APM I Exam 2

Which of the following men would have the highest risk for development of penile cancer? 2 month old uncircumcised male with uncorrected distal hypospadias 20 year old circumcised male with 3 prior sexual partners 40 year old uncircumcised male who is s/p successful vasectomy 60 year old uncircumcised male, BMI=50, smoker, severe untreated ED for 20 years, hasn't seen his penis in 10 years 80 year old circumcised male on daily Cialis who has penetrative intercourse with his wife twice weekly

60 year old uncircumcised male, BMI=50, smoker, severe untreated ED for 20 years, hasn't seen his penis in 10 years

Utilizing the 4-2-1 formula, what would the appropriate rate of fluid resuscitation be for a 50 kg patient? 70 ml/hr 80 ml/hr 90 ml/hr 100 ml/hr

90 ml/hr

What is the appropriate rate of correction for hyponatremia? <8 mEq/L over 24 hours >8 mEq/L over 24 hours <12 mEq/L over 24 hours >12 mEq/L over 24 hours

<8 mEq/L over 24 hours

What is the total urine protein level that indicates nephrotic-range proteinuria? < 3.5 g/24 hours >3.5 g/24 hours

> 3.5 g/24 hours

What criteria should be considered when deciding whether to put a patient on hemodialysis? (hint: AEIOU)

A - Acidosis E - Electrolyte disturbance I - ingestants (medications) O - overload (fluid) U - uremia (symptomatic)

What two vitamin deficiencies present with peripheral neuropathy? Vitamin B1 (thiamine) + Vitamin B12 (cobalamin) Vitamin B6 (pyridoxine) + Vitamin A Vitamin C + Vitamin A Vitamin B12 (cobalamin) + Vitamin B6 (pyridoxine)

Vitamin B12 (cobalamin) + Vitamin B6 (pyridoxine)

Which hormone primarily regulates body water, responding to changes in osmolality and EABV? ADH Aldosterone PTH Sodium

ADH

Muddy brown casts on microscopy are consistent with which type of AKI? AIN ATN GN

ATN

A 63-year-old woman presents with acute onset of abdominal pain that describes as a steady deep discomfort in the left lower quadrant. She was constipated initially, but she is now experiencing diarrhea. On physical examination, she has a temperature of 38°C. The abdomen is tender in the LLQ with guarding and rebound tenderness. She has positive fecal occult blood. What is the best test to determine the most likely diagnosis? Abdominal ultrasound Abdominal CT Barium enema Upper GI series Colonoscopy

Abdominal CT

A 35-year-old man presents after several episodes of vomiting in the last 24 hours; there is loose stool and strong pain localized in the upper middle region of the abdomen. Physical examination indicates a temperature of 101°F and a tender epigastrium. Lab tests reveal an initial WBC count of 18x109/L. C-reactive protein level is 325 mg/L, and amylase is 130 U/L. There is a lactate dehydrogenase level of 816 U/L. The patient has no history of pancreatic disease and denies alcohol use. He is overweight. He has a history of type 2 diabetes and hypertension. He takes medicine to control his high blood pressure and obesity. What is the most appropriate next step in establishing the diagnosis? Abdominal radiography Abdominal ultrasonography Abdominal compute tomography scanning Endoscopic retrograde cholangiopancreatography Endoscopic ultrasonography

Abdominal compute tomography scanning

What GI condition is suspected when Charcot's triad symptoms are present? Acute cholangitis Cholecystitis Choledocholithiasis Cholelithiasis

Acute cholangitis (fever > 40C, jaundice, RUQ pain)

A 50 yo female presents with a crampy post-prandial pain in the RLQ radiating to the back near the R scapula tip. She has N/V and an elevated WBC. What is her most likely diagnosis? Acute appendicitis Acute cholecystitis Acute pancreatitis Ectopic pregnancy

Acute cholecystitis

43-year-old man arrives at the emergency department via ambulance. His wife indicated that she found him lying on the living room floor when she came home from running errands around town. She also stated that he seemed "fine" before she left approximately 2 hours prior. He has a history of acid peptic disease. Upon arrival, he is conscious and indicates that he became dizzy upon standing. For the last couple of days, his stools have been coffee ground in color and he has had increasingly worse upper middle abdominal pain and nausea. His vitals are BP 90/48 mm Hg, pulse 145/min and thready, respirations 24/min, and pulse oximetry 88%. You order a hemoglobin and hematocrit, and the results are 8.2 g/dL and 24.8%, respectively. You review his records and find that 2 weeks ago his H&H was 15.6 g/fL and 48.2%, respectively. What is your initial assessment? Acute upper GI bleed due to noncompliance with treatment Stool color change due to Pepto-Bismol treatment Diverticular bleed Acute massive hemorrhage due to perforation Underlying ulcerative colitis

Acute massive hemorrhage due to perforation

A 50 yo female presents with sudden onset of epigastric pain radiating to her back on left side. She has N/V and lab tests shows elevations in serum bilirubin, AST, ALT, ALP and lipase levels. What is the likely diagnosis? Acute bowel obstruction Acute cholecystitis Acute cholelithiasis Acute pancreatitis

Acute pancreatitis

A patient is admitted to the hospital from the emergency department for shortness of breath; he has a past medical history significant for CHF, hypertension, gout, and nephrolithiasis. Upon presentation, the patient appears euvolemic and is hemodynamically stable. In the ED, a CT angiogram of the chest was completed which did not demonstrate a PE, but noted bilateral consolidations concerning for pneumonia. The patient was recently hospitalized for uncomplicated diverticulitis, requiring IV antibiotic administration. He is started on broad-spectrum antibiotics with vancomycin and cefepime for hospital-acquired pneumonia. Two days later they develop an AKI. Based on the information provided, what is the likely etiology of the patient's AKI? Pre-renal azotemia Post-renal azotemia Acute tubular necrosis

Acute tubular necrosis (vancomycin and radiocontrast)

What is the most common type of prostate cancer? Adenocarcinoma Intraductal adenocarcinoma Transitional cell carcinoma Small cell carcinoma

Adenocarcinoma

What entity is the most common cause of bowel obstruction in patients who have had prior abdominal surgery? Fistula Adhesions Leading edge Fibrosis

Adhesions

What nutrients might we need to be concerned about in patients following a vegetarian or vegan diet? Calcium and Vitamin D Iodine Protein Iron and Zinc All of the above

All of the above

Which serum tumor marker is associated with hepatocellular carcinoma? Alpha fetoprotein CA 135 Carcinoembryonic antigen (CEA) Human chorionic gonadotropin (hCG)

Alpha fetoprotein

What treatment is likely more effective in treating a 75 year old male with stage 4 prostate cancer with presents with back pain? Active surveillance Radical prostatectomy Radiation Androgen deprivation therapy

Androgen deprivation therapy

A patient presents to the ED for evaluation of fevers, rigors, and shortness of breath. They are hypotensive, hypoxic, and tachypneic. A VBG demonstrates low pH, low PaCO2, low HCO3, and anion gap outside of normal range. What is the patient's primary acid/base disorder? Non-anion Gap Metabolic Acidosis Respiratory Acidosis Anion Gap Metabolic Acidosis Anion Gap Metabolic Alkalosis

Anion Gap Metabolic Acidosis

A 42-year-old female IV drug user experiences vague symptoms consisting of fatigue, aches and pains, and nausea. She has developed a distaste for her cigarettes. She appeared jaundiced for a few days, but the condition spontaneously resolved. She goes to the free clinic and they run preliminary blood tests. The staff at the free clinic tell the patient she does not have hepatitis B. What may be present in this patient's lab work to indicate she may be in the window period? Anti-HBc HBsAg Anti-Hbe HBeAg Anti-HBs

Anti-HBc

A 48-year-old Caucasian woman with a chronic history of inability to tolerate oral intake is admitted to the hospital for J-tube placement. The patient also reports a rash that has developed on her upper extremities. Examination reveals diffuse petechiae and perifollicular hemorrhage. What is the most likely nutritional deficiency causing the rash? Niacin Cobalamin Biotin Ascorbic acid Choline

Ascorbic acid

Classic triad of Wernicke's encephalopathy (WE) includes all except Encephalopathy Asterixis Gait ataxia Oculomotor dysfunction

