Classroom to clinic combination of all quizzes

d (Factitious disorder)

26 yo man is brought to the ED by paramedics after he complains of dizziness and HA. Emergency room exam shows mydriasis of the right eye with right pupillary diameter of 5mm and left pupillary diameter 2 mm. The patient denies any precipitation event or general medical contusion. While awaiting further exam, he is observed surreptitiously placing eye drops in his right eye. When questioned about his action, he become angry, denies the behaviors, and abruptly leaves the hospital. What is the most likely diagnosis? a) Conversion disorder b) Dependent personality disorder c) Malingering d) Factitious disorder

c (Normal saline plus glucose and thiamine)

55 YO male is brought to the ED after a 3 day binge on whiskey. he stopped drinking abruptly several hours ago because of severe, diffuse abdominal pain. He has no history of diabetes. His blood pressure is 80/48, pulse 112 and regular, temp 99.8F, and RR 28. He appears slightly dehydrated but not malnourished. he is somewhat confused but is able to answer questions. His blood glucose is 250. Arterial blood gas determination reveals an anion gap acidosis. What is the most appropriate IV fluid to give the patient? a) Normal saline b) Normal saline plus bicarb c) Normal saline plus glucose and thiamine d) Normal saline plus insulin

b (Vascular dementia)

71 yo male with history of poorly treated HTN and previous history of stroke presents with new focal neurological findings and acute worsening of cognitive function. What is the most likely diagnosis? a) Alzheimer's b) Vascular dementia c) Vitamin B12 deficiency d) Delirium e) Creutzfeldt-Jakob disease

d (Normal pressure hydrocephalus)

73 yo female has had a history of progressive memory and intellectual slowness for 2 years. Her caretaker notes urinary incontinence. PE reveals an ataxic gait. What is the most likely dx? a) Alzheimer's disease b) Metastatic breast cancer of the brain c) Pick's disease d) Normal pressure hydrocephalus e) Multiple Sclerosis

c (Barium enema)

A 10 mo old baby is brought to the Ed with a 6 hour history of bilious vomiting, passage of pink jelly like material form the rectum and intermittent episodes of severe cryogen. On PE, a sausage like mass is felt on the right side of the abdomen. What is the next step in the management of this patient? a) Administration of atropine b) Exploratory laparotomy c) Barium enema d) Administration of antibiotics e) IV pyelography

a (Acetaminophen- dx is likely Roseola (caused by HPV 6). Treatment is supportive)

A 12 month old toddler presents with abrupt onset of high fever that lasted for 3 day and then suddenly resolved. The toddler then developed a pink rash generalized mostly on the trunk and neck. What is the recommended treatment? a) Acetaminophen b) ASA c) Acyclovir d) Amoxicillin

a (Penicillin VK)

A 12 year old boy presents with a fever, sore throat, and swollen lymph nodes. His quick strep is positive. He has no allergies to medications. What its he initial treatment? a) Penicillin VK b) Amoxicillin c) Azithromycin d) Erythromycin

c (Echocardiography)

A 12 yo female presets to your practice for a routine evaluation. Cardiac auscultation demonstrates a 3/6 systolic murmur heard best in the left second interspace. Which of the following is the best initial study to evaluate this finding? a) CXR b) 12 lead EKG c) Echocardiography d) Treadmill stress testing

b (Neurogenic diabetes insipidus)

A 12 yo male with chief complaint of excessive thirst and urination. He drinks gallons of ice cold water and can't seem to stop urinating. His history is significant for a recent severe concussion while skateboarding. His random finger's tick blood glucose is 95. What is the most likely diagnosis? a) Nephrogenic diabetes insipidus b) Neurogenic diabetes insipidus c) T1DM d) T2DM

d (Varicocele)

A 13 yo boy complains of heaviness in his scrotum and some vague pain that worsens with exertion. Palpation of the scrotum reveals a mass above the left testis that is contender, freely movable, and feels like a collection of soft tubules. What is the most likely diagnosis? a) Orchitis b) Testicular torsion c) Epididymitis d) Varicocele

d (Varicocele)

A 13 yo boy complains of heaviness in his scrotum and some vague pain that worsens with exertion. Palpation of the scrotum reveals a mass above the let testis that is contender, is freely moveable and feels like a collection of soft tubules. What is the most likely diagnosis? a) Orchitis b) Testicular torsion c) Epididymitis d) Varicocele

b (Juvenile rheumatoid arthritis)

A 13 yo female presents with left ankle pain for 2 months. She denies any injury, fever, or chills. On PE the patient has an effusion of the left ankle joint with painful range of motion. There is no erythema or ecchymosis. What is the most likely diagnosis? a) Chronic ankle sprain b) Juvenile rheumatoid arthritis c) Reactive arthritis d) Achilles tendonitis

c (T1DM)

A 13 yo male is brought to the ED by his mom for evaluation. The patient states that he has felt weak over the last few days. He also states he has been very thirsty lately and has been urinating more frequently. Despite increased intake of food and fluids the patient has had a 10 pound weight loss over the last 3 weeks. The patient denies any dysuria, hematite, abdominal pain, or other complaint. He is not taking any medication and is otherwise healthy. What is the most likely diagnosis? a) Hyperthyroidism b) Acromegaly c) T1DM d) Celiac sprue

b (Juvenile rheumatoid arthritis)

A 13 yo old female presents with left ankle pain for 2 months. She denies any injury, fever, or chills. On PE the patient has an effusion of the left ankle joint with painful range of motion. There is no erythema or ecchymosis. What its eh most likely diagnosis? a) Chronic ankle sprain b) Juvenile rheumatoid arthritis c) Reactive arthritis d) Achilles tendonitis

d (Peritonsillar abscess)

A 14 year old girl presents with sore throat, dysphagia, neck pain, stridor, and fever. On exam of the throat she has tonsillar enlargement and her uvula is deviated to the left. What is the most likely diagnosis? a) Epiglottitis b) Tonsillitis c) Mono d) Peritonsillar abscess

d) Radionucleotide scan

A 14yo boy complains of right testicular pain with some nausea for several hours. He denies any trauma or sexual activity. He denies any urethral discharge, dysuria, or dark colored urine. On exam, his vitals are normal for his age and his abdomen is being. His left testicle is nontender and mobile, and the right testicle is tender and sits higher than the left. Which of the following studies would be most definitive in confirming the most likely diagnosis? a) Surgical aspiration and drainage b) UA c) Voiding cystourethrogram d) Radionucleotide scan

d (Constitutional delay )

A 16 yo females presents with primary amenorrhea. PE is unremarkable. The patient is Tanner stage 3, with height 5'8" and weight 140 lb. What is the most likely diagnosis? a) PCOS b) Turner's syndrome c) Kallmann's syndrome d) Constitutional delay e) Anorexia nervosa

c (A 10-day tapered dose of corticosteroids)

A 16 yo girl was recently diagnosed with EBV. She has been using only symptomatic treatment for her throat pain and fever. Ten days later on her follow-up visit, her tonsils are still grossly enlarged and she is having tremendous pain when she swallows. She is having no difficulty breathing and no respiratory distress, but she has begun to lose weight because she refuses to eat because her throat pain is so severe. What is the recommended treatment for this patient? a) Reassurance and have her continue symptomatic treatment b) Ampicillin to treat superimposed bacterial infection c) A 10-day tapered dose of corticosteroids d) Emergent intubation

d (WPW)

A 16 yo male presents to your office complains of occasional episodes of tachycardia. His blood pressure and heart rate are normal. A 12 lead EKG is performed and you note that there is no distinct return to baseline between each P wave and the QRS complex. Instead, the waves appear to be slurred together. what diagnosis do these findings suggest? a) First degree heart block b) Intraventricular conduction delay c) Second-degree heart block type 2 d) WPW syndrome

d (hypertrophic cardiomyopathy)

A 16-year-old female presents to your office for evaluation following a syncopal episode. She is on her high school cross country team, and she "blacked out" while on a training run. She states she experiences no prodromal symptoms. She fell to the grass and was not injured. According to teammates, she was unconscious for less than a minute and was immediately fully oriented on regaining her consciousness. Exam reveals a systolic heart murmur over the left sternal border. The murmur's intensity increases with a Valsalva maneuver. What diagnosis does this constellation of findings suggest? a) Aortic stenosis b) Coarctation of the aorta c) Coronary atherosclerosis d) Hypertrophic cardiomyopathy e) Mitral stenosis

d (Refer to gynecologist)

A 17 yo girl is seen by her pediatrician for complaints of periodic lower abdominal pain that she attributes stress. She notes it lasts 2 days and is associated with bloating and constipation. Her family history is positive for irritable bowel syndrome in her mother. Menarche has not occurred. The patient denies sexual activity. Her exam shows a well-nourished female, 5'7" tall and weighing 135 pounds. She is a Tanner stage 5. Pelvic exam shows normal eternal genitalia, but the cervix is not visible. Her urine hCG is negative. Which would be the next best step? a) Refer to GI specialist b) Colonoscopy c) Barium enema d) Refer to gynecologist e) UA and culture and sensitivity

b (Serum iron and total iron binding capacity)

A 19 year old female presents with progressive fatigue and dyspnea. Blood work shows a decreased RBC, hemoglobin, hematocrit, and MCV. The RBC are hypo chromic on a peripheral smear. What is the next step in the evaluation of this patient's diagnosis? a) Colonoscopy b) Serum iron and total iron binding capacity c) Serum transferrin d) Vitamin B12 and folate level

b (US)

A 19 yo G0 female presents with a breast lump that she found yesterday. Her mother was recently diagnosed with breast cancer at 53 and is undergoing chemotherapy. Her maternal aunt developed breast cancer at age 48. On exam there is a 2 x 2 cm nontender mobile mass in the upper outer quadrant of the left breast. What is the most appropriate next step? a) Mammogram b) US c) MRI d) Biopsy

c (Irritable bowel syndrome)

A 19 yo female presents with complaints of intermittent lower abdominal cramps pain for about 3 months. She has noticed varying bouts of diarrhea and constipation. She states that the pain is relieved by defecation. What is the most likely diagnosis? a) Diverticulitis b) Appendicitis c) Irritable bowel syndrome d) Small bowel obstruction

b (Boxer's fracture)

A 19 yo male states he had a fight with his girlfriend and was so angry he hit his hand against a wall. He now has pain and swelling in his hand, primary over the 4th and 5th meracarpal-phalangeal joint. Based on this history alone, what is the most likely diagnosis? a) Fracture of the distal radius b) Boxer's fracture c) Scaphoid fracture d) Smith fracture

b (Serum iron and total iron-binding capacity- Iron deficiency anemia should be suspected.)

A 19-year-old female presents with progressive fatigue and dyspnea. Blood work shows a decreased red blood cell count, hemoglobin, hematocrit, and mean corpuscular volume (MCV). The red blood cells are hypochromic on a peripheral smear. What is the next step in the evaluation of this patient's diagnosis? a) Colonoscopy b) Serum iron and total iron-binding capacity c) Serum transferrin d) Vitamin B12 and folate level

a (Mycoplasma pneumoniae)

A 19-year-old female who lives in a college dormitory developed a sore throat followed by a non productive cough that lingers for 3 weeks. During the course of her illness she experiences a low-grade fever, which has now resolved. What is the most likely pathogen? a) Mycoplasma pneumoniae b) Streptococcus pneumoniae c) Staph aureus d) Klebsiella pneumoniae e) Influenza

b (Tetralogy of Fallot)

A 2 yo boy is brought to the pediatrician because of progressively worsening episodes of cyanosis. The child has moments when he turns blue and become dyspneic. During these episodes the child becomes irritable and remains in a squatting positing. PE reveals a small and thin child with clubbing of the fingers and toes. Lungs are normal. Heart auscultation reveals right ventricular lift and a grade 3/6 harsh systolic ejection murmur at the upper left streak border. What is the most likely dx? a) Transposition of the great vessels b) Tetralogy of Fallot c) PDS d) ASD e) VSD

c (Erythromycin)

A 20 year old college student presents to the ER with fever, nonproductive cough, bullies myringitis, and patchy infiltrates on chest x-ray. Her serum cold-agglutinin titers are positive. What is the first line treatment? a) Vancomycin b) Bactrim c) Erythromycin d) Ceftazidime e) Augmentin

b (Radiography of knee)

A 20 year old fell out of a truck 30 minutes ago and landed on his right knee. He reports a severe laceration to his right knee contaminated by several pieces of gravel and dirt. A proximally based flap, 5 cm on each side, is raised from the knee. The wound is irregular, has devitalized edges, and has sections of subcutaneous tissue with poor vascularization. What is the most appropriate next step? a) Arrange for delayed closure b) Radiography of knee c) Referral for arthroscopy d) Primary closure of the wound

d (Anterior glenohumeral dislocation)

A 20 yo college student develops left shoulder pain after jumping into a lake from a swinging rope. She presents holding her arm against her body and avoiding any shoulder movement. On exam, the rounded contour of the shoulder is lost and the head of the humerus is felt under the coracoid process. What is the most likely diagnosis? a) Inferior glenohumeral dislocation b) Rupture of the along head of the biceps c) Posterior glenohumeral dislocation d) Anterior glenohumeral dislocation

b (7%)

A 20 yo female presents for routine gyn care. Her mother has a history of endometriosis. What is the patient's chance of developing endometriosis? a) 1% b) 7% c) 12% d) 17%

a (Lateral epicondylitis)

A 20 yo woman presents complaining of proximal forearm pain exacerbated by extension of the wrist against resistance with the elbow extended. She denies trauma but us an avid racquetball player. What is the most likely diagnosis? a) Lateral epicondylitis b) Medial epicondylitis c) Olecranon bursitis d) Biceps tendonitis e) Long thoracic nerve early paralysis

d (Subacute thyroiditis)

A 21 yo male college student presents to the family practice clinic with complaints of fever, malaise, and soreness in the anterior neck, which extends up to the angle of his jaw on both sides of the neck for several days. What is the most likely diagnosis? a) Atypical otitis media b) Grave's disease c) Postpartum thyroiditis d) Subacute thyroiditis

a (Orchitis)

A 21 yo man who recently recovered from the mumps presents to the ED complaining of swollen and painful left testicle. PE reveals testicular tenderness. What is the most likely diagnosis? a) Orchitis b) Epididymitis c) Testicular torsion d) Varicocele e) Spermatocele

c (Admit the patient and start IV cefoxitin, clindamycin, and gentamicin)

A 22 G0 female presents to the the ED with abdominal pain that has been increasing for the past 3 days. Sh describes the pain as crampy and increased intensity with activity. She is sexually active and uses OCP. Her temp is 101.3, bp 134/78, pulse 84 and pain level 7/10. Her abdomen has normal bowel sounds with no masses or distention. She is tender in both lower quadrants with rebound tenderness and guarding. Pelvic exam shows normal external genitalia with a normal cervix. The uterus is normal sized with cervical motion tenderness and bilaterally tender adnexa. What is the best management of this patient? a) Outpatient therapy with oral cefotaxime and doxycycline b) Outpatient therapy with oral ceftizoxime, metronidazole and doxycycline c) Admit the patient and start IV cefoxitin, clindamycin, and gentamicin d) Admit the patient and start IV cefoxitin

c (Mastoiditis)

A 22 mo old patient presents with her mother approx 3 weeks after being treated for acute otitis media. Her mother reports she has a high fever and a bump behind her left ear. On further questioning the mother admits that she did not give the entire course of abx to the child because she always fought with her about taking the medicine. On exam, you note post auricular tenderness to palpation, swelling, and erythema. The pinna appears outwardly displaced. The tympanic membrane is erythematous and bulging. What is the most likely dx? a) Cellulitis b) Lymphadenitis c) Mastoiditis d) Meningitis e) Chronic otitis media

e (Refer to domestic safety services)

A 22 year old G1P0 female presents at 24 weeks for routine prenatal care. She is doing well and noted fetal movement. Her only concern is that of breast tenderness and a lump that she noted 3 days ago. On exam her breasts are soft with minimal tenderness and multiple areas of ecchymosis but no palpable masses. There are no palpable axillary nodes. What should you do next? a) Refer for US b) Refer for mammogram c) Refer for needle aspiration d) Referto surgical service e) Refer to domestic safety services

e (Refer to domestic safety service)

A 22 yo G1P0 female presents at 24 weeks for routine prenatal care. She is doing well and notes fetal movements. Her only concern is that of breast tenderness and a lump that she noted 3 days ago. On exam her breasts are soft with minimal tenderness and multiple areas of ecchymosis but no palpable masses. There are no palpable axillary nodes. What should you do next? a) Refer for US b) Refer for mammogram c) Refer for needle aspiration d) Refer for surgical service e) Refer to domestic safety service

e (Endoscopy)

A 22 yo male is brought to the ED for the evaluation of black stools for 3 days. PE reveals pallor, heart rate of 136 and blood pressure of 96/40. The abdomen is soft without hepatosplenomegaly, gurading, or rebound. After obtaining a CBC, clotting studies, and a type and cross, what is the most appropriate next step? a) Meckel scan b) Gastric lavage c) Upper GI radiograph series d) Abdominal US e) Endoscopy

b (US)

A 22 yo male presents with a painless lump on his left testicle. Which of the following tests is the initial diagnosis study of choice in your patient? a) CT of the pelvis b) US c) CBC with diff d) Alpha fetoprotein levels

a (CT scan)

A 22 yo patient presents with recurring sinusitis that has not been responsive to traditional antibiotic treatment. Which of the following diagnostic tests would you order next in the evaluation of this patient? a) CT scan b) Radiograph c) Ultrasound d) MRI

b (KOH test)

A 22 you African American male presents with mildly pruritic hypo pigmented macules and patch son his upper back and neck that he has had for several weeks. Which of the following diagnostic procedures would you do to solidify your diagnosis? a) Punch biopsy b) KOH test c) Patch test d) Tzanck smear

a (Multiple sclerosis)

A 22yo woman presents with diplopia for several weeks. She admits to occasional vertigo and ataxia. Six months ago she had urinary incontinence for 1 month. Exam of the eyes reveals reveals nystagmus, and fundoycopic exam reveals swelling of the optic nerve. The patient has increased muscle tone of the lower extremities with hyperreflexia. She has bilateral extensor plantar reflexes and loss of position sense. Wha tis the most likely diagnosis? a) Multiple sclerosis b) Friedreich's ataxia c) Acute transverse myelitis d) Brown-Sequard syndrom e) Syringomyelia

b (Psoriasis)

A 23 yo college student presents with complaints of newly developing rash located on his knees and elbow. On physical exam you note large raised plaques with silvery appearance that bleed when scraped. What is the most likely diagnosis? a) Erythema nodosum b) Psoriasis c) Tinea corporis d) Nummular eczema

c (Administer Tdap vaccine)

A 23 yo students presents to the health care clinic to update her vaccine status. After reviewing her records, yo not she had all of her childhood vaccinations and her last vaccine was a tetanus toxoid at age 12. What vaccine should you administer now, if any? a) No vaccines needed b) Administer Td vaccine c) Administer Tdap vaccine d) Administer pertussis vaccine

a (Complicated migraine)

A 23 yo woman complains of periodic, throbbing, right sided headaches accompanied by nausea and vomiting. On PE 3 hours after the headache started, the patient demonstrates right oculomotor nerve palsy. MRI of the brain is normal. What is the most likely diagnosis? a) Complicated migraine b) Basilar artery migraine c) Migraine with aura d) Migraine without aura e) Sinus headache

a (Simple partial seizure- these are characterized by focal tonic or clonic movements and focal sensory changes. Consciousness is not impaired)

A 23 yo woman has a history of repetitive involuntary movements of her right hand associated with abnormal facial movements. At times, the movements spread to involve the entire arm. She maintains normal consciousness during these episodes. What is the most likely diagnosis? a) Simple partial seizure b) Complex partial seizures c) Tonic-clonic seizures d) Absence seizures e) Myoclonic seizures

a (She and her husband should both be tested for Tay-Sachs disease)

A 23 yo woman presents for preconception counseling. She and her husband are both Jewish and Ashkenazi decent. Which of the following statements is true regarding genetic testing? a) She and her husband should both be tested for Tay-Sachs disease b) She should be tested for Tay'Sachs c) She and her husband should both be tested for BRCA1 d) She should be tested for BRCA1 e) No special testing needed

c (Viral pneumonia)

A 24 year old college student presents with a 3-day history of dry, hacking cough that initially was nonproductive but has become productive of scant, white sputum. The patient also complains of malaise, headache, fever, and arthralgia. PE reveals a temp of 103F and a few scattered rales in both lung bases. CXR reveals patchy interstitial infiltrates. What is the most likely dx? a) Streptococcus pneumonia b) Klebsiella pneumoniae c) Viral pneumonia d) Pneumocystis jiroveci pneumonia e) Staphylococcus aureus pneumonia

c (Compartment syndrome)

A 24 yo female in on the ortho floor after being in a MVA 24 hours ago. She complains of some pain in the right leg along with paresthesias and you note that there is pallor and a test swelling around the calf. What condition of you suspect? a) Lisfranc fracture b) Maisonneuve fracture c) Compartment syndrome d) Hones fracture

c (Ophthalmology consult)

A 24 yo man was just hit in the right eye with a baseball. He states he is having double vision, and on exam he has enophthalmos. What would you do next? a) Patch the eye and discharge b) Start IV abx c) Ophthalmology consult d) Order an MRI

d (Hordeolum)

A 24 yo patient presents with a small tender bump on his upper eyelid. He states that 2 days ago his eye was irritated and this morning he woke up and noticed the bomb. He denies any fever, chills, headache, changes in vision, photophobia, or recent URI. On exam you notice a discrete, small, painful nodule on his upper lid. What is the most likely diagnosis? a) Blepharitis b) Dacrocystitis c) Esotropia d) Hordeolum

d (Ruptured corpus luteum)

A 24yo female with a known intrauterine pregnancy is brought to the ED because she fainted at work. Her boss states that she clutched her abdomen and groaned before collapsing. Sh his conscious now and notes severe right lower quadrant pain. She denies vaginal bleeding or discharge, use of drugs, dysuria, urgency, diarrhea, nausea, or vomiting. Her past medical history includes a C0section for breech presentation 2 years ago. Her BP is 100/68, pulse is 100 bpm and temp is 98.4. Blood work shows hemoglobin 7.9 and hematocrit is 21%. Her abdomen is diffusely tender. US shows no masses, an intrauterine pregnancy at 10 weeks with a fetal heart of 140 beats per minute, and free fluid present in the cul de sac of the abdomen. What is the most likely diagnosis? a) Ectopic pregnancy b) Ovarian torsion c) Appendicitis d) Ruptured corpus luteum e) Diverticulitis

c (Migraine with aura- Migraine HA are characterized by throbbing and unilateral pain with nausea and may be preceded by an aura. Auras can include visual disturbances, paresthesias, weakness, numbness, language disturbances, hearing changes, and vertigo.)

A 24yo woman has a 2 year history of recurrent right sided headaches that are throbbing in nature and are preceded by 30 minutes of scintillating scotomas and fortifications. What is the most likely diagnosis? a) Complicated migraine b) Basilar artery migraine c) Migraine with aura d) Migraine without aura e) Sinus headache

c (Mature teratoma )

A 25 yo G1P1 females presents to the ED with right lower quadrant pain of 4 hours duration. On pelvic CT scan, a tooth-shaped object is noted in an enlarged right ovary. What is the most likely diagnosis? a) Endometrioma b) Serous adenoma c) Mature teratoma d) Ectopic pregnancy e) Corpus lute cyst

a (Oxytocin augmentation)

A 25 yo G3P2 female is currently in labor at term. She has had two previous spontaneous vaginal deliveries at term. This estimated fetal weigh tis 8 lb, and the fetal heart tracing is reactive with good variability and contractions even 6 minutes. Three hours ago your exam showed her to be at 8 cm and at 0 station. Your current exam shows a blood pressure of 120/78, cervix is 8 cm, and 0 station with a left occipital anterior vertex presentation. What is the best course at this point? a) Oxytocin augmentation b) Cesarean delivery c) Magnesium sulfate d) Vacuum extraction

d (Order a color Doppler scrotal us- This should be ordered to rule out torsion of the testicle, even through epididymitis is more likely.)

