PAeasy Practice
You are evaluating a urinalysis on a 44-year-old female due to complaints of recurrent urinary tract infections (UTIs). Which of the following microscopic findings would be most suggestive of chronic kidney disease?
Broad Waxy casts
A 22-year-old African American male presents to the emergency department with shortness of breath, which started 2 hours prior to arrival. He does not have a history of pulmonary disease that he is aware of, and he states that in the past at random events he has had similar episodes. He does nothing to get the episodes to stop, and he also states that he feels his chest pounding at the same time of the shortness of breath. He has no medical history that he is aware of, and he takes no medications or any illicit drugs. On examination he is alert, awake, and oriented. His vital signs show T 99.0, P 142, R 18, and BP 132/82. His chest x-ray is negative for any acute cardiopulmonary disease, and his electrocardiogram has an irregularly irregular rate of 142 with visible delta waves. Based on the information provided, what anatomical pathway is responsible for the above findings of the delta waves?
Bundle of Kent
What lung findings are consistent with a fungal infection?
Cavitation/wedge-shaped lesions
A 3-day-old infant has bilateral copious, yellow-green eye discharge and conjunctival inflammation. A Gram stain of this discharge reveals gram-negative intracellular diplococci. Which of the following antibiotics is the drug of choice for this infection?
Ceftriaxone; be thinking gonococcal ophthalmia
Which of the following etiologies is the most common cause of nontraumatic subarachnoid hemorrhage (SAH)?
Cerebral aneurysms
What other disease are people w/ migraine w/ aura at risk for?
Cerebrovascular accidents
Which other type of conjunctivitis besides allergic has cobblestoning look?
Chlamydia trachomatis
A 2-week-old male infant is being seen in the clinic for a profuse mucoid discharge from both eyes, with some associated tearing. On examination, you notice both eyes are hyperemic and the eyelids are red and swollen. Which of the following is the most likely cause of this patient's ophthalmia neonatorum (conjunctivitis in the newborn)?
Chlamydial
42-year-old female with history of severe rheumatoid arthritis requiring multiple medications follows up with her primary care physician assistant. She has been doing well on her current medication regimen but has been having some mild headaches. Her blood pressure today is 170/92 P = 82, T = 96.2˚F. She denies any previous history of hypertension. Which of the following medications that she is taking is most likely to be
Cyclosporine
Which disorder is characterized by episodes of hypomania and depression for greater than 2 years?
Cyclothymia
Which of the following is the first sign of puberty in a normal male?
Enlargement of testes
Which of the following viral exanthems includes a fever followed by a diffuse maculopapular rash that spares the face and resolves in about 2 days?
Erythema Subitum
1st line for Legionaire's pneumonia?
Erythromycin 500 mg QID 14-21 days OR doxycycline 200 mg once daily 14-21 days
A disk herniation that is putting pressure on the L5 nerve root may present with weakness of what muscle(s)?
Extensor Hallicus longus
What muscles/tendons are involved in De Quervains Tenosyonvitis?
Extensor Pollicus brevis and Abductor Pollicus longus
What is the most common site of an acute arterial occlusion due to embolic disease?
FEMORAL
Which of the following signs and symptoms is associated with the abdominal pain secondary to chronic intestinal ischemia?
Fear of eating
A 46-year-old male presents to your office for consultation of supraventricular tachycardia (SVT). His history shows that he has had multiple episodes of SVT, and on three occasions has been treated in the emergency department with adenosine, which has converted his rhythm back to sinus. The patient is otherwise healthy, has no medical problems, and is on no medications. His vital signs are stable and his physical examination is within normal limits. Based on this history, which medication is the best choice for treating this patient long-term?
Flecainide
A 26-year-old female presents to clinic complaining of increasing headaches for one year, irritability, bloating and fluid retention, and abdominal discomfort with loose stools during her menstrual cycle. The symptoms begin a day or two before her menses, and last until the middle of her cycle. She has tried acetaminophen and ibuprofen without improvement. On physical exam she is a well-developed, well-nourished female in no acute distress. Vitals are normal, CV and lungs are normal, pelvis exam is normal, pap smear is normal, and GC and Chlamydia testing are negative. What would be the most appropriate next step?
Fluoxetine on cycel day 21-7
What type of pharmacological agent would be used as a first-line medication to treat obsessive compulsive disorder?
Fluvoxamine -Also paroxetine and sertraline
You are evaluating a 32-year-old male who has possibly injured his Achilles tendon while planting his foot into the soft ground while playing touch football. When evaluating a patient with this suspected injury, you have the patient plantar flex his ankle as part of the exam. Based on your knowledge of anatomy, what two plantar flexing muscles attach into the Achilles tendon?
Gastrocnemius and Soleus
A 43-year-old woman presents complaining of a "pins and needles" sensation that started bilaterally in her feet 2 days ago. The sensation now extends up to her mid-thighs. On physical examination, she is noted to have mild sensory loss, weakness, and absent reflexes bilaterally in her legs. Which of the following is the most likely diagnosis?
Guillan-Barre syndrome
Do ACE/ARBs cause Hyper or Hypokalemia?
HYPERKALEMIA
A 45-year-old man presents to the office with the complaint of perianal pain and bleeding. Examination reveals an anal/perianal mass complex. Biopsy is taken and the results are positive for epidermoid carcinoma of the anus. Which of the following treatment options would be the most appropriate therapy for this patient?
Local resection, chemotherapy, and external beam radiation
A patient who is an Ashkenazi Jew and is homozygous for Factor XI deficiency requires abdominal surgery. Which hemostatic laboratory testing outcomes would you expect to find?
Normal platelets, prolonged aPTT, normal PT
Mr. Addley is a 69-year-old, recently retired accountant who comes to you in your family practice, accompanied by his wife, for a routine follow-up of his blood pressure. During his visit he comments that he is concerned about his memory. He notes that he is having some difficulty remembering where he left his car keys, the day of the week, and names of people immediately after being introduced to them. When his wife is asked, she has noticed nothing regarding any change in his mental status or his ability to perform activities of daily living. You perform a mini-mental state exam (MMSE) and he scores 25 out of 30. What is the most appropriate working diagnosis for Mr. Addley?
Mild cognitive impairment
In a 73-year-old male, laboratory and radiologic findings that demonstrate marrow plasmacytosis with >30% plasma cells, a monoclonal globulin spike present, and lytic bone lesions is most consistent with which of the following?
Multiple Myeloma
Which kidney disorder presents with edema, proteinuria, hypoalbuminemia, maltese crosses and lipiduria?
NEPHROTIC SYNDROME
A 65-year-old man presents to the emergency department with an acute ischemic stroke. His CT scan is normal. His blood pressure is 180/100 mm Hg. What is the most appropriate treatment for his hypertension?
NO antihypertensive at this time; may reduce blood flow and in turn cause the possibly salvagable brain tissue to die
Is Erythema Infectiosum contagious once the rash or "slapped cheek" appearance becomes prevalent?
NO; very contagious leading up to that but not contagious once rash breaks out
A 28-year-old male presents with hypotension, marked tachypnea, and severe dyspnea following a fistfight. A physical exam reveals ecchymoses over the lateral left rib cage, hyperresonance on the left, and tracheal shift to the right. Which of the following is the most appropriate next step for management of this patient?
Needle thoracostomy to the second intercostal space, midclavicular line
Which of the following laboratory findings will be observed in a patient with noninflammatory nonbacterial prostatitis?
Negative bacterial culture and normal leukocytes
The triad of "dermatitis, diarrhea, and dementia" (pellagra) results from a severe deficiency of which of the following vitamins?
