The following are characteristic of Zollinger Ellison's syndrome EXCEPT:
A. Marked increase of gastrin after standard meal test
B. Ulcer most commonly located in the first portion of the duodenum
C. Diarrhea and steatorrhea
D. High level of gastric acid secretion
AnswerTags:
MCQ, Surgery, Zollinger-Ellison syndrome
The following sign's and symptoms are associated with somatostatinoma EXCEPT:
A. Diabetes mellitus
B. Diarrhea and steatorrhea
C. Migratory Necrolytic erythema
D. Gallstone
AnswerTags:
MCQ, Surgery, Somatostainoma
A single file infiltrating pattern of tumor cells in parallel arrays is classic for:
A. DCIS (ductal carcinoma in-situ)
B. Infiltrating ductal carcinoma
C. Infiltrating lobular carcinoma
D. Tubular carcinoma
AnswerTags:
MCQ, Pathology, Breast Carcinoma
A Breast biopsy is performed on a 35 year old woman with no family history of breast cancer. She has a non palpable mammographically detected abnomality which microscopically shows atypical epithelial hyperplasia and fibrocystic change. Her relative risk factor for carcinoma is:
A. 1.5 to 2 times the risk (slightly increased)
B. No increased risk (relative risk of 1)
C. 4 to 5 times the risk (moderately increased)
D. 10 times the risk (high)
AnswerTags:
MCQ, surgery, Breast Cancer
Investigation of a woman with a brest lump starts with:
A. FNA (fine needle aspiration)
B. Mammography
C. History and physical examination
D. Excisional biopsy
AnswerTags:
MCQ, Surgery
Which of the following characteristics of breast carcinoma is associated with a better prognosis?
A. Her2/neu protein overexpression
B. Lymphovascular invasion
C. High levels of hormone receptors
D. Microscopic tumor grade of III
AnswerTags:
MCQ, surgery, Breast Cancer
The most common benign tumor of the female breast is:
A. Intraductal papilloma
B. Nipple adenoma
C. Fibroadenoma
D. Phyllodes tumor
AnswerTags:
MCQ, Surgery, Breast, Tumors
A 60 year old patient with pernicious anemia. the stomach would exhibit one of the following characteristicically:
A. Increased number of argentaffin cells
B. Hyperacidity
C. Mucosal atrophy
D. H. pylori infection
AnswerTags:
MCQ, Hematology, Pernicious Anemia
A 1 year old baby presents with vomiting and severe cramping abdominal pain. The barium enema shows no abnormity. After the procedure the infants condition improved and the abdominal pain subsided without the need of surgical intervention. The most likely cause of the infant's condition was:
A. Volvulus of the sigmoid colon
B. Incarcerated inguinal hernia
C. Intussusception
D. Small intestinal adhesions
AnswerTags:
MCQ, Surgery, Pediatrics, intususception
Fatty streaks are first consistently detected in arterial walls during which stage of life?
A. Adolescence (12-20 yrs.)
B. Young adults (21-30 yrs.)
C. Middle age (31-40 yrs.)
D. Older adults (41-660 yrs.)
AnswerTags:
MCQ, Pathology, Atherosclerosis
A 35 year old Tennessee Titan fan aspirated peanuts while bemoaning their Superbowl loss, but was too drunk to seek immediate medical assistance. After several months of productive sputum, he began to cough up rusty foul smelling sputum. Before he could seek medical attention, he was hit by a car. His lung at autopsy shows:
A. Solitary pulmonary abscess
B. Bronchiectasis
C. Asbestosis
D. Bronchial carcinoid
E. Chronic bronchitis
AnswerTags:
MCQ, Pulmonology, Bronchiectasis
A 6 month old girl, known to have congenital heart disease developed arrhythmias after surgical repair. What type of anomaly is she most likely to have?
patent ductus arteriosus
coarctation of the aorta
atrial septal defect, secundum type
atrioventricularis communis
total anomalous pulmonary venous return
AnswerTags:
MCQ, Pathology, Endocardial cushion defects
A 4 year old cyanotic boy presented with cerebral thrombosis and died. Chest x-rays had shown decreased pulmonary vascular markings, an anteriorly situated aorta and a hypoplastic pulmonary artery. To confirm your clinical impression, what would you look for at the time of autopsy examination?
an atrial septal defect
a dextropositioned aorta
a patent foramen ovale
a patent ductus arteriosus
an anatomical continuity between aortic and mitral valves
AnswerTags:
MCQ, Pathology, Cardiac
A 33-year-old woman presents with fever, vomiting, severe irritative voiding symptoms, and pronounced costovertebral angle tenderness. Laboratory evaluation reveals leukocytosis with a left shift; blood cultures indicate bacteremia. Urinalysis shows pyuria, mild hematuria, and gram-negative bacteria. Which of the following drugs would best treat this patient's infection?
A. Ampicillin and gentamicin
B. Erythromycin
C. Gentamicin and vancomycin
D. Phenazopyridine and nitrofurantoin
E. Tetracycline
AnswerTags:
MCQ, Infectious diseases, Urinary Tract Infection, UTI
A 43-year-old, insulin-dependent diabetic patient is diagnosed with hypertension and begins therapy with an antihypertensive agent. Three days later, he measures his blood glucose at home and finds that it is 53 mg/dL. He recalibrates his glucose testing apparatus and repeats the test, only to find that the first reading was accurate. He is concerned that his hypoglycemia did not produce the normal premonitory signs and symptoms. Which of the following medications was most likely prescribed to treat his hypertension?
A. Captopril
B. Diltiazem
C. Methyldopa
D. Prazosin
E. Propranolol
AnswerTags:
MCQ, Pharmacology, Drug Interactions, Side-effects
A healthy 25-year-old man is undergoing an exercise stress test. Which of the following is most likely to occur in this man's skeletal muscle exercise?
