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
Which of the following patients is least likely to get rhabdomyolysis?
-
New military recruit who does 4 mile run, 100 push-ups in 95 degree weather
-
Otherwise healthy 20 yo male who has influenza A
-
Construction worker trapped under large plank for 5 hours
-
25 yo woman who recently had unprotected anal intercourse with HIV positive male
-
70 yo female with CAD recently started on statin and fibrate
Which of the following is NOT considered appropriate treatment for rhabdomyolysis?
1.5 L/hr NS
Acidify urine to pH <4.5
Dialysis
Maintain UOP >300 ml/hr
Which of the following is NOT an mechanism for acute renal failure?
Myoglobin precipitating in renal tubules leading to renal tubular obstruction
Hypovolemia due to fluid shifting from intravascular space into damaged muscle and interstitum
Toxic effects of free cheletable iron on tubules
Obstruction of ureters due to kidney stones
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
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
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
Which of these can be an early or late feature of rhabdomyolysis?
