Internal med quiz questions Final
Which of the following best describes the initial stages of strangulating obstruction of the small bowel? A. Arterial occlusion B. Blockage without vascular compromise C. Blockage with vascular compromise D. Ischemia of the bowel wall
C
Which of the following is an early sign of pancreatic cancer and indicates that a tumor is present in the head of the pancreas? A. Enlargement of the spleen B.High blood sugar C.Jaundice D. Vitamin deficiencies
C
Which of the following is the best diagnostic procedure for stomach cancer? A. Barium x-rays B. CT scan C. Endoscopy D. Ultrasonography
C
Which rheumatic disease is the most common type of arthritis? A. Ankylosing spondylitis B. Polymyositis C, Osteoarthritis D. Sjogren's syndrome
C
A 19-year-old male is brought to the emergency department by his college roommate due to confusion and difficulty with arousing from sleep. The patient reports severe generalized headache, neck stiffness, and muscle aches. Temperature is 102.2°F (39°C), blood pressure is 102/68 mmHg, pulse is 107/min, and respirations are 22/min. On physical exam, a petechial rash is distributed on the thorax and extremities. While supine, neck flexion lead to involuntary knee flexion. Which of the following is the best treatment? A. IV acyclovir B. PO Amoxicillin or amoxicillin-clavulanate C. IV Ampicillin + Vancomycin & dexamethasone D. IV Ceftriaxone + Vancomycin & dexamethasone
D
A 23-year-old woman presents with pain with urination and increased urinary frequency. She reports that her symptoms began approximately 3 days ago and has not noticed any abnormal smell, vaginal discomfort, or vaginal discharge. Her vital signs and physical examination are all unremarkable. Her STI panel is negative. UA is significant for 2+ bacteria, + Nitrite, and numerous WBCs. Urine culture is pending. Which of the following is the best treatment? A. IV Vancomycin B. IM Ceftriaxone + PO Doxycycline C. IV Ampicillin + gentamicin D. PO Trimethoprim-sulfamethoxazole
D
A 56 year-old female with uncontrolled DM type lI is scheduled for an ORIF of the left ankle. When should cefazolin 2g be administered to this patient to prevent a surgical infection? A. After the incision is made B. 2-24 hours before surgery C. During the procedure D. 30-60 minutes before surgery
D
A patient who has symptoms of gastroesophageal reflux disease (GERD) is prescribed a trial of proton pump inhibitors. One month later the symptoms have not improved despite treatment, and findings on endoscopy are unremarkable. Which of the following is the most appropriate next step in management? A. Barium swallow x-ray study B. Esophageal manometry C. Repeat endoscopy in one month D. 24-hour pH testing
D
A person has AIDS when which of these occurs? A. HIV antibodies are found in the blood B. A person has HIV for 5 years C. Exposure to HIV D. The CD4+ count is lower than 200 or opportunistic infections develop in an HIV-infected person
D
Achalasia is a condition in which normal rhythmic contractions of the esophagus (peristalsis) are absent or impaired, the lower esophageal sphincter does not relax normally, and resting pressure of the lower esophageal sphincter is increased. In which of the following age groups does achalasia typically first occur? A. Infants and babies younger than 2 years old B. Children ages 2 to 11 years old C. Elderly individuals over the age of 65 D. Adults between 20 and 60 years old
D
After receiving the hepatitis B vaccine, which of the following tests shows immunity? A. HBsAg B. HBcAg C. HBeAg D. Anti- HBs
D
An obese woman with chief complaints of heartburn, upper abdominal pain within one hour of eating came into the clinic without having the sighs of active bleeding. The Esophageal endoscopy shows that she is having the Barrett's Esophagus. Which of the following disease do you suspect that cause her discomfort? A. None of the choices B. Stress Ulcer C. Gastric Cancer D. Gastroesophageal reflux disease (GERD)
D
Fulminant hepatitis (severe hepatitis with signs of liver failure) is more likely to develop in people who are infected with which of the following hepatitis virus? A. Hepatitis A B. Hepatitis B, particularly if the patient also has Hepatitis A C. Hepatitis C D. Hepatitis B, particularly if the patient also has Hepatitis D
D
How is COPD treated? A. Bronchodilators B. Inhaled corticosteroids C. Supplemental oxygen D. All of the above
D
This fistula is defined as a passageway between the anus and skin? A. Rectoskin fistula B. Enteroanal fistula C. Rectovaginal fistula D. Anal fistula
D
What does the "19" in "COVID-19" refer to? A. There are 19 variants of the coronavirus. B. There are 19 symptoms of coronavirus disease. C. This is the 19th coronavirus pandemic. D. The coronavirus and the disease it causes were identified in 2019.
