Mock 14

A 14-year-old girl has anterior chest pressure when running. The discomfort spontaneously ends with 3 minutes of rest. Vital signs are normal. Examination shows an non-cyanotic patient with normal jugular venous pressure and carotid upstroke. An apical lift is felt. A 2/6 ejection murmur is heard just medial to the apex and an apical S4 gallop is heard. Which of the following is the most likely diagnosis?

A 24-year-old asthmatic patient has the acute onset of paroxysmal supraventricular tachycardia. The patient is warm, dry, and alert. Blood pressure 110/74 mm Hg, pulse 200/min, respirations 16/min. Which of the following is the preferred initial management?

A 14-year-old boy with known hypertrophic cardiomyopathy has exertional breathlessness without angina pectoris. Blood pressure is 126/80 mm Hg, pulse 80/min/regular, respirations 18/min. Examination shows bibasilar lung crackles. An apical lift is felt in the 5th intercostal space in the mid-clavicular line. An apical S4 gallop is heard. Which of the following is the preferred initial medication?

Daily amiodarone therapy is initiated in prevention of recurrent atrial fibrillation in a 65-year-old woman with history of remote myocardial infarction. She should be counseled that which of the following is the most likely adverse effect?

Which of the following medications is the treatment of choice for hypotension caused by the administration of Verapamil?

A 72-year-old patient is found pulseless, apneic, and unconscious in one of your hospital beds. The cardiac monitor demonstrates junctional bradycardia. You should immediately do which of the following?

An 8-year-old girl has an undiagnosed large ventricular septal defect. Which of the following is the most likely long term complication?

A 72-year-old man has an acute myocardial infarction complicated by pulmonary edema. Which of the following is the pathophysiologic basis causing the pulmonary congestion?

A 71-year-old man has marked weakness due to chronic systolic heart failure. Blood pressure 94/70 mm Hg, pulse 92/min/regular. Electrocardiography demonstrates sinus rhythm. In addition to furosemide and captopril, which of the following is the preferred additional medicine to be taken by the patient?

A 60-year-old man has a 2 month history of anorexia, nausea, and 5 pound weight loss. Upon clinical evaluation, chronic adrenal insufficiency is diagnosed. Which of the following is the preferred initial management?

A 59-year-old woman has a 2 month history of anorexia, nausea, and weakness. Blood pressure, sitting, 94/70 mm Hg, pulse 106/min/regular. Examination shows hyperpigmentation of skin creases. Serum sodium is 122 meq/L and serum potassium is 5.8 meq/L. Which of the following is the most likely diagnosis?

A 66-year-old man presents to the office with erectile dysfunction and frequent urination, including nocturia x 3. Genital exam reveals Tanner stage 5 external genitalia with an erythematous rash in the groin area, and a slightly enlarged but symmetrically smooth prostate. KOH prep of the rash is positive. Which of the following laboratory test results is most likely given these clinical findings?

A 66-year-old woman with type 2 diabetes mellitus has dizziness upon arising from bed. Sitting blood pressure is 120/74 mm Hg with pulse rate 70/min. Standing blood pressure is 92/58 mm Hg with pulse rate 72/min. Which of the following is the mechanism that is causing the orthostatic hypotension?

A 70-year-old man who has a prosthetic aortic valve is to undergo gum surgery. He has no allergies. Which of the following is the preferred agent in endocarditis prophylaxis?

A 32-year-old woman in her first trimester of pregnancy has community acquired pneumonia. Which of the following is the preferred antibiotic therapy?

When evaluating arterial blood gas results, which of the following test results is the best indicator that your patient is hyperventilating?

A woman with chronic bronchitis has an acute respiratory infection causing the patient to be in severe respiratory distress. Which of the following is the most likely arterial blood gas values to be noted in the patient?

A 3-year-old child has repeated lung infections. Which of the following is the preferred initial test to be performed for suspected cystic fibrosis?

