Review Conference Questions
*How will a brachial plexus injury present?
-Loss of control of shoulder and elbow muscles, retained control of fingers -Loss of control of fingers -Stingers, burning sensations, pain
If a MEN II patient has evidence of hyperparathyroidism and medullary carcinoma of the thyroid and pheochromocytoma, describe the order in which you would deal with the various problems.
1. Pheochromocytoma 2. Thyroid cancer 3. Hyperparathryroidism
A 50 YO MS patient c/o sudden unilateral vision loss after leaving work a week ago. She stated that she saw everything in black and white at the time before she lost the vision in her right eye. She feels the vision has improved somewhat. On PE, she has painful EOMs, and a Marcus-Gunn pupil on the right eye. The optic nerve appears normal at this time. The patient most likely has which of the following? A. Amaurosis fugax B. Optic neuritis C. Retinal artery occlusion D. Retinal detachment
Answer B Optic neuritis
Horner's Syndrome is associated with which type of tumor? A. Teratoma B. Pancoast C. Lymphoma D. Carcinoid
Answer B Pancoast
A patient presents with pain and swelling of the distal middle digit. Pus is noted at the lateral nail fold. Which of the following is the most likely diagnosis? A. Onychomycosis B. Paronychia C. Onychomycosis D. Psoriasis
Answer B Paronychia
Primarily, diagnosis of valvular heart disease is made by A. Chest x-ray, arterial blood gases (ABGs) B. Patient history, physical exam, echocardiography, and Doppler C. Physical exam, cardiac catherization, ABG's and echocardiography D. Physical exam, ejection fraction, loud murmur, Doppler E. Electrocardiogram (ECG), CXR, echocardiography, cardiac catherization
Answer B Patient history, physical exam, echocardiography, and Doppler
A 60 y/o obese male presents with increased daytime somnolence. His bedpartner reports that he snores loudly at night and has frequent episodes where he stops breathing. What is the best diagnostic study this this patient? A. Transthoracic echocardiogram B. Polysomnogram C. Adenosine Thalium stress test D. Electroencephalogram
Answer B Polysomnogram
A 55 y/o male presents with a 3 day history of fever, chills, and cough productive of purulent sputum. CXR reveals a left lower lobe patchy infiltrate. Which of the following is most likely found on physical exam over the area of consolidation? A. Decreased tactile fremitus B. Positive egophany C. Hyperresonance with percussion D. Pleural friction rub
Answer B Positive egophany
A patient with jaundice, elevated Alk Phos & elevated GGT most likely has which of the following diagnosis? A. Gilbert's disease B. Primary Biliary Cirrhosis C. Dubin - Johnson Syndrome D. Hemolysis
Answer B Primary Biliary Cirrhosis
A 2 week-old Caucasian male is brought in by his father. He says that his son has been vomiting right after eating for the past 2 days. On exam, dry mucous membranes and lack of weight gain since last week's visit is noticed. The description of the child's vomiting is most likely as which of the following? a. Projectile, bilious b. Projectile, non-bilious c. Non-projectile, bilious d. Non-projectile, non-bilious
Answer B Projectile, non-bilious
A landscaper has a palm frond brush against her eye. She immediately has 8/10 pain with photophobia. What is your initial treatment? A. Bacitracin ophthalmic B. Proparacaine C. Eye patch D. Tobradex® ophthalmic
Answer B Proparacaine
A short 4th metacarpal is commonly seen in A. Vit D resistant rickets B. Pseudohypoparathyroidism
Answer B Pseudohypoparathyroidism
A patient who recently finished a course of clindamycin last week for a dental infection presents with severe diarrhea. Stool studies are positive for Clostridium difficile and the patient is placed on PO medronidazole (Flagyl). What is the most likely diagnosis? A. Crohn's Colitis B. Pseudomembranous Colitis C. Ulcerative Colitis D. Ischemic Colitis
Answer B Pseudomembranous Colitis
Which organism is the most common pathogen in contact lens wearers with bacterial keratitis? A. Fungal B. Pseudomonas C. Streptococcus D. Staphylococcus E. Moraxella
Answer B Pseudomonas
A 3 year old boy with a past history of 3 episodes of middle ear infections in the last six months that has responded well to antibiotics can BEST be described as having had: A. Acute otitis media (AOM) B. Recurrent acute otitis media (RAOM) C. Chronic otitis media (COM) D. Acute Otomastoiditis
Answer B Recurrent acute otitis media (RAOM)
Thyroid surgery with subsequent hoarseness. Which nerve is most likely affected: A. Superior laryngeal B. Recurrent laryngeal C. Inferior ganglion D. Hypoglossal
Answer B Recurrent laryngeal
What is your next treatment action for amblyopia? A. Reassurance B. Refer to ophthalmologist for evaluation C. Refer to optometrist for prism glasses D. Muscle exercises E. Perform fundoscopic exam
Answer B Refer to ophthalmologist for evaluation
An otherwise healthy premenarche 12 year old patient presents for a sports PE and has a spinal curve abnormality with marked elevation of the right scapula and a right thoracic hump. Results of spinal films indicate a 25 degree curvature. What is the management plan for this patient? A. Monitor every 3 months until menarche B. Refer to orthopaedic surgeon C. Aggressive physical therapy D. Refer to chiropractor for therapy
Answer B Refer to orthopaedic surgeon
A patient admitted with substernal CP undergoes cardiac catheterization. Angiography reveals 98% occlusion of the RCA . All other vessels are 100% patent. Which of the following is the most expected. EKG finding in this patient? A. ST elevation in leads I, avL, V5 and V6 B. ST elevation in leads II, III, and avF C. ST elevation across V2, V3 and V4 D. Tall upright R and T waves in V1 and V2
Answer B ST elevation in leads II, III, and avF
A 50 y/o female has frequent ED visits secondary to chest pain with a non-revealing cardiac work-up. A barium swallow at the time shows a "corkscrew" pattern. What is the most likely diagnosis? A. GERD B. Scleroderma C. Esophageal Spasm D. Achalasia
Answer C Esophageal Spasm
A patient complains of a foreign body sensation while grinding metal. His fluorescein stain shows linear corneal scratches. What part of the physical exam is essential? A. Check visual fields B. Check PERRLA C. Flip the upper lid D. Tonometry (check the eye pressure)
Answer C Flip the upper lid
What type of pharmacological agent would be used as a first-line medication to treat obsessive compulsive disorder? A. Risperidone B. Lonazepam C. Fluoxetine D. Trazadone E. Venlafaxine
Answer C Fluoxetine
After pituitary radiotherapy one should check pituitary function periodically for A. 6 months B. 1 year C. For life
Answer C For life
A diabetic patient who uses insulin suddenly feels weak, faint sweaty, shaky, and passes out. Immediately you would give: A. more insulin. B. water. C. glucose D. reassurance.
Answer C Glucose
A 32 year-old female presents with crampy abdominal pain and diarrhea after eating. She has lost approximately 10 pounds. She is found to be anemic and iron deficient. A prothrombin time (PT) is drawn and is slightly prolonged. Her tissue transglutaminase antibodies and anti-endomysial antibodies are positive. What is the best initial treatment for this patient? A. Ciprofloxacin (Cipro) B. Lactose free diet C. Gluten free diet D. Metronidazole (Flagyl)
Answer C Gluten free diet
A 42 year-old male presents with a 6 week history of "gnawing" epigastric pain that is somewhat improved after eating. EGD is performed & reveals the presence of gastric ulcers. A mucosal biopsy is performed and rapid urease test is sent and positive. Which of the following is the most likely etiology of this patient's peptic ulcer disease? A. Zollinger-Ellison Syndrome B. NSAIDs C. H Pylori D. CMV
Answer C H. Pylori
You fluorescein his eye and look with a cobalt blue light (dendritic lesions present). What is your diagnosis? A. Adenovirus B. Environmental allergen C. Herpes simplex D. Poor hygiene E. Staphyloccocus
Answer C Herpes simplex
19 YO white male c/o swelling and a 2/10 pain of his left upper lid (localized singular, swelling noted along eyelashes). He denies trauma. No vision complaints. What is the best treatment? A. Amoxicillin/ clavulanate B. Bacitracin ointment C. Hot compresses D. I and D E. Refer to ophthalmologist
Answer C Hot compresses
Describe what condition this patient has (blood in the eye with fluid level)? A. Acute angle closure B. Iritis C. Hyphema D. Orbital fracture E. Subconjunctival hemorrhage
Answer C Hyphema
Which of the following is the most important intervention in acute pancreatitis? A. IV Antibiotics B. ERCP C. IV fluids D. Abdominal CT
Answer C IV fluids
Allergic Rhinitis is mediated by which immunoglobulin? A. IgM B. IgG C. IgE D. IgA
Answer C IgE
Which of the following is the primary pathophysiologic abnormality in Eisenmenger syndrome? A. Low systemic vascular resistance B. Increased cardiac output C. Increased pulmonary vascular resistance D. Elevated LV end-diastolic pressure E. Left to right intracardiac shunting
Answer C Increased pulmonary vascular resistance
A 19 year old male gets into an altercation at a club in South Beach. His vision is 20/20 in both eyes. What does this patient need? A. Artificial tears B. Ice pack C. Indirect fundoscopic exam by ophthalmologist D. Reassurance E. Visine® to "get the red out"
Answer C Indirect fundoscopic exam by ophthalmologist
A 66 y/o female presents with a non-productive cough with malaise for the past week. Her temperature increases to 102F. A CXR reveals diffuse bilateral pulmonary interstitial infiltrates in all lung fields. A sputum gram stain reveals normal flora and few neutrophils. She recovers over the next two weeks without sequelae. Infection with which of the following organisms most likely caused her illness? A. Streptococcus pneumoniae B. Mycobacterium tuberculosis C. Influenza A D. Mycoplasma pneumonia
Answer C Influenza A
A 22-year-old male patient has done well in the hospital for treatment of his second episode of DKA. In order to design a program for home use, you now decide to initiate a plan of A. Metformin B. Pioglitazone C. Insulin D. Sitagliptin
Answer C Insulin
An 82 y/o male with a hx of CAD presents with a 6 month hx of periumbilical pain that starts 30 minutes after eating and lasts up to 2 hours. He has lost about 20 lbs secondary to decreased PO intake from fear of the pain. Which of the following is the most likely diagnosis? A. Chronic pancreatitis B. Chronic cholecystitis C. Intestinal ischemia D. Crohn's Disease
Answer C Intestinal ischemia
What laboratory test is the best choice to diagnose a case of tinea capitis? a. Gram Stain b. Tzanck test c. KOH prep d. Culture
Answer C KOH prep
A patient presents with flat-topped, violaceous, polygonal, sharply defined papules on the flexor aspect of the wrist. Which of the following is the most likely diagnosis? A. Seborrheic dermatitis B. Pityriasis rosea C. Lichen planus D. Psoriasis
Answer C Lichen planus
An ambulance transports a patient to your facility from the nursing home with anuria and diminished LOC . Paramedics report a BP of 225/130. Which of the following medications is most appropriate for this patient? A. Esmolol (Brevibloc) B. Nitroprusside sodium (Nipride) C. Nitroglycerine (Nitrostat) D. Nifedipine (Procardia)
Answer B Nitroprusside sodium (Nipride)
Does hypernatremia tell you that the total body sodium is high? A. Yes B. No
Answer B No
Does hyponatremia tell you that the total body sodium is low? A. Yes B. No
Answer B No
A 50 year-old alcoholic male presents with hematemesis after a period of vomiting and retching. The patient is treated with fluid resuscitation and blood transfusions. An EGD is performed and will likely show A. Multiple esophageal varices B. Severe discrete ulcers C. Linear mucosal tear at the gastroesophageal junction D. Metaplastic columnar cells
Answer C Linear mucosal tear at the gastroesophageal junction
A 80 yo complains of wavy lines in her right central vision for 3 days. You confirm this with an Amsler grid. She most likely has? A. Brain tumor B. Corneal edema C. Macular degeneration D. Retinal detachment E. Vitreous detachment
Answer C Macular degeneration
A spontaneous subconjunctival hemorrhage requires: A. Ophthalmologist exam B. Tetrahydrozaline C. Reassurance D. Fundoscopic exam E. Visual fields
Answer C Reassurance
During initial testing, what best distinguishes between aplastic anemia and hemolytic anemia? A. MCV indices B. Ferritin level C. Retic count D. Hemoglobin level
Answer C Retic count
Which of the following is used to treat verrucae? A. Acyclovir (Zovirax) B. Penicillin C. Salicylic acid D. Tretinoin cream
Answer C Salicylic acid
Which of the following is known to aggravate GERD? A. High protein foods B. Dairy products C. Smoking D. Exercise
Answer C Smoking
You are completing a physical on a patient and his blood pressure is 160/100. According to The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. What category would this blood pressure qualify as? A. Prehypertension B. Stage 1 hypertension C. Stage 2 hypertension D. Stage 3 hypertension
Answer C Stage 2 HTN
A 44 y/o male with lung cancer presented with swelling of the neck and right upper extremity. What is this called? A. Horner's Syndrome B. Milk-Alkali Syndrome C. Superior Vena Cava Syndrome D. Pancoast Syndrome
Answer C Superior Vena Cava Syndrome
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 is the treatment for this condition? a. Diuretics b. Physical Therapy c. Surgery d. No treatment needed
Answer C Surgery
The most appropriate management in a patient with a left tension pneumothorax: A. CPR B. Intubation C. Immediate placement of large bore needle with a catheter in the Right 2nd ICS MCL D. Immediate placement of large bore needle with a catheter in the Left 2nd ICS MCL
Answer D Immediate placement of large bore needle with a catheter in the Left 2nd ICS MCL
Which of the following conditions is associated with a unilateral, painful red eye, photophobia, blurred vision, tearing, decreased visual acuity, no discharge, and a ciliary injection? A. Acute Angle Closure Glaucoma B. Blephartitis C. Conjunctivitis D. Iritis E. Optic neuritis
Answer D Iritis
What kind of oral vitamin D preparation could you use to try to correct quickly a marked degree of hypocalcemia with total serum calcium of 5.0 mg/dL with normal albumin? A. Over-the-counter calcium with vitamin D B. Vitamin D 2,000 unit capsules. C. Vitamin D 50,000 units per capsule. D. Rocaltrol
Answer D Rocaltrol
What organism is a typical pathogen in orbital cellulitis? A. E. coli B. N. Gonorrhoeae C. P. aeruginosa D. S. pneumoniae E. T. Rubrum
Answer D S. pneumoniae
What is this condition (butterfly rash)? A. Dermatitis B. Eczema C. Rosacea D. Sytemic Lupus Erythematoisis
Answer D SLE
A 37-year-old woman under your care is diagnosed with bipolar I disorder. As part of her drug regimen, you prescribe lithium carbonate as long-term maintenance therapy. Which of the following would be most appropriate to perform or order prior to the initiation of lithium carbonate? A. Electrocardiogram B. Fasting plasma glucose C. Liver function tests D. Serum creatinine E. Urine culture
Answer D Serum creatinine
*Cryptococcus infection is most often transmitted in which situation? A. Improperly cooked foods B. Sexual activity C. Cats D. Soil contact
Answer D Soil contact
What is the APGAR score of a neonate who has been evaluated five minutes after birth? His heart rate is 90 BPM, he has vigorous cry, he demonstrates some flexion of the limbs, sneezed when a catheter was inserted into his nostril. His body was pink and extremities were blue. a. 3 b. 4 c. 5 d. 6 e. 7
Answer E 7
Which of the following medications may cause pulmonary fibrosis? A. Amiodarone B. Nitrofurantoin C. Bleomycin D. Methotrexate E. All of the Above
Answer E All of the Above
A 57 YO female with Type II DM x 12 years comes to the ER C/O 2 days of diplopia when she looks to her right. She has no vision problems otherwise. She has headaches only when the diplopia is present. Which cranial nerve is affected? A. CN II B. CN III C. CN IV D. CN V E. CN VI
Answer E CN VI
One year later, the patient returns. He has finished his BP meds, and he thought that "cured" his blood pressure. His blood pressure is 170/110. You examine his retina. How would you treat? A. Panretinal photocoagulation B. Aggressive anti-hypertensive therapy C. Macugen (pegaptanib) D. Add another glaucoma medication
Answer B Aggressive anti-hypertensive therapy
Following a motor vehicle accident with blood loss leading to prolonged, severe hypotension, a 30 y/o male is intubated and placed on a mechanical ventilator. He has progressively decreasing oxygen saturations despite increasing PEEP and FI02 of 100%. He remains afebrile. He dies 3 days later. At autopsy, the distal lungs show pink hyaline membranes, thickened interstitium, and many macrophages but few neutrophils. Which of the following pulmonary diseases most likely complicated his course? A. Acute Respiratory Distress Syndrome B. Bronchiectasis C. Tension pneumothorax D. Viral pneumonia
Answer A ARDS
When performing a pre-participation sports PE in adolescent population, a murmur with which of the following qualities indicates a risk for sudden death during exercise? A. Increases with the Valsalva maneuver B. Increases with squatting maneuver C. Associated with a mid-systolic click D. Mid-systolic without radiation to the carotids
Answer A Increases with the Valsalva maneuver
*What is the most likely pneumonia etiology for a patient with a seizure disorder?
