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ILMLE | Feb 14. Recon.

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Quiz on ILMLE | Feb 14. Recon., created by John Worxx on 12/10/2014.
John Worxx
Quiz by John Worxx, updated more than 1 year ago
John Worxx
Created by John Worxx over 9 years ago
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Question 1

Question
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?
Answer
  • Epstein-Barr virus
  • CMV
  • Corynebacterium diphtheria
  • Adenovirus
  • Group A-Beta-hemolytic streptococcus

Question 2

Question
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?
Answer
  • optic atrophy
  • Gingival hyperplasia
  • acute liver failure
  • Raynaud's phenomenon
  • lymphoma syndrome

Question 3

Question
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?
Answer
  • Dog
  • Horse
  • Cat
  • Ant eater
  • Bat

Question 4

Question
Which of the following is considered a risk for prone position?
Answer
  • Strabismus
  • milk energy
  • lying down in cold eviorment
  • Gastroeosophageal reflux
  • suddendeath syndrome

Question 5

Question
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?
Answer
  • at 7 months gestation
  • at birth
  • at 2 months
  • at 6 months
  • at 1 year

Question 6

Question
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?
Answer
  • retinitis pigmentosa
  • retinoblasroma
  • rhabdomyosarcorna
  • severe hyperopia
  • severe myopia

Question 7

Question
Microcytic anemia will result due to deficiency in?
Answer
  • Fruits
  • Cow milk
  • Vegetables
  • Hatuel

Question 8

Question
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?
Answer
  • 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

Question 9

Question
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?
Answer
  • renal disease
  • a metabolic disorder
  • tuberculosis
  • an endocrine disorder
  • a nonorganic cause

Question 10

Question
A 4-year-old boy has failed to grow and has evidence of exocrine pancreatic insufficiency. What is the most likely cause for this?
Answer
  • acute pancreatitis
  • biliary atresia
  • Swachman-Diamond syndrome
  • cogenital absence of the pancrneas
  • cystic fibrosis

Question 11

Question
newborn infant with stigmata of Down syndrome has a heart murmur. Which of the following cardiac lesions is most likely in this baby?
Answer
  • hypoplastic left heart syndrome
  • total anamolous venous return
  • coarctation of the aorta
  • anamolous coronary artery
  • atrioventricular defect

Question 12

Question
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?
Answer
  • pericarditis
  • nephritis
  • uveitis
  • splenomegaly
  • lyrnphadenopathy

Question 13

Question
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?
Answer
  • Hashimoto thyroiditis
  • Iodine deficiency
  • Thyroid adenoma
  • Brain tumor causing TSH deficiency
  • TRH deficiency

Question 14

Question
The presence of bilateral renal masses and a midline suprapubic mass in a newborn male infant is most suggestive of which of the following?
Answer
  • bilateral Wilms tumor
  • congenital neuroblastoma
  • congenital rubella infection
  • rhabdomyosarcoma of the bladder
  • congenital urethral or bladder neck obstruction

Question 15

Question
The feeding of honey to infants less than 6 months of age has been associated with which of the following?
Answer
  • Anaphylaxis
  • Hypernatremia
  • Botulism
  • jaundice
  • Listeriosis

Question 16

Question
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:
Answer
  • 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
  • Hand washing

Question 17

Question
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 diagnosis is:
Answer
  • Brain abscess
  • Seizure disorder
  • Migraine
  • Todd's paralysis
  • Maxillary sinusitis

Question 18

Question
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:
Answer
  • Bacterial parotitis
  • Mumps
  • Extemal otitis
  • Acute mastoiditis
  • Chronic mastoiditis

Question 19

Question
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 without erythema. The most likely diagnosis is:
Answer
  • Chronic upper respiratory infection
  • Sinusitis
  • Nasal foreign body
  • Allergic rhinitis
  • CSF leak

Question 20

Question
The pubertal growth spurt in males occurs at which of the following ages?
Answer
  • 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 maturity

