32 y/o male presents with burning sensation in chest following most large meals for 2-3 months. He denies dysphagia, weight change, or bleeding. Which of the following studies has the highest sensitivity for the initial diagnosis of GERD with typical symptoms?

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Question 1 of 5

32 y/o male presents with burning sensation in chest following most large meals for 2-3 months. He denies dysphagia, weight change, or bleeding. Which of the following studies has the highest sensitivity for the initial diagnosis of GERD with typical symptoms?

Correct Answer: B

Rationale: For typical GERD symptoms (heartburn after meals), an empiric trial of a PPI like omeprazole is highly sensitive and specific as a diagnostic test, with symptom resolution confirming the diagnosis. Invasive tests like pH monitoring or EGD are reserved for atypical or refractory cases.

Question 2 of 5

59 yo woman presents with onset of tingling in her toes. Her reflexes are depressed with downgoing toes. The finding that suggests most strongly that this is Guillain-Barré syndrome and not a spinal cord problem is:

Correct Answer: D

Rationale: Lack of incontinence strongly favors Guillain-Barré (peripheral neuropathy) over spinal cord lesions, which often affect bowel/bladder control.

Question 3 of 5

Opioids are often utilized in patients in palliative settings. Which side effect is generally associated with their use in this patient population?

Correct Answer: C

Rationale: Nausea is a common opioid side effect due to central nervous system and gastrointestinal effects. Opioids typically cause constipation (not diarrhea), sedation (not vigilance), and may relieve dyspnea in palliative care.

Question 4 of 5

If aseptic meningitis due to HSV is suspected, empiric therapy with which antimicrobial is indicated?

Correct Answer: B

Rationale: Acyclovir is the antiviral of choice for herpes simplex virus (HSV) meningitis because it effectively inhibits viral replication in this context.

Question 5 of 5

You are treating a 66-year-old man with stable angina with a statin, a b-blocker, a diuretic, and an ACE inhibitor. His BP is 130/82 mmHg and his heart rate is 64 beats/min. He generally feels fine; however, he has started to play golf since his retirement 4 months ago and his knee osteoarthritis is more apparent now. Which ONE of the following treatment recommendations would you suggest for this patient?

Correct Answer: B

Rationale: Acetaminophen is safer in patients with cardiovascular risk factors and does not exacerbate hypertension or renal dysfunction compared to NSAIDs.

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