Asterixis

A 60-year-old man with hypertension presents with constipation. He states that he has not had a bowel movement in the past 2 days. He was hospitalized with a myocardial infarction 1 month ago, but he is now stable on a low-fat, low-salt diet. He refuses a docusate sodium enema and is prescribed oral docusate tablets. What precaution should the patient take? Avoid long-term use of docusate (laxative) Consume docusate (laxative) with fruit juice only Increase his salt intake Consume mineral oil Be aware of the potential for dehydration

Avoid long-term use of docusate (laxative)

A 65 year old male presents with bothersome urinary symptoms of frequency, urgency, reduced stream and post void dribbling. Symptoms have progressed over the last year. What is the most likely diagnosis? Bladder cancer Erectile dysfunction BPH Hydrocele

BPH

A 65 year old man presents with gradual increase in urinary frequency over the past few months. Most recently, he has difficulties starting to urinate and the stream seems slow. Despite waking up several times at night to release his bladder, he continues to have a sensation of incomplete emptying. He has no history of STDs, surgery, or UTIs. Upon examination, he is slightly overweight and his vitals are normal. His abdomen feels soft, the genitals are benign, and his prostate is non-tender and moderately enlarged (35-40 g). Lab tests are negative for blood presence in the urine and indicate a protein-specific antigen (PSA) of 1.3 ng/mL. What is the most likely diagnosis? Benign prostatic hyperplasia Overactive bladder Prostate cancer Prostatitis UTI

Benign prostatic hyperplasia

A 48-year-old man presents with continuous right upper quadrant pain that developed after eating fried chicken. He has experienced previous episodes of less severe right upper quadrant pain that resolved spontaneously. The pain radiates to his right shoulder, accompanied by nausea, vomiting, and chills. Vital signs include BP 120/85 mm Hg, pulse 117/min, respirations 18/min, temperature 102.5°F. Physical examination is remarkable for scleral icterus and jaundice. His abdomen is slightly distended with right upper quadrant tenderness and a positive Murphy sign. CBC reveals mild leukocytosis, elevated serum aminotransferases and bilirubin, and normal lipase. What is the most likely cause of this patient's symptoms? Hepatitis Choledocholithiasis Pancreatitis Cirrhosis Hepatocellular Carcinoma

Choledocholithiasis

What condition is the most common cause of acute pancreatitis in both adults and children? Hypertriglyceridemia Cholelithiasis Alcohol Iatrogenic

Cholelithiasis

A 35-year-old male patient presents with a groin mass. The patient says the mass is painless, and there is no known trauma to the region. The mass is present upon standing and disappears when lying flat. Past medical history includes chronic constipation, hypertension, and hyperlipidemia. Past surgical history includes lipoma removal from the left shoulder. The patient denies tobacco use; he drinks about 6 beers per week. Ultrasound confirms the diagnosis, and surgical repair is scheduled. What is the most significant risk factor for this patient's condition? Alcohol use Chronic constipation Hyperlipidemia Hypertension

Chronic constipation

Phimosis can be treated with... (answer with all that apply) Circumcision Dorsal slit Topical steroids Traction 3-8 hours daily with PeniMaster Pro or Andropenis Partial penectomy

Circumcision, dorsal slit, and topical steroids

A 45-year-old man comes to the office because of abdominal pain and intermittent diarrhea. He reports that the pain is cramping in nature and is confined to the right lower quadrant. The diarrhea is watery in consistency and is not associated with food intake. He has had these symptoms for 2 years but has not previously sought medical attention. PMH: joint pain. FH: colorectal carcinoma in his paternal grandfather. Temp: 98.6 F, pulse 95/min, respirations 20/min, BP 115/70 mmHg. PE: pale conjunctiva. Abdominal examination reveals RLQ tenderness. Oropharyngeal exam reveals ulcer on the soft palate. Which of the following is most likely to be seen o the colonoscopy of this patient? Cobblestone appearance of ileal and colonic mucosa Flask-shaped ulcers in cecum Atrophic mucosa with loss of folds in the duodenum Friable exophytic endoluminal mass in the ascending colon Small, flask-like out-pouchings in the cecum

Cobblestone appearance of ileal and colonic mucosa (Crohn's disease)

These criteria are required to make a diagnosis of toxic megacolon except Leukocytosis Colonic dilation <6 cm Fever Tachycardia

Colonic dilation <6 cm (should be >6 cm)

A 52-year-old woman was noted on yearly examination to have a microcytic anemia. She has recently noted a change in bowel habits and rectal bleeding with bowel movement. She reports abdominal pain. She has no prior surgical history. Her only medical issue is an elevated cholesterol level that is controlled by diet. Her pulse is 92 BPM, blood pressure is 140/78 mm Hg, respiration rate is 14/min, and temperature is 98.7°F. Rectal exam is notable for guaiac positive stool without any masses. Neurological examination is normal. What test should be ordered to confirm the suspected diagnoses? (Labs are generally normal although hematocrit is low) PET scan Colonoscopy Chest, abdomen, and pelvis CT Pelvic MRI CEA level

Colonoscopy

58-year-old woman presents with a 3-month history of postprandial abdominal pain that always occurs 30 minutes after eating. Due to these symptoms, the patient has lost 30 pounds and is afraid to eat. Past medical history includes hypertension treated with enalapril and coronary artery disease for which she has undergone a right coronary artery stent; she underwent a carotid endarterectomy for symptomatic carotid stenosis. She has smoked 2 packs of cigarettes a day for 30 years. What is the best initial test for this patient? Barium enema Mesenteric angiogram Mesenteric duplex ultrasound Computerized tomography angiography Magnetic resonance angiography

Computerized tomography angiography

Which statement best describes Hirschsprung's disease? Congenital condition causing toxic megacolon Acquired condition causing peptic ulcer disease Congenital condition cause folic acid deficiency Acquired condition causing generalized malabsorption

Congenital condition causing toxic megacolon

An 81-year-old male is hospitalized for sepsis secondary to a pneumonia; he has a past medical history significant for hypertension and diabetes mellitus. On initial presentation, he is tachycardic, mildly hypotensive, and febrile. White blood cell count and lactate were elevated, but the rest of his labs were normal. The following day, he's noted to have an AKI. U/A is largely unremarkable. UOsm 121, UNa 37, FENa 2.3%. Outline a treatment plan. Conservative/supportive care and removal of nephrotoxins Aggressive diuresis and consider hemodialysis if patient deteriorates

Conservative/supportive care and removal of nephrotoxins (treatment for post-ischemic ATN due to sepsis)

A 15-year-old boy presents with bloody diarrhea and abdominal cramping. A double contrast barium enema shows fine serrations and narrowing of the rectum and sigmoid. Stool contains mucus, blood, and white blood cells, but no parasites or bacterial pathogens. Endoscopy shows inflamed mucosa and pseudopolyps. A biopsy finds an extensive inflammatory process in the mucosa and submucosa. The glands are filled with eosinophilic secretions; there is also mild involvement of the terminal ileum. Sulfasalazine treatment is attempted without improvement. What is the most appropriate next step in management? Corticosteroids Metronidazole 6-mercaptopurine Diphenoxylate Loperamide

Corticosteroids

Upon inspection of an 18 year old man's scrotum, you note that the left side is underdeveloped and the left testis is not palpable. There is no scrotal tenderness, swelling, or nodularity. Considering this is not an acute finding, what is the most likely diagnosis? Cryptorchidism Acute epididymitis Hydrocele Testicular cancer Strangulated inguinal hernia

Cryptorchidism

An 91-year-old male brought to the ED for lethargy, decreased oral intake, and worsening confusion; he has a past medical history significant for severe dementia and debility. Staff at his care facility have noticed increasing lethargy and fatigue over the last several days. He's also had rhinorrhea, nasal congestion, and a non-productive cough. Labs demonstrate a serum sodium of 162. U/A is largely unremarkable. UOsm 789. Outline a treatment plan. D5W (hypotonic) saline Isotonic (LR, NS) saline 3% NaCl (hypertonic) saline

D5W (hypotonic) saline (treatment for hypernatremia)

An 8 year old boy is evaluated for persistent bedwetting. He has never been continent, averaging 2-3 episodes of bedwetting per week. His urological evaluation revealed a normal bladder and urethra with no neurologic problems. Lately, his problem has been a source of much embarrassment; he is unable to attend camp or sleepovers due to fear of wetting his bed. He has tried multiple interventions, including lifestyle changes, alarm systems, and reward systems. PE show no abnormalities. His parents are keen on a rapid resolution to his problems, and they insist treatment be initiated. What is the best therapy? Tolterodine Desmopressin Imipramine Oxybutynin Corticosteroid