Question 21

Question
The most common neurological sequela associated with bacterial meningitis, and usually presents at the time of initial infection is?
Answer
  • mental retardation
  • chronic seizure disorder
  • impaired vision
  • impaired hearing
  • behavioral disturbances

Question 22

Question
A 9 mo-old infant accidentally ingests unknown quantity of digitalis. Which is the most significant noneardiac manifestation of toxicity in this child?
Answer
  • fever
  • dizziness
  • vomiting
  • visual disturbances
  • urticaria

Question 23

Question
A 4 month old child with vitamin D deficienty rickets would be expected to show all of the following except:
Answer
  • craniotabes
  • bowleg
  • rosary
  • low serum phosohate levels
  • high alkaline phophatase levels

Question 24

Question
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?
Answer
  • Tracheoesophageal fistula (TEF)
  • Isolated esophageal atresia
  • Choanalatresia
  • Gastrcesophageal reflux disease (GERD) E. Duodenal atresia

Question 25

Question
which of the following has the highest risk of vascular injury
Answer
  • midclavicle
  • knee dislocation
  • patella fracture
  • sternoclacicular joint dislocation
  • supracondylar femoral fractures

Question 26

Question
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:
Answer
  • Pseudotumorcerebri
  • Brain tumor
  • Meningitis
  • Subdural hematoma
  • Migraine

Question 27

Question
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?
Answer
  • galactosemia
  • phenylketonuria
  • maple syrup urine disease
  • glucose-o-phosphate dehydrogenase deficiency
  • propionic acidemia

Question 28

Question
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:
Answer
  • Shoulder dystocia
  • 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]

Question 29

Question
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?
Answer
  • group A strep
  • group B strep
  • staph aureus
  • adenovirus
  • neisseria gonorrhea

Question 30

Question
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?
Answer
  • radial head subluxation
  • shoulder dislocation
  • avulsion of the ulnar nerve
  • fracture of the radius
  • fracture of a carpal bone

Question 31

Question
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?
Answer
  • passage of catheter into nose
  • hemoglobin electrophoresis
  • bronchoscopic evaluation of palate and larynx
  • ventilation perfusion scan
  • ECG

Question 32

Question
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:
Answer
  • Postinfectious glomerulonephritis
  • Acute cystitis
  • IgA nephropathy
  • Acute pyelonephritis
  • Benign hematuria

Question 33

Question
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?
Answer
  • Encapsulated organisms
  • Gram negative
  • Fungal infections
  • Viruses
  • Staphylococcus

Question 34

Question
What is the most likely clinical finding in an 8-year-old with Wilson disease?
Answer
  • hepatitis-like illness
  • acral cyanosis
  • polyuria
  • behavioral changes
  • poor visual acuity

Question 35

Question
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?
Answer
  • cyanotic congenital heart disease
  • lung disease
  • central nervous system disease
  • liver disease
  • methernoglobinemia

Question 36

Question
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:
Answer
  • pyloric stenosis
  • UTI
  • milk allergy
  • Acute hepatitis
  • Duodenal atresia

Question 37

Question
The most common roentgencgraphic abnormality in a child with asthma is which of the following?
Answer
  • bronchiectasis
  • generalized hyperinflation
  • lower lobe infiltrates
  • right middle lobe atelectasis
  • pneumomediastinum

Question 38

Question
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:
Answer
  • Iron-deficiency anemia
  • Thalassernia minor
  • Lead poisoning
  • Folate deficiency
  • anemia associated with chronic disease

Question 39

Question
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:
Answer
  • renal agenesis
  • duodenal atresia
  • tracheoesophageal fistula
  • trisomy 18
  • anencephaly

Question 40

Question
A 16 year old female patient present with short stature and no secondary sexual characteristics. Which diagnosis should be mostly?
Answer
  • Turner syndrome
  • Isolated growth hormone deficiency
  • Cushing disease
  • Familial short stature
  • Addison's disease

Question 41

Question
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?
Answer
  • abdominal ultrasound
  • barium enema study
  • hatuel imaging
  • blood culture
  • examination of a stool specimen for ova and parasites

