Mock 10

A 51-year-old man with type 2 diabetes mellitus has new onset hypertension. Which of the following classes of medicine is the preferred initial therapy?

The presence of which of the following differentiates Gilbert’s syndrome from hemolytic anemia?

A 54-year-old female presents to the emergency room for evaluation of a “severe” left side headache. She describes a very sudden onset two hours ago while at work. She had a single episode of emesis just prior to coming to the ER. Vital signs are BP: 202/112mmHg; heart rate: 96bpm, regular; respirations: 20 breaths/min, non-labored; temp: 98.4° F (oral). Neck stiffness and decreased range of motion are present. Neurological examination reveals slight weakness on the right side. CT scan shows hyperdense areas in the left frontoparietal region without a midline shift. Based on this patient’s history and exam findings, which of the following is the correct diagnosis?

A 65-year-old woman comes to your office complaining of a one-month history of general weakness that worsens as the day progresses. Resting alleviates and physical activity worsens the weakness. She says that she has also been experiencing double vision as the day progresses. On exam you note slight bilateral ptosis and nystagmus on sustained lateral gaze as well as mild generalized muscle weakness. Reflexes and sensory exams are normal. Which of the following diagnostic tests is likely to be positive with this patient’s diagnosis?

An 8-year-old boy has facial tics and is disruptive in the school classroom because of outbursts of profanity and, at other times, echolalia in which he repeats sentences of his teacher. Which of the following is the most likely diagnosis?

Infant respiratory distress syndrome is due to what abnormality?

A dyspneic, coughing, wheezing 10-year-old boy manages to expectorate a mucus plug. You stain the specimen and discover numerous eosinophils. The most likely diagnosis is:

Your patient is a 40-year-old male who had a positive PPD skin test on this year’s physical examination. His medical records indicate a prior negative PPD. Which of the following is the next step in the management of this patient?

Which of the following childhood illnesses is considered infectious and isolation is recommended?

After 6 days of clindamycin therapy, a 57-year-old man has diffuse abdominal cramps and recurrent, watery diarrhea. Blood pressure 110/76 mm Hg, pulse 96/min. Examination shows diffuse abdominal tenderness with increased bowel sounds. Stool is hematest negative. White blood count is 13,500/microL. Which of the following is the most likely diagnosis?

A 28-year-old male presents with an acute onset of dyspnea. Physical exam reveals pulsus paradoxus. Which one of the following chest/pulmonary findings is most indicative of a spontaneous pneumothorax?

A 6-month-old down syndrome child is seen in the office. The chest x-ray demonstrates a boot shaped heart, elevation of the cardiac apex, concavity in the region of the main pulmonary artery, holosystolic murmur radiating to the right lower sternal border, right sided aortic arch and diminished pulmonary vascularity. Which of the following is the most likely diagnosis?

A 26-year-old woman with known Marfan syndrome wishes to become pregnant. The patient should be counseled that she is at increased risk for which of the following?

The most common cause of right sided heart failure is left sided heart failure. Which of the following is the most common cause of left sided heart failure?

A 55-year-old gentleman presents to your clinic for a follow-up visit. He has a history of anxiety, hypercholesterolemia, and GERD. His blood pressure when he entered the room was 146/98mmHg. On your repeat measurement it is 142/90mmHg. At his last two visits his blood pressure was 150/92mmHg and 148/88mmHg. His current medications are buspirone, atorvastatin, and omeprazole. Which of the following is the recommended initial management for this patient?

A 56-year-old male presents with “recurring episodes of light-headedness, dimming of vision, overall weakness, and a fainting sensation” over the past several months. He states that symptoms usually occur when he gets up from his recliner after watching television for several hours in the evening. His blood pressure in the left arm is as follows: 136/76 mm Hg when supine and 100/50 mm Hg standing. Exam is unremarkable. EKG is NSR. Which of the following is the most likely cause of his symptoms?

A 55 year-old female presents with a diastolic harsh rumbling murmur with an opening snap that radiates to the apex, where is this murmur heard best?

Antibiotic prophylaxis against endocarditis is most appropriate for which of the following men?

A 65-year-old male patient presents with a history of recurrent fainting spells over the past three weeks. No cardiac murmurs. Blood pressure supine is 130/70 and standing 128/74. Pulse supine is 72 bpm, standing pulse is 80 bpm. EKG reveals normal sinus rhythm. What would be the next appropriate study to perform?

