and Clinical Sciences Foundations

Phenytoin exhibits zero-order kinetics at therapeutic doses. This means that which statement is true?

  1. The half-life is independent of dose
  2. A constant amount of drug is eliminated per unit time Correct answer.
  3. The fraction of drug eliminated per unit time is constant
  4. Elimination is proportional to plasma concentration

Explanation

Zero-order kinetics occurs when metabolic enzymes are saturated, so a constant amount of drug is eliminated per unit time regardless of concentration. Small dose increases can therefore produce disproportionately large rises in plasma level.

Question 25Basic and Clinical Sciences Foundations

An increase in 2,3-bisphosphoglycerate in erythrocytes shifts the oxygen-hemoglobin dissociation curve to the right. What does this mean?

  1. Carbon dioxide transport is reduced
  2. Hemoglobin binds oxygen more tightly in the lungs
  3. Hemoglobin releases oxygen more readily to tissues Correct answer.
  4. Oxygen solubility in plasma increases

Explanation

A rightward shift indicates decreased hemoglobin affinity for oxygen, so oxygen is unloaded more readily at tissue oxygen tensions. 2,3-BPG stabilizes the deoxygenated form of hemoglobin.

Question 26Basic and Clinical Sciences Foundations

Which structure passes through the foramen ovale of the sphenoid bone?

  1. Internal carotid artery
  2. Maxillary division of the trigeminal nerve (V2)
  3. Mandibular division of the trigeminal nerve Correct answer.
  4. Facial nerve within the stylomastoid foramen

Explanation

The foramen ovale lies in the greater wing of the sphenoid and transmits the mandibular division of the trigeminal nerve, along with the accessory meningeal artery and the lesser petrosal nerve. Each division of the trigeminal nerve has its own skull base opening, so the mandibular branch is identified by this foramen.

Question 27Basic and Clinical Sciences Foundations

A gram-positive coccus grows in clusters and is catalase-positive and coagulase-positive. Which organism is most likely?

  1. Staphylococcus aureus Correct answer.
  2. Enterococcus faecalis
  3. Streptococcus pyogenes
  4. Staphylococcus epidermidis

Explanation

Coagulase production separates Staphylococcus aureus from the other catalase-positive gram-positive cocci, and its cluster arrangement reflects division in multiple planes. Coagulase converts fibrinogen to fibrin, which helps the organism wall itself off from host defenses.

Question 28Basic and Clinical Sciences Foundations

The plateau phase of the ventricular myocyte action potential is maintained mainly by which ionic event?

  1. Activation of the sodium-potassium ATPase
  2. Rapid inactivation of voltage-gated sodium channels
  3. Efflux of potassium through inward rectifier channels
  4. Influx of calcium through L-type channels Correct answer.

Explanation

Phase 2 reflects a balance between calcium entering through slow L-type channels and potassium leaving the cell, which holds the membrane potential near zero for a prolonged period. This plateau lengthens the action potential and gives the ventricle time to contract and eject blood before repolarization.

Question 29Basic and Clinical Sciences Foundations

In a healthy nephron, the bulk of filtered glucose is reabsorbed in which segment?

  1. Proximal convoluted tubule Correct answer.
  2. Medullary collecting duct
  3. Thin descending limb of the loop of Henle
  4. Distal convoluted tubule

Explanation

Sodium-coupled glucose transporters in the early proximal tubule reclaim essentially all filtered glucose under normal conditions, so no glucose appears in the final urine. Because this capacity is saturable, glucose spills into the urine only once the plasma level exceeds the transport maximum.

Question 30Basic and Clinical Sciences Foundations

A neonate develops lethargy, vomiting, and hyperammonemia after feeding. Plasma citrulline is low and urinary orotic acid is markedly elevated. Which enzyme is deficient?

  1. Carbamoyl phosphate synthetase I
  2. Argininosuccinate synthetase
  3. Argininosuccinate lyase
  4. Ornithine transcarbamylase Correct answer.