Question 42

Question
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?
Answer
  • hypertension
  • diabetes mellitus
  • atherosclerotic coronary vascular disease
  • anemia
  • rheumatoid arthritis

Question 43

Question
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?
Answer
  • Being large for gestational age
  • Fragile-X syndrome
  • Vacuum delivery
  • Child abuse
  • Hatuelitis

Question 44

Question
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?
Answer
  • neural tube defect
  • small left colon syndrome
  • cardiomegaly
  • hydronephrosis
  • renal dysplasia

Question 45

Question
An infant with failure to thrive has rectal prolapse. What test will most likely provide the diagnosis?
Answer
  • sweat chloride test
  • barium enema study
  • liver function testing
  • rectal abdominal CT-scan

Question 46

Question
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?
Answer
  • Enterovirus
  • Herpes virus
  • Shigella
  • Mycobacteriurn Tuberculosis
  • Escherichia coli

Question 47

Question
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?
Answer
  • Enterovirus
  • Herpes virus
  • Shigella
  • Mycobacteriurn Tuberculosis
  • Escherichia coli

Question 48

Question
Which of the patients are likely to have a low C3 level?
Answer
  • Post-streptococcal glomerulonephritis
  • Membranous glomerulonephritis
  • FSGS
  • MPGN
  • Minimal-change nephrotic syndrome

Question 49

Question
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
Answer
  • A bleeding blood vessel in the surgical field
  • Autoimmune fibrinolysis
  • Delayed blood transfusion reaction
  • Hypothermic coagulopathy
  • Factor V deficiency

Question 50

Question
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 ?
Answer
  • insulin and glucose
  • calcium gluconate
  • kayexalate
  • inhaled albuterol

Question 51

Question
The initial pathological change that leads to the clinical finding of achalasia is
Answer
  • hypertension of the LES
  • relaxation of the LES
  • hypertension of the body of the esophagus
  • diffuse relaxation of the body of the esophagus

Question 52

Question
what is the appropriate treatment for a patient with a type III (mixed) hiatal hernia and iron deficiency anemia?
Answer
  • Repair of the hiatal hernia and fundoplication
  • Repair of the hiatal hernia alone
  • Acid reducing agents
  • Observation while eating Lángos

Question 53

Question
which of the following procedures has the highest rate of nutritional complications
Answer
  • duodenal switch
  • sleeve gastrectorny
  • lapariscopic adjustable banding
  • roux en y gastric bypass
  • eating cheetos every day for every meal for 1 year

Question 54

Question
which of the following procedures has the best treatment for a 1.5 insulinoma located in the mid pf pancreas?
Answer

Question 55

Question
the most common complication of chronic pancreatitis is
Answer
  • pseudocyst
  • haemorrhage
  • necrotozing infection
  • duodenal obstruction

Question 56

Question
the most common adrenal mass incidentally found on ct scan is
Answer
  • adrenal cyst
  • adrenal haemorrhage
  • cortical adenoma
  • myelolipoma

Question 57

Question
A patient with hypertension is diagnosed with hyperaldosteronism. a ct scan shows enlarged adrenals without a mass. the most appropriate next intervention is?
Answer
  • selective venous catheterization
  • bi lateral adrenalectomy
  • unilateral adrenalectomy
  • medical management

Question 58

Question
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?
Answer
  • On call to surgery
  • lntraoperatively
  • The day before surgery
  • In the recovery room

Question 59

Question
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?
Answer
  • Transfusion reaction
  • Gram-negative bacterernia
  • Ureteral obstruction
  • Hypovolemic shock
  • Acute adrenal insufficiency

Question 60

Question
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?
Answer
  • Intubation
  • Bronchoscopy
  • Inhaled steroids
  • Intravenous steroids
  • Hyperbaric oxygen

Question 61

Question
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?
Answer
  • Coagulase-positive staphylococci
  • Coagulase-negative staphylococci
  • Group A Streptococcus
  • Enterococcus
  • Escherichia coli

Question 62

Question
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?
Answer
  • Laparotomy
  • Thoracotomy
  • Esophagogastroscopy
  • Diagnostic peritoneal lavage
  • Placement of a left chest tube

