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 duration