A 25 yo male presents to the clinic complains of pain in his scrotum since this morning. He woke up with a dull ache and now it hurts bad. On exam, you find a very tender right testicle, especially posteriorly. The testicles hang equally, appear symmetrical, are not enlarged, and are equal in size. The patient has a positive Prehn's sign. What is the most appropriate next step in the management of this patient? a) Refer for surgical exploration b) Provide scrotal support, and antibiotic directed at E. coli, and pain medication c) Transilluminate the scrotum d) Order a color Doppler scrotal us

b (Culture)

A 25 yo male presents with yellow-green discharge form his penis aft having unprotected intercourse while on vacation. He denies fever, chills, or rash. you suspect he may have gonorrhea. Which of the following would give you a definitive diagnosis? a) Gram stain b) Culture c) Biopsy d) Lumbar puncture

b (Mallory-Weiss tear)

A 25 yo previously healthy woman presents to the ED with a sudden onset of painless hematemesis that followed an episode of vomiting after heavy alcohol use last nigh. What is the most likely diagnosis? a) Bleeding esophageal varices b) Mallory-Weiss tear c) Esophagitis d) Gastric cancer

d (Iron decreased, TIBC increased- in iron deficiency anemia, the serum iron is decreased and the TIBC is increased)

A 26 year old female presents with fatigue and palpitations. She states she has also been experiencing SOB during exercise. Her menstrual periods have been heavier than usual over the past 6 months. What would results of serum iron and total iron-biding capacity be if this patient has iron-deficiency anemia? a) Iron increased, TIBC decreased b) Iron decreased, TIBC decreased c) Iron increased, TIBC increased d) Iron decreased, TIBC increased

b (Cruciate ligament injury)

A 26 yo male with a history of twisting and hyperextension of his right knee complains of a rapid development of effusion in the injured knee over 1-2 hours. What is your most likely diagnosis? a) Posterior hip dislocation b) Cruciate ligament injury c) Hip fracture d) Tibial fracture e) Anterior hip dislocation

d (Iron decreased; TIBC increased)

A 26-year-old female presents with fatigue and palpitations. She states that she has also been experiencing shortness of breath during exercise. Her menstrual periods have been heavier than usual over the past 6 months. What would results of serum iron and total iron-binding capacity (TIBC) be if this patient has iron-deficiency anemia? a) Iron increased; TIBC decreased b) Iron decreased; TIBC decreased c) Iron increased; TIBC increased d) Iron decreased; TIBC increased

c (Endometriosis)

A 27 yo G0P0 female presents with a 6 month history of dysmenorrhea. She has been married for 3 years and has not been using birth control. Her pain is unresponsive to acetaminophen and ibuprofen, and she has been consistently missing work for the first 2 days of her period. Exam shows an anteverted, ante flexed uterus of normal size. There is no cervical motion tenderness, The rectovaginal exam shows some palpable firm nodules posterior to the cervix. What is the most likely dx? a) Leiomyoma b) Functional cyst c) Endometriosis d) IBD

b (Friction rub)

A 27 yo male presents to your office complaining of sharp central chest pain. He notes that the pain is somewhat relieved by sitting upright and leaning forward. His medical history of significant only for a cough and fever a month ago for which he did not seek treatment. Which of the following physical exam findings will confirm your suspected diagnosis? a) Fever b) Friction rub c) HTN d) Tachycardia e) Tachypnea

b (Complex partial seizures)

A 27 yo woman has temporal lobe sclerosis as seen on MRI. what type of seizure is she most likely to have? a) Simple partial seizure b) Complex partial seizures c) Tonic-clonic seizures d) Absence seizures e) Myoclonic seizures

d (Ceftriaxone and azithromycin)

A 28 year old male presents with dysuria and yellow discharge from his penis that started 2 days ago. he states his girlfriend was just treated for an infection. He refuses any diagnosis testing and states, "just treat me with some pills." What is the best treatment for this patient? a) Cipro and azithromycin b) Doxycycline and azithromycin c) Cipro and ceftriaxone d) Ceftriaxone and azithromycin

a (Sheehan's syndrome)

A 28 yo G1P1 female presents for evaluation of amenorrhea of 14 months duration. She delivered a baby 10 months ago by normal spontaneous vaginal delivery. Her pregnancy was complicated by gestational diabetes and a postpartum hemorrhage requiring several transfusions. She was unable to breastfeed, and her hug is negative. What is the most likely etiology for her amenorrhea. a) Sheehan's syndrome b) Stein-Leventhal syndrome c) PCOS d) Aherman's syndrome

d (C-section delivery- likely placental abruption secondary to trauma)

A 28 yo G4P1 female is brought into to the ED by ambulance following a head on collision in which she was the driver and the air bag deployed. She is 38 weeks pregnant and having contractions every 7 minutes. She also notes pain below the umbilicus that worsens with each contraction. Her blood pressure is 110/70 and pulse if 96. The funds is 35cm with palpable contractions, and you note a 4 x 4cm area in the suprapubic region that is very tender. There is no rebound tenderness. Vaginal exam reveals the cervix is 100% effaced and 1 cm dilated with intact membranes. A fetal heart tracing shows a fetal heart rate of 180 wit no variability and contractions every 7 minutes with late decelerations. What is the best course of action? a) IV hydration and magnesium sulfate b) Artificial rupture of membranes c) Oxytocin augmentation d) C-section delivery

a (Posterior hip dislocation )

A 28 yo male presents after a motor vehicle accident in which his knees hit the dashboard. On exam the left hip is adducted and internally rotated. What is your most likely diagnosis? a) Posterior hip dislocation b) Cruciate ligament injury c) Hip fracture d) Tibial fracture e) Anterior hip dislocation

a (Posterior hip dislocation)

A 28 yo male presents after a motor vehicle accident in which his knees hit the dashboard. On exam the left hip is adducted and internally rotated. What is your most likely diagnosis? a) Posterior hip dislocation b) Cruciate ligament injury c) Hip fracture d) Tibial fracture e) Anterior hip dislocation

a (Erythema multiforme)

A 28 yo, 3 month gravid female presents with a rash that has persisted for 1 week. On exam, you note multiple target lesions on her arms and soles. She has no further complaints. What is your most likely diagnosis? a) Erythema multiforme b) SLE c) SJS d) TEN

d (variant angina)

A 28-year-old female presents to your office complaining of episodic chest pain. She states that around five times in the past 2 months she has been awakened in the early morning by severe, squeezing substernal chest pain. The pain usually resolves spontaneously within 15-20 minutes. The patient denies a history of hypertension, hypercholesterolemia, and smoking and states her parents are healthy. What syndrome does this presentation suggest? a) Aortic dissection b) Coarctation of the aorta c) Mitral valve Prolapse d) Variant angina

a (Iron-deficiency)

A 28-year-old patient has Crohn's disease. What type of anemia is this patient at risk of developing as a result of the disease? a) Iron deficiency b) Vitamin B12 c) Sideroblastic d) Pernicious anemia

b (Antibiotic associated colitis)

A 28year old female recently treated for sinusitis presents to the ED with acute diarrhea and abdominal cramps for 3 days. She states that she passes foul-smelling, must-like, watery stools, as often as 20 times a day. She denies any recent outings or events. She feels well aside from the annoyance of diarrhea and occasional flush feeling. Her temp is 99.9 and her pulse if 94 beats permits. She appears well overall and has mild diffuse abdominal pain to palpation. Her rectal exam is negative for occult or frank blood. What is the most likely diagnosis? a) Viral gastroentiritis b) Antibiotic associated colitis c) IBS d) Ulcerative colitis

d (C-section)

A 28yo G4P2 female is brought to the ED by ambulance following a head-on collision. She is 38 weeks pregnant and having contractions q 7 minutes. She also notes pain below the umbilicus which worsens with each contraction. Her BP is 110/70 and pulse is 96. The funds is 35cm with palpable contractions and you note a 4 cm by 4cm area in the suprapubic region that is very tender. There is no rebound tenderness. Vaginal exam reveals the cervix is 100% effaced and 1cm dilated with intact membranes. A fetal heart tracing shows a fetal heart rate of 180 with no variability and contractions q 7 minutes with late decelerations. What is the best course of action? a) IV hydration and magnesium sulfate b) Artificial rupture of membranes c) Oxytocin Augmentation d) C-Seciton

d (Immediate US/exploratory laparotomy and administration of blood products)

A 28yo male presents to the ED after being thrown from the back of a pickup truck at high speed. He receive 2L of IV fluid in transit to the hospital. His pulse upon arrival is 120 and BP 60/40. He is awake and without focal neurological signs. He has a distended tender abdomen and a stable pelvis, with no deformities of the LE. A portable CXR is normal. What is the most appropriate next step in management? a) Immediate CT scan of abdomen and head b) Fluid administration while awaiting cell counts on lavage fluid c) Dopamine infusion to improve blood pressure followed by observation d) Immediate US/exploratory laparotomy and administration of blood products

c (Tetralogy of Fallot)

A 2yo girl comes to your office with dyspnea on very short walking distance. Lately the parent noticed that she toddles a short distance, then "squats" down. She repeats this pattern often. On observation, you note a smaller than average child who appears mildly cyanotic. What is the most likely diagnosis? a) ASD b) PDA c) Tetralogy of Fallot d) VSD

d (Pityriasis rosea)

A 3 yo boy develops a solitary, round pink lesion with a raised border and fine, adherent scales in the margin. Approx 1 week later, oval, salmon-colored, slightly raised maculopapular lesions in a "Christmas tree" distribution pattern on the boy's trunk. What is the most likely diagnosis? a) Varicella b) Measles c) Scarlet fever d) Pityriasis rosea e) Fifth disease

c (Perform immediate endoscopic maneuver)

A 3 yo boy ingested a calculator battery about 20 minutes ago. He is in no distress. CXR demonstrates the battery in the esophagus. What is the most appropriate next step? a) Administer IV glucagon b) Have parents observe his stool for the battery c) Perform immediate endoscopic maneuver d) Perform Heimlich maneuver e) Administer syrup of ipecac

c (Direct exam of the throat)

A 3 yo boy presents to the ED febrile, drooling, and sitting in a tripod position to help breathing. Which of the following should be avoided? a) Auscultation of the lungs b) Auscultation of the heart c) Direct exam of the throat d) Direct exam of his eyes and ears.

b (Thumbprint sign- Epiglottis)

A 3 yo boy presents with drooling, stridor, and difficulty swallowing. On exam, he is sitting with his knees pulled toward his chest, and he is leaning forward. What would you expect to see on a lateral radiograph of the neck? a) Steeple sign b) Thumbprint sign c) Teardrop sogn d) Sail sign

a (The radial head has slipped out of the annular ligament)

A 3 yo child grabs a branch wit her right outstretched hand to stop herself fro falling out of the tree. Th child later complains of pain in the elbow and wants to hold the right hand with the palm facing down. Radiographs sho no evidence of fracture. What injury is most likely? a) The radial head has slipped out of the annular ligament b) The extensor muscles have been strained or torn c) The radio lunar joint bursa has ruptured, limiting supination d) A tea in the long head of the biceps tendon has occurred

c (Splint and refer to and orthopedist for repeat imaging)

A 30 yo female has slipped on the ice twice while walking to her care at the mall. You examine her to find she has pain in the wrist, primarily in the anatomical snuff box area. You order radiographs, but no fracture is seen. What is your suggested treatment for this patient? a) No treatment is needed because no fracture is seen b) Splint for 2-3 week then the patient can return to normal activities as tolerated. c) Splint and refer to and orthopedist for repeat imaging d) Refer to an orthopedist immediately

c (Splint and refer to an orthopedist for repeat imaging)

A 30 yo female has slipped on the ice while walking to herder at the mall. You examine her to find she has pain in the wrist, primarily in the anatomical snuff box area. You order radiographs, but no fracture is seen. What is your suggested treatment for this patient? a) No treatment is needed because no fracture is seen b) Splint 2-3 weeks, then the patient can return to normal activities as tolerated c) Splint and refer to an orthopedist for repeat imaging d) Refer to an orthopedist immediately

c (Hyperthyroidism)

A 30 yo female presents with resting tachycardia, warm, moist skin, distal hand tremor, pretibila edema, and brisk, deep tendon reflexes. What is the most likely diagnosis? a) Anorexia nervosa b) Anxiety disorder c) Hyperthyroidism d) Cocaine use

d (Benzathine penicillin G- Syphilis)

A 30 yo homosexual male presents with a low-grade fever, headache, malaise, and sore throat. On exam he has generalized LAD and a papular rash with a superficial scale on his palms and soles. you notice he has a healing ulcer on his left groin. What is the most appropriate treatment for this patient? a) Ceftriaxone b) Rifampin c) Ampicillin d) Benzathine penicillin G

b (Carpal tunnel syndrome)

A 30 yo woman with a history of diabetes presents with a 3 week juster of hand numbness that often awakens her from sleep. The sx resolve after she shakes her hands for a few minutes. On PE there is no sensory or motor deficit of her hands but there is a positive Tinel's sign. What is the most likely diagnoses? a) Thoracic outlet syndrome b) Carpal tunnel syndrome c) Dupuytren's contracture d) Diabetes neuropathy e) Tenosynovitis

d (CT of the abdomen)

A 31 year old woman with a 5-year history of Crohn's disease presents to the ED complaining of fever, malaise, and steady right lower quadrant pain for 6 hours. Significant physical exam findings include an oral temperature of 101.2F and a tender lower abdominal mass. A CBC shows leukocytosis. What is the most appropriate step in evaluating this patient? a) Flat plate of the abdomen b) Barium enema c) US of the abdomen d) CT of the abdomen

b (Cluster headache)

A 31 yo man complains of daily throbbing headaches that last 2 weeks. He has approximately eight episodes per day, each lasting 10-20 minutes. The headaches are localized to the left periorbital area and are accompanied by tearing of the left eye, left ptosis, rhinorrhea, and left facial redness. The patient remembers having a similar episode 2 years ago that lasted 3 weeks. He did not see medical help at that time. The patient feels that the headaches are often precipitated by drinking a glass of wine. What is the most likely diagnosis? a) Migraine headache b) Cluster headache c) Tension headache d) Trigeminal neuralgia e) Sinusitis

d (C-section- an occipital posterior delivery is not ideal for vaginal delivery.)

A 32 year old G4P2 female is in the second stage of labor at term. Your recent exam shows a vertex presentation that is left occipital posterior with a station of 1+, which has not changed over the 2.5 hours of her second stage. The fetal heart tracing is reactive. What is the most reasonable course of action at this point? a) Forceps delivery b) Reassess q 30 minutes c) Vacuum extraction d) C-section e) Oxytocin augmentation

b (Oral ferrous sulfate)

A 32 year old female has iron deficiency anemia as a result of blood loss during elective surgery. Her hemoglobin is 8.7 and hematocrit is 27%. What is the recommended treatment for her anemia? a) parental iron dextran b) Oral ferrous sulfate c) Parental EPO d) IM cyanocobalamin

a (Influenza)

A 32 year old female presents with complaints of fever, chills, malaise, myalgia, headache, congestion, sore throat, and a dry cough. PE reveals mild pharyngeal erythema and mild conjunctival injection bilaterally. The lungs are clear to auscultation bilaterally. She appears sick but is not toxic and is in no distress. What diagnosis is suspected? a) Influenza b) Pneumonia c) Pertussis d) Severe acute respiratory syndrome

a (Generalized ST segment elevation)

A 32 year old male presents with stabbing central chest pain. the pain increases with respiration and is relived by leaning forward. The patient notes he felt febrile yesterday. What finding would you expect on this patient's 12 lead EKG? a) Generalized ST segment elevation b) Q waves in leads II, III, and aVF c) A large, notched P wave in lead V1 d) An upright QRS complex in lead aVR

d (C-section delivery)

A 32 yo G4P2 female is in the second stage of labor at term. Your recent exam shows a vertex presentation that is left occipital posterior with a station + 1, which has not changes over the 2.5 hours of her second stage. The fetal heart rate is reactive. What is the most reasonable course of action at this point? a) Forcep delivery b) Reassess after 30 minutes c) Vacuum extraction d) C-section delivery e) Oxytocin augmentation

a (Schedule a biopsy)

A 32 yo female presents with persistent dermatitis of her nipple for the last several months. She has been seen previously and was given a weak steroidal cream. What should you do next? a) Schedule a biopsy b) Prescribe a more potent steroid c) Test for HIV d) Treat with cryotherapy e) Prescribe an antibacterial cream

d (UTI)

A 32 yo woman presents to your office with dysuria and frequency with no previous history of GU tract problems. What is the most likely diagnosis? a) Cervical cancer b) Pregnancy c) Uterine fibroid d) UTI

b (Oral ferrous sulfate)

A 32-year-old female has iron-deficiency anemia as a result of blood loss during elective surgery. Her hemoglobin is 8.7 g/dL and hematocrit is 27%. What is the recommended treatment for her anemia? a) Parenteral iron dextran b) Oral ferrous sulfate c) Parenteral erythropoietin d) Intramuscular cyanocobalamin

a (hemolytic- Likely G6PD deficiency)

A 32-year-old male of Mediterranean descent presents with acute-onset palpitations and dyspnea. He was given a sulfa medication for a respiratory infection yesterday. The patient states that he is otherwise healthy. Hemoglobin and hematocrit are decreased, but indices are within normal limits. Heinz bodies are noted on a peripheral smear, the reticulocyte count is increased, and haptoglobin is decreased. Iron and total iron binding are normal. What type of anemia does this patient most likely have? a) Hemolytic b) Iron deficiency c) Macrocytic d) Thalassemia

a (Nerve root impingement)

A 33 year old grad student complains of low back pain after carrying a heavy suitcase on a recent vacation in Europe. Because of his pain, he went to a neurologist in London who recommended bed rest and NSAID agents. After 10 days, the back pain resolved, but the patient comes to see you because of new weakness of his right anterior tibias. The rest of the PE is normal. What is the most likely dx? a) Nerve root impingement b) Tibial stress fracture c) Anterior compartment syndrome d) Gastrocnemius muscle tear e) Popliteal cyst

a (Asherman's syndrome)

A 33 yo G3P2 female presents with a year long history of amenorrhea. She is sexually actice and uses her husband's vasectomy as birth control. Her past medical history is significant for two normal spontaneous vaginal delivers. She also had a miscarriage, which was treated with a dilation and curettage last year.Her pelvic exam shows a normal sized uterus and both ovaries are contender and normal size. What is the most likely diagnosis? a) Asherman's syndrome b) Shehan's syndrome c) Kallmann's syndrome d) hyperprolactinemia e) Hypothyroidism

b (Myasthenia gravis)

A 33 yo female presents to the ED with weakness for the last month that is exacerbated by activity and relieved by rest. Her husband tells you that she no longer smiles and looks like she is snarling and wonders is there is something wrong with her face as well. What is the most likely diagnosis? a) Guillain-Barre b) Myasthenia gravis c) Ankylosing spondylitis d) Spinal cord tumor

b (Esophageal varices)

A 33 yo male presents with frank hematemesis. His family states that shortly after an uneventful waking this morning, they noticed the patient spitting up quite a bit of red blood. The family states that the patient has a history of cirrhosis of the liver but never had problems with swallow gin or bleeding previously. His exam demonstrates hypotension, tachycardia, and persistent frank hematemesis. What is the most likely cause of his bleeding? a) Mallory-Weiss tear b) Esophageal varices c) Esophageal neoplasm d) Gastritis

c (Begin antibiotics and oxytocin )

A 34 yo G4P2 Ab1 woman presents at 34 weeks with abdominal pain and fever. The pain started 2 days ago has been slowly intensifying, and is now ranked 8/10. She is unable to localize it, saying that her whole abdomen hurts. She also notes that she has been leaking clear fluid for 4 days. Her blood pressure is 124/72, pulse 102, and temp 102.1, and the fetal heart rate is 156. Her bowel sounds are hypoactive. The funds is firm and tender to light palpation and has a height of 28cm. A sterile speculum exam shows clear fluid positive nitrazine and ferrying. Her which blood cell count is 14800 with 8% bands. Fetal tracing shows a baseline heart rate of 150 with good variability and no contraction. What is the best treatment for this patient? a) Begin steroids to increase fetal lung maturity b) Begin tocolytic therapy to stop labor c) Begin antibiotics and oxytocin d) Immediate delivery by C-section e) Surgical consul to rule out appendicitis

b (T2DM)

A 35 year old female presents with polyuria, polydipsia, and polyphagia. Her random plasma glucose is 207 mg/dL. She is hoping to conceive a baby in the near future. What is the most likely diagnosis? a) Gestational diabetes b) T2DM c) Hyperglycemia of pregnancy d) Renal-induced hyperglycemia

a (A cup of fruit juice)

A 35 year old male patient with T2DM presents to a family practice office with concerns about recent episodes of a pounding heart, sweating, and tremors before lunch several times in the past month. The patient has recently lost more than 20 pounds on a low carb, low calorie diet in the past 4 months and has had no diabetes medication adjustments for more than year. He has no history of cardiac or psychological problems. What is the recommended acute treatment? a) A cup of fruit juice b) A cup of diet soda c) Half of a turkey and mayo sandwich d) Several low-carb hard candies

b (Diabetic ketoacidosis)

A 35 year old male presents to the ER with constant nausea, vomiting, and abdominal pain for one day. The patient denies any significant medical history but appears confused. Blood work reveals: glucose 446, Sodium 130, Potassium 5.6, and arterial pH 7.0. On exam, you find the patient is hypotensive and tachycardia What is the most likely diagnosis? a) Hyperglycemic hyperosmolar state b) Diabetic ketoacidosis c) Nephrogenic diabetes insipidus d) Neurogenic diabetes insipidus

b (Herniated intervertebral disk)

A 35 year old male presents to your clinic complaining of sudden onset of low back pain after lifting a heavy box 2 hours ago. Because the injury occurred at work, his boss told hi to get checked out by a doctor. He stated that he had numerous episodes of straining his back while lifting weight in the past but states that the pain is different this time. The pain starts in the lower back and it shoots down through his buttocks, down the right leg and to the right foot. While performing a straight leg raise test, he right leg and to the right foot. He also has weakness and numbers in the right foot. What is the most likely dx? a) Ankylosing spondylitis b) Herniated intervertebral disk c) Latissimus dorsi musacee strain d) Sacroiliac strain

a (A cup of fruit juice)

A 35 yo male patient with T2DM presents to a family practice office with concerns about recent episodes of a pounding heart, sweating, tremors, and before lunch. In the past 4 months the patient has lost more than 20 pounds on a low carb diet and has had no diabetes medication adjustments for more than 1 year. He has no cardiac history of physics problems. What is the recommended acute treatment? a) A cup of fruit juice b) A cup of diet soda c) Half of a turkey and mayo sandwich d) Several low carb hard candies

b (T2DM)

A 35 yo obese female preens with polyuria, polydipsia, and polyphasic. Her random plasma glucose is 207. She is hoping to conceive a baby in the near future. What is the most likely diagnosis? a) Gestation diabetes b) T2DM c) Hyperglycemia of pergnancy d) Renal-induced hyperglycemia

a (Amitriptyline- fibromyalgia)

A 35 yo woman complains of aching all over. She says she sleeps poorly and all her joints hurt. Sx have progressed over several years. PE shows multiple points of tenderness over the neck, shoulders, elbows, and knees. No joint swelling or deformity is seen. A complete blood count and erythrocyte sedimentation rate are normal. RF is negative. What is the treatment for this patient? a) Amitriptyline b) Prednisone c) ASA and Methotrexate d) Plaquenil

c (CXR)