Desmopressin (ADH analog, reduced production of urine at night, very effective, rapid onset of action, taken as an oral tablet; tolterodine and oxybutynin would be treatment options for nighttime urination in adult patients, NOT children)

A 60 year old man presents with difficulty initiating voiding, incomplete emptying, and increasing urinary frequency over the past few months. He has no history of stones, cancer, surgery, diabetes or AID; he takes no medications. PE shows a temperature of 98.6 F, BP of 128/78 mm Hg, suprapubic fullness, an enlarged prostate, and no peripheral edema. The remainder of his exam is normal. He has been referred to urology. UA shows no protein or blood, post-void bladder scan is 225 mL, renal US is unremarkable, serum creatinine is 0.9 mg/dL, serum sodium is 139 meq/L, serum potassium is 3.9 meq/L, and total WBC count is 5 x 10^3 clles/mm^3. What medical intervention will help prevent the loss of renal function that may accompany his primary disorder? Increased fluid intake Doxazosin Sodium bicarbonate Ofloxacin Potassium

Doxazosin (relieves symptoms of urinary retention and prevents renal damage in obstructive uropathy due to enlarged prostate)

A 26-year-old man comes to his outpatient provider because of "yellowing of the skin." Two days earlier the patient was started on trimethoprim-sulfamethoxazole for bacterial cystitis. The patient previously had a similar episode during college after a viral URI. PMH: asthma for which he uses albuterol inhaler. FH: hypertension in mother, peripheral vascular disease in father. Vitals are within normal limits. PE: scleral icterus and jaundice of the skin. Peripheral blood smear: Heinz bodies and bite cells. Which of the following laboratory findings will be most likely present in this patient? Normal unconjugated bilirubin, conjugated bilirubin and urine hemoglobin Normal unconjugated bilirubin, elevated conjugated bilirubin and urine hemoglobin Elevated unconjugated bilirubin and urine hemoglobin, normal conjugated bilirubin Elevated unconjugated bilirubin, conjugated bilirubin and normal urine hemoglobin Elevated unconjugated bilirubin, normal conjugated bilirubin and urine hemoglobin

Elevated unconjugated bilirubin and urine hemoglobin, normal conjugated bilirubin (glucose-6-phosphage dehydrogenase-bite cells/Heinz bodies)

A 60-year-old African American man presents due to dysphagia. The dysphagia started 3-4 months ago and has progressively gotten worse. He has also lost weight; current weight and height are 170 lb and 72". He appears older than his stated age. He wants something to help him in swallowing. He does not report heartburn.​ You note he does not eat on a regular basis, and when he does eat, it is usually fast food. He has smoked for the last 40 years, 2 packs a day. He drinks 12 cans of beer on weekdays and approximately 48 cans of beer during the weekend. He uses recreational drugs occasionally.​ What is the most likely diagnosis? Gastroesophageal reflux disease Esophageal stricture Esophageal varices Esophageal neoplasm Mallory-Weiss Syndrome

Esophageal neoplasm

A 73-year-old man with hypothyroidism has been hospitalized with a spinal cord injury and is evaluated at bedside. He is unable to have bowel movements; he has only passed a stool twice in the past 10 days. He states that he has had involuntary passage of small loose or liquid stools during this time, associated with abdominopelvic discomfort. Dietary history is remarkable for a low-fiber diet that lacks raw fruits and vegetables. He takes oxycodone for chronic back pain. He denies any abdominal or pelvic pain, weight loss, hematochezia, melena, fever, chills, or urinary issues. Rectal exam reveals good sphincter tone, but a firm immovable mass is detected. Bedside pelvic radiograph shows colonic distension. What is the most likely diagnosis? Acute colitis Fecal impaction Prostatitis Rectal abscess Rectal cancer

Fecal impaction

What is the classic triad for Acute Interstitial Nephritis? Hypothermia + rash + leukocytosis Low BUN + rash + eosinophilia Fever + eosinophilia + rash Fever + renal lesions + eosinophilia

Fever + eosinophilia + rash

Tamsulosin, alfuzosin, finasteride, and silodosin are all medications that can be used to treat BPH in men with bothersome symptoms. Which medication is designed to reduce volume/size of the prostate after taking it for 3-6 months? Tamsulosin Alfuzosin Finasteride Silodosin

Finasteride

You are evaluating an 45 year-old male who presented to the hospital for lethargy, fatigue, and subjective weakness; he has a past medical history significant for multiple myeloma, currently on treatment, hypertriglyceridemia, secondary to chemotherapy. On physical examination, his mucus membranes are moist, her JVP is 9 cm, and capillary refill and pulses are normal. No pitting edema is noted. Laboratory evaluation shows low sodium, low chloride, low serum osmolality, urine osmolality of 515, and urine sodium of 52. What treatment would you recommend for his hyponatremia? Fluid restriction of <2 L/day Salt tablets NaCl 0.9% fluid administration No treatment indicated (pseudohyponatremia)

Fluid restriction of <2 L/day Patient has SIADH (hypotonic, euvolemic, >100 urine osmolality)

When a male patient presents with progressive scrotal pain with open scrotal sores, erythema, fever, and pain, you should be considering the differential of...? Peyronie's Disease Scrotal Pearl Testicular cancer Fournier's Gangrene (necrotizing fasciitis)

Fournier's Gangrene (necrotizing fasciitis)

Dysmorphic RBC on urinalysis should prompt consideration for what group of diseases? Pre-renal AKI AIN ATN GN Post-renal AKI

GN (glomerulonephritis)

A 45-year-old man presents with a 30-minute history of substernal chest pain. He describes the pain as burning. He denies any trauma to the chest. He has had similar episodes like this many times. He denies any additional symptoms such as shortness of breath or diaphoresis, but he states that his voice is often hoarse. His medical issues include diabetes mellitus and heavy alcohol use. What is the most likely cause of his chest pain? Gastroesophageal reflux Pneumonia Aortic dissection Pulmonary embolism Unstable angina

Gastroesophageal reflux

A previously healthy 19-year-old male comes to his physician complaining of recurrent bloating, abdominal pain, and flatulence for the past several months. The patient has not had any recent illnesses. He recently started training to become a competitive bodybuilder and has been on a diet consisting of mainly protein shakes and yogurts. PMH is noncontributory. Meds: multivitamin daily. Recently traveled to China to visit relatives. Vital signs are within normal limits. PE: normoactive bowel sounds, no tenderness to abdominal palpation. He is administered 50 g of lactose orally. Three hours later, there is an increase in breath hydrogen content. Stool sampling reveals a decreased pH. Which of the following is the most likely cause of the patient's symptoms? Developmental lactose malabsorption Genetically regulated reduction of lactase enzyme activity Loss of intestinal brush border enzyme due to gastroenteritis Small intestinal bacterial overgrowth Congenital lactase deficiency

Genetically regulated reduction of lactase enzyme activity

An 18-year-old man presents for a screening physical exam to join his college freshman lacrosse team. He reports no medical problems, and he does not take any medications. Physical exam is unremarkable. His immunizations are current, and he denies sexual activity or smoking. Review of routine labs reveals an elevation in unconjugated bilirubin. His total bilirubin level 4 mg/dL. Liver enzymes, serum electrolytes, complete blood count, and conjugated bilirubin level are within normal limits. What is the most likely diagnosis? Alcoholic hepatitis Crigler-Najjar syndrome Dubin-Johnson syndrome Gilbert's syndrome Infectious hepatitis

Gilbert's syndrome

An African American male neonate born 12 hours ago presents with yellowish coloration of the whites of his eyes. His skin also appears darker and yellowish compared to his twin sister's skin. Pregnancy was normal, and the 23-year-old mother had no infections or complications and took no drugs during the pregnancy. Delivery was uneventful; the neonates were born on term with APGAR score 9 and 10, respectively. Family history of anemia, splenectomy, bile stones, and liver disease is negative, but the father has a "beans allergy" that presents with abdominal pain and jaundice. Peripheral smear does not reveal spherocytosis, echinocytosis, or eliptocytosis, but some keratocytes are present. Bilirubin levels in the patient are high (13 mg/dL) with direct bilirubin 1 mg/dL. Coombs test is negative and hemoglobin is low. What is the most likely diagnosis? Breastmilk jaundice Breastfeeding jaundice Rotor syndrome Neonatal sepsis Glucose-6-phosophate dehydrogenase deficiency