D
Which is not considered a common method of transmission for HIV? A. Blood B. Genital secretions C. Breast milk D. Urine
D
Which of the following is NOT used in the treatment of diverticulitis? A. Surgery to remove part of the intestine B. Antibiotics C. A liquid diet D. Intravenous steroids
D
Which of the following statements about the presentation of exocrine pancreatic insufficiency is accurate? A. The symptom of weight loss is the most common patient complaint B. Significant weight loss is uncommon in patients with exocrine pancreatic insufficiency C. Patients with exocrine pancreatic insufficiency typically report an absence of pain D. Steatorrhea and weight loss are the major symptoms of exocrine pancreatic insufficiency
D
Which of the following tests are preferred for initial diagnosis of H. pylori infection? A. Endoscopy to obtain mucosal biopsy samples B. Serologic antibody assays C. Stool antibody assays D. Urea breath testing
D
Which of the following types of drugs are commonly used to treat rheumatoid arthritis but do not prevent the disease from progressing? A. Biologic agents B. Disease- modifying antirheumatic drugs (DMARDs) C. Immunosuppressive drugs D, Nonsteroidal anti- inflammatory drugs (NSAID)
D
Which of these is a symptom of HIV infection? A. Swollen lymph nodes B. Fever C. Tiredness D. All of the above
D
Why is a combination of medicines called a cocktail-used to treat HIV? A. The virus changes (mutates) rapidly B. Each person responds to each medicine differently C. Combining medicines triples their strength D. A and B
D
Your patient who has been diagnosed with Chronic Gastritis for 3 years presents to your primary care office complaining of worsening epigastric pain, stating "I'm still taking Protonix every day, but my symptoms have been getting worse." How would you explain the main difference between Gastritis and Peptic Ulcer disease? A. You have actually had Peptic Ulcer disease this whole time. B. I wouldn't worry about it, sometimes symptoms worsen during periods of stress C. Have you ingested any foreign objects recently? D. With your worsening symptoms, I think you may have developed a peptic ulcer in addition to Gastritis. I'm ordering a scope to see what's going on.
D
Current approaches for Covid-19 treatments include A. Oxygen B. Antivirals C. Anti-inflammatories D. Antibody treatments E. All of the above
E
Infectious diseases are transmitted through A. Air B. Contaminated food or water C. Body fluids D. Direct contact E. Animal vectors F. All of the above
F
T/F The presence of orange-red urine during tuberculosis treatment usually indicates that the patient's condition is worsening.
False
A 55- year- old woman presents to the emergency department with acute pain in the left proximal interphalangeal (PIP) joint of the second digit. She reports that the pain is excruciating and has happened once a few years ago but self- resolved over the course of 2 weeks. She states that she recently increased her alcohol and red meat consumption and was recently started on hydrochlorothiazide. On physical exam the PIP joint is swollen, erythematous, warm, and tender to palpation. Preparations are made for an arthrocentesis to be performed. _____________________
Gout
A 3- year- old boy presents to the emergency department due to worsening joint pain, fever, and a new rash. He is accompanied by his mother who reports that he has been pointing at his knee and hip while crying. She believes he has been having this symptom for approximately 2 months. He has been having 1- 2 fevers a day, and she reports seeing a 'pink- like" rash. On physical exam, there is an evanescent salmon- colored rash on the left thigh. There is tenderness to palpation of the left knee and hip with limited range of motion. Lab results show an elevated ESR, CRP, and positive ANA. A pediatric rheumatologist is consulted for further evaluation. _____________________
Juvenile Idiopathic Arthritis (JIA)
A 60- year-old woman presents to her physician's office for headache and muscle weakness. She reports that she usually never has headaches but recently started experiencing headaches in the morning about 2 weeks ago, scalp tenderness and pain with chewing. She also reports feeling very weak and tired in the mornings and cannot even raise her arms to brush her hair. Physical exam shows that she has normal strength and normal range of movement. She is sent for further laboratory workup that reveals a normocytic normochromic anemia with normal iron studies, slight thrombocytosis. ESR and CRP are both significantly elevated. ____________________
Polymyalgia Rheumatica
A 60- year- old man presents to the emergency department for severe left knee pain. His symptom began approximately 8 hours prior to presentation. He denies trauma to the joint and this is the first time this occurred. Medical history is significant for hemochromatosis managed with weekly phlebotomy. On physical exam, the left knee is erythematous, warm, enlarged, and tender to palpation. Radiography of the affected joint demonstrates chondrocalcinosis. Joint aspiration demonstrates a leukocyte count of 2500/mm3 with a negative Gram stain. Polarized microscopy shows weakly positively birefringent rhomboid crystals. _________________________