Explanation

Ornithine transcarbamylase condenses carbamoyl phosphate with ornithine to form citrulline, so its loss lowers citrulline and causes carbamoyl phosphate to accumulate. The excess carbamoyl phosphate is diverted into pyrimidine synthesis, producing the characteristic orotic aciduria.

Question 31Basic and Clinical Sciences Foundations

Which mechanism best explains the blood-pressure-lowering effect of an ACE inhibitor?

  1. Reduced conversion of angiotensin I to angiotensin II Correct answer.
  2. Increased degradation of bradykinin in the lung
  3. Inhibition of renin release from juxtaglomerular cells
  4. Direct blockade of angiotensin II type 1 receptors

Explanation

Angiotensin-converting enzyme converts angiotensin I to angiotensin II, so inhibiting it lowers circulating angiotensin II and reduces aldosterone secretion and vasoconstriction. Because the same enzyme degrades bradykinin, inhibition also raises bradykinin levels, which contributes to both vasodilation and the characteristic dry cough.

Question 32Basic and Clinical Sciences Foundations

The p53 protein is best described as which of the following?

  1. A receptor tyrosine kinase that drives cell-cycle entry
  2. A protease that cleaves nuclear lamins during programmed cell death
  3. A transcription factor arresting the cycle after DNA damage Correct answer.
  4. A chaperone that refolds denatured cytosolic proteins

Explanation

p53 senses DNA damage and acts in the nucleus as a transcription factor, inducing targets such as the cyclin-dependent kinase inhibitor p21 to pause the cell cycle for repair. If the damage is irreparable, p53 instead promotes apoptosis, which is why loss of function predisposes to malignancy.

Question 33Basic and Clinical Sciences Foundations

A screening test is applied in a population whose disease prevalence is much higher than the population used to validate it, while sensitivity and specificity remain unchanged. Which measure increases?

  1. Negative predictive value of the test
  2. Specificity of the test
  3. Likelihood ratio for a negative result
  4. Positive predictive value Correct answer.

Explanation

Predictive values depend on prevalence, whereas sensitivity, specificity, and likelihood ratios do not. When disease is more common, a larger share of positive results are true positives, so the positive predictive value rises while the negative predictive value falls.

Question 34Basic and Clinical Sciences Foundations

From lateral to medial, the contents of the femoral triangle are ordered as which sequence?

  1. Femoral nerve, artery, vein, canal, lymphatics Correct answer.
  2. Femoral vein, artery, nerve, lymphatics, canal
  3. Femoral lymphatics, vein, artery, nerve, canal
  4. Femoral artery, vein, nerve, canal, lymphatics

Explanation

The femoral nerve lies most laterally, followed by the femoral artery, femoral vein, and the empty femoral canal, with lymphatics medial to the canal. This lateral-to-medial order is why the femoral artery is palpated just below the inguinal ligament and why the vein is cannulated medial to the arterial pulse.

Question 35Basic and Clinical Sciences Foundations

A child has recurrent sinopulmonary infections with encapsulated bacteria and develops glomerulonephritis after minor infections. Deficiency of which component best fits this pattern?

  1. Mannose-binding lectin
  2. C5a receptor
  3. C3 Correct answer.
  4. C1 esterase inhibitor

Explanation

C3 is the central amplification point for all three complement pathways, so its absence impairs opsonization of encapsulated organisms and clearance of immune complexes. The resulting defect in both host defense and complex disposal explains the combination of pyogenic infections and glomerulonephritis.

Question 36Basic and Clinical Sciences Foundations

An orally administered drug has 30% bioavailability, whereas the same dose given intravenously is fully available. Which statement best explains this difference?