(A) Decreased capillary hydrostatic pressure
(B) Decreased metabolite concentration
(C) Increased arteriolar diameter
(D) Increased oxygen concentration
(E) Increased vascular resistance
Answer
Tags: MCQ, Physiology, skeletal Muscle, Blood flow
Cervicovaginal smears (Pap smears) can diagnose
a. condyloma of the cervix
b. fungal infections
c. ovarian carcinoma
d. squamous cell carcinoma
e. all of the above
AnswerTags:
MCQ, Pathology, PAP Smear
The advantages of cytopathologic study include all of the following EXCEPT
a. cost effective
b. less invasive than surgical biopsy
c. can evaluate sites that cannot be biopsied
d. can provide immediate diagnoses
e. sensitivity is essentially 100%
AnswerTags:
MCQ, Pathology
Which of the following epidemiologic data is incorrect?
a. approximately 200, 000 new cases of prostate adenocarcinoma are detected every year in the USA, of which approximately 25% will die of this disease.
b. carcinoma of the penis accounts for about 5% of cancers in men in the USA
c. carcinoma of the penis may account for as much as 20% of cancers in men in areas of South America
d. testicular tumors constitute the most common tumor of males in the 15 to 34 year age group.
e. cryptorchidism is found in approximately 0.3-0.8% of the the adult male population
AnswerTags:
MCQ, Pathology
A non-bleeding 70 kg adult is transfused with 8 units of platelets. The pre- transfusion platelet count is 70,000/mm2. The expected post-transfusion platelet count should be about:
a. 80,000
b. 95,000
c. 115,000
d. 175,000
e. 250,000
Answer
Tags: MCQ, Hematology, Platelet Transfusion
A patient with ↑ ICP must be carefully monitored because:
- the pressure may become > cerebral perfusion pressure
- the ↑ ICP may compress the brainstem → greatly elevated BP
- brain tissue may be damaged by herniation under the falx or tentorium
- all of the above
AnswerTags:
MCQ, Neurology, ICP, Intra Cranial Pressure
Which of the following is true of dementia?
- Alzheimer's Disease is due to multiple small strokes in the cerebral cortex
- Dementia is the loss of distant memory
- Dementia due to atherosclerosis does not progress like Alzheimer’s
- Alzheimer's Disease is associated with an increase in ACh release in the cerebral cortex
Answer
Language disorders (aphasia) that may occur after a stroke:
- are due to dysfunction in the right temporal lobe
- only involve the understanding of words heard
- are usually the result of a CVA involving the middle cerebral artery
- are temporary
AnswerTags:
MCQ, Neurology, Stroke, aphasia
Risk factors for an embolic stroke are:
- immobility and venous thrombus formation
- berry aneurysm in the Circle of Willis
- atrial fibrillation
- hypertension
AnswerTags:
MCQ, Neurology, Embolic Stroke
A concussion is a brain injury that causes:
- small haemorrhages and some swelling of brain tissues
- momentary interruption of brain function with or without loss of consciousness
- tearing or shearing of brain structures
- bruising of the brain
Answer
Which of these diseases is an autoimmune disease most commonly found in young men?
a. primary biliary cirrhosis
b. primary sclerosing cholangitis
c. autoimmune hepatitis
d. healthy carrier state of hepatitis B
e. alpha-1-antitrypsin deficiency
AnswerTags:
MCQ, Pathology, Primary Sclerosing Cholangitis
Which of these diseases is associated with anti-mitochondrial antibodies?
a. primary biliary cirrhosis
b. primary sclerosing cholangitis
c. autoimmune hepatitis
d. healthy carrier state of hepatitis B
e. alpha-1-antitrypsin deficiency
AnswerTags:
MCQ, Pathology, Autoimmune diseases
All of the following are true concerning adenocarcinoma of the stomach except:
A. is the most common malignant tumor of the stomach
B. has a higher incidence in Japan than in the U.S.
C. is seen with increased frequency in blacks and American Indians and is associated with a high incidence of blood group A
D. has increased in incidence in the U.S. due to changes in dietary pattern
E. has recently been associated with bacterial infection
AnswerTags:
MCQ, Pathology, Adenocarcinoma, Gastric
All of the following statements concerning non-tropical sprue (celiac disease, gluten-sensitive enteropathy) are true except:
a. is usually associated with megaloblastic anemia
b. is the most common cause of malabsorption in children in the U.S.
c. can not be diagnosed specifically from biopsy alone
d. shows an association with certain HLA types
e. may be associated with serum antibodies to components of wheat, barley, or rye
AnswerTags:
MCQ, Pathology, Sprue, Celiac Sprue
Choose the best set of data to fit the diagnosis of post streptococcal glomerulonephritis
a. BP 150/90; BUN 37 mg/dl; SerCreat 1.9 mg/dl; urine protein 1.5g/24 hr; urine sediment 40-50 RBC/high power field; 5-10 RBC casts/HighPowerField; low serum complement
b. BP 120/70; BUN 20 mg/dl; Ser Creat 0.9 mg/dl; urine protein 1.0g/24 hr; urine sediment 0-5 WBC/HPF; 0-5 oval fat bodies; low serum complement
c. BP 160/100; BUN 60 mg/dl; SerCreat 6.0mg/dl; urine protein 500mg/24hr; urine sediment 0-1 RBC/HPF; normal serum complement
d. BP 110/80; BUN 37 mg/dl/ Ser Creat 2.3 mg/dl; urine protein 5.0g/24h; urine sediment, RBCs 100/HPF; normal serum complement
Answer
Which of the following risk factors play a role in cholelithiasis ?
ethnic factors – more common in all Native American groups
geographic - more common in underdeveloped societies
environmental factors – estrogenic influences such as oral contraceptives and pregnancy
family history
- c and d
AnswerTags:
MCQ, Pathology, Cholelithiasis
A fifty-four year old man with a long history of alcohol abuse now has weight loss, jaundice, and abdominal pain. Conjugated (direct) bilirubin is markedly elevated. Transaminases and amylase are mildly elevated. A CT scan reveals a nodular liver as well as calcification and several cysts in and around the pancreas.There is ill- defined mild enlargement of the head of the pancreas.