Glucose-6-phosphate dehydrogenase deficiency

What nutrition-related disorder is more common in those of African American descent characterized by splenomegaly, hyperbilirubinemia, jaundice, fever, often presenting after acute infection or consumption of fava beans? Vitamin B6 deficiency Paget Disease Glucose-6-phosphate dehydrogenase deficiency Pernicious anemia

Glucose-6-phosphate dehydrogenase deficiency

A 25-year-old man presents for evaluation of intermittent chest pain. He reports a burning sensation in his chest 1-2 days per week after eating. The symptoms are worse with large meals, eating late at night, and excessive alcohol consumption. He denies difficulty swallowing, weight loss, night sweats, chest pain, use of tobacco, or coughing up blood. His vital signs and physical examination are unremarkable. What is the most appropriate treatment for this patient's current symptoms? H2 receptor antagonist Proton pump inhibitor Antibiotics Prokinetic agents

H2 receptor antagonist

What initial test, if negative, rules out the diagnosis of celiac disease? tTg-IgA antibody Ferratin HLA-DQ2/DQ8 typing Small bowel biopsy

HLA-DQ2/DQ8 typing

What antibody in the blood indicates acute or recent hepatitis A infection? Hepatitis A antigen Hepatitis A IgG antibody Hepatitis A IgM antibody

Hepatitis A IgM antibody

Which hepatitis virus can only replicate in the presence of hepatitis B? Hepatitis A Hepatitis C Hepatitis D Hepatitis E

Hepatitis D

A 50-year-old male patient presents with a 3-month history of weakness, fatigue, and abdominal discomfort. He acknowledges a lack of sexual desire. He denies any photosensitivity. On physical examination, the liver is enlarged, and the spleen is palpable. He has abnormal skin pigmentation on the face, neck, and elbows that gives his skin a metallic gray hue. His labs are as follows:​ -TIBC 275 mcg/dL (normal 250-350 mcg/dL)​ -Plasma iron 220 mcg/dL (normal 80-160 mcg/dL)​ -Transferrin saturation 90% (normal 16-57%​) What serious complication is associated with this patient's condition? Bronchogenic carcinoma Hepatocellular carcinoma Leukemia Lymphoma Pancreatic carcinoma

Hepatocellular carcinoma

A 20-year-old woman presents with 2 weeks of anorectal pain. She notes streaks of blood on her stool and toilet paper. She reports "a tearing pain during each bowel movement." She dreads having a bowel movement, and she attempts to hold it as long as she can. She broke her leg in a skiing accident 4 weeks ago and was prescribed oxycodone/acetaminophen (Percocet) for the first few days due to her pain. An anoscope reveals an acute anal fissure. What should be the next step in treatment? High fiber diet and stool softeners Topical diltiazem Lateral internal sphincterotomy Botulinum toxin Percocet for rectal pain

High fiber diet and stool softeners

What disease can present in the first few months of life with abdominal distention, bilious emesis and lack of meconium passage and is more common in infants with trisomy 21? Pyloric stenosis Hirschsprung's disease Phenylketonuria Cystic fibrosis

Hirschsprung's disease

The mother of a 3-year-old boy asks to have a blood test done on her son for lead poisoning. He has not been tested before. They have moved into an older home, built before 1960. She has noticed some peeling paint on windowsills and doors and has seen small paint chips on the floors. They are now having the house repainted and are staying with relatives. A careful environmental history is obtained, and risk reduction and nutrition education are provided. His fingerstick blood lead level comes back at 13 mcg/dL. What is the next step in the management of this patient? Oral chelation therapy Home visit to identify potential lead sources Repeat lead level in 6 months Repeat lead level in 1 year Hospitalization and IV chelation therapy

Home visit to identify potential lead sources

A 2 week old male infant presents with his father for evaluation of enlarged scrotum. The father states that the scrotum was a little large in the first few days after birth than it is now, but it has not reduced in size enough to make him feel comfortable that it is normal. PE reveals normally developed penis with abnormally large scrotum that transilluminates (red) on the right side when light is shined on it. What is the most likely diagnosis? Hydrocele Inguinal hernia Spermatocele Testicular tumor Varicocele

Hydrocele

What are the two most common causes of hypercalcemia? Hypertension + Malignancy Chronic kidney disease + Thiazide diuretics Lithium + Hypovitaminosis D Hyperparathyroidism + Malignancy

Hyperparathyroidism + malignancy (releases PTH-rp)

A 6-week-old male infant presents with a 2-day history of vomiting after every feeding of cow's milk-based formula with iron, 4 ounces per feeding. There has been no fever, diarrhea, or other symptoms except increased crying. The child appears alert and hungry. The mother describes the vomiting as forceful, traveling about 2 feet. Physical evaluation reveals minimal tear production with mild skin tenting. Bowel sounds are decreased. BUN 29 mg/dL; serum sodium 129 mg/dL; serum potassium 3.4 mg/dL; serum chloride 89 mg/dL; serum bicarbonate 34 mg/dL. What is the next step in this patient's care? Exploratory laparotomy Gastric aspirate for Helicobacter pylori IV fluids and abdominal ultrasound High-dose IV methylprednisolone Trial of oral rehydration

IV fluids and abdominal ultrasound

A 33-year-old woman presents for an annual physical. She has past medical history of GERD, asthma, and irritable bowel syndrome. She drinks 1-2 alcoholic beverages per week and has never smoked; she does not use illicit drugs, and she consumes a vegetarian diet. Her past surgical history includes an appendectomy at age 14. Her father passed away from a heart attack at age 63. Her mother is alive with history of colorectal cancer, which was diagnosed at age 41. What is the recommended colorectal cancer screening for this patient? Screening colonoscopy at age 50 Screening colonoscopy at age 45 Screening colonoscopy if she becomes hemoccult positive Immediate screening colonoscopy

Immediate screening colonoscopy

A 7-year-old boy is brought to the pediatrics PA by his parents because of bone pain and an abnormal gait pattern. The patient and his family recently immigrated to the US from Southeast Asia and previously had limited access to healthcare. According to the parents, the patient's PMH is notable for several episodes of pneumonia and greasy foul-smelling stools. His diet consists of fish, vegetables, and some meats. Vitals are within normal limits. He is below the 10th percentile for height and weight. PE is notable for bowing of the legs and tenderness on palpation of the lower extremities. Lab testing reveals low phosphorus. Which of the following is the most likely explanation for the patient's symptoms? Inadequate dietary vitamin D intake Genetic defect impairing osteoclast activity Intestinal damage secondary to autoimmune response Inadequate dietary calcium intake Impaired absorption of fat-soluble vitamins

Impaired absorption of fat-soluble vitamins

A 10-month-old girl is brought ot the pediatrics PA by her parents because of poor growth. The patient was born at 38-weeks gestational age via an uncomplicated vaginal delivery. The patient is exclusively breast fed, does not consume formula, and spends most of her time indoors. PMH is notable for a viral upper respiratory tract infection at 7-months-old. Family history is notable for Celiac disease in her older brother. The patient is below the 10th percentile for height and weight. PE reveals bowing of the legs. Skeletal imaging reveals bone abnormalities. Which of the following is the most likely cause of the patient's presentation? Inadequate dietary vitamin D intake Congenital defect impairing chondrocyte proliferation Reduced bone resorption by osteoclasts Gluten-related autoimmune intestinal damage

Inadequate dietary vitamin D intake

A 71-year-old woman presents with her daughter for dizziness. The daughter is worried about a potential fall; her mother recently had surgery for a right ankle fracture. The patient denies syncope but feels lightheaded when trying to stand. She lives alone and is in a walking boot with crutches. She has not had to use her narcotic pain medicine for 5 days, stating her ankle pain is controlled with ibuprofen alone. She is limiting fluid intake to minimize bathroom trips. Past medical history is remarkable for stable overactive bladder and hypothyroidism. Medications: oxybutynin, ibuprofen, levothyroxine. Only surgery is the recent ankle fracture repair. She denies allergies and use of tobacco, alcohol, and recreational drugs. On physical exam, the patient is wearing the boot and reports dizziness as she moves to the exam table. Exam is remarkable for mild tachycardia and decreased skin turgor, remainder is normal. BP 94/58, Pulse 110, Wt 117 lb, Ht 63". Laboratory evaluation shows elevated sodium and high serum osmolality. What is the most appropriate next step in the management of her care? Change ibuprofen to hydrocodone Initiate IV fluids Increase oxybutynin Initiate desmopressin

