You examine an 18-year old male college student with a 5-day history of fever, sore throat and fatigue. Physical examination reveals a exudative and bilateral enlarged and slightly tender posterior cervical lymph nodes. The spleen is palpable 3 cm below the rib cage. Which agent is most likely responsible for this patient's illness?
Group A-Beta-hemolytic streptococcus
You have just prescribed phenytoin for a 12 year old boy with new onset of epilepsy. Of the following side effects, which is most likely to occur in this patient?
acute liver failure
Hydrocephalus, chorioretinitis and diffuse cerebral calcifications are present in a newborn male. Of the following pets, which is most likely to be the source of this zoonotic congenital infection?
Which of the following is considered a risk for prone position?
lying down in cold eviorment
Vision milestones are being discussed with a group of student nurses. One student asks when babies can begin to visually follow people as they walk across the room. Fixation and tracking through the visual field are well developed by which of the following ages?
at 7 months gestation
at 2 months
at 6 months
at 1 year
A 2-year-old child is being evaluated because the mother notes that her right eye has been turning in. Physical examination documents strabismus with a right esotropia. Attempts to visualize the fundi are unsuccessful, but it is noted that the red reflex. is replaced by a yellow white pupillary reflex in the right eye. This child most likely has which of the following?
Microcytic anemia will result due to deficiency in?
The family of a 2-year-old child with Tay-Sachs disease is interested in having another child. They would like to know the risk of having a second child with Tay-Sachs, What advice would you give?
No risk, since. Tay-Sachs is caused by a spo radic mutation
100%, since Tay-Sachs is an autosomal- dominant disease
25%, since Tay-Sachs is an autosomal-recessive disease
lt depends on the sex of the fetus, since Tay- Sachs is X-linked
One can determine the risk-only by genetic testing after conception
A 3-month-old infant presents with poor growth and inadequate weight gain. There is no history of vomiting or diarrhea. Except for the appearance of malnutrition and lack of subcutaneous fat, the physical examination is normal. What is the most likely cause of this child's failure to thrive?
a metabolic disorder
an endocrine disorder
a nonorganic cause
A 4-year-old boy has failed to grow and has evidence of exocrine pancreatic insufficiency. What is the most likely cause for this?
cogenital absence of the pancrneas
newborn infant with stigmata of Down syndrome has a heart murmur. Which of the following cardiac lesions is most likely in this baby?
hypoplastic left heart syndrome
total anamolous venous return
coarctation of the aorta
anamolous coronary artery
A 5-year-old girl diagnosed with pauciarticular juvenile idiopathic arthritis has a positive antinuclear antibody test. Which of the following would most likely be found in this patient?
A 7-year-old Caucasian girl is seen in your office for her annual physical. Her physical examination
is remarkable for a palpable goiter. The mother has a positive family history of hypothyroidism, requiring thyroid hormone replacement What is the most likely diagnosis?
Brain tumor causing TSH deficiency
The presence of bilateral renal masses and a midline suprapubic mass in a newborn male infant is most suggestive of which of the following?
bilateral Wilms tumor
congenital rubella infection
rhabdomyosarcoma of the bladder
congenital urethral or bladder neck obstruction
The feeding of honey to infants less than 6 months of age has been associated with which of the following?
A mother is concerned that her baby might be sharing a room in the hospital with an infant who has RSV. She is asking for a private room. To reas sure her, you counsel her that the most important measure that can be taken to prevent the spread of RSV disease in a hospitalized patient is:
Wearing a mask in the room of an infected patient
Wearing a paper gown when entering the room of an infected patient
Keeping the patient in respiratory isolation for the first 24 hours on appropriate antibiotics
Testing all children with respiratory illnesses for RSV during the winter respiratory viral season
A l O-year-old boy is examined because of recurrent headaches. The headaches started 6 months ago and occur about once a month. He is asymptomatic between episodes. Each headache begins with blurry vision and abdominal pain, followed by rightsided, throbbing pain. It lasts about 60 minutes,
during which he feels better if be takes some ibuprofen and rests in a darkened room. The most likely
2 year old boy is seen in your office because of fever, ear pain and postauricular swelling, erytherna and tenderness. The pinna protrudes out on the involved side. The tympanic membrane is red and
bulging, with decreased mobility seen on pneumatic otoscopy. the angle of the jaw is easily palpated and the opening to stensen's duct appear normal. Most likely Dg:
A 3-year old boy is brought to the emergency room with complaint of persistent rhinorrhea for the past 6-weeks. Otherwise the patient has been asymptomatic on examination, you note that the patient has mouth breathing and has dark circles under his eyes. In the nose you find watery discharge and edematous, swollen, bluish mucous membrane
The most likely diagnosis is:
Chronic upper respiratory infection
Nasal foreign body
The pubertal growth spurt in males occurs at which of the following ages?
precedes the growth spurt in females by 2 years
has its onset at the same age as in females but lasts longer
follows the growth spurt in females by 2 years
coincides with attainment of the ability to ejaculate
begins at Tanner IV stage of sexual
The most common neurological sequela associated with bacterial meningitis, and usually presents at
the time of initial infection is?
chronic seizure disorder
A 9 mo-old infant accidentally ingests unknown quantity of digitalis. Which is the most significant noneardiac manifestation of toxicity in this child?
A 4 month old child with vitamin D deficienty rickets would be expected to show all of the following except:
low serum phosohate levels
high alkaline phophatase levels
A newborn in the nursery is noted to have frothy secretions from the mouth and nose, and has coughing and cyanosis when given a bottle. The nurse reports that she was unable to pass an NG tube into the stomach. A flat- plate x-ray of the abdomen reveals gaseous dilatation of the stomach. Which of the following is the most likely diagnosis?
Tracheoesophageal fistula (TEF)
Isolated esophageal atresia
Gastrcesophageal reflux disease (GERD) E. Duodenal atresia
which of the following has the highest risk of vascular injury
sternoclacicular joint dislocation
supracondylar femoral fractures
An obese 9-year-old girl is brought to your office because of a week-long history of persistent headache and blurred vision. She has been alert and has had no constitutional or focal neurologic symptoms. She has had some mild vomiting, but no fever. On physical examination, you find
papilledema, Visual field testing reveals an inferior nasal blind spot. An MRI scan is normal. When you perform a lumbar puncture, the open ing pressure is elevated, but the CSF composition is normal. Laboratory tests, including a CBC, com prehensive metabolic panel, and thyroid tests, are all normal.
The most likely diagnosis is:
An irregular red reflex is noted on the initial examination of an infant. The infant is referred to the opthalmologist for evaluation of a cataract.
Which of the following is most likely to be associated with a cataract in the newborn?
maple syrup urine disease
glucose-o-phosphate dehydrogenase deficiency
A woman without prenatal care is admitted at 38 weeks by dates for the delivery of her third child. The 8 lb 13 oz infant is born vaginally and APGAR scores are 6 and 9. The pediatrician is called several hours later by the nursery staff to evaluate the left arm. The initial examination reveals an R-sided cephalohematorna. There is asymmetry of the upper limb movements with minimal movement of the left arm. The grasp is preserved. The most likely cause for this paralysis is:
CNS manifestations of syphilis
Pefipheral neuropathy associated with undiagnosed gestational diabetes
Hypoxic event during pregnancy secondary to drug abuse
Grade II intraventricular hemorrhage [I VH]
you see a 12 months boy because he is refusing to walk. His mother tells you that he started walking at 10 months and was developing normally until this moment. on examination: 39C, baby looks mildly ill with medially rotated left hip and limitation of active and passive motions. what is the most probable cause?
group A strep
group B strep
After being lifted up by one hand, a young toddler refuses to use that arm and holds it against her trunk flexed at the elbow with the forearm
midway between pronation and supination.