Anaerobes
*What is the most likely pneumonia etiology of a passed out alcoholic?
Anaerobes
*The patient was petting the cat outdoor, the cat was purring Cat suddenly bit the patient and ran off. What organisms need to be "covered?"
Answer Pasteurella multocida
*The patient was petting the cat outdoor, the cat was purring Cat suddenly bit the patient and ran off. What antibiotic is recommended?
Answer Yes, amoxicillin/clavulanate (augmentin)
*The patient was petting the cat outdoor, the cat was purring Cat suddenly bit the patient and ran off. Does the patient need a rabies vaccination?
Answer Yes, rabies vaccine and immune globulin
A concerned mother brings her 5 year old child to your office because his eyes have a "funny look" since he was 3 years old. She just got medical insurance for the family. The child calls this his "super power." What is your main concern about his condition? A. Amblyopia B. Diplopia induced headaches C. Brain tumor D. Social stigma
Answer A Amblyopia
In clinical practice today how many classes of oral diabetic agents are commonly used to treat type 1 diabetes? A. 0 B. 1 C. 2 D. 3 E. 4
Answer A 0
Four patients present with complaints of progressive hip pain. In which patient would SCFE be suspected? A. 11 YO obese boy w/hx of right hip and knee pain for < 6 months B. 20 YO obese female w/sudden onset right hip pain after a fall C. 15 YO tall, thin male with sudden onset severe right hip pain when catching in a baseball game D. 12 MO infant, not walking yet, with marked difference in gluteal skin folds
Answer A 11 YO obese boy w/hx of right hip and knee pain for < 6 months
Which of the following patients with congenital heart disease would be expected to exhibit cyanosis? a. A 2 yo girl with Tetralogy of Fallot b. A 6 yo girl with Turner's syndrome and coarctation of the aorta c. An 18 month boy with a ventricular septal defect d. A 10 yo boy with a congenital ASD
Answer A A 2 yo girl with Tetralogy of Fallot
A 71-y/o man complains of occasional lower back pain. His BP is 150/85 mm Hg and his HR is 80/min. Cardiac exam reveals an S4 gallop. Abdominal exam reveals a pulsatile mass approximately 5.0 cm in diameter palpable in the epigastric area. Peripheral pulses are normal. Which of the following is the most likely diagnosis? A. Abdominal aortic aneurysm B. Cancer of the proximal colon C. Peptic ulcer disease D. Chronic pancreatitis E. Lipoma of the abdominal wall
Answer A AAA
A 37-y/o female with a new onset of AF is sent to the ED by her primary care provider. She complains of a recent onset of fatigue and DOE which has now progressed to dyspnea at rest. The patient also admits to associated orthopnea and peripheral edema. On cardiac exam, prominent RV & PA pulsations are visible and palpable. S2 is widely split and does not vary with breathing & a loud SEM is heard in 2nd & 3rd interspaces parasternally. The patient states she was told that she had a murmur when she was a child, but she does not recall what it was or if she had any other testing. Which of the following is the most likely diagnosis? A. ASD B. VSD C. PDA D. Congenital MS E. Coarctation of the Aorta
Answer A ASD
A 32 year old white male comes to your practice complaining of 2 days of red eyes, watery d/c, slightly blurred vision, and no pain. He has symptoms of an upper respiratory infection. The most likely cause of his symptoms is? A. Adenovirus B. Environmental allergens C. Herpes simplex D. Poor hygiene E. Staphyloccocus
Answer A Adenovirus
A 65-year-old male with a history of BPH develops HTN . Which of the following would be the best treatment option for this patient's HTN? A. Alpha blocker B. Beta blocker C. ACE inhibitor D. Diuretic
Answer A Alpha blocker
Which classification of medication would most likely contribute to a patient's hearing loss? A. Aminoglycosides B. Fluoroquinalones C. Sulfonylureas D. Macrolides
Answer A Aminoglycosides
Which of the following psychiatric conditions has the highest mortality rate? A. Anorexia nervosa B. Bulimia nervosa C. Depression D. Generalized anxiety disorder E. Obsessive-compulsive disorder
Answer A Anorexia nervosa
A 63-year-old woman presents to the urgent care facility with complaints of persistent heartburn. The patient has not had any success in alleviating symptoms with antacids or over-the-counter ranitidine. She feels that her heartburn spreads throughout her entire chest and upper abdomen. Vital signs are normal. Blood sample for tests has been obtained and sent for analysis, and reports are awaited. At the intake, ECG has been obtained (ST changes in V3 and V4). What is the most probable diagnosis? A. Anterior myocardial infarction B. Wolf-Parkinson-White syndrome C. Inferior wall myocardial infarction D. Left ventricular hypertrophy E. Acute pericarditis
Answer A Anterior myocardial infarction
A 37 year-old female with history of Turner's syndrome and coarctation of the aorta repaired at the age of 3 presents for routine examination. The patient is without complaints of chest pain, dyspnea, palpitations, or syncope. On PE, VS reveal a BP of 130/76, HR 70, regular, RR 16. On cardiac examination you note a grade II/VI SEM at the LSB and a grade III/VI blowing diastolic murmur. Which of the following does this patient require? A. Antibiotic prophylaxis B. Beta blocker therapy C. Chest CT D. Exercise stress test
Answer A Antibiotic prophylaxis
A 68 y/o WF presents to her PA with c/o "fainting spells off and on for a month or so". She is well known to your staff for her history of non-compliance with her antihypertensive medications. On PE you find bilateral carotid bruits, no JVD and clear lung fields. Cardiac exam is significant for a regular sustained apical impulse lateral to the midclavicular line and a 4/6 systolic cresendo-decresendo murmur at the base. The most diagnosis and cause of her symptoms is A. Aortic valve stenosis B. Mitral stenosis C. Pulmonic valve stenosis D. Mitral regurgitation E. Tricuspid valve regurgitation
Answer A Aortic valve stenosis
A 45 Y.O. Hispanic female presents to the eye ER with burning and itching for 6 months. Her eyes appear "white and quiet." What can you recommend for her treatment? A. Artificial tears B. Oral acyclovir C. Hot compresses D. Topical anesthetic E. Topical steroids
Answer A Artificial tears
What is the treatment for viral conjunctivitis? A. Artificial tears B. Ciprofloxacin ophthalmic drops C. Cycloplegic D. Timolol ophthalmic E. Tobramycin/ dexamethasone
Answer A Artificial tears
A 23 year old male presents with a sever sore throat and a "hot potato" sounding voice. He has is febrile at 101° F with mild unilateral tonsillar edema. What treatment is most indicated? A. Aspiration B. Emergency tonsillectomy C. Intubation D. Oral PCN
Answer A Aspiration
What is the most common cause of adult exophthalmos? A. Autoimmune B. Cavernous hemangiomas C. Infection D. Tumor
Answer A Autoimmune
A patient describes a desire for close relationships and to be more successful at work. However, she views herself as being undesirable and inferior. Because of these feelings she avoids social activities and extra occupational projects out of fear of criticism, rejection, and embarrassment. Which diagnosis would best fit this description? A. Avoidant personality disorder B. Borderline personality disorder C. Histrionic personality disorder D. Schizoid personality disorder
Answer A Avoidant personality disorder
Respiratory Acidosis may be seen in a patient with A. COPD B. Anxiety C. Fever D. Hyperventilation
Answer A COPD
A 70 year old male smoker complains of sudden vision loss. On fundoscopic exam he has a deep red spot on his macula. This is pathognomonic of what condition? A. Central retinal artery occlusion (CRAO) B. Central retinal vein occlusion (CRVO) C. Retinal detachment D. Uveitis E. Wet type macular degeneration
Answer A CRAO
What is the cause of sudden, painless vision loss in this patient (fundoscopic exam reveals severe AV nicking- "pizza" apperance)? A. Central Retinal Vein Occlusion (CRVO) B. Retinal Detachment C. Uveitis D. Grade IV hypertensive retinopathy
Answer A CRVO
A 30-year-old male patient presents with a recurrent history of mouth and jaw pain. He states that he gets swelling on the right side of his jaw/ face that begins while eating and subsides within 2 hours after he is done eating. On physical exam, there is no swelling or pus noted, but a mass is palpable on the right side of the jaw, near the TMJ. No other significant findings are noted. What is the suspected cause? A. Calculus formation in the Stenson's duct B. Bacterial infection of the parotid gland C. Parotid gland cancer D. Paramyxoviral infection
Answer A Calculus formation in the Stenson's duct
What is the Diagnosis? HAV Ab IgM (+) HCV Ab (+) HBsAg (-) HBcAb IgM(-) A. Acute Hepatitis A and Acute Hepatitis B B. Acute Hepatitis B and Hepatitis C C. Acute Hepatitis A and Hepatitis C D. Acute Hepatitis B and Acute Hepatitis B
Answer C Acute Hepatitis A and Hepatitis C
A 68-year-old man with a history of hypertension, diabetes, and urinary retention awoke feeling nauseated and light-headed. He did not respond to questions from his wife. When the emergency medical technicians arrived, his blood pressure was 60 by palpation. IV fluids and oxygen were administered. Vital signs obtained in the ER were blood pressure 60, heart rate 120 and regular, temperature 38.9°C (102°F), and respiratory rate 30. A brief physical examination revealed coarse rales approximately halfway up in the chest bilaterally and inaudible heart sounds. An indwelling urinary catheter was placed with drainage of 10 to 20 mL of dark urine. Chest x-ray revealed bilateral interstitial infiltrates; ECG was unremarkable except for sinus tachycardia. Antibiotics were administered, and the patient was transferred to the ICU, where a right heart catheterization was performed. Pulmonary capillary wedge pressure was 28 mmHg. Cardiac output was 1.9 L/min. Right atrial mean pressure was 10 mmHg. These findings are most consistent with which of the following types of shock A. Cardiogenic B. Hypovolemic C. Septic D. Obstructive E. Distributive
Answer A Cardiogenic
65-year-old woman, with a history of HTN , presents with a 3 week history of an ulcer on her left ankle. Patient is a non-smoker. On physical examination the ulcer is located over the left medial malleolus. The edges are rough and the surrounding skin is darkly pigmented, edematous, and atrophic. Pedal pulses are 2+ and the feet are warm. Sensory exam is normal. Which of the following is the most likely diagnosis? A. Chronic venous insufficiency B. Arterial insufficiency C. Buerger's disease D. Cellulitis
Answer A Chronic venous insufficiency
The following arterial blood gas finding is most associated with pulmonary embolism: A. Decreased PO2 and Decreased PCO2 B. Decreased PO2 and Increased PCO2 C. Increased PO2 and Increased PCO2 D. Increased PO2 and Decreased PCO2
Answer A Decreased PO2 and Decreased PCO2
Which of the following is usually the inciting factor in cholesteatoma? A. ETD B. Otitis media C. Otitis externa D. Mastoiditis
Answer A ETD
A 76 y/o female with known chronic AR has a 3-week history of arthralgia, weakness, and low-grade fever. BP is 135/65, pulse is 90, and resp. is 22. Axillary temp is 100.2 degrees. Exam showed an alert, oriented patient with conjunctival petechiae and a 2/6 LSB diastolic murmur. Hgb is low at 9.4 g/dL and WBC count is high at 18.2 K/UL. Which of the following is the most likely diagnosis? A. Endocarditis B. Multiple myeloma C. Ankylosing spondylitis D. Waldenstrom's macroglobulinemia E. Idiopathic thrombocytic purpura
Answer A Endocarditis
Which of the following should be performed in a patient with multiple peptic ulcers who is refractory to standard treatment? A. Fasting Serum Gastrin Level B. Endoscopy C. Fasting Serum Glucose Level D. Barium Swallow