Niacin
An 8-year-old male child presents with brown, nonpruritic, annular lesions on the back of his hands and feet. Intradermal nodules are seen on the extensor surfaces of the elbows and knees that have been present for several months. At today's visit, the lesions are essentially unchanged since his last visit about a month ago. What is the best treatment for this suspected disorder?
No tx; its granuloma annulare and it is a benign skin condition that is self-limiting
Cellular phase of allergic response?
Occurs 4-6 hours after exposure
What is the MC complication of acute pancreatitis?
Pancreatic pseudocyst; the development of abdominal mass after an episode of pancreatitis should lead you to this
Your patient is asked to see you in followup for his fasting labs. His total cholesterol = 230 mg/dl, triglycerides = 1200 mg/dl, unable to calculate LDL. Your patient should be advised that due to these findings he is at risk for which of the following?
Pancreatitis
A 21-year-old female returns to clinic for treatment of her abnormal pap smear. She had been sexually active since age 18. She uses oral contraceptives for birth control. Her pap smear showed mild cervical intraepithelial neoplasm, with positive high-risk HPV. What is the most appropriate next step for management of her pap smear?
Pap smear in 6 months
A patient has a 2-day history of an itchy red left eye and marked tearing. There is no history of injury. On physical exam the conjunctiva appear markedly erythemic. What physical finding would help most in differentiating this as a viral conjunctivitis?
Preauricular lymph node
What is the most common heart sound that is heard in patients with pulmonary hypertension?
Split S2
Which of the following is the initial treatment step in an adolescent who presents to the emergency department with status epilepticus?
Stabilize airway
CKD stages w/ corresponding GFR?
Stage 1: normal; >90 Stage 2: 60-89 Stage 3: 30-59 ml/min stage 4: 15-29 stage 5: <15
A diet high in nitrates is a significant risk factor for cancer of which of the following?
Stomach
Which of the following is the most common etiologic agent of bacterial meningitis in the pediatric population of the United States?
Streptococcus Pneumoniae
Which of the following types of renal calculi is associated with an infectious cause?
Struvite; Struvite stones form when urea-splitting organisms, such as Proteus, Klebsiella, Pseudomonas, and Staphylococcus, are present in the urinary tract.
What is the best treatment for open/closed comedones?
Topical Retinoids (these are Comedolytics)
MC fractured long bone in adults and children?
Tibia
What is the most common bone fracture that is associated with compartment syndrome?
Tibia
A patient being treated for Burkitt's lymphoma is found to have hyperkalemia, hyperphosphatemia, hypocalcemia, a metabolic acidosis, hyperuricemia, and appears to be going into renal failure after the first dose of chemotherapy. These are all classic signs of which of the following?
Tumor lysis syndrome
The risk of extrapyramidal side effects (pseudoparkinsonism) and tardive dyskinesia is associated with which class of medications?
Typical 1st Gen Anti-psychotics (Haloperidol, chlorpromazine)
When does the humoral phase of allergic response occur?
Within the first 15 minutes of being exposed to an allergan
Is Christmas Factor Deficiency (Hemophilia) Sex linked?
YES! All daughters of a hemophilic male become carriers and all sons are normal
Which of the following drugs block the actions of leukotrienes and can be used for long-term control of mild persistent asthma?
Zafirlukast
Which of the following is diagnostic of nephrotic syndrome?
hypoalbuminemia, hyperlipidemia, proteinuria >3.5 g/24 h
A 16-year-old girl presents to the office complaining of a very sore throat, swollen lymph nodes, fever, and general malaise. Her examination reveals a temperature of 102.2°F, enlarged exudative tonsils, tender cervical lymphadenopathy, and borderline enlarged spleen. Rapid strep screen is negative. Which of the following laboratory findings best supports the most likely diagnosis?
increased atypical lymphocytes on white blood cell differential
Definition of Sprain:
injury to ligaments and joint capsules
A 74-year-old man with end-stage renal failure is suffering from a number of bone abnormalities, including osteomalacia. Which of the following is most likely diminished in this patient?
production of 1,25-dihydroxycholecalciferol
A 50-year-old male is seen with a routine check-up. He is concerned about the possibility of developing diabetes mellitus. He has a negative family history of diabetes. He has no signs or symptoms of diabetes and he is not overweight. Without any risk factors for diabetes, what is the recommended screening protocol for this patient according to the American Diabetes Association (ADA)?
screen everyone over 45 years of age every three years
What is spondylolisthesis?
the forward movement of one vertebral body on the vertebra below; most commonly occurs between L5-S1
A 33-year-old woman treated with trifluoperazine for the past 3 months is seen in the emergency department because of recent-onset fever, stiffness and tremor, as reported by her accompanying sister. The patient also appears to be mildly confused when asked about location, day, and time. Her temperature is 104.5°F, and her serum creatine kinase (CK) level is markedly elevated. Which of the following has most likely occurred?
the patient has developed neuroleptic malignant syndrome
When is the rapid influenza test MOST accurate
At the onset of sx and no later than 4-5 days after
A 23-year-old patient who has recently been on a ski trip presents with pain to the right hand after sustaining a fall. It is difficult to move, and there is pain on flexion of the digit. Based on this history what ligament would the patient most likely have injured?
!st MCP joint ulnar collateral ligament
What is the normal serum PTH?
10-65 pg/mL
How many types of primary osteoporosis are there?
2
A patient was recently diagnosed with acromegaly. He was reading on the Internet that acromegaly is associated with diabetes mellitus. He is especially concerned, since his father was recently diagnosed with diabetes as well. How would you reply to the patient's following question: "What percentage of people with acromegaly develop diabetes mellitus?"
25%
What absolute tissue pressure generally is used as a guideline for diagnosing compartment syndrome?
30 mm Hg
Approximately what percentage of patients with a solid primary tumor elsewhere will end up with metastatic disease of the vertebrae during the clinical course of their cancer?
50%
In taking the family history of your 25-year-old male patient, you discover that he has numerous relatives with breast and ovarian cancers. In the past, his mother received genetic counseling and testing for the BRCA1 and BRCA2 gene mutations and was found to be positive for a mutant allele. What is his risk for developing this genetic cancer?
50%
A 19-year-old presents to clinic requesting emergency contraception. She is a G1P0Ab1 and a non smoker who has had intercourse and the condom broke. Her LMP was 3 weeks ago. Her PMH is negative. What would be the time frame for maximum efficacy for her to use emergency contraception?
72 hrs
The Centers for Disease Control and Prevention recommend the first lead screening for children living in high risk areas in the United States at which age?
9 months
A 53-year-old woman presents to clinic complaining of amenorrhea, irritability, and hot flashes for 6 months. She would like to try hormone replacement therapy. You are counseling her about possible risks versus benefits. Which of the following is a benefit of combined estrogen progestin therapy?
A decrease in somatic symptoms
A 33-year-old man with HIV infection is brought in by his partner for evaluation of altered mental status. The partner has noticed waxing and waning periods of confusion throughout the day, difficulty in performing tasks such as balancing a checkbook, and deterioration of handwriting. The patient reports no fever or headache. What is the most likely diagnosis?
AIDS dementia complex
What disease are Auer rods found in?
AML
A 7-year-old male is suspected to have a Wilms' tumor (nephroblastoma). What is the most common symptom at presentation?
Abd mass
A 14-year-old boy presents to the emergency department with acute scrotal pain and vomiting for the past 2 hours. His left testicle is in extreme pain and he states the pain started while playing basketball in gym class. On physical exam of the affected testicle, which of the following findings would suggest testicular torsion?