The child most likely has which of the following?
radial head subluxation
avulsion of the ulnar nerve
fracture of the radius
fracture of a carpal bone
full term newborn in font is having episodes of cyanosis and apnea which are worse with attempting to feed but seem better with crying. which of the following is the most important next step to quickly establish the diagnosis?
passage of catheter into nose
bronchoscopic evaluation of palate and larynx
ventilation perfusion scan
A 5-year-old boy presents with a history of grossly bloody urine, puffy eyes, and headache for one day. He has been a well developed child, but he did have a fever and sore throat about 10 days ago which resolved without treatment. The most likely diagnosis is:
Because of abnormal spleen functions and high risk of bacterial infections, infants, who have sickle cell anemia get penicillin prophylaxis at age of 4 weeks.To which organisms infants with sickle cell anemia are mostly sensitive?
What is the most likely clinical finding in an
8-year-old with Wilson disease?
poor visual acuity
newborn infant presents with cyanosis and mild tachypnea at about 6 hours of life. The infant is placed in 95% oxyhood and saturations normalize.Which of the following is the most likely diagnosis in this infant?
cyanotic congenital heart disease
central nervous system disease
A 2 month old boy is seen for nonbilous vomiting after he had been breastfeeding well until 2 weeks ago, when vomiting worsened. on physical ex he has jaudance and gastric peristaltic waves are seen on the abdomen. blood test reveal hypokalernic, hypochlorernic alkalosis. the most likley diagnosis is:
The most common roentgencgraphic abnormality in a child with asthma is which of the following?
lower lobe infiltrates
right middle lobe atelectasis
Patient 26 years old drink alcohol every day in big amount comes with
hemoglobin 0.5 g I dL, mean corpuscular volume 110 tL, and reticulocyte count 0.5%. The most likely diagnosis:
anemia associated with chronic disease
You are called to delivery of a women with no parenteral care ..Her examination reveal oligohydroamnion. When you get to the newborn at the nursery you should carefully evaluate him for which of the following:
A 16 year old female patient present with short stature and no secondary sexual characteristics. Which diagnosis should be mostly?
Isolated growth hormone deficiency
Familial short stature
An 8-month-old child has vomiting and screaming episodes for 12 hours. Physical examination reveals a sausage-shaped mass in the right upper quadrant. Which of the following would be most useful?
barium enema study
examination of a stool specimen for ova and parasites
A mother presents for prenatal care with a complicated medical history as listed in the following choices.Which of the conditions most predisposes her fetus to congenital heart disease?
atherosclerotic coronary vascular disease
A mentally retarded l-t-year-old boy has long face, large ears, micropenis and large testes. Chromosomal analysis is likely to demonstrates which of the following?
Being large for gestational age
A 38-week infant is born to a mother with gestational diabetes. Birth weight is 4255 g. What would you expect to see most commonly in this infant?
neural tube defect
small left colon syndrome
An infant with failure to thrive has rectal prolapse. What test will most likely provide the diagnosis?
sweat chloride test
barium enema study
liver function testing
rectal abdominal CT-scan
A 6-month-old boy is found to have very low levels of lgG, lgM, and lgA. Which of the following organisms is most likely to cause problems in this patient?
Which of the patients are likely to have a low C3 level?
Minimal-change nephrotic syndrome
A 65-year-old man undergoes a technically difficult abdorninal-perineal resection for a rectal cancer during which he receives 3 units of packed red blood cells. Four hours later, in the intensive care unit (ICU), he is bleeding heavily from his perineal wound. Emergency coagulation studies reveal normal prothrornbin, partial thrornboplastin, and bleeding times. The fibrin degradation products are not elevated, but the serum fibrinogen content is depressed and the platelet count is 70,000htL. Which of the following is the most likely
A bleeding blood vessel in the surgical field
Delayed blood transfusion reaction
Factor V deficiency
which of the following should be the first treatment administered to a patient with a potassium level of 6.3 and flattened p waves on their ecg ?
insulin and glucose
The initial pathological change that leads to the clinical finding of achalasia is
hypertension of the LES
relaxation of the LES
hypertension of the body of the esophagus
diffuse relaxation of the body of the esophagus
what is the appropriate treatment for a patient with a type III (mixed) hiatal hernia and iron deficiency anemia?
Repair of the hiatal hernia and fundoplication
Repair of the hiatal hernia alone
Acid reducing agents
Observation while eating Lángos
which of the following procedures has the highest rate of nutritional complications
lapariscopic adjustable banding
roux en y gastric bypass
eating cheetos every day for every meal for 1 year
which of the following procedures has the best treatment for a 1.5 insulinoma located in the mid pf pancreas?
duodenal sparing total pancreatectomy
the most common complication of chronic pancreatitis is
the most common adrenal mass incidentally found on ct scan is
A patient with hypertension is diagnosed with hyperaldosteronism. a ct scan shows enlarged adrenals without a mass. the most appropriate next intervention is?
selective venous catheterization
bi lateral adrenalectomy
A cirrhotic patient with abnormal coagulation studies due to hepatic synthetic dysfunction requires an urgent cholecystectorny. A transfusion of FFP is planned to minimize the risk of bleeding due to surgery. What is the optimal timing of this transfusion?
On call to surgery
The day before surgery
In the recovery room
A 26-year-old man is resuscitated with packed red blood cells following a motor vehicle collision complicated by a fractured pelvis and resultant hemorrhage. A few hours later the patient becomes hypotensive with a normal central venous pressure (CVP), oliguric, and febrile. Upon examination, the patient is noted to have profuse oozing of blood from his intravenous (IV) sites. Which of the following
is the most likely diagnosis?
Acute adrenal insufficiency
man who was in a house fire is transferred to your burn unit He has singed nose hairs and facial burns. Direct laryngoscopy in the emergency room demonstrates pharyngeal edema and mucosa! sloughing. He has 60% total body surface area burns. Which of the following is the next step in the management of this patient?
A 30-year-old man with a history of Crohn disease develops an enterocutaneous fistula and is
placed on total parenteral nutrition through a right subclavian central venous catheter. After 5 days, the patient develops a fever and leukocytosis; CT scan of the abdomen reveals no intra-abdominal abscess. The subclavian catheter insertion site is inspected and noted to be erythematous and painful. Blood cultures are positive. Which of the following organisms is the most likely cause of his fever?
Group A Streptococcus
teenage boy falls from his bicycle and is run over by a truck. On arrival in the emergency room
(ER), he is awake and alert and appears frightened but in no distress. The chest radiograph suggests an
air-fluid level in the left lower lung field and the nasogastric tube seems to coil upward into the left chest. Which of the following is the next best step in his management?
Diagnostic peritoneal lavage
Placement of a left chest tube
A 10-year-old boy was the backseat belted passenger in a high-speed motor vehicle collision. On presentation to the ER, he is awake, alert, and hemodynamically stable. He is complaining of abdominal pain and has an ecchymosis on his anterior abdominal wall where the seatbelt was located. Which of the following is the best next step in his management?
Observe him regardless of negative test results
Discharge him home if an abdominal computed tomography (CT) scan is negative
Discharge him home if his abdominal pl,ain films are negative for the presence of free air
Discharge him home if his amylase level is normal
Discharge him home without any other workup
a patient with a solid malignancy is discussing chemotherapy with his oncologist. he is interested in the risks of the treatment. what is the primary toxicity of doxorubicin (adriamycin )?
uric acid nephropathy
A 70-year-o!d woman has nausea, vomiting, abdominal distention, and episodic crampy midabdominal pain. She has no history of previous surgery but has a long history of cholelithiasis for which she has refused surgery. Her abdominal radiograph reveals a spherical density in the right lower quadrant. Which of the following is the definitive treatment for this patient's bowel obstruction?