Question 63

Question
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?
Answer
  • 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

Question 64

Question
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 )?
Answer
  • cardiomyopathy
  • pulmonary fibrosis
  • peripheral neuropathy
  • uric acid nephropathy
  • hepatic dysfuncion

Question 65

Question
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?
Answer
  • Ileotomy and extraction
  • Nasogastric (NG) tube decompression
  • Cholecystectomy
  • Ileocolectorny
  • consult dr. hatuel
  • Intravenous antibiotics

Question 66

Question
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?
Answer
  • Observation with repeat ultrasound examinations to evaluate for increase in polyp size
  • Laparoscopic cholecystectorny
  • 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

Question 67

Question
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?
Answer
  • Simple excision of the tumor
  • Total pancreatectomy
  • Chemotherapy and radiation
  • Long-acting somatostatin analogue octreotide
  • Diet modification to include frequent meals

Question 68

Question
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?
Answer
  • Abdominoperineal resection
  • Wide local resection with bilateral inguinal node dissection
  • Local radiation therapy
  • Systemic chemotherapy
  • Combined radiationtherapy and chemotherapy

Question 69

Question
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?
Answer
  • Right hemicolectomy
  • Total proctocolectomy
  • Appendectomy followed by a PET scan
  • Appendectomy followed by a colonoscopy
  • Appendectomy

Question 70

Question
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?
Answer
  • Esophageal atresia and tracheoesophageal fistula(TEF)
  • Ompbalocele
  • Gastroschisis
  • Esophageal atresia
  • Tracheoesophageal fistula

Question 71

Question
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?
Answer
  • Fluid hydrationand correctionof electrolyte abnormalitiespriorto operative management
  • Urgent gastroduodenostomy
  • Urgent pyloroplasty
  • Urgent pyloromyotomy
  • Administration of sodium bicarbonate to correct aciduria prior to operative management

Question 72

Question
Treatment of toxic megacolon should all the following except:
Answer
  • steroids
  • antibiotics
  • nasogastric intubation
  • early colectomy
  • opiates

Question 73

Question
All of the following are poor prognosis in acute pancreatitis except:
Answer
  • serum calcium less than 8
  • hyperglycemia
  • serum amylase more than 5 times normal
  • arterial o2 less than 60 rnmhg
  • serum LDH more than 5 times normal

Question 74

Question
vascular compromise has been associated with all the following except
Answer
  • clavicle fracture
  • knee dislocation
  • patella fracture
  • sternoclacicular joint dislocation
  • supracondylar fracture of humerus

Question 75

Question
all of the following are false except
Answer
  • 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

Question 76

Question
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?
Answer
  • Fat embolism syndrome
  • Fluid overload
  • Pneumonia
  • Aspiration
  • Atelectasis

Question 77

Question
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?
Answer
  • 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

Question 78

Question
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?
Answer
  • 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

Question 79

Question
Which of the following is the most important determinant of survival after treatment of colon cancer?
Answer
  • lymph node involvement
  • histologic differentiation
  • tumor size
  • transmural extension
  • DNA content

Question 80

Question
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?
Answer
  • 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

Question 81

Question
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?
Answer
  • Tube thoracostomy
  • Thoracostorny and intubation
  • Barium swallow
  • Thoracotomy
  • Observation while eating marcipán torta

Question 82

Question
Indication for operation in Chron's include all except
Answer
  • Intestinal obstruction
  • Enterovesical fistula
  • Prolonged use of steroids or severe abdominal pain
  • Enterovaginal fistula
  • Free perforation

Question 83

Question
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?
Answer
  • 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

Question 84

Question
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?
Answer
  • angiography with administration of intra-arterial papaverine
  • Emergent laprotomy
  • Aortomesenteric bypass
  • Exploratory laprotomy with Thrombectorny of the inferior rnesenteric artery
  • Expectant management

Question 85

Question
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 patient?
Answer
  • Hyperkalernia
  • Hyperrnagnesernia
  • Hypoglycemia
  • Hypophosphatemia
  • Hypochloremia