A 36 year old previously healthy male presents with the sudden onset of chills, fever, a cough productive of rust-colored sputum, and sharp chest pain. He is a nonsmoker and a nondrinker. Auscultation of the chest reveals crackles in the right lower lobe. What is the most appropriate test to order? a) Sputum culture b) Urine antigen test for Streptococcus pneumoniae c) CXR d) CT scan of the chest

a (Ultrasound- placenta previa)

A 36 yo G5P4 female presents at 39 weeks with a sudden onset of painless vaginal bleeding. She was watching TV when the bleeding started and she states it was a lot. On presentation her clothing is soaked with blood and she is continuing to bleed moderately. Her blood pressure is 116/72, pulse 68, and temp is 98.6. The fetal heart is 120 with good variability, and there are no contractions. What is the best intervention for her at this point? a) Ultrasound b) Sterile vaginal exam c) Sterile speculum exam d) Oxytocin induction e) C-section delivery

c (Posterior shoulder dislocation)

A 36 yo female is evaluated following a grand mal seizure. her left arm is adducted against her chest and is internally rotation. What its he most likely diagnosis? a) Proximal humerus fracture b) Humeral shaft fracture c) Posterior shoulder dislocation d) Anterior shoulder dislocation e) AC joint injury

a (US)

A 36yo G5P4 female presents at 39 weeks with sudden onset of painless vaginal bleeding. Sh was watching TC when the bleeding started and she starts it was a lot. On presentation her clothing is soaked with blood and she is continuing to bleed moderately. her BP is 116/72, pulse 68, and temp 98.6F. The fetal heart is 120 with good variability, and she is not having contractions. What is the best intervention for her at this point? a) US b) Sterile vaginal exam c) Sterile speculum exam d) Oxytocin induction e) C-Section

b (DVT)

A 37-year-old accountant presents to you complaint of left leg pain. She things she may have twisted it last week while she was on vacation in Italy but cannot recall a specific episode. Her history is significant for a left ankle fracture 20 years ago and smoking. On exam, sensation is grossly normal and dorsals pedis and posterior tibia pulses are present. The malleoli are contender to palpation. The extremity is warm, and pitting edema is noted to the mid-shin. The calf is tender to palpation. What diagnosis does this presentation suggest? a) Ankle Sprain b) DVT c) Osteosarcoma d) Peripheral arterial Occlusion e) Syndesmosis injury

d (Pterygium)

A 38 year old construction worker states he has a chronic irritation of his left eye. He states it is constantly tearing, but he has no associated pain or discomfort. On exam a yellowish elevation extending fro the medial cants to the nasal cornea is noted. What is the most likely diagnosis? a) Rust ring subsequent to a foreign body in the eye b) Cataract c) Corneal ulcer d) Pterygium

e (NSAIDs for 5-7 days)

A 38 yo afebrile woman complains of 2 days of lower back pain with no radiation to the legs that begun after she did some heavy lifting. She has some limitation to full flexion and rotation but no spinal or paravertebral tenderness. Findings on motor and sensory exam of her legs are normal. In the straight leg raising test, you can raise each of her legs 80 degrees off the table without causing any radicular pain. What treatment would you recommend? a) MRI of the lumbar spine b) Strict bed rest for 1 week c) Daily muscle relaxant for 1 week d) PT three times per week for 2 weeks e) NSAIDs for 5-7 days

a (ITP)

A 3yo girl with recent history of viral infection presents with petechiae, baleen gums, and ecchymotic skin lesions. Which of the following would you most suspect? a) ITP b) Functional asplenia c) Leukemia reaction d) Neuroblastoma e) Sickle cell anemia

c (Scarlet fever)

A 4 yo girl deveoples an erythematous rash that feels like sandpaper and that appears on the upper torso and spreads to the remainder of the trunk, sparing her palms and soles. She is feverish and complains of a headache. Exam of the oral cavity reveals a "strawberry" tongue. Her vaccines are up to date. What is the most likely diagnosis? a) Varicella b) Measles c) Scarlet fever d) Pityriasis rosea e) Fifth disease

d (Ferritin)

A 4-year old child is in the office for an annual exam. Her mother is concerned about her nutrition intake because she is a picky eater. The child in in the 20th percentile in height and weight on the growth scale. She is pale, but her physical exam is otherwise normal. What lab test will best determine iron stores for this patient? a) Transferrin b) Total iron c) Total iron binding capacity (TIBC) d) Ferritin

d (Ferritin)

A 4-year-old child is in the office for an annual examination. Her mother is concerned about her nutritional intake because she is a picky eater. The child is in the 20th percentile in height and weight on the growth scale. She is pale, but her physical exam is otherwise normal. What lab test will best determine iron stores for this patient? a) Transferrin b) Total iron c) Total iron-binding capacity d) Ferritin

c (T2DM)

A 40 year old African American female presents with fatigue, excessive thirst, increased urination, weight loss despite decreased caloric intake, and recurrent vulvovaginitis. What is the most likely diagnosis? a) Addison's disease b) T1DM c) T2DM d) Maturity onset diabetes of youth

b (random glucose)

A 40 year old male presents with progressive visual loss that has been getting worse over the past week. He states he has felt a little sluggish lately and has put on some weight. He goes to the doctor for acute care only and has not had a physical exam in "years." On fundoscopic exam there are scattered dot and blot hemorrhages and cotton wool spots. What test would you order to possibly assist in the diagnosis of what is causing his visual changes? a) Liver enzyme profile b) Random glucose c) Lipid profile d) Ceruloplasmin

a (Oral squamous cell carcinoma)

A 40 year old male with a 10 year history of frequently using chewing tobacco presents with a "white patch" on the side of his cheek. He is not sure how long it has been there, but he is concerned because it did not come off when he tried to remove it with with his toothbrush. On exam, you notice a thickened white patch on his inner buccal mucosa, which cannot be removed with a tongue depressor. you advise the patient that the lesion should be further evaluated because this type of lesion can lead to which of the following? a) Oral squamous cell carcinoma b) Kaposi's sarcoma c) Lichen planus d) Oral candidiasis

c (Meniere's disease)

A 40 year old women presents with a sudden onset of episodic vertigo, tinnitus, and hearing loss. She states that she had two episodes over the past week and each on lasted about 20 minutes. She cannot remember any favors that may have precipitated the episodes. What is the most likely diagnosis? a) Otosclerosis b) Positional vertigo c) Meniere's disease d) Acoustic neuroma

c (T2DM)

A 40 yo AA female presents with fatigue, excessive thirst, increased urination, weight loss despite increase caloric intake, and recurrent vulvovaginitis. What is the most likely diagnosis? a) Addison's disease b) T1DM c) T2DM d) MODY

d (Surgery to remove the adenoma)

A 40 yo male with known hyperparathyroidism demonstrates a worsening of her serum calcium and deterioration of her renal function with routine pharmacological intervention. Her serum calcium is consistently 1 above normal, and her recent dual energy x-ray absorptiometry scan shows a T-score of <2.5. She has a solitary parathyroid adenoma. What is the treatment of choice? a) Early dialysis to reduce the parathyroid hormone levels b) Chemoablation of the parathyroid adenoma c) Radiation of the parathyroid adenoma d) Surgery to remove the adenoma

d (Transplantaiton of cryopreserved parathyroid tissue form prior surgery)

A 40 yo patient presents with a new-onset muscle cramping, tingling of the hands, feet, and around the mouth and irritability. She has recently had a thyroidectomy for uncontrolled hyperhtyroidism. You strongly suspect a diagnosis of hypoparathyroidism. She is unable to control her serum calcium levels despite intensive medial management. Which of the following is an option for her? a) Implantation of slow-release calcium b) Pituitary ablation to reduce parathyroid stimulation c) Suppression of vitamin D deficiency d) Transplantaiton of cryopreserved parathyroid tissue form prior surgery

b (Oral iron therapy)

A 40-year-old female is diagnosed with iron-deficiency anemia as a result of menorrhagia. Her hemoglobin is 9.8 g/dL. What is the recommended initial therapy for this patient? a) Dietary changes and a daily multivitamin b) Oral iron therapy c) Parenteral iron d) Red blood cell transfusion

b (Sterile speculum exam)

A 41 yo G3P2 woman presents at 28 weeks complaining of wet underwear following an episode of sneezing several times. She is uncertain if she leaked urine or not. She reports normal fetal movement. What is the next best step in evaluating the patient? a) Sterile vaginal exam b) Sterile speculum exam c) US d) Nonstress test e) Pap test

b (Urine metanphrines and vanillymandelic acid)

A 41yo woman presents with recurring episodes of severe headache in association with an elevated systolic blood pressure. IN evaluation of possible pheochromocytoma, which would be the most appropriate diagnostic test? a) Serum renin levels b) Urine metanphrines and vanillymandelic acid c) Levels of serum serotonin and its metabolite d) Serum cortisol levels e) Urine levels of aldosterone and its metabolites

b (Sebaceous cyst)

A 42 yo male presents with firm, contender, non ulcerated mass in his scalp. The mass slides easily on the scalp. What is the most likely diagnosis? a) Basal cell carcinoma b) Sebaceous cyst c) Cellulitis d) Hematoma e) Cephalhematoma

d (Compartment syndrome)

A 42 yo man presents with a crush injury to his LLE. He complains of severe leg pain that seems out of proportion to his injury. He also complains of paresthesias of the injured extremity. Leg exam is significant for pallor and coldness. The doraslis pedis and posterior tibias pulses are not palpable. What is your most likely diagnosis? a) Arterial insufficiency b) Pelvic fracture c) DVT d) Compartment syndrome

b (Hepatic cirrhosis)

A 43 yo alcoholic presents with complaints of weight loss, weakness, fatigue, muscle cramps, and an anorexic appetite. Your exam reveals hepatomegaly, spider nevi, mild jaundice, and cheilosis. What is the most likely diagnosis? a) Acute pancreatitis b) Hepatic cirrhosis c) Vitamin K deficiency d) Wernicke-Korsakoff syndrome

a (Acute pancreatitis)

A 43 yo mildly obese female presents with moderate epigastric pain radiating to her mid back. She has accompanying nausea and vomiting but no change in bowel habits. She states that the pain seems to wax and wane. A general assessment reveals her to be in mild-moderate pain, holding her epigastrium. Her skin is warm and dry, and she has no evidence of jaundice. Her pulses are intact throughout. Her abdomen exam demonstrates pain to palpation of the epigastrium with guarding and diminished bowel sounds. There is a negative Murphy's sign, and there is no evidence of abdominal mass or bruit. What is the most likely diagnosis? a) Acute pancreatitis b) Acute cholecystitis c) Acute mesenteric ischemia d) Acute hepatitis

a (infectious endocarditis)

A 43-year-old female presents with a 3-week history of fever. She states her temperature has generally been around 101 F. She also complains of fatigue and malaise. During a funduscopic exam, you note several small retinal hemorrhages. Cardiac auscultation reveals a II/VI systolic murmur heard best over the left sternal border. What condition is suggested by this presentation? a) Infectious endocarditis b) Pulmonary tuberculosis c) Rheumatic fever d) Rheumatoid arthritis e) SLE

b (posterior-anterior and lateral views)

A 45 year old female presents with a temperature of 38.8 C heart rate of 105 bpm, blood pressure of 140/75 mm Hg, oxygen saturation of 92% on room air, pleuritic chest pain, and a cough with purulent sputum. What is the best chest radiograph view to evaluate a possible pneumonia? a) Lateral decubitus views b) Posterior-anteroir and lateral views c) Anterior-posterior view d) Inspiratory and expiratory views

d (<200)

A 45 year old male patient with known HIV presents with PCP pneumonia. what would you expect his CD4 count to be? a) > 800 b) > 500 c) between 200-500 d) <200

b (Parotitis)

A 45 year old patient presents with a sudden onset of pain, tenderness, and swelling of the right side of the face. On exam the right side of the patient's face is tender and swollen. Prior to the onset of these symptoms, the patient states he has been well. What is the most likely diagnosis? a) Mastoiditis b) Parotitis c) Otitis media d) Retropharyngeal abscess

c (Prostate cancer)

A 45 yo AA male presents to your office with a chief complaint of back pain. Exam of the back is normal. A DRE is performed and shows some areas of prostatic indurations and an intact real sphincter. The patient denies any urological symptoms, smoking or drug abuse. What its he most likely diagnosis? a) Bladder cancer b) BPH c) Prostate cancer d) Hemorrhoids e) Chronic pancreatitis

b (Posterior hip disclocation)

A 45 yo female has been involved in a motor vehicle accident. Upon observation, you note that she is in extreme pain and her right leg is internally rotated, adducted, and flexed. What is the most likely diagnosis? a) Anterior hip disclocation b) Posterior hip disclocation c) Intertrochanteric fracture of the left hip d) Femoral neck fracture of the hip

b (PA and lateral views)

A 45 yo female presents with a temperature of 38.8 C, heart rate of 105 bpm, blood pressure of 140/75, oxygen saturation of 92% on from air, pleuritic chest pain, and cough with purulent sputum. What is the best chest radiograph view to evaluate a possible pneumonia? a) Lateral decubitus view b) PA and lateral views c) AP view d) Inspiratory and expiratory views

b (Achilles tendon rupture)

A 45 yo male was plating basketball over the weekend when he heard a loud "pop" and felt a pain in his calf as his feet landed on the floor after going up for a rebound. What is your likely diagnosis? a) Stress fracture of the metatarsals b) Achilles tendon rupture c) Ankel sprain d) Baker's cyst rupture

a (Basal cell carcinoma)

A 45 yo male who is a professional surfer develops a raised papule with a pearly border containing telangiectatic vessels on his face. What is the most likely diagnosis? a) Basal cell carcinoma b) Squamous cell carcinoma c) Mycosis fungoides d) Malignant melanoma e) Bowen's disease

c (Scaphoid fracture)

A 46 yo female was jogging in the morning when she missed her step and fell. She tried to save herself by extending her right hand, but unfortunately she landed on it. Exam of the right wrist reveals tenderness in the region of the anatomical snuffbox. What type of fracture is probably present in this patient? a) Metacarpal fracture b) Phalanx fracture c) Scaphoid fracture d) Colles fracture

d (Esophageal tumor)

A 46 you male present with complaints of dysphagia of solid foods for 3 months. he also states he believes he is getting a cold because of recent development of a hoarse voice. He has noted a 16 pound weight loss in about 6 months. His medical history includes a10 year history of drinking a case of beer every other day, and he has smoked about one pack of cigarettes daily since age 16. Aside form this information, his ROS is negative. Vital signs and exam are normal. What is the most likely diagnosis? a) Alcoholism b) Malnutrition c) Barrett's esophagus d) Esophageal tumor

b (Lumbar strain)

A 47 year old man complains of low back pain after shoveling his driveway after a snowstorm. he denies radiculopathy, paresthesias, and bowel and bladder incontincence. He has a history of back pain in the past, but he has never had diagnostic imaging. Today, his x-rays are negative. He is tender to palpation along his bilateral lumbar pararspinal muscles and contender along the lumbar spine. What is the most likely diagnosis? a) Spinal stenosis b) Lumbar strain c) Herniated nucleus pulposus d) Cauda equina syndrome e) Sciatica

c (Leiomyoma)

A 47 yo G3P3 female state post tubal ligation presents for an annual exam with complaints of menorrhagia. On exam there is a palpable abdominal mass, which is firm and nontender. Pelvic exam shows an enlarged uterus measuring 16cm above the pubic symphysis. Urine hcg is negative. What is the most likely diagnosis? a) Pregnancy b) Adenomyosis c) Leiomyoma d) Ovarian cyst

b (Esophageal spasm)

A 47 yo female presents with recent onset of difficulty swallowing foods and chest pain. She had a barium esophogram that showed a "corkscrew" appearance to the esophagus. What is the most likely diagnosis? a) Achalasia b) Esophageal spasm c) Esophageal webs d) Esophageal tumor

b (Blunt trauma)

A 47yo male was involve in a MVA. The emergency technician reports that the patient was not wearing a seat belt and the steering wheel was bent forward in the car. The blood pressure is 80/60 and the heart rate is 120 beats permute. There is a large ecchymosis over the left flank area. What is the possible mechanism of injury in this patient? a) Penetrating trauma b) Blunt trauma c) Blast trauma d) Multiple traumas

c (Radicular back pain)

A 48 year old construction worker complains of back pain that radiates down his left leg that is worsened when coughing or sneezing. On exam, upon raising his left leg, the patient complains of pain in his low back. Also, his left knee reflex is slightly diminished. What type of back pain is the patient experiencing? a) Mechanical back pain b) Referred pain c) Radicular back pain d) Spasm-induced back pain

c (Heterozygote for familial hypercholesterolemia- Total cholesterol levels are usually >300 with LDL >200 in familial hypercholesterolemia, whereas triglycerides are generally norma. The patient is likely heterozygote because there is no family history of early cardiac death on his maternal side)

A 48 year old male presents to the ED with anew-onset MI. He has had no routine medical care or laboratory tests for many years and has a family history of early cardiac death in his paternal uncle and older brother. His ordered lab tests reveal total cholesterol of 400 mg/dL, a low density lipoprotein level of 240 mg/dL, and a TG level of 132 mg/dL. His CMP and CBC were normal. What is the most likely diagnosis? a) Bile duct obstruction b) Excessive dietary cholesterol intake c) Heterozygote for familial hypercholesterolemia d) Homozygote for familial hypercholesterolemia

c (Heterozygote for familial hypercholesterolemia)

A 48 yo male presents to the ED with a new onset MI. He has no routine medical care or lab tests for many years and a family history of early cardiac death in his parental uncle and older brother. His ordered lab tests reveal total cholesterol of 400, a LDL of 240, and a TG of 132. His complete metabolic profile and complete blood count were normal. What is the most likely diagnosis? a) Bile-duct obstruction b) Excessive dietary cholesterol intake c) Heterozygote for familial hypercholesterolemia d) Homozygote for familial hypercholesterolemia

a (Dyshidrosis)

A 49 yo male presents complaining of itchy blisters on both hands for 1 week. On exam, you note that the vesicles are 1-2 mm, that there is no surrounding erythema or burrows, and that they are distributed on the palms and sides of the fingers of both hands. A potassium hydroxide (KOH) preparation does not reveal any hype. What is the most likely diagnosis? a) Dyshidrosis b) Tinea manus c) Zoster d) Scabies e) Bullous phemphigoid

d (Cervical spondylosis)

A 49 yo truck driver presents with severe, diffuse neck pain and pain in his right shoulder and arm. He has parenthesis and numbness in his fingers. He has no history of trauma. On PE, pain is found to be increased by extension of the neck and relieved by flexion and changes in the joints of Luschka and the facet joints. What is the most likely diagnosis? a) Muscle spasm in the extensor muscles of the neck b) Meningitis c) Ankylosing spondylitis d) Cervical spondylosis

d (Cervical spondylosis)

A 49 yo truck driver presents with severe, diffuse neck pain and pain in his right shoulder and arm. He has paresthesias and numbness in the fingers. He has no history of trauma. On PE, pain is found to be increased by extension of the neck and relieved by flexion and changes in the joint os Luschka and the facet joints. What is the most likely diagnosis? a) Muscle spam in the extensor muscles of the neck b) Meningitis c) Ankylosing spondylitis d) Cervical spondylosis

d (Multiple small vesicles )

A 5 year old boy presents with a 3 day history of painful sores in his mouth. On exam, he has a fever and swollen lymph nodes. You diagnose the patient with herpetic stomatitis. What would you expect to find on exam of his mouth? a) Thick, white patches b) Deep purple-colored lesions c) Small red spots d) Multiple small vesicles

a (Steroids)

A 5 year old child is diagnosed with idiopathic thrombocytopenia purport (ITP). what is the recommended treatment? a) Steroids b) Desmopressin c) Platelet transfusion d) Fresh frozen plasma

b (Perform a throat swab)

A 5 yo child presents with an acute case of fever, chills, adenopathy, and pharyngitis. The caretake has tried symptomatic treatment for more than a week. What would be the next appropriate step in this situation? a) Perform a cervical spine radiograph to look at the soft tissue structures of the neck b) Perform a throat swab c) Start amoxicilin d) Observe the patient for 48 hours before starting treatment

d (Turner's syndrome)

A 5 yo female is being evaluated for short stature and body weight appropriate for height. She comes from a stable home with adequate financial resources. you suspect some form of dwarfism and order a chromosome evaluation, which reveals XO pattern. What is the cause of this child's short stature? a) Achondroplasia b) Larson's dwarfism c) Nutritional deprivation d) Turner's syndrome

a (Orbital cellulitis)

A 5 yo girl presents with her mother who noticed left eye redness and swelling that has been worsening over the past 2 days. The child also has had a URI for the past week. On PE, her temp is 101F. Visual acuity in the left is 20/200 and the right is 20/20. The red reflex is present bilaterally, and EOM are decreased on the left and normal on the right. What is the most likely dx? a) Orbital cellulitis b) Viral conjunctivitis c) Preseptal conjunctivitis d) Bacterial conjunctivitis e) Acute sinusitis

c (Inappropriate antidiuretic hormone)

A 50 yo male who has smoked two packs of cigarettes per day for the past 30 years presents with lung mass on chest x-ray. He also says that he has recently gained weight. Lab exam shows hyponatremia with hyperosmolar urine. What is the most likely diagnosis? a) Addison's disease b) Conn's syndrome c) Inappropriate antidiuretic hormone d) Pituitary failure e) Renal failure

e (Referral to surgeon for a simple mastectomy)

A 50 yo white woman comes to you because she has found a breast mass. On exam, you feel a firm, fixed, contender, 2cm mass. She has no nipple discharge, and axially nodes are palpable. You send her for a mammogram and fine-needle aspiration. The mammogram is read as "Suspicious" and the cytology reports reads "a few benign ductal epithelioid cells and adipose tissue." What is the most appropriate next step? a) Another mammogram in 3 months b) Repeat fine needle aspiration in 3 months c) An excision biopsy of the mass d) Referral for breast irradiation e) Referral to surgeon for a simple mastectomy

c (Meniere's disease)

A 50-year-old woman presents with a sudden onset of episodic vertigo, tinnitus, and hearing loss. She states she had two episodes over the past week and each one lasted about 20 minutes. She cannot remember any factors that may have precipitated the episode. What is the most likely diagnosis? a) Otosclerosis b) Positional vertigo c) Meniere's disease d) Acoustic neuroma

a (Fibronodular shadowing involving one or both apices)

A 51 yo homeless man presents to you with fever, night sweats, and a productive cough that has been occurring for the past 2 weeks. He tells you there has been recent outbreaks of TB in the shelter. Which of the following findings on a chest radiograph would support your presumed diagnosis of TB? a) Fibronodular shadowing involving one or both apices b) Fibronodular shadowing involving one or both bases c) Diffuse bilateral infiltrates d) Irregulary shaped cavity with an air-fluid level inside

b (Rosacea)

A 52 yo golfer comes to see you about her "ruined complexion." She states over the last 4-5 months her nose and cheeks just keep getting redder and redder. She states ash is embarrassed at the acne-looking pustules that are on her nose, forehead, and cheeks. When asked what she thinks makes the condition worse she states, " I know you will think this is really weird but whenever I go to Amigos, an outdoor Mexican restaurant after a full day of golfing in the sun, things just get worse. I am not sure why that combination is such problem." What is the most likely diagnosis? a) Herpes zoster b) Rosacea c) Erysipelas d) Tinea corporis

d (Pancreatic carcinoma)