Ileotomy and extraction
Nasogastric (NG) tube decompression
consult dr. hatuel
A 4 7-year-old asymptomatic woman is incidentally found to have a 5-mm polyp and no stones in her gallbladder on ultrasound examination. Which of the following is the best management option?
Observation with repeat ultrasound examinations to evaluate for increase in polyp size
Open cholecystectomy with frozen section
En bloc resection of the gallbladder, wedge resection of the liver, and portal lymphadenectorny
Aspiration of the gallbladder with cytologic examination of the bile
A 55-year-otd man who is extremely obese reports weakness, sweating, tachycardia, confusion, and headache whenever he fasts for more than a few hours. He has prompt relief of symptoms when he eats. Labarotory examination reveals an inappropriately high level of serum insulin during the episodes of fasting.Which of the following is the most appropriate treatment for this condition?
Simple excision of the tumor
Chemotherapy and radiation
Long-acting somatostatin analogue octreotide
Diet modification to include frequent meals
A 57-year-old woman sees blood on the toilet paper. Her doctor notes the presence of an excoriated bleeding 2.8-cm mass at the anus. Biopsy confirms the clinical suspicion of anal cancer. In planning the management of a 2.8-cm epidermoid carcinoma of the anus, which of the following is the best initial management strategy?
Wide local resection with bilateral inguinal node dissection
Local radiation therapy
Combined radiationtherapy and chemotherapy
During an appendectomy for acute appendicitis, a 4-cm mass is found in the midportion of the appendix. Frozen section reveals this lesion to be a carcinoid tumor. Which of the following is the most appropriate management of this patient?
Appendectomy followed by a PET scan
Appendectomy followed by a colonoscopy
A newborn infant born from a mother with polyhydramnios presents with excessive salivation along with coughing and choking with the first oral feeding. An x-ray of the abdomen shows gas in stomach and a nasogastric tube coiled in the esophagus. Which of the following is the most likely diagnosis?
Esophageal atresia and tracheoesophageal fistula(TEF)
4-week-old male infant presents with projectile, nonbilious ernesis. Ultrasound of the abdomen reveals a pyloric muscle thickness of 8 mm (normal 3-4 mm). Which of the following is the best initial management of this patient?
Fluid hydrationand correctionof electrolyte abnormalitiespriorto operative management
Administration of sodium bicarbonate to correct aciduria prior to operative management
Treatment of toxic megacolon should all the following except:
All of the following are poor prognosis in acute pancreatitis except:
serum calcium less than 8
serum amylase more than 5 times normal
arterial o2 less than 60 rnmhg
serum LDH more than 5 times normal
vascular compromise has been associated with all the following except
sternoclacicular joint dislocation
supracondylar fracture of humerus
all of the following are false except
leptin is high in the obese
pyy and glp1 decrease after gastric bypass
leptin comes from the stomach
ghrelin is high in the obese
ghrelin is secreted from adipocytes
A 19-year-old man sustains severe lower-extremity trauma, including a femur fracture and a crush injury to his foot. He requires vascular reconstruction of the popliteal artery. On the day after surgery, he becomes dyspneic and hypoxernic and requires intubation and mechanical ventilation. Which of the following is the most likely etiology of his decompensation?
Fat embolism syndrome
A 52-year-old man with a family history of multiple endocrine neoplasia type 1 (MEN l ) has an elevated gastrin level and is suspected to have a gastrinoma. Which of the following is the most likely location for his tumor?
Within the triangle formed by the junction of the second and third portions of the duodenum, the junction of the neck and body of the pancreas, and the junction of the cystic and common bile duct
Tail of the pancreas
Within the triangle formed by the interior edge of the liver, the cystic duct, and the common hepatic duct
Antrum of the stomach
Fundus of the stomach
A patient is brought to the ER after a motor vehicle accident. He is unconscious and
has a deep scalp laceration and one dilated pupil. His heart rate is 120 beats per minute blood pressure is 80/40 mm/Hg, and respiratory rate 35 per min. Despite rapid administration of 2 L normal saline, and patients vital signs do not change significantly. Which of the following is the most appropriate next step in the workup of his hypotension?
Abdominal-ultrasound (focused assessment with sonography in trauma, FAST)
Administration of mannitol and hyperventilation to treat his elevated intracranial pressure
Emergent burr hole draining at the bedside for suspected epidural hematoma
Neurosurgical consulation for emergent craniotoymy for suspected subdural hematorna
Neurosurgical consultation for emergent ventriculostomy to manage his intracranial pressure
Which of the following is the most important determinant of survival after treatment of colon cancer?
lymph node involvement
A 53-year-old man presents with constipation and a 20-lb weight loss over the course of 6 months. Colonoscopy reveals a fungating mass in the sigmoid colon; biopsy is consistent with adenocarcinoma. His metastatic workup is negative, A CEA level is obtained and is 4-fold greater than normal. Which of the following is the appropriate use of this test?
As an indication for neoadjuvant chemotherapy
As an indication for postoperative radiation therapy
As an indication for a more aggressive sigmoid resection
As a baseline measurement prior to monitoring postoperatively for recurrence
As an indication for preoperative PET scanning
A previously healthy 20-year-old man is admitted to the hospital with acute onset of left-sided chest pain. Electrocardicgraphic findings are normal, but CXR shows a 40% left pneumothorax. Appropriate treatment consists of which of the following procedures?
Thoracostorny and intubation
Observation while eating marcipán torta
Indication for operation in Chron's include all except
Prolonged use of steroids or severe abdominal pain
A 53-year-old man presents to the emergency room with left lower quadrant pain, fever, and
vomiting. CT scan of the abdomen and pelvis reveals a thickened sigmoid colon with inflamed
diverticula and a 7-cm by 8-cm rim-enhancing fluid collection in the pelvis. After percutaneous drainage and treatment with antibiotics, the pain and fluid collection resolve. He returns as an outpatient to clinic
1 month later. He undergoes a colonoscopy, which demonstrates only diverticula in the sigmoid colon. Which of the following is the most appropriate next step in this patient's management?
Sigmoid resection with primary anastomosis
Long-term suppressive antibiotic therapy
Sigmoid resection with end colostomy and rectal pouch (Hartmann procedure)
Cystoscopy to evaluate for a fistula
Expectant management with sigmoid resection if symptoms recur
A 72 years old man status post CABG 5 years ago present with hernatochezia, abdominal pain and fever. colonoscopy reveals dusky appearing mucosa at splenic
flexure without active bleeding. which is the most appropriate management of thispatient?
angiography with administration of intra-arterial papaverine
Exploratory laprotomy with Thrombectorny of the inferior rnesenteric artery
A 71-year-old man develops dysphagia for both solids and liquids and weight loss of 60 lb over the past 6 months. He undergoes endoscopy, demonstrating a distal esophageal lesion, and biopsies are consistent with squamous cell carcinoma. He is scheduled for neoadjuvant chemoradiation followed by an esophagectomy. Preoperatively he is started on total parenteral nutrition, given his severe malnutrition reflected by an albumin of less than l 6r/dL
Which of the following is most likely to be a concern initially in starting total parenteral nutrition in this
A 49-year-old obese man has become irritable, his face has changed to a round configuration, he has developedpurplish lines on his flanks, and he is hypertensive. A 24-hour urine collection demonstrates glevated cortisol levels. This is confirmed with bedtime cortisol measurements of 700 ng/mL. Which of the following findings is most consistent with the diagnosis of Cushing disease?