Answer A Fasting Serum Gastrin Level
A previously healthy 58-y/o man is admitted to the hospital because of acute pancreatitis. Within several hours, he becomes oliguric & hypotensive (BP 90/60 mmHg). Insertion of a PA (Swan-Ganz) catheter reveals PCWP 4 mmHg; PA, 22/4 mmHg; mean RA 11 mmHg. This man's hypotension would best be treated with A. Fluids B. Norepinephrine C. Dopamine D. Intraaortic balloon counterpulsation E. Dobutamine
Answer A Fluids
Which of the following treatments would be most urgent in treating hypovolemic hypotension? A. Fluids for IV hydration B. Dopamine as a pressor C. Initiation of IV antibiotics D. Nitrates to lower venous congestion E. Sub Q Epinephrine and initiate IV steroids
Answer A Fluids for IV hydration
Which of the following is most indicated in the diagnosis of corneal abrasion? A. Fluorescein stain B. Orbital ultrasound C. Measurement of intraocular pressure D. Radiograph E. Slit lamp examination
Answer A Fluorescein stain
An 18 year-old male high school basketball player comes to clinic for a routine physical exam. His height is 193 cm (76 in.); arm span is 201 cm (79 in.). He has long fingers and toes. BP is 146/62mmHg and HR 64/min. Which of the following exam findings is most consistent with the diagnosis? A. Grade 2/6 high-frequency diastolic murmur at the third right intercostal space B. Grade 2/6 systolic ejection murmur at the second left intercostal space with a fixed widely split S2 C. Grade 2/6 continuous murmur heard best at the high left sternal border D. Grade 2/6 systolic murmur at the fourth left intercostal space that decreases with squatting
Answer A Grade 2/6 high-frequency diastolic murmur at the third right intercostal space
A 15-year-old male has anterior chest pressure radiating into his left arm while playing soccer. The pressure ends in 5 minutes with rest. BP is 145/95, pulse is 90 and regular, and respirations are 20. Exam shows a rapid carotid pulse upstroke, double apical impulse, and 2/6 SEM in the 4th ICS along the LSB that radiates to the apex. Which of the following is the most likely diagnosis? A. Hypertrophic obstructive cardiomyopathy B. Variant angina pectoris C. Mitral valve prolapse D. Ventricular septal defect E. Ruptured chordae tendineae
Answer A HOCM
A 26 year-old male presents with increased dyspnea with exercise. He has noted a decrease in his exercise tolerance over the past several months. He denies chest pain or skipped heart beats. Echocardiogram reveals LVH with asymmetric septal hypertrophy. EF is 65%. Which of the following is the most likely presenting history or physical exam finding? A. He has an older brother with the same diagnosis B. An S3 gallop is heard C. Patient notes completing a course of adriamycin D. Elevated jugular venous distension is noted
Answer A He has an older brother with the same diagnosis
In the presentation of a hematoma, which of the following is the most likely cause? A. Hemophilia A B. ITP C. TTP D. Hemophilia B
Answer A Hemophilia A
A 44 y/o male who takes care of pigeons presents with a chronic cough & dyspnea with exertion. CXR shows a diffuse nodular lung pattern. Labs reveal an elevated erythrocyte sedimentation rate and C-related peptide. What is the most likely diagnosis? A. Hypersensitivity pneumonitis B. Bronchiectasis C. Pneumobilia D. Bronchiolitis
Answer A Hypersensitivity pneumonitis
Which of the following esophageal manometry features are seen with Achalasia? A. Incomplete LES relaxation with swallowing B. Gastric pressures greater than intraesophageal pressures C. Increased Peristalsis D. High amplitude waves with swallowing
Answer A Incomplete LES relaxation with swallowing
What findings would you suspect on Echocardiogram for an ASD? A. RAE & LAE B. RVH & LVH C. RAE & RVH D. LAE & LVH E. RAE, RVH, LAE, LVH
Answer C RAE & RVH
A 24-year-old man with a recent history of a viral illness comes to the ED complaining of severe left-sided chest discomfort, which radiates through to the left trapezius region. On coming into the room, you note that he is sitting up and hunched forward. On PE , the patient's T 39°C, BP 135/78, with HR of 85, and a pericardial friction rub is noted. Laboratory findings demonstrate elevated serum creatine kinase levels and normal serial troponin levels. His EKG demonstrates diffuse ST segment elevation in the precordial leads. His CXR demonstrates no acute process. Which of the following is the most appropriate treatment for this patient? A. Indomethacin B. Enoxaparin C. Nitroglycerin D. Morphine E. Penicillin V
Answer A Indomethacin
A 23 YO male presents with acute onset of non-traumatic left knee pain with fever and chills. The joint is swollen and warm to the touch with a limited range of motion. What is the most likely diagnosis? A. Infectious arthritis B. Gout C. Pseudogout D. Degenerative joint disease
Answer A Infectious arthritis
A 20 y/o female with asthma presents with symptoms requiring use of albuterol three times a week, but less than once a day. The next appropriate medication to add to this patient's regimen is: A. Inhaled flunisolide (Aerobid) B. Oral montelukast (Singular) C. Inhaled Salmeterol (Serevent) D. Oral Theophylline
Answer A Inhaled flunisolide (Aerobid)
A 34-year-old woman contemplating pregnancy is diagnosed with stage 1 hypertension, and after an evaluation is noted to have no complications. Which of the following antihypertensive classes may be appropriate for this individual? A. Labetolol B. Angiotensin-receptor blockers C. Direct renin inhibitors D. Hydrochlorothiazide
Answer A Labetolol
A 68-y/o man with a history of HTN, DM, & urinary retention awoke feeling nauseated & light-headed. He did not respond to questions from his wife. When emergency medical technicians arrived, his BP was 60 by palpation. IV fluids & oxygen were administered. VS obtained in the ER were BP 60, HR 120 and regular, T 38.9°C (102°F), & RR 30. A brief PE revealed coarse rales approximately halfway up in the chest bilaterally and inaudible heart sounds. An indwelling urinary catheter was placed with drainage of 10 to 20 mL of dark urine. CXR -bilateral interstitial infiltrates. ECG sinus tachycardia but was unremarkable. Antibiotics were administered, & patient transferred to ICU, where a right heart catheterization was performed. PCWP was 28 mmHg. CO was 1.9 L/min. RA mean pressure was 10 mmHg. The most likely cause of this man's hypotension A. Left ventricular dysfunction B. Right ventricular infarction C Gram negative sepsis D Gastrointestinal bleeding E Pulmonary emboli
Answer A Left ventricular dysfunction
A 22-year-old male presents with a 2 week history of an URTI. He has been taking amoxicillin for 6 days. He is still c/o malaise, sore throat, subjective fever, and a nonproductive cough. Physical exam reveals diffuse crackles. What is the MOST appropriate class of antimicrobials? A. Macrolide B. Fluoroquinolone C. Cephalosporin D. Sulfonamide
Answer A Macrolide
A 33 y/o Type I diabetic male presents with abdominal bloating, fullness, early satiety, and unexpected fluctuations in his blood glucose after eating. Which of the following treatments could be considered over the short term? A. Metoclopramide B. Omeprazole C. Tegaserod D. Capsaicin
Answer A Metoclopramide
In patients with COPD, the respiratory drive is most sensitive to A. O2 B. CO2 C. pH D. HCO3
Answer A O2
A two-week-old female is being evaluated in the clinic, and on examination she is noted to have bounding pulses with a widened pulse pressure. There is a rough, machinery sounding murmur present at the second left intercostal space. Cyanosis is not present. Which of the following is the most likely diagnosis? A. Patent ductus arteriosus (PDA) B. Ventricular septal defect (VSD) C. Tetralogy of Fallot D. Coarctation of the aorta
Answer A PDA
A 58 year-old male presents with CP . Vital signs include BP of 210/175, pulse 80, RR 20. Which of the following would you expect to find on physical examination? A. Papilledema B. Carotid bruit C. Diastolic murmur D. Absent peripheral pulses
Answer A Papilledema
Which of the following is the most appropriate treatment for an infant with phenylketonuria? a. Reducing protein in diet b. Providing phenylalanine in diet c. Discouraging breastfeeding d. Increasing wheat products in diet
Answer A Reducing protein in diet
A 65 y/o female patient complains of fatigue and SOB. Objective findings note an elevated JVP and a Kussmaul's sign. There is low voltage on the EKG with nonspecific repolarization changes. An echocardiogram shows impaired diastolic filling with preserved contractile function. You suspect which of the following? A. Restrictive Cardiomyopathy B. Dilated Cardiomyopathy C. Hypertrophic Cardiomyopathy D. RHD E. Pericardial effusion
Answer A Restrictive Cardiomyopathy
A 42 year-old female has dysphagia, symptoms of reflux, widespread thickening of the skin with loss of normal folds, areas of increased pigmentation, & telangiectasias. What is the most likely diagnosis? A. Scleroderma B. Barrett's Esophagus C. Esophageal Web D. Plummer-Vinson Syndrome
Answer A Scleroderma
The same patient progresses to complete ophthalmoplegia and headache. What is the next best step in management? A. Send for a stat MRI B. Control blood sugar C. Start daily ASA 81 mg/ day D. Start IV methylprednisalone
Answer A Send for a stat MRI
A 37 year old female presents with headaches, nasal congestion and minimal purulent nasal discharge for 4 days. On physical examination, her vital signs are stable and she has mild tenderness over the maxillary area. Which of the following tests is most appropriate in confirming your diagnosis? A. Sinus X-ray B. Nasal Culture C. CBC with differential D. MRI
Answer A Sinus X-ray
An obese adolescent male presents with a chief complaint of intermittent left knee pain and limping for the past 2 weeks. He has no history of trauma. Denies recent URI. The hip exam demonstrates limited internal rotation and mild tenderness. What is the most likely cause of this patient's condition? a. Slipped Capital Femoral Epiphysis b. Osgood-Schlatter Disease c. Septic arthritis d. Developmental dysplasia
Answer A Slipped Capital Femoral Epiphysis
Which of the following is not associated with ITP? A. Splenomegaly B. Megakaryocytosis C. Petechiae D. Bruising
Answer A Splenomegaly
33-year-old female noticed some mild neck swelling in her low anterior neck along with local pain, nervousness, a tremor of both hands, and a bit of sweating. Pulse was 110 and regular. With BP 150/80. Westergren ESR was markedly elevated at 85. Free T4 was elevated, and TSH was reported to be zero. The radioactive uptake was down to almost zero, and the radioactive uptake scan showed virtually no uptake in the gland. Your diagnosis is A. subacute thyroiditis. B. Graves' disease C. Toxic multinodular goiter D. Hashimoto's thyroiditis.
Answer A Subacute thyroiditis
The 4 cardinal symptoms of aortic stenosis are: A. Syncope, dyspnea, angina, sudden death B. Fatigue, syncope, hemoptysis, weakness C. Pounding in the head, palpitations, fatigue, dizziness D. Angina, sudden death, palpitations, syncope E. Dyspnea on exertion, PND, orthopnea, angina
Answer A Syncope, dyspnea, angina, sudden death
A 4-week-old infant presents with cyanosis. Workup of the patient reveals a VSD , overriding aorta, PS & RYH. Which of the following is the most likely diagnosis? A. Tetralogy of Fallot B. Coarctation of aorta C. PDA D. Complete transposition of the great vessels
Answer A TOF
Which is the FALSE statement? A. Type 1 diabetics may generally stop their insulin after age 60. B. Diabetic patients can learn about what goals are important. C. Diabetic patients should be taught how to take care of themselves. D. Diabetic patients should be taught about the chronic complications of diabetes.
Answer A Type 1 diabetics may generally stop their insulin after age 60.