Pseudogout
A 32- year- old man presents with redness of the eye as well as discharge. He reports that he experiences pain with urination and stiffness and pain of the knee and ankle. He says that he a had a sexually transmitted disease approximately 5 weeks ago but is otherwise healthy. On physical exam there is conjunctivitis, asymmetric oligoarthritis, and discharge from the urethral meatus. __________________
Reactive Arthritis (Reiter's Syndrome)
A 35- year- old woman presents with joint stiffness and pain of the hands and wrists for the last two months. Her symptoms are most severe in the morning and improve in the afternoon. She reports an unintentional loss of 15 pounds over the course of 3 months as well as fatigue. On physical exam, there is swelling and tenderness at the metacarpophalangeal and proximal interphalangeal joints. Bilateral hand x- rays confirm joint erosions, and joint space narrowing in the MCP and PIP joints. A serum anti- CCP is positive _________________
Rheumatoid Arthritis
T/F Cystic fibrosis (CF) is a genetic disorder that causes the endocrine glands to work incorrectly.
True
T/F The most common cause of a pulmonary embolism (PE) is the result of a blood clot from a deep vein traveling to the lungs, where it becomes lodged in the pulmonary arteries.
True
SOFA is used to help identify patients with the ED/wards who have a worse predicted outcome from sepsis. What are the 3 criteria utilized for SOFA? ____________ (3)
1) Altered mental status (Glasgow Coma Score <15) 2) Respiratory rate ≥22 3) Systolic BP ≤100
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 had a complete series previously. What treatment would be most beneficial? A. Amoxicillin / Clavulanate B. Ciprofloxacin C. Dicloxacillin D. Doxycycline
A
A 24-year-old female graduate student presents to the student health clinic with a complaint of dysuria and pain in her right knee. On physical exam, her knee is erythematous and tender with pain elicited on passive range of motion. Pelvic examination is significant for purulent endocervical discharge. The patient is sexually active and recalls having unprotected sexual intercourse with her most recent partner. Gram stain of a cervical swab shows gram-negative, kidney-shaped cocci in pairs. How should this be treated? A. Ceftriaxone IM B. Doxycycline po C. Ciprofloxacin po D. IV penicillin E. TMP-SMX po
A
A 48-year-old HIV+ female presents with a productive cough of purulent sputum. CXR reveals an apical infiltrate and a small right pleural effusion. Gram stain of the sputum reveals normal flora. Acid-fast stain of the sputum reveals the presence of acid fast bacilli. Which of the following is the most likely diagnosis? A. Mycobacterium tuberculosis B. Histoplasmosis C. Pneumocystitis Jiroveci D. Mycoplasma pnemoniae
A
A 50 year-old male with a history of ETOH abuse presents to the emergency department with a 3 day history of epigastric abdominal pain. The pain is 8/10 in severity, radiating to the back and is partially alleviated by leaning forward. Pain is associated with nausea and nonbloody, profuse, non-projectile vomiting. He denies any fever, diarrhea, constipation or bleeding per rectum. Which of the following is best to diagnose this condition? A. Amylase and lipase B. Complete blood count C. Ultrasound D. Upper endoscopy
A
A 55 year-old man presents with sensation of food getting stuck at the level of the epigastrium. Especially with steak or bread. Sensation lasts a few seconds and is relieved by swallowing water. Which of the following is the most likely diagnosis? A. Schatzki ring B. Mallory Weiss tear C. Achalasia D. Esophageal spasm
A
A blood test can be used to help diagnose primary liver cancer. A. True B. False
A
A patient is admitted to the ER with the following signs and symptoms: very painful mid-epigastric pain felt in the back, elevated glucose, fever, and vomiting. During the head-to-toe assessment, you notice bluish discoloration around the belly button. As the nurse, you know this is called? A. Cullen's Sign B. Grey-Turner's Sign C. Homan's Sign D. McBurney's Sign
A
After a TB exposure during one of your rotations, your PPD comes back at 15mm indurated and is positive when compared to a o indurated negative PPD last year. Your Chest x-ray is negative and you do not have any symptoms. Which of the following is the best management? A. Daily Rifampin × 4 months B. Rifamin, Isoniazide, Pyrazinamide, & Ethambutol until negative sputum C. Repeat the PPD in 3 months D. Observation and yearly chest x-rays
A
All of the following statements are true about the pathogenesis of osteoarthritis (OA) EXCEPT: A. It is simply a "wear and tear" process. B. Risk factors include aging, joint injury, obesity, and genetics C. X-rays may be normal despite significant pain from OA early in the process D. Current treatments for OA are directed to controlling pain, and none have been proven to alter the progression of the disease.