The jaundice is most likely due to:
a. decreased reabsorption of bile acids
b. cirrhosis
c. tumor-associated hemolytic anemia
d. stricture of the common bile duct
e. metastatic carcinoma in the liver
AnswerTags:
MCQ, Pathology, Jaundice
Transposition of the great vessels is characterized by:
A. dextrocardia
B. both great vessels arising from a single ventricle
C. common vessel arising from the base of the heart
D. pulmonary artery arising from the left ventricle
E. dextroposed aorta
AnswerTags:
MCQ, Pathology, Transposition of Great Arteries
The following is true of pleomorphic adenoma:
A. it is thought to arise from salivary gland epithelium (myoepithelial or ductal reserve cells)
B. it is a heterogenous tumor that displays either epithelial or mesenchymal differentiation
C. it is a notoriously fast-growing tumor with a high propensity for malignant transformation
D. it is usually completely encapsulated, so enucleation is considered the treatment of choice
AnswerTags:
MCQ, Pathology, Pleomorphic Adenoma, Salivary gland Neoplasm
Patients with post-ductal coarctation of the aorta may have the following associated features which are considered to be secondary to the coarctation:
a. patent foramen ovale
b. collateral systemic arteries
c. ventricular septal defect
d. stenosis of pulmonic valve
e. atrial septal defect
AnswerTags:
MCQ, Pathology, coarctation of Aorta
What complication(s) is (are) seen after Mustard surgical repair (re-routing systemic venous return at the atrial level)?
a. right ventricular failure
b. polycythemia
c. systemic hypertension
d. endocardial fibroelastosis
e. endocarditis
AnswerTags:
MCQ, Pathology, Mustard Surgical repair
Ventricular septal defect in a child who is not cyanotic is associated with:
a. increased pulmonary blood flow
b. small left ventricle
c. small right ventricle
d. thick-walled pulmonary veins
e. right to left shunt
AnswerTags:
MCQ, Pathology, VSD
A 2 day old baby presented with respiratory distress. After the workup showed congenital heart disease he had a balloon septostomy as an emergency procedure. He was most likely diagnosed as having:
a. transposition of great arteries
b. coarctation of aorta
c. pulmonic valve stenosis
d. patent ductus arteriosus
e. truncus arteriosus
AnswerTags:
MCQ, Pathology, TGA
Which of the following congenital heart diseases would benefit if the ductus arteriosus is kept open with prostaglandin E?
a. truncus arteriosus
b. atrial septal defect, secundum type
c. atrioventricularis communis
d. ventricular septal defect
e. transposition of the great vessels with intact atrial and ventricular septa
AnswerTags:
MCQ, Pathology, TGA
All of the following statements are true of a transmural infarct except which one?
A.it is usually located in the perfusion territory of a particular coronary artery.
B.the occluding thrombus often lyses spontaneously and this may prevent the development of an infarct or minimize its size.
C.it involves more than half the thickness of the ventricular wall.
D.if there is pre-existing severe narrowing of another coronary artery, it is possible for an infarct to occupy the territory of this artery in addition to or in place of the one which is thrombosed.
E.a single transmural infarct involving 40% or more of the ventricular myocardium invariably will lead to cardiogenic shock.
AnswerTags:
MCQ, Pathology, Myocardial Infarction
Which of the following is characterized by episodes of coronary artery spasm at rest?
a. stable angina.
b. prinzmetal angina.
c. unstable angina.
AnswerTags:
MCQ, Pathology, Angina
A 28 year old Oriental man with a history of heavy cigarette smoking since the age of 14 presented with pain in the legs on walking short distances. Examination revealed weak dorsalis pedis pulses bilaterally and cold blue toes. He was advised to stop smoking, which he did. One month later, his pulses were much improved, the toes were no longer cold and blue, and he could walk a much longer distance without pain. Which one of the following is the most likely diagnosis?
a. coarctation of the aorta.
b. dissection of the descending thoracic and abdominal segments of the aorta.
c. infrarenal atherosclerotic aneurysm.
d. Takayasu’s arteritis.
e. Buerger disease (thromboangiitis obliterans).
AnswerTags:
MCQ, Pathology, Thromboangitis Obliterans
Which of the following does not usually present with a restrictive type of cardiomyopathy?
a. amyloid heart disease.
b. glycogen storage disease types II and III.
c. AIDS-associated myocarditis.
d. endomyocardial fibrosis.
e. Loeffler’s endomyocarditis.
AnswerTags:
MCQ, Pathology, Cardiomyopathy
The Aschoff body is the characteristic histological lesion of which one of the following diseases?
a. infective endocarditis.
b. rheumatoid heart disease.
c. Marfan’s syndrome.
d. myocardial sarcoidosis.
e. rheumatic carditis.
