Mock 12

A 15-year-old girl uses an albuterol inhaler to treat her asthma. She uses the inhaler as needed and reports symptoms occurring 3-4 days per week. She experiences symptoms at night no more than once a month. Her spirometry during her most recent office visit is normal. What is the appropriate medical management of this patient?

A 47-year-old homeless man presents to the primary care clinic complaining of fever, weight loss, anorexia, night sweats and a chronic cough that recently became productive of purulent sputum that is blood streaked. Examination reveals a chronically ill and malnourished patient. Which of the following chest x-ray findings supports your suspected diagnosis?

A 33-year-old pregnant female presents to the Emergency Department with an abrupt onset of a single shaking chill followed by a fever, productive cough of rust colored sputum, and pleuritic chest pain. Chest x-ray is pending. Upon physical examination you find the right lower lobe has dullness to percussion, coarse rales, and increased tactile fremitus. What is the treatment of choice?

A 22-year-old male with shortness of breath and a nonproductive cough presents to your office. You have seen the patient in the past and know he is a long time IV drug user. The patient’s temperature is 103.5 degrees F, respiration 40/minute, O2 sat 90% on non-rebreather mask and pulse 140/bpm. Physical exam reveals a thin dyspneic male in moderate respiratory distress, scattered rhonchi, and peripheral cyanosis. Chest x-ray reveals diffuse interstitial and alveolar infiltrates. LDH level is very high. The most probable diagnosis is:

Inhaled beclomethasone therapy in an asthmatic patient increases the risk for which of the following?

Which of the following classes of medications is most likely to cause angioneurotic edema?

An 82-year-old woman has chronic weakness. Blood pressure is 90/70 mm Hg, pulse 94/min/irregularly irregular, and respirations 24/min. Lungs are clear to auscultation. The apical impulse is in the 6th intercostal space in the anterior axillary line. A 2/6 apical holosystolic murmur and apical S3 gallop are heard. Which of the following should not be administered?

A 77-year-old man with known dyslipidemia has a 3 week history of recurrent episodes of dyspnea on exertion without associated wheezing or cough. The dyspnea ends after 4 to 5 minutes of rest. The patient has never smoked. Vital signs are normal. Examination of the lungs and heart is normal. Which of the following is the preferred initial diagnostic test?

Intravenous adenosine is administered to a 30-year-old healthy woman who has the acute onset of paroxysmal supraventricular tachycardia. Which of the following is most likely to interfere with the action of the medication?

A 56-year-old woman has a 3 week history of progressively worsening edema of her feet, ankles, and legs followed by increasing abdominal swelling over the past 6 days. Blood pressure 90/72 mm Hg, pulse 122/min/regular, and respirations 26/min. Examination shows elevation of jugular venous pressure, lungs clear to auscultation, and distant heart tones. Shifting abdominal dullness is noted. Three plus (3 +/4) bilateral edema of the feet and ankles is noted. Which of the following is the most likely diagnosis?

An 84-year-old man with known severe atherosclerotic coronary heart disease is in systolic heart failure. Intravenous administration of which of the following is the best predictor of improved systolic left ventricular function after a revascularization procedure?

Which of the following is the most common cause of sudden cardiac death in young athletes?

Which of the following presentations best describes someone suffering from acute pulmonary edema caused by congestive heart failure?

A 13-year-old boy has exertional angina pectoris without dyspnea. Examination shows normal vital signs, bisferiens carotid arterial pulse, apical lift, 2/6 ejection murmur just medial to the apex, and lungs clear to auscultation. Which of the following medications should be taken by the patient?

A 38-year-old woman has an atrial septal defect with a large left to right shunt. She is at increased risk of which of the following complications?

An 82-year-old man with type 2 diabetes mellitus has newly diagnosed systolic heart failure. Which of the following medicines in heart failure therapy is most likely to lower the plasma glucose level?

A 15-year-old girl is brought to the emergency department in a coma. Exam reveals respiratory rate of 18/min and deep; blood pressure is 88/66 mm Hg right arm recumbent; pulse is 120/min and regular. The patient’s breath has a sweet odor. Blood sugar is 480 mg/dL. Arterial pH is 7.31. Glycosuria and ketonuria are noted. Which of the following is the proper therapy?