A
As long as a person has no symptoms of an STI, they: A. None of the choices B. No need any examination C. Don't have an STI D. Cannot pass on an STI
A
Asymptomatic sexually active with rash on feet and hands. Feels perfectly fine otherwise. FTA-ABS + and VDRL is 1:128. What treatment do they need? A. Benzathine LA PCN IM 2.4 million Units B. Doxycycline PO 100 mg po BID C. Chloramphenicol IV dosed per weight D. PCN IV dosed per weight
A
Cirrhosis is the widespread distortion of the liver's internal structure that occurs when a large amount of normal liver tissue is permanently replaced with nonfunctioning scar tissue. Which of the following is a common cause of cirrhosis of the liver in developed countries? A. Alcohol abuse B. Celiac disease C. Gallbladder surgery d. Kidney Disease
A
Coal workers' pneumoconiosis (black lung) is a lung disease caused by deposits of coal dust in the lungs. Which of the following is a FALSE statement about black lung? A. It is a type of emphysema. B. It results from inhaling coal dust or graphite over a long time. C. Symptoms are more likely in smokers. D. It can cause disabling shortness of breath.
A
Differential diagnosis of pulmonary embolism is challenging. Pulmonary embolism should be considered in the differential diagnosis of patients suspected of having cardiac ischemia, heart failure, COPD exacerbation, pneumothorax, pneumonia, sepsis, acute chest syndrome (in patients with sickle cell disease), and acute anxiety with hyperventilation. Which of the following is the preferred imaging technique for diagnosing acute PE? A. CT angiography B. V/Q scans C. Duplex ultrasonography D. Echocardiography
A
How do you get TB? A.Through the air B. Through sexual contact C. Through contaminated D. Through blood E. A and C
A
James has a strong nonproductive cough and he is very tired and has a strongheadache. He believes that he has contracted bacterial pneumonia. Why is he likely NOT correct? A. A nonproductive cough can be a sign of fungal or viral pneumonia but not bacterial. B. Feeling tired is usually not a symptom of any form of pneumonia. C. Headaches are a sign of fungal, rather than bacterial pneumonia. D. The excessive adrenaline usually makes you feel excited.
A
Opportunistic infections occur in people whose immune systems do not function well; these infections would often not cause problems for healthy individuals. Opportunistic infections are more common in people with HIV, but they are less common now than in the early days of the HIV epidemic due to improved treatment protocols. A.True B. False
A
Prophylaxis against Pneumocystis carinii should be started when the CD4 count is? A.Less than 200 B. Less than 300 C. Less than 600 D. Less than 400 E. Less than 100
A
Soft, painless, bluish papules on the legs in persons with AIDS are most likely due to: A. Kaposi sarcoma. B. Malignant melanoma. C. Molluscum contagiosum. D Pityriasis rosea.