AnswerTags:
MCQ, Pathology, Aschoff bodies
Pneumonia can result from all of the following except:
a. neutropenia
b. impairment of macrophage function
c. low host resistance
d. loss of goblet cells
e. loss of type II pneumocytes
AnswerTags:
MCQ, Pathology, Pneumonia
A forty year old woman developed ground glass densities in her lung fields as seen on a CT scan. A diagnosis of desquamative interstitial pneumonitis was made. An open lung biopsy showed numerous cells in the alveolar spaces. These cells represent:
a. desquamated lining epithelial cells
b. activated alveolar macrophages
c. neutrophils
d. lymphocytes
e. eosinophils
AnswerTags:
MCQ, Pathology, Diffuse Interstitial Pneumonia
Pulmonary infiltrates with eosinophilia encompass all of the following except:
a. allergic bronchopulmonary aspergillosis
b. chronic eosinophilic pneumonia
c. simple (Loeffler’s syndrome)
d. tropical eosinophilia
e. extrinsic allergic alveolitis
AnswerTags:
MCQ, Pathology, Farmer's Lung
The characteristic lesion of pulmonary asbestosis is:
a. interstitial fibrosis
b. psammoma bodies
c. emphysema
d. dense pleural fibrosis in the upper lobes
e. granulomas
AnswerTags:
MCQ, Pathology, Pneumoconiosis, Asbestosis
A 35 year old machine operator developed diffuse restrictive lung disease and assymetric hilar adenopathy. A PPD was unchanged from a few years ago. He had no systemic disease. He was given steroids with no improvement. Granulomas with numerous schaumann bodies were found on a biopsy. Urine examination most likely showed:
a. beryllium
b. angiotensin converting enzyme
c. red blood cells
d. albumin
e. acid fast bacilli
Answer
Tags: MCQ, Pathology, Sarcoidosis
Idiopathic pulmonary fibrosis is associated with all of the following except:
a. temporal variegation
b. lower lobe disease
c. sudden onset and a rapid course
d. simultaneous epithelial and endothelial injury
e. circulating antibodies
AnswerTags:
MCQ, Pathology, Idiopathic Pulmonary Fibrosis
You are a junior pathologist, first week as an attending, and receive a biopsy labeled “nasopharyngeal mass”. Histologic examination reveals an overwhelming number of small dark cells diffusely distributed with vague nests and scattered single large oval cells with relatively abundant cytoplasm. You believe this lesion represents a type III undifferentiated nasopharyngeal carcinoma. Which immunophenotype would best support your belief?
1.positive Leukocyte Common Antigen (LCA- lymphoid cell marker) in both small and large cells.
2.positive Cytokeratin (CK- epithelial cell marker) in the small dark blue cell population only.
3.positive EBV (Epstein-Barr virus genomic DNA marker) in the small dark blue cell population only.
4.Positive Cytokeratin (CK- epithelial cell marker) and EBV (Epstein-Barr virus genomic DNA marker) in the large oval cells.
5.positive Leukocyte Common Antigen (LCA- lymphoid cell marker) in the small dark blue cells and no staining of the large oval cells with cytokeratin (CK- epithelial cell marker).
AnswerTags:
MCQ, Pathology, Nasopharyngeal Cancer
A tumor of the parotid gland in a 55 year old man histologically is found to consist predominantly of solid sheets of basaloid cells (resembling transitional epithelium). Occasionally these cells are thought to have intracytoplasmic mucin. A mucicarmine stain confirms the rare intracytoplasmic mucin. What is your diagnosis?
a. low grade mucoepidermoid carcinoma.
b. papillary cystadenoma lymphomatosum.
c. high grade mucoepidermoid carcinoma.
d. adenoid cystic carcinoma.
e. malignant mixed tumor.
AnswerTags:
MCQ, Pathology, Salivary Gland, Neoplasms
All of the following statements are true for glycoprotein lIb/IIIa complex except:
a. is a member of the integrin family of adhesion receptors
b. fibrinogen binding is not blocked by an epitope on glycoprotein IIb/IIIa
c. is selectively expressed on the surface of platelets
d. ADP activates the complex
e. can bind fibrinogen
AnswerTags:
MCQ, Pathology, GPIIb/IIIa
The antigen in Goodpasture’s syndrome is:
a. unknown
b. probably a globular non-collagenous domain of collagen IV
c. an Infectious agent such as EBV
d. an organic inhalant
e. denatured DNA
AnswerTags:
MCQ, Pathology, GoodPasture's syndrome
Which one of the following is a manifestation of pauci-articular juvenile rheumatoid arthritis?
A) Uveitis
B) Splenomegaly
C) Thrombocytopenia
D) Glomerulonephritis
E) Erythema nodosum
ANSWERTags:
MCQ, Orthopedics, Rheumatic Disease, Arthritis
The most serious complication of a slipped capital femoral epiphysis is:
A) osteomyelitis.
B) pathologic fracture.
C) avascular necrosis.
D) chondrolysis.
E) gastrocnemius hypertrophy.
ANSWERTags:
MCQ, Orthopedics, femoral epiphysis
An 18-year-old white female presents to the emergency department with a history consistent with a lateral ankle sprain that occurred 2 hours ago while she was playing softball. She complains of pain over the distal anterior talofibular ligament, but is able to bear weight. There is mild swelling, mild black and blue discoloration, and moderate tenderness to palpation over the insertion of the anterior talofibular ligament, but the malleoli are nontender to palpation.
Which one of the following statements is true regarding the management of this case?
A) Anteroposterior, lateral, and 30° internal oblique (mortise view) radiographs should be done to rule out fracture.
B) Stress radiographs will be needed to rule out a major partial or complete ligamentous tear.
C) Early range-of-motion exercises should be initiated to maintain flexibility.
D) For best results, functional rehabilitation should begin within the first 24 hours after Injury.
E) The patient should use crutches and avoid weight bearing for 10-14 days.
AnswerTags:
MCQ, Orthopedics, Sprains, Fracture
A 10-year-old male is brought to your office after sustaining a fall on an outstretched hand. Radiographs show a nondisplaced fracture of the middle third of the clavicle.
Appropriate management would include which one of the following?
A) Intermittent heat to the area to help control pain
B) A figure-of-8 splint or sling support
C) Orthopedic consultation for surgical intervention
D) Early shoulder abduction exercises to prevent adhesive capsulitis
E) Weekly radiographs to assess callus formation
ANSWERTags:
MCQ, Orthopedics, Clavicular Fracture, Clavicle
An 18-year-old male has acute low back pain without paresthesias or other neurologic signs. There is no lower extremity weakness.