  1. Hepatic metabolism inactivates drug before systemic entry Correct answer.
  2. Renal tubular secretion eliminates the drug during absorption
  3. Irreversible binding to plasma albumin inactivates the drug
  4. Incomplete absorption of the drug across the intestinal wall

Explanation

Orally absorbed drug travels through the portal circulation and must pass the liver before reaching the systemic circulation, where first-pass metabolism can remove a substantial fraction. Bioavailability compares the systemic exposure after oral dosing with that after intravenous dosing, so a value of 30% indicates that roughly two-thirds of the dose is lost before entering the systemic compartment.

Question 37Basic and Clinical Sciences Foundations

The stapes, styloid process, and lesser horn of the hyoid derive from which pharyngeal arch?

  1. Fourth pharyngeal arch
  2. Third pharyngeal arch
  3. First pharyngeal arch
  4. Second pharyngeal arch Correct answer.

Explanation

The second pharyngeal arch, also called the hyoid arch, gives rise to the stapes, styloid process, stylohyoid ligament, and the lesser horn and upper body of the hyoid. Its associated nerve is the facial nerve, which supplies the muscles derived from this arch.

Question 38Basic and Clinical Sciences Foundations

Vitamin B12 deficiency and folate deficiency both cause macrocytic anemia with elevated homocysteine. Elevation of which metabolite distinguishes B12 deficiency from folate deficiency?

  1. 5-methyltetrahydrofolate
  2. Methylmalonic acid Correct answer.
  3. Cystathionine
  4. Homocysteine

Explanation

Methylmalonyl-CoA mutase requires adenosylcobalamin, the vitamin B12 cofactor, so B12 deficiency causes methylmalonic acid to accumulate while folate status has no effect on this reaction. Homocysteine rises in both deficiencies because methionine synthase depends on both cobalamin and folate.

Question 39Basic and Clinical Sciences Foundations

A patient's serum chemistry shows sodium 140 mEq/L, chloride 100 mEq/L, and bicarbonate 14 mEq/L. Which acid-base disorder is present?

  1. Respiratory acidosis with renal compensation
  2. High anion gap metabolic acidosis Correct answer.
  3. Mixed respiratory and metabolic alkalosis
  4. Normal anion gap metabolic acidosis

Explanation

The anion gap is calculated as sodium minus the sum of chloride and bicarbonate, giving 140 minus 114, or 26 mEq/L, which exceeds the normal range of roughly 8 to 12. A raised gap with a low bicarbonate indicates accumulation of unmeasured anions, characteristic of a high anion gap metabolic acidosis.

Question 40Basic and Clinical Sciences Foundations

Which statement best explains why a mitochondrial DNA disorder varies in severity among the children of one affected mother?

  1. Different degrees of heteroplasmy among oocytes Correct answer.
  2. Imprinting of the maternal allele
  3. Anticipation from trinucleotide repeat expansion
  4. Skewed X-inactivation in female offspring

Explanation

Mitochondrial DNA is present in many copies per cell, and oocytes carry differing proportions of mutant and wild-type genomes, a situation termed heteroplasmy. The fraction of mutant genomes transmitted determines the resulting biochemical defect, so siblings can differ widely in phenotype from the same mother.

Question 41Internal Medicine and Its Subspecialties

Which medication has been shown to reduce mortality in heart failure with reduced ejection fraction?

  1. Eplerenone Correct answer.
  2. Digoxin
  3. Furosemide
  4. Amlodipine

Explanation

Mineralocorticoid receptor antagonists such as eplerenone reduce cardiovascular death and heart failure hospitalization in HFrEF. Loop diuretics relieve congestion but do not improve survival, and digoxin reduces hospitalizations without a mortality benefit.

Question 42Internal Medicine and Its Subspecialties

What is the most common bacterial cause of community-acquired pneumonia in adults?

  1. Pneumococcus Correct answer.
  2. Mycoplasma pneumoniae
  3. Klebsiella pneumoniae
  4. Haemophilus influenzae

Explanation

Streptococcus pneumoniae (pneumococcus) remains the most frequently identified bacterial cause of community-acquired pneumonia in adults. Atypical organisms and gram-negative bacilli are less common overall.