Initiate IV fluids (isotonic, treat hypotonic, hypovolemic hyponatremia, caused by oxybutynin)

A 40-year-old man presents with a 2-year history of severe, burning epigastric pain. A detailed history reveals that the pain is greatest in the early hours of the morning and wakes him up from sleep. The pain is also felt 2-3 hours after meals. He reports diarrhea for the past 2 years. On examination, his pulse is 74/min and blood pressure 136/84 mm Hg. There is slight epigastric discomfort on palpation. Lab examination shows hyperchlorhydria. What is a potential complication of this patient's diagnosis? Gallstones Intestinal ulcers Macrocytic anemia Kidney stones Weight gain

Intestinal ulcers

An 67-year-old male presents for nausea, vomiting, and diarrhea. She has a past medical history significant for hypertension. Exam demonstrates mucus membranes are dry, a JVP of 5 cm, capillary refill 3 seconds. Laboratory evaluation demonstrates a creatinine of 1.8 and a BUN of 32? FENa = 0.7%. Urine sodium = 14. What is your treatment of choice? D5W (hypotonic) saline Calcium gluconate Isotonic (LR, NS) saline Treat underlying cause

Isotonic (LR, NS) saline (fluid resuscitation for hyponatremia)

An 85-year-old man is brought in by his niece to the clinic after finding him confused outside his house. He denies the incident and says that he was "just walking his dog around the neighborhood" after having a meal with friends. After the consultation, his niece states that "He doesn't own a dog, he lives alone, and most of his meals consist of reheating canned foods." PMH: hypertension, hypercholesterolemia, and type 2 diabetes. Meds: hydrochlorothiazide, atorvastatin, and metformin. Family history is noncontributory. He has been drinking 5-6 beers daily for the past 30 years. Vitals are within normal limits. He is oriented to person and place, but not time. Immediate and delayed memory recall are poor. Horizontal nystagmus is elicited on lateral gaze. What is the most likely diagnosis? Frontotemporal dementia Vascular dementia Alzheimer dementia Korsakoff syndrome Lewy body dementia

Korsakoff syndrome

A 58-year-old man presents with a 1-day history of severe abdominal pain, nausea, and vomiting. He initially thought he had some indigestion with pain located in the epigastric region and tried some calcium carbonate (Tums) with no relief. The pain and vomiting progressed through the night and kept him from sleeping and going to work. He feels the pain boring through to his back. He denies hematemesis, fever, diarrhea, out-of-the-country travel, and contact with sick people. Prior to onset of pain, he reports good health. He has no known medical conditions and takes no medications. He has had no surgeries. He smokes cigarettes (40 pack-years), admits "moderate" alcohol use, and denies drug use. He is married and works as a welder.​Vitals are: BP: 102/56 mm Hg; HR: 116 bpm; RR: 15; Temp: 98.9°F; O2 Sat: 95% on room air. On physical exam, the patient appears uncomfortable on the exam table and grimaces when changing position for exam. He is cooperative, alert, and oriented. Abnormal physical exam findings include distended abdomen, decreased bowel sounds, and epigastric region tenderness with guarding. He is tachycardic. No jaundice is noted. The remainder of the exam is normal. This patient's test results are shown in the table. What pharmacologic treatment is the most important intervention for this patient's most likely condition?​​ Lactated Ringer's​ Ertapenem​ Hyocyamine​ Pancrealipase​ Promethazine​

Lactated Ringer's

A patient presents for generalized malaise and weakness. They are confused and unable to provide any significant history. Family found them to be acutely confused today and brought them to the emergency department. They have a past medical history significant coronary artery disease, hypertension, hyperlipidemia, and diabetes mellitus type II. On examination the patients JVP is 12 cm. They have 3+ pitting edema bilaterally. Laboratory evaluation shows elevated potassium, low chloride, and high BUN and creatinine. ECG demonstrates normal sinus rhythm without abnormalities. What is the next best step in caring for the patient? Lasix + insulin + dextrose Potassium chloride Calcium gluconate

Lasix + insulin + dextrose

A 57-year-old male presents to the ED for evaluation of weakness and fatigue. He has a past medical history significant for hypertension on an ACE-I and prior lung cancer. He had a CT with contrast 2 days prior for cancer surveillance. He appears euvolemic on examination. Laboratory evaluation today demonstrates an AKI with a creatinine of 1.9 and hyperkalemia of 6.7. ECG demonstrates peaked T waves. Outline a treatment plan for the patient. Lasix + insulin + dextrose + IV calcium gluconate +/- IVF HCTZ + IV potassium chloride LR + albuterol + insulin + magnesium

Lasix + insulin + dextrose + IV calcium gluconate +/- IVF

A 12 year old boy presents with acute onset of 3 hours of severe pain in the right testis rated 8/10, associated with nausea and scrotal swelling. This is the worst pain he has ever experienced. He denies any problems with urination and recent trauma. No surgical history. On exam, he is in visible distress with temperature of 37 F, HR 95 bpm, and BP 120/70 mm Hg. Genital examination reveals enlargement and edema of the entire scrotum. The right testicle is erythematous and tender to palpation; it appears to sit higher and lies horizontally in the scrotal sac relative to the left side. The cremasteric reflex is absent ipsilaterally, and there is no relief of pain upon elevation of the scrotum (Prehn's sign). What clinical feature helps the most too differentiate this patient's condition from other causes of scrotal pain? Tenderness Horizontal line Prehn's sign Loss of cremasteric reflex

Loss of cremasteric reflex (most accurate and sensitive sign of testicular torsion; positive Prehn's sign is indicative of epididymitis)

What are the diagnostic criteria for SIADH? Low sodium osmolality <280, high urine osmolality >100 usually >300, high urine sodium >40 High sodium osmolality >280, low urine osmolality <100 usually <300, low urine sodium <40

Low sodium osmolality <280, high urine osmolality >100 usually >300, high urine sodium >40

A 48-year-old female patient with a past medical history of obesity presents with a 2-month history of intermittent mild epigastric and right upper quadrant pain. The pain is intermittent and occurs in "waves." She notes nausea, vomiting, and radiation of pain to the right shoulder. Physical exam reveals unremarkable vital signs, but tenderness is noted in the right upper quadrant. There is no guarding or rebound. Bedside ultrasonography is obtained. What health maintenance advice is recommended for this patient? Avoidance of Vitamin C Moderate, fatty or greasy meals Low-fat, low-cholesterol diet Prolonged fasting Rapid weight loss

Low-fat, low-cholesterol diet

A 65 yo male with hx of alcoholism complains of retching with his emesis showing frank blood, twice in the last two days. What is the likely diagnosis? Esophageal cancer Borhaave's syndrome Mallory-Weiss syndrome Zenker's diverticulum

Mallory-Weiss syndrome

A 12-year-old African American boy presents with a 1-month history of poor appetite and has complained of overall not feeling well. When questioned, the boy cannot delineate any specific symptoms except that he feels "puffy." He denies pain, eating disorder, rash, depression, drug use, and fevers. The family denies recent travel. His PMH is unremarkable with no recent or chronic illnesses. He has had no surgeries, and he takes no medications. His family history includes grandparents on both sides with hypertension, with one of these grandparents also having died from some type of kidney problem. His ROS is entirely negative except for the above symptoms and some noted change in urine, which he describes as frothy. He denies dysuria, gross hematuria, polyuria, and nocturia in the ROS. On physical exam, his vitals are: Tem: 97.9°F; Resp 14; HR 90; BP 120/74 mm Hg right arm sitting. It is noted weight is up 2 pounds from his charted weight 3 months ago. HEENT, neck/thyroid, lungs, cardiac, abdominal, musculoskeletal, neurological and derm exams are unremarkable. Examination of extremities reveals bilateral 1-2+ edema in the upper and lower extremities, with 2+ pulses. Basic laboratory studies show CBC within normal limits, albumin 2.7 g/dL, BUN 30 mg/dL, and glucose 88 mg/dL. Dipstick urinalysis reveals protein 3+, blood 1+, glucose/ketones/nitrates/leukocyte esterase negative, and specific gravity 1.025. Given the proteinuria, a urine protein to creatinine ratio is obtained, showing 3.6 mg/mL. What is the most likely diagnosis? Post-streptococcal glomerulonephritis Diabetic nephropathy Henoch-Schönlein purpura Nephrotic syndrome