A
Which of the following conditions commonly misdiagnosed as pneumonia has the most serious outcomes? A. Pulmonary embolism B. Acute bronchitis C. Airway obstruction D. Heart failure
A
Which of the following is an important measure in the management of peptic ulcer disease? A. Treat and eradicate Helicobacter pylori B. Quit a stressful job C. Take intermittent H2 blocker therapy D. Avoid hot, spicy foods
A
Which of the following is the most common first symptom of rectal cancer? A. Bleeding during a bowel movement B. Constipation C. Crampy abdominal pain D. Fatigue
A
Which of the following symptoms is LEAST common in patients with idiopathic pulmonary fibrosis? A. Low-grade fever B. Clubbing C. Dyspnea D. Nonproductive cough
A
Which of the following would lead the nurse to suspect that a client with a fracture of the right femur may be developing a fat embolus? A. Acute respiratory distress syndrome B. Migraine like headaches C. Numbness in the right leg D. Muscle spasms in the right thigh
A
Which of the following are Koch's criteria to demonstrate that a specific disease is caused by a particular agent? (Select all that apply) A. The specific agent must be associated with every case of the disease. B. The agent may not be able to be isolated from a diseased host but can always grown in culture. C. When the culture-grown agent is introduced into a healthy susceptible host, the agent must cause the same disease. D. The same agent must again be isolated from the infected experimental host.
A, C, D
A 37-year-old female with a history of type II diabetes mellitus presents to the emergency department complaining of blood in her urine, left-sided flank pain, nausea, and fever. She also states that she has pain with urination. Vital signs include: temperature is 39.4 C, blood pressure is 114/82 mmHg, pulse is 96/min, respirations are 18, and oxygen saturation of 97% on room air. On physical examination, the patient appears uncomfortable and has tenderness on the left flank and left costovertebral angle. A. What is the most likely diagnosis? _________ B. What is the next best test in the management of this patient? ________ C. What are the first-line antibiotic choices in this patient? ________ (1 IV and 3 PO)
A. Pyelonephritis B. Urine culture C. IV Ampicillin + gentamicin PO Ciprofloxacin PO Levofloxacin PO Trimethoprim-sulfamethoxazole
An 18 year-old male presents with fever, headache nuchal rigidity with a positive Kernig and Brudinski's sign. A. What is the best diagnostic test? _______ B. What is the treatment? _________
A: Lumbar puncture B: IV Ceftriaxone or Cefotaxamine + Vancomycin
A 25 years- old obese female complains of increasing episodes of substernal burning and belching about 1 1 hr after meals for the last 3 months. The same symptoms occur every night and are accompanied by cough. What is the likely cause of these symptoms? A. Peptic ulcer disease B Cholelithiasis C. Nonulcer dyspepsia D. Gatroesophageal reflux disease
B
A 32 y/o man with long-standing ulcerative colitis (pancolitis) which has been quiescent for the past 1-2 years on sulfasalazine presents with 2 weeks of severe profuse bloody diarrhea, low grade fevers, and lassitude. An abdominal X-ray is seen below. The patient is admitted and there is no change after 48 hours of steroids and supportive treatment. What is the most likely diagnosis? A. Appendicitis B. Toxic megacolon C. Colon cancer D. Colonic fistula
B
A 35-year-old man is evaluated for a 2-year history of intermittent chest pain. The pain is retrosternal, lasts for seconds to minutes, is unrelated to exertion, and does not radiate. It is occasionally associated with swallowing. He reports intermittent dysphagia to solids and liquids. He denies any reflux symptoms or weight loss. He does not have any risk factors for cardiac disease. Physical examination is unremarkable. Upper endoscopy is normal. A barium swallow is shown. Which of the following is the most likely diagnosis? A. Achalasia B. Diffuse esophageal spasm C. Eosinophilic esophagitis D. S chatzki ring
B
A 37-year-old healthy construction worker presents 1 week after stepping on a nail at work. He reports continued pain, fever, and drainage. Treatment with 7-days of amoxicillin clavulanic acid did not improve his symptoms. Which additional antibiotic are you most likely to prescribe? A. Doubling the dose of Amoxicillin B, Trimethoprim and sulfamethoxazole C. Ciprofloxacin D. Rifampin E. Vancomycin
B