A 53 yo male presents with painless jaundice that started last night. The patients admits to a 14 pound weight loss over 3 months and has a diminished appetite. On eval, the patient appears jaundiced. The only abdominal abnormality per exam is a hard palpable periumbilical (Sister Joseph's) nodule. The initial plain abdominal radiograph series reveals widening of the duodenal loop, and an initial UA reveals glycosuria. Further tests are pending. What is the most likely diagnosis? a) Acute pancreatitis b) Gallbladder carcinoma c) Hepatic cirrhosis d) Pancreatic carcinoma

c (Hypothyroidism)

A 53 yo postmenopausal patient presents with complaint of several months of fatigue, modest weight gain desire poor appetite, cold intolerance, constipation, myalgia, dry skin, and some hair loss. What is the most likely diagnosis? a) Growth hormone excess b) Hypoparathyroidism c) Hypothyroidism d) T1DM

a (Streptococcus pneumonia)

A 55 year old female who was recovering from an episode of bronchitis suddenly develops shaking chills followed by a high fever, pleuritic pain, and cough productive of purulent rusty sputum. On exam, the patient appears acutely ill, with a respiratory rate of 30 per minute. Bronchial breath sounds and rales are heard in the left lower lobe. CXR reveals a consolidation present in the left lower lobe. What is the most likely diagnosis? a) Streptococcus pneumonia b) Klebsiella pneumoniae c) Viral pneumonia d) Pneumocystis jiroveci pneumonia e) Staphylococcus aureus pneumonia

a (hypoglycemia)

A 55 year old male patient with T2DM presents to the family practice office with concerns about recent episodes of pounding heart, sweating, and tremors before lunch several times in the past month. The patient has recently lost more than n 20 pounds on a low-carb and low calorie diet in the past 4 months and has had no adjustment in his oral diabetes medications for more than 1 year. He has no history of cardiac or psychological problems. What is the most likely diagnosis? a) Hypoglycemia b) Hyperglycemia c) Mitral valve prolapse d) New onset panic disorder

e (Pulmonary embolism )

A 55 yo female has sudden episode of pleuritic chest pain on the left side. The patient was in the hospital 20 days after a laparotomy for a perforated gallbladder complicated by peritonitis. She gives a history of congestive heart failure. What is the most likely diagnosis? a) Bronchiectasis b) CMV pneumonitis c) Left upper lobe abscess d) Lobar pneumococcal pneumonia e) Pulmonary embolism

d (Gastrinoma- Zollinger-Ellison syndrome)

A 55 yo male has been treated for an ulcer with a PPI for the last 4 months, and he states the symptoms are not improving. he still complains of heartburn symptoms and now has had episodes of diarrhea and steatorrhea. He states that he has noticed weight loss of about 12 pounds in the last 4 months. He denies noting any blood in the stool, has not traveled anywhere recently, and has had no complaints of emesis. A recent upper endoscopy showed a solitary ulcer in the duodenal bulb. A recent fasting gastrin level was more than 150. What is the most likely diagnosis? a) Gastric outlet obstruction b) PUD c) Hiatal hernia d) Gastrinoma

a (Hypoglycemia)

A 55 yo male with T2DM presents to the office with concerns of a pounding heart, sweating, and tremors before lunch in the past month. In the past 4 months the patient has lost more than 20 pounds on a low-carb diet, low calorie diet and has no adjustments in his oral diabetes medications for more than 1 year. he has no history of cardiac or psychological problems. What is the most likely diagnosis? a) Hypoglycemia b) Hyperglycemia c) Mitral valve prolapse d) New-onset panic disorder

a (Pasteurella multocida)

A 55yo woman presents to the ED having bitten by her car. What pathogen is most likely to cause an infection in this patient? a) Pasteurella multocida b) Staph epidermidis c) Eikenella corrodens d) Pseudomonas aeruginosa

a (Mammogram)

A 56 yo G3P3 female presents with a palpable breast lump, which she found on breast exam 3 days ago. Her mammogram last year was normal. Her family history is negative for breast cancer. On exam there is a 3 x 3cm firm mobile mass under the left nipple. No nipple discharge is noted. What is the most appropriate next step? a) Mammogram b) US c) MRI d) Biopsy

a (CAP of the right lower lobe)

A 57 year old male presents with a complaint of 5 days of cough productive of hello, blood-tinged sputum; difficulty breathing; chest pain with cough and deep inspiration; and shaking chills. Physical exam reveals crackles in the right base on auscultation of the lungs. There is also slight dullness to percussion over the right lower lung. What is the most likely diagnosis? a) CAP of the right lower lobe b) Nosocomial pneumonia of the right lower lobe c) Acute bronchitis d) Aspiration pneumonia

a (CAP of the right lower lobe)

A 57 yo male presents with complaint of 5 days of productive cough of yellow, blood-tinged sputum, difficulty breathing, chest pain with cough and deep inspiration, and shaking chills. PE reveals crackles in the right base on auscultation of the lungs. There is also slight dullness to percussion over the right lower lung. What is the most likely diagnosis? a) CAP of the right lower lobe b) Nosocomial pneumonia of the right lower lobe c) Acute bronchitis d) Aspiration pneumonia

a (Endometrial biopsy)

A 57 yo woman presents for a routine gene exam without any complaints. She has been menopausal since age 54. She does have a family history of breast cancer and her mammogram 2 months ago was normal. ROS reveals occasional spotting with intercourse. Her exam is unremarkable, and transvaginal ultrasound shows an endometrial lining of 9mm. What do you recommend? a) Endometrial biopsy b) Pelvic ultrasound c) Pelvic CT d) Coposcopy

d (Prednisone)

A 58 year old male presents to the ED with a laceration of his hand from a kitchen knife. His current medications include metformin, ASA for CAD, prednisone for COPD, and simvastatin. Which of his medications is most likley to affect the length of time it takes for his wound to heal? a) ASA b) Simvastatin c) Metformin d) Prednisone

a (Colonoscopy)

A 58 yo previously healthy male presents for routine screening. He states that he feels well except that occasionally he is unable to complete his exercise routine because he is a little tired. His vitals are unremarkable except you notice a 10 pound weight loss since his last visit 1 year ago. His exam is only remarkable for occult blood in the stool, and his hemoglobin is 9.8. What is the next step in the evaluation of this patient? a) Colonoscopy b) Barium enema c) CT scan d) PET scan

d (Pyloric stenosis)

A 6 week old infant is brought to you because of feeding problems noted over the last week. The mother says that the infant seems to have emesis after each meal and appears persistently hungry. She is now concerned because the child has lost about 1 pound over the week and seems more fatigued than normal. On exam, the child is alert and consolable but appears slightly dehydrated. Abdominal exam reveals a firm 1-2 cm palpable olive like mass in the epigastrium. What is the most likely diagnosis? a) Pyelonephritis b) Gastroenteritis c) Ileus d) Pyloric stenosis

d (Pyloric stenosis)

A 6 week old infant is brought to you because of feeding problems noted over the past week. The mother says that the infant seems to have emesis after each meal and appears persistently hungry. She is now concerned because the child has lost about 1 pound over the week and seems more fatigued than normal. On exam, the child is alert and consolable but appears slightly dehydrated. Abdominal exam reveals a firm 1 to 2 cm palpable olive-like mass in the epigastrium. What is the most likely diagnosis? a) Pyelonephritis b) Gastroenteritis c) Ileus d) Pyloric stenosis

a (oral antibiotics)

A 60 year old male with a 10 year history of emphysema presents with a cough and increased sputum production. His temperature is 100F, respiratory rate is 10 per minute, and pulse is 88 beats per minute. Arterial blood gases show pH 7.44, PaO2 75 mmHg, PaCO2 40 mmHG, and O2 sat 92%. The examination is remarkable for increased anterior-posterior chest diameter and diminished breath sounds without wheezes, bronchi or other signs of respiratory distress. What is the most appropriate treatment for this patient? a) Oral antibiotics b) IV antibiotics c) IC corticosteroids d) Theophylline

b (Hypoparathyroidim)

A 60 year old patient presents with new onset muscle cramping, tingling in the hands, feet, and around the mouth, and irritability. He has recently has a thyroideceomty for uncontrolled hyperthyroidism. What is the most likely diagnosis? a) Hyperthyroidism b) Hypoparathyroidim c) Hypermagnesemia d) Hypokalemia

c (CXR)

A 60 year old smoker presents to the clinic suddenly with complaints of blood-tinged productive sputum on coughing and weight loss. He was found to have a temp of 100 F and significant weight loss. There is no family history of cancer. What would be the next step in evaluating the patient? a) PPD skin test b) Sputum culture c) CXR d) Bronchoscopy e) Oral antibiotics

c (Lumbar puncture)

A 60 yo patient develops a sudden severe headache followed by a decreased level of consciousness. Blood work and CT scan of the head without contrast are normal. What is the most appropriate next step in evaluating this patient? a) CT of the head with contrast b) EEG c) Lumbar puncture d) MRI of the brain e) Tilt-table testing

c (Maintain a serum calcium in the range of 8-9)

A 60 yo patient presents with a new-onset muscle cramping, tingling of the hands, feet, and around the mouth and irritability. He has recently had a thyroidectomy for uncontrolled hyperthyroidism. You strongly suspect a diagnosis of hyperparathyroidism. Which of the following is a recommended medical benchmark? a) Maintain a serum calcium in the range of 6-7 b) Maintain a serum calcium in the range of 7-8 c) Maintain a serum calcium in the range of 8-9 d) Maintain a serum calcium in the range of 9-10

d (diabetic retinopathy)

A 60-year-old female presents with progressive visual loss that has been getting worse over the past week. She denies any history of trauma to her eye. She states she has not had a physical exam in years. On fundoscopic exam there is scattered dot and blot hemorrhages and cotton wool spots. What is the most likely diagnosis? a) Angle closure glaucoma b) Optic neuritis c) Central retinal artery occlusion d) Diabetic retinopathy

c (Parkinson's disease)

A 61yo male presents with a 12 month history of hemiparesis. PE notes a stooped posture with very slow movements and a fixed facial expression. The patient appears rigid and has difficulty getting up from a sitting position. What is the most likely diagnosis? a) Multiple systems atrophy b) ALS c) Parkinson's disease d) Combined systems degeneration e) Alzheimer's disease

d (chronic bronchitis)

A 62 year old male cigarette smoker of 1.5 ppd presents with a complaint presents with complaint of recurrent cough productive of sputum. Each episode lasts for "months" and has been recurring for the past 3 years. He denies fever, chest pain, sore throat, nausea, or vomiting. He does complain of mild dyspnea, but he denies having his sleep disrupted by shortness of breath. What is your most likely diagnosis? a) Asthma b) Bronchiectasis c) Emphysema d) Chronic Bronchitis

b (CHF)

A 62 yo females presents to your office complaining of increasing fatigue for the past 6 mo. She states she often feels weak and short of breath. On physical exam the patient is afebrile. You note moderate JVD. Crackles are present in the lower third of the lungs bilaterally. Cardiac auscultation reveals a regular S1 and S2 with an S3. There is moderate pitting edema of both lower extremities. What diagnosis does this presentation suggest? a) Atypical pneumonia b) CHF c) Idiopathic pulmonary fibrosis d) Influenza e) Pulmonary embolism

d (TIA)

A 62yo woman complains of sudden painless loss of vision in the left eye that lasted about 20 minutes. She says the loss of vision was like pulling a cover over her eye. What is the most likely diagnosis? a) GCA b) Glaucoma c) Retinal detachment d) TIA e) Uveitis

d (Posterior cerebral artery transient ischemic attack (TIA))

A 63 yo man develops transient episodes of hemianopsia and dyslexia. What is the most likely diagnosis? a) Anterior communicating artery aneurysm b) Hypertensive encephalopathy c) Occlusion of the middle cerebral artery d) Posterior cerebral artery transient ischemic attack (TIA)

b (Normal pressure hydrocephalus)

A 63 yo man is brought in by his family with complaints of difficulty walking, urnary urgency and incontinence, and impaired recall of recent events. His gait is slow and slightly wide based, His thyroid function tests, serum B12, and erythrocyte sed rate are all normal. Syphilis serology is negative. EEG shows mild diffuse slowing but no epileptiform discharges. He has severe impairment in learning new lists of words and mild to moderate impairment in remembering spoken narrative on neurophysiological testing. CT scan shows dilation of the ventricular system out of proportion to any cortical atrophy of sulcal enlargement. What is the most likely diagnosis? a) Creutzfeldt-Jakob disease b) Normal pressure hydrocephalus c) Dementia with Lewy bodies d) Binswanger disease e) Pick disease

d (Fistula)

A 64yo female underwent vaginal hysterectomy 3 mo ago for uterine prolapsed. Since that time she notes difficulty voiding. She finds she frequently wets herself but has no urge to void nor does she have the sensation she is voiding on those occasions. She finds herself frequently voiding to avoid accidents and wears an adult diaper. She denies dysuria, hematuria, abdominal pain, urgency, or the sensation of a full bladder. Her past medical history includes normal vaginal delivers, T2DM, and hyperlipidemia. She takes simvastatin only. Exam shows normal external genitalia with atrophic changes and a wet perineum with urine odor. A cystocele is visible when she strains. There is a well-healed vaginal cuff and poorly rugged vagina with clear yellow fluid in the vaginal vault. Bimanual exam shows a soft contender cuff and no masses. A rectovaginal exam shows a small rectocele and good sphincter tone. What is the most likely diagnosis? a) UTI b) Cystocele c) Stress incontinence d) Fistula e) Overflow incontinence

a (Simple partial seizure)

A 65 yo male is brought to the ED after suffering a seizure while eating a meal in a restaurant. his wife states that this is the first seizure and that the patient developed convulsive jerking in his right arm and leg that lasted approx 5 min. There was no loss of consciousness. His wife described the jerking as progressing from the head to the shoulder. What is the most likely diagnosis? a) Simple partial seizure b) Complex partial seizure c) Absence seizure d) Tonic-clonic seizure e) Myoclonic seizure

c (Urethritis)

A 65 yo man attended a community heal fair, where it was discovered his PSA level was elevated. He was referred to you for further eval. The patient states that he has always been healthy and that he has not seen a physician for years. On ROS, he does note some frequent, hesitancy, and urgency on urination, which he has been experiencing for the past few years. DRE reveals a smooth, contender, symmetrically enlarged prostate gland and brown guaiac negative stool Which of the following is unlikely to cause elevation of PSA levels? a) Prostate cancer b) BPH c) Urethritis d) Prostatitis

a (call and ophthalmologist)

A 65-year old patent presents with a cc of "I think I have a sinus infection." He states he has had a headache, his eyes have been red, and this morning he had nausea and vomited once. You ask if he has any sinus congestion to which he replies, "I have allergies. I am always congested." On exam he has no sinus tenderness, inferior turbinates are not inflamed, and there is no nasal discharge. his ears, throat, lung, and heart exam are all normal. The only pertinent finding is that his right eye is red and appears cloudy during the eye exam. Also his pupil was not reactive to light. However, his EOM were intact and he had no proptosis. What is the most appropriate first step? a) Call an ophthalmologist b) Call an ears, nose, and throat specialist c) Perform a sinus radiograph d) Perform a sinus CT

c (Hip fracture)

A 66 yo female with a history of falling is lying on the exam table with her right left shortened and externally rotated. What is your most likely diagnoses? a) Posterior hip dislocation b) Cruciate ligament injury c) Hip fracture d) Tibial fracture e) Anterior hip dislocation

c (Hip fracture)

A 66 yo female with a history of falling is lying on the exam table with her right leg shortened and externally rotated. What is your most likely diagnoses? a) Posterior hip dislocation b) Cruciate ligament injury c) Hip fracture d) Tibial fracture e) Anterior hip dislocation

a (Symmetry)

A 68 yo farmer presents for a routine health exam. He states he is doing well. On exam you note that the patient has some sun damage to his skin and that he has a dark complexion. There is a hyper pigmented, slightly raised lesion measuring 1 cm on his left forearm. There is no LAD in his arm or axilla. The patient states that he does not really remember noticing this lesion before; he denies using sunscreen. You are worried that the lesion on his forearm may be a melanoma. What characteristic would reduce the likelihood of it being melanoma? a) Symmetry b) Flatness c) Irregular pigmentation d) Indistinct borders

a (Stasis dermatitis)

A 68 yo female complains of chronic, itchy rash on her legs that is sometimes red and weeping and sometimes crusted over. She admits to poor circulation and says that her brother has a similar problem. What is the most likely diagnosis? a) Stasis dermatitis b) Venous circulation c) Cellulitis d) Seborrheic dermatitis

b (Thyroid cancer)

A 68 yo female presents with a complaint of feeling a bump on the left side of her thyroid. Her friends have told her that her thyroid is not equal in size and her voice has become hoarse despite rest and an OTC antihistamine. What is the most likely diagnosis? a) Hyperthyroidism b) Thyroid cancer c) Thyroid goiter d) Hodgkin's lymphoma

d (Amoxicillin)

A pregnant woman has been diagnosed with Lyme disease. What is the treatment of choice? a) Doxycycline b) Levofloxacin c) Rifampin d) Amoxicillin

c (Metabolic alkalosis)

A previously healthy 5 week old male infant has a 5 day history of nonbiliuos projectile vomiting. He vomits immediately after every feeding and then seems hungry again. What acid-base disorder is most likely? a) Respiratory alkalosis b) Respiratory alkalosis c) Metabolic alkalosis d) Metabolic acidosis

c (Radiography of the digit)

A racquetball played was swinging back for an overhand shot when he hit the back wall of the court with his right index finger. he crushed the fingertip between the wall and the racquet handle. On physical exam, he has a 50 percent sublingual hematoma, fracture of the distal nail, and maceration of the distal pad. What should be the next step in his care? a) Drainage of the hematoma thought the nail b) Removal of the nail c) Radiography of the digit d) Primary closure with absorbable sutures

b (Azithromycin)

A recent outbreak of shigella has occurred in a day care. All of the children are under 5 years of age. What is the recommended treatment for this age group? a) Ciprofloxacin b) Azithromycin c) Levofloxacin d) Doxycycline

b (GCA)

A significant number of patients with polymyalgia rheumatic also develop what condition? a) SLE b) GCA c) Ankylosing spondylitis d) Reactive arthritis

d (Absence seizures)

A teenage girl has a long history of daydreaming in school. EEG reveals evidence of a generalized seizure disorder, but there has never been a history of convulsive muscular activity. What is the most likely diagnosis? a) Simple partial seizure b) Complex partial seizures c) Tonic-clonic seizures d) Absence seizures e) Myoclonic seizures

c (Azithromycin )

A young boy is diagnosed with otitis media. What would you that this child with if he was allergic to penicillin? a) Cefuroxime b) Amoxicillin c) Azithromycin d) Cephalexin

a (Pyrantel)

A young child presents with complaint of perianal pruritus that is causing him to wake frequently throughout the night. On further questioning the caretaker states that other children in the day care center are having similar sx. After applying a piece of tape to his anus at night, ova are found. What is the recommended treatment for this patient? a) Pyrantel b) Chloroquine c) Sulfadiazine d) Isoniazid

c (If this patient had designated a health car proxy or durable health care power of attorney, that person's judgement could be superseded the advice of the treating physician)

A 68 yo previously healthy female is struck by an oncoming car when she opens her car door. She suffers a TBI and cervical spine injury that leaves her comatose state. Her cervical spit injury is surgically stabilized, however the prognosis for return of motor function to her extremities is very poor. The patient has requested that life-sustains measures be stopped. Which of the following statements regarding advance directives in this scenario is true? a) If this patient did not have an advance directive, the treating physician would always make the ultimate determination regarding stopping life support b) If this patient had an advance directive, the wording would have to be specific to this case to cover a special situation such as this scenario c) If this patient had designated a health car proxy or durable health care power of attorney, that person's judgement could be superseded the advice of the treating physician d) If an unsigned advance directive is found in the patient's home, this document can be used for guidance in the absence of a properly executed living will

c) Lewy body dementia

A 68yo male is here for sx that have been developing over the past few months. The wife reports that her husband has experience pronounced auditory and visual hallucinations and paranoid delusions over the past 6 months. Also during the last year progressive cognitive deficits have become increasingly noticeable to her and other family members. Whereas substantial fluctuations in cognitive ability have been noticed from day to day, a definite downhill course is apparent. PE reveals a right upper extremity resting tumor and mild cog-wheeling rigidity. The patient's gift is characterized by short, shuffling steps and a decreased arm swing. The patient's only medication is a diuretic for HTN. What is the most likely dx? a) Parkinson's disease b) Creutzfeldt-Jakob disease c) Lewy body dementia d) Vascular dementia

b (Sickle cell disease)

A 6yo AA child presents to the ED with excruciating abdominal pain several hours after falling off a bike. His granddaughter states that now both knees are swollen and the child has difficulty walking. Based on this information what disease should you suspect in this child? a) Aplastic anemia b) Sickle cell disease c) Thalassemia major d) Hemoglobin C disease

b (A physical exam with vital sings prior to starting any stimulant)

A 7 yo boy is brought to your clinic by his parents who are referred by the child's school for behavioral and learning difficulties. The boy does not pay attention to the teacher when instructions are given, and he fails to follow individual instructions. he also distracts otters students by getting up from his desk and roaming around the classroom making noise and playing with the other student's papers. What is the appropriate medical intervention for this boy? a) Office trial of methylphenidate to observe his response b) A physical exam with vital sings prior to starting any stimulant c) No intervention needed d) Formal evaluation of the child for mental retardation

a (Appendicitis)

A 7 yo boy presents with persistent abdominal pain for 24 hours accompanied by anorexia and nausea. His PE is remarkable for right lower quadrant tenderness and guarding. What is the most likely diagnosis? a) Appendicitis b) Gastroenteritis c) Intussusception d) Pyloric stenosis

b (Pediculosis humanus)

A 7 yo female is brought to your office by her mother. The child has been sent home form school because she has been scratching her head nonstop. On close inspection you find egg sack cemented to the hair shafts forming nits. Which of the following is the most likely cause of her sx? a) Sarcoptes scabiei b) Pediculosis humanus c) HPV d) Candida albicans

b (Gingivostomatitis- also known as primary herpetic gingivostomatitis)

A 7 yo male presents with generalized cervical LAD, malaise, fever, and multiple, discrete superficial ulcers through the oral cavity and on the buccal mucosa, gingival, and hard palate. The lesions have been forming over the past week and are so painful that he is reluctant to eat or drink. What is the most likely dx? a) Thrush b) Gingivostomatitis c) Peutz-Jeghers disease d) Apthous ulcers

a (Bone marrow biopsy)

A 7-year-old child presents to the office with fatigue and weakness. On physical examination there is lymphadenopathy, hepatosplenomegaly, and bruising noted on extremities. Blood work shows anemia, a white blood cell count of 20,000/μL, a platelet count of 90,000/μL, and blasts on peripheral smear. What is your next step in the diagnosis of this patient? a) Bone marrow biopsy b) Spinal fluid analysis c) CT of abdomen d) Initiate intravenous antibiotics for sepsis

b (Klebsiella pneumoniae)

A 70 year old alcoholic male with a history of COPD is admitted to the hospital suffering from fever, shortness of breath, chest pain, and cough productive of "current jelly: sputum and blood. Physical exam reveals a temperature of 104F, a respiratory rate of 28 per minute and decreased breath sounds heard in the right upper lobe. Chest x-ray confirms the presence of a right upper role pneumonia. What is the most likely causative organism? a) Streptococcus pneumoniae b) Klebsiella pneumoniae c) Mcoplasma pneumoniae d) Haemophilus pneumoniae e) Staphylococcus aureus

a (E. coli)

A 70 yo nursing home resident developed a painful swelling of the right testicle 3 days ago with a temperature of 102. Exam reveals no CVA, a diffusely enlarger tender prostate without nodules, and a tender small mass along the posterior aspect of the right superior testicle. What is it organism most likely responsible for the patient's condition? a) E. coli b) S. aureus c) Enterococcus species d)Chlamydia trachomatis

d (Colonoscopy)