A 72-year-old man collapses while playing golf. He has a 5-year history of angina and type 2 DM . Paramedics arrive in 10 minutes. Examination shows no respirations or BP . CPR is attempted for 10 minutes without success. Which of the following is the most likely cause of death in this patient? A. Ventricular fibrillation B. Rupture of the papillary muscle C. Necrosis of the myocardium D. Embolus to the right middle cerebral artery E. Cardiac tamponade
Answer A V-fib
Which of the following is the first step in the evaluation of a patient with a foreign body in the eye? A. Visual acuity B. Tonometry C. MRI scanning D. Fluorescein staining
Answer A Visual acuity
A patient presents with decreased hearing and fullness in the right ear. Otoscopic exam reveals hard, yellow/ brown debris. The tympanic membrane can not be visualized. What exam finding would you expect? A. Weber lateralizes to the right B. Weber lateralizes to the left C. Weber is equal
Answer A Weber lateralizes to the right
The most common cause of low TSH is A. excess thyroid hormone in the blood B. secondary hypothyroidism
Answer A excess thyroid hormone in the blood
Avoid treating osteoporosis with denosumab if A. serum calcium is low B. serum calcium is high C. serum potassium is low D. serum potassium is high
Answer A serum calcium is low
A 66 YO male c/o unsteadiness for several months. He now has low back and upper thigh pain that is relieved with rest. Peripheral pulses are strong. MRI shows diffuse narrowing of the spinal canal. For symptom reduction, this patient should be counseled about: A. weight loss and exercise B. steroid use C. spine manipulation D. decompressive laminectomy
Answer A weight loss and exercise
Which of the following is most consistent with a obstructive lung disease on spirometry? A. Decreased FEV1/FVC ratio B. Decreased FVC C. Increased FEV1/FVC ratio D. Increased FVC
Answer A Decreased FEV1/FVC ratio
In addition to 24-hour urine creatinine, which 3 of the following urine tests would you be likely to arrange for if you thought a patient might have a pheochromocytoma? A. Catecholamines B. Cortisol C. Calcium D. Metanephrines E. Estrogen F. VMA G. Aldosterone
Answer A, D, F Catecholamines, Metanephrines, VMA
Patient W has an elevated serum calcium of 13.7 mg/dl with a normal albumin of 4.0 g/ dl. He has not had any kidney stones. Patient X has a history of 2 kidney stones (the latter was analyzed and found to be a calcium stone). His serum calcium is slightly high at 10.8 mg/dl. With a normal albumin. Serum PTH is elevated. Patient Y has a mildly low serum calcium of 8.2 mg/dl with a normal albumin of 4.0 and an elevated PTH. He has not had any kidney stones. Patient Z has a normal serum calcium of 9.1 with a normal albumin of 4.0 mg/dl. Serum PTH is in the low-normal range. He has had a kidney stone. Using the current 2014 guidelines, how many of these patients would you send for neck surgery? A. 1 B. 2 C. 3 D. 4
Answer B 2 (Patient W and X)
A 53-year-old man presents to the ED after the acute onset of CP . The episode occurred 8 h prior to his arrival and lasted for a total of 20 to 30 min. The CP is now resolved. The patient has a long Hx of DM and hypercholesteremia and has smoked approximately 1 to 1 1/2 packs per day of cigarettes for past 30 years. On PE, BP of 84/52, and HR is 54. He has JVD to angle of mandible and clear lung fields. His rhythm strip reveals a Wenkebach pattern. Given his hypotension, a SG catheter is placed. RA pressure is estimated at 16 mmHg (normal 0-5), PA pressure at 20/10 mmHg (normal 12-28/3-13), and PCWP s 8 mmHg (normal range 3-10). Which of the following is most consistent with this clinical picture? A. An anterior wall myocardial infarction B. A right ventricular infarction C. A ruptured mitral valve leaflet D. A constrictive pericarditis following a myocardial infarction E. A lateral wall myocardial infarction
Answer B A right ventricular infarction
A 56-year-old male came to the ED with complaints of palpitations and SOB since 1 week ago. He has a longstanding history of poorly controlled HTN. PE reveals an elevated BP of 190/98 , mild hepatomegaly, bilateral pedal edema, and rales at the lung bases. Diagnostic studies reveal concentric LVH without significant valvular abnormalities on echocardiogram. Which of the following drugs is beneficial in the treatment of the patient's condition by virtue of both afterload and preload reduction? A. Loop diuretics (furosemide) B. Angiotensin-converting enzyme inhibitor- enalapril C. Positive inotropic agents (digoxin) D. Thiazide diuretics (hydrochlorothiazide) E. Arterial vasodilators (hydralazine)
Answer B ACE-I: Enalapril
Which of the following should be used to screen for HCC in a patient with chronic HCV or HBV? A. CEA B. AFP C. CA 19-9 D. PSA
Answer B AFP
What is the Diagnosis? HAV Ab IgM (-) HCV Ab (-) HBsAg (+) HBcAb IgM(+) A. Acute Hepatitis A B. Acute Hepatitis B C. Acute Hepatitis C D. Acute Hepatitis D
Answer B Acute Hepatitis B
A 68-year-old man is recently diagnosed with depression associated with the loss of his close sister to an automobile accident. He is currently taking oxybutynin for overactive bladder disease and lisinopril for hypertension. He has no known drug allergies. Which of the following medications would be most appropriate to prescribe for this patient? A. Alprazolam B. Amitriptyline C. Buspirone D. Desipramine E. Fluoxetine
Answer B Amitriptyline
Jarish-Herxheimer reaction is thought to be: A. A sign of sepsis B. An immune response to killed treponema organisms C. Treatment failure in syphilis D. IRIS (immune reconstitution inflammatory response)
Answer B An immune response to killed treponema organisms
An increased ESR is noted in which of the following? A. Lead Poisoning B. Anemia of Chronic Disease C. B12 Deficiency D. Hemolytic Anemia
Answer B Anemia of Chronic Disease
A 23-year-old student presents to your office for health clearance to play collegiate sports. He is asymptomatic and exercises daily. On PE, his BP is 160/50 mm hg and his HR 60/min. there is pulsus bisferiens. Heart examination reveals a blowing diastolic murmur at the LSB. Nail beds reveal a Quincke pulse. Which of the following is the most likely diagnosis? A. Cardiac tamponade B. Aortic insufficiency C. Mitral stenosis D. Atrial septal defect(ASD) E. Tetralogy of Fallot
Answer B Aortic insufficiency
A 56 year-old male with a known history of polycythemia suddenly complains of pain and paresthesia in the left leg. PE reveals the left leg to be cool to the touch and the toes to be cyanotic. The popliteal pulse is absent by palpation and Doppler. The femoral pulse is absent by palpation but weak with Doppler. The right leg and upper extremities have 2+/4+ pulses throughout. Given these findings what is the most likely diagnosis? A. Venous thrombosis B. Arterial thrombosis C. Thromboangiitis obliterans D. Thrombophlebitis
Answer B Arterial thrombosis
Which of the following is NOT a risk factor for gallstones? A. Crohn's Disease B. Aspirin Use C. Sickle Cell Anemia D. Rapid Weight Loss
Answer B Aspirin Use
A 55-year-old presents with orthopnea and PND. On PE, JVD and pulmonary rales are noted. Which of the following laboratory tests would most likely be elevated in this patient? A. Thyroid stimulating hormone B. Brain natriuretic peptide C. Myoglobin D. Renin
Answer B BNP
A 43 year old flight attendant complains of nausea and vomiting associated with severe dizziness when she rolls out of bed in the mornings. She claims to have had these symptoms for the last couple of days. She further states that she has been previously healthy except for an upper respiratory infection 2 weeks ago. Her audiogram reveals no hearing loss. The MOST likely diagnosis is: A. Meniere's Syndrome B. Benign Paroxysmal Positional Vertigo C. Vertebrobasilar insufficiency D. Labyrinthitis
Answer B Benign Paroxysmal Positional Vertigo
In addition to verapamil (Calan), which of the following medications is considered the treatment of choice for patients with hypertrophic cardiomyopathy? A. ACE inhibitors B. Beta-blockers C. Antiarrhythmics D. Alpha-agonists
Answer B Beta-blockers
A 60 YO man came to the outpatient clinic complaining of bad mouth odor that has been occurring for months. The patient has a 40 pack year history of smoking. He has chronic bronchitis with colorless sputum. He has been visiting his dentist who assured the absence of caries and sent him to be examined for the lesion shown. The patch can't be rubbed or removed by cotton tipped applicator. What evaluation does this patient need? A. KOH B. Biopsy C. CBC with Differential D. Gram stain
Answer B Biopsy
What is the cause of this condition (swollen nodule on upper eyelid)? A. Blepharitis B. Blocked sebaceous gland C. Pseudomonas species D. Rosacea E. Trauma
Answer B Blocked sebaceous gland
What is the most common cause of vision loss in an HIV + patient? A. Candidiasis B. Cytomegalovirus C. Pneumocystis D. Toxoplasmosis
Answer B CMV
Another construction worker (who was not wearing eye protection) presents as below (nail embedded in eyebrow). What does he need for his evaluation? A. MRI B. CT scan C. Plain film radiograph D. Applanation tonometry
Answer B CT scan
A 24-year-old male has an eight-month history of loose thought associations, social withdrawal, auditory hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted to have a flat affect, perceptual distortions, and behaves like he is detached from his own actions. Which of the following medications used in treatment of this disease has the risk of prolonging the QTc interval? A. Aripiprazole (Abilify) B. Chlorpromazine (Thorazine) C. Loxapine (Loxitane) D. Quetiapine (Seroquel) E. Ziprasidone (Geodon)
Answer B Chlorpromazine (Thorazine)
A 22 year old male steps on a nail which punctures through his sneaker into his right foot. Two days later, he presents to the free clinic with pain on ambulation and moderate redness/ swelling of his plantar and dorsal foot. No pus is expressed. His last tetanus toxoid was 8 years ago, and he completed a primary series. What treatment would be most beneficial? A. Amoxicillin/ Clavulanate B. Ciprofloxacin C. Cloxacillin D. Azithromycin E. SMT/ TMP
Answer B Ciprofloxacin
Which of the following coronary arteries is typically involved in a lateral wall myocardial infarction? A. Right coronary artery B. Circumflex artery C. Left anterior descending artery D. Left coronary artery
Answer B Circumflex artery
During a routine physical exam, a 16-year-old male complains of a painful lesion on the inside of his cheek. A round whitish-gray ulcer that has a red surrounding halo is noted on exam. The lesion is tender to the touch. The patient denies any medical, surgical, sexual, or social history. How would you make the diagnosis most readily/easily? A. RPR B. Clinical presentation C. Culture D. Biopsy E. Glycoprotein
Answer B Clinical presentation
Which of the following is the most common cause of obstructive jaundice? A. Pancreatic neoplasm B. Common duct stone C. Gilbert's Disease D. Primary Biliary Cirrhosis
Answer B Common duct stone
In a healthy neonate, which of the following vaccinations is to be administered prior to discharge from the hospital after birth? a. Hepatitis A vaccine b. Hepatitis B vaccine c. Haemophilus influenza type B vaccine d. Combination diphtheria, tetanus, and acellular pertussis vaccine e. Inactivated polio vaccine
Answer B Hepatitis B vaccine
A 21 y/o male presents with a five day history of an upper respiratory tract infection and a two day history of progressive shortness of breath. He has a five year history of allergic rhinitis. His father has asthma. On physical exam, he appears anxious. His temperature is 37.8°C (100°F), pulse is 115/min, respirations are 24/min and labored, and blood pressure is 140/90 mm Hg. Diffuse wheezes are heard throughout all lung fields. Examination shows no other abnormalities. CXR shows hyperinflation. Pulse oximetry on room air shows an oxygen saturation of 94%. Which of the following is the most appropriate management of this patient? A. Oxygen therapy via nasal cannula and intravenous diazepam therapy B. Corticosteroid therapy and inhaled β2-adrenergic agonist therapy C. Oral broad-spectrum antibiotic therapy D. Inhaled ipratropium and corticosteroid therapy
Answer B Corticosteroid therapy and inhaled β2-adrenergic agonist therapy
For the past 8 years, an 18 y/o female experienced chronic diarrhea and abdominal pain that could not be explained by the doctors treating her. During an AP science class, she brought in slides of her intestinal tissue. Looking through a microscope, she spotted a granuloma. What was her diagnosis? A. Celiac Sprue B. Crohn's Disease C. Lactose intolerance D. Ulcerative Colitis
Answer B Crohn's Disease
A 62-year-old male in the ICU is undergoing treatment for severe pancreatitis and has not eaten for weeks. He is receiving TPN (Total Parenteral Nutrition) via a central IV line at 75 mL per hour. The IV line suddenly comes out, and the bag of IV fluids may be contaminated. The pharmacy cannot prepare a matching bag of IV fluids for 6 hours. What should we do? Start an IV infusion at the same rate using: A. D5W B. D10W C. D20W D. D30W
Answer B D10W
A 32 YO white female complains of swelling of the upper lid with pain and redness extending around the orbit. Her EOMS are intact. She has no chemosis or fever. She has purulent discharge from the tear ducts. (PE of left eye reveals diffuse swelling) A. Conjunctivitis with 2nd infection B. Dacryoadenitis C. Infected hordeolum D. Orbital cellulitis E. Trauma
Answer B Dacryoadenitis
Which of the following is most consistent with an restrictive lung disease on spirometry? A. Decreased FEV1/FVC ratio B. Decreased FVC C. Increased FEV1/FVC ratio D. Increased FVC
Answer B Decreased FVC
Sexually active young male worried about an unprotected sex contact noticed these lesions (pink papules) on his penis when he self examined himself. What would be the best treatment of these lesions? A. Aldara® (imiquimod) B. Do nothing C. Podophillin D. Trichloroacetic acid E. Veregen® (sinecatechins)
Answer B Do nothing
A 65 year-old male 5 days status-post MI is evaluated for anterior CP . The pain improves with sitting up. The patient has associated fever, leukocytosis and a pericardial friction rub. Which of the following is the most likely diagnosis? A. Tako-tsubo cardiomyopathy B. Dressler syndrome C. Rupture of papillary muscles D. Recurrent myocardial infarction
Answer B Dressler syndrome
Patients with gallstones and jaundice (serum bilirubin >5mg/dL) or a dilated common bile duct (>7mm) &/or stones seen in common bile duct on US or CT scan should receive which of the following treatment options initially? A. Laparoscopic cholecystectomy B. ERCP w/ sphincterotomy C. Peritoneal Lavage D. HIDA Scan
Answer B ERCP w/ sphincterotomy
A 35 y/o male status-post PDA repair at 5 years of age, presents with low-grade fever, fatigue and dyspnea worsening over the past 10 days. Prior to the onset of these symptoms, he was healthy and free of any complaints. Examination is significant for petechiae on the palate, a high pitched holo-systolic murmur heard best at the apex, and splinter hemorrhages on both hands under his fingernails. Which of the following is the most appropriate next step in the evaluation of this patient? A. Cardiac catheterization B. Echocardiogram C. MUGA scan D. Chest radiograph
Answer B Echo
You are seeing in your office a patient with the chief complaint of relatively sudden onset of SOB and weakness but no CP. ECG shows nonspecific ST-T changes. You would be particularly attuned to the possibility of painless, or silent, MI in the A. Advanced coronary artery disease patient with unstable angina on multiple medications B. Elderly diabetic C. Premenopausal female D. Inferior MI patient E. MI patient with PVCs
Answer B Elderly diabetic
What else would you expect to find in a patient with retinopathy? A. Elevated BP B. Elevated HgA1C C. Elevated intraocular pressure D. Elevated T3/T4
Answer B Elevated HgA1C
What has been shown to benefit patients with a hyphema? A. NSAIDs B. Elevation of the head C. Coumadin D. Artificial tears
Answer B Elevation of the head
What symptom(s) might a patient have that would have you suspect they had a detached retina? A. Eye pain B. Flashes and floaters C. Scintillating scotomata D. Severe headache
Answer B Flashes and floaters
A 32 year-old female who is a cardiac transplant recipient presents with odynophagia and dysphagia. EGD reveals diffuse, linear yellow-white plaques adherent to the esophageal mucosa. Which of the following is the best treatment? A. Acyclovir B. Fluconazole C. Highly active antiretroviral therapy (HAART) D. Ciprofloxacin
Answer B Fluconazole
Three weeks later, the patient with viral conjunctivitis returns slightly worse with more redness and discomfort. What exam should he have? A. Tonometry B. Fluorescein stain C. Formal visual fields D. CT scan of orbit E. Culture
Answer B Fluorescein stain
Follow-up endoscopy should be performed 6-12 weeks after the start of therapy for patients with...... A. Duodenal Ulcers B. Gastric Ulcers C. Both Duodenal and Gastric Ulcers D. Neither Duodenal nor Gastric Ulcers
Answer B Gastric Ulcers
A 56-year-old man is admitted to the hospital for chest pain of 2-hour duration. His heart rate is 42 bpm, with sinus bradycardia on ECG, as well as ST-segment elevation in leads II, III, aVF. Which of the following is the most likely diagnosis? A. He is in good physical condition with increased vagal tone. B. He likely has suffered an IWMI C. He likely has a LV aneurysm D. The low HR is a reflection of a good cardiac EF
Answer B He likely has suffered an IWMI
Hutchinson's sign is indicative of which infection? A. Gonorrhea B. Herpes zoster C. Toxoplasmosis D. Syphilis
Answer B Herpes zoster
A 59-year-old man is brought to the emergency department because of a 4-day history of nausea, vomiting, and diarrhea. He also has been confused and agitated during this period. He has a history of mild hypertension. His current medication is a diuretic. His temperature is 37°C (98.6°F), pulse is 108/min, respirations are 26/min, and blood pressure is 70/47 mm Hg. Physical examination shows delayed capillary refill of the lips and nail beds and cool extremities. His oxyhemoglobin saturation in a central vein is 60% (N=70-75). These findings are most consistent with which of the following types of shock A. Cardiogenic B. Hypovolemic C. Septic D. Obstructive E. Distributive
Answer B Hypovolemic
A previously healthy 58-year-old man is admitted to the hospital because of an acute inferior myocardial infarction. Within several hours, he becomes oliguric and hypotensive (blood pressure is 80/60 mmHg). Insertion of a pulmonary artery (Swan-Ganz) catheter reveals the following pressures: pulmonary capillary wedge, 4 mm Hg; pulmonary artery, 22/4 mmHg; and mean right atrial, 11 mmHg. These findings are most consistent with which of the following types of shock A. Cardiogenic B. Hypovolemic C. Septic D. Obstructive E. Distributive
Answer B Hypovolemic
A 58 y/o male with silicosis develops latent tuberculosis infection with a 15mm reaction to the Mantoux tuberculin skin test. Which of the following options are indicated in this person? A. INH, Rifampin, Pyrazinamide, and Ethambutol for 9 months B. INH for 9 months C. Follow-up CXR every 9 months D. Repeat PPD in 9 months
Answer B INH for 9 months
A 66 year-old female with a history of DM and HTN presents for routine evaluation. Since beginning her ACE inhibitor and diuretic therapy her BP have averaged 138/85 mmHg. Which of the following is the next best step in the management of this patient? A. Congratulate her for being "at goal" with a blood pressure of less than 140/90 mmHg. B. Increase ACE inhibitor to achieve blood pressure of less than 130/80 mmHg. C. Convert ACE inhibitor to angiotensin receptor blocker. D. Explain blood pressure is a little lower than needed so discontinue diuretic.
