Which symptom is required for a diagnosis of post-traumatic stress disorder?

Avoidance of trauma-related stimuli

Which laboratory pattern is most consistent with secondary hypogonadism?

Low testosterone with low luteinizing hormone

Normal testosterone with low gonadotropins

Low testosterone with elevated luteinizing hormone

Elevated testosterone with suppressed luteinizing hormone

SPEX

Free SPEX Practice Questions

10 sample questions for the SPEX, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: General Principles, Multisystem Processes AND Disorders, Immune System, Blood AND Lymphoreticular System, Behavioral Health, Nervous System AND Special Senses, Female Reproductive System AND Breast, Skin AND Subcutaneous Tissue, Musculoskeletal System, Cardiovascular System, Respiratory System, Gastrointestinal System, Renal AND Urinary System, Pregnancy, Childbirth, AND the Puerperium, Male Reproductive System, Endocrine System, Biostatistics AND Epidemiology/population Health AND Interpretation of Medical Literature/social Science, Hemoglobinopathies, Hypersplenism, Toxicology.

Question 1 · General Principles
A patient experiences chronic hypoxia due to longstanding lung disease. Which cellular adaptation is most likely to occur in response to this condition?
- A.Hyperplasia
- B.Metaplasia
- C.Hypertrophy
- D.Atrophy
Show answer and explanation
Answer: C. Hypertrophy
Chronic hypoxia increases cellular workload. Cells adapt by increasing size to meet metabolic demand. This response is hypertrophy. Hyperplasia increases cell number, metaplasia changes cell type, and atrophy reflects decreased cell size or number.
Question 2 · Behavioral Health
A patient experiences hallucinations, delusions, and disorganized speech for 8 months with significant functional decline. Which diagnosis is most likely?
- A.Brief psychotic disorder
- B.Schizoaffective disorder
- C.Schizophreniform disorder
- D.Schizophrenia
Show answer and explanation
Answer: D. Schizophrenia
Schizophrenia requires at least 6 months of symptoms with functional impairment. Schizophreniform disorder lasts 1–6 months. Brief psychotic disorder lasts less than 1 month.
Question 3 · Nervous System AND Special Senses
A patient presents with proximal muscle weakness and elevated creatine kinase levels. Which condition is most likely?
- A.Myasthenia gravis
- B.Amyotrophic lateral sclerosis
- C.Peripheral neuropathy
- D.Polymyositis
Show answer and explanation
Answer: D. Polymyositis
Polymyositis causes inflammatory muscle weakness affecting proximal muscles with elevated creatine kinase. Myasthenia gravis affects neuromuscular transmission without elevated CK.
Question 4 · Renal AND Urinary System
A hospitalized patient develops a sudden rise in serum creatinine after severe dehydration. Which type of acute kidney injury is most likely?
- A.Intrinsic renal
- B.Prerenal
- C.Postrenal
- D.Glomerular
Show answer and explanation
Answer: B. Prerenal
Prerenal acute kidney injury results from decreased renal perfusion, commonly due to dehydration, volume loss, or hypotension. Early recognition is critical because it is often reversible with volume restoration.
Question 5 · Male Reproductive System
Which condition is most commonly associated with erectile dysfunction due to vascular causes?
- A.Diabetes mellitus
- B.Depression
- C.Hypogonadism
- D.Performance anxiety
Show answer and explanation
Answer: A. Diabetes mellitus
Diabetes mellitus causes endothelial dysfunction and neuropathy, making it a common vascular cause of erectile dysfunction.
Question 6 · General Principles
When you are ready, say “Start Practice Test 2”, and I will begin Practice Test 2 starting from Question 101, following the same structure and rules, with no repeated questions from Practice Test 1.
Chronic gastric acid exposure leads to replacement of normal esophageal squamous epithelium with columnar epithelium. This process is best described as:
- A.Hyperplasia
- B.Dysplasia
- C.Metaplasia
- D.Hypertrophy
Show answer and explanation
Answer: C. Metaplasia
Metaplasia is a reversible adaptive change in which one differentiated cell type is replaced by another better suited to withstand chronic stress. Barrett esophagus is a classic example.
Question 7 · Behavioral Health
Which symptom is required for a diagnosis of post-traumatic stress disorder?
- A.Hallucinations
- B.Avoidance of trauma-related stimuli
- C.Disorganized speech
- D.Elevated mood
Show answer and explanation
Answer: B. Avoidance of trauma-related stimuli
PTSD requires exposure to trauma with symptoms including intrusion, avoidance, negative mood changes, and hyperarousal. Avoidance is a core diagnostic feature.
Question 8 · Nervous System AND Special Senses
Chronic inflammatory back pain improving with exercise and associated with reduced spinal mobility is most consistent with:
- A.Lumbar disc herniation
- B.Ankylosing spondylitis
- C.Osteoporosis
- D.Vertebral compression fracture
Show answer and explanation
Answer: B. Ankylosing spondylitis
Ankylosing spondylitis causes inflammatory back pain that improves with activity and leads to progressive spinal stiffness.
Question 9 · Renal AND Urinary System
Practice Test 2 – Section 11: Renal and Urinary System (Questions 161–166)
A patient develops acute kidney injury after receiving intravenous contrast for imaging. Which mechanism most likely explains this condition?
- A.Immune complex deposition
- B.Direct tubular toxicity
- C.Renal artery thrombosis
- D.Urinary tract obstruction
Show answer and explanation
Answer: B. Direct tubular toxicity
Contrast-induced nephropathy is caused by direct tubular epithelial toxicity and renal vasoconstriction, leading to acute tubular necrosis.
Question 10 · Male Reproductive System
Which laboratory pattern is most consistent with secondary hypogonadism?
- A.Low testosterone with low luteinizing hormone
- B.Normal testosterone with low gonadotropins
- C.Low testosterone with elevated luteinizing hormone
- D.Elevated testosterone with suppressed luteinizing hormone
Show answer and explanation
Answer: A. Low testosterone with low luteinizing hormone
Secondary hypogonadism results from hypothalamic or pituitary dysfunction, leading to low testosterone with inappropriately low gonadotropin levels.

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