Suppression with high-dose dexamethasone suppression testing
A l-cm bronchogenic mass on magnetic resonance imaging (MRI)
A 3-cm adrenal mass on computed tomography (CT) scan
Glucocorticoid use for the treatment of inflammatory disorders
Decreased ACTH levels
A 23-year-old woman undergoes total thyroidectomy for carcinoma of the thyroid gland. On the second postoperative day, she begins to complain of a tingling sensation in her bands. She appears quite anxious and later complains of muscle cramps.
Which of the following is the most appropriate initial management strategy?
Continuous infusion of calcium gluconate
Oral calcium gluconate
100 µg oral Synthroid
Oral vitamin D
10 mL of 10% magnesium sulfate intravenously
A 72-year-old woman who is planning to undergo ventral hernia repair is on warfarin for atrial fibrillation. She is advised to cease her warfarin several days before her surgery and is hospitalized preoperatively for heparinization. During her hospital stay, she complains of severe abdominal and flank pain. Her prothrornbin time (PT) is normal, but her activated partial thrornboplastin time (aPTT) is elevated. An abdominal CT scan demonstrates a large retroperitoneal bematoma. Which of the
following should be administered to reverse the effects of the heparin?
A 42-year-old man sustains a gunshot wound to the abdomen and is in shock. Multiple units of packed red blood cells are transfused in an effort to resuscitate him. He complains of numbness around his mouth and displays carpopedal spasm. An electrocardiogram demonstrates a prolonged QT interval. Which of the following is the most appropriate treatment?
Intravenous parathyroid hormone
A 27-year-old m(E) hypoglycemiae gunshot wound to the left thigh. In the ER, he is noted to have a large hematoma of his media I thigh. He complains of paresthesias in his left foot. On examination, there are weak pulses palpable distal to the injury and the patient is unable to move his foot. Which of the following is the most appropriate initial management of this patient?
Immediate exploration and repair in the operating room
Fasciotomy of the anterior compartment of the calf
Observation for resolution of spasm
Local wound exploration at the bedside
A 45-year-old man was an unhelmeted motorcyclist involved in a high-speed collision. He was ejected from the motorcycle and was noted to be apneic at the scene. After being intubated, he was brought to the ER, where he is noted to have a left dilated pupil that responds only sluggishly. What is the pathophysiology of his dilated pupil?
Infection within the cavernous sinus
Herniation of the uncal process of the temporal lobe
Laceration of the corpus callosum by the falx cerebri
Occult damage to the superior cervical ganglion
A 31-year-old man is brought to the ER following an automobile accident in which his chest struck
the steering wheel, Examination reveals stable vital signs and no evidence of respiratory distress, but the patient exhibits multiple palpable rib fractures and paradoxical movement of the right side of the chest. Chest x-ray shows no evidence of pneumothorax or hemothorax. Which of the following is the most appropriate initial management of this patient?
Pain control, chest physiotherapy, and close observation
Immediate operative stabilization
Stabilization with towel clips
Stabilization of the chest
wall with a szusza berek figure
Intubation, mechanical ventilation, and positive end-expiratory pressure
Following a head-on motor vehicle collision, a 21-year-old unrestrained passenger presents to the ER with dyspnea and respiratory distress. She is intubated and physical examination reveals subcutaneous emphysema and decreased breath sounds. Chest x-ray reveals cervical emphysema, pneumomediastinum, and a right-sided pneumothorax. What is the most likely diagnosis?
A 53-year-old woman presents with complaints of weakness, anorexia, malaise, constipation, and back pain. While being evaluated, she becomes somewhat lethargic. Laboratory studies include a normal chest x-ray, serum albumin 3.2 mg/dl., serum calcium 14 mg/dL, serum phosphorus 2.6 mg/dL, serum chloride 108 mg/dL, blood urea nitrogen (BUN) 32 mg/dl., and creatinine 2.0 mg/dl.. Which of the following is the most appropriate initial management?
Intravenous normal saline infusion
Administration of thiazide diuretics
Administration of intravenous phosphorus
Use of mithramycin
A 40-year-old woman presents with a rash involving the nipple-areola complex for the last month with associated itching. On physical examination there is crusting and ulceration of the nipple with surrounding erytherna involving the areola and surrounding skin, no palpable breast masses, and no cervical or axillary lymphadenopathy. Which of the following is the most appropriate next step in the management of this patient?
Mammogram and biopsy of the affected area
Modified radical mastectomy
Administration of oral antibiotics
Corticosteroid cream to the affected area
Re-examine the patient in 1 month
A 42-year-old man has bouts of intermittent crampy abdominal pain and rectal bleeding.
Colonoscopy is performed and demonstrates multiple hamartomatous polyps.
The patient is successfully treated by removing as many polyps as possible with the aid of intraoperative endoscopy and polypectomy.
Which of the following is the most likely diagnosis?
A 61-year-old woman with a history of unstable angina complains of hematemesis after retching and vomiting following a night of binge drinking. Endoscopy reveals a longitudinal mucosal tear at the gastroesophageal junction, which is not actively bleeding. Which of the following is the next recommended step in the management of this patient?
Systemic vasopressin infusion
Angiography with embolization
Exploratory laparotorny, gastrotomy, and oversewing of the tear
a 30 year old female, G5P4, is l 0 weeks pregnant/intrauterine pregnancy) in the presence of an intrauterine device (ID). She is interested in continuing the pregnancy. The IUD wire is visible at the cervical os.
Which of the following is the apropiate management?
remove the IUD now, followed by expectant management
terminate the pregnancy due to the increased infection risk
perform a laparoscopy to exclude heterotopic pregnancy
leave the IUD in place with no forther treatment
leave the lUD in place and treat with antibiotics
which of the following is not absolute contraindication for oral contraceptive administration?
diabetes without end organ demage
lower extremity varices
a religious couple is trying to concieve. they are calculating ovulation 14 days after the last day of menstrual cycle.
where is the problem?
they miscalculated the ovulation date
arrest of descent
A 30 years old male, diagnosed as non obstructive azospermia, small testicle, lack of facial and pubic hair and gynecomastia. Most probable hormonal status :
High LH, high FSH, low testosterone
Low LH, low FSH, low testosterone
High LH, low FSH, high testosterone
High LH, high FSH, high testosterone
High LH, low FSH, high testosterone
Which of the following is a test for ovarian reserve?
FSH level one cycle day 3
Estradiol level on cycle day 6
Progesterone level following ovulation
LH level before ovulation
Inhibin A level
A 25 year old female is been evaluated for infertility with regular periods. Which of the following confirms the existence of ovulation?
progesterone level >5 ng/ml
proliferative histology in endometrial biopsy in the luteal phase viscous
increase in corporal temperature after the menstrual period
increase in LH and decrease in progesterone in the luteal phase
Which of the following potential abnormality or complication in pregnancy is associated with Valproic acid?
A decent looking hungarian milf with prima gravida, uneventful cervix and estimated fetal wight 3800 g which is the most appropriate management at 42+0 week gestation?
Epidural analgesia prior to induction of labor
Hospitalization and bed rest
To re-date the pregnancy
Stage lb cervical cancer is diagnosed in a young woman who wishes
to retain her ability to have sexual intercourse. Your consultant has therefore recommended a radical hysterectomy. Assuming that the cancer is
confined to the cervix and that intraoperative biopsies are negative, which
of the following structures would not be removed during the radical hysterectomy?
