Mock 1

A 45 year-old male presents with flank pain and hematuria, he was treated and discharged with pain medications and a urine strainer. He brought in his stone and analysis reveals a calcium oxylate stone.  Which of the following is effective in lowering urine calcium in idiopathic hypercalciuria to prevent the formation of stones?

A 26-year-old woman has a 2 month history of diffuse pain in muscles and joints, tingling in the arms and legs, and fatigue. Vital signs are normal. Examination shows tender points in the trapezius muscles, lateral epicondyles, and greater trochanter areas. There is no evidence of muscle or joint inflammation. Which of the following is the most likely diagnosis?

Naltrexone therapy is to be initiated in a 62-year-old woman for alcohol abuse. Which of the following is the mechanism of action of this medication?

A 54-year old man is brought to the ED stuporous. He was found lying beside a park bench. His breath smells like whiskey, and physical findings are as follows: T 103o F; P 102 bpm and regular, R 30/minute. Laboratory findings are: WBC 32,000 cells/mm3; 86% polys; 10% bands; hematocrit 40%. Chest x-ray shows consolidation density of right lower lobe. Which of the following is the most likely diagnosis?

A 26-year-old male with HIV and acute bilateral pneumocystis jiroveci pneumonia develops new onset atrial fibrillation. The most likely mechanism responsible for the atrial fibrillation is:

An advertising campaign has begun in order to educate the public about the zoster vaccination. Which of the following persons should be counseled to receive the zoster vaccination?

Which of the following patients should receive recombinant hepatitis B vaccine?

A patient presents to your office with a school physical form for entrance into the local college. The patient reports she has received all three of her hepatitis B vaccinations however, she is unable to produce her vaccination record. Which of the following could be ordered to determine if this patient received the immunizations and is immune to hepatitis B?

A 36-year-old woman has newly diagnosed bipolar disorder for which lithium therapy is initiated. Serial determination of which of the following blood tests should be advised?

A 72-year-old man has claudication of the legs due to isolated peripheral artery disease. Addition of which of the following medications is most likely to make the symptoms worse?

A 65 year old male is undergoing evaluation for weakness in the ER. He has a BP of 148/92 and has no chest pain. Which of the following is the correct evaluation of the EKG below?

A newborn infant has meconium ileus. Which of the following is the most likely underlying cause?

A 32-year-old woman has a 3 week history of generalized pruritus. Which of the following diseases is least likely to be associated with this symptom?

According to the latest American Heart Association (AHA) and the American College of Cardiology Foundation (ACCF) guidelines, which of the following is the most important consideration in the treatment of Stage A congestive heart failure (CHF)?

A 35-year-old male presents to your clinic for an initial visit. He has no current complaints and has no significant past medical history. He drinks alcohol occasionally, smokes 1-2 cigars each week, and denies recreational drug use. He does not take any medications on a regular basis but admits to a daily multivitamin. Family history is significant for a father with hypertension and insulin dependent diabetes. Physical examination reveals a well appearing male with blood pressure of 132/84mmHg verified on repeated measurement. The remainder of his exam is unremarkable. Which of the following should you recommend to your patient?

A 45-year-old male suffered a myocardial infarction 4 weeks ago. He now presents to the ED with chest pain, which he has not had since the MI. He describes the pain as a “pressure” sensation in the retrosternal area. The pain has been continuous for the past 24 hours and seems to ease up when he sits up and leans forward. He can’t sleep due to the pain and it hurts when he coughs. What is the most likely etiology of his pain?

A lag in timing between palpation of the radial and femoral pulses in an infant suggests which of the following?

A 67-year-old man with a 10-year history of uncontrolled high cholesterol presents with recurrent episodes of weakness of his right arm and right leg, each episode lasting 15-20 minutes. Physical exam performed when the patient is asymptomatic reveals blood pressure 110/80 mm Hg, pulse 70 beats per minute and regular, and respirations 16/min. Normal sinus rhythm is seen on EKG. Homan’s sign is negative. Cardiac and neurologic exams are normal. Which one of the following initial diagnostic tests should be ordered?

Which of the following medications most commonly causes first degree atrioventricular block?

An 84 year old nursing home patient suffers a cardiac arrest. Upon initial evaluation, she is found to be in the rhythm shown below. After initial unsynchronized cardioversion, which of the following is the most appropriate next treatment?

Which of the following pathogenetic mechanisms is the primary cause of asthma?

A 45-year-old male presents with a 40 pack year smoking history complaints of a chronic cough productive of mucopurulent sputum. The cough has been present for the past 3 years, but he attributed it to a “smoker’s cough”. He has been coughing up a lot of sputum lasting all winter long for the past 2 years. He denies any hemoptysis, weight loss or chest pain. Physical examination reveals a moderately obese male in no acute respiratory distress. Lung fields reveal presence of scattered rhonchi and wheezes. There is 1+ peripheral edema. Which of the following is the most likely diagnosis?