Answer B Increase ACE inhibitor to achieve blood pressure of less than 130/80 mmHg.
Which of the following treatments would be most urgent in treating cardiogenic shock? A. Fluids for IV hydration B. Initiation of IV dopamine C. Initiation of IV antibiotics D. IV Dexamethasone E. SQ Epinephrine
Answer B Initiation of IV dopamine
A 36-year-old woman has severe burning chest pain that radiates to her neck. The pain occurs particularly after meals, especially when she lies down, and is not precipitated by exertion. She is admitted for observation. Serial EKG and troponin levels are normal. Which of the following is the best next step? A. Stress thallium treadmill test B. Initiation of a proton pump inhibitor C. Coronary angiography D. Initiation of a SSRI E. Referral to psychiatry
Answer B Initiation of a proton pump inhibitor
A man calls the office complaining of splashed bleach in his eye. You should instruct him to: A. Patch the eye and immediately go to the ER B. Irrigate the eye for 15 minutes and then go to ER C. Immediately apply lubricating ointment and then go to the ER D. Immediately wash the eye with contact saline solution and go to the ER if he notices any change in vision
Answer B Irrigate the eye for 15 minutes and then go to ER
*Which elevated lab test would be most indicative of pneumocystitis infection? A. Aspartate aminotranferase (ALT) B. Lactate dehydrogenate (LDH) C. Mean corpuscular volume (MCV) D. Sodium bicarbonate (-HCO3)
Answer B LDH
Which of the following treatment options would be indicated in a patient with a distended gallbladder? A. ERCP B. Laparoscopic cholecystectomy C. MRCP D. CT guided biopsy
Answer B Laparoscopic cholecystectomy
A 69-year-old man with a 50-pack/year history of cigarette smoking presents with a known diagnosis of COPD. Which medication would be LEAST effective in treating this patient? A. Ipratropium B. Leukotriene modifier C. B-adrenergic agents D. Corticosteroids
Answer B Leukotriene modifier
Which is true concerning nonoxyl-9? A. It is known to prevent STDs B. May cause an increase risk of HIV infection C. Causes an increase in pregnancy when used with condoms D. Causes decreased local sensitivity
Answer B May cause an increase risk of HIV infection
A 26-year-old female comes into the ER with complaints of dyspnea on exertion. On further questioning, she gives a history of increasing cough over the last week and limitation of her daily activities. She also gives a history of breathlessness at night after going to bed. Her PMH is significant for a bout of RF at age 15. Examination shows a female in distress. There is peripheral and facial cyanosis. There are prominent 'a' waves in the JVP . Palpation yields a diastolic thrill at the apex in the left lateral position. Auscultation shows the presence of a mid-diastolic murmur best heard in the mitral area. What condition does this patient most likely have? A. Mitral insufficiency B. Mitral stenosis C. Aortic stenosis D. Aortic insufficiency E. Tricuspid stenosis
Answer B Mitral stenosis
A 56 year-old female four days post MI presents with a new murmur. On examination the murmur is a grade 3/6 pansystolic murmur radiating to the axilla. She is dyspneic at rest and has rales throughout all her lung fields BP 108/68, HR 110. Which of the following would be the definitive clinical intervention? A. Intra-aortic balloon counterpulsation B. Mitral valve replacement C. Coronary artery bypass surgery D. Immediate fluid bolus
Answer B Mitral valve replacement
Stress, poor hygiene, and malnutrition is most associated with which condition? A. Fournier's gangrene B. Necrotizing ulcerative gingivitis C. Actinomycoses D. Angular cheilitis
Answer B Necrotizing ulcerative gingivitis
A 76 y/o male from Kenya is brought into a clinic. He has chronic diarrhea and mild dementia. His diet consists mainly of corn & is very low in calories, protein, and fresh fruits/vegetables. On physical exam he has pigmented patches on the sun exposed areas of his body. This patient probably has a deficiency of which vitamin? A. Riboflavin B. Niacin C. Thiamine D. Folate
Answer B Niacin
A 60-year-old male presents with substernal chest tightness after mowing the lawn. He also noted mild dyspnea and diaphoresis. All his symptoms resolved in ten minutes. Vitals and PE are normal. EKG reveals normal sinus rhythm with no acute changes. Which of the following is the most appropriate treatment for this patient? A. Hydrocodone (Vicodin) B. Nitroglycerine (Nitro) C. Furosemide (Lasix) D. Omeprazole (Prilosec)
Answer B Nitroglycerine (Nitro)
A 50-year-old African American male presents with increasing shortness of breath for the past 4 months. He denies any tobacco use history. On physical examination his temperature is 98.6 F. There are fine rales auscultated in all lung fields. CXR reveals hilar lymphadenopathy and a reticulonodular pattern of small densities in all lung fields. A transbronchial biopsy is performed that microscopically shows numerous small pulmonary interstitial non-caseating granulomas. Which of the following is the most likely diagnosis? A. Histoplasmosis B. Sarcoidosis C. Tuberculosis D. Adenocarcinoma
Answer B Sarcoidosis
A 58 y/o male presents with a 2 month history of a 20 lb unintentional weight loss and hemoptysis. CXR reveals a 6 cm mass near the left hilum. Sputum cytology is positive for malignancy. Which of the following is the most likely predisposing factor to the development of this disease? A. Silicosis B. Smoking C. Asbestosis D. Radon gas exposure
Answer B Smoking
Despite successive increases in insulin dosage, Fred has awakened each morning with an increasingly higher fasting blood glucose. Next you plan to perform a blood glucose test at 3 AM one morning to rule out A. a Dawn phenomenon B. a Somogyi reaction C. an elevated glucose D. an elevated cholesterol
Answer B Somogyi reaction
The most frequent malignant neoplasm involving the larynx is: A. Adenocarcinoma B. Squamous cell carcinoma C. Squamous papilloma D. Metastatic tumor E. Fibrosarcoma
Answer B Squamous cell carcinoma
A 23-year-old female with gestational diabetes has an uncomplicated pregnancy until the 29th week of gestation, when she has the onset of premature labor and delivers. The infant initially has Apgar scores of 4 and 6 at 1 and 5 minutes, but within an hour is in severe respiratory distress and requires intubation with mechanical ventilation. Which of the following treatments should be administered to the infant at this time? A. Prednisone B. Surfactant C. Nafcillin D. Racemic epinephrine
Answer B Surfactant
What is the treatment for a pterygium? A. Artificial tears B. Surgery C. Avoid sun, wind, dust D. Reassurance E. Bacitracin ointment
Answer B Surgery
A newborn is showing the following symptoms: meconium ileus, failure to thrive and respiratory symptoms. Which diagnostic test should be performed? a. Ultrasound of abdomen b. Sweat chloride test c. Pulmonary function testing d. Complete blood count
Answer B Sweat chloride test
What tetanus prophylaxis is recommended after dirty wound puncture and it's been 8 years since last vaccination? A. None! B. Td or Tdp C. Tetanus immune globulin D. TD or Tdp and tetanus immune glubulin
Answer B Td or Tdp
Which of the following is the most common cause for acute myocardial infarction? A. Occlusion caused by coronary microemboli B. Thrombus development at a site of vascular injury C. From congenital abnormalities D. Severe coronary artery spasm
Answer B Thrombus development at a site of vascular injury
Which of the following features is associated with entropion? A. Decreased lacrimation B. Trichiasis C. Lack of light sensitivity D. Photophobia
Answer B Trichiasis
Tinea corporis is due to infection with which one of the following organisms? A. Pityrosporum species B. Trichophyton species C. Pseudomonas species D. Propionibacterium species E. Tinea rubrum
Answer B Trichophyton species
A 55 year-old morbidly obese male is seen in the office for routine examination. He has a history of PHTN and cor pulmonale. Examination reveals a visible JVP and a systolic flow murmur on the right side of the sternum. Which of the following is the most likely diagnosis? A. Mitral insufficiency B. Tricuspid insufficiency C. Hepatic vein thrombosis D. Aneurysm of the thoracic aorta
Answer B Tricuspid insufficiency
What is the difference in the pathophysiology of type 1 diabetes and type 2 diabetes? A. There is no difference B. Type 1 is basically the result of the absence of insulin; whereas, type 2 involves insulin resistance. C. Like B above, but the other way around. D. Does it matter?
Answer B Type 1 is basically the result of the absence of insulin; whereas, type 2 involves insulin resistance
A 56 y/o male with a 30 pack-year smoking history presents with substernal CP. The pain is described as a pressure that radiates to his jaw. The pain has lasted consistently for 30 minutes with variable relief. His current medications include atorvastatin (Lipitor) and glyburide (Micronase). Which of the following aggravating or relieving factors about the pain would support the diagnosis? A. Precipitated by exercise and relieved with rest B. Unrelieved by nitroglycerin C. Aggravated by deep breaths D. Relieved with food
Answer B Unrelieved by nitroglycerin
A patient who was recently diagnosed with viral pericarditis now complains of severe dyspnea and non-productive cough with pain over the precordial region. His VS reveal a HR 130 and respiratory rate 26. BP is 130/105 but fluctuates with inspiration resulting in a 20 mmHg decline in the systolic pressure. Which of the following is the most appropriate therapy for this patient? A. Serial echocardiography B. Urgent pericardiocentesis C. Surgery for pericardial window D. Furosemide (Lasix) bolus
Answer B Urgent pericardiocentesis
Meniere's Disease is associated with: A. Unsteadiness, ear pain, and ear fullness B. Vertigo, hearing loss, tinnitus C. Mydriasis, anhydrosis, ptosis D. Nystagmus, nausea, increased ventricle size
Answer B Vertigo, hearing loss, tinnitus
You sent a 25-year-old male to a urologist for corrective surgery for cryptorchidism. Afterwards, A. you discharge him from your practice and that of the urologist because the problem is cured. B. arrange for him to have periodic physical exams. C. Check the serum level of the androgen DHEAS. D. Immediately check FSH and LH.
Answer B arrange for him to have periodic physical exams.
The drug amiodarone may lead to A. pancreatic disease B. thyroid disease
Answer B thyroid disease
A 16 YO football player presents with a unilateral knee effusion. He states he twisted, felt a pop and had immediate swelling and pain. He has positive Lachman and negative posterior drawer signs. What structure is most likely torn? A. Medial meniscus B. Lateral meniscus C. Anterior cruciate ligament D. Posterior cruciate ligament
Answer C ACL
A 68 y/o male w/ a hx of HTN, CKD stage II, gout, and a-fib is admitted to the ICU with a life-threatening UGIB. Endoscopy reveals several actively bleeding gastric ulcers. 2 days ago the patient was placed on indomethacin and colchicine for an acute gout attack. Other medications include lisinopril, warfarin, and amlodipine. Which of the following was the likely cause of this patient's bleeding? A. Failure to stop ACE-I prior to gout tx B. Failure to stop the CCB prior to gout tx C. Addition of indomethacin to the regimen D. Addition of colchicine to the regimen
Answer C Addition of indomethacin to the regimen
What is the most likely diagnosis? AST 400 (nl 15-37) ALT 150 (nl 30-65) A. Chronic hepatitis C B. Tylenol Overdose C. Alcoholic liver disease D. Spontaneous Bacterial Peritonitis
Answer C Alcoholic liver disease
A 66 y/o male presents with increasing dyspnea for the past year. He is retired from the construction business. Physical examination reveals some dry rales in both lungs upon auscultation. A CXR reveals bilateral diaphragmatic pleural plaques with focal calcification as well as diffuse interstitial lung disease. A sputum cytology shows no atypical cells. Pulmonary function studies reveal a low FVC and a normal FEV1/FVC ratio. These findings are most likely to suggest prior exposure to which of the following environmental agents? A. Silica dust B. Beryllium C. Asbestos D. Cotton Fibers
Answer C Asbestos
A 27-year-old female has gained 2 pounds in weight over the last 4 months and has experienced a little fatigue. She has 2 children, ages 2 and 4. Her T3-resin uptake test is low at 21%. Her total T4 is elevated 14.8 mcg/dL. She has not had any heat or cold intolerance or any dry skin or excessive sweating. P 72, R 16, BP 110/75. No palpable goiter. Reflexes 2+. Skin texture and moisture normal. Your next step is A. Diagnose thyrotoxicosis. B. Decide she has T3-hypothroidism. C. Ask her if she uses birth-control pills.