Uterosacral and uterovesical ligaments
The upper third of the vagina
The entire parametrium on both sides of the cervix
A patient presents for her routine prenatal visit at 32 weeks' EGA. Her pregnancy up to now has
been uncomplicated. Her BMI is 25. Her laboratory testing is normal including a I-hour glucose screen. An anatomic ultrasound done at 22 weeks was normal and confirmed her dating. Her fundal height is 37 cm today. A brief bedside ultrasound reveals an amniotic fluid index (AFl) of 30 cm. Which of the following situations is most likely to be the etiology of polyhydramnios?
Which can result amenorrhea
Arcuate nucleus injury
Olfactory nerve injury
Post Hypophisis injury
Media-lateral Hypophisis injury
Which of the follows doesn't produce hirsutism?
ovarian aromatase deficit
A 29-year-old woman presents with a 6-month history of erythema and edema of the right breast with palpable axillary lymphadenopathy. A punch biopsy of the skin reveals neoplastic cells in the dermal lymphatics.
Which of the following is the best next step in her management?
Combined modality therapy with chemotherapy, surgery, and radiation
Combined modality chemotherapy and radiation therapy to the right breast with surgery reserved for residual disease
Modified radical mastectomy followed by adjuvant chemotherapy
Modified radical mastectomy followed by hormonal therapy
A course of nafcillin to treat the overlying cellu litis and then neoadjuvant chemotherapy for breast cancer
A patient presents with a positive pregnancy test , the exact date of the start of her last normal menses,
and the date of her luteinizing hormone (LH) surge from a urine kit . Her expected date of delivery can
most correctly be calculated by which of the following?
counting 280 from the first day of the LMP
counting 40 weeks from the last day of the LMP
adding 254 to the date of the start of the LMP
counting 10 lunar months from the time of ovulation
adding 256 to the date of the elevated urinary LH when detected by home testing
A 37-year-old obese woman wishes to use OCs for birth control. Her medical history is remarkable only for a 3-y ear history of diabetes that is controlled with diet and an oral agent. She smokes one pack
of cigarettes daily. Her blood pressure is 140/ 90. Physical and pelvic examinations are normal . Total
serum cholesterol is 275 mg/dL (normal <200 mg I dL) . You advise her that combined OCs are primarily contraindicated because of which of the following known factors about her?
smoking above the age of 35
24-year -old primigravida at 36 weeks' gestation is exposed to chicken pox. She has no history of varicella. What is the most appropriate next step in the management oft his patient ?
immediate serologic testing for varicella, and if negative, administration of VZIG
IV acyclovir and the varicella vaccine within 96 hours
varicella vaccine within 48 hours of exposure
VZIG within 96 hours
immediate administration of varicella zoster immuneglobulin (VZIG) and acyclovir
A 50-year-old woman is diagnosed with cervical cancer. Which lymph node group would be the first involved in metastatic spread of this disease beyond the cervix and uterus?
Paracervical or urcteral nodes
External iliac nodes
Common iliac nodes
Which is not use for therapy of uterine myoma?
Uterine artery embolizatione
Use focused Ultra sound
A 67-year-old woman is brought to the ED by paramedics complaining of dyspnea.fatigue, and palpitations. Her BP is 80/50 mm Hg, HR is 139 beats per minute, and RR is 20 breaths per minute. Her skin is cool and she is diaphoretic. Her lung examination reveals bilateral crackles and she is beginning to have chest pain. Her ECG shows a narrow complex irregular rhythm with a rate in the
l 40s. Which of the following is the most appropriate immediate treatment for this patient?
A 55-year-old man presents to the ED at 2:00 a.m. with left-sided chest pain that radiates down his left arm. He takes a b-blocker for hypertension, a proton-pump inhibitor for reflux disease, and an antilipid agent for high cholesterol. He also took sildenafil last night for erectile dysfunction. His blood pressure is 130/70 mm Hg and heart rate is 77. Which of the following medication is contraindicated in
A 50-year-old patient with long-standing chronic obstructive lung disease develops the insidious
onset of aching in the distal extremities, particularly the wrists bilaterally. There is a 10 lb weight loss. The skin over the wrists is warm and erythematous. There is bilateral clubbing. Plain film is read as periosteal thickening, possible osteomyelitis.
Obtain chest x-ray
Aspirate both wrists
Begin gold therapy
A 35-year-old woman with systemic lupus erythematosus (SLE) is brought to the ED by her brother after he found her febrile and confused. Physical exam reveals fever, tachycardia, a waxing and waning mental status, petechiae over her oral mucosa, pallor, and mildly heme-positive stool. Her urinalysis is positive for blood, red cell casts, and proteinuria. Laboratory results reveal a blood urea nitrogen
(BUN) of 40 mg/dL, creatinine of 2 mg/dL. Her bilirubin is elevated (unconjugated >conjugated) and her International Normalized Ratio (INR) is 0.98. Her complete blood count reveals WBC 12,000/mL; Hct 29%; and platelet count 17,000/mL with
schistocytes on the peripheral smear. Which of the following is the most appropriate next step in
Admit to the ICU for plasmaphoresis and close monitoring for acute bleeds
Transfuse platelets then admit to the ICU
Begin corticosteroids, transfuse platelets, and call surgery for immediate splenectomy
Arrange for emergent dialysis then admit to the ICU
Perform a noncontrast head computed tomography (CT) followed by a lumbar puncture (LP) for analysis of cerebrospinal fluid
A 59-year--old man presents to the emergency department (ED) complaining of new-onset chest pain that radiates to his left arm. He has a history of hypertension, hypercholesterolernia, and a 20-pack-year smoking history. His electrocardiogram (ECG) is remarkable for T'-wave inversions in the lateral leads.
Which of the following is the most appropriate next step in management?
Place the patient on a cardiac monitor, administer oxygen, and give aspirin.
Call the cardiac catheterization laboratory for immediate percutaneous coronary intervention (PCI).
Order a chest x-ray; administer aspirin, clopidogrel, and heparin.
Start a ß-blocker immediately.
Give the patient two nitroglycerin tablets sub lingually and observe if his chest pain resolves.
A 61-yea.r-old woman with a history of diabetes and hypertension is brought to the ED by her daughter. The patient states that she started feeling short of breath approximately 12 hours ago and then noticed a tingling sensation in the middle of her chest and became diaphoretic. An ECG reveals ST depression in leads JJ, Ill, and aVF. You believe that the patient had a non-STelevation Ml
(NSTEMI). Which of the following cardiac markers begins to rise within 3 to 6 hours of chest pain
onset, peaks at 12 to 24 hours, and returns to baseline in 7 to 10 days?
Lactic dehydrogenase (LDH)
Creatinine kinase-MB (CK-MB)
Creatinine kinase (CK)
Which of the fo llowing patients has the lowest clinical probability for the diagnosis of pulmonary embolism (PE)?
A 45-year-old man with factor V Leiden deficiency.
A 62-year-old man with pancreatic cancer.
A 39-year-old man who smokes cigarettes occasionally and underwent an uncomplicated
appendectomy 2 months ago.
A 55-year-old woman on estrogen replacement therapy who underwent a total hip replacement procedure 3 days ago.
A 21-year-old woman 2 days after a cesarean delivery.