A 55 year-old male with Diabetes Mellitus presents with a cat bite to the left leg. They have no known drug allergies. Which of the following is the antibiotic of choice? A. Amoxicillin/Cephalexin B, Amoxicillin/Clavulanate C. Amoxicillin/Ciprofloxacin D. Amoxicillin/Azithromycin
B
A 68 year-old woman presents with intermittent crampy abdominal pain and vomiting of 6 hours' duration. She feels bloated but denies rectal bleeding. Examination of the abdomen reveals no palpable mass and you note an upper midline scar from previous abdominal surgery. An abdominal radiograph demonstrates dilated loops of small bowel with air-fluid levels. Which of the following is the most likely cause of this patient's symptoms? A. Intussusception B. Adhesions C. Sigmoid volvulus D. Incisional hernia
B
A health care worker sustains a needle stick puncture from an HIV+ individual. Which of the following treatments is correct? A. 2 drug therapy with Truvada (emtricitabine/tenofovir) is the drug treatment of choice B. Treatment should continue for 4 weeks C. Postexposure prophylaxis should be started within a week D. Finish the work day and then report the needlestick to occupational health
B
Breast cancer metastasize to liver is a Hepatocellular Cancer. A. True B. False
B
Gout is a disorder in which deposits of uric acid crystals accumulate in the joints because of high blood levels of uric acid. Which of the following is the most common cause of high blood levels of uric acid? A. Consumption of too much alcohol B Inadequate elimination of uric acid via the kidneys C. Infection causing build- up of uric acid D. Production of too much uric acid in the body
B
Like adult rheumatoid arthritis, JRA is chronic and lifelong. A. True B. False
B
Portal hypertension is abnormally high blood pressure in the portal vein and its branches. The portal vein is the large vein that brings blood from the intestine to the liver. In Western countries, the most common cause of portal hypertension is which of the following? A. Diabets B. Cirrhosis C. High cholesterol D. Anemia
B
The antibiotic ciprofloxacin is very effective in the treatment of irritable bowel syndrome (IBS)? A. True B. False
B
This condition began as a small ulcer which resolved. Now the patient has this fluctuant, inguinal swelling. Ho should it be treated? A. Ceftriazone IM/ azithromycin po B. Doxycycline po C. Imiquimod (Aldara) topical D. PCN LA 2.4 million units IM
B
What does it mean to be "HIV-positive?" A. It means that you have AIDS. B. It means that two tests have been identified positive for HIV. C. It means the virus cannot be passed to another person. D. None of the above
B
Which of the following is Liver Function Tests A. Aspartate transaminase (AST) B. Prothrombin Time/INR C. Alkaline Phosphatase D. Bilirubin
B
Which of the following is a cause of an obstructive pattern on spirometry? A. Interstitial lung diseases B. Bronchiectasis C. Chest wall deformity D. Pulmonary hypertension
B
Which of the following is the most common cause of acute pancreatitis? A. Alcoholism B. Gallstones C. Smoking D. Viral infection
B
Which of the following is the most common first symptom of rectal cancer? A. Crampy abdominal pain B. Bleeding during a bowel movement C. Constipation D. Fatigue
B
Which of the following is the primary symptom of achalasia? A. Chest pain B. Difficulty swallowing C. Mild to moderate weight loss D. Spitting up (regurgitating) undigested food
B
Which of these is not a common COVID-19 symptom? A. Fever B. Blurred vision. C. Unusual fatigue D. Inability to taste or smell. E. A cough
B
While on a medical mission trip you are bit on the hand by a stray dog who is foaming at the mouth and acting strangely. The bite wound is severe and has penetrated the joint capsule of your wrist. You have received all of your childhood vaccines and your last tetanus booster was 3 years ago. Click all the treatment options below that you should receive at this time. A. Tetanus vaccine (Tdap or Td) B. Amoxicillin/clavulanate (Augmentin) Rabies vaccine Rabies Immunoglobulin Extensive wound cleansing C. Tetanus immunoglobulin
B
A 33 year-old female presents with odorous vaginal discharge. On saline wet mount, motile flagellates are seen. Which of the following is the best treatment? A. Clindamycin B. Doxycycline C. Metronidazole D. Nitrofurantoin E. Piperacillin
C
A 37-year-old healthy construction worker presents 1 week after stepping on a nail at work. He reports continued pain, fever, and drainage. Treatment with 7-days of amoxicillin clavulanic acid did not improve his symptoms. What tetanus prophylaxis does he need? A .Tetanus Immune globulin B. Tetanus toxoid C. Tetanus Immune globulin and toxoid D. No immunization recommended
