A 40-year-old, moderately obese man presents with a persistent productive cough. The cough has been present for several weeks, but recently the man noted that his sputum has assumed a greenish color. Further questioning elicits a history of productive cough , usually in the winter months, over the past several years. He has smoked two packs of cigarettes per day since he was 16 years old. On examination, the man is febrile (100° F), and coarse rhonchi and wheezes can be appreciated bilaterally. Which of the following is the most likely diagnosis?
A. Bronchogenic carcinoma
B. Chronic bronchitis with superimposed infection
C. Cystic fibrosis
D. Emphysema
E. Pulmonary tuberculosis
Answer
A healthy, 37-year-old, recently divorced woman loses her job at the auto factory. She picks up her three young children from the factory day care center and gets into an automobile accident on the
way home. Her 5-year-old son, who was not wearing a seat belt, sustains a severe head injury. The woman was not hurt in the accident, but is hyperventilating as she sits in the waiting room at the
hospital. She complains of feeling faint and has blurred vision. Which of the following is decreased in this woman?
A. Arterial oxygen content
B. Arterial oxygen tension (PO2)
C. Arterial pH
D. Cerebral blood flow
E. Cerebrovascular resistance
Answer
A 37-year-old female presents to the emergency room with a fever. Chest x-ray shows multiple patchy infiltrates in both lungs. Echocardiography and blood cultures suggest a diagnosis of acute bacterial endocarditis limited to the tricuspid valve. Which of the following is the most probable etiology?
A. Congenital heart disease
B. Illicit drug use
C. Rheumatic fever
D. Rheumatoid arthritis
E. Systemic lupus erythematosus
Answer
A 26-year-old man is admitted through the emergency department to the hospital for a heroin overdose. His heart rate is 45 beats/min, and his blood pressure is 75/40 mm Hg. Which of the following best depicts the results from an arterial blood sample ?
pH PaCO2 (mm Hg) HCO3- (mEq/L)
A. 7.22 66 26
B. 7.34 29 15
C. 7.40 40 24
D. 7.47 20 14
E. 7.49 48 35
Answer
A chronic alcoholic develops severe memory loss with marked confabulation. Deficiency of which of the following vitamins would be most likely to contribute to the neurologic damage underlying these symptoms?
A. Folic acid
B. Niacin
C. Riboflavin
D. Thiamine
E. Vitamin B12
Answer
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
Answer
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
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
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
Which of the following is not true about serum amylase in a case of acute pancreatitis?
a) It is widely used as a screening test
b) Remains elevated for weeks
c) 85% have elevated levels
d) Maybe normal with coexisting hypertrigyceridemia
Answer
A 75 year old man presents with a 1 year history of progressive memory loss. He has a past history of MI, hypertension & type II diabetes. Examination reveals absent peripheral pulses & bilateral carotid bruits. Which of the following tests is most likely to determine the cause of his memory loss?
Psychometric testing
CSF examination
CT Brain
EEG
Carotid doppler
Answer
What is the most common organism causing pneumonia in an elderly lady living in a rest home?
St pneumonia
H influenzae
Mycoplasma
Klebsiella
Chlamydia pneumonia
Answer
An elderly patient has dysphagia. The patient is at high risk of aspiration with which of the following?
A. Refusal to eat
B. Absent gag reflex bilaterally
C. Dysarthria
D. Facial weakness & drooling
E. Weak cough & decreased voice strength
Answer
One of the following statements is incorrect about Jaundiced patients
A. non A - non B hepatitis can be transmitted by drinking contaminated water.
B. hepatitis B is associated with the development of hepatocelllular carcinoma.
C. acute cholangitis carries a mortality of about 40%.
D. hepatitis A typically produces a carrier state following the acute infection.
Answer