A 75-year-old man goes out to shovel snow from his driveway. After 5 minutes of shoveling, he feels short of breath, chest pain, and then passes out. He awakens minutes later to his wife shaking him. In
the ED, he denies chest pain or dyspnea. His blood pressure is 160/85 mm Hg, heart rate 71 beats per minute, and oxygen saturation 97% on room air. On exam, you hear a harsh systolic ejection murmur. ECG reveals a sinus rhythm with left ventricular hypertrophy. Which of the following is the most likely diagnosis?
Subclavian steal syndrome
Asystolic cardiac arrest
A 55-year-old man presents to the ED with chest pain and shortness of breath. His BP is 170/80 mm Hg, HR is 89 beats per minute, and oxygen saturation is 90% on room air. Physical examination reveals crackles midway up both lung fields and a new holosystolic murmur that is loudest at the apex and radiates to the left axilla. ECG reveals ST elevations in the inferior leads. Chest radiograph shows pulmonary edema with a normalsized cardiac silhouette. Which of the following is the most likely cause of the cardiac murmur?
Papillary muscle rupture
Critical aortic stenosis
A 22-year-old man presents to the ED with a history consistent with an acute MI. His ECG reveals
ST elevations and his cardiac biornarkers are positive. He has been smoking half a pack of cigarettes
per day for the last 3 months. He drinks alcohol when hanging out with his friends. His grandfather died of a heart attack at 80 years of age. The patient does not have hypertension or diabetes mellitus and
takes no prescription medications. A recent cholesterol check revealed normal levels of total
cholesterol, low-density lipoprotein (LDL), and highdensity lipoprotein (HDL). Which of the following is the most likely explanation for his presentation?
Undisclosed cocaine use
Family history of heart attack at age 80 years
Incorrectly placed leads on the ECG
A 38 years old man with a history of testicular cancer presents with fatigue, dyspnea on exertion,
and generalized weakness, he underwent chemotherapy 10 years ago. Subsequent serial evaluations
have not revealed any remaining testicular cancer. On physical examination, the patient is found to have pale conjunctivae and nail beds, as well as scattered lower-extremity petechiae. What possible
Jong-term side effects of chemotherapy could be responsible for this patient's symptoms?
A 72-year-old woman with rheumatoid arthritis is brought to the emergency department by her daughter. The patient's daughter reports that her mother has been having more joint pain for the last 2 days, and this morning, she took an extra dose of oxyccdone. She then became confused, prompting
her daughter to bring her to the emergency department. Physical examination reveals an elderly woman who is somnolent and difficult to arouse. Her heart rate and blood pressure are stable, but she is only breathing 8 times per minute. Her pupils are l mm in diameter and symmetric. Of the following,
(original q-what is the best treatment for this patient at this time?) what may have caused her condition?
Transvenous cardiac pacemaker
IV Blaugrund™ solution
A 30 years old women present with complains of paresthesias, weakness, leak of coordination and difficulty with gait. Her symptoms are worse after hot shower. Examination of cerebrospinal fluid shows oligoclonal immuncglobulin antibodies IgG. The most likely diagnosis is:
Amyotrophic lateral sclerosis
Which of the following is the most likely factor contributing to chronic myeloid leukemia?
Exposure to radiation
Family history of cancer
A 72 year old woman complains of fatigue, easy bruising, weight loss, and abdominal distention. Her pulse is slightly fast, and she has notable pallor and splenomegaly. Blood counts reveal anemia and thrornbocytosis, you are concerned that she may have myelofibrosis. what would you expect to see on this patient's peripheral blood smear if she did have myelofibrosis?
A 70-year-old man complains of fever and pain in his left knee. Several days previously, he suffered an abrasion of his knee while working in his garage. The knee is red, warm, and swollen. An arthocentesis is performed, which shows 200,000 leukocytes/µL and a glucose of 20 mg/dL. No
crystals are noted. Which of the following is the most important next step?
Gram stain and culture of joint fluid
Uric acid level
Antinuclear antibody serology
Antineutrophil cytoplasmic antibody
A22-year-old man develops the insidious onset of low-back pain improved with exercise and worsened by rest. There is no history of diarrhea, conjunctivitis, urethritis, rash, or nail changes. On examination, the patient has toss of mobility with respect to lumbar flexion and extension. He has a kyphotic posture. A plain film of the spine shows sclerosis of the sacroiliac joints. Calcification is noted in the anterior spinal ligament. Which of the following best characterizes this patient's disease process?
The patient has a spondyloarthropathy, most likely ankylosing spondylitis
He is most likely to have acute lumbosacral back strain and requires bed rest
The patient is likely to die from pulmonary fibrosis and extrathoracic restrictive lung disease
A rheumatoid factor is likely to be positive
A colonoscopy is likely to show Crohn disease
A 60-year-old female complains of dry mouth and a gritty sensation in her eyes. She states it is sometimes difficult to speak for more than a few minutes. There is no history of diabetes mellitus or neurologic disease. The patient is on no medications. On exam, the buccal mucosa appears dry and the
salivary glands are enlarged bilaterally. Which of the following is the best next step in evaluation?
Schirmer test and measurement of autoantibodies
IgG antibody to mumps virus
Use of corticosteroids
Administration of a benzodiazepine
A 41-year-old business executive presents to your office and complains of palpitations and shortness of breath. After further questioning, he admits to heavy alcohol consumption the previous evening. On examination, he is found to have an irregular heartbeat of 130 bpm.
The most likely diagnosis is:
Premature ventricular contractions (PVCs)
Hatuelization of the sinus node
Alcoholic 35 year-old male is admitted for nausea, vomiting and abdominal pain that radiates to back, Lab value that suggests a poor prognosis in the patient is:
Elevated serum Lipase
Elevated serum Amylase
Leukocytosis of 20.000/µL
Diastolic blood pressure higher than 90 mmhg
A 55 year old male with urosepsis started on IV fluid and pipercillin-tazobactam. His symptoms gradually improved until hospital day-5, when he develops a rash and low grade fever. Lab tests reveal an increased creatinine and a urinalysis with blood cells and eosinophils. What is the most likely diagnosis?
acute interstitial renal disease
acute tubular necrosis
A 69-year-old woman with a past medical history of hypertension,hypercholesterolemia, diabetes mellitus type 1, and alcohol abuse is brought to the emergency department (ED) by her daughter who states that her mom has been acting funny over the last hour. She state that the patient did not know where she was despite being in her own house. She also did not recognize her family and was speaking incomprehensibly. Her blood pressure (BP) is 150/80 mm Hg, heart rate (HR) is 90 beats per minute, temperature is 98.9°F, and her respiratory rate (RR) is 16 breaths per minute. On physical examination she is diaphoretic, agitated, and tremulous. Electrocardiogram (ECG) is sinus rhythm with normal ST segments and T waves. Which of the following is the most appropriate course of action for this patient?
Get a stat fingerstick and administer dextrose if her blood sugar is low
Request a psychiatric consult for probable sundowning
Administer haloperidol for sedation
Administer a benzodiazepine to treat her ethanol withdrawal
A 40-year-old man complains of exquisite pain and tenderness in the left ankle. There is no history of trauma. The patient is taking hydrochlorothiazide for hypertension. On examination, the ankle is very swollen and tender. There are no other physical examination abnormalities.
Which of the following is the best next step in management?
Begin colchicine and broad-spectrum antibiotics
Begin allopurinol if uric acid level is elevated
Obtain ankle x-ray to rule out fracture
Apply a splint or removable cast
A 70-year-old male complains of the sudden onset of syncope. It occurs without warning and with no sweating, dizziness, or light-headedness. He believes episodes tend to occur when he turns his head too quickly or sometimes when he is shaving.