Which treatment has been shown to be of most benefit initially?
A) Complete bed rest for 2 weeks.
B) Bed rest plus local injection of steroids.
C) A low back strengthening program.
D) Resumption of physical activity as tolerated.
E) Herbal formulations and/or traction.
ANSWERTags:
MCQ, Orthopedics, Back Pain
A high incidence of osteonecrosis of the femoral head occurs with:
A) femoral neck fractures.
B) intertrochanteric fractures.
C) subtrochanteric fractures.
D) femoral shaft fractures.
E) supracondylar femoral fractures.
ANSWERTags:
MCQ, Orthopedics, Osteonecrosis
An 18-year-old white male comes to your office complaining of pain in the right wrist since falling 2 weeks ago. On examination, he is tender in the anatomic snuffbox. A radiograph reveals a fracture of the proximal one-third of the carpal navicular bone (scaphoid).
Which one of the following is the most appropriate management at this time?
A) A bone scan
B) Physical therapy referral
C) A Velcro wrist splint
D) A short arm cast
E) A thumb spica cast
ANSWERTags:
MCQ, Orthopedics, Wrist Sprain, Fracture
A 3-year-old white female is brought to your office because she is complaining of pain in her right arm. Her mother tells you the pain began after she pulled her daughter by the arm while the girl was fighting with her brother. You examine the child and diagnose “nursemaid’s elbow”.
You recommend which one of the following?
A. Manipulation of the forearm to reduce radial head subluxation
B. Long arm cast immobilization
C. Use of a sling for arm rest
D. A cock-up wrist splint
E. Referral for family counseling
AnswerTags:
MCQ, Orthopedics, nursemaid’s elbow
A high school golfer presents with a history of “tingling hands.” Which one of the following would support a diagnosis of carpel tunnel syndrome?
A) Absence of symptoms at night
B) Numbness in the fourth and fifth digits
C) Wasting of the thenar compartment
D) Provocation of symptoms
E) Positive Phalen’s maneuver
ANSWERTags:
MCQ, Orthopedics, Carpal Tunnel Syndrome
An 18-year-old male is admitted to the hospital after being found lying on the floor unconscious from a drug overdose. The next morning, he is alert and complains of constant pain in the anterior aspect of his left leg. On examination you note pain with passive stretching, pain with palpation anteriorly, and a slightly decreased dorsalis pedis pulse on the left. There is no edema or erythema. Radiographs of the lower extremity are normal.
Which one of the following would you do now?
A. Recommend rest, ice, and elevation along with physical therapy.
B. Begin empiric intravenous antibiotics.
C. Order duplex Doppler ultrasonography of the left leg.
D. Order impedance plethysmography of the left leg.
E. Obtain immediate surgical consulation.
ANSWERTags:
MCQ, Orthopedics, Drug Overdose
An 18-year-old white female college marathon runner presents with persistent pain and tenderness over the public symphysis. With exercise, pain is noted in the lower abdomen and medial thighs. There is no fever. A radiograph shows widening of the pubic symphysis.
What is the most likely diagnosis?
A.Osteomyelitis of the pubis
B.Stress fracture of the pubis
C.Osteitis pubis
D. Inguinal hernia
E. Cystitis
ANSWERTags:
MCQ, Orthopedics, Pubic Pain
A 22-year-old white male who is a distance runner on his school track team complains of left knee pain. On examination, you note tenderness over the distal lateral femoral condyle.
The most likely diagnosis is
A) Osgood-Schlatter disease.
B) osteochondritis dissecans.
C) bipartite patella.
D) iliotibial band syndrome.
E) patellar tendiniti.
ANSWERTags:
MCQ, Orthopedics, Knee Pain
Idiopathic osteonecrosis or avascular necrosis of the capital femoral epiphysis (Legg-Calve-Perthes disease):
A) usually occurs in tall children.
B) affects girls more often than boys.
C) frequently occurs during adolescence.
D) is usually bilateral.
E) is usually associated with a painless limp.
ANSWERTags:
Legg-Calve-Perthes, Orthopedics, MCQ
A 3-year-old white female is brought to your office because she is complaining of pain in her right arm. Her mother tells you the pain began after she pulled the child by her arm while the child was fighting with her brother. You examine the child and diagnose “nursemaid’s elbow.”
You recommend which one of the following:
A) Hyperpronation of the forearm to reduce radial head subluxation
B) Long arm cast immobilization
C) Use of a sling for arm rest
D) A cock-up wrist splint
ANSWERTags:
MCQ, Orthopedics, nursemaid’s elbow
A 13-year-old white female with no prior history of arm pain or dysfunction has sudden severe pain in the upper arm and hears a loud snapping sound in her arm as she serves the ball while playing tennis. The pain is persistent, and swelling develops over the deltoid region. On examination, the upper arm is very tender.
Likely diagnostic possibilities include which of the following?
A) Unicameral bone cyst
B) Aneurysmal bone cyst
C) Osteoid osteoma
D) Primary lymphoma
E) Osteoscarcoma
ANSWERTags:
MCQ, Orthopedics, Bone Tumors, Bone cysts
You are seeing a 5-year-old female child with in-toeing due to excessive femoral anteversion. She is otherwise normal and healthy, and her mobility is unimpaired. Her parents are greatly concerned by the cosmetic appearance and possible future disability, and request that she be treated.
You recommend which one of the following?
A) Observation
B) Medial shoe wedges
C) Torque heels
D) Sleeping in a Dennis Browne splint for 6 months
E) Derotational osteotomy of the femur
ANSWERTags:
MCQ, Orthopedics, In toeing
As a member of the local emergency response management team you are asked about the treatment of nerve gas (e.g., sarin) poisoning. Which one of the following is most effective in reversing the symptoms of nerve gas toxicity?