Answer C Ask her if she uses birth-control pills
A 59-year-old male smoker complains of severe substernal squeezing chest pain of 30-minute duration. The paramedics have given him SL NTG and oxygen by nasal cannula. His BP is 110/70 mm Hg and HR is 90 bpm on arrival to the ER. The EKG is normal. Which of the following is the best next step? A. Echocardiography B. Thallium stress test C. Aspirin D. Coronary angiography E. CABG
Answer C Aspirin
Which of the following is characterized by reversible airway obstruction, inflammation and bronchial hyperreactivity? A. Chronic Bronchitis B. Bronchiectasis C. Asthma D. Bronchiolitis
Answer C Asthma
Which of the following treatment modalities has been proven to lower mortality and should be instituted for all patients having a MI (unless contraindications exist)? A. Lidocaine B. Digoxin C. Beta blockers D. Alpha blockers
Answer C Beta blockers
An 80-y/o male presents with a 6-month history of SOB with exertion. He states his condition has worsened over the past two days and has also noted an 8 pound weight gain. PMH is also positive for a MI 10 years ago and a 40-pack-year smoking history. PE reveals bilateral basilar rales and 2+ pitting edema in the lower extremities. Which of the following is the most likely diagnosis? A. Pneumonia B. Lung cancer C. Congestive heart failure D. Chronic obstructive pulmonary disease
Answer C CHF
Direct Coombs test is more likely to be positive in which of the following? A. HUS B. TTP C. CLL D. G6PD
Answer C CLL
Imatinib mesylate is the treatment for which of the following? A. Sickle Cell Disease B. Chronic Myelogenous Leukemia C. von Willebrand Disease D. Lead Poisoning
Answer C CML
A patient has developed greater than normal(10mm Hg) inspiratory decreases in systolic BP. The arterial pulse (taken with the patient's wrist overlying his lap) almost seems to disappear when palpated during inspiration These findings are most consistent with: A. Volume overload B. Aortic regurgitation C. Cardiac tamponade D. Marfan's syndrome E. Bisferiens pulse
Answer C Cardiac tamponade
A 5 day old infant is brought in for evaluation of red eyes. She was born via spontaneous vaginal delivery at 40 weeks gestation. On exam, there is copious amounts of purulent discharge and marked erythema and edema of the of the palpebral conjunctiva. Which of the following organisms is the most likely cause of her conjunctivitis? A. Adenovirus B. Staphylococcus aureus C. Chalmydia trachomatis D. Coxsackievirus E. Enterovirus
Answer C Chalmydia trachomatis
A 68 y/o male is diagnosed with small cell lung cancer. Which of the following treatment options may be offered at this time? A. Curative surgery B. Lobectomy + chemotherapy C. Chemotherapy D. Tarceva
Answer C Chemotherapy
A 12-y/o boy presents to the office with pain in his legs with activity gradually becoming worse over the past month. He is unable to ride a bicycle with his friends due to the pain in his legs. Exam of the heart reveals an ejection click and accentuation of S2. Femoral pulses are weak and delayed compared to the brachial pulses. BP obtained in both arms is elevated. CXR reveals rib notching. Which of the following is the most likely diagnosis? A. Abdominal aortic aneurysm B. Pheochromocytoma C. Coarctation of the aorta D. Thoracic outlet syndrome
Answer C Coarctation of the aorta
After cleaning the backyard, a patient notes severe itching and linear vesicular lesions. Which of the following is the most likely diagnosis? A. Dyshidrosis B. Nummular eczema C. Contact dermatitis D. Lichen simplex chronicus
Answer C Contact Dermatitis
A 19-year-old college student presents to the urgent care clinic c/o pain and redness in OS on awakening. Denies history of any recent sexual contact. Regularly wears his soft contact lens while sleeping. PE: significant conjunctival injection and discharge. Fluorescein staining: large oval defect in the central cornea with an underlying white haze. What is the most likely diagnosis? A. Herpes simplex keratitis B. Corneal abrasion C. Corneal ulcer D. Giant pupillary conjunctivitis
Answer C Corneal ulcer
A 65-year-old patient presents with dyspnea at rest, two-pillow orthopnea and a 2+ bilateral ankle edema. Which of the following diagnostic tests would be most helpful in the evaluation of this patient? A. 24-hour Holter monitor B. Cardiac stress test C. Echocardiogram D. Chest x-ray
Answer C Echo
Which of the following agents has been shown to reduce mortality in patients with congestive heart failure? A. Digitalis B. Furosemide C. Enalapril D. Procainamide E. Aspirin
Answer C Enalapril
A 13 year-old patient is hospitalized with a fever of 102.5 F and a rash. After 36 hours the rash has rapidly progressed to enlarging macules that appear ring or crescent shaped with central clearing. He also complains of multiple arthralgias involving his ankles, knees, and now his elbows. The EKG shows evidence of a 1st AV block. Labs were significant for an elevated ESR and leukocytosis. Which of the following physical examination findings would be most likely in this patient? A. Cord-like palpable calf vein B. Diminished lower extremity pulses C. Mitral regurgitation murmur D. Oral cyanosis
Answer C Mitral regurgitation
A patient presents to the emergency department with right upper quadrant pain over eight hours, nausea, and vomiting. On exam there is a fever of 101.2 degrees F. Ultrasound shows a distended gallbladder. Which of the following signs could be seen in this patient? A. McBurney's Sign B. McMurray's Sign C. Murphy's Sign D. Mendoza's Sign
Answer C Murphy's Sign
The best treatment for a 6 y/o female with persistent (> 6 months) middle ear effusion that has not resolved with antibiotics and has a 40dB conductive hearing loss is? A. Antibiotics as per otitis media B. Prophylactic, once daily antibiotics C. Myringotomy & tympanostomy tubes D. Watchful waiting
Answer C Myringotomy & tympanostomy tubes
A 63 y/o male presents with dyspnea with exertion and a chronic cough over the past 5 years. Spirometry reveals a FEV1 that is decreased more than the FVC so that the FEV1/FVC ratio is less than 70% of normal. Physical exam reveals increased AP diameter, hyper-resonance without dullness, and inspiratory scattered wheezes. Which of the following is most likely the cause of this patient's pulmonary disease? A. Silica B. Chlorine C. Nicotine D. Carbon
Answer C Nicotine
A 51 year-old patient presents for follow-up after a recent stroke. Cardiac examination reveals a moderately loud SEM in the 2nd and 3rd interspaces parasternally. S2 is fixed and widely split. Which of the following is the most likely diagnosis in this patient? A. AS B. MR C. Patent foramen ovale D. VSD
Answer C Patent foramen ovale
Which of the following is considered to be the first EKG evidence of acute myocardial infarction? A. ST segment depression B. ST segment inversion C. Peaking of T waves D. Q wave formation
Answer C Peaking of T waves
Two weeks after a dental extraction, a patient presents with an abscess and draining sinus tract. The gram stain shows gram- positive branching filamentous bacteria. Sulfur granules are also present. Which of the following is the treatment of choice? A. Doxycycline B. Metronidazole C. Penicillin D. Trimethoprim-sulfamethoxazole
Answer C Penicillin
A 50 y/o male presents with a sudden onset of severe generalized abdominal pain. On exam the patient is lying very still & appears ill. He has severe pain as you accidentally bump into his bed. The abdomen is quiet with + rebound tenderness. Upright abdominal and CXR films reveal free air under the diaphragm. What is the most likely diagnosis? A. Gastric Outlet Obstruction B. Peptic Ulcer Penetration C. Peptic Ulcer Perforation D. Peptic Ulcer UGIB
Answer C Peptic Ulcer Perforation
A 25 y/o female presents with a three day history of CP aggravated by coughing and relieved by sitting and leaning forward. She is febrile and a CBC with differential reveals leukocytosis. Which of the following PE signs is characteristic of her problem? A. Pulsus paradoxus B. Localized crackles C. Pericardial friction rub D. Wheezing
Answer C Pericardial friction rub
A 20-year-old patient presents with severe itching between their fingers. On physical examination elevated erythematous vesicles, papules are noted in the finger webs. Which of the following is the treatment of choice for this patient? A. Fluconazole (Diflucan) B. Mebendazole (Vermox) C. Permethrin (Elimite) D. Triamcinalone (Kenalog)
Answer C Permethrin (Elimite)
This condition (erythema multiforme) is most commonly linked to exposure of which of the following medications? A. Levofloxacin (Levaquin) B. Glucophage (Metformin) C. Phenytoin (Dilantin) D. Amiodarone (Cordarone)
Answer C Phenytoin (Dilantin)
A 50 y/o male with abnormal LFT's has increased skin pigmentation on exam. His Transferrin saturation is calculated at 68%. Genetic testing and a liver biopsy confirm the diagnosis. What is the best treatment for this patient? A. Urosodeoxycholic acid B. Oral Penicillamine C. Phlebotomy D. Pegylated Interferon
Answer C Phlebotomy
Which of the following tests will most likely be present in a patient with primary biliary cirrhosis? A. Elevated Urinary Copper B. Low Alpha-1 antitrypsin level C. Positive Anti-Mitochondrial Ab D. Elevated Transferrin Satruation >50%
Answer C Positive Anti-Mitochondrial Ab
Which of the following tests would be positive in a patient with tinea corporis? A. Acid fast bacillus smear B. Fern test C. Potassium hydroxide D. Tzanck smear
Answer C Potassium hydroxide
Which of the following is an absolute contraindication to thrombolytic therapy in a patient with an acute STEMI? A. History of severe HTN presently controlled B. Current use of anticoagulation therapy C. Previous hemorrhagic stroke D. Active PUD
Answer C Previous hemorrhagic stroke
A 50 y/o male with a history of Ulcerative Colitis presents with jaundice & physical exam findings of chronic liver disease. Labs reveal mild elevation of the transaminases and elevation of alkaline phosphatase level and GGT. Which of the following is the most likely diagnosis in this patient? A. Primary Biliary Cirrhosis B. Autoimmune hepatitis C. Primary Sclerosing Cholangitis D. Gilbert's Disease
Answer C Primary Sclerosing Cholangitis
A 22 year-old female patient presents with palpitations and episodes of CP at rest. These episodes are very bothersome to the patient. PE reveals a mid-systolic click and a late systolic murmur. Holter monitoring reveals frequent PVCs during the episodes of palpation. Treatment of choice is: A. Quinidine B. Procainamide C. Propanolol D. Verapamil E. Digoxin
Answer C Propanolol
A 25-year-old male presents to the clinic c/o mild DOE. Examination reveals a prominent jugular pulsation and a palpable parasternal lift. There is a harsh systolic murmur best heard at 2nd and 3rd LSB; it radiates to the left shoulder. An early systolic sound precedes the murmur during expiration. ECG demonstrates RAD. What is the most likely diagnosis? A. Aortic Stenosis B. Mitral Regurgitation C. Pulmonic Stenosis D. Tricuspid Regurgitation
Answer C Pulmonic Stenosis
Which of the following situations in the periinfarction period would suggest the presence of ventricular septal perforation? A. Systolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium equals that in right ventricle B. Systolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium is greater than that in right ventricle C. Systolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium is less than that in right ventricle D. Diastolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium is less than that in right ventricle E. Diastolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium is greater than that in right ventricle
Answer C Systolic murmur, large v waves in pulmonary capillary wedge tracing; Po2 in right atrium is less than that in right ventricle
First-line therapy in prophylaxis against Pneumocystis jirovecii in the HIV-positive patient is A. Aerosolized pentamidine B. Azithromycin C. Trimethoprim-sulfamethoxazole D. Dapsone
Answer C Trimethoprim-sulfamethoxazole
A two month-old infant appeared well until three weeks ago when he became dyspneic and had difficulty feeding. A 4/6 holosystolic murmur is heard at the LLSB in the 3rd ICS. An EKG shows both LVH, & RVH. Which of the following is the most likely diagnosis? A. Atrial septal defect B. Pulmonary hypertension C. Ventricular septal defect D. Tricuspid insufficiency
Answer C VSD
A 75-year old man is noted to have chest pain with exertion and has been passing out recently. On exam he is noted to have a harsh systolic murmur. Which of the following is the best therapy for this condition? A. Coronary artery bypass B. Angioplasty C. Valve replacement D. Carotid endarterectomy
Answer C Valve replacement
A 40-year old woman is awakened at 2 AM with anterior CP. ECG taken during the discomfort shows ST segment elevation in leads V1-V4. Five minutes after SL nitroglycerin discomfort ends and repeat ECG is normal. Which of the following is the most likely diagnosis? A. Acute pericarditis B. Dissection of coronary artery C. Variant angina pectoris D. Hypertrophic cardiomyopathy E. Basilar migraine
Answer C Variant angina pectoris
There are many sources of potential emboli that may cause a CVA. The most common source of cerebral emboli is: A. the carotid arteries B. the aortic arch C. the heart D. the vertebral basilar arteries E. posterior/inferior cerebellar artery
Answer C the heart
What is true about primary open angle glaucoma? A. It is an acute ophthalmologic emergency B. It is a rare indication for steroid drops C. It tends to run in families D. The intraocular pressure can be normal (10-21mm HG) E. Topical NSAID are indicated
Answer C and D -It tends to run in families -The intraocular pressure can be normal (10-21mm HG)
A 37-year-old patient has a serum TSH that is below the range of normal. You plan to investigate further because he might, on the one hand, have secondary hypothyroidism, but he might, on the other hand, be using l-thyroxine (T4), OR he might be using the thyroid medicine Cytomel (triiodothyronine), OR he might have Graves' disease, OR he might have an autonomous thyroid nodule(s). Of the possibilities "on the other hand" how many might really be correct? A. 1 B. 2 C. 3 D. 4
Answer D 4 (all of them)
A 55-y/o male presents complaining of episodic substernal CP that occurs especially during strenuous exercise. Suspecting CAD, an exercise stress test is ordered. The test is considered to be abnormal if which of the following occurs? A. Systolic blood pressure increases during exercise. B. The heart rate reaches maximal value during exercise. C. Random premature ventricular beats occur at peak exercise. D. A 2 mm ST-segment depression is seen on the ECG at peak exercise.
Answer D A 2 mm ST-segment depression is seen on the ECG at peak exercise.
Which of the following statements regarding shock and its treatment is acute MI is (are) true? A. The acute MI patient may develop shock secondary to hypovolemic hypotension B. The acute MI patient may develop shock secondary to persistent hypotension and a poor cardiac index C. Both forms of shock respond well to treatment with IV fluids(Ringer's lactate or normal saline solution) D. A and B only E. All of the above
Answer D A and B only
A patient had an acute inferior, transmural myocardial infarction 4 days ago. A new murmur raises the suspicion of MR due to papillary muscle rupture. Which of the following murmur descriptions describes this condition? A. A grade III/VI diastolic murmur heard best at the apex without radiation. B. A grade IV/VI systolic ejection murmur heard best at the base with radiation to the left clavicle. C. A grade II/VI systolic murmur heard best at the apex preceded by a click and without radiation. D. A grade IV/VI systolic murmur heard best at the apex with radiation to the left axilla.