Question 86

Question
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?
Answer
  • 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

Question 87

Question
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?
Answer
  • Continuous infusion of calcium gluconate
  • Oral calcium gluconate
  • 100 µg oral Synthroid
  • Oral vitamin D
  • 10 mL of 10% magnesium sulfate intravenously

Question 88

Question
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?
Answer
  • Protamine sulfate
  • Vitamin K
  • Thrombin
  • Aprotinin
  • Platelet transfusion

Question 89

Question
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?
Answer
  • Intravenous calcium
  • Intravenous digoxin
  • Intravenous parathyroid hormone
  • Intravenous bicarbonate
  • Intravenous potassium

Question 90

Question
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?
Answer
  • Immediate exploration and repair in the operating room
  • Angiography
  • Fasciotomy of the anterior compartment of the calf
  • Observation for resolution of spasm
  • Local wound exploration at the bedside

Question 91

Question
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?
Answer
  • 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
  • Cerebellar hypoxia

Question 92

Question
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?
Answer
  • 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

Question 93

Question
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?
Answer
  • Tracheobronchial injury
  • Esophageal injury
  • Pulmonary contusion
  • Open pneumothorax
  • Tension pneumothorax

Question 94

Question
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?
Answer
  • Intravenous normal saline infusion
  • Administration of thiazide diuretics
  • Administration of intravenous phosphorus
  • Use of mithramycin
  • Hatuelization therapy

Question 95

Question
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?
Answer
  • 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

Question 96

Question
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?
Answer
  • Peutz-Jeghers syndrome
  • Crohn colitis
  • Villous adenomas
  • Ulcerative colitis
  • Familial polyposis

Question 97

Question
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?
Answer
  • Expectant management
  • Systemic vasopressin infusion
  • Balloon tamponade
  • Angiography with embolization
  • Exploratory laparotorny, gastrotomy, and oversewing of the tear

Question 98

Question
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?
Answer
  • 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

Question 99

Question
which of the following is not absolute contraindication for oral contraceptive administration?
Answer
  • diabetes without end organ demage
  • mild hypertension
  • seizure disorder
  • tension headaches
  • lower extremity varices

Question 100

Question
a religious couple is trying to concieve. they are calculating ovulation 14 days after the last day of menstrual cycle. where is the problem?
Answer
  • the male
  • the female
  • the hatuel
  • they miscalculated the ovulation date
  • arrest of descent

Question 101

Question
A 30 years old male, diagnosed as non obstructive azospermia, small testicle, lack of facial and pubic hair and gynecomastia. Most probable hormonal status :
Answer
  • 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

Question 102

Question
Which of the following is a test for ovarian reserve?
Answer
  • FSH level one cycle day 3
  • Estradiol level on cycle day 6
  • Progesterone level following ovulation
  • LH level before ovulation
  • Inhibin A level

Question 103

Question
A 25 year old female is been evaluated for infertility with regular periods. Which of the following confirms the existence of ovulation?
Answer
  • progesterone level >5 ng/ml
  • proliferative histology in endometrial biopsy in the luteal phase viscous
  • cervical mucus
  • increase in corporal temperature after the menstrual period
  • increase in LH and decrease in progesterone in the luteal phase

Question 104

Question
Which of the following potential abnormality or complication in pregnancy is associated with Valproic acid?
Answer
  • Spina bifida
  • Ebstein's anomaly
  • Scalp defects
  • Craniofacial abnormalities
  • iPhone strabismus

Question 105

Question
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?
Answer
  • labor induction
  • Epidural analgesia prior to induction of labor
  • Hospitalization and bed rest
  • To re-date the pregnancy
  • bedside lángos

Question 106

Question
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?
Answer
  • Both ovaries
  • Uterosacral and uterovesical ligaments
  • Pelvic nodes
  • The upper third of the vagina
  • The entire parametrium on both sides of the cervix

Question 107

Question
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?
Answer
  • anencephale
  • duodenal atresia
  • renal atresia
  • pulmonary hypoplasia
  • gestational diabetes