A 70-year-old male presents with vague abdominal pain, fatigue, and dyspnea on exertion. On physical exam he appears pale and there is conjunctival pallor. Stool guaiac is negative. Hemoglobin is 9.0 g/dL; hematocrit 27.2%; mean corpuscular volume (MCV) 78.5 μm3; and serum ferritin 6.5 ng/dL. Based on this information, what is the most appropriate recommendation for this patient? a) Intravenous iron b) Oral iron supplementation c) CT of abdomen d) Colonoscopy

d (Pulmonary embolism)

A 71 yo male with a history of prostate cancer presents to the ED with a complaint of sudden onset of dyspnea and chest pain with inspiration. On physical exam he is found to have a blood pressure of 128/84, pulse of 118, RR of 28, and a temperature of 100.2. The chest x-ray is unremarkable and the EKG reveals sinus tachycardia at 120 but is otherwise normal. There are slight crackles present in the right base. Which of the following is the most likely diagnosis? a) Pneumonia b) COPD c) MI d) Pulmonary embolism

c (Xerosis)

A 72 yo male in otherwise good health complains of generalized pruritus that worsens in the winter. the itch is most intense after he bathes. Recently, he noticed the rash on his abdomen and legs as well. ON exam, you note poorly defined, red, scaly, plaques with fine fissures on the abdomen. No eruption is present at other pruritic sites. What is the most likely cause of the problem? a) Candidiasis b) Roasacea c) Xerosis d) Lichen simplex chronic e) Stasis dermatitis

c (Acyclovir)

A 72 yo patient with T2DM presents with a rash on his torso. He states he noticed some tingling along the side of his body yesterday and this morning he woke up with a slightly pruritus and painful rash. On exam there are crops of vesicles along his eighth rib on his left side. The rash does not cross the midline. Which of the following medications would you administer to this patient? a) Amoxicillin b) Tamiflu c) Acyclovir d) Zanamivir

a (aortic stenosis)

A 72-year-old male is brought to the emergency room by ambulance. The paramedic states the patient apparently experienced a syncopal episode while helping his son carry a bookcase up a flight of stairs. on arrival, he was alert and oriented. Your physical exam is unremarkable except for a systolic murmur in the right second interspace. What diagnosis does this presentation suggest. a) Aortic stenosis b) Aortic regurgitation c) Coarctation of the aorta d) Mitral stenosis e) Mitral regurgitation

b (Atrophic vaginitis)

A 73 yo AA female presents with vaginal bleeding. It is no severe and occurs only after intercourse. She is not taking HRT. What is the most likely diagnosis? a) Cervical polyps b) Atrophic vaginitis c) Cervical cancer d) Endometrial cancer e) Endometrial hyperplasia

b (Common names for this fracture are Colles fracture or silver fork deformity)

A 73 yo woman was watering her lawn when she tripped over the hose and landed on the ground. Her right hand took most of the impact. Radiographs show a break in the distal radius with the distal fragments minimally displaced toward the solar aspect. Which of the following is true? a) The complications of such fracture will be associated with median nerve and radial artery damage b) Common names for this fracture are Colles fracture or silver fork deformity c) The fracture can be treated best by wrapping with a bulky dressing until the swelling subsides and then casting in a long-arm cast for 6 weeks d) If the fracture is stable, it can be casted without trying to reduce the minimally displaced fracture

a (Lung cancer)

A 75 yo male has cough, dyspnea, and headache associated with neck vein distention and puffiness of the face and arms. What is the most likely diagnosis? a) Lung cancer b) Thyoma c) Hodgkin's disease d) Metastatic cancer of the thyroid

d (Total abdominal hysterectomy with bilateral salpingo-oophorectomy)

A 75 yo woman presents with postmenopausal bleeding. Her endometrial biopsy shows well- differentiated endometrial cancer. What is the best treatment for her? a) Radiation therapy b) Chemo with cisplatinum c) Combination of radiation and chemo with cisplatinum d) Total abdominal hysterectomy with bilateral salpingo-oophorectomy

a (Atrial fibrillation)

A 76 yo dedales presente for a routine physical exam. Her history is significant for longstanding hypertension. During the physical exam, you note her pulse to be irregularly irregular. Which of the following diagnoses does this finding suggest? a) Atrial fibrillation b) First-degree heart block c) Third-degree heart block d) LVH

d (Addition of 5-alpha-reductase inhibitors)

A 76 yo male has complains of frequency of urination, nocturia, hesitancy, urgency, and a weak urinary stream. He has been taking doxazosin for 5 months no with no relief. What is the next logical treatment of choice? a) TURP procedure b) Open prostatectomy c) Thermotherapy d) Addition of 5-alpha-reductase inhibitors

d (Arrange home health care for nurse directed multidisciplinary services )

A 76 yo male with CHF was admitted to the hospital for the third time in 1 year. He responded to treatment with IV lasix, oxygen, and morphine. Upon discharge from the last admission his medication included digoxin 0.125 daily, lasix 40 daily, and lisinopril 40 daily. He was also placed on a low salt diet. Which one of the following is most likely to help prevent future admissions and decrease overall medical costs for this patient in the next year? a) Increase the dosage of lisinopril b) Start amiodarone as prophylaxis against arrhythmia c) Admit to nursing home d) Arrange home health care for nurse directed multidisciplinary services

b (Palpable left ovary)

A 78 yo G5P5 woman presents for a routine annual pelvic exam. She has noted some weight gain recently but has no other complaints. On exam, her abdomen is soft, contender, and slightly obese with no palpable masses. Her liver span is 12 cm in the midclavicular line, she has a negative Murphy's sign. Her pelvic exam shows atrophic genitalia with a lack of rogation of the vaginal walls and a small, nontender, mobile uterus. Her left ovary is palpable, mobile, and contender. The right ovary is not palpable. What physical finding is abnormal in this patient? a) Nonpalpable with ovary b) Palpable left ovary c) Liver span of 12 cm d) Lack of vaginal wall rugation e) Parous cervix

d (unstable angina)

A 78-year-old male with a history of angina presents complaining of increasing chest pain. He notes he was previously able to walk six blocks before developing dyspnea and chest pain that would resolve with rest. Over the past several days, he has developed retrosternal chest pain on walking two to three blocks. He is presently comfortable at rest. What diagnosis does this presentation suggest? a) Aortic dissection b) Myocardial infarction c) Pulmonary hypertension d) Unstable angina

d (Silent abdomen, tympanic to percussion)

A 78yo female recently underwent hemicolectomy. Two days later she complains of abdominal pain and bloating. She denies flatulence and bowel movement. What will an abdominal exam show? a) Hypoactive bowel sounds, tympanic to percussion b) Hyperactive bowel sounds, tympanic to percussion c) Hypoactive bowel sounds, dull to percussion d) Silent abdomen, tympanic to percussion e) Silent abdomen, dull to percussion

b (Large red tonsils with or without exudates)

A 7yo boy tested positive for group A beta-hemolytic strep. What physical finding supports the diagnosis of this? a) Gray exudates on the tonsils b) Large red tonsils with or without exudates c) Trismus d) Tonsillar asymmetry

d (Intussusception)

A 9 mo old girl is brought into the ER. The mother reports that the child pulls her legs up to her abdomen and cries for 5-10 minutes followed by episodes of relaxed silence. She also reports that the child is passing blood and mucus in her stools. On exam, the patient is noted to have distended abdomen and a sausage shaped mass is palpable in the mid to lower right abdomen. The diaper is noted to contain a large amount of stool resembling currant jelly. What is the most likely dx? a) Cecal volvulus b) Diverticulitis c) Acute occlusion of mesenteric vessels d) Intussusception e) Ulcerative Colitis

d (Achalasia)

A barium esophagogram showing a "Bird's beak" appearance is characteristic of what disorder? a) Esophageal spasm b) Scleroderma c) Esophageal web d) Achalasia

c (Acute leukemia)

A bone marrow biopsy shows hypercellular marrow with 50% blast cells. This result is diagnostic of which of the following? a) Aplastic anemia b) Multiple myeloma c) Acute leukemia d) Chronic leukemia

b (Opens and closes the toy car door repeatedly and is upset if stopped)

A child who displays characteristics of autism is likely to show which of the following behaviors? a) finds parents to show off a new trick that he or she has learned b) Opens and closes the toy car door repeatedly and is upset if stopped c) Is excessively verbal with his or her peers d) Laughs at your jokes

c (The inability to sit still at a desk at school)

A child who has ADHA typically exhibits which of the following traits? a) A unique ability to stack blocks higher than the average child b) The ability to follow instructions precisely c) The inability to sit still at a desk at school d) Quiet and withdrawn behavior

c) Tertiary

A contaminated wound to the thigh is derided for several days while the patient is placed on systemic antibiotics. After 5 days, a skin graft is placed and the wound is closed. What type of closure is this? a) Primary b) Secondary c) Tertiary d) Delayed Secondary

b (Secondary)

A contaminated wound to the thigh is derided for several days while the patient is placed on systemic antibiotics. The wound is left open to heal on its own. What type of closure is this? a) Primary b) Secondary c) Tertiary d) Delayed primary

b (Prednisone and cyclophosphamide)

A favorable treatment result of polyarteritis nodes is seen with the combination of which medications? a) Prednisone and NSAIDs b) Prednisone and cyclophosphamide c) Methotrexate and NSAIDs d) Methotrexate and sulfasalazine

c (HTN)

A funduscopic exam that reveals dilated tortuous vessels and silver wiring is most commonly associated with which of the following diagnoses? a) Acquired immunodeficiency syndrome b) Diabetes c) HTN d) Marfan syndrome e) Sarcoidosis

c (Spontaneous pneumothorax)

A healthy appearing 25 yo male cigarette smoker presents to the ED with pleuritic chest pain and dyspnea. He is in mild distress. He is tall and thin and gives no medical history of significant problems. What is the most likely diagnosis? a) Pulmonary embolism b) Malignant effusion c) Spontaneous pneumothorax c) Pericarditis

c (Pancreatitis)

A middle aged female with primary hypertriglyceridemia presents with acute epigastric pain described as stabbing pain. She denies any alcohol intake for many years. What medical condition must be considered? a) ATN b) Aortic dissection c) Pancreatitis d) Toxic megacolon

d (surgery)

A mother brings her child to your office with concerns about "blue spells" that her child is having. She has noticed that he often squats down to rest when he is playing with his brothers. What its the treatment for this condition? a) Amoxicillin b) Erythromycin c) Physical therapy d) Surgery e) No treatment needed

a (Hyperacute rejection)

A patient becomes anuric 1 hour after undergoing surgical transplantation of a kidney. What type of rejection is this? a) Hyperacute rejection b) Accelerated acute rejection c) Acute rejection d) Chronic rejection

b (Atelectasis)

A patient develops a fever 1 days after elective gastrectomy surgery. her temp is 102F orally and she has a pulse rate of 112. What is the most likely cause? a) Anxiety syndrom b) Atelectasis c) Phlebitis d) UTI e) Wound infection

c (Supportive treatment)

A patient develops hemolytic anemia after taking a prophylactic antimalarial medication. A glucose-6-phosphatase dehydrogenase (G6PD) deficiency has been determined to be the most likely cause. The patient is stable. What is the recommended treatment for this patient? a) Red blood cell transfusion b) Intravenous prednisone c) Supportive treatment d) Intravenous vitamin K

b (Prepatellar bursitis)

A patient is a carpet layer who compulsions of knee pain and swelling over the past 2-3 days. On exam, you find warmth and edema directly over the dorsal aspect of his knee. Which of the following conditions would you expect to be present? a) IT band bursitis b) Prepatellar bursitis c) Pes anserinus bursitis d) Osgood-Schlatter disease

c (chronic pancreatitis)

A patient is sent to you with an elevated amylase and lipase and an abnormal endoscopic retrograde cholangiopancreatography report (ERCP) showing evidence of an autoimmune process and irregular narrowing of specific ducts. What is the most likely diagnosis? a) Chronic hepatitis b) Chronic cholangitis c) Chronic pancreatitis d) Chronic cholelithiasis

d (Diaphrosis)

A patient of yours with known panic disorder has just had another panic attack. Which of the following physical findings will you likely see? a) Bradycardia b) A steady hand c) Orthopnea d) Diaphrosis

d (Oral fluconazole)

A patient positive for HIV presents with new-onset dysphagia and odynophagia. On oral exam, you notice he has thrush along his tongue and buccal mucosa. What is the appropriate treatment for this patient? a) Topical clotrimazole troches b) Oral acyclovir c) Oral nystatin d) Oral fluconazole

b (Stage I hypertension)

A patient presents for a routine checkup and yo note his blood pressure to be 142/84. Which of the following is the most appropriate diagnosis for this patient? a) Prehypertension b) Stage I hypertension c) Stage II hypertension d) Accelerated hypertension e) Malignant hypertension

b (Lateralization to the affected ear. If Rinne then bone conduction would be greater than air conduction in the affected ear for the conductive hearing loss mentioned here)

A patient presents with a feeling of fullness in her right ear. She states it started 2 days ago and is getting worse. You examine her ear and it it full of wax. What would you most likely find on the Weber test? a) Lateralization away from the affected ear b) Lateralization to the affected ear c) Air conduction greater than bone conduction d) Bone conduction greater than air conduction

d (Angle-closure glaucoma)

A patient presents with a red, painful eye; nausea; vomiting; and a fixed mid-dilated pupil. What is your most likely diagnosis? a) Age-related macular degeneration b) Retinal detachment c) Primary open-angle glaucoma d) Angle-closure glaucoma

c (PT and PTT)

A patient presents with a severe posterior nosebleed. What initial laboratory studies should you order on this patient? a) CMP b) Factor V Leiden c) PT and PTT d) Serum iron

c (audiogram)

A patient presents with recurrent episodes of vertigo, tinnitus, and hearing loss. You suspect she may have Meniere's disease. Which of the following tests should you order during your initial work of this patient? a) CBC b) Blood cultures c) Audiogram d) CT of head

d (Reticulocyte count)

A patient was initiated on ferrous sulfate 325 mg three times daily for iron-deficiency anemia. What test can you order after 7 days that will signify bone marrow response to the iron? a) Hemoglobin and hematocrit b) Serum iron c) Red blood cell count d) Reticulocyte count

a (Order a CT scan of the orbits)

A patient was just in a fight and was taken by ambulance to the ED. As you examine the EOM, the patient states he is seeing double when he looks down and to the side. Based on this information, what do you do next? a) Order a CT scan of the orbits b) Order and MRI of the orbits c) Order a bone scan of the skull d) Order a PET scan of the orbits

b (Crusting and oily material around the eyelids)

A patient was told by his dermatologist that he has seborrheic blepharitis. What physical exam finding supports this diagnosis? a) Erythema and swelling around the eyelids b) Crusting and oily material around the eyelids c) Redness and watery discharge from the eye d) Contender, nonerythematous, and non fluctuant nodules on the eyelid

a (Antipsychotics)

A patient who has been diagnosed with borderline personality disorder is having trouble with anger, hostility and brief periods of loss of reality. Which of the following pharmacotherapeutic class would be best to use in reducing his symptoms? a) Antipsychotics b) Anxiolytics c) Anticonvulsants d) Antidepressants

c (Headache, abdominal pain, leg pain, and chest pain at the same or different visits)

A patient who has been diagnosed with somatization disorder is likely to have exhibited which of the following? a) Pain in the knee following an injury b) Diarrhea following a trip out of the country c) Headache, abdominal pain, leg pain, and chest pain at the same or different visits d) Headache after working all day

c (IV thiamine)

A patient who is suspect of having Wernicke's syndrome require which of the following clinical interventions? a) Outpatient treatment with oral multivitamin b) IV glucose c) IV thiamine d) IV vitamin B6

b (Bactrim)

A patient with HIV presents with fever, chills, night sweats, malaise, fatigue, exertion dyspnea, a nonproductive hacking cough, and retrosternal chest tightness. He has tachypnea on exam, and his finger pulse oxygen level is than 80% on room air. The chest radiograph reveals interstitial infiltrates beginning in the perihilar areas and spreading to the lower and upper lung fields in a butterfly pattern. what is the recommended treatment in this patient? a) Rifampin b) Bactrim c) Azidothmidine d) Atazanavir

d (transdermal scopolamine)

A patient with Meniere's disease requests medication because she is constantly dizzy and the spinning is making her nauseated. What is the first line treatment for her dizziness? a) Decrease salt in her diet b) HCTZ c) Intra-tympanic gentamicin d) Transdermal scopolamine

d (Pancreatitis)

A patient with a 20 year history of hyperparathyroidism consumes alcohol in large quantities. In addition to the alcohol, this medical condition generates increased concerns for which of the following? a) Alzheimer's disease b) Hepatic failure c) Hypocalcemia d) Pancreatitis

d (Red, painful eye with cloudy vision)

A patient with angle-closure glaucoma will present with which of the following complaints? a) Painless progressive central vision loss b) Decreased acuity, photophobia, and floaters c) Unilateral sudden loss of vision d) Red, painful eye with cloudy vision

c ( Inpatient psychologic treatment with all available therapy measures for several months)

A patient with anorexia nervosa who is 30% below the expected weight for height will require which of the following interventions? a) An increase in TCA b) More closely managed outpatient group therapy sessions c) Inpatient psychologic treatment with all available therapy measures for several months d) Negative reinforcement of weight gain through allowing exercise when desired

b (Clonazepam)

A patient with avoidant personality disorder may best be helped with rejection sensitivity by which of the following medications? a) Valproic acid b) Clonazepam c) Phenelzine d) Amitriptyline

a (Parenteral iron dextran)

A patient with inflammatory bowel disease has iron-deficiency anemia because of an inability to absorb iron. What is the recommended treatment for this patient? a) Parenteral iron dextran b) Oral ferrous sulfate c) Parenteral erythropoietin d) Intramuscular cyanocobalamin

a (Hypoglycemia)

A patient with known moderate Alzheimers disease and T2DM treated with along action oral SU for many years presents to the ED with her caregiver. Her caregiver reports that she administered the patient's morning diabetes pill over 12 hours ago and left food in the fridge for her to eat. The caregiver then left because of a family emergency, returnign in the evening to a stuporous patient and food still in the fridge. What is the most likely diagnosis? a) Hypoglycemia b) Hyperglycemia c) Sepsis d) TIA

b (Alprazolam and paroxetine immediately then decrease alprazolam when sx improve)

A patient with panic disorder has just had a new panic attack and is very fearful. he is not on any medicate at this time because of remission of all symptoms for more than 3 years. What is the appropriate urgent treatment that you should give this patient? a) Alprazolam and paroxetine immediately then decrease parexetine when sx improve b) Alprazolam and paroxetine immediately then decrease alprazolam when sx improve c) Haloperidol at a sufficient quantity until symptoms resolve d) Oral TCA

b (Diazepam)

A patient with severe acute adjustment disorder with anxiety that is bordering on panic would best be cared for with which of the following medications? a) Amitriptyline b) Diazepam c) Haloperidol d) Fluoxetine

c (Primary hypertriglyceridemia)

A patient's routine blood work shows a large amount of chylomicrons producing a supernatant chylomicron layer after refrigeration What is the most likely diagnosis? a) Cushing's syndrome b) Primary hypercholesterolemia c) Primary hypertriglyceridemia d) Congenital nicotinic acid deficiency

c (Primary hypertriglyceridemia)

A patient's routine blood work shows a large amount of chylomicrons producing a supernatant chylomicron layer after refrigeration. What is the most likely diagnosis? a) Cushing's syndrome b) Primary hypercholesterlemia c) Primary hypertriglyceridemia d) Congenital nicotinic acid deficiency

d (They will usually not look you in the eye)

A person who has been diagnosed with schizoid personality disorder is likely to have which of the following physical signs? a) They will have very detailed and long answers to your questions b) Their sensorium will be altered c) Their memory is bad d) They will usually not look you in the eye

c (Sleeping trouble)

A person who has known major depressive disorder is likely to have which of the following sx? a) Excessive energy b) Rare anxiety c) Sleeping trouble d) Continued interest in hobbies

c (Fears that they might be embarrassed in a social setting)

A person who has social phobia typically has which of the following? a) Does not see the phobia as excessive b) Always avoids any social setting c) Fears that they might be embarrassed in a social setting d) Dose not have panic attacks

b (A history of gambling money he or she doesn't have to lose)

A person with borderline personality disorder is likely to have which of the following findings? a) A stable mood overtime b) A history of gambling money he or she doesn't have to lose c) A history of loving family relationships d) A history of being overly happy and sometimes inappropriately happy

a (An appearance that is stiff, formal, and rigid in demeanor)

A person with obsessive-compulsive personality disorder is likely to have which to the following physical findings on mental status exam? a) An appearance that is stiff, formal, and rigid in demeanor b) A flatt affect c) A relaxed appearance during questioning d) Answers that are unusually short and concise

b (Irrigating with large volumes of normal saline under pressure)

Cleaning of open wounds is best accomplished using which method? a) Soaking the wound in sterile water b) Irrigating with large volumes of normal saline under pressure c) Irrigating liberally with iodine-based disinfectant d) Soaking wound in hydrogen peroxide

b (Nitrates)

Concurrent use of which class of drugs is an absolute CI to taking a PDE-5? a) Thiazide diuretics b) Nitrates c) Androgens d) Alpha-1 receptor blocker

b (Adrenal gland)

Addison's disease is a condition related to idiopathic failure of what organ? a) Islet cells of the pancreas b) Adrenal gland c) Pituitary gland d) Thymus gland

d (Sigmoid colon)

Diverticulosis occurs more frequently in which of the of the following locations? a) Ascending colon b) Descending colon c) Transverse colon d) Sigmoid colon

b (Indirect inguinal hernia)

During a PE of a 23 yo male, you place a fingertip into the scrotal sac and advance up into the inguinal canal. You notice a slight bulge protruding from the superolateral ring into the inferomedial region and the bulge lightly strikes the distal tip of the finger. What type of hernia is the most consistent with? a) Direct inguinal hernia b) Indirect inguinal hernia c) Incisional hernia d) Umbilical hernia

b (Manual extraction)

During the third stage of labor your patient suddenly begins to hemorrhage. What is the best treatment for the patient? a) Administer oxytocin b) Manual extraction c) Vacuum extracion d) C-section delivery e) Forceps

b (Mental status testing)

Early recognition of dementia by health-care providers can be aided by routine use of which of the following? a) CT or MRI b) Mental status testing c) CSF protein analysis d) APO-E testing

b (CHF)

Examination of fluid from a pleural effusion reveals that the fluid is a transudate. Which of the following is the most likely etiology? a) Pulmonary malignancy b) CHF c) Pneumonia d) Tuberculosis

a (Iron-deficiency anemia)

Fatigue, pallor, and reduced exercise capacity are common manifestations of which of the following conditions? a) Iron-deficiency anemia b) Vitamin B12 deficiency c) Folate deficiency d) Thrombotic thrombocytopenia purpura

b ("Slapped cheek" appearance)

Fifth disease can present with what type of appearance? a) "Dew drops on rose petals" rash b) "Slapped cheek" appearance c) "Christmas tree" distribution rash d) "Strawberry" tongue

d (Ganiclovir)

First line treatment for a patient with HIV recently diagnosed with the CMV includes which of the following? a) Acyclovir b) Cidofovir c) Itraconazole d) Ganiclovir

a (Topical estrogen)

For menopausal patients with symptomatic atrophic vaginits, what is the treatment of choice? a) Topical estrogen b) Oral estrogen c) Oral progesterone d) Topical progesterone

a (Carpal tunnel syndrome)

For what condition would you use a Tinel test? a) Carpal tunnel syndrome b) de Quervain's disease c) Ganglion cyst d) Dupuytren's contracture

b (Tinea versicolor)