Answer D A grade IV/VI systolic murmur heard best at the apex with radiation to the left axilla.
A 34 year-old male driver of an automobile arrives in the ED after a head-on collision. The patient is unresponsive, vitals: R 10 and shallow, HR 140 with weak, thready pulses, BP 105/60, monitor shows sinus tachycardia. You note absence of lung sounds on the left side with tracheal deviation to the right. Immediately, you suspect: A. A right spontaneous pneumothorax B. A left spontaneous pneumothorax C. A right tension pneumothorax D. A left tension pneumothorax
Answer D A left tension pneumothorax
In which of the following patients would PTCA most likely be used? A. A patient with left main stem disease B. A patient with triple-vessel disease C. A patient with a ventricular aneurysm D. A patient with one vessel disease E. Any of the above are good indications for PCTA
Answer D A patient with one vessel disease
A 24-year-old woman comes to your office complaining of anxiety. The patient had witnessed a traumatic event 3 days earlier that made her feel fearful. She has not been able to tell her family about this experience. She now feels like she is numb and in a dazed, dreamlike state with poor concentration, and difficulty sleeping. She experienced a flashback of the event yesterday. What is the most likely diagnosis? A. Post-traumatic stress disorder B. Dissociative fugue C. Psychosis D. Acute stress disorder E. Depersonalization
Answer D Acute stress disorder
Which of the following is the most common long-term complication of ulcerative colitis? A. Peri-anal fistulae B. Colonic stricture C. Bile acid induced diarrhea D. Adenocarcinoma of the colon
Answer D Adenocarcinoma of the colon
A second year PA student was vaccinated for hepatitis B before starting PA school. She had an episode of jaundice three years ago after a trip to Mexico that resolved without treatment. Testing at the time was consistent with hepatitis A. Which of the following hepatitis studies would be likely in this patient at this current time? A. HBsAg (+), HAV IgG (+) B. Anti-HBs (+), HAV IgM (+) C. HCV Ab (+), HBsAg(+) D. Anti-HBs (+), HAV IgG (+) E. Anti-Hbs (+), Anti-HBc IgM (+)
Answer D Anti-HBs (+), HAV IgG (+)
A 55 year-old male presents with complaint of sudden ripping CP that radiates into the abdomen. On examination the patient is found to have diminished peripheral pulses and a diastolic murmur. EKG reveals LVH . Which of the following is the most likely diagnosis? A. Acute myocardial infarction B. Pulmonary embolism C. Acute pericarditis D. Aortic dissection
Answer D Aortic dissection
A patient presents to the office following a syncopal episode. The patient claims that the syncope occurs when he changes position such as rolling over in bed or when he bends over to tie his shoes. Which of the following is the most likely explanation for this presentation? A. Carotid sinus hypersensitivity B. Vasovagal episode C. Subclavian steal syndrome D. Atrial myxoma
Answer D Atrial myxoma
A 42 year-old male with unremarkable past medical history is admitted to the general medical ward with community-acquired pneumonia. He has a 20 pack-year history of cigarette smoking. He is empirically started on ceftriaxone (Rocephin). Which of the following antibiotics would be most appropriate to add to his empiric treatment regimen? A. Piperacillin B. Vancomycin C. Clindamycin D. Azithromycin
Answer D Azithromycin
Which of the following is the first line agent in the outpatient management of Legionella pneumonia? A. Penicillin B. Cefaclor (Ceclor) C. Amoxicillin/Clavulanate (Augmentin) D. Azithromycin (Zithromax)
Answer D Azithromycin (Zithromax)
Coronary artery bypass graft (CABG) surgery may be indicated as the treatment of choice for angina pectoris with which of the following angina patients? A. A patient with triple-vessel disease B. A patient with one-vessel disease C. A patient with two-vessel disease D. CABG may be first-line therapy in any of the above
Answer D CABG may be first-line therapy in any of the above
A 65 year-old male presents with a transudative pleural effusion. This patient most likely has a history of which of the following? A. Uremia B. Pneumonia C. Connective tissue disorder D. Congestive heart failure
Answer D CHF
A 50 y/o male with history of alcohol abuse presents with complaint of worsening dyspnea. PE reveals bibasilar rales, elevated JVP , an S3 and lower extremity edema. CXR reveals pulmonary congestion and cardiomegaly. EKG shows frequent ventricular ectopy. Echocardiogram shows left ventricular dilatation and an EF of 30%. Which of the following is the most likely diagnosis in this patient? A. Restrictive cardiomyopathy B. Hypertrophic cardiomyopathy C. Tako-Tsubo cardiomyopathy D. Dilated cardiomyopathy
Answer D Dilated cardiomyopathy
A 28 year-old female, 3 months post-partum, complains of gradually increasing DOE . She also complains of near syncope last week. She denies chronic medical conditions and hospitalizations other than for the delivery of her child. She denies tobacco, alcohol or illicit drug abuse. Exam is noteworthy for a laterally displaced apical impulse, an S3 and a SEM best heard in the left axilla. Which of the following is the most likely diagnosis? A. Pulmonary embolism. B. Pericardial effusion C. Tricuspid insufficiency D. Dilated cardiomyopathy
Answer D Dilated cardiomyopathy.
Mr. Smith leaves home and does not return nor does he go to work. A friend of Mr. Smith sees him in another state while on vacation. When he approaches Mr. Smith, he does not recognize him and has a total different demeanor. What type of disorder does Mr. Smith have? A. Amnesia B. Dissociative fugue C. Schizophrenia D. Dissociative identity disorder E. Depersonalization
Answer D Dissociative identity disorder
A patient with a history of severe peptic ulcer disease is 5 weeks s/p Billroth I surgery. Last week he restarted his normal diet and has had the onset of severe nausea, abdominal cramping, and light-headedness that occur approximately thirty minutes after eating. The abdominal exam is unremarkable. Which of the following is the most likely diagnosis? A. Celiac Sprue B. Irritable Bowel Syndrome C. Inflammatory Bowel Disease D. Dumping syndrome
Answer D Dumping syndrome
A 13-year-old boy who has a VSD with a large left to right shunt is at increased risk of developing which of the following? A. Acute myocardial infarction B. Ruptured chordae tendineae C. Third degree atrioventricular block D. Eisenmenger syndrome E. Aortic ring abscess
Answer D Eisenmenger syndrome
A 62 year-old male with a 100 pack year smoking history presents with a 6 month history of dysphagia and a 30 lb unintentional weight loss. What is the best next step? A. Chest CT B. Barium Swallow C. Esophageal Manometry D. Endoscopy
Answer D Endoscopy
What antibiotic would be used to treat GABS in a penicillin allergic patient? A. Cephalexin (Keflex) B. Ciprofloxacin C. Mucopiricin D. Erythromycin
Answer D Erythromycin
Greenish-brown discoloration of the flanks seen in severe acute pancreatitis is called A. Cullen's Sign B. Murphy's Sign C. Rosving's Sign D. Grey-Turner Sign
Answer D Grey-Turner Sign
Which of the following is the most sensitive test in the diagnosis of acute cholecystitis? A. Right upper quadrant ultrasound (RUQ US) B. Plain films of the abdomen C. Abdominal CT scan D. Hepatic iminodiacetic acid (HIDA) scan
Answer D HIDA scan
A 30-year-old male patient, who has a history of schizotypal personality disorder, presents to the emergency department due to a decompensation to psychosis. He has had transient episodes similar to this in the past. What is the best medication for this patient during this period of psychosis? A. Buspirone (Buspar) B. Desvenlafaxine (Pristiq) C. Imipramine (Tofranil) D. Haloperidol (Haldol) E. Paroxetine (Paxil)
Answer D Haloperidol (Haldol)
What is the most likely diagnosis in this patient with jaundice? Total bilirubin 5.8 mg/dl (nl 0.2 - 1.0) with conjugated of 0.8 (nl 0-0.3mg/dl) Normal LFTs A. Hepatitis C B. Pancreatitic Cancer C. Dubin Johnson Syndrome D. Hemolysis
Answer D Hemolysis
A 43 year old flight attendant complains of nausea and vomiting associated with severe dizziness when she rolls out of bed in the mornings. She claims to have had these symptoms for the last couple of days. She further states that she has been previously healthy except for an upper respiratory infection 2 weeks ago. Her audiogram reveals a mild mid-frequency hearing loss. The MOST likely diagnosis is: A. Meniere's Syndrome B. Benign Paroxysmal Positional Vertigo C. Vertebrobasilar insufficiency D. Labyrinthitis
Answer D Labyrinthitis
Being a thorough PA, you decide to perform a fundoscopic exam on a patient who ran out of medication with a blood pressure of 190/90 to check for end organ damage. The patient has no complaints of vision problems, but has not had a recent eye exam. Their tonometry measures 28 mm Hg. What treatment does this most likely patient require other than anti-hypertensives? A. Atropine sulfate eye drops B. No treatment C. LAZER peripheral iridotomy D. Latanoprost eye drops
Answer D Latanoprost eye drops
A 66-year-old male presents to the clinic with a complaint of not being able to hear the beeping of his microwave oven when it finishes heating. This type of hearing loss is related to which one of the following alterations in the ear? A. Fibrosis of the tympanic membrane B. Hypersecretion of cerumen in the external auditory meatus C. Ankylosis of the stapes at the oval window D. Loss of cochlear hair cells E. Loss of otoconia in the otolithic membrane
Answer D Loss of cochlear hair cells
A 58 y/o non-smoker male aspirates gastric contents upon intubation during a code. Over the next 14 days he develops a non-productive cough, along with a fever of 101.5F. CXR reveals a 4 cm mass with an air fluid level in the right lung. What is the most likely diagnosis? A. Squamous cell carcinoma B. Acute Bronchitis C. Bronchiectasis D. Lung Abscess
Answer D Lung Abscess
Which of the following is the drug of choice for antihypertensive therapy during pregnancy? A. Benazepril B. Atenolol C. Amlodipine D. Methyldopa E. Losartan
Answer D Methyldopa
Which of the following is a risk factor for retinal detachment? A. African- American race B. Male C. Presbyopia D. Myopia
Answer D Myopia
Which of the following will minimize the effect of barotrauma while diving? A. Antihistamines B. Breath holding during ascent C. Leopold's maneuvers D. Nose pinching valsalva
Answer D Nose pinching valsalva
A patient is experiencing visual loss in the temporal half of each eye. Where do you suspect the lesion is located? A. Left optic nerve B. Right optic tract C. Occipital lobe D. Optic chiasm
Answer D Optic chiasm
A foreman at a construction site is accidentally hit in the eye with a 2 by 4. He complains of diplopia and pain. He also has epistaxis. What does this same foreman have as seen in this photo? A. Avulsion of the optic nerve B. Detached retina C. Nasal fracture D. Orbital fracture E. Hyphema
Answer D Orbital fracture
A 44 year-old female presents to clinic for evaluation of a syncopal episode that occurred while walking her dog two days ago. She denies amnesia or head trauma. She has had increasing DOE and pedal edema. PE reveals clubbing of her fingers and central cyanosis. Auscultation reveals TR, widely split 2nd heart sound with a palpable P2. Echocardiogram reveals a large ostium secundum ASD with bidirectional flow. Which of the following is a secondary complication in this patient? A. Left heart failure B. Ebsteins anomaly C. Tricuspid stenosis D. PHTN
Answer D PHTN
A 16 y.o. male presents with a history of injury to his left pinna while competing in a wrestling match. The superior outer portion of the pinna is edematous and fluctuant to palpation. There is minimal tenderness to palpation. Which of the following is the most appropriate management? A. Apply a soft, bulky, loose fitting dressing B. Have the patient return only for a fever > 101F C. Prescribe a 10 day course of amoxicillin and schedule a 1 week follow up D. Perform an I and D and pressure dressing
Answer D Perform an I and D and pressure dressing
A 59-year-old diabetic woman had suffered an acute AWMI. Five days later she gets into an argument with her husband and complains of chest pain. Her initial EKG shows no ischemic changes, but serum cardiac troponin levels are drawn and return mildly elevated at this time. Which of the following is the best next therapy? A. Use thrombolytic therapy B. Treat with PTCA C. Perform CABG surgery D. Perform serial ECGS and obtain CK-MB
Answer D Perform serial ECGS and obtain CK-MB
An eighty year old female complains of a gradual decrease in vision which is especially worse at night while driving around street lights. She does not have a red reflex. What does this patient need to improve her vision? A. Artificial tears B. Glaucoma drops C. New glasses D. Phacoemulsion of the lens with intraocular lens (IOL) replacement E. LASER Peripheral Iridotomy (LPI)
Answer D Phacoemulsion of the lens with intraocular lens (IOL) replacement
A 55-year-old female with a known pituitary adenoma suddenly experiences severe headache, difficulty seeing objects in her lateral visual fields on both sides, and a fall in blood pressure. While getting a syringe of hydrocortisone, the astute PA says , "I had better call a neurosurgeon because I know what is going on." The patient has A. acute subarachnoid hemorrhage. B. a vasovagal reaction. C. orthostatic hypotension D. pituitary apoplexy.