A 17-year-old female presents with recent weight loss, thinning of her hair, nervousness and heat intolerance. On exam she has a resting heart rate of 100/min, a fine tremor of her outstretched hands and a smooth, nontender, diffusely enlarged thyroid gland. Which of the following tests would provide the most specific information regarding the etiology of her disease?

One week after falling on the basketball court, a 9-year-old girl has a 1 day history of redness and painful swelling of her left elbow. Which of the following is the preferred initial diagnostic test?

Which of the following is the preferred endocarditis prophylaxis for gingival (gum) surgery in a 71-year-old woman who has a mechanical aortic valve prosthesis and is allergic to penicillin?

A 34-year-old woman who has multiple sclerosis has a 2 day history of worsening pain and blurred vision in her right eye. Which of the following is the most likely ocular diagnosis?

A 37-year-old female with type 1 diabetes awakes with left-sided facial weakness and vague periauricular pain. She is unable to close her left eye. Which of the following is the most likely diagnosis?

The presence of which of the following differentiates delirium from dementia?

A patient suffering from cluster headaches will usually complain of:

The presence of which of the following differentiates acne rosacea from acne vulgaris?

A 76-year-old female presents with a painful rash on the right posterolateral chest wall which she first noticed two days ago. The lesions are localized to the bra line and appear to be erythematous plaques with a few scattered vesicles. She denies any known contacts and has not recently changed her hygiene or laundry products. Which of the following treatment plans is the best choice to treat this patient’s condition?

An 8-year-old boy has facial tics and is disruptive in the school classroom because of outbursts of profanity. Tourette syndrome is diagnosed. Which of the following is the preferred initial therapy?

A 5-year-old boy exhibits a lack of social interaction manifest by a lack of facial expression and eye to eye gaze. He will not play with other children. Which of the following is the most likely diagnosis?

Which of the following skin diseases is best described as consisting of flesh-colored or slightly hyperpigmented lesions with a dry, rough, adherent scale that appear on sun-exposed areas and may progress into squamous cell carcinoma?

A patient’s chest x-ray incidentally shows areas of periosteal elevation, soft tissue swelling, and multiple healed fractures of both arms. Which of the following diagnosis are these findings most suggestive of?

The presence of which of the following differentiates allergic rhinitis from vasomotor rhinitis?

A 46-year-old male 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 7 year old boy presents with bilateral parotid enlargement and orchitis. He has no past medical history, however has not received his vaccines as his mother believes they cause autism. Which of the following is the recommended treatment?

A 9-year-old asymptomatic patient on routine examination of the ears is found to have air fluid levels present and a mild bulging of the left tympanic membrane. The patient has no present complaint and has been a relatively healthy child other than an ear infection three months ago. Which of the following is the most likely diagnosis?

A 44-year-old female presents shortly after starting a new medication complaining of pain and swelling in her gums. Inspection find significant gingival hypertrophy. Which of the following is the most likely causative agent?

A 38-year-old female complains of acute right upper quadrant pain and fever. Examination reveals icteric sclera, right upper quadrant pain with light and deep palpation. Murphy sign is negative. What is the most likely diagnosis?

Fifteen minutes after finishing a meal, a 50-year-old man has dumping syndrome manifest by sweating, tremor, and weakness. Which of the following is the pathophysiologic basis of dumping syndrome?

A 34-year-old woman who has a long history of abdominal bloating and gas is diagnosed with celiac disease. Which of the following is the most likely complication?

A 41-year-old intoxicated male presents to the ED with severe epigastric pain that began acutely 2 hours ago. He has had similar episodes 4-5 times in the past year but never this bad. He is taking prednisone for his psoriasis, lisinopril for his hypertension, protonix for GERD, and wellbutrin as part of a smoking cessation program. Vital signs are stable. Bowel sounds are hyperactive and he has severe epigastric tenderness with guarding and rebound tenderness. Which of the following is the most likely cause of his symptoms?

Which of the following laboratory tests assesses the “intrinsic” coagulation pathway?

A 15-year-old athletic boy has a 2 week history of left knee pain. Examination shows tenderness of the tibial tuberosity and swelling of the joint, but without overlying erythema or heat. Osgood Schlatter disease is diagnosed. Which of the following is proper counseling for the patient?