Abnormal transverse line
A 64-year-old male presents with fatigue, pallor, and dyspnea on exertion. He has noted this gradual onset over the last several months. His initial reason for coming in was due to new papules and nodules that he noted on his skin, with some violaceous in color. On exam you also note petechiae to the lower extremities and splenomegaly. On questioning him further, he notes feeling full sooner than he had in the past. On laboratory you note a pancytopenia. What is the most likely diagnosis?
Acute myelogenous leukemia with leukemia cutis- (nontender infiltrates in the dermis)
what is the MC lung cancer seen in nonsmokers?
Adenocarcinoma
What age group is most at risk to develop osteoid osteoma?
Adolesents
A 38-year-old man presents to the emergency department experiencing a severe headache and heart palpitations. He appears to be anxious and perspiring heavily. On exam, he is found to be tachycardic and his blood pressure is 158/102 mm Hg. His urine catecholamines are increased. If imaging were performed, what is the most likely location where a lesion would be found?
Adrenal Gland--be thinking pheochromocytoma
What is the MC extrapyramidal s/e of neuroepileptic meds?
Akathisia: state of agitation, distress, restlessness// inability to sit still
A patient presents with hyperleukocytosis (WBC 100,000). The bone marrow is consistent with T-cell ALL. The uric acid is less than 7.0 mg/dl. Prior to starting chemotherapy, what is the best therapy to initiate on this patient?
Allopurinol and IV fluids
A patient presents to your office with a sudden onset of headache, right eye pain, decreased visual acuity, nausea and vomiting. His intraocular pressure is 47. Which of the following classes of medications are indicated for treatment of this condition?
Alpha agonist and BB: acute angle closure gluacoma
A 43 year-old woman is brought to the emergency department in critical care secondary to a traumatic brain injury. Which of the following best describes her Cheyne-Stokes respiratory pattern?
Alternating of shallow and deep respirations
A 54-year-old male with a known history of hypercholesterolemia presents to your office complaining of vision changes in his right eye. He states that this morning, while working on his computer, he noticed darkening of his vision, which he described as a "shade being pulled down over my eye." This was followed by approximately three minutes of vision loss in the right eye, which resolved. He denies any other symptoms and does not have a history of eye problems. Which of the following is the most likely diagnosis?
Amaurosis Fugax
Which of the following cardiac medications is known to cause clinically significant hypothyroidism?
Amiodarone
An 18-year-old female presents with two weeks of severe sore throat and fatigue. Her exam shows an exudative tonsillitis. A mono-spot test is positive, and a rapid strep test is positive. Which of the following medications should be avoided?
Ampicillin--will cause rash
What is the most common cause of restrictive cardiomyopathy?
Amyloidosis
A parent brings her child into the office with the concern of the way he stands. To the parent the child looks like they are knocking knees. If the child is indeed presenting this way, what would be the best description of this orthopedic abnormality?
Angulation of an extremity at a joint with the more distal part angled away from the midline.
A 16-year-old girl is brought to the emergency department by ambulance after reportedly ingesting "a bottle of aspirin." Vital signs are temperature 37.8°C oral; pulse 94/min; respirations 30/min; blood pressure 100/68 mm Hg. What would you expect the blood gases to show that would confirm she had swallowed the aspirin?
Anion gap metabolic acidosis and resp alkalosis
A 47-year-old female presents to the office complaining of excessive menstrual flow for the past two months. She complains of mid-cycle bleeding, as well as periods that last for nine days. What is the mostly likely cause of her bleeding?
Annovulatory uterine bleeding
A 20-year-old male presents to the emergency department complaining of pain to the right shoulder region while playing basketball. He states that his arm was pulled back and rotated while he was moving forward, and then felt a popping sensation in the shoulder. Since then he has not been able to move the shoulder at all due to pain and immobility. It is suspected that he has a dislocation. Given this scenario, what would be the most likely type? What type of shoulder dislocation did he most likely experience?
Anterior
2 MC regions for compartment syndrome?
Anterior compartment of leg and volar compartment of forearm
A 19-year-old male is brought by his mother to your primary care office. She is at her wits' end as he has just gotten out of juvenile detention but continues to engage in the behaviors that resulted in his incarceration. He lies, cheats, steals, and seems to disregard the rights and needs of others to the point of endangering their safety. This pattern has been present since early childhood, since at least age four. He does not feel that there is a problem, but his family and others around him are disturbed by his attitudes and behaviors. What is the most likely diagnosis?
Antisocial PD
At what point are stress fractures visible after initial presentation?
Anywhere from 14-42 days; repeat x-rays then in order to further detect and dx
A mother presents with a 2-month-old infant with a concern of bald spots in the child's scalp. She states that there were ulcerated areas present at birth that healed within a few days. What is the most likely diagnosis?
Aplastic cutis congenita
A 58-year-old man presents with the acute onset of abdominal pain associated with fever and shaking chills. The patient is hypotensive and febrile with a temperature of 102.2°F. Although he is confused and disoriented, he complains of right upper quadrant pain during palpation of the abdomen. His sclerae are icteric and the skin is jaundiced. Which of the following is the most likely diagnosis?
Ascending Cholangitis
What is the Tx for PSVT?
Aside from pharm therpay, cardiac cath and ablation
Following emergent appendectomy, a 58-year-old obese male develops a temperature of 102.4˚F, 18 hours postoperatively. His respiratory rate is 26 and his pulse is 116bpm. A physical exam reveals scattered fine rales. What is the most likely diagnosis?
Atelectasis
A 32-year-old female is brought into the emergency department by her partner. His report indicates that she had been in her usual state of good health until a couple of days ago. At that time she started to complain of feeling fatigued. She now appears jaundiced and lethargic, and is complaining of chest pain. On exam, her spleen is palpable. Hemoglobin is 6 g/dl and she is Coombs positive. What is the most likely diagnosis?
Autoimmune hemolytic anemia
A 22 year-old male presents with a 2-week history of an upper respiratory infection that hasn't improved after taking amoxicillin for 6 days. He notes persistent sore throat, intermittent fever, and a worsening nonproductive cough. Physical examination reveals bilateral diffuse crackles. What is the most appropriate antibiotic to initiate after discontinuing the amoxicillin?
Azithromycin--covers atypicals
Is halo nevi benign or pre-malignant?
BENIGN; reassurance is the only tx needed
What type of vaginitis has a positive whiff test and clue cells?
BV
According to the Centers for Disease Control and Prevention (CDC), which of the following cannot be treated with a course of doxycycline 100 mg PO BID for 10 to 14 days?
Babesiosis
A 21-day-old male is brought to the pediatric clinic for concern of irritability, sweating with feeds, and fatigue. Upon examination, there is a discrepancy in the pulse between the arms and legs. The femoral pulses are diminished when compared to the brachial pulses. A murmur is present, and heard in the left axilla and the left back. An EKG is obtained, which show right ventricular hypertrophy. Echocardiography shows a localized narrowing of the aortic arch, just distal to the origin of the left subclavian artery. What is the best definitive treatment for this patient?
Balloon angioplasty of the abnormality
A 7-year-old child is brought into the office by her mother who states that the child "is still wetting the bed at night." The child has already decreased liquid intake and uses the bathroom before going to bed. The mother is worried that there is something wrong with the child. Upon examination there is no abnormality. Urinalysis is negative. Which of the following is the treatment of choice for this disorder?
Bed-wetting alarm
A 51-year-old male patient presents to your family practice office complaining of genital discomfort with dysuria. His digital rectal exam reveals an enlarged, tender prostate. His prostate-specific antigen (PSA) returns elevated with a value of 11.1 mg/mL, which you fractionate, and this reveals approximately 75% free PSA. His urinalysis reveals moderate white cells and trace blood. What would be your next step in treating this patient?
Begin him on 6 weeks of doxycycline to treat his prostatitis and when resolved, repeat his PSA level.