Nephrotic Syndrome (high level of proteinuria/frothy urine, hypoalbuminemia, and edema)

A 51-year-old woman presents with difficulty swallowing. She reports a 2-month history of problems swallowing liquids and solids and bringing up undigested food. X-ray reveals a bird's beak appearance of the esophagus. What medication would be most appropriate in this patient? Nifedipine Pantoprazole Famotidine Ciprofloxacin Nystatin

Nifedipine

A 28-year-old man presents with rectal bleeding. He had noticed blood with bowel movements 3 times. The blood is described as bright red in color and small in amount. He also complains of rectal pain, especially with passing hard stools. He has tried some over-the-counter hemorrhoid creams without relief.​ The patient admits episodic constipation. He denies dark tarry stools, easy bruising, and prior episodes of rectal bleeding. He has not noticed blood in his urine or with brushing his teeth. He denies nausea, vomiting, diarrhea, fevers, and weight loss. He has no known medical conditions. Family history is negative for gastrointestinal disorders. Social history reveals he is in a heterosexual relationship and denies anal intercourse.​ On physical exam, abdomen is normal. The anus has no visible protrusions or rash, but there is a very small erythematous and tender area that appears like a "paper cut" or crack in the skin. The patient experiences pain with digital rectal exam (DRE). No masses are noted in the rectal vault​ What is the most appropriate prescription treatment for this patient's current condition? Bacitracin ointment Minoxidil topical Nitroglycerin ointment Nystatin topical Tretinoin topical

Nitroglycerin ointment

A 43-year-old woman presents with a 6-month history of vague right upper quadrant discomfort. The patient denies any relation of pain to meals and describes it as a dull constant discomfort. The patient was diagnosed with type 2 diabetes mellitus 1 year ago, which is controlled with diet. She does not smoke but admits to drinking a glass of wine occasionally. She denies any medications except for over-the-counter acetaminophen, which she takes occasionally for joint pains. She does not have any family history of chronic liver disease. There is no history of blood transfusions in the past. On physical examination, the patient is obese with a BMI of 31; BP 140/90 mm Hg. The liver is palpable 3 cm below the right costal margin and is slightly tender. No other signs of chronic liver disease are evident. See laboratory studies below.​What is the most likely diagnosis? Hemochromatosis​ Chronic hepatitis B​ Non-alcoholic steatohepatitis​ Alcoholic hepatitis​ Acetaminophen hepatotoxicity

Non-alcoholic steatohepatitis

A 35 year old woman just found out she is pregnant. She is experiencing polyuria, but she denies dysuria and incontinence. Her UA is unremarkable. Her fetal ultrasound is normal, and her renal ultrasound shows normal physiologic hydronephrosis of pregnancy. Her pre-pregnancy weight was 155 lbs, and she is 5 feet tall. Her calculated BMI is 30.3 kg/m^2. She takes no medications. She smoke half a pack of cigarettes per day. In this patient, how can you best prevent urinary stress incontinence postpartum? Normalize weight Episiotomy Vaginal childbirth Prescribe duloxetine Prescribe oxybutynin

Normalize weight

A 66-year-old male patient with a history of obesity and hyperlipidemia presents with an 8-month history of progressing "burning in his chest." This sensation is noted in the midline of the chest, and it is provoked when bending over, when wearing tight clothing, after eating a large meal, and when lying supine. He denies chest pressure, cough, shortness of breath, palpitations, dizziness, lightheadedness, and diaphoresis. Physical examination is unremarkable. An upper endoscopy is performed and inflammation in the esophagus is noted. What is the most appropriate pharmacotherapeutic intervention for this patient? Omeprazole Nystatin Cisapride Metoclopramide Sucralfate

Omeprazole

Results of a celiac disease serology cascade are as follows: Tissue transglutaminase (tTG)-IgA antibody 20 g/L (normal 7-15 g/L). Based on this result, what would be your next step? Order colonoscopy Order EGD and small bowel biopsy

Order EGD and small bowel biopsy

A 40 year old otherwise healthy nulligravida woman presents with involuntary loss of urine that occurs after drinking a small amount of water, when washing the dishes, when hearing water running, and sometimes for no reason discernable to the patient. It is preceded by suddenly feeling the need to urinate, and it happens both during the day and at night. Urine analysis and culture, pelvic, gynecologic, and neurological examinations are normal. Cytometric studies show residual volume of 45 mL (normal) with involuntary detrusor contractions, starting already with 200 mL. What is the best treatment option for this patient? Psychiatric consultation Antibiotic trial Oxybutynin (anticholinergic) Neostigmine (cholinesterase inhibitor) Kegel exercise

Oxybutynin (anticholinergic) (prevents involuntary urgency and incontinency; Kegel exercises are not indicated as this patient is nulligravida and has no signs of problems with pelvic relaxation)

What GI condition causes malabsorption in most individuals (up to 85%) with cystic fibrosis? Celiac disease IBD Pancreatic Insufficiency Excessive mucus covering lining of intestines

Pancreatic insufficiency (causes diarrhea + steatorrhea)

What is the most common ECG change associated with hyperkalemia? Prolonged QTc U waves Peaked T waves PVC's/PAC's

Peaked T waves Also shortened QTc, widening of PR interval and QRS, P wave disappears, sine wave develops

A 16-year-old female patient with a 2-year history of ulcerative colitis presents with signs of an acute exacerbation. There is abdominal pain and frequent passing of large quantities of blood and mucus from the rectum. She is treated with sulfasalazine, glucocorticoids, and intravenous alimentation. Diarrhea decreases markedly, but her status continues to deteriorate. Tachycardia, volume depletion, and electrolyte imbalance develop; temperature 38.77°C (101.8°F). Physical examination shows abdominal tenderness, but no mass is observed. Plain radiography shows the transverse colon is dilated up to 7 cm. What is the most appropriate next step in management? Perform barium enema Perform colectomy Stop sulfasalazine Taper glucocorticoids

Perform colectomy

What is the name of the condition whereby immune-mediated inflammation results in destruction of gastric parietal cells causing loss of intrinsic factor production and inability to absorb food-bound dietary vitamin B12? Pernicious Anemia G6PD PKU Celiac Disease

Pernicious Anemia

A 47-year-old man presents with abdominal pain and difficulties breathing. He has a history of alcohol abuse and confirmed cirrhosis of the liver. On examination, you see a malnourished and jaundiced patient with a distended belly. Percussion of the abdomen reveals a huge amount of fluid and wave sign. What is the primary cause of the ascites? Increased albumin production Increased ammonia production Portal hypertension Decreased fluid intake Blockage of the common bile duct

Portal hypertension

A 1-year-old female is brought to the clinic for evaluation of developmental delay. Parent occasionally notices a "musty" smell to the patient's urine when changing her diaper. Pregnancy and birth were unremarkable; however, the patient has not been able to sit up or stand up on her own. She has not begun to say words though occasionally babbles. The family immigrated from Croatia 2 months ago, where the patient was born at home. Patient's weight is <5th percentile for her age. Head circumference is 10th percentile for her age. Temp is 36.4, pulse 145 bpm, respiratory rate is 34/min. Physical exam reveals eczema and hypopigmentation over the chest and arms. Motor exam is normal. Abdominal exam is unremarkable. The physician suspects a genetic disorder. This patient's condition is caused by a deficiency in what enzyme? Homogentisate oxygenase Tyrosinase Phenylalanine Hydroxylase Pyruvate Dehydrogenase Branched chain alpha-keto acid dehydrogenase

Phenylalanine Hydroxylase

The desire to crunch on ice or other non-food items such as dirt, clay, etc. is known as what? Glossitis Korsakoff Syndrome Pica

Pica

What painful condition occurs most often in young adult males with significant hair growth on the buttocks? Pilonidal disease Hemorrhoids Anal fissure Rectal polyps

Pilonidal disease

What are the two categorical types / causes of ATN? Pre-ischemic ATN + antibiotics Post-ischemic ATN + antibiotics Pre-ischemic ATN + nephrotoxins Post-ischemic ATN + nephrotoxins