A 48 year old male presents to the ER complaining of crushing substernal chest pain which began 1 hour ago. He is pale and diaphoretic and has mild shortness of breath. Which of the following disorders is most likely?

The basic effect of hyperventilation on the body is what?

A pre-term newborn infant has transient tachypnea of the newborn. Which of the following is the primary pathophysiologic abnormality in this disorder?

A patient is diagnosed with hypothyroidism and drug therapy is initiated with levothyroxine. When is it best to recheck the TSH level?

Which of the following is the most significant adverse effect of a continuous subcutaneous insulin infusion (insulin pump)?

Your patient is an insulin-dependent diabetic who checks her blood glucose levels at home and recently noticed that her fasting levels have been high and that she has also has been experiencing night sweats and early morning headaches. Last night, during one of these sweats, she checked her blood glucose level and it was 50 mg/dL. Which of the following is the cause of her fasting hyperglycemia?

A 27-year-old man who has AIDS should be counseled not to receive which of the following vaccines?

A 35-year-old woman has the acute onset of right hemiplegia. Blood pressure 116/76 mm Hg, pulse 116/min/irregularly irregular, respirations 20/min, axillary temperature 102 degrees F. Examination of the lungs is normal. A 2/6 apical holosystolic murmur is heard. Right hemiplegia is noted with positive right Babinski. Which of the following is the most likely diagnosis?

The presence of which of the following differentiates peripheral cranial nerve VII palsy in Ramsay Hunt syndrome from the typical Bell’s palsy?

A 33-year-old man has optic neuritis related to multiple sclerosis. Which of the following is characteristic of the eye disorder?

A 36-year-old woman recently returned from a trip to visit relatives in Boston where she sustained insect bites in a wooded area. One week later, a rash developed at the site of one of the bites and increased in size over several days. The rash was flat, erythematous, and measured about 12 cm in diameter; it persisted for 2 weeks and then cleared. The patient was well for another 3 weeks and then she experienced a syncopal attack. A second degree heart block was found on EKG. Which of the following diagnoses is the most likely?

Your patient has a strong family history of allergic disease and personally has allergic asthma and atopic dermatitis. Which of the following conditions is most likely to also be in this patient’s history?

An 18-year-old female is seeing you for a routine pre-college examination. She has no complaints and review of systems is negative. Vital signs including height and weight are within normal limits. Physical exam is normal except for the oropharynx which appears injected without areas of erosion, and the loss of enamel on the front teeth. Which of the following diagnoses do you suspect from these findings?

A patient presents concerned about multiple vesicles with an erythematous base which are grouped around the Vermilion border of his lips. Some of the vesicles have opened into shallow ulcers and are painful. The patient states that the lesions occurred 2 to 3 days after some flulike symptoms. He has had similar episodes in the past. Which of the following is the most likely diagnosis?

Which of the following radiologic findings is the strongest indication of child abuse?

A 72-year-old woman who has diabetes mellitus has a 1 week history of increasing right ear pain with otorrhea. Malignant otitis externa is diagnosed. Which of the following is the most likely infecting organism?

An 18-year-old man has a traumatic injury to the right side of his face causing an orbital floor fracture. He is most likely to have which of the following symptoms on the affected side?

A 49-year-old female presents complaining of intense right eye pain associated with unilateral headache, nausea, and colored rings around lights. On examination you note decreased visual acuity, a pupil that is fixed and mid-dilated, medial crescent shadow, and ciliary flushing. Which of the following is the most likely diagnosis?

A patient who has intravascular hemolysis caused by glucose-6 phosphate dehydrogenase deficiency in erythrocytes is most likely to have which of the following?

An 18-year-old male presents the emergency room after sustaining a cut on his right sole while walking on the street barefoot two days ago. The wound is been significantly contaminated with soil. The patient’s last tetanus immunization with six years ago. Which of the following would be the most appropriate to administer?

A 29-year-old male presents concerned about a lump he found on his neck. He denies any pain or discomfort and found the mass incidentally. The patient has no prior medical history and denies any recent somatic complaints. Physical exam finds a firm, mobile lymph node in the anterior cervical chain. The patient states that the lump has been there for two months and is not changed. Which of the following is the most appropriate course of action?