A) Albuterol (Proventil, Ventolin) via inhalation
B) Ciprofloxacin (Cipro)
C) Atropine
D) Parenteral verapamil (Calan, Isoptin)
E) Parenteral corticosteroids
ANSWERTags:
MCQ, Pharmacology, Chemical Warfare, Nerve Gas
The hospital nursery reports that a 24-hour-old male has developed "acne" confined to his nose and cheeks. Your examination confirms the presence of acneiform lesions, including papules. Which one of the following would be most appropriate?
A) Benzoyl peroxide, half-strength
B) Clindamycin (Cleocin-T) topically
C) An emollient lotion
D) Boric acid rinses
E) No treatment
ANSWERTags:
MCQ, Pharmacology, Acneiform Lesions
Which one of the following intravenous agents given to the mother during labor is the drug of choice for prophylaxis of neonatal group B streptococcal disease?
A) Clindamycin (Cleocin)
B) Erythromycin
C) Gentamicin (Garamycin)
D) Metronidazole (Flagyl)
E) Penicillin G
ANSWERTags:
MCQ, Pharmacology, Drug Of Choice
Which one of the following is indicated for treatment of chlamydial urethritis during pregnancy?
A) Amoxicillin (Amoxil)
B) Ciprofloxacin (Cipro)
C) Erythromycin base
D) Doxycycline (Monodox)
E) Ofloxacin (Floxin)
ANSWERTags:
MCQ, Pharmacology, Dug Of Choice, Antibiotics, Pregnancy
A 25-year-old male has a dental infection associated with facial swelling and lymphadenopathy. Which one of the following is the most appropriate antibiotic?
A) Cephalexin (Keflex)
B) Tetracycline
C) Penicillin
D) Ciprofloxacin (Cipro)
E) Azithromycin (Zithromax)
ANSWERTags:
MCQ, Pharmacology, Drug Of Choice
A 16-year-old sexually active nulliparous white female complains of pelvic pain and vaginal discharge. On examination she is found to have a temperature of 39.8° C (102.0° F), pain with movement of the cervix, and tenderness and a mass in the right adnexa.
According to CDC guidelines, which one of the following treatments would be appropriate?
A) Outpatient treatment with penicillin G procaine (Wycillin) intramuscularly; probenecid (Benemid) orally; plus doxycycline (Vibramycin) orally for 14 days and reexamination in 3 days
B) Outpatient treatment with ceftriaxone (Rocephin) intramuscularly; probenecid orally; plus doxycycline twice a day for 14 days and reexamination in 1 week
C) Outpatient treatment with cefoxitin (Mefoxin) intramuscularly; plus doxycycline twice a day for 14 days and reexamination in 10 days
D) Hospitalization for treatment with cefoxitin intravenously and doxycycline orally or intravenously, then doxycycline orally twice a day to complete 14 days of treatment
E) Metronidazole (Flagyl) 2 grams orally as a single dose and Pap smear
AnswerTags:
MCQ, Pharmacology, PID, Drug Of Choice
Which one of the following is contraindicated in a patient taking an SSRI?
A) Phenothiazines
B) Electroconvulsive therapy
C) α-Receptor blocking agents
D) Monoamine oxidase inhibitors
E) Benzodiazepines
ANSWERTags:
MCQ, Pharmacology, Drug Interactions
You see an 18-year-old obstetric patient late in her third trimester for mild dysuria and urinary urgency. Microscopic examination of the urinary sediment is notable for bacteria and you make a presumptive diagnosis of cystitis.
Which one of the following antibiotics would be CONTRAINDICATED?
A) Nitrofurantoin (Macrodantin)
B) Trimethoprim/sulfamethoxazole (Bactrim, Septra)
C) Amoxicillin/clavulanate (Augmentin)
D) Cephalexin (Keflex)
E) Amoxicillin (Amoxil)
ANSWERTags:
MCQ, Pharmacology, Pregnancy, Drugs
A 30-year-old white female returns to your office for a 6-week follow-up for depression. Six weeks ago she started fluoxetine (Prozac) and she now complains that her libido, which was decreased when she started the drug, has become significantly worse. Which one of the following is appropriate?
A) Continue fluoxetine and tell her that her libido will improve.
B) Continue fluoxetine but increase the dosage.
C) Stop fluoxetine and start imipramine (Tofranil).
D) Stop fluoxetine and start bupropion (Wellbutrin).
E) Stop fluoxetine and start sertraline (Zoloft).
ANSWERTags:
MCQ, Pharmacology, Sexual Drive, Adverse Effects
Which one of the following is a common early side effect of fluoxetine (Prozac)?
A) Constipation
B) Loss of appetite
C) Orthostatic hypotension
D) Atrioventricular block
E) Skin rash
ANSWER
Tags:
MCQ, Pharmacology, Fluoxetine
An 18-year-old female complains of generalized headache, dizziness (characterized as lightheadedness), and generally not feeling well for 3 days. This started at the same time as her menses and coincided with a major examination in a college class she is taking. Her review of symptoms is otherwise negative. Her past medical history includes a recent acute onset of low back pain related to lifting and a recent depressive episode which responded well to medication. Her current medications include an oral contraceptive, which she has taken for 2 years, a corticosteroid nasal spray, and ibuprofen for the past 2 weeks. She was on paroxetine (Paxil), 30 mg/day, for 7 months, but this was stopped 5 days ago because of sexual dysfunction. Because of her symptoms she has not taken any medications for the past 2 days. Since then the headache has eased substantially, but the feeling of lightheadedness has remained. A physical examination is unremarkable.
Which one of the following is the most likely cause of her symptoms?
A) Allergic rhinitis
B) Paroxetine withdrawal
C) Serotonin syndrome
D) Viral infection
E) Stress
ANSWERTags:
MCQ, Pharmacology, Psychiatric Drugs
Which one of the following can contribute to serum calcium elevation?