A 65-year-old recent alcoholic comes to the emergency department with recent onset of dyspnea, with exertion, 3 pillow orthopnea, lower extremity edema, and palpitations, in which he describes his heart as racing. Which of the following is most likely to be the cause of his high-output congestive heart failure?
Beriberi
A 43 year-old woman presents to the clinic due to the presence of a bulls eye rash on her right upper back. She is prescribed tetracycline. What is the mechanism of tetracycline?
Bind to the 30s ribosomal subunit to inhibit protein synthesis
A 65-year-old woman presents with a complaint of blood in her urine, intermittently for the last month. The patient denies any fever, chills, flank pain, or dysuria. Social history is positive for tobacco use (45 pack years), but patient reports stopping her tobacco use last year. What is the most likely cause of her hematuria?
Bladder cancer
What is the most helpful dx study for ITP?
CBC
A 12-year-old boy presents to the clinic for follow-up regarding his recently diagnosed partial seizures. He reports no seizures or side effects since starting carbamazepine (Tegretol) 1 month ago. What study should be ordered to monitor this patient's treatment?
CBC; carbamazapine can cause blood dyscrasias
Which two pulmonary disorders are associated with transudative effusions?
CHF and PE
A 64-year-old man has been experiencing intermittent left lower abdominal pain associated with alternating diarrhea and constipation. The pain has been increasing over the past 24 hours and is now associated with a fever. The abdomen is tender with evidence of peritoneal signs. Which of the following diagnostic studies is most appropriate to evaluate this patient?
CT
A 64-year-old female presents for an annual examination. She is 5'0" and weighs 92 pounds; compared to her examination 3 years ago she has lost an inch in height. After performing a dual-energy x-ray absorptiometry (DXA) scan the diagnosis of osteoporosis is confirmed. Which of the following supplements should be recommended?
Calcium carbonate 1,000 mg and vitamin D 800 international units daily
Patients diagnosed with an auricular hematoma are at increased risk of developing which condition?
Cartilage necrosis
Which of the following foodborne illnesses is most likely to be acquired through eating raw oysters?
Cholera--from raw shellfish
What is the most common pulmonary complaint of a patient with tuberculosis?
Chronic cough
Which tpe of leukemia is associated with the Ph chromosome?
Chronic myelogenous leukemia
A 16-year-old girl is referred for a sports physical. Her blood pressure is 170/92 mm Hg. Urinalysis (UA) reveals 2+ protein. The girl's mother reports multiple episodes of urinary tract infections (UTIs) throughout childhood that were never investigated. The most likely diagnosis is
Chronic reflux nephropathy
A 62-year-old male presents with complaints of numbness in his hands and feet, with occasional foot drop, memory disturbance, fatigue, paleness, anorexia, nausea, and weight loss. He has a known history of diabetes and hypertension. Which of the following conditions is most likely responsible for these symptoms?
Chronic renal failure
What is clanging?
Clanging is a disturbance in thought in which the person selects words that are similar by sound, but do not mean the same. Sometimes the person will rhyme the words.
What are the classic signs on Non-Hodgkin Lymphoma?
Classic signs of Non-Hodgkin lymphoma, consisting of mediastinal mass, "B" symptoms, and painless lymphadenopathy.
A 24-year-old female, with a history of type 2 diabetes, presents with the inability to conceive after 14 months of unprotected sexual intercourse with her husband. Her vital signs are unremarkable and you calculate a BMI of 31. Physical examination reveals acne vulgaris and hirsutism. Which of the following treatment options for her infertility would be the most effective considering your suspected diagnosis?
Clomiphene citrate
A 68-year-old female presents to the emergency department with signs and symptoms of an acute ischemic stroke. The initial CT scan is normal. Her blood pressure is 164/105. What is the most appropriate treatment for the blood pressure of this patient?
Close monitoring; dont want to decrease blood flow to ischemic area bc it could cause further ischemia and death of tissue
which anti-schizoid tx causes severe agranulocytosis and requires weekly WBC monitoring?
Clozapine
A new patient is seen in your internal medicine office today. She is coming in to request the removal of several skin tags. She is a 55-year-old woman with a history of untreated acromegaly. A health maintenance plan is set up with the patient, and includes a colonoscopy. This patient is at increased risk for which of the following findings on colonoscopy?
Colon Polyps
A 48-year-old woman presents with new-onset headache that she describes as nonspecific, worse on awakening, intermittent throughout the day but can worsen with bending over or coughing. Her husband reports that she has not been herself since the headaches started about 4 to 6 weeks ago. Which of the following tests would be best for determining the etiology of her presenting symptoms?
Contrast enhanced brain MRI
A 35-year-old homeless male presents with a painful red right eye and decreased visual acuity, which occured over the past 48 hours. He doesn't recall any trauma, and prior to this his vision was good. His past history includes alcoholism and liver disease. On physical exam you notice a white opacity in the center of his right cornea. You are unable to do an ophthalmoscopic exam due to the opacity, and a fluorescein staining is strongly positive. What is the likely etiology of the white opacity?
Corneal Ulcer
What is the best test to dx Addison's dz?
Cosynotropin Stimulation test: The cosyntropin (ACTH) stimulation test should reveal a low am cortisol level and an elevated ACTH level if he has Addison's disease.
Which of the following U.S. Preventive Services Task Force (USPSTF) recommendations for prostate cancer is correct?
DREs are not recommended and PSA screening is recommended based upon patient risk, but only after discussing the benefits and risks with the patient and the patient expressing the desire to have the examination performed.
A 24-year-old male is brought to the clinic by his mother, who is concerned because her son believes that a local TV news anchor is in love with him. The mother states that this thought has been persistent for the last two to three months, and that he goes around town telling everyone about their relationship; however, she knows that her son does not even know the TV news anchor. The mother notes that this belief has not impaired his daily functioning, but has significantly affected his social functioning. The patient is exhibiting signs most consistent with which of the following psychiatric disorders?
Delusional disorder
A 30 year old female complains of a dome shaped slightly erythematous nodule on her right thigh. Upon clinical examination it exhibits the "dimple sign". The patient states the lesion is not changing and is asymptomatic. What is the most likely diagnosis?
Dermatofibroma
A 28-year-old male presents with a rash on his hands that is unresponsive to topical steroids. On physical exam you notice periocular violaceous erythema and edema. He also exhibits significant proximal muscle weakness. What is the most likely diagnosis?
Dermatomyositis
A 39-year-old male patient, who underwent a kidney transplant four months ago, reports to the clinic complaining of pain on swallowing and difficulty swallowing solids. On physical exam, you note a few white plaques present on his tongue. You order an upper endoscopy, which reveals small, yellow-white plaques with surrounding erythema present along the esophagus. What is your treatment of choice for this patient?
Diflucon-Fluconazole
A two-year-old male presents with a nodule on the side of his index finger. His mother states that he has had this nodule on one prior occurrence during infancy, and it resolved on its own. What is the most likely diagnosis?
Digital Fibroma
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?
Dissociative Fugue
Which of the following conditions is the most common cause of massive lower gastrointestinal bleeding?
Diverticular Disease
A 14-year-old boy presents to the emergency department with acute scrotal pain and vomiting for the past 2 hours. His left testicle is in extreme pain and he states the pain started while playing basketball in gym class. Which diagnostic test would help confirm your suspected diagnosis?
Doppler US; Be thinking Testicular Torsion
A 5-year-old male child presents to the office for his kindergarten physical examination. Assuming that the patient's immunizations have been up to date, which of the following are the immunizations that the patient should receive at the end of today's visit?