Question 43Internal Medicine and Its Subspecialties

Which laboratory finding is most characteristic of diabetic ketoacidosis?

  1. urine ketones absent
  2. arterial pH >7.45
  3. glucose always >600 mg/dL
  4. bicarbonate <18 mEq/L Correct answer.

Explanation

DKA produces a high-anion-gap metabolic acidosis with a low serum bicarbonate, typically below 18 mEq/L. Blood glucose is elevated but can be below 600 mg/dL, and ketones are present.

Question 44Internal Medicine and Its Subspecialties

Which ECG change is an early manifestation of hyperkalemia?

  1. prominent U waves
  2. ST-segment elevation
  3. prolonged QT interval
  4. peaked T waves Correct answer.

Explanation

Hyperkalemia initially produces tall, peaked T waves, followed by PR prolongation, QRS widening, and sine-wave patterns as potassium rises further. U waves are more typical of hypokalemia.

Question 45Internal Medicine and Its Subspecialties

Which laboratory pattern is most consistent with iron deficiency anemia?

  1. high serum ferritin
  2. high transferrin saturation
  3. low total iron-binding capacity
  4. low serum ferritin Correct answer.

Explanation

Iron deficiency lowers ferritin, the best single indicator of depleted iron stores, and typically raises TIBC while lowering transferrin saturation. Ferritin is an acute-phase reactant but is still usually low in uncomplicated iron deficiency.

Question 46Internal Medicine and Its Subspecialties

Which regimen is appropriate first-line therapy for uncomplicated cystitis in a nonpregnant woman?

  1. nitrofurantoin Correct answer.
  2. amoxicillin for 7 days
  3. vancomycin IV
  4. ciprofloxacin for 7 days

Explanation

Nitrofurantoin is a first-line option for uncomplicated cystitis because it concentrates in urine and has good activity against common uropathogens. Fluoroquinolones are reserved for more serious infections, and amoxicillin has high resistance rates.

Question 47Internal Medicine and Its Subspecialties

Which antibody is most specific for systemic lupus erythematosus?

  1. anti-CCP
  2. ANA
  3. anti-dsDNA Correct answer.
  4. rheumatoid factor

Explanation

Anti-double-stranded DNA is highly specific for SLE and correlates with lupus nephritis and disease activity. ANA is sensitive for SLE but is common in many other conditions and in healthy people.

Question 48Internal Medicine and Its Subspecialties

Which serum test is most specific for acute pancreatitis?

  1. amylase
  2. lipase Correct answer.
  3. GGT
  4. ALP

Explanation

Lipase is more specific than amylase for acute pancreatitis and remains elevated longer. Amylase can also rise in salivary gland disease, bowel obstruction, and renal failure.

Question 49Internal Medicine and Its Subspecialties

Which ECG finding most strongly supports a diagnosis of acute transmural myocardial infarction?

  1. diffuse ST depression
  2. prominent peaked T waves
  3. new first-degree AV block
  4. contiguous ST elevation Correct answer.

Explanation

ST elevation in anatomically contiguous leads is the hallmark of acute transmural injury and defines STEMI in the appropriate clinical setting. Diffuse ST depression suggests ischemia or pericarditis rather than a focal transmural infarct.

Question 50Internal Medicine and Its Subspecialties

A 24-year-old with episodic wheezing has reversible airflow obstruction after a bronchodilator. Which is the best long-term controller medication?

  1. inhaled corticosteroid Correct answer.
  2. oral prednisone
  3. tiotropium
  4. long-acting beta agonist alone

Explanation

Inhaled corticosteroids are the cornerstone of long-term asthma control because they reduce airway inflammation and exacerbations. Long-acting beta agonists should not be used as monotherapy in asthma.