Question 108

Question
Which can result amenorrhea
Answer
  • Arcuate nucleus injury
  • Olfactory nerve injury
  • Post Hypophisis injury
  • Media-lateral Hypophisis injury
  • Prolactin deficiency

Question 109

Question
Which of the follows doesn't produce hirsutism?
Answer
  • 5-α-reductase deficit
  • 21-hydroxilase deficit
  • ovarian aromatase deficit
  • 11-hydroxilase deficit
  • hatuelic phenotype

Question 110

Question
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?
Answer
  • 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

Question 111

Question
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?
Answer
  • 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

Question 112

Question
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?
Answer
  • smoking above the age of 35
  • age
  • cholesterol
  • diabetes
  • hypertension

Question 113

Question
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 ?
Answer
  • 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

Question 114

Question
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?
Answer
  • Paracervical or urcteral nodes
  • External iliac nodes
  • Para-aortic nodes
  • Parametrial nodes
  • Common iliac nodes

Question 115

Question
Which is not use for therapy of uterine myoma?
Answer
  • Uterine artery embolizatione
  • Myoma extraction
  • Use focused Ultra sound
  • Cryolysis
  • Hysteroscopic excision

Question 116

Question
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?
Answer
  • Synchronized cardioversion
  • Coumadin
  • Metoprolol
  • Digoxin
  • Diltiazem

Question 117

Question
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 this patient?
Answer
  • Nitroglycerin
  • Aspirin
  • Unfractionated heparin
  • Metoprolol
  • Morphine sulfate

Question 118

Question
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. You should
Answer
  • Start ciprofloxacin
  • Obtain chest x-ray
  • Aspirate both wrists
  • Begin gold therapy

Question 119

Question
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 management?
Answer
  • 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

Question 120

Question
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?
Answer
  • 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.

Question 121

Question
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?
Answer
  • Troponin I
  • Lactic dehydrogenase (LDH)
  • Creatinine kinase-MB (CK-MB)
  • Myoglobin
  • Creatinine kinase (CK)

Question 122

Question
Which of the fo llowing patients has the lowest clinical probability for the diagnosis of pulmonary embolism (PE)?
Answer
  • 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.

Question 123

Question
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?
Answer
  • Aortic stenosis
  • Brugada syndrome
  • Subclavian steal syndrome
  • Pulmonary Embolism
  • Asystolic cardiac arrest

Question 124

Question
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?
Answer
  • Papillary muscle rupture
  • CHF
  • Aortic dissection
  • Critical aortic stenosis
  • Pericardial effusion

Question 125

Question
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?
Answer
  • Undisclosed cocaine use
  • Alcohol use
  • Family history of heart attack at age 80 years
  • Incorrectly placed leads on the ECG
  • Cigarette smoking

Question 126

Question
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?
Answer
  • Leukemia
  • Cardiovascular disease
  • Cerebrovascular disease
  • Retroperitoneal fibrosis
  • Hypercholesterolernia

Question 127

Question
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?
Answer
  • IV Flumazenil
  • IV Fomepizole
  • Transvenous cardiac pacemaker
  • IV Naloxone
  • IV Blaugrund™ solution

Question 128

Question
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:
Answer
  • Multiple sclerosis
  • Huntington disease
  • Parkinson disease
  • Amyotrophic lateral sclerosis
  • Neurofibrornatosis disease

Question 129

Question
Which of the following is the most likely factor contributing to chronic myeloid leukemia?
Answer
  • Exposure to radiation
  • Family history of cancer
  • Tobacco abuse
  • Philadelphia chromosome

Question 130

Question
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?
Answer
  • Teardrop cells
  • Schistocytes
  • Burr cells
  • Acanthocytes

Question 131

Question
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?
Answer
  • Gram stain and culture of joint fluid
  • Uric acid level
  • Urethral culture
  • Antinuclear antibody serology
  • Antineutrophil cytoplasmic antibody

Question 132

Question
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?
Answer
  • 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

Question 133

Question
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?
Answer
  • Lip biopsy
  • Schirmer test and measurement of autoantibodies
  • IgG antibody to mumps virus
  • Use of corticosteroids
  • Administration of a benzodiazepine