Dtap, IPV, MMR, Varicella
A 48-year-old African American male presents with dyspnea, 2-pillow orthopnea, and swelling to his lower legs that has developed over the last month. He also complains of fatigue and decreased exercise tolerance, stating that he has trouble climbing one flight of steps. On physical examination, his blood pressure is 178/98, pulse rate is 102, and respiratory rate is 20. There is 5 cm JVD, crackles at the bilateral lung fields, and tachycardia and an S 3 is heard on cardiac auscultation. There is 2+ pitting edema to the lower extremities. His electrocardiogram reveals a sinus tachycardia at a rate of 105 and left ventricular hypertrophy. The chest x-ray reveals cardiomegaly with increased interstitial markings in all lung fields. There is a small right pleural effusion that blunts the costophrenic angle. Which initial diagnostic test gives you the best information regarding this patient's pathology?
Echo
What is factor XI deficiency also called and who is at risk?
Hemophilia C; Ashkenazi jews
A 5-year-old boy presents to urgent care complaining of painful lesions in his mouth that have made eating difficult the past 2 days. The mother confirms he has been unable to eat for 48 hours, but has been able to sip water. On physical exam he has a temperature of 102.6 F; numerous small vesicles and ulcers on the buccal mucosa and tongue, inflamed gingiva; and tender anterior cervical adenopathy. Which of the following is the most likely diagnosis?
Herpes Simplex Gingivostomatitis
A 15 year old male presents with lesions on his palms, dorsum of his hands and lower arm. They began as red macules that developed a central vesicle over a few days. The lesions are pruritic with no other symptoms. What is the most common etiology?
Herpes Simplex Infection--The condition being described is erythem multiforme
Your supervising physician asks you to advise him which finding is least likely to be suggestive of a thyroid malignancy in your 49-year-old female with a small palpable thyroid nodule. Which of the following choices would be least likely to suggest malignancy in this patient?
Hot nodule on 1231 uptake scan; hot nodules are normally suggestive of BENIGN hyper-functioning thyroid nodules
An 18-year-old G1P0 presents for evaluation of her amenorrhea. Her LMP was 2 months ago. Her HCG is positive, and she has been having vaginal spotting x 2 weeks. Her ultrasound reveals an intrauterine heterogeneous echogenic mass, without fetus or placenta. What is the most likely diagnosis?
Hydatidiform mole
A 63-year-old male with chronic kidney disease is in the ICU with bradycardia, flaccid paralysis, and an ileus. A stat work-up includes an ECG showing peaked T waves. Which lab finding would you suspect?
Hyperkalemia; other EKG findings are prolonged PR interval, tall peaked T waves, and QRS widening
A 3-week-old male infant is brought in by his mother due to his vomiting. The mother notes that a few days ago her son started vomiting after feeding, and it has become projectile in nature. The vomitus is non-bilious and contains no blood. The child seems hungry and nurses regularly, but the vomiting has become more frequent and is occurring with every feeding now. On physical examination, an oval mass is palpated in the right upper quadrant. What laboratory finding is most consistent with the suspected diagnosis?
Hypochloremic Alkalosis
A 46-year-old man with a history of EtOH abuse is brought to the emergency department in the morning by his wife. She has noted that he has developed tremors in both arms, and he seems mildly confused to her. He complains of feeling weak, with some cramping in the legs. On physical examination, his blood pressure is noted to be 162/95 mm Hg, and his heart rate is 108 beats/min. There is no asterixis. Which of the following electrolyte disorders are you likely to find in this patient?
Hypomagnesemia; common electrolyte imbalance in ETOHics
A 70-year-old man, with a history of HTN and aortic valve replacement 3 months ago, presents with complaints of arthralgia, myalgia, anorexia, fatigue, and weight loss over the last month, with recent dyspnea on exertion and lower extremity edema. Vital signs are as follows: Temperature 38°C, BP 102/64, P 98, RR 20. On physical exam, a new high-pitched, blowing, decrescendo diastolic murmur is noted along the left lower sternal border. Two separate blood cultures are positive for S. aureus, and found to be methicillin-resistant. A transesophageal echocardiogram demonstrates a paravalvular abscess. Which of the following is the most appropriate therapy in the management of this patient?
IV vancomycin, IV gentamicin, and PO rifampin with surgical treatment
A 29-year-old female complains of a two-month history of easy bruising. She describes that the bruising is located primarily on her shins, but has noted them on other areas as well. She also describes red freckles on her lower extremities. On exam, you note non-blanching and non-palpable purpura to both legs and petechiae. She denies recent illnesses and states that she has essentially been feeling fine. The PE is normal other than the skin findings. A platelet count of 118,000 is noted. What is the most likely diagnosis?
Idiopathic thromocytopenic purpura; ITP normally comes on suddenly and pts feel fine otherwise
A 13-year-old female is seen for the first time to establish care. She is known to carry the diagnosis of beta-thalassemia major and has been maintained on regular transfusions for her anemia. She is short for her age and has not achieved menarche. Her glucose level is elevated and she has developed signs of diabetes mellitus. These findings are consistent with which of the following?
Inadequate iron chelation
A 24-year-old gravid 3 para 0 ab 2 presents complaining of vaginal pressure every 2 hours, but no pain. She is at 26 weeks gestation. This pregnancy is uncomplicated to date. On physical exam she is in no acute distress and her vitals are normal. She is placed on a fetal monitor and no contractions are noted; fetal heart tones are 138. A sterile speculum exam reveals her cervix to be dilated to 4 cm. What is the most likely diagnosis?
Incompetent cervix
Assuming that a patient has maintained a normal baseline creatinine of 1.0 mg/dL with a normal glomerular filtration rate (GFR) of 100 mL/min, which of the following indicates a more significant change in the GFR?
Increase in Creatinine from 1.0 to 2.0 mg/dL
A 29-year-old man who is taking combination antiretroviral therapy develops severe right-sided flank pain and dysuria. He is also nauseated, which he attributes to the severity of the pain. He is unable to sit still and paces about the examination room. Dipstick urine is remarkable for 3+ hematuria. Which of the following drugs is most likely to be responsible for this clinical picture?
Indinavir
Strain?
Injury to muscles and tendons
A 41-year-old male presents due to concerns regarding headaches. He states that for the past month and a half he has had daily headaches, described as aching, which he notes are worse first thing in the morning and do not seem to change with activity or position. He has noted that when he drives, his left hand seems weaker on the steering wheel, and he drops things more often. He denies any other neurologic symptoms or recent illnesses. A physical exam reveals weakness of the left hand, forearm, and upper arm, with mildly decreased reflexes. There are no other significant findings. Which of the following is the most likely diagnosis?
Intracerebral neoplasm
Which of the following is an absolute contraindication to acute thrombolysis, with a recombinant tissue plasminogen activator (tPA) in an ischemic stroke patient?
Ischemic stroke in past 2 months; Other absolute CI include: -Sustained BP >185/110 despite treatment -Platelets <100,000; HCT <25%; glucose <50 or >400 mg/dL -Use of heparin within 48 h and prolonged PTT, or elevated INR -Rapidly improving symptoms -Prior stroke or head injury within 3 months; prior intracranial hemorrhage -Major surgery in preceding 14 days -Minor stroke symptoms -Gastrointestinal bleeding in preceding 21 days R-ecent myocardial infarction
A 42-year-old male presents with a history of low grade fever, cough, and myalgias for five days. He states that these symptoms began after a cave exploration trip along the Ohio River two weeks ago, and have since worsened. An x-ray reveals focal consolidation, and you suspect Histoplasmosis pneumonia. Which of the following is the first line treatment of choice?