A 45-year-old woman has had increasing shortness of breath, fever, weight loss, and night sweats for the past 4 months. She works as a seamstress, is a non-smoker, takes no chronic medications and did not recently travel prior to her illness. On physical examination her temperature is 100 degrees F and there are fine rales heard in all lung fields. A chest X-ray reveals hilar lymphadenopathy and a reticulonodular pattern of small densities in all lung fields. She is anergic by skin testing to mumps and Candida antigens. A transbronchial biopsy shows numerous small pulmonary interstitial non-caseating granulomas. Which of the following is the most likely diagnosis?

A woman has anaphylaxis manifest by wheezing, flushing, swelling of the lips, and hypotension. Administration of which of the following is the preferred initial therapy?

A 65-year-old Caucasian male presents with a progressive, constant and severe history of dyspnea for the last few weeks. There is a 40 pack-year history of smoking. Physical examination reveals a thin, wasted-appearing gentleman. No cyanosis present. The AP chest diameter is increased. Percussion note over the lung fields is hyperresonant. Laboratory studies reveal increased total lung capacity and absent respiratory acidosis. This is a presentation of which of the following?

An 18-year-old man has a generalized seizure that is his first seizure. Which of the following is the most likely underlying cause?

A 40-year-old man has a 2 month history of easy bruising, weight gain, and purple rash on his abdomen. Blood pressure 146/94 mm Hg. Examination shows a round face with central obesity. Depressed purple striae are noted on the abdominal wall. A high dose dexamethasone suppression test shows decreased ACTH and increased cortisol. Which of the following is the most likely diagnosis?

A 61-year-old woman has a 3 month history of cold intolerance, dry skin, constipation and puffiness of her fingers. Hypothyroidism is suspected. Which of the following is the preferred initial diagnostic test?

A 57-year-old woman has a 2 month history of nausea, anorexia, and 7 pound weight loss. Blood pressure 92/70 mm Hg, pulse 94/min/reg, and respirations 16/min. Examination shows generalized brown hyperpigmentation. Examination of the lungs, heart, and abdomen is normal. Serum sodium is 128 mEq/L and serum potassium is 5.8 mEq/L. Which of the following is the most likely diagnosis?

Which of the following is the common pathophysiologic abnormality in all patients who have syncope?

An 82-year-old man has an episode of blurred vision and is diagnosed as having amaurosis fugax. Which of the following is characteristic of this eye disorder?

A 59-year-old woman has a 3 month history of fatigue, cold intolerance, dry skin, and constipation. Which of the following signs is most suggestive of hypothyroidism?

A 37-year-old male presents with new onset headaches for the past 3 months. They occur daily and are worse in the morning. In the past week, he has noticed a tendency to drop things from his right hand. On examination, vital signs are normal, and general examination is unremarkable. Complete neurologic examination reveals, only a mild weakness of the right upper extremity compared to the left. Which of the following is the most likely diagnosis?

A 4-year-old boy exhibits a lack of social interaction manifest by a lack of facial expression and eye to eye gaze. He has no interest in sharing the activities or excitement of other children. Which of the following is the most likely diagnosis?

A 23-year-old woman has seborrhea on her face. Which of the following is proper counseling?

A 22-year-old presents with “blood in my eye”. He is unable to relate any specific etiology and denies any recent trauma. Normal visual acuity. Physical examination reveals a small amount of blood in the lateral aspect of the sclera of the right eye. Which of the following is the most appropriate treatment for this patient’s condition?

Two weeks after an upper respiratory infection, a 30-year-old man suddenly has vertigo and nausea, but no visual disturbance or headache. Blood pressure is 130/70 mmHg in his left arm sitting and 136/74 mmHg standing. Exam shows an alert man who has nystagmus on right horizontal gaze. Auditory acuity is diminished in the left ear. Weber test lateralizes to the right ear. Air conduction is longer than bone conduction bilaterally. Finger-to-nose and heel-to-shin testing are normal. Which of the following is the most likely diagnosis?

A 22-year-old male presents status post upper respiratory tract infection last week, now complaining of severe pain over the last three days in his right ear. Physical exam finds a bulging tympanic membrane, with loss of landmarks and opacification of the middle ear. Which of the following is the recommended initial treatment for this patient?

A seven-year-old male is brought to the clinic by his mother who is concerned about the patient’s right ear. The child has history recurrent acute otitis media and has been complaining of right ear pain for the last 14 days. The patient reports that the pain has become progressively worse. Physical exam finds otoscopic findings consistent with otitis media. The patient is presently febrile with a temperature of 102°F and you notice a protrusion of his right ear. Which of the following is the most likely diagnosis?