A 29-year-old nulliparous patient comes to your office to discuss pregnancy. She and her mate have been trying for more than a year to have a child. Her history is unimpressive except for diagnosed polycystic ovarian syndrome. Semen analysis of her partner is noncontributory. Initial management for this patient would be which of the following?

A 23-year-old breastfeeding female has acute mastitis. Which of the following is the most common organisms in postpartum mastitis?

A 47-year-old man has a 1 week history of polydipsia and polyuria. Serum sodium is 152 mEq/L and fasting plasma glucose is 89 mg/dL. Which of the following is the most likely diagnosis?

A 57-year-old postmenopausal female with a history of diabetes, epilepsy, and hypertension presents with numbness and tingling in her fingers and toes, intermittent muscle spasms in her hands and legs, and a depressed mood for the past several weeks. HPI is otherwise unremarkable. Current medications include phenytoin, hydrochlorothiazide/spironolactone, conjugated estrogens, and pioglitazone. Vital signs are stable. Physical examination is significant for a positive Chvostek’s sign and diminished light touch sensation in the fingers and toes. Strength is equal bilaterally. ECG shows a prolonged QT interval. Which of the following is the most likely diagnosis?

A 13-year-old male presents to the emergency department with fever (102.1° F; oral), anorexia, and oliguria with dark urine. Physical examination reveals periorbital edema and right-sided CVA tenderness. CBC is WNL. Basic metabolic profile is significant for a creatinine level of 4.2 mg/dL (normal: 0.8-1.4 mg/dL). Urinalysis reveals proteinuria and RBC casts. Which of the following is the most likely diagnosis?

A 20-year-old African American man who is an intravenous heroin drug abuser now has nephrotic syndrome. Which of the following is the most likely kidney disorder?

A 64 year old male presents with painless jaundice. An increasing serum level of which of the following is most suggestive of the development of pancreatic cancer?

A 32-year-old male presents complaining of a 3 month history of alternating constipation and diarrhea with transient abdominal pain. He does note that abdominal pain, when it occurs, is relieved with defecation. The patient states he does have mucus but no blood in his stool. He has had no fevers or weight loss. Which of the following is the most likely diagnosis for this patient?

Which of the following is the most common presentation of sickle cell anemia in an infant?

A 38-year-old male sustains a twisting injury to his right knee. He is placed in the supine position and the knee is placed in a position of maximal flexion. On rotating the leg externally and gradually extending the knee (McMurray’s test), a clicking sensation is noted. This is suggestive of which of the following diagnosis?

Carpal tunnel syndrome is caused by compression of which of the following structures?

The Ortolani test involves the examination of which of the following?

A 32-year-old female who is 34 weeks pregnant presents with painless vaginal bleeding. She has a previous obstetric history which is unremarkable except for spotting which occurred at 27 weeks gestation. Which of the following, which is the most likely diagnosis?

A 24-year-old female complains of worsening dysmenorrhea. She has periods which occur at normal intervals however are heavy with clotting and mild pain with defecation. She also has an associated abdominal pain which she states worsens just prior to and during her menstruation, and states she has been unable to conceive for the past four years. Pelvic exam is normal except for painful nodules noted posterior and to the left of the cervix. Which of the following is the most likely diagnosis this patient?

Methotrexate therapy is initiated in a 33-year-old woman in treatment of rheumatoid arthritis. The patient should take which of the following supplements?

A 34-year-old woman with known Raynaud’s disease now has hypertension. Administration of which of the following is most likely to worsen the vasoconstriction of Raynaud’s disease?

A 62-year-old female presents to your office with a sudden episode of left-sided sharp chest pain and mild shortness of breath two days after a month long vacation in Australia. She states she had the flu at the start of the vacation but she was feeling better in about 2 weeks. B/P is 120/70 mmHg, HR is 112 bpm and Respirations are 22. Her V/Q scan is positive. Which of the following is the most likely EKG finding for this patient?

A 62 year old male presents to the ER with “palpitations” and chest pain. His BP is 82/50 mmHg and you note him to be pale and diaphoretic. An EKG is obtained and is show below. Which if the following is the most appropriate initial treatment?

A 66-year-old woman has the acute onset of palpitations. Electrocardiography shows new atrial fibrillation. Which of the following is most closely associated with atrial fibrillation?