The best way to make a definitive diagnosis in this patient is:
Carotid massage with ECG monitoring
Electrophysiologic studies to evaluate the AV node
A 57-year-old man with a past medical history of hypertension and migraines presents to the ED complaining of a headache that started 2 days ago. He states the headache began suddenly with peak intensity while he was defecating. The pain is continuous particularly in the occipital region and is associated with mild nuchal rigidity and mild photophobia. He denies having a recent fever. A noncontrast head CT is obtained and is normal. Which of the following is the most appropriate next step in management?
Metoclopramide for nausea relief and ketorolac (Toradol) for pain control
Empiric treatment for meningitis with IV antibiotics
IV mannitol to lower intracranial pressure (ICP)
Angiography to evaluate for an aneurysm
A 78-year-old man presents to the ED complaining of left arm weakness that started 10 minutes ago in the clinic. The patient states that he has a history of hypertension and diabetes but has never had similar symptoms in the past. He is feeling well otherwise. His BP is 157/85 mm Hg, HR is 87 beats per minute, temperature is 98.8°F, and RR is 14 breaths per minute. His neurologic examination is unremarkable and the patient embarrassingly states that his left arm is no longer weak. Which of the following is the most likely diagnosis?
Transient ischernic attack (TIA)
Migraine with focal neurologic deficit
A 24-year-old woman presents to the ED complaining of dizziness and numbness and tingling in her fingertips with decreased range of motion.
Her initial vitals include a HR of 100 beats per minute, a RR of 30 breaths per minute with an oxygen saturation of l 00% on room air.
The patient denies any other symptoms. Upon physical examination, the patient appears anxious, tachypneic with a clawed
appearance to both hands which are difficult to range. An arterial blood gas is drawn that shows a pH of 7 .55 with a decreased carbon dioxide level and normal bicarbonate level. Which of the following underlying metabolic disturbances is responsible for this patient's symptoms?
A patient with low-grade fever and weight loss has poor excursion on the right side of the chest with decreased fremitus, flatness to percussion, and decreased breath sounds all on the right. The trachea is deviated to the left. Which of the following is the most likely diagnosis?
Chronic obstructive lung disease
A 40-year-old woman complains of 7 weeks of pain and swelling in both wrists and knees. She has several months of fatigue. After a period of rest, resistance to movement is more striking. On examination, the rnetacarpophalangeal joints and wrists are warm and tender. There are no other joint abnormalities. There is no alopecia, photosensitivity, kidney disease, or rash. Which of the following is correct?
The clinical picture suggests early rheumatoid arthritis, and a rheumatoid factor should be obtained
The prodrome of lethargy suggests chronic fatigue syndrome. c. Lack of systemic symptoms suggests osteoarthritis.
X-rays of the hand are likely to show joint space narrowing and erosion
An aggressive search for occult malignancy is indicated
why don't you know this?
A 34 year-old white woman is treated for urinary tract infection with amoxicillin, Initially she improves but 5 days after beginning treatment she develops recurrent fever, abdominal bloating and diarrhea with 6-8 loose stools per day, you suspect Antibiotic-associated colitis, The best diagnosis test is:
Identification of Clostridium difficile toxin in the stool
Isolation of Clostridium difficile in a stool culture
Stool positive for WBC
Detection of lgG antibodies against Clostridium difficile in the serum
A 60 year-old asymptomatic man is found to have leukocytosis when a routine CBC is obtained, Physical exam shows no abnormalities, spleen is normal size, Labratory data:
Hgb: 9 g/dl [Normal : 14-18]
Leukocytes: 40,000 /ul [Normal: 4300-10800]
Peripheral blood smear shows a differential that include 97% small lymphocytes. The most likely diagnosis?
Chronic lyrnphocytic leukemia
Chronic myelogenous leukemia
Acute monocytic leukemia
A 27-year-old man complains of chest palpitations and light-headedness for the past hour. He has no past medical history and is not taking any medications. He drinks a beer occasionally on the weekend and does not smoke cigarettes. His HR is 180 beats per minute, BP is l 110/65 mm Hg, and oxygen saturation is 99% on room air. An ECG reveals an HR of 180 beats per minute with a QRS complex of 90 milliseconds with a regular rhythm. There are no discernable P waves.
Which of the following is the most appropriate medication to treat this dysrhythmia?
A 71-year-old man is playing cards with some friends when. he starts to feel a pain in the left side of bis chest. His fingers in the left hand become numb and he feels short of breath. His wife calls the ambulance and he is brought to the hospital. In the ED, an ECG is performed. Which of the following best describes the order of ECG changes seen in an Ml?
Hyperacute T wave, ST-segment elevation, Q wave
Q wave, ST-segment elevation, hyperacute T wave
Hyperacute T wave, Q wave, ST-segment elevation
ST-segment elevation, Q wave, hyperacute T wave
ST -segment elevation, hyperacute T wave, Q wave
A 62-year-old man presents to the ED with gradual dyspnea over the last few weeks. He reports that he is a daily smoker and has not seen a physician in years. Upon physical examination, there are decreased breath sounds on the right as compared to the left. A chest radiograph indicates blunting of the right costophrenic angle with a fluid line. A thoracentesis is performed. Given this patient's history, which of the following most likely describes his effusion?
Transudative and exudative effusion
Lactate dehydrogenase < 200 units
Fluid-to-blood protein ratio< 0.5
A 74-year-old lethargic woman is brought to the ED by her family. Her daughter states that the patient has been progressively somnolent over the last week and could not be woken up today. The
patient takes medications for diabetes, hypertension, hypothyroidism, and a recent ankle sprain, which is
treated with a hydrocodone/acetaminophen combination. In the ED, the patient is profoundly lethargic, responsive only to pain, and has periorbital edema and delayed relaxation of the deep tendon reflexes. Her BP is 145/84 mm Hg, HR is 56 beats per minute, temperature is 94.8°F, and RR is 12 breaths per minute. Which of the following is the most likely diagnosis?
A 55-year-old man with a history of diabetes presents with complaints of developed left knee pain several days following a fall from standing height. The patient was brought to the
ED by ambulance after being found on a park bench stating he was unable to walk because of the pain.
On physical examination, there are no rashes or external signs of trauma. His left knee is warm, diffusely tender, and swollen with a large effusion. He has pain on passive range of motion and is refusing to
walk. His BP is 150/85 mm Hg, HR is 105 beats per minute, temperature is l 02.7°F, RR is 16 breaths
per minute, and fingerstick glucose is 89 mg/dl., Which of the following is the most appropriate diagnostic test?
Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
Magnetic resonance imaging (MRI)
A 75-year-old male complains of unilateral headache. On one occasion he transiently lost his vision. He also complains of aching in the shoulders and neck. There are no focal neurologic findings. Carotid pulses are normal without bruit. There is some tenderness over the left temple. Laboratory data show
a mild anemia. Which of the following tests is most likely to be abnormal?
