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1. A 65-year-old man presents with chest pain, dyspnea, diaphoresis and
nausea. He has a history of hypertension, diabetes and smoking. You
suspect he is having an acute myocardial infarction (AMI). What is the most
appropriate initial diagnostic test to confirm your suspicion?
a) Electrocardiogram (ECG)
b) Cardiac troponin
c) Chest X-ray
d) Coronary angiography
*Answer: a) Electrocardiogram (ECG)*
Rationale: An ECG is the most rapid and reliable test to diagnose an AMI, as
it can show characteristic changes in the electrical activity of the heart due
to ischemia or necrosis. Cardiac troponin is a biomarker that can also
confirm an AMI, but it may take several hours to rise after the onset of
symptoms. Chest X-ray can show signs of pulmonary edema or
cardiomegaly, but it is not specific for an AMI. Coronary angiography is an
invasive procedure that can visualize the coronary arteries and identify the
location and severity of the occlusion, but it is not usually done as the first
test.
2. A 45-year-old woman complains of fatigue, weight gain, constipation,
dry skin and hair loss. She has a family history of thyroid disease. You
suspect she has hypothyroidism. What is the most appropriate initial
diagnostic test to confirm your suspicion?
a) Thyroid-stimulating hormone (TSH)
b) Free thyroxine (FT4)
c) Thyroid peroxidase antibody (TPOAb)
d) Thyroid ultrasound
*Answer: a) Thyroid-stimulating hormone (TSH)*
Rationale: TSH is the most sensitive and specific test to diagnose
hypothyroidism, as it reflects the feedback mechanism between the
pituitary gland and the thyroid gland. A high TSH indicates primary
hypothyroidism, which is the most common type. FT4 measures the
amount of free or active thyroid hormone in the blood, but it may be
normal or low in hypothyroidism depending on the severity and durationÂ
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