Gently scraping the scale of the lesion and evaluating it under a microscope with KOH reveals a "meatball and spaghetti" pattern. What is the most likely diagnosis? a) Guttate psoriasis b) Tinea versicolor c) Pityriasis rosea d) Nummular eczema

a (Oral-fecal route)

Hepatitis A is commonly spread by which of the following? a) Oral-fecal route b) IV drug use c) Sex d) Mother-fetus

b (Rough and ofter hyperkeratotic)

How are the borders of actinic keratosis lesions best described? a) Smooth and pearly b) Rough and ofter hyperkeratotic c) Greasy and stuck on d) Raised with a fine scale

d (History and physical)

How is Guillain-Barre diagnosed? a) Positive finding on brain MRI b) PET of the spinal column c) Increased glucose in spinal fluid d) History and physical

b (3-5)

How many days should sutures for lacerations on the face stay in place before removal? a) 1-2 b) 3-5 c) 7-10 d) 10-14

d (Care for the physical needs of the patient and offer safe shelter information)

If you suspect domestic abuse what is the most appreciate intervention? a) Keep the suspected abuser with the patient to keep a closer watch on the suspected abuser b) Call law enforcement immediately so they can arrest the suspected abuser c) Care of the physical needs of the patient after confronting him or her about the abuse d) Care for the physical needs of the patient and offer safe shelter information

d (Testicular torsion)

In a 12 yo male with symptoms of epididymitis, what is the most common differential diagnosis that first must be ruled out? a) Acute orchitis b) Hydrocele c) Spermatocele d) Testicular torsion e) Testicular tumor

c (Anxiolytics)

In a patient diagnose with conversion disorder, besides hypnosis and behavioral relaxation exercises, what pharmacotherapeutic class of medication may be of benefit in reducing the patient's symptoms? a) TCA b) Antipsychotics c) Anxiolytics d) Sedatives

c (Clindamycin)

In a patient with a congenital heart defect and a history of anaphylaxis to penicillin, what agent is usually used for endocarditis prophylaxis when undergoing dental procedures? a) Cefazolin b) Cefotetan c) Clindamycin d) Vancomycin

b (Fecal impaction)

In elderly patients in hospital and nursing homes, what is fecal incontinence most commonly the result of? a) Decreased sphincter tone b) Fecal impaction c) IBD d) Infectious diarrhea

c (Serum iron)

In iron-deficiency anemia, the synthesis of hemoglobin continues as long as which go the following remains on a normal level? a) Total iron binding capacity (TIBC) b) Ferritin c) Serum iron d) Transferrin

c (Serum iron)

In iron-deficiency anemia, the synthesis of hemoglobin continues as long as which of the following remains at a normal level? a) Total iron-binding capacity (TIBC) b) Ferritin c) Serum iron d) Transferrin

c (bone density)

In patients receiving cortisol replacement therapy for primary adrenocortical insufficiency what must be monitored? a) Hemoglobin b) Sodium levels c) Bone density d) TSH levels

d (Asymmetry)

In regard to the ABCD rule for moles, what does "A" represent? a) Ascription b) Assessment c) Allowance of margins d) Asymmetry

b (Years before a lesion can be palpated)

In relation to a clinical exam, when can mammogram detect breast cancer? a) About the same time the lesion can be palpated b) Years before a lesion can be palpated c) Only a year after the lesion can be palpated d) Only if the lesion is cystic

c (Second degree heart block- Mobitz II)

In reviewing a patient's EKG strop, you note that there are two P waves for every QRS complex. What rhythm does this finding describe? a) First degree heart block b) Second degree heart block- Mobitz I c) Second degree heart block- Mobitz II d) Third degree heart block

b (Functional residual capacity)

In the elderly, which one of the following measures of pulmonary function is characteristically increased as a result of increasing age? a) FEV1 b) Functional residual capacity c) Resting PaCO2 arterial tension d) Vital capacity e) Total lung capacity

d) >10%

In the first trimester, what level of Hgb A1C is associated with a greater than 20% risk of a major congenital malformation of the fetus? a) <4% b) <6% c) >8% d) >10%

d (>10)

In the first trimester, what level of Hgb A1C is associated with a greater than 20% risk of major congenital malformation of the fetus? a) <4 b) <6 c) >8 d) >10

b (He should wait until about 6-8 weeks after onset of sx to resume any activities that may cause abdominal trauma)

After a recent episode of mono caused by EBV, a young man would like to get back to participating in sports. He states he feels better and denies any residual symptoms such as malaise or fatigue. What advice would you give him? a) He can begin to play sports again immediately b) He should wait until about 6-8 weeks after onset of sx to resume any activities that may cause abdominal trauma c) He should wait until about 2 weeks after the onset of sx to resumes any activities that may cause abdominal trauma d) Sports related activities are strictly prohibited for 6 months after the onset of sx

d (Within 72 hours)

After an episode of unprotected intercourse, when should emergency contraception be administered? a) Within 24 hours b) Within 36 hours c) Within 48 hours d) Within 72 hours

d (Antidepressants)

Along with cognitive behavioral therapy, which class of pharmacotherapeutics is most effective in reducing the binge/purge rate in a patient with bulimia nervosa? a) Antipsychotics b) Anxiolytics c) Sedatives d) Antidepressants

c (Molluscum contagiosum)

Am 18 yo wrestler states that he has had "funky bumps" on his head, abdomen, and armpits for several weeks now. These bumps you find appear to be pearly, papular, umbilicate, and normopigmented in some areas and hypo pigmented in others. The bumps measure 2-5 mm in diameter. What is the presumptive diagnosis? a) Verruca vulgaris b) Herpes simplex c) Molluscum contagiosum d) Folliculitis capitis

d (Heterophile test)

An 18 yo patient presents with enlarged, beefy-red tonsils. She is empirically treated with amoxicillin for a presumed bacterial infection. Two days later she returns to the clinic with diffuse rash also ver her body. What diagnostic test would best confirm your diagnosis? a) CBC b) Lyme titer c) HIV titer d) Heterophile test

d (Fibula)

An 18 yo woman wearing high heels twisted her right ankle while rushing to keep an appointment. Swelling and pain are evident in the lateral aspect of the ankle. What type of fracture are yo likely to see on an oblique x-ray? a) Calcaneus b) Metatarsals c) Tibia d) Fibula

c (Multiple pink/red based lesions found in various states, including macular, vesicular, and crusted, throughout the torso and face with little involvement of the extremities)

An 8 yo female has been brought to your office for evaluation for complaints of decreased activity; low grade fever; mildly runny nose; and an itchy, slightly tender rash that broke out on the torso 2 days ago and has begun to develop in the mucosal regions of the body. Your diagnosis is chicken-pox because of which of the following term findings? a) Multiple, pink, slightly raised lesions from 2-5 cm in diameter b) Multiple macular and blistering lesions with a positive Nikolsky's sign c) Multiple pink/red based lesions found in various states, including macular, vesicular, and crusted, throughout the torso and face with little involvement of the extremities d) Multiple small pink/red based lesions with small vesicles located in a dermatome distribution on the right side of the face

b (Risk factors for falls include weakness, gait and balance deficits, visual impairment, depression, poor lighting, and loose carpet in the home)

An 80 yo man comes to your clinic accompanies by his daughter. She is concerned because her father recently lost his balance while walking through the house. The daughter explains that is she had not been walking with her father, he would have fallen and injured himself. He has HTN, BPH, and CAD but is able to perform activities of daily living. Which of the following statements is true regarding the primary care assessment of gait and falls in the elderly? a) Older patients should be assessed for risk of falls every 5 years b) Risk factors for falls include weakness, gait and balance deficits, visual impairment, depression, poor lighting, and loose carpet in the home c) A single fall is always a sign of major problem and an in creed risk for subsequent falls d) Medications that decrease the risk for falls include loop diuretics, vasodilators, adrenergic antagonists, antidepressants, and sedative hypnotic agents

c (B12 and folate)

An 80-year-old male complains of fatigue and a sore tongue. His mean corpuscular volume (MCV) is 102 μm3 and hypersegmented neutrophils are noted on peripheral smear. What test would be most beneficial to order next on this patient? a) Ferritin b) Serum iron c) B12 and folate d) Bone marrow biopsy

b (Drug-induced delirium)

An 82 yo male recovering in the hospital from surgical hip replacement has the onset of confusion, anxiety, and disorientation. He has received several doses of meperidine for pain control over the pst several hours. He is afebrile and his lungs are clear to auscultation. MRI of the brain reveals mild cortical atrophy. There is no previous medical history of dementia. What is the most likely diagnosis? a) Alzhemier's b) Drug-induced delirium c) Delirium resulting from occult infeciton d) Wenicke's encephalitis

d (Ischemic bowel)

An 82-year-old woman arrives at the emergency department complaining of severe abdominal pain. The pain started suddenly and has progressively increased since the onset a couple hours earlier. She had one episode of bloody diarrhea before arrival. She has a history of atrial fibrillation and hypertension. Abdominal exam is significant for diffuse tenderness, but the pain is our of proportion to the exam. What is the most likely diagnosis? a) Cholecystitis b) Diverticulitis c) Ruptured aortic aneurysm d) Ischemic bowel

d (If the patient/patient's family accepts hospice, he could continue to be hospitalized in the future under certain circumstance)

An 88 yo man with end-stage Alzheimers disease is re-admitted to a nursing home after a hospital admission for aspiration pneumonia. During the hospitalization, his family reiterated their knowledge that the patient would not have wanted a feeding tube or resuscitative measure to prolong the dying process. One of the nurses at the nursing home asks whether the patient is a hospice candidate. Which of the following is true? a) Patient does not qualify for hospice based on Alzhemier diagnosis b) Patient cannot qualify for hospice care through another community agency because the nursing home is responsible for providing all of the patient's care c) Because the patient is profoundly demented, he will not benefit from hospice d) If the patient/patient's family accepts hospice, he could continue to be hospitalized in the future under certain circumstance

c (Admit him to the hospital to gain pharmacotherapy control)

An Iraq War veteran with known PTSD has threatened to do bodily harm to the local police chief. What it the most appropriate management for this patient? a) Increase his dose of paroxetine b) Increase his group therapy sessions c) Admit him to the hospital to gain pharmacotherapy control d) Add a benzo to his regimen on an outpatient basis

d (Folate deficiency)

An alcoholic patient has a megaloblastic anemia. What is the most likely cause? a) Liver failure b) Vitamin B12 deficiency c) Niacin deficiency d) Folate deficiency

b (LAD)

An anterior wall MI typically results from atherosclerotic dishes of which of the following coronary arteries? a) Circumflex b) LAD c) Posterior descending artery d) Right

c (Prevent adhesive capsulitis)

An elderly patient recovering from a proximal humerus fracture is advised to do pendulum exercises. What is the purpose of this therapy? a) Promote healing of the fracture b) Prevent hidradenitis suppurative c) Prevent adhesive capsulitis d) Promote range of motion of the elbow

c (Prevent adhesive capsulitis)

An elderly patient recovering from a proximal humerus fracture is advised to do pendulum exercises. What is the purpose of this therapy? a) Promote healing of the fracture b) Prevent hidradenitis suppurative c) Prevent adhesive capsulitis d) Promote range of motion of the elbow

d (vitamin D deficiency)

An elderly person has a 3-year history of progressively increasing diffuse skeletal pain, proximal muscle weakness, and an antalgic gait. The medical history is significant for multiple fractures with little known trauma. What is the most likely diagnosis? a) Secondary hyperparathyroidism b) Osteoporosis c) Rheumatoid arthritis d) Vitamin D deficiency

a (Incision and drainage)

An oversight 34 yo woman presents with a swollen, painful lesion in her right axilla. On further questioning, she states that she has had these before and that she is a smoker. PE reveals a fluctuant, tender nodule with no erythema or streaking. The patient is afebrile and nontoxic with normal vital signs. What is your treatment? a) Incision and drainage b) Topical abx c) Oral abx d) Parental abx

a (Ankylosing spondylitis)

Any patient between ages 15-25 years who presents with dull, aching back pain and boring stiffness may likely have mechanical back pain but should also be considered for what condition? a) Ankylosing spondylitis b) Myasthenia gravis c) Herniated nucleus pulposus d) Spondyloisthesis

a (Ankylosing spondylitis)

Any patient between ages 15-25 years who presents with dull, aching back pain and morning stiffness ay likely have mechanical back pain but should also be considered for what condition? a) Ankylosing spondylitis b) Myasthenia gravis c) Herniated nucleus pulposis d) Spondylolistheis

b (Report all suspected child abuse to child protective services or other appropriate agency)

Appropriate intervention in a suspected child abuse case is which of the following? a) Call law enforcement to arrest the suspected abuser b) Report all suspected child abuse to child protective services or other appropriate agency c) Call security personnel in case the suspected abused strikes at you d) Report child abuse if your state law requires that you must do so

b (40%)

Approximately what percentage of patients with bipolar I disorder will have a lifelong chronic condition that will require continued treatment? a) 10% b) 40% c) 80% d) 100%

d (Hip fracture)

As you walk through the hospital you see an elderly patient lying on a gurney and waiting to go into the x-ray department. Her feet and lower legs are exposed and you notice her left leg is shortened and externally rotated. Base on the finding, what is your presumptive diagnosis? a) Dislocated hip b) Fracture of the femoral shaft c) Fracture of the tibia d) Hip fracture

d (Hip fracture)

As you walk through the hospital you see an elderly patient lying on a gurney and waiting to go into the x-ray department. Her feet and lower legs are exposed and you notice her left leg is shortened and externally rotator. Base on the finding, what is your presumptive diagnosis? a) Dislocated hip b) Fracture of the femoral shaft c) Fracture of the tibia d) Hip fracture

c (1500IU)

At that level of B-HCG can an intrauterine pregnancy be detected by transvaginal US? a) 500 IU b) 1000 IU c) 1500IU d) 3000IU e) 4500 IU

c (1500 IU)

At what level of B-hcg can an intrauterine pregnancy be detected by transvaginal ultrasound? a) 500 IU b) 1000 IU c) 1500 IU d) 3000 IU e) 4500 IU

b (A diffuse white-out appearance)

Chest radiography in the patient with acute respiratory distress syndrome (ARDS) reveals which of the following classic patterns? a) Lobar consolidation b) A diffuse white-out appearance c) A visible pleaural line d) Bilateral bat wing-shaped infiltrates

c (Respiratory arrest and loss of patellar reflexes)

Intrapartum management of severe preeclampsia involves IV magnesium sulfate. Hypermagnesemia is associated with what side effect? a) Oliguira and respiratory arrest b) Seizures and loss of patellar reflexes c) Respiratory arrest and loss of patellar reflexes d) Seizures and oliguria e) Seizures and respiratory arrest

b (Seizures and loss of patellar reflex)

Intrapartum management of severe preeclampsia involves IV magnesium sulfate. Hypermagnesemia is associated with which of the following side effects? a) Oliguria and respiratory arrest b) Seizures and loss of patellar reflex c) Respiratory arrest and loss patellar reflex d) Seizures and oliguria e) Subcutaneous insulin pumps

a (Acute lymphocytic leukemia (ALL))

Kevin is a 9-year-old soccer player. His mother is concerned because he seems to get tired quickly while playing and has been sleeping a lot. He also complains of bone pain in his legs and has more bruises on his legs than usual. Blood work shows a pancytopenia. A monospot is negative. In addition to aplastic anemia, which of the following should be included in the differential diagnosis? a) Acute lymphocytic leukemia (ALL) b)Chronic lymphocytic leukemia (CLL) c) Chronic myelogenous leukemia (CML) d) Hodgkin's lymphoma

d (Exposure to asbestos)

Mesothelioma is a type of lung cancer that is associated with which of the following? a) Chronic exposure to silica dust b) Exposure to benzene c) Chronic alcohol use d) Exposure to asbestos

a (Recurrent hospitalizations)

More than 50% of patients diagnosed with schizophrenia often require which of the following clinical interventions? a) Recurrent hospitalizations b) Minimal family support c) Infrequent medication adjustments d) Psychosocial therapy alone

c (Methylmalonic acid (MMA)- The homocysteine level can be elevated in both Vitamin B12 and folate deficiency. The MMA will be increased only in vitamin B12 deficiency)

Mr. Carpenter, who is 72 years old, has symptoms consistent with a megaloblastic anemia. In a vitamin B12 deficiency his folate level will be normal. What other test can you order to differentiate between a vitamin B12 and folate deficiency? a) Homocysteine b) Antiparietal antibody c) Methylmalonic acid (MMA) d) Serum electrophoresis

a (Cystic fibrosis)

Mrs. Jones presents with her 2 year old male child, whose chief complaints are chronic respiratory infections, foul-smelling pale stools, weight loss, and wheezing. The parent reports using moist mist treatments repeatedly with some relief. Clinical exam shows delayed growth, enlarged spleen upon palpation, and clubbing of fingers and toes. Auscultation of the lungs demonstrates pulmonary congestion. Las results report a positive fecal fat test and a sweat chloride test. What is the most likely diagnosis? a) Cystic fibrosis b) Pulmonary aspergilloma c) Pulmonary histiocytosis d) Pulmonary nocardiosis e) Pulmonary tuberculosis

c (corticosteroids)

Patient with polymyositis should initially be tried on what medication? a) COX-2 inhibitors b) Methotrexate c) Corticosteroids d) No medication regimen is helpful

c (Patient education, pharmacotherapy, and psychotherapy)

Patients who have PTSD best improve over time with which of the following therapeutic approaches? a) Pharmacotherapy and behavior therapy b) Cognitive and behavior therapy c) Patient education, pharmacotherapy, and psychotherapy d) Group therapy and family therapy

b (Antidepressants)

Patients with schizoaffective disorder should be prescribed which class of medication? a) Sedative/hypnotics b) Antidepressants c) Anxiolytics d) Narcotic-analgesics

c (Feelings of depression and hopelessness)

People who are obese typically have which of the following findings? a) Member of upper socioeconomic class b) Knowledge of food groups and appropriate choices c) Feelings of depression and hopelessness d) Being a Caucasian male

d (Vitamin B12)

Pernicious anemia is a deficiency commonly associated with which vitamins? a) Vitamin B1 b) Vitamin B3 c) Vitamin B6 d) Vitamin B12

a (renal)

Polyarteritis nodosa is a necrotizing vasculitis of small and medium sized muscular arteries and frequently involved which organ system? a) Renal b) CNS c) Pulmonary d) Lymphatic

c (Iron deficiency)

Pregnant women and menstruating females are at risk of developing which of the following types of anemia? a) Folate deficiency b) Vitamin B12 deficiency c) Iron deficiency d) Spherocytosis

b (CT scan)

What is the preferred initial image study when there is a suspicion that the patient has pancreatic cancer? a) Endoscopic ultrasound b) CT scan c) Cholangiography d) ERCP

a (Blood supply to the scaphoid)

What is the primary reason scaphoid fractures have problems healing? a) Blood supply to the scaphoid b) Inability to properly x-ray the bone c) Inability to properly diagnose d) Mechanism of the injury

a (Blood supply of the scaphoid)

What is the primary reason that scaphoid fractures have problems healing? a) Blood supply of the scaphoid b) Inability to properly x-ray the bone c) Inability to properly diagnose d) Mechanism of injury

b (Prevention of a relapse of ALL)

What is the purpose of post-remission chemotherapy in acute lymphocytic leukemia (ALL)? a) Continual suppression of the white blood cell count b) Prevention of a relapse of ALL c) Prevention of systemic central nervous system (CNS) effects d) To ensure CNS penetration by chemotherapy

d (Surgical resection)

What is the recommended treatment for Cushing's caused by an identified adrenal adenoma? a) Chemotherapy b) Cortisol blocking agents c) Radiation therapy of the adenoma d) Surgical resection

b (Kobner's phenomenon)

What is the reproduction of skin lesions as a result of nonspecific trauma such as scratching, sunlight, or a burn called? a) Lichenification b) Kobner's phenomenon c) Wickham's striae d) Auspitz sign

c) Inflammatory stage

What is the stage in wound healing that involved the accumulation of lymphocytes and granulocytes and the removal of debris and macrophages? a) Proliferaticestage b) Epitheliazation c) Inflammatory stage d) Neovascularization e) Tissue remodeling

b (Open reduction with internal fixation)

What is the surgery of choice for a fracture of the femoral neck? a) Total hip arthroplasty b) Open reduction with internal fixation c) Replacement of femoral head d) Acetabular replacement

c (Prokinetic agents)

What is the treatment for postoperative ileus? a) Immediate laparoscopy b) Barium enema c) Prokinetic agents d) upper endoscopy

c (Sacrolitis)

What is the typical finding on MRI of patients with ankylosing spondylitis? a) Herniated nucleus pulposis b) Spinal stenosis c) Sacrolitis d) Spondylolisthesis

b (Abrupt or step wise cognitive deterioration)

What is vascular dementia characterized by? a) Gradual cognitive deterioration b) Abrupt or step wise cognitive deterioration c) Normal neurologic exam d) Normal blood pressures

c (Sacroilitis)

What it the typical finding on MRO of patients with ankylosing spondylitis? a) Herniated nucleus pulposis b) Spinal stenosis c) Sacroilitis d) Spondylolisthesis

a (TSH)

What lab test is used for screening hypothyroid conditions? a) TSH b) T3 c) T4 d) Antithyroglobulin antibodies

d (Glucocorticoid therapy)

What medication is used as the mainstay in treatment polymyalgia rheumatic? a) Hydroxychloroquine b) Methotrexate c) NSAIDs d) Glucocorticoid therapy

c (Staphylococus aureus)

What organism is the most commonly associated with infectious endocarditis in a patient who is an IV drug abuser? a) Cardiobacterium hominis b) Eikenella corrodens c) Staphylococus aureus d) Streptococcas mutans

d (Steeple sign)

What radiographic finding is associated with croup? a) Thumbprint sign b) Throckmorton;s sign c) Empty cup sign d) Steeple sign

d (alcohol)

What should a patient diagnosed with cluster headaches avoid? a) Prolonged sleeping b) Caffeine c) Weight lifting d) Alcohol e) Carbonated beverages

a (Patients planning to get pregnant should start taking 0.4 mg/day before conception)

What statement is true regarding folic acid supplementation? a) Patients planning to get pregnant should start taking 0.4 mg/day before conception b) Folic acid supplementation should be decreased in patient with gestational diabetes c) Folic acid can help prevent miscarriages d) Folic acid supplementation should be decreased in patient with HTN

a (Vitamin C)

What supplement is recommended with oral iron therapy to enhance absorption? a) Vitamin C b) Vitamin D c) Vitamin B12 d) Calcium

c (Direct Coomb's test)

What test establishes the diagnosis of autoimmune hemolytic anemia? a) CBC with differential b) Hemoglobin c) Direct Coomb's test d) Haptaglobin level

b (Positive Nitrazine test)

What test would be helpful in confirming that a patient has ruptured membranes at 28 weeks? a) Positive whiff test b) Positive Nitrazine test c) Absence of ferning d) Lecithin/sphinogomyelin ration e) Presence of phosphatidylglycerol

c (Barium esophagogram)

What test would best demonstrate the etiology of common esophageal motility disorders? a) CT scan b) Esophageal endoscopy c) Barium esophagogram d) Transesophageal ultrasound

c (High-dose IV corticosteroids)

What treatment for multiple sclerosis can shorten an acute attack? a) High-dose parental antibiotics b) Parenteral NSAIDs c) High-dose IV corticosteroids d) High-dose oral cordicosteroids

d (The desire and will to quit)

What treatment is most effective for people who use tobacco to quit? a) Nicotine patches, gum, and nasal sprays b) Smoke-free work environments c) Non-nicotine medications such bupropoion d) The desire and will to quit

b (Small cell carcinoma)

What type of bronchogenic carcinoma is associated with the worst prognosis? a) Squamous cell carcinoma b) Small cell carcinoma c) Adenocarcinoma d) Large cell carcinoma e) The prognosis is the same for all types

b (Cluster headache)