Itraconazole; histoplasmosis is a fungus in endemic areas (Ohio and Mississippi in US)
A 19-year-old woman presents to the emergency department complaining of headache. The headaches are generalized and increasing in intensity. They have not responded to over-the-counter (OTC) medications. She complains of approximately 1 week of blurred vision, intermittent diplopia, and vague dizziness. Her medical history includes obesity and acne. She takes Accutane and oral contraceptives. She is found to have bilateral papilledema, visual acuity of 20/30 on physical examination, and a normal MRI of the brain. The next most appropriate step would be
Lumbar puncture; The presence of headache associated with papilledema raises the concern for a brain tumor. The MRI excluded a mass lesion, raising a strong suspicion of pseudotumor cerebri. This is also known as benign intracranial hypertension.
Which of the following is most useful in diagnosing renal artery stenosis?
MRA (angiography)
A 62-year-old man is brought to the emergency department after being found unresponsive in his car. On physical examination, his pupils are noted to be 7 mm on the right and 3 mm on the left. Which of the following diagnostic tests is most likely to identify the cause of the patient's signs and symptoms?
MRI with contrast
A 21-year-old male presents to the emergency department due to vomiting blood. He is a college student and was initiated into a fraternity earlier in the week, and admits to drinking enough alcohol to make him vomit that night. There was no blood in the vomit at that time. The hematemesis started today, about 20 minutes after he finished a workout at the gym. He notes that today was a particularly tough workout, as he increased the amount of weight he was lifting significantly compared to previous workouts. His vital signs are as follows: heart rate 86 bpm, respirations 14, BP 126/82, temp 98.8°F. What is his most likely diagnosis?
Mallory-Weiss Syndrome
Koplik spots are a differentiating diagnostic feature of which of the following viral exanthems?
Measles; The rash in measles usually presents as a red-brown rash starting with the head and moving caudally. It follows a 3- to 4-day prodrome consisting of fever, nasal drainage, conjunctivitis, and cough.
A 6-year-old girl presents to the emergency department with abdominal distension of 1-day duration. She has not had a bowel movement or passed flatus in 72 hours. Examination reveals markedly diminished bowel sounds with tympany to percussion. She has also passed bloody mucus from her rectum. There is no evidence of hernia, and surgical history is negative. Which of the following is the most likely diagnosis?
Meckel Diverticulum
A 34-year-old man presents to your office with the complaint of pain and fatigue in his right wrist. He states that the pain can sometimes wake him up at night and feels as if his thumb is falling asleep. He reports the problem started since he has been writing a book. On physical examination, you note a positive Tinel sign but no response to a Phalen maneuver. While sending him for a nerve conduction study, you tell him the most likely diagnosis is
Median Nerve compression
A 27-year-old woman complains of years of menstrual irregularity and increasing facial and chest hair. PMH: significant for ovarian cyst and left cytectomy. She is a non-smoker and non-drinker. Labs include a negative uCG, elevated LH, and low FSH. She desires fertility and she has not responded to three cycles of clomiphene. What would be the next choice of medication that may return ovulation?
Metformin
A 78-year-old male returns to the FP office for a follow up of non-insulin-dependent diabetes mellitus (NIDDM) as a new patient to you, although he has been an office patient for the past year. He denies any problems this visit and says his blood sugars are in the 90-120 mg/dl range. He is currently taking the medications listed in the following choices. You receive his labs and note that his creatinine is 2.0 mg/dl and on the previous few labs this creatinine was also in the 1.8-2.0 mg/dl range. What medication should be discontinued?
Metformin
You are evaluating a 77-year-old male with stage 3 chronic kidney disease (CKD). He denies any complaints today. His renal function has been stable over the past 6 months. However, you note that his Hgb has decreased from 10 g/dl to 8.5g /dl despite erythropoietin injections. Hemoccult stool times 3 is negative. What should you do next?
Order an iron profile with ferritin
A patient was prompted to visit his health care provider after his wife started to notice that he was not interested in eating, has lost weight, and has been suffering from nausea for the last few weeks. The practitioner notes hyperpigmentation of the patient's skin, although the patient denies any recent sun or tanning salon exposure. Routine non-fasting blood work reveals the following: Sodium = 130 meq/L Potassium = 5.2 meq/L Chloride = 105 meq/L Glucose = 135 mg/dL Hemoglobin = 13.0 g/dL Hematocrit = 39.0 WBC count = 8,000/mm 3 Which of the following physical exam findings would you expect to see in this patient?
Orthostatic Hypotension Adrenal Insuff/Addison's: melanocyte increase causing skin pigmentation, changes in hair distr, orthostatic hypo, hypoglycemia, weakness, wt loss, low serum Na, high serum K
A 36-year-old male with a history of acute lymphoblastic leukemia (ALL) is treated with high dose methotrexate and glucocorticoids, vincristine, and L-asparaginase at age 10. He has been in remission since induction therapy was completed. He presents with pain to his right hip/back area, which radiates down his leg. He is also having some back pain that keeps him up at night. What is the most likely diagnosis?
Osteonecrosis of the right hip
What is the most widely used dx test to dx Cushing's disease?
Overnight Dexamethasone suppression test
What is the laboratory test that has the best predictability for diagnosing pneumonia caused by adenovirus?
PCR
A 15-year-old male presents complaining of a sore throat, headache, and mild cough that started 8 days ago and has progressed to include a worsening cough and increasing fatigue. His chest x-ray reveals bilateral hilar infiltrates and a CBC is normal. Which of the following diagnostic tests will most likely confirm the suspected diagnosis?
PCR testing of sputum
A 42-year-old man who is HIV positive develops fever of 38.8°C, mild nonproductive cough, and shortness of breath. He takes no medications other than a multivitamin tablet, does not smoke cigarettes, or use alcohol or illicit drugs. Of the following findings on diagnostic studies, which is most consistent with a diagnosis of Pneumocystic jiroveci pneumonia in this man?
PO2 of 54 mm Hg; Severe hypoxemia is a common finding in Pneumocystis pneumonia even when symptoms are not severe.
Tumor necrosis factor (TNF) inhibitors are most often considered for use in patients with rheumatoid arthritis (RA) that does not respond to initial therapy. Which of the following screenings should occur before a patient is placed on this class of medication?
PPD test; due to increased risk of opportunistic infections like TB
A patient seen at the prenatal clinic develops Graves disease at 25 weeks' gestation. Which of the following is the most appropriate treatment?
PTU100 mg PO TID; PTU is safer than methimazole in pregnancy
What is almost entirely specific to Hodgkin lymphoma?
Pain in involvedl lymph nodes after ingesting alcohol
A 38-year-old male presents with red-brown urine in the mornings. The discoloration has come and gone several times over the last several months. He has also noted hard, painful areas on his skin, which seem to be located over veins, which have occurred intermittently. Laboratories reveal nonspherocytic red cells and a Coombs negative intravascular hemolysis. What is the most likely diagnosis?
Paroxysmal Nocturnal Hemoglobinuria
What microbe/virsu causes erythemia infectiosum/fifth disease?
Parvovirus B19
A 30-year-old woman and her husband have been trying unsuccessfully to become pregnant for the past year. Over-the-counter ovulation tests have indicated that she is ovulating. As part of her evaluation she undergoes a hysterosalpingogram that reveals tubal scarring. Which of the following is the most likely explanation for this finding?
Past asymptomatic chlamydial infection
A 63-year-old male with type 2 diabetes mellitus and hyperlipidemia is being seen for routine blood work to assess his renal function. Blood pressure is 130/90 and pulse is 75. His blood chemistries show hypoalbuminemia and hypoproteinemia. His urinalysis shows urine protein excretion of 3.5 grams per 24 hours, microscopically shows oval fat bodies in the urine, and Maltese crosses under polarized light. Which of the following findings would support the suspected diagnosis?