A 62-year-old man has a 2 week history of progressive weakness. Serum sodium concentration is 123 mEq/L. Syndrome of inappropriate secretion of anti-diuretic hormone is diagnosed. Which of the following is the most likely underlying cause?

A 40-year-old man has recurrent urinary calcium stones and is diagnosed with idiopathic hypercalciuria. Which of the following is the preferred initial therapy?

A 7-year-old boy comes to the office with his mother concerned about him wetting the bed on most nights. Which of the following is the preferred pharmacological agent to decrease the incidence of bed wetting episodes?

A 68-year-old man with symptomatic benign prostatic hypertrophy asks you to prescribe a drug that will make him less symptomatic. You prescribe finasteride. Which of the following is the mechanism of action of this drug?

A 39-year-old white male presents to your office complaining of difficulty swallowing. He said that he first noticed the problem several years ago, but it has slowly worsened so that now he has problems swallowing both liquid and solid foods. He also complains of occasional regurgitation of undigested food, some chest burning and a nocturnal cough. He has not lost any weight. A barium swallow shows a bird’s beak tapering of the distal esophagus. Which of the following is the most likely diagnosis?

Your 63-year-old male patient visits you after having had a routine screening colonoscopy and tells you that several diverticuli were seen in his sigmoid colon. He has no present complaints and his abdominal exam is normal. Which of the following should you recommend to him to prevent complications from his diverticuli?

A 67-year-old woman who suffers from chronic alcohol abuse has a 3 month history of recurrent upper abdominal pain, nausea, vomiting, and 8 pound weight loss. Examination shows a thin, non-icteric patient who has a normal lung, heart, and abdominal examination. Which of the following is the expected radiographic sign to be noted on a plain film of the abdomen?

A 15-year-old athletic boy has a 2 week history of left knee pain. The pain is worsened by jumping and squatting. Examination shows tenderness of the tibial tuberosity and swelling of the joint, but without overlying erythema or heat. Stressing the left quadriceps reproduces the pain. Which of the following is the most likely diagnosis?

Over a period of 3 months, a 56-year-old woman has developed bilateral carpal tunnel syndrome. Which of the following laboratory diagnostic tests should be ordered?

A 12-year-old girl falls on her outstretched left hand. Examination shows tenderness in the ipsilateral anatomic snuff box. A fracture of which of the following bones is most likely?

A 23-year-old woman thinks that she is pregnant and obtains a home pregnancy test. Which of the following is the methodology of this test?

A 71-year-old woman has newly diagnosed carcinoma of the endometrium. Which of the following is the most likely underlying cause of the malignancy?

Hydrocodone with acetaminophen is prescribed for pain in a 55-year-old woman who sustained an ulnar bone fracture. The patient takes nifedipine for essential hypertension. Which of the following is appropriate counseling during intake of the analgesic?

An 84-year-old nursing home patient is brought to the emergency room after one week of progressively worsening diffuse abdominal pain, constipation and abdominal distention. The patient has been vomiting for the last 24 to 48 hours and is unable to eat or drink. Exam shows a patient with a markedly distended abdomen, diffuse tenderness and tympanic percussion. Auscultation finds the patient to have high pitched bowel sounds. Which of the following is the best initial diagnostic study?

Which type of shock is most commonly associated with a long bone fracture?

An epiphyseal plate fracture that extends transversely below the epiphyseal plate away from the joint is classified as a:

Bony enlargement of the distal interphalangeal joints of the fingers is called which of the following?

A 64-year-old female presents to your office complaining of pain with intercourse. She is otherwise healthy and his had no other gynecological issues, and had a negative Pap smear six months ago. She also reports some minor postcoital bleeding. Physical examination reveals thin vaginal tissue with ecchymosis. Which of the following is the most likely cause of this patient’s complaints?

A 50-year-old female with a history of four for vaginal births, complains of incomplete rectal evacuation, rectal fullness and a sense of pressure in her vagina. Which of the following is most likely to be found on physical examination?

A 57-year-old man has chronic systolic heart failure. Addition of spironolactone to his regimen of metoprolol, furosemide, and lisinopril is most likely to cause which of the following adverse effects?