A) Furosemide (Lasix)
B) Verapamil (Calan, Isoptin)
C) Enalapril (Vasotec)
D) Hydrochlorothiazide (HCTZ)
E) Allopurinol (Zyloprim)
ANSWERTags:
MCQ, Pharmacology, Hypercalcemia
A 9-year-old white female comes to your office complaining of painful, cold finger tips which turn white when she attends evening football games in October and November. While there is no approved treatment for this condition at this time, which one of the following drugs has been shown to be useful?
A.Propranolol (Inderal)
B.Nifedipine (Procardia XL)
C.Ergotamine/caffeine (Cafergot)
D.Methysergide (Sansert)
E.Alcohol (e.g., Budweiser, Lone Star, etc.)
Answer
Which one of the following statements is most accurate concerning juvenile rheumatoid arthritis?
A) Fever is a rare systemic manifestation.
B) Ten years after the onset of disease, most patients have excellent functional status.
C) Most patients have a permanent deformity of a least 1 extremity.
D) The disease is characterized by lifelong recurrences.
E) Most patients require sustained corticosteroid treatment(s).
ANSWERTags:
MCQ, Medicine, Rheumatology
A 74-year-old man is noted to have purplish-discolored right third and fourth toes 4 days after coronary angiography and a creatinine level of 2.4 mg/dL (creatinine level was normal on admission). He has a history of adult-onset diabetes mellitus, hypertension, and 50 pack-years of smoking. Cholesterol crystal atheromatous embolization is suspected. Which of the following may be present?
A. Livedo reticularis
B. Elevated erythrocyte sedimentation rate and/or leukocytosis and/or eosinophilia
C. Prominent gastrocnemius pain or claudication
D. Source(s) of the cholesterol emboli are usually the abdominal aorta or iliofemoral arteries rather than the more distal arteries.
E. All of the above
AnswerTags:
MCQ, Medicine, Atheroma, emboli
Each of the following is characteristic of polymyalgia rheumatica, except
A. Mild joint inflammation
B. Stiffness of the shoulder and hip girdles
C. Weakness of the shoulder and hip girdles
D. Elevated erythrocyte sedimentation rate
E. Normochromic normocytic anemia
AnswerTags:
MCQ, Polymyalgia rheumatica, Medicine
A 50-year-old white man is transferred to your hospital with a presumptive diagnosis of tuberculosis. His chest radiograph shows nodular cavitary lesions in both lung fields. His urinalysis shows 50 RBCs per high power field and 3+ proteinuria. He is scheduled for bronchoscopy with transbronchial lung biopsy in the morning. That evening he has a sudden deterioration consisting of massive hemoptysis and progressive renal failure. The most appropriate therapeutic intervention at this point would be supportive management and
A. IV corticosteroids
B. Antituberculous medications
C. IV cyclophosphamide 4 mg/kg
D. Oral cyclophosphamide 2 mg/kg
E. IV corticosteroids and IV cyclophosphamide 4 mg/kg
AnswerTags:
MCQ, Wegener's granulomatosis, Medicine
Extra-articular manifestations of rheumatoid arthritis that may be associated with severe morbidity or mortality include
A. Rheumatoid vasculitis
B. Pericarditis
C. Cachexia
D. Rheumatoid nodule within the aortic valve
E. All of the above
AnswerTags:
MCQ, Medicine, Rheumatoid Arthritis
A 32-year-old woman presents with left inguinal and groin pain of 1 week duration that is worse with weightbearing and ambulation. Physical examination reveals full range of motion of the left hip. She walks with a limp. She had previously been treated with mechlorethamine, vincristine, procarbazine, and prednisone therapy for Hodgkin's disease. An anteroposterior film of the pelvis demonstrates no osseous abnormality. Which of the following tests would be most useful in making the diagnosis?
A. Serum rheumatoid factor
B. Erythrocyte sedimentation rate
C. Magnetic resonance imaging (MRI) of the left hip
D. Arthrogram of the left hip
E. Blood alcohol level
AnswerTags:
MCQ, Orthopedics, Hip Pain
All of the following are characteristic patterns of joint involvement in rheumatoid arthritis, except
A. Polyarticular involvement
B. Oligoarticular involvement
C. Symmetrical involvement
D. Involvement of the proximal interphalangeal (PIP), metacarpophalangeal (MCP) wrist, and metatarsophalangeal (MTP) joints
E. Frequent cervical spine involvement
AnswerTags:
MCQ, Orthopedics, Rheumatoid Arthritis
A 46-year-old man on hemodialysis for 12 years complains of insidious onset of painful nocturnal dysesthesias involving the thumb and three fingers, relieved by shaking the hand. Physical examination of the hand reveals thenar wasting and numbness over the fingers. Each of the following statements is true, except
A. Deposits of β2-microglobulin AH (amyloidosis associated with hemodialysis) amyloid compressing the median nerve could produce these findings.
B. An entrapment neuropathy could explain these findings.
C. Paresthesias involving the radial side of the thumb, second, third, and fourth fingers suggest compression of the medial nerve.
D. Carpal tunnel syndrome could explain these findings.
E. Deposits of amyloid of the primary type AL (amyloidosis associated with light chains) would be typical.
AnswerTags:
MCQ, Orthopedics, Nerve Entrapment
An 82-year-old woman was hospitalized for treatment of congestive heart failure. She experienced a warm, painful right knee on the 3rd hospital day. The most appropriate procedure would be
A. Blood cultures followed by IV antibiotics
B. Arthrocentesis for diagnostic/therapeutic purposes
C. IV colchicine
D. Allopurinol
E. Ultrasound study of right knee, including popliteal fossa
AnswerTags:
MCQ, Medicine, Septic Arthritis
Rheumatoid factor may be present in each of these conditions, except
A. Adult Still's disease
B. Subacute bacterial endocarditis
C. Vasculitis syndromes
D. Sarcoidosis
E. Sjögren's syndrome
AnswerTags:
MCQ, Medicine, Rheumatoid Factor
All of the following conditions involve the distal interphalangeal (DIP) joint, except
A. Multicentric reticulohistiocytosis
B. Erosive osteoarthritis
C. Psoriasis with nail changes
D. Juvenile chronic arthritis
E. Rheumatoid arthritis
AnswerTags:
MCQ, Orthopedics, Phalangeal joint
A 42-year-old woman with seropositive rheumatoid arthritis has become disabled by pain and tightness behind the right knee. Physical examination reveals cystic swelling over the popliteal fossa and semimembranous tendon. Which of the following is the most appropriate next step?