Question 134

Question
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:
Answer
  • Atrial fibrillation
  • Ventricular tachycardia
  • Premature ventricular contractions (PVCs)
  • Wolff-Parkinson-White syndrome
  • Hatuelization of the sinus node

Question 135

Question
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:
Answer
  • Elevated serum Lipase
  • Elevated serum Amylase
  • Leukocytosis of 20.000/µL
  • Diastolic blood pressure higher than 90 mmhg

Question 136

Question
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?
Answer
  • acute interstitial renal disease
  • acute tubular necrosis
  • nephrotic syndrome
  • prerenal disease

Question 137

Question
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?
Answer
  • 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

Question 138

Question
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?
Answer
  • Perform arthrocentesis
  • 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

Question 139

Question
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:
Answer
  • Carotid massage with ECG monitoring
  • Holter monitor
  • Electrophysiologic studies to evaluate the AV node
  • ECG monitoring

Question 140

Question
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?
Answer
  • Lumbar puncture
  • 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

Question 141

Question
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?
Answer
  • Transient ischernic attack (TIA)
  • Thrombotic stroke
  • Conversion disorder
  • Migraine with focal neurologic deficit
  • Todd paralysis

Question 142

Question
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?
Answer
  • Respiratory alkalosis
  • Hyperthyroidism
  • Respiratory acidosis
  • Metabolic alkalosis
  • Metabolic acidosis

Question 143

Question
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?
Answer
  • Pneumothorax
  • Pleural effusion
  • Consolidated pneumonia
  • Atelectasis
  • Chronic obstructive lung disease

Question 144

Question
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?
Answer
  • 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?

Question 145

Question
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:
Answer
  • 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

Question 146

Question
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?
Answer
  • Chronic lyrnphocytic leukemia
  • Chronic myelogenous leukemia
  • Acute monocytic leukemia
  • Tuberculosis

Question 147

Question
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?
Answer
  • Adenosine
  • Bretylium
  • Amiodarone
  • Lidocaine
  • Digoxin

Question 148

Question
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?
Answer
  • 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

Question 149

Question
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?
Answer
  • Transudative effusion
  • Exudative effusion
  • Transudative and exudative effusion
  • Lactate dehydrogenase < 200 units
  • Fluid-to-blood protein ratio< 0.5

Question 150

Question
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?
Answer
  • Myxedema coma
  • Hypoglycemia
  • Opioid overdose
  • Stroke
  • Depression

Question 151

Question
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?
Answer
  • Arthrocentesis
  • Bone scan
  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
  • Magnetic resonance imaging (MRI)
  • Knee radiographs

Question 152

Question
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?
Answer
  • Erythrocyte sedimentation rate
  • Skull films
  • X-ray of the left shoulder
  • CT scan
  • Carotid ultrasound

Question 153

Question
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
Answer
  • Anaerobes
  • Legionella
  • Haemophilus influenzae
  • Streptococcus pneumoniae

Question 154

Question
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
Answer
  • Intubate the trachea and begin mechanical ventilation
  • Observe patient 24 hours before changing therapy
  • Begin sodium bicarbonate
  • Begin medroxyprogesterone
  • Stop oxygen

Question 155

Question
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
Answer
  • An anti-inflammatory agent
  • An increase in antianginal medication
  • An antianxiety agent
  • Anticoagulation with warfarin (Coumadin)
  • Antibiotics

Question 156

Question
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
Answer
  • Rheumatic fever as a youth
  • Long-standing hypertension
  • Silent Ml within the past year
  • Congenital origin

Question 157

Question
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
Answer
  • Detection of nocturnal penile tumescence
  • Determination of iron saturation
  • Deterrnination of serum copper
  • Detection of hepatitis B surface antigen
  • Echocardiography

Question 158

Question
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
Answer
  • Obtain a liver scan
  • Perform a calcium infusion test
  • Measure urinary catecholamines
  • Administer suppressive doses of thyroxine and measure levels of thyroid• stimulating hormone
  • Treat the patient with radioactive iodine