Peripheral edema -Be thinking nephrotic syndrome
Tx for 3rd degree AV block?
Permanent pacemaker
A 35-year-old male presents complaining of increasingly constant headaches, double vision centrally, and a progressive loss of peripheral vision for two weeks. He has no previous headache history and denies any other medical conditions. Physical examination reveals bitemporal hemianopsia without additional neurologic findings. What is the most likely diagnosis?
Pituitary Adenoma Symptoms are based upon the location and size of the tumor, and may include bitemporal hemianopsia, double vision, color desaturation, and visual acuity loss.
A 34-year-old female with a definitive diagnosis of multiple sclerosis presents with an acute symptomatic exacerbation for two days, causing difficulty ambulating and markedly painful paresthesias, which is affecting her ability to sleep. She is currently on Interferon-β-1A, although she admits to missing some recent doses. Which of the following medications is most appropriate for treating her acute exacerbation?
Prednisone
A 60-year-old female presents to her primary care practitioner for her yearly check up. Her past medical history is significant only for a history of repeat kidney stones. She enjoys gardening outside, has no significant family history, and is not taking any medications. Routine mammograms have been normal. During the review of her systems, the patient describes feeling tired lately and has noticed muscle aches over the last few weeks. Initial lab values are shown below: Hemoglobin = 12.0 gm/dL Hematocrit = 36% BUN = 10 mg/dL Creatinine = 0.7 ng/mL Calcium = 12 mg/dL Phosphate = 2.0 mg/dL PTH = 100 pg/mL TSH = 2.0 UIU/mL What is the most likely cause of her symptoms?
Primary Hyperparathyroidism
A 23-year-old woman presents to clinic complaining of amenorrhea for 3 months. She also complains of increasing facial hair and weight gain. On exam, PMH: menarche age 13. Physical exam reveals a well-developed, slightly obese female with a BMI of 29. Her amenorrhea can likely be improved with which therapy?
Progesterone administration
MC causative agent of malignant otitis externa?
Pseudomonas
Is sickle cell autosomal dominant or recessive?
RECESSIVE
What is Charcot's triad?
RUQ pain, jaundice, fever Triad used to dx ascending cholangitis
What finding with you have on histological exam in someone with Hodgkin Lymphoma?
Reed Sternberg cells
A 23-year-old female has been seen in your Emergency Department after being beaten by her husband. As you counsel her before she leaves, which of the following will you recommend?
Referral to a local women's shelter
A 39-year-old male complains of intermittent episodes of hematuria over the past 6 months, which resolved spontaneously without treatment. He also has noted some dull bilateral flank discomfort recently that he attributed to a strain after moving. He denies any dysuria or penile discharge. He further denies any history of kidney stones. His mother died in her 60s of kidney disease that required dialysis. On examination his BP is 148/92, P = 68, T = 98.2˚F. His examination is unremarkable except for bilateral palpable enlarged kidneys. Urine dip is positive for +1protein. What diagnostic test would be most helpful to confirm your suspected diagnosis?
Renal US--pt has Polycystic kidney disease
What is the most common blood gas abnormality in patients with a pulmonary embolism?
Respiratory Alkalosis-from hyperventilation
You have just diagnosed Mr. Jones, a 31-year old male, with community-acquired pneumonia. He has no comorbidities and was treated for a strep throat with antibiotics within the last three months. According to the Infectious Disease Society of America (ISDA) and American Thoracic Society (ATS) guidelines, the first-line antibiotic choice would be?
Respiratory Fluoroquinilone
An 8-year-old girl is rushed to the emergency department by her parents because she has become delirious. The child was diagnosed with influenza three days prior. Her parents say that she had begun vomiting yesterday, almost nonstop, and has not been able to hold down fluids. They also note that she has been breathing rapidly. Your exam reveals a tachypneic, disoriented female with hyperreflexia, a positive babinski reflex, and liver enlargement. CSF analysis reveals a normal protein and cell count. What is the most likely diagnosis?
Reye's syndrome
A 57-year-old male is being monitored for Binet Stage A CLL. He is emergently seen in the clinic with rapid lymph node enlargement, fever, weight loss, and hepatosplenomegaly. On laboratory examination, he is found to have an elevated serum lactate dehydrogenase and a monoclonal gammopathy on serum protein electrophoresis. A retroperitoneal ultrasound reveals bulky adenopathy. What is the most likely diagnosis?
Richter transformation
A 37-year-old man with a history of Paget disease presents with a deviation of the tongue to the right side upon sticking it out. The right side of the tongue is also observed to have slight atrophy. These symptoms most likely point to a lesion of which of the following cranial nerves?
Right Hypoglossal nerve (it supplies muscles ipsilaterally)
The organism responsible for most cases of peritonitis in patients on peritoneal dialysis is
S. Aureus
A 6-year-old female child presents with neck pain and fever for 2 days. Her remote history consists of 2 to 3 days of diarrhea and vomiting. She attends a local daycare where other kids had similar nausea/vomiting, but recovered. The LP was positive for gram-negative bacilli, decreased glucose, increased protein, and increased neutrophils. Which of the following is the most likely etiologic agent?
Salmonella species
You have determined that a multiple sclerosis patient with relapsing-remitting disease has not returned to her baseline functional status with her most recent exacerbations, despite her returning to baseline with exacerbations for many years. Her exam also reveals residual neurologic dysfunction. Which of the following multiple sclerosis clinical types would you classify this patient within?
Secondary progressive
A 61-year old female patient who is a smoker is undergoing a routine physical examination in your family practice. She is otherwise asymptomatic but her urinalysis reveals microscopic hematuria. Your next definitive step would include which of the following?
Send her urine for cytology and refer her to a urologist to rule out bladder cancer.
A 32 year-old male presents to the emergency department in Acute Renal Insufficiency (AKI). Which of the following conditions would be most likely observed in intrinsic AKI?
Septic Shock; some of the MC causes of intrinsic AKI are ischemia, nephrotoxicity and sepsis
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?
Serum creatinine
The two major risk factors for human immunodeficiency virus (HIV) infection in American women are intravenous drug use and which of the following?
Sexual contact with an infected male
In Western society, diverticulosis most often occurs in which portion of the colon?
Sigmoid Colon
A 63-year-old woman presents with shortness of breath, cough, and proximal muscle weakness of 1-month duration. On clinical exam, she is noted to have a blood pressure of 156/102 mm Hg, facial flushing, mild hirsutism, truncal obesity, marked proximal muscle weakness of both the upper and lower extremity, and hyperpigmentation over the palms and back of the neck. Laboratory exam reveals hypercortisolism and increased ACTH. Which of the following would be the most likely primary diagnosis in this patient?
Small cell lung carcinoma
A 56-year-old male is diagnosed with a duodenal ulcer through endoscopy. He is placed on an appropriate regimen of medications to heal the ulcer. Which of the following lifestyle choices is known to retard the rate of ulcer healing and should be discouraged?
Smoking
Which one of the following is a characteristic finding on computed tomography (CT) of the abdomen in a patient with acute diverticulitis?
Soft tissue inflammation of the pericolic fat
A 42-year-old healthy male presents to the emergency department with the complaint of a progressively worsening sore throat, and difficulty swallowing over the past 48 hours. He also complains of a subjective fever, but denies any headaches, nausea, or vomiting. On exam, the patient is afebrile and in mild distress, with a presentation of leaning forward on the exam table. His TM examination is normal, there is no rhinorrhea, and the oropharynx is patent without signs of stridor. His lungs are clear, and he has a regular rhythm on cardiac exam. What diagnostic test is indicated for a definitive diagnosis?
Soft tissue x-ray of the neck
What is primary hyperparathyroidism caused by in 80% of pts?