C
A 43 yearold male presents with cirrhosis. Slit- lamp evaluation reveals a yellow- brown ring in the limbus of the cornea. The patient has recently developed an unsteady gait, tremors, and involuntary chorea- like movements. What is the most likely diagnosis? A. Hemochromotosis B. Autoimmune Hepatitis C. Wilson's Disease D. Primary Biliary Cirrhosis
C
A 46-year-old male has a history of gastroesophageal reflux disease (GERD) with biopsy confirming Barrett's esophagus on therapy with omeprazole. Review of systems is unremarkable, and the patient is otherwise doing well. Omeprazole should be continued to prevent which of the following most probable long-term sequelae associated with Barrett's esophagus? A .MALT lymphoma B. Transitional cell carcinoma C. Adenocarcinoma D. Squamous cell carcinoma
C
A 62 year- old male presents with complaints of vague epigastric abdominal pain associated with jaundice and generalized pruritus. Physical examination reveals jaundice and a palpable non- tender gallbladder, but is otherwise unremarkable. Which of the following is the most likely diagnosis? A. Gilbert's syndrome B. Acute cholecystitis C. Pancreatic cancer D Viral hepatitis
C
A combination of medications are used in the treatment of tuberculosis for the following reason A. To reduce resistance of the organism to treatment B. To bring about a better response C. Both of the above D. None of the above
C
A nurse arranges a department meeting after an increased incidence of infectious complications in surgical clients. The group analyzes the inefficiency of prophylactic antibiotics. What reason is the main contributor to the ineffectiveness of prophylactic antibiotics? A. Inappropriate antibiotic choice B. Under-dosing the antibiotic C. Wrong timing of administration D. Wrong site of administration
C
A young woman is bitten by a wild raccoon while attempting to keep it away from her dog. After washing the wound with soap and water, how should she be treated? A. Give rabies immune globulin B. Give rabies vaccine C. Give rabies immune globulin and rabies vaccine D. Give tetanus prophylaxis now and rabies vaccine if she develops symptoms later E. No further treatment is necessary
C
Fatty liver that is not caused by alcohol (called nonalcoholic fatty liver) usually occurs in people with which of the following? A. A high- fat diet B. Gallbladder disease C. Diabetes d. Hyperthyroidism
C
In patients with rheumatoid arthritis, which of the following predicts a worse prognosis? A. Interferon gamma B. Granulocyte- macrophage colony- stimulating factor (GM-CSF) C, Anti-CCP D. Tumor necrosis factors (TNF)
C
The most important goals of treatment for ankylosing spondylitis include relieving pain, maintaining range of motion of the joints, and which of the following? A. Decreasing the risk of hip arthritis B. Increasing chest wall motion C. Preventing end- organ damage D. Reversing the kyphosis
C
What is the CD4 T-cell count at which AIDS is considered to have developed? A. Below 1,000 per cubic milliliter B. Below 500 per cubic milliliter C. Below 200 per cubic milliliter D. Below 50 per cubic milliliter
C
What makes TB hard to diagnose? A. Symptoms aren't always obvious B. Symptoms come and go C. The disease may take years to become active D. A and B
C
When was HIV first recognized in the U.S.? A. 1970 B. 1975 C. 1981 D. 1986
C
Which of the following best describes the initial stages of strangulating obstruction of the small bowel? A. Ischemia of the bowel wall B.Blockage without vascular compromise C. Blockage with vascular compromise D.Arterial occlusion
C
a 42- year- old wife, mother with a history of migraine headaches, low back pain, and chronic interstitial cystitis presents with worsening pain and tenderness in the neck/shoulder region for more than 8 weeks. She also states she has had pain " all over" in muscles and joints for more than 4 months. She has frequent insomnia, states sleep is not refreshing, wakes frequently at night, and has fatigue and struggles with daytime sleepiness. She works 5 days/week in a daycare center. Lab results obtained in the last 6 months were normal, including a complete blood count (CBC), chemistry screen, thyroid- stimulating hormone test (TSH), and tests of antinuclear antibody (ANA) and erythrocyte sedimentation rate (ESR). What is the most possibe diagnosis? _________________________
fibromyalgia