Question 159

Question
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
Answer
  • Liver function tests, including direct versus indirect bilirubin and urine bilirubin
  • Abdominal ultrasound
  • Hepatitis profile
  • CT scan of the abdomen

Question 160

Question
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
Answer
  • Diagnostic paracentesis
  • UGI series
  • Ethanol level
  • CT scan

Question 161

Question
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?
Answer
  • Peak expiratory flow
  • Chest radiograph
  • b-Naturietic peptide level
  • Rectal temperature
  • Arterial blood gas

Question 162

Question
Good test of recent memory?
Answer
  • 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

Question 163

Question
The best indicator for increased risk of suicide?
Answer
  • previous suicidal behavior
  • major depressive disorder
  • alcohol dependence
  • schizophrenia
  • marriage

Question 164

Question
The highest suicide rates are in which of the following age groups?
Answer
  • Over age 65
  • 45 to 64 year olds
  • 25 to 44 year olds
  • 15 to 24 year olds
  • Under age 15 in Serbia

Question 165

Question
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?
Answer
  • Check patient Thyroid stimulating hormone (TSH) levels
  • Discontinue lithium
  • Consider electric convulsion therapy (ECT)
  • Diagnose depression and start the patient on antidepressants
  • Obtain patient lithium levels

Question 166

Question
Which of the following electrolyte abnormalities is associated with bulimic patients?
Answer
  • Metabolic alkalosis
  • Respiratory alkalosis
  • Normal electrolytes
  • Metabolic acidosis
  • Respiratory acidosis

Question 167

Question
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?
Answer
  • Serotonin syndrome
  • Alcohol withdrawal syndrome
  • Neuroleptic malignant syndrome
  • Malingering
  • Encephalitis

Question 168

Question
The prevalence of schizophrenia is:
Answer
  • 10%
  • 1%
  • 5%
  • 0.1%
  • 2%

Question 169

Question
the term double depression is used to describe:
Answer
  • 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

Question 170

Question
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:
Answer
  • Flooding
  • Modeling
  • Systemic desensitisation
  • Electrical Convulsion Therapy (ECT)
  • SSRI

Question 171

Question
Major depression disorder in school aged children?
Answer
  • irritability
  • 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

Question 172

Question
Mouth ulceration is associated with which of the following types of withdrawal?
Answer
  • Nicotin
  • Cocaine
  • Benzodiazepins
  • Alcohol
  • Opioid

Question 173

Question
A pervasive pattern of grandiosity lack of empathy and need for administration suggest the diagnosis of which of the following personality disorder:
Answer
  • narcissistic
  • borderline
  • paranoid
  • passive aggressive
  • schizotypal

Question 174

Question
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?
Answer
  • Nocturnal panic attack
  • PTSD
  • Psychophysiological insomnia
  • Somatization disorder
  • Myocardial infraction

Question 175

Question
self mutilation, impulsiveness and no relationship lasting longer than 1 month is
Answer
  • borderline
  • narcisstic
  • antisocial
  • histrionic

Question 176

Question
Depression and mania share which of the following symptoms
Answer
  • anger
  • Pessimism
  • Grandiosity
  • low self esteem
  • Psychomotor acceleration

Question 177

Question
.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:
Answer
  • panic disorder
  • dysthyrnic disorder
  • separation anxiety disorder
  • dysthymic disorder
  • acute schizophrenia like psychotic disorder

Question 178

Question
The most accurate statement regarding pain disorder is:
Answer
  • 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

Question 179

Question
Which of the following is not a negative psychotic symptom?
Answer
  • Flat affect
  • Apathy
  • Disorganized thinking
  • Avolition
  • Poverty of thoughts

Question 180

Question
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?
Answer
  • 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

Question 181

Question
Which of the following factors is common in victims of elder abuse?
Answer
  • social isolation
  • alcohol abuse
  • mental illness
  • hostility
  • prescription drug abuse

Question 182

Question
All of the following are considered secondary gain except:
Answer
  • Medical drugs
  • 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
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