Post-ischemic ATN + nephrotoxins

A 7-year-old girl presents with a 1-day history of bloody urine. The grossly bloody urine scared both the girl and her parents, but she denies dysuria and frequency. No trauma or sexual abuse has occurred. The parents deny recent fever in the patient, but they note that she had a fever for a few days accompanying a sore throat. She was given acetaminophen at an appropriate dosage for her weight, and about 3 days of some leftover amoxicillin; both the fever and pharyngitis then resolved. Her past medical history is unremarkable for any chronic illnesses. Her only medication is a multivitamin, and she has NKDA. She has had no surgeries, and family history is unremarkable for urinary tract disorders or any bleeding disorders. On physical exam, she appears interactive and in no apparent distress. She is well-nourished, non-obese, and perhaps mildly edematous. Vitals are a temperature of 99.0°F and a BP of 138/85 mm Hg; pulse is 98, and respiratory rate is 20. No rashes are found. Cardiac exam reveals normal rate and rhythm; there are no murmurs or rubs. On abdominal exam, her abdomen is non-distended, non-tender, and without masses or hepatosplenomegaly. She has no CVA tenderness. A urinalysis is performed; the significant findings are as follows: Protein 2+ Glucose Negative Ketones Negative Blood 4+ Nitrites Negative Leukocyte esterase 1+ Microscopic analysis is performed, confirming the presence of red blood cells (RBCs) that are dysmorphic and indicate RBC casts. Blood tests are ordered, revealing a complete blood count within normal limits and a complete metabolic panel with elevated creatinine. The patient's antistreptolysin O level is elevated. What is the most likely diagnosis for this patient? Anti-GBM glomerulonephritis Acute interstitial nephritis Wilm's tumor Postinfectious glomerulonephritis

Postinfectious glomerulonephritis

A Fractional Excretion of Sodium of < 1% is consistent with which type of AKI? Pre-renal AKI Intrarenal AKI Post-renal AKI

Pre-renal AKI

A patient presents to the emergency department for light headedness and dizziness. They have been feeling unwell, with fevers, rigors, cough, and shortness of breath. Laboratory evaluation demonstrates a BUN of 39, creatinine of 1.8, and mildly low sodium of 133. The remainder of the patient's labs are normal. An influenza swab demonstrates the patient has influeza A. Urinalysis demonstrates RBCs and WBCs on microscopy, a Uosm of 512, UNa 18, and FENA of 0.9%. The patient's acute kidney injury is likely secondary to which of the following? Pre-renal azotemia Post-renal azotemia Acute Tubular Necrosis Acute Interstitial Nephritis Acute Glomerulonephritis

Pre-renal azotemia (concentrated urine, low urine sodium, and low FENA)

A vasectomy... (answer with all that apply) Is analogous to neutering (removal of testes) Decreases circulatory serum testerone Causes retrograde/anejaculation Increases the risk of de novo prostate cancer later in life Prevents a man from conceiving naturally Preserves erectile, ejaculatory, and orgasmic function

Prevents a man from conceiving naturally Preserves erectile, ejaculatory, and orgasmic function

Potential causes of retrograde ejaculation include... (answer with all that apply) Prostate outlet procedures (TURP, PVP, HoLEP, etc.) Alpha antagonists (alfuzosin, Tamsulosin, terazosin, etc.) Retroperitoneal lymph node dissection (for bulky residual testicular cancer) Advanced age with atrophy of seminal vesicles PDE-5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil)

Prostate outlet procedures (TURP, PVP, HoLEP, etc.) Alpha antagonists (alfuzosin, Tamsulosin, terazosin, etc.) Advanced age with atrophy of seminal vesicles

A 2-year-old boy with his parents presents with colicky pain, a history of irritability, and a 2-day history of lethargy. There is also history of rectal bleeding and passage of "currant jelly" stool for the past 2 days. Vital signs reveal blood pressure of 105/70 mm Hg, heart rate of 90 bpm, respiration of 18/minute, and temperature 99.2°F. Plain abdominal film shows evidence of obstruction, and barium enema detects coiled-spring appearance to the bowel. Based on the most likely diagnosis, what is the best next step in management of this patient? Resection of the bowel Reduction by contrast enema Observation for spontaneous reduction Manual reduction Reduction by air enema

Reduction by air enema

Which of the following can cause an anion-gap metabolic acidosis? Elevated lactate level + severe diarrhea Aspirin overdose + liver failure Renal failure + antifreeze overdose Acetaminophen overdose + heart failure

Renal failure + antifreeze overdose (elevated lactate levels, aspirin overdose, and acetaminophen overdose can also cause anion-gap metabolic acidosis)

A patient presents to the ED for evaluation of fevers, rigors, and shortness of breath. They are somnolent and confused. A VBG demonstrates low pH and high PaCO2. What is the patient's primary acid/base disorder? Respiratory Acidosis Respiratory alkalosis Non-anion gap acidosis Metabolic alkalosis

Respiratory Acidosis

In the winter, an 11-month-old male infant presents with a 2-day history of vomiting, diarrhea, and fever. He has not had routine medical care since birth. Mother reports no significant past medical history. His temperature is 102°F. Clinically, he appears dehydrated; his white blood cell count is 5400 cells/mm3 with a normal differential. His stool and urine are negative for white blood cells. What is the most likely cause of gastroenteritis in this child? Clostridioides difficile Escherichia coli Rotavirus Norovirus Shigella

Rotavirus

Early one afternoon, a 12-year-old boy presents with his parents to the ER with lower right abdominal pain, anorexia, nausea, and vomiting. He rates his pain at 8/10. Pain started around the umbilical area and has moved to the right lower abdomen worsening since the onset of symptoms of nausea and vomiting this morning. He denies any known history of gastrointestinal disease or recent illnesses. He denies any known ill contacts. Vital signs include temperature of 101°F, heart rate 80 bpm and regular, blood pressure 118/70 mm Hg. Based on the suspected diagnosis, what do you expect to find on physical exam? Cullen's sign Murphy sign Grey Turner's sign Rovsing's sign Dance's sign

Rovsing's sign

An 87-year-old lady presents for fatigue, weakness, and muscle aches. She has a past medical history significant for a total knee arthroplasty 2 days ago, depression on SSRI and chronic pain on opioids. Exam demonstrates moist mucus membranes, a JVP of 8 cm, capillary refill < 2 seconds. Serum sodium is 121 and serum osmolality is 252. Uosm 567, Una 52. What is the likely etiology of the patient's hyponatremia? Hypothyroidism SIADH Opioid Use Chronic dehydration

SIADH (hyponatremia, hypotonic, euvolemic, low serum osmolality, high urine osmolality, recent surgery)

A 15-year-old girl presents with a 1-year history of intermittent abdominal pain with nausea and occasional bloody diarrhea. She denies fever and weight loss; there is no travel history. Past medical history is significant only for migraines. She takes a multivitamin. Her vital signs are within normal limits. She has mild diffuse abdominal tenderness to palpation and guaiac-positive stool. Her exam is otherwise normal. Hemoglobin 9.7, hematocrit 28%, WBC 12,000/uL. What is the most appropriate next step in her management? Monitor clinically and schedule follow-up in 2 months Begin trial antibiotics for possible bacterial gastroenteritis Order ultrasound of the abdomen Send stool studies and refer for colonoscopy Refer immediately to the emergency department

Send stool studies and refer to colonoscopy

For a patient with hyponatremia, what is the first step in evaluation? Urine osmolality Serum osmolality

Serum osmolality

A reduction in capillary oncotic pressure would result in which of the fluid movements outlined below? Shift from intracellular space to interstitial space Shift from interstitial space to intracellular space Shift from intravascular space to the interstitial space Shift from interstitial space to the intravascular space

Shift from intravascular space to the interstitial space

A 46-year-old woman presents with nausea, vomiting, crampy abdominal pain, and loud bowel sounds for the past several hours. She denies weight loss. She has had one normal bowel movement since the symptoms began, but it did not help her symptoms. She has a past surgical history of an abdominal hysterectomy 7 years prior. On physical exam, she is afebrile, with hyperactive and high-pitched bowel sounds localized to the left upper quadrant. She also has mild diffuse abdominal tenderness. What is the most likely diagnosis? Small bowel obstruction Whipple's disease Diverticulitis Acute paralytic ileus Irritable bowel syndrome