A 58-year-old male returns from a 5 day business convention with anorexia, malaise, and a minimal cough that is nonproductive. He has a fever of 103.7 F, respirations are 26/min, and pulse rate 99 bpm. Exam reveals dry oral membranes and rales over the right base. Chest x-ray shows bilateral pulmonary infiltrates. Serum sodium is 124 mEq/L. The most probable diagnosis is:

A 77-year-old man has shortness of breath. Exam shows a dilated left ventricle and apical S3 gallop. Chest X-rays shows a pleural effusion. Which of the following would be expected in this patient?

A 65 year-old smoker presents with multiple small 3 mm lesions scattered across both lungs, previous chest X-ray shows similar findings. What is the recommended follow up?

The drug of choice for treating Pneumocystis jiroveci pneumonia (PJP) in a patient allergic to sulfa drugs is:

Which of the following is a premalignant condition which predisposes a person to development of squamous cell carcinoma?

A necessary component in the treatment of erythema multiforme includes:

A 45-year-old male presents for a routine physical. His mother and father both had ischemic strokes in their 70’s. He is a non- smoker. His blood pressure is 128/80 mmHg, pulse 78/minutes and regular, respiratory rate of 12/minute. He has an unremarkable cardiac exam and no bruits. Which of the following studies should be ordered to further evaluate this patient’s risk of stroke?

A 54-year-old woman has right sciatic nerve impingement caused by arthritis. Which of the following physical examination signs is most likely to be present on the ipsilateral side?

A 26-year-old woman has painful loss of vision in her right eye that is progressive over two days. Optic neuritis is diagnosed. Which of the following is the most likely underlying cause of the visual disturbance?

A 28-year-old female presents with sudden onset of shortness of breath, a choking sensation, circumoral and carpopedal paresthesia, and carpopedal spasm. She also complains of vague chest pain. Review of systems is unremarkable except for recent increase in stress at work. Vital signs are BP: 110/70 mmHg; R: 32 breaths/min and shallow; P: 82 beats/ min, regular; and an oral temperature of 98.6 degrees F. ECG shows a normal sinus rhythm. Exam reveals tachypnea, although the patient’s breath sounds are normal, and the exam is otherwise normal. Check X-ray reveals no acute cardiopulmonary disease. Which of the following is the most likely diagnosis?

A patient presents to the office with suspected obsessive compulsive disorder; they would most likely have which of the following findings?

A 32-year-old male was struck in the head by a softball during an intramural game and was unconscious for about a minute (according to bystanders). He arrives via EMS and your initial assessment reveals no neurological sequelae. As you are getting ready to send the patient home he asks for a couple of Tylenol because he is getting a headache. He appears a little drowsy and his grip is weak on the right side. You send him back to his bed and order a stat CT scan. Which of the following do you anticipate to see on his scan?

A 14-year-old boy presents with recurrent pruritic eruptions in the flexor surfaces of his arms and legs. Inspection finds the patient with mildly erythematous areas which are mildly lichenified and scaly. The patient has a past medical history which is significant for asthma and allergic rhinitis. Which of the following is the most likely diagnosis?

What personality disorder is associated with poor self-image, unstable interpersonal relationships and poor impulse control?

A 33-year-old man has a 2 day history of vertigo and nausea. The onset of nystagmus during which of the following maneuvers is most compatible with a diagnosis of benign positional vertigo?

For 1 week, a 50-year-old woman has had a common cold with sneezing, rhinorrhea, and nasal congestion. She now has right facial pain, right ear pressure, and decreased sensation of smell. Which of the following is the most likely diagnosis?

Primaquine therapy is initiated in a 21-year-old African American soldier for anti-malarial prophylaxis. One week later the patient has dark brown urine, jaundice, and anemia. Which of the following is the most likely diagnosis?

Which of the following is the primary pathophysiological abnormality in the patient who has hemochromatosis?