Answer D Pituitary apoplexy
A 45-year-old female has noted recently marked fatigue and poor appetite. You see that the creases in her skin seem unusually dark. There is hyponatremia and slight hyperkalemia. You want to check her A. Serum estrogen B. Serum testosterone C. T4 D. Plasma cortisol
Answer D Plasma cortisol
Which of the following medications should be prescribed for a patient with portal HTN who is found to have esophageal varices on screening endoscopy? A. Amlodipine B. Spironolactone C. Hydralazine D. Propranolol
Answer D Propranolol
Which of the following conditions may be linked to sleep apnea? A. Hypercalcemia B. Anorexia Nervosa C. Addison's Disease D. Pulmonary Hypertension
Answer D Pulmonary Hypertension
A 12-year-old boy is admitted to your ED complaining of difficulty in breathing. Arterial blood gas (ABG) studies performed while the patient is breathing room air (21% oxygen) reveal pH, 7.21; Po2, 65 mm Hg; Pco2, 62 mm Hg; and Hco3, 25mEq/liter. Which of the following reflect this child's ABG results? A. Metabolic Alkalosis B. Metabolic Acidosis C. Respiratory Alkalosis D. Respiratory Acidosis
Answer D Respiratory Acidosis
A 60 y/o male who is s/p ORIF of the left hip presents with acute onset of shortness of breath with exertion. On physical exam, he appears anxious and tachypneic. His temperature is 37.8°C (100°F), pulse is 120 beats per minute, respirations are 24/min and labored, and blood pressure is 140/90 mm Hg. Lungs are clear to auscultation bilaterally. Cardiac exam reveals an increased pulmonic component of S2. ECG reveals a S wave in lead I, a Q wave in lead III, and T wave changes in lead III. Which of the following diagnostic studies is the best indicated in this patient? A. Chest x-ray B. Spirometry C. Bronchoscopy D. Spiral CT of the chest
Answer D Spiral CT of the chest
A 61-year-old man with coronary artery disease complains of progressive orthopnea and pedal edema. He is hospitalized with a blood pressure of 190/105mm Hg. The cardiac enzymes and EKG are normal. IV furosemide has been administered. What is the best next step? A. Prescribe a beta-blocker to decrease myocardial oxygen demands B. Start intravenous dopamine C. Observe D. Start an ACE inhibitor
Answer D Start an ACE-I
An 18 month female presents, with a 2 day history of URI symptoms and a T-max of 100.6. Tonight she began a barking cough. The most likely X-ray finding is: a. Thumbprint sign b. RLL pneumonia c. Hyperinflation d. Steeple sign
Answer D Steeple sign
Which pneumonia is characterized by "rusty colored" sputum? A. Pneumocystis carinii pneumonia B. Mycoplasma pneumonia C. Klebsiella pneumonia D. Streptococcal pneumonia
Answer D Streptococcal pneumonia
The most likely pathogen causing otitis media is: A. Haemophilus influenza B. Moraxella catarrhalis C. Pseudomonas aeruginosa D. Streptococcus pneumonia
Answer D Streptococcus pneumonia
A 30-year-old presents with a number of salmon-red oval, slightly raised plaques on the trunk and proximal upper extremities. The patient states the rash started with a single lesion and then spread. What would hasten the resolution of this rash? A. Topical antifungal B. Antibiotic cream C. Tar cream D. Sun exposure
Answer D Sun exposure
A healthy 75-year-old man undergoing an ultrasound examination for suspected gallbladder disease is found incidentally to have a 6.0-cm abdominal aneurysm of the aorta. Which of the following is the best management for this patient? A Serial ultrasound examination every 6 months B. Urgent MRI C. Beta-agonist therapy D. Surgical repair of the aneurysm
Answer D Surgical repair of the aneurysm
What is the hallmark finding that is essential to the diagnosis of primary dilated cardiomyopathy? A. Asymmetric septal enlargement B. Atrial enlargement C. Infiltrative myocardial disease D. Systolic dysfunction
Answer D Systolic dysfunction
A newborn is being evaluated for perioral cyanosis while feeding associated with sweating. T is 37.8 100 F , BP 80/45, HR 180, and RR 40. A grade 3/6 harsh SEM with a single loud S2 is heard at the LUSB. ECG shows RVH with RAD . CXR shows a boot- shaped heart and decreased pulmonary vascular markings. Which of the following is the most likely diagnosis? A. ASD B. Total anomalous pulmonary venous return C. Coarctation of the aorta D. Tetralogy of Fallot
Answer D TOF
Crohn's Disease most commonly affects the... A. Splenic Flexure B. Duodenum C. Rectosigmoid colon D. Terminal ileum
Answer D Terminal ileum
A 13-year-old male complains of abdominal pain but is unable to locate it with a finger. His abdominal exam in unremarkable. His left testicle is acutely tender, with an absent cremasteric reflex. What is the best next step in the workup? a. Barium enema b. Abdominal CT c. KUB d. Testicular ultrasound
Answer D Testicular ultrasound
A 76 year-old male presents after returning from a Safari in Africa. Seven days ago he experienced CP lasting one hour that did not respond to three sublingual nitroglycerin tablets. There was no ability to have lab work or an EKG. The pain has not returned. If the patient had a non-STEMI myocardial infarction, which of the following studies will still be positive? A. Electrocardiogram B. Myoglobin C. CK-MB index D. Troponin I
Answer D Troponin I
A 65 year-old female who recently had an anterior MI returns to clinic for follow-up six weeks after. She has no CP , but reports decreased exercise tolerance EKG shows persistent ST elevation in leads V2- V4. Which of the following is the most likely diagnosis? A. RV infarction B. Pericarditis C. Re-occlusion of the RCA D. Ventricular aneurysm
Answer D Ventricular aneurysm
Four days after an anterior MI, a patient abruptly develops severe hypotension. A pansystolic murmur is heard at the LSB. Most likely diagnosis is: A. Pericardial tamponade B. Acute mitral regurgitation C. Right ventricular infarction D. Ventricular septal rupture
Answer D Ventricular septal rupture
What has been shown to decrease the risk of dry macular degeneration? A. Daily alcohol intake B. Certain herbal supplements C. Relaxation therapy D. Vitamins supplements
Answer D Vitamins supplements
If there are no contraindications, what is the preferred long-term treatment for a patient with a pulmonary embolism? A. Transvenous placement of a Greenfield vena caval filter B. Streptokinase C. Heparin D. Warfarin (coumadin)
Answer D Warfarin (coumadin)
What is the best treatment for an asymptomatic 4 y/o male with bilateral serous otitis media for less than 3 weeks. He took a course of amoxicillin which improved the pain and redness? A. Antibiotics as per otitis media B. Prophylactic, once daily antibiotics C. Myringotomy & tympanostomy tubes D. Watchful waiting
Answer D Watchful waiting
Which of the following is the most appropriate treatment for a tympanic membrane perforation secondary to trauma? A. Ciprofloxacin/dexamethesone (Ciprodex) B. Amoxicillin / Clavulanate (Augmentin) C. Culture and Sensitivity D. Water precautions
Answer D Water precautions
Most cases of posterior epistaxis originate at which site? A. Kiesselbach's plexus B. Allen's plexus C. Willis' plexus D. Woodruf's plexus
Answer D Woodruf's plexus
Which of the following indicates a poor prognosis for someone diagnosed with schizophrenia? A. Acute onset B. Co-morbid mood disorder C. Obvious precipitating event D. Younger age at diagnosis
Answer D Younger age at diagnosis
A 56- year-old diabetic smoker describes progressive "tiredness" and "cramping" in his left calf for 6 to 8 months. Two years ago he jogged 1 to 2 miles every day. Now walking 5 to 6 blocks or climbing stairs produces leg discomfort that is relieved with 2 to 3 minutes of rest. These symptoms are MOST consistent with A. Acute arterial insufficiency B. Deep venous thrombosis C. Thromboangiitis obliterans (buerger's disease) D. Arterial embolus E. Chronic arterial insufficiency
Answer E Chronic arterial insufficiency
A newborn presents with a possible cyanotic, CHD. Which of the following is in the differential diagnosis? A. Patent ductus arteriosus B. Coarctation of the aorta C. Atrial septal defect D. Aortic stenosis E. Complete transposition of the great arteries
Answer E Complete transposition of the great arteries
A 4 yo female presents with ulcers on her tongue and oral mucosa. The patient refuses to eat due to pain in her mouth. Her temperature is 38.3oc (101of). A maculopapular, vesicular rash is also noted on the hands, feet, and buttocks. This common disease of children is caused by: a. Paramyxovirus b. Rubella virus c. Herpes virus 6 d. Parvovirus B-19 e. Coxsackie A virus
Answer E Coxsackie A virus
What diagnostic test will identify the most likely etiology of the patient's murmur symptoms? A. Chest X-ray B. Pulmonary function tests C. Electrocardiogram (ECG) D. Holter monitor E. Echocardiogram
Answer E Echo
A 62-year-old African-American male is seen for his yearly physical exam. He has no complaints. He denies any current medications or medical problems, but the occupational medicine nurse has taken his blood pressure several times in the past year and told him it was high. He denies any tobacco or alcohol use. His blood pressure is 156/92 today. What is the most likely cause of his elevated blood pressure? A. Sleep apnea B. Primary aldosteronism C. Pheochromocytoma D. Renal artery stenosis E. Essential hypertension
Answer E Essential HTN
What treatments are available for dry type macular degeneration? A. Macugen (pegaptanib) B. Avastin (bevacizumab) off label C. Triamcinalone D. Photodynamic therapy E. None
Answer E None
What is the treatment for HSV keratitis? A. Artificial tears B. Bacitracin ophthalmic ointment C. Tobarmycin/ D. Dexamethasone E. Oral acyclovir F. Ciprofloxacin drops
Answer E Oral acyclovir
A 37-year-old Caucasian woman swims regularly for exercise. She starts to notice severe right ear pain and itching. She sees her family doctor and mentions her complaints. When she goes to insert the otoscope, she gently pulls on her ear. This causes her much pain. She notes an inflamed external ear canal, but the tympanic membrane is normal. What is the most likely pathogen? A. Streptococcus pneumonia B. Staphylococcus aureus C. Aspergillosis D. Proteus E. Pseudomonas aeruginosa
Answer E Pseudomonas aeruginosa
A patient comes to you complaining of a "piece of meat" growing on her eye. Please identify this condition: A. Allergic reaction to contact lens solution B. Contact lens overwear C. Ectropion D. Pinguecula E. Pterygium
Answer E Pterygium
A 16-year-old Caucasian female is brought to your family practice office by her mother because she has been missing school and her mother is concerned. The patient has symptoms consistent with mild to moderate depression. She has a history of menstrual migraines and now has vague constitutional symptoms all the time and doesn't want to get out of bed in the morning. The patient confesses that over the past month she has felt that she is not important to anyone and wonders if the world will be better off without her. Of the following, which is your greatest concern when considering prescribing her a selective serotonin reuptake inhibitor (SSRI)? A. Compliance to the medication regime B. Increased risk of suicide as detailed in black box warnings C. Nausea-related side effects as you titrate upwards D. Risk of pregnancy when taking psychiatric medications E. Risk of serotonin syndrome, should you need to prescribe a triptan for her migraines
Answer E Risk of serotonin syndrome, should you need to prescribe a triptan for her migraines
The risk of extrapyramidal side effects (pseudoparkinsonism) and tardive dyskinesia is associated with which class of medications? A. Amphetamines B. Benzodiazepines C. Monoamine oxidase inhibitors (MAOIs) D. Tricyclic antidepressants (TCAs) E. Typical (first-generation) antipsychotics
Answer E Typical (first-generation) antipsychotics
Which of the following is the appropriate management for an acute external hordeolum? A. Eye patch B. Saline flush C. Topical antibiotics D. Topical steroids E. Warm compresses
Answer E Warm compresses
At what age is alignment neutral, without genu varum or valgum? A. 6 months B. 18 months C. 4 years D. 14 years
Answers B and D 18 months and 14 years
*What is the mechanism of injury for a Bankart fracture?
Anterior shoulder dislocation
*What structure might be injured in a clavicle fracture?
Brachial plexus
After pituitary surgery it is important to watch what parameters every 6 hours?
Urine osmolality, serum osmolality, and serum electrolytes
*What are the signs and symptoms of a rotator cuff injury?
Weakness, deep pain (often at night), and pain with overhead motion
*Jane returns two years later and is now complaining of numbness and weakness in her 3rd, 4th and 5th fingers. Which nerve root is compressed now?
C7-8
*What is the most likely pneumonia etiology for patient with a history of travel to the southwestern US?
Coccidioides
*A 17-year-old boy presents to the emergency department following a motor vehicle accident 2 hours ago. He is clinically stable but reports trouble breathing and significant pain in his chest. Per the passenger, he hit the steering wheel pretty hard despite the dispatch of airbags. A physical examination demonstrates severe bruising and ecchymosis of the chest area. As the patient inhales, you observe a portion of the chest moving inward. A chest radiograph demonstrates several broken ribs. First line treatment? Second line?
Dx Flail Chest First line: oxygen and intubation/ventilator support Second line: surgery
*What other lab test will be elevated in Ankylosing spondylitis?
ESR
True or False: Surgery for cryptorchidism eliminates the risk of testicular cancer.
False
*What is the most life-threatening concern with rib fractures?
Flail chest
If you are treating diabetes with oral agents, what is the number two choice after metformin?
GLP-1 agonist or SGLT-2 inhibitor (both reduce CV death)
*What is positive in 90% of patients with Ankylosing spondylitis?
HLA-B27
*What is the most likely pneumonia etiology for a patient with a recent history of spelunking?
Histoplasmosis
*What is the most important thing to consider if your patient has a knee dislocation?
Injury to popliteal artery (vascular referral if needed)
*What is the most likely pneumonia etiology of alcoholic?
Klebsiella
*Jane presents to your office complaining that she woke up and was numb on the outside of her calf and foot and was unable to stand on her tip toes. She also complains that she is numb between her big toe and second toe. Numbness in this web space is which nerve root?
L5
In the entity of alcohol-induced hypoglycemia, where is the chemical locus of the pathology?
Lactate to pyruvate conversion
*What is the most likely pneumonia etiology for a patient who returned from a cruise?
Legionella
*What is the most likely pneumonia etiology for a patient with altered mental status and pneumonia?
Legionella
*What is the most likely pneumonia etiology for a patient with diarrhea and pneumonia?
Legionella
*6 year old has achy knee pain and a limp, especially at the end of the day. What will diagnose the problem?
MRI (Legg-Calve-Perthes, r/o AVN)
*What is the most likely pneumonia etiology college student?
Mycoplasma
Review Neuro
No questions in this ppt set
Review OB/GYN
No questions in this ppt set
Review Renal
No questions in this ppt set
*Jane presents to your office complaining that she woke up and was numb on the outside of her calf and foot and was unable to stand on her tip toes. Which nerve is compressed?
Peroneal nerve S1 root
*What is the most likely pneumonia etiology of cystic fibrosis patient?
Pseudomonas aeruginosa
*30 year old with insidious onset of peripheral arthritis, "sausage" fingers, history of cutaneous psoriasis (may be remote), joint swelling, tenderness, nail changes like pitting, traverse ridging, onycholysis, involvement of sacroiliac joint or ankylosing spondylitis, dry erythematous papular regions or conjunctivitis. What is the likely diagnosis?
Psoriatic arthritis
Review EKG Questions
Slides 260-291
*Patient presents with Neurogenic- or psuedo-cladication in which pain and paresthesias of the back and extremities is exacerbated by standing and walking, alleviated with rest or in flexed spine position. For instance, sitting, cycling and going uphill relieves, walking downhill worsens. What is the diagnosis?
Spinal stenosis
*What is the most likely pneumonia etiology for a patient with a recent influenza infection?
Staph aureus
*What is the most likely pneumonia etiology for a 55-year-old?
Strep pneumo
*What are the four structures involved in the rotator cuff?
Supraspinatus, Infraspinatus, Teres minor, Subscapularis
What is the difference between Cushing's syndrome and Cushing's disease?
Syndrome: Too much steroid in the body Disease: Too much steroid in the body coming from the pituitary gland (specifically)