A 57-year-old man has a macrocytic megaloblastic anemia. Which of the following is most likely to be noted in his past medical history?

A 66-year-old man who is receiving unfractionated heparin for 6 days now has diffuse petechiae. Platelet count is 22,000/microL. Which of the following is the most likely mechanism causing the thrombocytopenia?

A patient presents with extreme pain, edema and fever after receiving a puncture wound to the left foot from a nail that penetrated his tennis shoe and sock. The injury occurred 2 days ago. X-rays reveal bony involvement. Which of the following is the most likely organism to cause this condition?

A 15-year-old boy has a 1 day history of pain in this left elbow after playing football. Examination shows local tenderness over the medial elbow. Resisted wrist flexion increases the pain. Pulses in the wrist, arm and hand sensation, and deep tendon reflexes in the arm are normal. Which of the following is the most likely diagnosis?

A 52-year-old female experiences pain on the plantar surface of her right foot in the plantar region that is worse when initiating walking. Wearing tight shoes worsens the pain and the pain is relieved by removing shoes. Examination reveals point tenderness, elicited by dorsiflexing the patient’s toes with one hand in order to pull the plantar fascia taut, and then palpating with the thumb or index finger of the other hand along the fascia from the heel to the forefoot. The patient has tried wearing wider shoes with metatarsal cushions, applying ice, stretching and taking NSAIDS but her symptoms persist. What is the best therapeutic option at this point?

A 42-year-old woman is suspected of having sarcoidosis. An increase in which of the following serum values would be expected in this patient?

A 69-year-old man has a 2 month history of worsening pain in his shoulders, wrists, elbows, and ankles. Examination shows clubbing of fingers and toes. Radiography of the affected areas shows subperiosteal new bone formation. Which of the following is the most likely diagnosis?

A 2-year-old girl ingested a calculator battery. A chest X-ray shows that the battery is in the esophagus at the level of the lower esophageal sphincter. What would be the most appropriate course of action to take at this time?

A 30-year-old patient presents with weight loss, diarrhea, and steatorrhea. A workup reveals that the antiendomysial antibody is positive. What is the most likely diagnosis?

A 71-year-old man has diarrhea that is thought related to antibiotic therapy. Which of the following is the preferred initial diagnostic test for Clostridium difficile infection?

A 14-year-old girl has a 3 month history of cyclic pelvic pain and amenorrhea. Examination shows a purple-red bulge at the vaginal introitus. Which of the following is the most likely diagnosis?

A 16-year-old G0P0 patient presents complaining of lower pelvic pain that alternates from right to left side of her pelvis. She states that it is related to her menstrual cycle and occurs most commonly midcycle. She denies sexual activity. She reports that she takes Motrin with some relief. Her pelvic examination is unremarkable. Which of the following is the most likely diagnosis?

Which of the following is appropriate counseling for a 27-year-old woman who has a history of genital herpesvirus (HSV2) infection?

A 27-year-old female who is 10 weeks pregnant presents the office with vaginal bleeding. Your initial exam finds a uterus which is much larger than expected for her gestational age. This is her first visit to the gynecologist and she has only tested herself with a home pregnancy test. Beta hCG levels are drawn in the office and found to be significantly more elevated than expected. Ultrasound is performed and shows a snowstorm pattern. Which of the following is the most likely diagnosis?

A 27-year-old man has cholera manifest by severe watery diarrhea. Which of the following is the most likely acid-base state to be noted in the patient?

A 20-year-old man has noted a penile discharge with some pain on urination for the last 2 days. On physical examination there is a small amount of whitish exudate that can be expressed from the urethral meatus. Laboratory studies with culture of the penile discharge reveal Neisseria gonorrhea. If untreated, which of the following complications is he most likely to develop as a consequence of his disease?

A 27-year old man presents to the ED complaining of scrotal pain. The pain began 4 days ago and gradually worsened. The patient states his scrotum is too tender to allow for an adequate examination. Rectal exam is normal. Which of the following is the most probable diagnosis?

Which of the following is not a high anion gap acidosis cause?

A 44-year-old woman has an acute ischemic cerebellar stroke. Blood pressure 146/92 mm Hg, pulse 102/min/regular, rectal temperature 102.4 degrees F, and respirations 22/min. Lungs are clear to auscultation. Cardiac examination shows a 2/6 left sternal border diastolic heart murmur. Which of the following is the most likely diagnosis?

A 73 year old male presents with a painful lump on his eyelid. Inspection finds the picture below. Which of the following in the most likely diagnosis?

Presence of which of the following differentiates infectious mononucleosis from Hodgkin’s disease?