A 67-year-old man has a 3 month history of profuse, clear rhinorrhea without nasal congestion that occurs immediately after eating. Gustatory rhinitis is diagnosed. Which of the following is the preferred initial management?

A four-year-old boy is brought in by his mother with concerns about trouble in preschool. She reports that the child does not appear to be paying attention and is also having difficulties with speech. Which of the following must be ruled out first?

A 28-year-old male presents to the emergency room with pain and difficulty opening his jaw. Which of the following is not a potential diagnosis?

A 45 -year-old male presents with small bowel obstruction and he is made NPO, a NGT was placed, antibiotics and IV fluids started. Which of the following Arterial blood gas is most likely to be seen in the patient with continuous nasogastric suction for 4 days?

Normal ranges  – CO2 is 35-45, HCO3 is 23-28

A 27 year-old female with generalized anxiety disorder has a panic attack when she sees a mouse run across the floor. What ABG findings would you find in this patient?

Normal ranges  – CO2 is 35-45, HCO3 is 23-28

A 65-year-old diabetic male on long term dialysis is noted to be anemic but asymptomatic. What treatment for his anemia do you recommend if you suspect it is due to his chronic renal disease?

A 22-year-old black female who suffers from heroin addiction now has generalized edema and massive proteinuria. Which of the following is the most likely diagnosis?

Two weeks after having undergone a Roux-en-Y operation in order to lose weight, a 55-year-old man has weakness, tremor, and profuse sweating that starts 15 minutes after eating. Which of the following is the most likely diagnosis?

Barrett’s esophagus patients are at increased risk for which one of the following?

Phototherapy is initiated in a newborn infant in treatment of physiologic jaundice. The parents should be counseled that which of the following is the most likely adverse effect?

An 18-year-old woman is very thin and is diagnosed with anorexia nervosa. She is most likely to have which of the following signs on examination?

A 12-year-old boy who has sickle cell disease has acute severe pain in his right hip without history of trauma. Examination shows normal vital signs and local tenderness in the hip. Hemoglobin is 9 g/dL. White blood count is 6400/microL. Which of the following is the most likely pathophysiologic basis of the hip pain?

Which of the following clinical characteristics is associated with bicipital tendonitis?

A 23-year-old woman wishes to begin oral contraceptive therapy. She should be counseled that which of the following is an absolute contraindication to estrogen-progestin oral contraception?

In the case of anterior vaginal wall defects, which of the following should be tested?

A 67-year-old obese man has a 1 month history of chronic hoarseness. In the past week he has awakened twice with acute wheezing. He has no dysphagia and has not regurgitated undigested food. Vital signs are normal. Examination of the lungs and heart is normal. Which of the following is the most likely diagnosis?

A 60-year-old male patient presents with intermittent pain over his right metatarsophalangeal joint. On inspection, you notice a tender, red, swollen joint. He is afebrile. Which of the following medications is most likely to be contributory to this patient’s diagnosis?

A 44-year-old woman has tight and shiny skin on her face and fingers. In addition, she has Raynaud’s phenomenon when holding a frozen package. Which of the following is the most likely diagnosis?

A 7-year-old presents complaining of bilateral leg pain and a limp for several weeks. Vital signs are stable. Findings on physical examination are negative except for diminished internal rotation and abduction of the hips bilaterally. Which of the following is the most likely diagnosis?

A 29-year-old female presents complaining of not having a period for the last seven months. She is a busy executive and a year ago started training for a marathon. Beta hCG testing is negative. Which of the following best describes her condition?

Which of the following is the uterine phase present from day 15-28 in the normal menstrual cycle?

A 30-year-old woman has cold, pale, numb fingers in both hands when she holds the cold steering wheel of her automobile during a winter day. Warming the hands for 15 minutes causes the hands and fingers to be flushed. Which of the following is the most likely underlying cause?

What vitamin deficiency can cause rickets and osteomalacia?

A 48 year old patient presents complaining of a “racing heart”. An EKG is obtained and is shown below. Which of the following best describes this rhythm?