What type of headache is more common in men and typically presents with a unilateral non throbbing headache, lacrimation, and nasal congestion? a) Tension headache b) Cluster headache c) Migraine headache d) Temporal arteritis e) Brain tumor

d (Postoperative ileus)

What type of ileus can be caused by anesthesia, electrolyte imbalance, and/or wound infections? a) Dynamic ileus b) Adynamic ileus c) Mechanical ileus d) Postoperative ileus

b (Gram negative bacteria)

What type of organism is most frequently involved in septic shock? a) Gram positive bacteria b) Gram negative bacteria c) Intracellular obligates d) Rickettsiae e) Helminths

c (Hypovolemic)

What type of shock is the most common one during surgery? a) Cardiogenic b) Neurogenic c) Hypovolemic d) Anaphylactic

e (5-0 nonabsorbable on a cutting needle- the thinner the better)

What type of suture and needle should be used for closure of a laceration on the chin of a4-year-old girl? a) 2-0 nonabsorbable on a taper needle b) 2-0 absorbable on a cutting needle c) 3-0 nonabsorbable on a cutting needle d) 5-0 absorbable on a cutting needle e) 5-0 nonabsorbable on a cutting needle

a (Gastrin secreting)

What type of tumor causes Zollinger-Ellison syndrome? a) Gastrin secreting b) Epinephrine secreting c) Bile secreting d) Prostaglandin secreting

b (Inability to speak in a high pitch)

What would injury to the superior laryngeal nerve on one side cause? a) Hoarse voice b) Inability to speak in a high pitch c) Inability to elevate shoulders d) Weak cough

c (The levels should double)

What would you expect to see in a normal pregnancy when comparing the levels go B-hcg taken 48 hours apart? a) the levels should remain unchanged b) The levels should decrease by half c) The levels should double d) The levels should triple

c (The levels should be double in 48 hours)

What would you expect to see in normal pregnancy when comparing the levels of B-HCG taken 48 hours apart? a) The levels should be unchanged over 48 hours b) The levels should be decreased by half in 48 hours c) The levels should be double in 48 hours d) The levels should triple in 40 hours

d (Class IV)

When evaluating a patient for anesthesia prior to the operation, you have the patient open his mouth. All you can see is hard palate. What Mallampati classification is this? a) Class I b) Class II c) Class III d) Class IV

b (Class II)

When evaluating a patient for anesthesia prior to the operation, you have the patient open his mouth. You can see his hard palate, soft palate, and most of the uvula. What Mallampati classification is this? a) Class I b) Class II c) Class III d) Class IV

c (ASA)

When treating a child with influenza, which of the following meds should be avoided? a) Amantadine b) Acetaminphen c) ASA d) Ibuprofen

a (Sigmoid colon)

Where do most episodes of volvulus occur? a) Sigmoid colon b) Descending colon c) Transcending colon d) Ascending colon

e (Tetracycline)

Which antibiotic class is absolutely contraindicated in pregnancy? a) Penicillin b) Cephalosporin c) Aminoglycoside d) Erythromycin e) Tetracycline

a (Vitamin B12 and thiamine deficiencies)

Which are reversible cause of dementia? a) Vitamin B12 and thiamine deficiencies b) Secondary syphilis and neurosyphilis c) Frontal lobe infarction and vascular dementia d) Creutzfeldt-Jakob disease an do the prion disease

c (Pes anserinus bursitis)

Which bursitis of the knee is most prevalent in runners with excessive gene valgum? a) IT band bursitis b) Prepatellar bursitis c) Pes anserinus bursitis d) Osgood-Schlatter disease

d (Benzodiazepines)

Which category of meds can be used to best control interpersonal anxiety in patients diagnosed with schizoid personality disorder? a) Antidepressants b) Antipsychotics c) Serotonergic agents d) Benzodiazepines

d (SSRIs)

Which drug category is the most widely used in the US for depressive disorders? a) TCA b) MAOI c) Sympathomimetics d) SSRIs

c (CNS stimulants)

Which drug class is used as first line treatment to control the symptoms of ADHD and ADD? a) SSRIs b) TCA c) CNS stimulants d) Anxiolytics

c (Dopamine receptor antagonists- antipsychotic meds)

Which drug class, introduced in the early 1950s, significantly changes treatment of schozophrenia? a) SSRIs b) TCA c) Dopamine receptor antagonists d) MAOIs

b (Epididymitis)

Which findings is most specific in distinguishing pyelonephtiris from cystitis? a) Orchitis b) Epididymitis c) Testicular torsion d) Varicocele e) Hydrocele

d (MRI)

Which imaging technique has proved most useful for breast cancer screening in women who have had silicone breast implants? a) Thermography b) US c) Mammography d) MRI

d (Surgery in a patient with congenital prothrombin deficiency )

Which is an indication for transfusion of fresh frozen plasma? a) Planned surgery in a patient with hypoalbuminemia b) Planned surgery in a patient with nutritional deficits c) Volume replacement following surgery d) Surgery in a patient with congenital prothrombin deficiency

a (Cognitive behavioral therapy)

Which is the first line treatment for bulimia nervosa? a) Cognitive behavioral therapy b) Dynamic psychotherapy c) Pharmacotherapy d) Family therapy

c (Ipratropium bromide- anticholinergic agent- antagonizes acetylcholine receptors, producing bronchodilation)

Which is the preferred bronchodilator agent in the patient with COPD? a) Albuterol b) Salmeterol c) Ipratropium bromide d) Saline

d (Ibuprofen)

Which medication can cause constriction of the fetal ductus arteriosus and should not be given after 32 weeks? a) Heparin b) Codeine c) Warfarin d) Ibuprofen e) Acetaminophen

e (Persistent late decelerations)

Which of the fetal tracing patterns listed is an indication for immediate delivery by cesarean? a) Variable decelerations b) Early decelerations c) Acceleration after scalp stimulation d) Decreased variability e) Persistent late decelerations

a (A child with previous history of multiple fractures)

Which of the findings could be consistent with child abuse? a) A child with previous history of multiple fractures b) A child that is consolable by parents when a medical practitioner appears c) A child that has bruise on the knee from a flap off a bike d) A child that shows you an injury in from of his or her parents

b (Gallstones/alcoholism)

Which of the following are most commonly associated with acute pancreatitis? a) Drugs/toxins b) Gallstones/alcoholism c) Trauma/iatrogenic d) Metabolic/genetic factors

d (Nulliparity, early menarche, late menopause)

Which of the following are risk factors for developing breast cancer? a) Multiparty, late menarche, early menopause b) Nulliparity, late menarche, late menopause c) Multiparity, early menarche, late menopause d) Nulliparity, early menarche, late menopause

d (troponin)

Which of the following cardiac enzymes is the most specific indicator of myocardial tissue death? a) Creatinine b) Creatine kinase c) Myoglobin d) Troponin

c (Tetralogy of Fallot)

Which of the following conditions is classically associated with the finding of a "boot-shaped" heart on a plain chest radiograph? a) Atrial septal defect b) Coarctation of the Aorta c) Tetralogy of Fallot d) VSD

a ( Vitamin K deficiency)

Which of the following conditions occurs as a result of intentional malabsorption? a) Vitamin K deficiency b) Vitamin C deficiency c) Chronic pancreatitis d) Diverticulosis

a (Epididymitis)

Which of the following conditions would have positive Prehn's sign? a) Epididymitis b) Testicular torsion c) Acute prostatitis d) Chronic prostatitis e) Paraphimosis

c (Latex condoms)

Which of the following contraceptive methods offers the most protection against STI? a) IUD b) OCP c) Latex condoms d) Cervical caps e) Diaphragms

c (Decline in creatinine clearance with an increase in age)

Which of the following correctly describes an age-related physiological alteration that affects the pharmacokinetics of medications in geriatric patients? a) Altered GI function leading to decreased drug absorption b) Decrease in the body fat compartment c) Decline in creatinine clearance with an increase in age d) Decrease in serum albumin levels with an increase in age e) Increase in the water compartment

c (Spirometry)

Which of the following diagnostic aids has utility in distinguishing obstructive lung disease from restrictive lung disease and can be used to determine the severity of functional impairment? a) Pulse ox b) Arterial blood gas analysis c) Spirometry d) Chest radiograph

d (GERD)

Which of the following disorders is most commonly associated with Barrett's esophagus? a) Variceal disease b) Esophageal spasm c) Achalasia d) GERD

c (Haloperidol)

Which of the following drugs is best used to treat acute delirium? a) Chloramphenicol b) Diazepam c) Haloperidol d) Amobarbital

b (PSA)

Which of the following exams/tests would be most helpful in screening the differential diagnosis for an enlarged prostate? a) DRE b) PSA c) Bone scan of the lumbar spine d) Urethrocystoscopy

b (Painless loss of vision)

Which of the following eye complaints requires an immediate referral to an ophthalmologist? a) Conjunctival injection b) Painless loss of vision c) Photophobia d) Hemorrhange in sclera

c (Displacement of the uvula)

Which of the following findings helps to confirm the diagnosis of a peritonsillar abscess? a) Enlarged tonsils b) Pharyngeal erythema c) Displacement of the uvula d) Swollen lymph nodes

e (Elevated serum angiotensin-converting enzyme level)

Which of the following findings is more likely to be noted on evaluation of a patient with sarcoidosis than on evaluation of a patient with emphysema? a) Prolonged expiratory phase b) Elevated serum alpha1-antitrypsin level c) Increased total lung capacity d) Hyperlucency of the lungs e) Elevated serum angiotensin-converting enzyme level

d (Hyperpigmentaiton of the ankles)

Which of the following findings is most commonly associated with chronic venous insufficiency of the legs? a) Atrophy of the calf muscle b) Diminished dorsals pedis pulses c) Gangrene of the distal toes d) Hyperpigmentaiton of the ankles

b (honey)

Which of the following food products should be avoided in children younger than 6 months old? a) Wheat b) Honey c) Sugar d) Dairy

d (Absence seizures)

Which of the following forms of epilepsy usually starts in childhood? a) Simple partial seizure b) Complex partial seizures c) Tonic-clonic seizures d) Absence seizures e) Myoclonic seizures

d (Maternal age greater than 35 years )

Which of the following increases the risk of trisomy 21? a) Family of trisomy 21 b) previous preteen birth c) Elevated AFP at 16 weeks d) Maternal age greater than 35 years

a (Behavioral modification therapies)

Which of the following interventional methods has been shown to have the best long-term effect on obesity? a) Behavioral modification therapies b) Low-caloric intake diets c) Exercise d) Bariatric surgery

d (Outpatient psychotherapy along with appropriate pharmacotherapy)

Which of the following interventions has been shown to be the most effective in an adolescent diagnosed with bulimia nervosa? a) Punishment for binge and purge episodes b) SSRI alone c) Inpatient treatment for 6 mo or longer d) Outpatient psychotherapy along with appropriate pharmacotherapy

a (FNA)

Which of the following interventions is recommended for the workup of "cold" thyroid nodule? a) FNA b) Measurement of thyroid cancer antigens c) Radioactive iodine imaging d) Thyroidectomy

d (ATN)

Which of the following is a common cause of intrinsic renal failure? a) Diuretic induced azotemia b) Bladder neck obstruction c) Prostate cancer d) ATN

a (The pain occurs with decreasing exertion levels)

Which of the following is a hallmark of unstable angina? a) The pain occurs with decreasing exertion levels b) The pain is associated with dyspnea c) The pain is characterized as retrosternal burning d) The pain is associated with palpitations

c (Bupropion)

Which of the following is a non-nicotinic medication that can be used to aid a person during smoking cessation attempts? a) Amitriptyline b) Nicorette gum c) Bupropion d) NicoDerm CQ

d (Decrease in hepatic flow)

Which of the following is a normal physiological change of aging? a) Fatigue b) Decrease in body fat c) increase in maximum heart rate d) Decrease in hepatic flow

d (Using the telephone)

Which of the following is an instrumental ADL? a) Toileting b) Transferring c) Bathing d) Using the telephone

b (Lichen planus)

Which of the following is considered a papulosquamous rash? a) Nodular acne b) Lichen planus c) Tinea versicolor d) Erysipelas

d (Routine measurement of blood pressure)

Which of the following is considered a standard of care for management of T2DM of 10 years duration? a) Screening for microalbumineria every 5 years b) Screening for diabetic retinopathy every 10 years c) Screening for peripheral neuropathy when painful d) Routine measurement of blood pressure

c (Cardiac transplantation)

Which of the following is the best long term treatment for a patient with refractory left ventricular failure? a) Aortic valve replacement b) Aortic balloon pump c) Cardiac transplantation d) LVAD

c (biopsy)

Which of the following is the diagnostic test of choice for cutaneous cryptococcosis? a) Gram stain b) Culture c) Biopsy d) Lumbar puncture

a (Coronary angiography)

Which of the following is the gold standard for the evaluation of coronary artery disease? a) Coronary angiography b) Echocardiography c) Electrocardiography d) Nuclear medicine imaging

a (Chronic renal failure)

Which of the following is the most common cause of secondary hypertension? a) Chronic renal failure b) Coarctation of the aorta c) Hyperthyroidism d) Pheochromocytoma e) Renal artery stenosis

a (EEG)

Which of the following is the most important to obtain when diagnosis a seizure disorder? a) EEG b) MRI c) CT with contract d) CT without contrast e) PET

c (CHF)

Which of the following is the most likely cause of transudative pleural effusion? a) Bacterial infection b) Chest trauma c) CHF d) Malignancy

a (Hyperparathyroidism)

Which of the following is the most likely diagnosis for a generally healthy 60 yo white female with elevated ransom serum calcium. She eats a healthy diet and denies supplement use or prescription medication use. a) Hyperparathyroidism b) Hypoparathyroidism c) Sarcoidosis d) Vitamin D intoxication

c (echocardiography)

Which of the following is the procedure of choice for the assessment of pericardial effusion? a) CXR b) CT c) Echocardiography d) MRI

c (Bactrim)

Which of the following is the treatment of choice for pneumocystis jiroveci pneumonia? a) Penicillin b) A macrolide c) Bactrim d) Augmentin

c (Trimethoprim-sulfamethoxazole)

Which of the following is the treatment of choice for pneumocystis jiroveci? a) Penicillin b) A macrolide antibiotic c) Trimethoprim-sulfamethoxazole d) Amoxicillin with clavulanate

c (Persistent inflammatory synovitis)

Which of the following is typical of rheumatoid arthritis? a) Thickening of the skin proximal to the MCP joints b) A butterfly shaped rash on the face c) Persistent inflammatory synovitis d) Vesicular, hyperkeratotic lesions on the palms and soles

a (FTA-ABS)

Which of the following lab tests should be ordered to confirm a positive plasma reagin test in a patient with a suspected diagnosis of syphilis? a) FTA-ABS b) Dark-field exam c) VDRL d) Western Blot

b (Heterophile antibody test)

Which of the following lab tests would help confirm the diagnosis of acute infectious mono caused by EBV? a) Rapid plasma reagin test b) Heterophile antibody test c) Antinuclear antibody test d) CMP

d (No meds have been identified)

Which of the following leads to a definite improvement in the core symptoms of anorexia nervosa? a) Amitriptyline b) Paroxetine c) Valproate d) No meds have been identified

c (Low density lipoproteins)

Which of the following lipids plays the most significant role in the development of atherosclerotic disease? a) Chylomicrons b) High density lipoproteins c) Low density lipoproteins d) Triglycerides

c (Disulfiram)

Which of the following medications has been shown to aid in the prevention of relapse in a patient with known alcohol abuse? a) Lithium b) Fluoxetine c) Disulfiram d) Aripiprazole

b (Paroxetine)

Which of the following medications has the best effectiveness and tolerance for the long term treatment of panic disorder? a) Amitriptyline b) Paroxetine c) Phenelzine d) Diazepam

c (Sertraline)

Which of the following medications is considered first-line treatment for post-traumatic stress disorder? a) Imipramine b) Phenelzine c) Sertraline d) Valproate

d (Calcification of the mitral valve annulus, leading to AV conduction abnormalities)

Which of the following occurs in the heart as a function of age? a) a reduction in LV function at rest b) Slight elevation in the resting heart rate as a results of decreased general physical condition c) An increase in the rate of spontaneous automatic firing of ventricular pacemaker cells, leafing to increased automaticity d) Calcification of the mitral valve annulus, leading to AV conduction abnormalities e) Loss of normal valvular fibrous tissue, leading to increase incidence of valve prolapse

c (Transsphenoidal pituitary surgery)

Which of the following offers the best chance of cure in a 50 yo patient with acromegaly caused by a known pituitary adenoma measuring less than 2mm and mildly elevated growth hormone levels? a) Radiation therapy b) Pharmacological therapy c) Transsphenoidal pituitary surgery d) Watchful waiting

d (Antipsychotics)

Which of the following pharmacotherapeutic classifications are used to deal with ideas of reference and illusions that can be associated with schizotypal personality disorder? a) Anxiolytics b) Anticonvulsants c) Sedative hypnotics d) Antipsychotics

b (Episodic, early morning chest pressure that radiates to the neck)

Which of the following presentations is suggestive of prinzmetal angina? a) Sharp, central chest pain associated with exertion b) Episodic, early morning chest pressure that radiates to the neck c) Severe, tearing sensation that radiates to the back d) A fluttering sensation in the chest associated with syncope

b (Functional asplenia)

Which of the following puts a person with sickle cell disease at increased risk for bacterial infection? a) Abnormal neutrophil function b) Functional asplenia c) Inability to produce fever in response to infection d) Low serum immunoglobulin levels

c (Eggshell calcifications)

Which of the following radiographic findings is suggestive of a chronic silicosis? a) Honeycombing b) Large nodules that appear in the lower lobes c) Eggshell calcifications d) Pleural thickening and plaques

a (Decreased FEV1/FVC ratio and MMFR, and high RV)

Which of the following represents an obstructive pattern of impairment during pulmonary function tests? a) Decreased FEV1/FVC ratio and MMFR, and high RV b) Normal FEV1/FVC ratio, decreased RV and vital capacity c) Increased FVC, decreased FEV1 and RV d) Increased FVC, FEV1, and RV e) Normal FEV1, FVC, and RV

b (Influenza immunization)

Which of the following should be ordered annually for an asx person older than age 65? a) Pap test b) Influenza immunization c) Graded exercise electrocardiogram d) Barium enema e) Serum cholesterol

c (Patient appearance can range from normal to bizarre)

Which of the following signs are more commonly found in the patient with a diagnosis of schizophrenia? a) Catatonic schizophrenics are talkative b) Paranoid schizophrenics are friendly c) Patient appearance can range from normal to bizarre d) The thought process if normal

a (Hospitals are required by law to inform all patients of their right to formulate advance directives)

Which of the following statements regarding advanced directives are true? a) Hospitals are required by law to inform all patients of their right to formulate advance directives b) Hospital are required by law to inform surgical and intensive care patients only of their right to formulate advance directives c) All patients admitted to hospitals or skilled nursing facilities must complete an advanced directive d) All durable powers of attorney for health care apply only to patients who are terminally ill

a (Patients planning to get pregnant should start takin 0.4 mg/day before conception)

Which of the following statements regarding folic acid supplementation during pregnancy is true? a) Patients planning to get pregnant should start takin 0.4 mg/day before conception b) Folic acid supplementation should be decreased in patients with gestational diabetes c) Folic acid can help prevent miscarriage d) Folic acid supplementation should be decreased in patients with hypertension

a (history)

Which of the following studies if most helpful in evaluating a patient's risk for a routine operative procedure? a) History b) PE c) CXR d) Electrocardiogram e) Liver function profile

a (BNP)

Which of the following studies is most accurate in establishing a diagnosis of congestive heart failure? a) BNP b) Creatine kinase c) Myoglobin d) Troponin

a (Lipase)

Which of the following tests is the preferred choice for acute pancreatitis? a) Lipase b) Amylase c) Alkaline phosphatatse d) Bilirubin

b (Positive Nitrazine test)

Which of the following tests would be helpful in confirming that a patient has ruptured membranes at 28 weeks? a) Positive whiff test b) Positive Nitrazine test c) Absence of ferning d) L/S ratio e) Presence of PG

a (Embryonal carcinoma)

Which of the following tumors is associated with elevations in both AFP and B-hCG? a) Embryonal carcinoma b) Endodermal sinus tumor c) Seminoma d) Teratoma e) Choriocarcinoma

d (Enlarged prostate with PSA level of 1.4)

Which of the following would more likely be BPH than cancer? a) A 42 yo AA male with an enlarged hard prostate b) PSA level of 15 and 20 taken over 3 months c) Prostate nodule found on a 55 yo d) Enlarged prostate with PSA level of 1.4

c (Cherry red spot)

Which of the following would you expect to find on fundoycopic exam in a patient recently diagnosed with a central retinal artery occlusion? a) Cotton wool spots b) Drussen c) Cherry red spot d) Pale white spot

c (Keep the heat turned down somewhat in the winter to avoid dragon our the indoor air)

Which one of the following is recommended for the treatment of dry skin in the elderly? a) avoid skin emollients, especially those content lactate or urea b) Dry the skin vigorously with a towel immediately after bathing c) Keep the heat turned down somewhat in the winter to avoid dragon our the indoor air d) Take long, hot tub baths rather than brief showers e) Use soap more thoroughly to clean all areas of the skin when bathing

b (Hydrocele)

Which scrotal mass will transilluminate? a) Varicocele b) Hydrocele c) Seminoma d) Torsion of the testice

a (It is primarily a condition in older men)

Which statement about BPH is most true? a) It is primarily a condition in older men b) It presents a nodular prostate on exam c) It is a precursor to prostate cancer d) Transurethral resection of the prostate is the only effective therapy

c (Muscle biopsy)

Which test is definitive in establishing the diagnosis of polymyositis? a) MRI b) CK level c) Muscle biopsy d) EMG studies

b (Metformin)

Which therapeutic regimen is not appropriate for treatment of gestational diabetes in a G1P1 with no previous history of diabetes? a) Diet and exercise b) Metformin c) Short acting insulin d) Long acting insulin e) Subq insulin pumps

e (Endocervical and squamous)

Which two cell types must be present on a pap test for it to be considered adequate? a) Endocervical and endometrial b) Endocervical and squamous c) Endocervical and epithelial d) Epithelial and squamous e) Endocervical and squamous

c (16 and 18)

Which types of HPV have the greatest oncogenic potential? a) 6 and 11 b) 42 and 43 c) 16 and 18 d) 52 and 56 e) 35 and 45

e (MMR)

Which vaccine is CI in pregnancy? a) Influenza b) Diphtheria, pertussis, tetanus c) Tetanus d) Hepatitis B e) MMR

d (Mitral stenosis)

While examining a 45 year old female who presented complaining of dyspnea on exertion, you note a regular S1 and S2 followed by an opening snap. The sound is heard best at the apex. What diagnosis do these findings suggest? a) Aortic regurgitation b) Aortic stenosis c) Mitral regurgitation d) Mitral stenosis

a (Atrial septal defect)

While examining a patient in the newborn nursery, you note a fixed, split S2. What abnormality is the finding most commonly associated with? a) Atrial septal defect b) Coarctation of the Aorta c) PDA d) VSD

b (Phimosis)

While examining the genitalia of a patient who is uncircumcised, you are unable to retract the foreskin. There is no evidence of erythema. What is the most likely diagnosis? a) Balanitits b) Phimosis c) Paraphimosis d) Hypospadias e) Priapism

d (The degree of contamination of the wound determines the risk of infection)

Why is the history of a wound important in determining treatment requirements? a) the age of the wound determines scar size after suturing b) The mechanism of injury determines when sutures should be removed c) The extent of injury determines the need to tetanus immunization d) The degree of contamination of the wound determines the risk of infection

d (Ovarian cancer)

