10 questions and answers for Swedish physicians

Single Choice Questions (10 Items)
A 68-year-old male in Sweden presents with gradual memory loss, personality changes, and difficulty performing daily activities. Brain imaging shows hippocampal atrophy. Which is the most likely diagnosis?
A. Vascular dementia
B. Alzheimer's disease
C. Lewy body dementia
D. Frontotemporal dementia
Answer: B
Explanation: Alzheimer's disease is the most common cause of dementia in Sweden, accounting for ~60% of cases. Key features include progressive memory impairment, hippocampal atrophy on imaging, and late-stage functional decline. Vascular dementia (A) is linked to stroke history and focal neurological signs. Lewy body dementia (C) involves visual hallucinations and fluctuating cognition. Frontotemporal dementia (D) primarily affects behavior and language early on (B is correct).
Which pathogen is the leading cause of community-acquired pneumonia (CAP) in elderly patients in Sweden, according to the Swedish Respiratory Society guidelines?
A. Mycoplasma pneumoniae
B. Streptococcus pneumoniae
C. Legionella pneumophila
D. Haemophilus influenzae
Answer: B
Explanation: Swedish guidelines prioritize Streptococcus pneumoniae as the top pathogen for CAP in all adult groups, especially the elderly (≥65 years). It accounts for 30%-45% of CAP cases in Sweden. Mycoplasma pneumoniae (A) is more common in younger adults. Legionella pneumophila (C) is associated with waterborne outbreaks. Haemophilus influenzae (D) is secondary to S. pneumoniae (B is correct).
A 45-year-old female with type 2 diabetes in Sweden has a HbA1c of 7.8% despite metformin therapy. According to the Swedish National Diabetes Register (NDR) recommendations, which drug is preferred as add-on therapy?
A. Sulfonylurea
B. Sodium-glucose cotransporter 2 (SGLT2) inhibitor
C. Thiazolidinedione
D. Alpha-glucosidase inhibitor
Answer: B
Explanation: The NDR recommends SGLT2 inhibitors as first-line add-on to metformin for type 2 diabetes, due to proven cardiovascular and renal protection—critical given Sweden's high cardiovascular disease burden in diabetics. Sulfonylureas (A) carry hypoglycemia risk. Thiazolidinediones (C) have fluid retention side effects. Alpha-glucosidase inhibitors (D) have limited efficacy (B is correct).
A 30-year-old male presents with severe abdominal pain, vomiting, and constipation. Abdominal X-ray shows air-fluid levels. Which condition is most consistent with these findings in Sweden?
A. Acute appendicitis
B. Small bowel obstruction
C. Acute cholecystitis
D. Pancreatitis
Answer: B
Explanation: Small bowel obstruction is a common surgical emergency in Sweden, typically presenting with colicky pain, vomiting, constipation, and air-fluid levels on X-ray. Acute appendicitis (A) causes RLQ tenderness without air-fluid levels. Acute cholecystitis (C) involves RUQ pain and fever. Pancreatitis (D) presents with epigastric pain radiating to the back (B is correct).
Which antihypertensive drug is recommended first-line for a 55-year-old male with hypertension and stable angina in Sweden, per the Swedish Heart Association guidelines?
A. Angiotensin-converting enzyme inhibitor (ACEI)
B. Beta-adrenergic blocker
C. Calcium channel blocker (CCB)
D. Angiotensin II receptor blocker (ARB)
Answer: C
Explanation: Swedish guidelines prioritize CCBs as first-line for hypertension with stable angina, as they reduce myocardial oxygen demand and control blood pressure. Beta-blockers (B) are reserved for post-MI patients. ACEIs/ARBs (A, D) are preferred for patients with heart failure or diabetes (C is correct).
A 28-year-old pregnant female in Sweden tests positive for Chlamydia trachomatis at 20 weeks' gestation. Which antibiotic is safe and recommended for treatment?
A. Doxycycline
B. Azithromycin
C. Ciprofloxacin
D. Tetracycline
Answer: B
Explanation: Sweden's National Board of Health and Welfare recommends azithromycin for chlamydia in pregnancy, as it is safe for the fetus. Doxycycline (A) and tetracycline (D) cause tooth discoloration in fetuses. Ciprofloxacin (C) is contraindicated in pregnancy due to tendon rupture risk (B is correct).
A 72-year-old female in Sweden develops a painful, vesicular rash along the thoracic dermatome. She has a history of chickenpox as a child. What is the most likely diagnosis?
A. Herpes simplex virus (HSV) infection
B. Varicella zoster virus (VZV) reactivation
C. Contact dermatitis
D. Measles
Answer: B
Explanation: VZV reactivation (shingles) is common in elderly Swedes, with thoracic dermatomes most frequently affected. It presents as unilateral vesicular rash with dermatomal distribution, often preceded by pain. HSV (A) causes recurrent oral/genital ulcers. Contact dermatitis (C) is pruritic without vesicles. Measles (D) has a maculopapular rash and fever (B is correct).
According to Swedish public health guidelines, which population is prioritized for annual influenza vaccination?
A. Healthy adults aged 18-49 years
B. Children aged 2-5 years
C. Adults aged ≥65 years
D. Adolescents aged 12-17 years
Answer: C
Explanation: Sweden's Public Health Agency prioritizes adults ≥65 years for annual flu vaccination, as this group has higher mortality/morbidity from influenza. Children (B) and adolescents (D) are targeted in specific programs but not first priority. Healthy younger adults (A) are not prioritized (C is correct).
A 50-year-old male in Sweden is diagnosed with gastroesophageal reflux disease (GERD) with erosive esophagitis. Which proton pump inhibitor (PPI) is most commonly prescribed in Sweden for this condition?
A. Omeprazole
B. Esomeprazole
C. Lansoprazole
D. Pantoprazole
Answer: A
Explanation: Omeprazole is the most widely prescribed PPI in Sweden due to cost-effectiveness and proven efficacy for erosive GERD. It is recommended as first-line in Swedish gastroenterology guidelines. Esomeprazole (B) and pantoprazole (D) are used if omeprazole is ineffective (A is correct).
A 40-year-old female presents with fatigue, pallor, and a hemoglobin level of 95 g/L. Serum ferritin is low, and transferrin saturation is 12%. What is the first-line treatment in Sweden?
A. Oral iron supplements
B. Intravenous iron infusion
C. Blood transfusion
D. Vitamin B12 injections
Answer: A
Explanation: This patient has iron deficiency anemia, the most common anemia in Sweden. Swedish guidelines recommend oral iron (e.g., ferrous sulfate) as first-line for uncomplicated cases. IV iron (B) is reserved for oral intolerance or severe anemia. Blood transfusion (C) is for life-threatening anemia. B12 injections (D) treat megaloblastic anemia (A is correct).