Small bowel obstruction

You are caring for a patient who is hospitalized for acute, symptomatic hyponatremia. You note that their serum sodium, was 120 yesterday at 0800, and is 129 today at 0800. What is true regarding the trend of sodium correction? Sodium correction is appropriate as it's > 8 mmol/L in 24 hrs Sodium correction is inappropriately fast as it's > 8 mmol/L in 24 hrs Sodium correction is appropriate as it's <12 mmol/L in 24 hrs

Sodium correction is inappropriately fast as it's > 8 mmol/L in 24 hrs

A 38-year-old man presents with a 2-day history of a mass and severe pain in his scrotum. Physical examination reveals that his right testicle appears much larger than his left. On palpation, you note a small hole in his inguinal canal, and you are unable to place the contents into the canal. The contents of the hernia appear ischemic. What is the best description of this hernia? Incarcerated Irreducible Recurrent Reducible Strangulated

Strangulated

What is the treatment for congenital pyloric stenosis? Antibiotics Bowel rest Frequent, small feedings Surgery

Surgery (pyloromyotomy/Ramstedt's)

A 24-year-old man presents to the ED with worsening abdominal pain that began suddenly after eating pizza 2 nights ago. The patient reports the pain has progressively worsened and is now 8/10. He reports no change in bowel movements during this time, but he has a decreased appetite and moderate nausea. PMH: lactose intolerance. Temp is 100.2 F, pulse 72/min, respirations 14/min, BP 108/66 mmHg. Abdominal examination shows RLQ pain with passive right hip extension. Which of the following will most likely provide definitive treatment for this patient's condition? Dietary restriction Oral rehydration Polyethylene glycol IV antibiotics Surgical intervention

Surgical intervention (acute appendicitis)

A 25 year old man presents to the local ED due to severe testicular pain. The pain began abruptly 2 hours ago and has gotten progressively worse. He is currenting rating it as a 9/10. This is only affecting the left testicle. He has never had an episode like this before. He states he has become nauseated during the presentation. What is the most likely diagnosis, categorizing this patient as a surgical emergency? Testicular torsion Varicocele Hydrocele Scrotal hernia Cryptorchidism

Testicular torsion

What autoimmune disorder causes chronic continuous inflammation starting distally in the rectum and progresses proximally? Crohn's disease IBS Ulcerative Colitis IBD

Ulcerative colitis (always involves the rectum, continuous lesions)

A 84 year-old male presents for evaluation of lethargy, fatigue, muscle weakness, anorexia, and constipation; she has a past medical history significant for hypertension, on HCTZ, nephrolithiasis, and diabetes mellitus type II. Laboratory evaluation shows elevated calcium, low serum osmolality, and high PTH-rp. What is the most likely cause of the patient's electrolyte disturbance? Thiazide dietetic use Hyperparathyroidism Undiagnosed malignancy Hypervitaminosis D

Undiagnosed malignancy (as indicated by the elevated PTH-rp)

A 10-year-old boy presents with a 2-month history of intermittent burning pain in the epigastrium. Pain is felt more during the night and between meals; it is partly relieved by eating food or by taking antacids. Pain usually lasts 30-60 minutes and is accompanied by nausea and vomiting. He often has a feeling of bloating and burping. He remains asymptomatic for several days between. There is no history of taking analgesics or anti-inflammatory drugs. Physical examination shows epigastric tenderness. The rest of the examination is essentially normal. Stool examination for occult blood is positive. What is the investigation of choice for establishing the diagnosis? Abdominal ultrasound Upper GI barium studies CT scan abdomen Stool microscopy Upper GI endoscopy

Upper GI endoscopy

A 75-year-old woman presents with heartburn and dyspepsia. She was diagnosed with osteoarthritis 4 years ago. For the past 18 months, she has been managing pain with naproxen. The gastroenterologist suggests that the patient be tested for Helicobacter pylori infection. What is the most sensitive and specific non-invasive method to diagnose this infection? Gastric Biopsy Fecal Antigen Test Culture of H. pylori Urea breath test Schillings test

Urea breath test

A 69 year old woman presents with a 3 month history of intermittent urinary incontinence. After further questioning, she reveals that she experiences leakage after having an intense need to void. This is an example of what type of incontinence? Stress Urge Overflow Functional Mixed

Urge

A 75 yo male with a long history of alcoholism presents with confusion, decreased reflexes, edema and tachycardia. What nutritional deficiency represents his likely diagnosis? Vitamin A Vitamin B1 (thiamine) Vitamin B3 (niacin) Vitamin B6 (pyridoxine) Vitamin C

Vitamin B1 (thiamine)

A 36-year-old woman presents with a 24-hour history of sudden severe diarrhea described as profuse, gray, cloudy, watery stools without blood or fecal odor. She was recently in Bangladesh for work and returned yesterday, which was when the diarrhea began. She is also experiencing a mildly elevated temperature with a very dry mouth, headache, and severe fatigue. What is the most likely offending organism? Clostridioides difficile Enterotoxigenic E. coli Norwalk virus Shigella dysenteriae Vibrio cholerae

Vibrio cholerae (treat with hydration and antibiotics like fluoroquinolones, azithromycin, and tetracycline)

A 55-year-old woman comes to the clinic with generalized fatigue, unsteady gait, and numbness in her lower limbs for the past 2 months. She often experiences a "tingling" sensation in her legs and feet. Her PMH: hypertension, hypercholesterolemia managed with hydrochlorothiazide and atorvastatin. She had gastric bypass surgery 1 year ago. Temp 98.6 F, pulse 96/min, respirations 18/min, BP 136/95 mmHg. She is oriented to time, place and person, but is slow to respond to questions. Motor strength is 4/5 in the bilateral lower limbs, and DTRs are diminished at the ankles. Sensory loss is noted in the bilateral feet with diminished perception to touch and vibration. The patient's gait is ataxic. Romberg test is positive. CBC reveals a hemoglobin of 10 g/dL (range: 12-16 g/dL). Peripheral smear shows multiple hyper-segmented polymorphonuclear cells. Which of the following is the most likely diagnosis? Lead poisoning Thiamine deficiency Infection with Treponema pallidum Vitamin B12 deficiency Hypothyroidism

Vitamin B12 deficiency

A 20-year-old woman presents with intermittent nose bleeds for the past 2 weeks. She also reports that her menstrual periods have increased in number in the past 2 months. She recently underwent surgery for small bowel resection and eats only one meal a day. Laboratory investigations reveal prolonged prothrombin time, prolonged activated partial thromboplastin time, and a normal platelet count. What is the most likely diagnosis? Thiamine deficiency Riboflavin deficiency Vitamin K deficiency Vitamin D deficiency Iron deficiency

Vitamin K deficiency

A 10-year-old boy is brought in by his parent to the clinical for evaluation of numbness in his feet and hands. He states his hands and feet often have a tingling and burning sensation. He has had no abdominal pain, vomiting, constipation or diarrhea. PMH: latent pulmonary TB, for which he was started on isoniazid 3 months ago in India. His family recently immigrated from India in the past month, and the patient has continued taking his medication. His mother states he is doing well in school and is currently placed in advanced academic classes. Vitals are within normal limits. Neurological exam reveals symmetrical "glove and stocking" distribution peripheral neuropathy of the hands and feet, with diminished perception of touch and temperature. Motor strength is 5/5 in all four extremities, and DTRs are 2+ in the upper and lower extremities. Which of the following could have prevented this patient's current symptoms? Drinking filtered water Hemin supplementation Diet modification Vitamin supplementation Frequent insulin administration

Vitamin supplementation (Vitamin B6 deficiency)

A 12-year-old boy has jaundice, non-tender hepatomegaly and splenomegaly, and tremor. He has been healthy and is on no medications. He is afebrile. Golden-brown rings on the peripheral corneas are noted on slit lamp eye exam. Laboratory studies reveal low levels of serum ceruloplasmin and elevated 24-hour urine copper excretion. What is the most likely diagnosis? Reye Syndrome Autoimmune hepatitis Drug-induced hepatitis Wilson disease Acute hepatitis A virus

Wilson disease

A 56-year-old woman presents to the clinic for loss of taste x 2 months. She has been unable to taste or smell food, so she has been eating much less than usual. She has also noticed thinning hair in the axillae and pubic area. PMH: alcoholic cirrhosis. Vitals are within normal limits. On PE: sharply-demarcated red rash around the mouth and on the hands and buttocks. Which of the following nutrients is most likely deficient in this patient? Iodine Zinc Niacin Iron Vitamin B12

Zinc