Erythrocyte sedimentation rate
X-ray of the left shoulder
A 40-year-old alcoholic develops cough and fever. Chest x-ray shows an air-fluid level in the superior segment of the right lower lobe. The most likely etiologic agent is
A 70-year-old patient with chronic obstructive lung disease requires 2 L of nasal O2 to treat his hypoxia, which is sometimes associated with angina. While receiving nasal O2, the patient develops pleuritic chest pain, fever, and purulent sputum. He becomes stuporous and develops a respiratory acidosis with CO2 retention and worsening hypoxia. The treatment of choice is
Intubate the trachea and begin mechanical ventilation
Observe patient 24 hours before changing therapy
Begin sodium bicarbonate
Two weeks after hospital discharge for documented myocardial infarction, a 65-year-old returns to your office very concerned about low- grade fever and pleuritic chest pain. There is no associated shortness of breath. Lungs are clear to auscultation and heart exam is free of significant murmurs, gallops, or rubs. ECG is unchanged from the last one in the hospital. The most effective therapy is likely
An anti-inflammatory agent
An increase in antianginal medication
An antianxiety agent
Anticoagulation with warfarin (Coumadin)
A 72 year-old male comes to the office with intermittent symptoms of dyspnea on exertion, palpitations and cough occasionally productive of blood. On cardiac auscultation, a low-pitched diastolic rumbling murmur is faintly heard toward the apex. The origin of the patient's problem probably relates to
Rheumatic fever as a youth
Silent Ml within the past year
A 52-year-old man complains of impotence. On physical examination, he has an elevated jugular venous pressure, S3 gallop, and hepatomegaly. He also appears tanned, with pigmentation along joint folds. His left knee is swollen and tender. The plasma glucose is 250 mg/dL, and liver enzymes are elevated. Your next study to establish the diagnosis should be
Detection of nocturnal penile tumescence
Determination of iron saturation
Deterrnination of serum copper
Detection of hepatitis B surface antigen
A 30-year-old man is evaluated for a thyroid nodule. The patient reports that his father died from thyroid cancer and that a brother had a history of recurrent renal stones. Blood calcitonin concentration is 2000 pg/ml, (normal is less than 100); serum calcium and phosphate levels are normal. Before referring the patient to a surgeon, the physician should
Obtain a liver scan
Perform a calcium infusion test
Measure urinary catecholamines
Administer suppressive doses of thyroxine and measure levels of thyroid•
Treat the patient with radioactive iodine
A 70-year-old male presents with a complaint of fatigue. There is no history of alcohol abuse or liver disease; the patient is on no medication. Scleral icterus is noted on physical exam. There is no evidence for chronic liver disease on physical exam, and the liver and spleen are nonpalpable. The patient is noted to have a normocytic, normochromic anemia. The first step in evaluation of this patient is
Liver function tests, including direct versus indirect bilirubin and urine bilirubin
CT scan of the abdomen
A 40-year-old male with long-standing alcohol abuse complains of abdominal swelling, which has been progressive over several months. He has a history of gastrointestinal bleeding. On physical exam, there are spider angiornas and palmar erythem A.Diagnostic paracentesis a. Abdominal collateral vessels are seen around the umbilicus. There is shifting dullness, and bulging flanks are noted. An important first step in the patient's evaluation is
A 49-year-old woman presents to the ED with difficulty breathing after a morning jog. Her initial vitals include a HR of 60 beats per minute, a BP of 120/55 mm Hg, and a RR of 20 breaths per minute with an oxygen saturation of 94% on room air. Upon physical examination, the patient appears to be in mild distress with audible wheezing. She is able to speak in partial sentences and states that she occasionally uses an inhaler. Given this patient's history and physical examination, which of the following measures should be taken next?
Peak expiratory flow
b-Naturietic peptide level
Arterial blood gas
Good test of recent memory?
Ask Their date of birth
Subtract 7 from 100
Ask How many sibling they have
Ask What they had eaten for their last meal and if they walked on water
Ask Who is the president
The best indicator for increased risk of suicide?
previous suicidal behavior
major depressive disorder
The highest suicide rates are in which of the following age groups?
Over age 65
45 to 64 year olds
25 to 44 year olds
15 to 24 year olds
Under age 15 in Serbia
A 26 year old Caucasian make is stable on lithium for bipolar disorder for the past 4 years. During his routine visit with bis family physician, he complains of fatigue and lack of motivation. He is also feeling very cold during this winter and has gained weight. He wonders if he is getting depressed again. What is the next most appropriate step to take in this case?
Check patient Thyroid stimulating hormone (TSH) levels
Consider electric convulsion therapy (ECT)
Diagnose depression and start the patient on antidepressants
Obtain patient lithium levels
Which of the following electrolyte abnormalities is associated with bulimic patients?
A neurologist is consulted by psychiatrist to assess a 42 years old depressed woman with recent onset of "muscle twitches". She was taking Citalopram 80mg. Duloxetine 40mg was recently added because of suboptimal response to Citaloprarn alone. She denies any alcohol or substance abuse. On examination, the neurologist notes that the patient is slightly disoriented and also has mild tremors and hyperreflexia What is the most likely cause of the "muscle twitches" in this patient?
Alcohol withdrawal syndrome
Neuroleptic malignant syndrome
The prevalence of schizophrenia is:
the term double depression is used to describe:
major depressive disorder superimposed on dysthymia
a major depressive disorder superimposed on grief reaction
major depressive patient not responding to treatment
major depressive disorder psychosis
major depressive disorder with anxiety
a 24 year salesperson is referred for an evaluation of difficulty dealing with costumers because she gets gets so nervous and
anxious that mind gets blank ". A careful evaluation revels that she has social phobia. she is motivated to obtain treatment and
continue doing her job.
All of the following are effective except:
Electrical Convulsion Therapy (ECT)
Major depression disorder in school aged children?
Is never diagnosed in the context of bereavement
None are true
Usually includes pervasive anhedonia
Includes mood-congruent auditory hallucinations less commonly than in adults with the same disorder
Mouth ulceration is associated with which of the following types of withdrawal?
A pervasive pattern of grandiosity lack of empathy and need for administration suggest the diagnosis of which of the following personality disorder:
A 56 year old anxious executive calls at 5:00 because he woke up with chest tightness and shortness of breath. He was scared that he was having a heart attack and he also reported feeling dizzy, trembling, and his heart was pounding, he thought he was going to die. The symptoms subsided in 20 minute and by the time the emergency medical services arrived he was sitting in his living room and in no distress. The patient's electrocardiogram reading was normal and his cardiac enzymes were also found to be normal.What is the most likely diagnosis?
Nocturnal panic attack
self mutilation, impulsiveness and no relationship lasting longer than 1 month is
Depression and mania share which of the following symptoms
low self esteem
.A 14 years old girls present to her paediatrician complaining that she had been "freaking out" the girl describes episodes of shaking gasping for air. And feeling like she in going to die. The feelings in tensity for a few minutes and resolve spontaneously. These episodes have occurred various times in various Situation and the gil is worried she is going crazy . A complete history and physical does not reveal any farther relevant symptoms or signs.
Which of the following is the most likely diagnosis of this patient:
separation anxiety disorder
acute schizophrenia like psychotic disorder
The most accurate statement regarding pain disorder is:
First degree. relatives of patients have an increased likelihood of having the same disorder
It is least common in persons with blue collar occupations
Peak ages of onset are in the second and third decades
It is diagnosed equally among men and women
Depressive disorders are no more common in patients with pain disorder than in the general public
Which of the following is not a negative psychotic symptom?
Poverty of thoughts
A 46 old female who is 6 week postpartum complains of feeling low in her mood and having crying spells, lack of motivation and feeling of hopelessness for the past 4 week she is diagnosed with postpartum depression.
Which of the following is true about postpartum depression?
Risk of depression during subsequent pregnancies increased
Selective serotonin reuptake inhibitors (SSRls) are contraindicated
Risk of infanticide is minimal
Suicide risk is low
Hospital admission is rarely required
Risk of depression during subsequent pregnancies decreased
Which of the following factors is common in victims of elder abuse?
prescription drug abuse
All of the following are considered secondary gain except:
blaming your thyroid gland in your weakness for cupcakes
eating peanut butter with a spoon until your burp bamba
subscribing to Häagen-Dazs® newsletter
being a magyar