Women who have a father or brother with colon cancer have an increased risk of what type of cancer? a) Lung cancer b) Vulvar cancer c) Clear-cell vaginal cancer d) Ovarian cancer

c (Tolerance)

You are acting for a 67 yo man with widely metastatic small cell carcinoma of the lung who was diagnosed 4 mo ago. He suffers from chronic pain secondary to bony mets. He is on morphine BID for pain. He has recently called requesting an increase in his pain meds for breakthrough pain. What is the patient experiencing with regard to his pain medications? a) Addiction b) Pseudoaddiction c) Tolerance d) Substance abuse e) Drug resistance

d (Ventricular fibrillation)

You are called to the bedside of a 56 yo male who is scheduled to undergo elective cardiac cath. The nurse reports that she was just speaking with the patient when he suddenly lost consciousness and she is having difficulty locating a pulse. You attach a cardiac monitor, which demonstrates chaotic electrical activity with no discernible pattern. What diagnosis does this scenario suggest? a) Asystole b) First degree heart block c) Torsades de Pointes d) Ventricular fibrillation e) Ventricular tachycardia

b (Second degree heart block- Mobitz I)

You are caring for a 69 yo male who presents complaining of easy fatiguability. As part of your workup you perform a 12 lead EKG. You note that the ECG demonstrates progressive lengthening of the PR segment. Every fifth P wave is not followed by a QRS complex. What rhythm does this finding describe? a) First degree heart block b) Second degree heart block- Mobitz I c) Second degree heart block- Mobitz II d) Third degree heart block

b (Hemoglobin A1C)

You are evaluating a patient with T1DM and want to monitor their glycemic control. What is the best test? a) Urine ketones b) Hemoglobin A1C c) Urine glucose d) Serum glucose

b (Indirect inguinal hernia)

You are examining a 20 mo old child who you suspect may have an inguinal hernia. On exam you observe a noticeable elliptical swelling in the scrotal area when the patient is standing. On palpation the posterior wall of the canal is firm and resistant. On coughing the hernia comes down the canal against the side of your finger through the scrotum in the lateral to medial direction but is easily pushed back without much force. This hernia is considered to be which of the following? a) Direct inguinal hernia b) Indirect inguinal hernia c) Incarcerated, indirect inguinal hernia d) Strangulated, direct inguinal hernia

d (Hypertrophic cardiomyopathy)

You are following a 15 yo male for syncopal episode. He experienced during basketball practice. Your PE was unremarkable, but you sent him for an echo and cardiology follow-up. Today the echo report has arrived and noted marked hypertrophy of the ventricular septum. What is the most likely diagnosis? a) Aortic stenosis b) Dilated cardiomyopathy c) Ebstein abnormality d) Hypertrophic cardiomyopathy e) Ventricular septal defect

a (Finasteride)

You diagnose BPH in an elderly gentleman. Which of the following meds prevents the conversion of testosterone to dihydrotestosterone to decrease the size of the prostate? a) Finasteride b) Terazosin c) Prazosin d) Oxybutynin

b (Reactive arthritis)

Your patient is 24 yo male who comes to the clinic of heel pain. He states that he has had heel pain for 3 weeks that has not improved despite activity modifications and over the counter NSAIDs. He is otherwise healthy except for a recent STD for which he was treated. What condition do you suspect? a) Plantar fasciitis b) Reactive arthritis c) Syphilis d) Psoriatic arthritis

a (Azithroycin)

Your patient is 24 yo male who comes to the clinic of heel pain. He states that he has had heel pain for 3 weeks that has not improved despite activity modifications and over the counter NSAIDs. He is otherwise healthy except for a recent STD for which he was treated. What is the next step in treating this patient who appears unresponsive to NSAIDs? a) Azithromycin b) Penicillin c) Prednison d) Cortisone shot of the plantar fascia

a (Basal cell carcinoma)

Your patient is 74 years old with red hair and blue eyes. She presents with a raised, smooth tumor on the left nasolabial area surrounded b telangiectasis. She reports that the lesion has been slowly growing for 6 years. What is your most likely diagnosis? a) Basal cell carcinoma b) Squamous cell carcinoma c) Seborrheic keratosis d) Malignant melanoma

b (Finkelstein- DeQuervains)

Your patient reports pain when she abducts her thumb or stretches her wrist in an ulnar direction. She states sometimes just writing with a pen or pencil is difficult. You palpate directly over the first extensor tender, which elicits tenderness. What its he next test you would perform? a) Tinel b) Finkelstein c) Translumination d) Phalen

d (Colonoscopy)

a 70 year old male presents with vague abdominal pain, fatigue, and dyspnea on exertion. On PE he appears pale and there is conjunctival pallor. Stool guaiac is negative. Hemobglobin is 9.0, hematocrit is 27.2%, MCV is 78.5 (normal is 82-98), and serum ferritin is 6.5 (normal is 11 to 250). Based on the information, what is the most appropriate recommendation for this patient? a) IV iron b) Oral iron supplementation c) CT of the abdomen d) Colonoscopy

c (Transrectal US-guided biopsy)

Prostatic indurations are noted on a routine exam of an asx 57 yo male. A PSA and UA are done several days later. The PSA is 12 and the UA is normal. A repeat PSA done 2 weeks later is 10. You refer this patient to the urologist to rule out a GU disroder . What will be the urologists first step? a) Scroal US b) Pelvic CT scan c) Transrectal US-guided biopsy d) Bone scan of the lumbar spine e) Cystoscopy

c (Transrectal US-guided biopsy)

Prostatic indurations are noted on a routine exam of an asx 57yo male. A PSA and UA are done several days later. The PSA is 12 (normal for age is <3.5) and the UA is normal. A repeat PSA done 2 weeks later is 10. You refer this patient to the urologist to rule out genitourinary disorder. What will be the urologists first step? a) Scrotal ultrasound b) Pelvic CT scan c) Transrectal US-guided biopsy d) Bone scan of the lumbar spine e) Cystoscopy

a (Aortic aneurysm)

Rib notching on a chest X-ray is associated with which of the following conditions? a) Aortic aneurysm b) Aortic dissection c) Arteriovenous fistula d) Coarctation of the aorta e) Subclavian steal syndrome

b (Acne vulgaris)

Systemic and topical retinoid, systemic and topical antimicrobials and systemic hormonal therapy are the main therapeutic classes of treatment for which of the following dermatological complaints? a) Hidradenitis suppurativa b) Acne vulgaris c) Psoriasis d) Cellulitis

d (Intermittent fever)

Systemic juvenile arthritis is characterized by arthritis seen in combination with other sign? a) Rash b) Anemia c) Conjunctivitis d) Intermittent fever

d (Intermittent fever)

Systemic juvenile rheumatoid arthritis is characterized by arthritis seen in combination with what other sign? a) Rash b) Anemia c) Conjunctivitis d) Intermittent fever

b (Accidents related to environmental hazards)

The daughter of an 80yo is concerned because her mother has fallen several times recently at home. When advising her on this issue, which of the following would you point to as the most frequent cause of falls among elderly? a) Medication SE b) Accidents related to environmental hazards c) Lower-extremity weakness d) Gait disorders e) Acute illness

a (Vaginal cancer)

The daughters of women who were exposed to DES in utero have an increased risk of what type of cancer? a) Vaginal cancer b) Uterine cancer c) Breast cancer d) Ovarian cancer

b (Down syndrome)

The development of Alzheimer's disease is highly suggestive with which of the following? a) Amyotrophic lateral sclerosis b) Down syndrome c) Guillain-Barre syndrom d) Multiple sclerosis e) Muscular dystrophy

a (Assume scaphoid fracture, apply an arm splint and refer to an orthopedist)

The next patient you are asked to evaluate complains of pain in the right wrist. Her history involved falling on this wrist with the hand dorsiflexed. Pain is generalized at the base of the thumb. X-rays are negative. What is your plan of treatment? a) Assume scaphoid fracture, apply an arm splint and refer to an orthopedist b) Reassure the patient that this is just a sprain and have her follow up with her primary care provider as needed c) This is an orthopedic emergency, refer immediately d) Assume the scaphoid fracture, apply thumb spica splint, and refer to an orthopedist

b (Injected conjunctiva)

The person who is found to have cannabis abuse is likely to have which of the following PE findings? a) Appetite depression b) Injected conjunctiva c) Bradycardia d) Increased oral secretions

a (Proteinuria)

The presence of what distinguishes preeclampsia from gestational hypertension? a) Proteinuria b) Hematuria c) Glycosurea d) BP >160/110 e) Pedal edema

a (Proteinuria)

The presence of what distinguishes preeclampsia from gestational hypertension? a) Proteinuria b) Hematuria c) Glycosuria d) Blood pressure >160/100 e) Pedal edema

b (8)

The rescue squad brings a n unresponsive patient to the ED. The patient makes grunting sounds and opens his eyes only in response to painful stimuli. He also withdraws from painful stimuli. What is the Glasgow coma scale score for this patient? a) 4 b) 8 c) 11 d) 13

d (chronic bronchitis)

The term "blue bloater" refers to a patient with what disease? a) Asthma b) Cystic fibrosis c) Emphysema d) Chronic bronchitis

c (Apply a piece of cellophane tape to the perirectal area at night on all the kids)

There has been a recent outbreak of pinworms at a local day-care center. Which of the following is the next best clinical intervention in this situation? a) Obtain stool cultures on all the kids b) Obtain blood cultures on all the kids c) Apply a piece of cellophane tape to the perirectal area at night on all the kids d) Empirically treat the kids for pinworms

c (Acetic acid)

To help detect and magnify HPV lesions on the genital muscle of females, which of the following can be applied? a) Nitrazine b) Giemsa stain c) Acetic acid d) Crysta violet

e (Tetracycline- results in tooth discoloration)

What antibiotic class is absolutely contraindicated in pregnancy? a) PCN b) Cephalosporin c) Aminoglycoside d) Erythromycin e) Tetracycline

e (Coagulation factors)

What blood components are present in cryoprecipitate? a) erythrocytes, leukocytes, platelets, plasma, and coagulation factors b) Erythrocytes, platelets, plasma, and coagulation factors c) Platelets, plasma, and coagulation factors d) Plasma and coagulation factors e) Coagulation factors

d (Sepsis)

What can cause postoperative ileus? a) Hyperkalemia b) Cholinergic medicaitons c) Increased parasympathetic activity d) Sepsis

d (Inspiratory arrest with palpation of the right upper abdomen)

What characterized a positive Murphy's sign on physical exam? a) Pain when percussing the right upper abdomen b) Tenderness in the right upper abdomen c) A palpable fullness to the gallbladder d) Inspiratory arrest with palpation of the right upper abdomen

c (Echocardiogram)

What diagnostic procedure evaluated cardiac wall motion and ventricular function? a) CXR b) Stress test c) Echocardiogram d) Cardiac cath e) Electrocardiogram

b (Acetylcholine receptor antibody levels)

What diagnostic study is used to confirm a diagnosis of myasthenia gravid? a) There is no test to confirm the condition b) Acetylcholine receptor antibody levels c) MRI of the spinal cord d) Biopsy the affected muscle

d (Areas of demyelination in the brain and spinal cord)

What does a "plaque" in multiple sclerosis refer to? a) Blood clots in the central nervous system b) Lipid and protein deposits in the brainstem c) Patches of oligodendrocyte and Schwann cells d) Areas of demyelination in the brain and spinal cord

d (20 week pregnancy)

What does a uterine funds height at the umbilicus connote? a) 8 week pregnancy b) 12 week pregnancy c) 16 week pregnancy d) 20 week pregnancy

b (Irregular bleeding)

What does the term metrorrhagia refer to? a) Heavy, excessive bleeding b) Irregular bleeding c) Infrequent bleeding d) Spotting e) Pain with menstruation

c (Gleason score)

What grading system is used to evaluate the histology of a prostate biopsy? a) Ranson score b) Osler score c) Gleason score d) Simpson score

d (Women have been compliant with Pap smear screening)

What has most contributed to the decreased number of cervical cancer deaths in the US? a) Women are having fewer sexual partners b) Women are marrying later in life c) Women have decreased their smoking d) Women have been compliant with Pap smear screening

b (Unheralded loss of consciousness)

What historic feature suggests primary dysrhythmia as a cause of syncope? a) Prodromal events b) Unheralded loss of consciousness c) Recent use of cephalosporin antibiotic d) Related to rapid position changes

b (Subdemral injection)

What injection technique can minimize the pain of anesthetizing a forehand laceration? a) Rapid injection b) Subdemral injection c) Use of a large needle d) Use of a cool injection

c (myxedema coma)

What is a potential fatal consequence of untreated hypothyroidism? a) Excess weight gain b) Loss of menses c) Myxedema coma d) Thyroid storm

a (Endometrial cancer. Tamoxifen is used to treat breast cancer)

What is a well known potential side effect of tamoxifen? a) Endometrial cancer b) Breast cancer c) Osteoporosis d) Ovarian cancer

d (Ceftriaxone)

What is an appropriate choice for testing gonococcal urethritis and cervicitis? a) Ciprofloxacillin b) Cefoxitin c) Metronidazole d) Ceftriaxone

c (Patients with large acute burns)

What is an indication for parental nutrition? a) Dementia b) Anorexia nervosa c) Patients with large acute burns d) Patients on prolonged respiratory support

d (A patient who is tachycardia and oliguric with a hemoglobin of 8)

What is an indication for transfusion of red blood cells? a) To speed wound healing b) An otherwise healthy patient with hemoglobin 10 c) A patient with coronary artery disease who will be undergoing bypass surgery and whose hemoglobin is 12 d) A patient who is tachycardia and oliguric with a hemoglobin of 8

a (10-20)

What is considered to be a normal IOP of the eye? a) 10-20 b) 10-15 c) 10-35 d) 15-30

a (Parkinson-like sx)

What is diffuse Lewy body dementia characterized by? a) Parkinson-like sx b) Auditory hallucinations c) Urinary incontinence d) Vitamin B12 deficiency

b (Adequately treat the underlying hyperthyroid state)

What is the best prevention of thyrotoxicosis? a) Provide ample sources of dietary iodine b) Adequately treat the underlying hyperthyroid state c) Massage the thyroid to maximize production d) Treat underlying depression with antidepressants

c (Careful history PE)

What is the best screening method for ovarian cancer? a) CA-125 levels b) Pelvic US c) Careful history PE d) CT

b (Methylene blue instillation)

What is the best test to confirm a diagnosis of vesicovaginal fistula? a) Ultrasound b) Methylene blue instillation c) MRI d) CT scan

d (surgery)

What is the best treatment for normal pressure hydrocephalus? a) Medication b) Behavioral therapy c) Electroconvulsive therapy d) Surgery

b (Bradykinesia, tremors, and rigidity)

What is the classic triad of Parkinson's disease? a) Rigidity, bradykinesis, and micrographia b) Bradykinesia, tremors, and rigidity c) Tremors, hemiparesis, and akinesia d) Tremors, rigidity, and macrophagia

b (Na - (HCO3 - Cl))

What is the correct equation to calculate the anion gap? a) K - (HCO3 + H2O) b) Na - (HCO3 - Cl) c) Cl + (H2O2 + HCO3) d) Na + (Cl + H2O2)

b (high-resolution CT scan of chest)

What is the diagnostic study of choice for bronchiectasis? a) Posterior-anterior and lateral view chest x-rays b) High-resolution CT scan of chest c) MRI of the chest d) PET of the chest

a (Antipsychotics)

What is the drug class of choice for a person with delusional disorder? a) Antipsychotics b) Anticonvulsants c) Sedative hypnotics d) Anxiolytics

a (Epinephrine)

What is the drug of choice for anaphylaxis? a) Epinephrine b) Hydrocortisone c) Hydroxyzine d) Diphenhydramine

c (Night blindness)

What is the earliest sx of vitamin A deficiency? a) Corneal ulceration b) Endophthalmitis c) Night blindness d) Mouth sores

c (Autoimmune related)

What is the etiology of MS? a) Genetic factors during the prenatal period and a subacute bacterial infection 20-30 years later b) A progressive infection of the central and peripheral nervous system c) Autoimmune related d) A traumatic injury to the brain

c (Destruction of dopaminergic neurons)

What is the etiology of Parkinson's disease? a) Destruction of the hypothalamus b) Neuronal inflammation in locus ceruleus c) Destruction of dopaminergic neurons d) Neuronal proliferative in substantia nigra e) Increase of dopaminergic neurons

b (SSRI)

What is the first line treatment of MDD? a) MAOI b) SSRI c) TCA d) Group and individual therapy sessions only

d (age)

What is the greatest risk factor for a woman to develop breast cancer? a) Family history b) Eating a high fat diet c) Nulliparity d) Age

a (Ascending motor paralysis)

What is the hallmark presentation of Guillain-Barre? a) Ascending motor paralysis b) Descending motor paralysis c) Dysphagia and hoarseness d) Hyperreflexia of deep tendon reflexes

c (Hospitalize to achieve better pharmacotherapeutic control)

What is the immediate treatment for a patient with bipolar disorder who is in a manic phase that is so out of control as to be socially inept? a) Increase the dose of lithium b) Increase the dose of SSRI c) Hospitalize to achieve better pharmacotherapeutic control d) Increased vigilance during cognitive therapy sessions

c (Reduce leukemic blasts in peripheral blood to undetectable levels)

What is the initial goal of treatment of acute lymphocytic leukemia (ALL)? a) Reduce the white blood cell (WBC) count to <10,000 b) Reduce the WBC count to <5000 c) Reduce leukemic blasts in peripheral blood to undetectable levels d) Reduce leukemic blasts to undetectable levels and restore normal marrow function

b (Glucocorticoid therapy)

What is the initial treatment of autoimmune hemolytic anemia with significant hemolysis? a) Supportive treatment only b) Glucocorticoid therapy c) Splenectomy d) Azathioprine

c (Serum iron)

What is the lab test of choice for the diagnosis of iron-deficiency anemia? a) Hemoglobin and hematocrit b) Mean corpuscular volume c) Serum iron d) Bone marrow aspiration

d (Dopamine agonists and/or levodopa)

What is the mainstay of treatment for Parkinson's disease? a) Antidepressants and pro kinetic agents b) Cholinergic agents c) Diazepam and/or valproic acid d) Dopamine agonists and/or levodopa e) Clozapine and/or gabapentin

a (It is a narcotic and can lead to dependence)

What is the major disadvantage of using methadone to treat heroin addicts? a) It is a narcotic and can lead to dependence b) It produces excessive euphoria c) It produces excessive drowsiness d) It is associated with increased criminal activity

c (Colonoscopy)

What is the method of choice for diagnosing colon cancer? a) CEA testing b) DRE c) Colonoscopy d) Fecal occult blood

b (Subq heparin)

What is the most appropriate medication to use as prophylaxis for pregnancy patients with a known increased risk of thromboembolic events? a) Oral heparin b) Subq heparin c) IV heparin d) Oral warfarin e) Subq warfarin

e (Serous)

What is the most common benign ovarian cyst of epithelial origin? a) Transitional cell b) Mucinous c) Endometrioma d) Clear cell e) Serous

a (Atelectasis)

What is the most common cause for a posteropertaive fever that occurs 24 hour after surgery? a) Atelectasis b) Wound infection c) UTI d) DVT e) Blood transfusion

c (cystic fibrosis)

What is the most common cause of bronchiectasis? a) Asthma b) Recurrent pneumonia c) Cystic fibrosis d) Chronic bronchitis

a (iron deficiency)

What is the most common cause of microcytic anemia? a) Iron deficiency b) Thalassemia minor c) Chronic disease d) Hemoglobinopathies

a (Failure to thrive in a child)

What is the most common initial presentation of sickle cell disease? a) Failure to thrive in a child b) Heavy periods in an adolescent c) Sudden death in an athlete d) Painful crisis in an adult e) Prenatal chorionic biopsy

a (hypoglycemia)

What is the most common often preventable acute complication of type 2 DM? a) Hypoglycemia b) Gangrene c) Ketosis d) UTI

a (E. coli)

What is the most common pathogen associated with acute cystitis in females? a) E. coli b) Pseudomonas species c) S. epidermidis d) Chlamydia trachomatis

a (Strep pneumoniae)

What is the most common pathogen associated with otitis media? a) Strep pneumoniae b) Haemophilus influenza c) Moraxella catarrhalis d) Staph aureus

c (Streptococcus pneumonia)

What is the most common pathogen involved in pulmonary bacterial superinfection after influenza infection? a) Staph aureus b) Nocardia ateroids c) Streptococcus pneumonia d) Haemophilus influenza

d (Conjunctival pallor)

What is the most common physical exam finding associated with iron-deficiency anemia? a) Cheilosis b) Koilonychia c) Xerosis d) Conjunctival pallor

b (Common carotid bifurcation)

What is the most common site for thrombi causing ischemic stroke? a) Vertebral artery b) Common carotid bifurcation c) Aortic arch d) Left atrium

a (Pelvic pain)

What is the most common symptom associated with endometriosis? a) Pelvic pain b) Menorrhagia c) Mittelschmerz d) Bloatin

a (Serous carcinoma)

What is the most common type of ovarian ovarian cancer in the US? a) Serous carcinoma b) Endometrioid carcinoma c) Undifferentiated tumor d) Brenner tumor e) Clear cell carcinoma

c (Pain history)

What is the most important to obtain when first evaluating abdominal pain? a) CBC with diff b) CT of abdomen and pelvis c) Pain history d) UA e) Liver profile

c (Ganglion cyst)

What is the name for a mass that occurs from a herniation at a joint and transluminates? a) Bone tumor b) Rheum nodule c) Ganglion cyst d) Gouty tophi

c (Pityriasis rosea)

What is the name for the acute, benign, self-limiting skin condition that presents initially with a large single lesion that is followed by sharply defined, thin, oval, plaques with a collarette scale? a) Acne vulgaris b) Guttate psoriasis c) Pityriasis rosea d) Tinea corporis

c (Review old x-rays)

What is the next step in the evaluation of a solitary pulmonary nodule seen on cxr? a) CT scan b) MRI c) Review old x-rays d) Confirm the diagnosis with repeat PA and lateral chest x-rays

b (5000-12000)

What is the normal WBC count in pregnancy? a) 4000-8000 b) 5000-12000 c) 12000-15000 d) 15000-20000 e) 20000

b (5000-12000)

What is the normal WBC count in pregnancy? a) 4000-8000 b) 5000-12000 c) 12000-15000 d) 15000-20000 e) >20000

b (3.5-4.0)

What is the normal pH of the vagina in reproductive age women? a) 2.5-3.5 b) 3.5-4.0 c) 6.5-7.0 d) 7.0-8.0

d (Long term psychotherapy and pharmacotherapy )

Obsessive-compulsive personality disorder is best controlled with which of the following interventions? a) Short term pharmacotherapy alone b) Long term psychotherapy alone c) Short-term psychotherapy and pharmacotherapy d) Long term psychotherapy and pharmacotherapy

b (Cigarette smoking)

On routine urinalysis, a 50 yo man is noted to have microscopic hematuria. He is asx and cannot recall if he ever had hematuria previously. After taking history, you decide to further evaluate this finding. Which factor increase the likelihood that there is a serious underlying abnormality? a) Acetaminophen use for chronic low back pain b) Cigarette smoking c) A high number of WBC in the urine d) Urge incontinece e) Recent vigorous exercise

d (Administer vaccine at 15 months and 4 years)

One of the most effective methods to prevent measles, mumps, and rubella would be to do which of the following? a) Administer vaccine at birth and 12 months b) Administer vaccine at 12 months and 24 months c) Administer vaccine at 15 months and 3 years d) Administer vaccine at 15 months and 4 years

c (IV corticosteroids)

One week after receiving a lung transplant, the patient begins to experience coughing and wheezing. After ruling our infection, what is your treatment of choice? a) Oral levofloxacin b) IV levofloxacin c) IV corticosteroids d) Remove the transplanted organ immediately