Solitary parathyroid adenoma
A 32-year-old male presents to your office with the complaint of low back pain for 7 months. The patient states he was initially injured on the job while trying to lift a 50-pound barrel off a truck. He denies any paresthesias or bowel/bladder problems associated with the low back pain. The patient states that he had been given NSAIDs and a muscle relaxer, followed by physical therapy treatments. X-rays that were taken 5 months ago were reported as normal. He was placed on light duty at that time. The patient has seen many practitioners who have "not helped him." Another person who works with this patient was at the clinic and stated the patient has had problems with one of his other coworkers. You consider trying the patient on an antidepressant first and then possibly sending him to a pain clinic if there is no success. What is the most likely diagnosis?
Somatoform Pain disorder
A 49-year-old man presents to the office complaining of general malaise with muscle aches, anorexia, fever, and severe pain over his anterior neck radiating to his ears. He states that he was ill about 2 weeks ago with a sore throat, but it resolved within a few days. On palpation, the thyroid gland is enlarged and tender. His laboratory workup shows a high T4 level and increased erythrocyte sedimentation rate (ESR). What is the most appropriate therapy for this patient's disease?
Supportive therapy only-subacute thyroiditis is self-limiting
What is the definitive treatment for the majority of patients presenting with mild symptoms of hyperthyroidism secondary to subacute thyroiditis?
Sx tx
Optic neuritis Sx
Symptoms may include sudden or progressive unilateral vision loss, often with central field defect (scotoma).
A 43-year-old obese man presents for a health maintenance visit. On physical exam, it is noted that his waist circumference is 106 cm and blood pressure is 148/92 mm Hg. Which of the following fasting laboratory levels would suggest a diagnosis of metabolic syndrome (syndrome X) in this patient?
TGs of 190 mg/dL Criteria: Waist circum>102 cm M or 88 F Serum TGs of 150 or more HDL <40 M or <50 F BP130/85 or more Glucose over 110 mg/dL
A patient presented to your office with multiple somatic complaints. During the mental status exam, you notice that the patient loses the thread of conversation and discusses irrelevant topics based on an external stimulus. The patient never gets back to the main point he or she was trying to express. What is this thought process called?
Tangentiality
Which of the following best describes the mechanism of action of angiotensin-converting enzyme (ACE) inhibitors in controlling blood pressure and preventing or slowing kidney damage?
They result in dilation of the efferent arteriole, reducing glomerular pressure.
A 32-year-old man who is HIV positive has a seizure. On presentation to the emergency department (ED) he is confused and unsure of what happened. His partner reports that he had been complaining of headache in the days preceding the event. CT scanning of the head demonstrates five peripheral contrast-enhancing lesions. What is the most likely diagnosis?
Toxoplasmosis
A 46-year-old female with a history of poorly-controlled diabetes and grand mal seizures presents for evaluation of bilateral foot pain. She describes the pain as burning and has noticed it is worse at night. She occasionally has this pain in her feet. She denies other medical conditions, and her medications are metformin and dilantin. Which of the following medications, used for the suspected diagnosis, should be avoided in this patient?
Tramadol--bc it decreases siezure threshold
What is one of the easiest and most sensitive dx tools to use in pts with new occurrence valvulopathy?
Transthoracic echo
A 52-year-old male, who is a known alcoholic, is admitted to the hospital for GI bleed. Librium is ordered, but he must be monitored for early signs of alcohol withdrawal as his total daily intake of alcohol prior to admission is unknown. Which of the following symptoms might occur as an early sign of withdrawal rather than a later sign?
Tremulousness --Followed later by N/V, hallucinations and siezures
What is the tx for atopic dermatitis?
Triamcinolone (topical steroid) and Hydroxyzine (antihistamine)
Active elbow extension is primarily controlled by which muscle(s)?
Triceps
A 46-year-old African American male is seen in the emergency department with upper right quadrant pain that radiates to the right infrascapular area. The pain is colicky and was precipitated by a meal of fried fish and French fries. Which of the following diagnostic studies is the initial study of choice for this patient?
US
What kind of DVTs warrant a workup for inherited thrombophilia?
Upper extremity DVTs
Your patient returns to your office for a follow up for non-insulin-dependent diabetes mellitus (NIDDM). Her HgA1c in the office is 6.4%. She is concerned about developing kidney disease from her diabetes and requests that you test her for this. What initial screening test should you order that would provide clues to potential diabetic nephropathy allowing for treatment to slow the disease progression?
Urine microalbumin
MC cause of bladder Cancer?
Urothelial (transitional) cell carcinoma
A 25-year-old gravida 1 woman who is HIV positive arrives at the hospital in early labor. Membranes are intact and the cervix is 50% effaced and 3 to 4 cm dilated. Fetal heart rate is 150 beats/min. Which of the following procedures is contraindicated during labor?
Use of fetal scalp electrodes
During a pre-surgical workup, a patient reports that she had received Desmopressin following the birth of her son. Her CBC is within normal range, as well as her PT and aPTT. What is the most likely cause of her needing this medication?
Von Willebrand's disease
Your patient is a 66-year-old female who has been dropping her coffee cup and concurrently slurring her speech. The episodes last for approximately 15 minutes. Her blood work, carotid dopplers, and MRI of the brain are normal and you suspect recurrent transient ischemic attacks (TIAs). Which of the following is NOT approved or recommended for the prevention of stroke in this patient?
Warfarin; anticoag not antiplatelet so no benefit
A 12 year old female found a tick on her leg after a camping trip. The tick was removed without incident. According to CDC recommendations, what is the appropriate testing for Lyme disease?
Western blot if + or equivocal Elisa
This is a protrusion of pharyngeal mucosa that develops at the phayngoesophageal junction, between the inferior pharyngeal constrictor and the cricopharyngeus. It often presents in older patients, with symptoms of dysphagia and regurgitation that develop slowly over many years. Late in the disease process patients may note halitosis, spontaneous regurgitation of undigested food, or nocturnal choking. Which of the following choices is the correct term for this condition?
Zenker Diverticulum
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?
Ziprasidone
An adult male, not previously vaccinated for rabies, presents to the emergency department after being bitten by an aggressive stray dog. The dog was captured, and declared "probably rabid" by a local veterinarian. Which of the following treatment options should you select for this patient?
administer human rabies immune globulin and human diploid cell rabies vaccine
A physician assistant student suffers a needlestick injury while caring for an HIV-positive patient whose viral load is currently undetectable. Of the following, which is the most appropriate management for the student?
administration of zidovudine and lamivudine for 4 weeks
What is the triad of autoimmune hemolytic anemia?
anemia, jaundice, and splenic enlargement
When initially screening for CKD, which of the following would be ordered?
blood pressure measurement, serum creatinine level, spot urine protein measurement
A 28-year-old woman who was born and brought up just outside of Washington, DC, comes in for evaluation of vague "problems with swallowing." She has no other symptoms except "my neck is bigger than it used to be." Examination reveals only a diffuse, somewhat irregular, nontender enlargement of the thyroid gland with distinct masses palpable within it. What is the most likely diagnosis?
multinodular goiter
A 16-year-old girl presents to the clinic complaining of strong desires to sleep at inappropriate times. She is very concerned because she "felt paralyzed" while falling asleep on the couch last night. Which of the following is the best diagnostic test to confirm this patient's diagnosis?
multiple sleep latency tests
A 43-year-old pilot is interested in quitting his 20-year habit of smoking. His medical history includes type 2 diabetes mellitus diagnosed 6 years ago for which he is currently taking metformin. Which of the following would be most appropriate to recommend to this patient?
nicotine replacement therapy; verenicline is banned for pilots and air traffic controllers because of potential side effects