A. Arthrogram of the right knee
B. Synovial biopsy of the right knee
C. Ultrasound study of the right knee popliteal fossa
D. Venogram of right lower extremity
E. None of the above
AnswerTags:
MCQ, Orthopedics, Swelling, Knee
A 74-year-old woman complains of worsening left knee pain with weight-bearing and ambulation. Examination of the knee reveals a small effusion without warmth, bony enlargement, and crepitus with flexion and extension of the knee. A diagnostic arthrocentesis is performed. Each of the following characteristics of the synovial fluid would be expected, except
A. Pale yellow color
B. Good viscosity
C. Routine culture negative
D. WBC count 800/mm3
E. Glucose 22 mg/dL
Answer
54-year-old woman complains of severe right shoulder pain localized mainly to the midhumerus but also diffusely around the anterolateral shoulder. The onset was sudden and not precipitated by trauma. Physical examination reveals limited abduction with point tenderness over the subacromial bursa and the greater tuberosity of the humerus. A radiograph reveals a linear calcific density in the supraspinatus tendon. All of the following statements are true, except
A. Treatment consists of cortisone injection into the subacromial bursa, NSAIDs, and physical therapy.
B. The calcific density is most likely calcium urate.
C. The diagnosis could not be made by an arthrocentesis.
D. Local tendon injury may be the major cause.
AnswerTags:
MCQ, Orthopedics, Shoulder Pain
43-year-old woman presents with a 3-year history of progressive rheumatoid arthritis that has been partially responsive to various nonsteroidal anti-inflammatory drugs (NSAIDs) and to low-dose oral corticosteroids. After the examination, you decide to treat her active arthritis with methotrexate, currently the most widely used and effective agent for rheumatoid arthritis. Some of the facts to tell her about methotrexate therapy include
A. Therapeutic effects are delayed so that clinical improvement is not generally seen for 3 to 6 weeks after initiation of treatment.
B. Adverse effects may include oral ulcers, nausea, vomiting, pneumonitis, bone marrow suppression, and cirrhosis.
C. CBC, platelet count, alkaline phosphatase level, and serum glutamic-oxaloacetic transaminase (SGOT) level should be obtained every 4 to 6 weeks to monitor therapy.
D. Birth control measures must be in use before methotrexate is started.
E. All of the above.
AnswerTags:
MCQ, Medicine, Methotrexate
A 54-year-old white man is admitted to the hospital because of abdominal pain and "black stools." He has not seen a doctor in years. He smokes two packs of cigarettes daily. Physical exam reveals poor dentition, normal cardiovascular exam, moderate splenomegaly with mild epigastric and left upper quadrant tenderness, and a guaiac stool test positive for occult blood.
Laboratory values reveal a hemoglobin of 9.5 g/dL, hematocrit of 29%, WBC count of 14,500/μL with a fairly normal differential, a platelet count of 540,000/μL, and a ferritin level of 4 μg/L. Serum vitamin B12 levels are elevated.
A bone marrow exam shows hypercellularity without other specific findings, and chromosomes are reported as normal. Endoscopy reveals a gastric ulcer and biopsies are negative for malignancy but positive for Helicobacter pylori infection. Appropriate management at this stage should be
A. Splenectomy
B Transfusion of two units of packed RBCs
C. Observation
D. Antibiotic treatment for the H. pylori infection and iron supplementation for the iron deficiency anemia
E. Antibiotic treatment for the H. pylori infection
AnswerTags:
MCQ, Hematology, Polycythemia
A 62-year-old woman with a platelet count of 1,350,000/μL has been diagnosed with essential thrombocytosis after an exhaustive search failed to reveal any reactive causes for the elevated platelet count. Her platelet count has been greater than 1 million for more than 6 months. The most appropriate therapy now that a diagnosis of essential thrombocytosis has been established is
A. Platelet pheresis
B. Aspirin
C. Anagrelide
D. Hydroxyurea
E. Interferon-[agr ]
AnswerTags:
MCQ, Hematology, Leukemia, Thrombocytosis
A 53-year-old woman comes to see you regarding a possible diagnosis of essential thrombocytosis. She says her gynecologist has noted a platelet count of >550,000/μL on three separate occasions over the past 2 years. Apart from two uneventful childbirths, the woman says she really has no significant medical history. She says she has never been told she was anemic. Lab values reveal a normal hemoglobin, hematocrit, and MCV. The platelet count is 580,000/μL. Your review of the peripheral smear reveals no microcytosis or hypochromia but does show RBC Howell-Jolly bodies. The platelet count on the smear appears elevated, but there are no giant platelets or platelet clumps. What is the next most appropriate step in your diagnostic work-up?
A.Perform bone marrow aspirate and biopsy.
B. Obtain a C-reactive protein and a sedimentation rate, looking for a state of chronic inflammation.
C. Obtain a ferritin level to confirm that there is no iron deficiency.
D. Go back and obtain a more thorough history and repeat the physical exam.
E. Perform chest, abdominal, and pelvic CT scans, searching for an occult malignancy.
AnswerTags:
MCQ, Hematology, Splenectomy
