Mock 15

The presence of which of the following differentiates diastolic left heart failure from right heart failure?

A 67-year-old man who has chronic bronchitis now has chronic atrial fibrillation. Which of the following is the preferred medication to control the ventricular rate during his therapeutic walking program?

A 55-year-old woman is suspected of having deep vein thrombosis of her leg. A serum D-dimer level is ordered. Which of the following best describes D-dimer?

A 32-yer-old man has ankylosing spondylitis. Which of the following is most likely sign to be noted on physical examination?

A 26-year-old man is experiencing a prolonged episode of “palpitations”. In the triage area he get weak after complaining of dizziness, shortness of breath, and chest pain. His vital signs are BP: 138/84 mmHg; pulse: 200 bpm, regular; respirations: 20 breaths/min. Cardiac monitor reveals a regular, narrow QRS complex and a heart rate of 200 beats/min. Which of the following is the most appropriate initial intervention?

An 88-year-old male suddenly faints while sitting on the sofa. The syncopal episode lasted approximately 10 seconds. There are no associated symptoms. He is brought to the emergency department where your exam reveals an alert, asymptomatic man with no significant physical examination findings. BP = 140/76 mmHg (right arm, supine), pulse = 78 bpm (irregular), respirations = 16 breaths/min (nonlabored); temp = 97.8° F (oral); SaO2 = 97% on room air. Which of the following tests should be performed first?

A 14-year-old girl has an atrial septal defect. Which of the following is the expected abnormality to be noted on chest radiography?

A 32-year-old man has tendinous xanthomas on his elbows. He is most likely to have which of the following conditions?

Lisinopril therapy is initiated in an 80-year-old woman in treatment of systolic heart failure. In addition to decreasing preload, which of the following is the primary action of the angiotensin converting enzyme inhibitor?

A 70-year-old man has a 2 week history of fatigue and low grade fever. Presence of which of the following would suggest endocarditis as the underlying disease?

A 61-year-old woman has newly diagnosed hypothyroidism caused by Hashimoto’s thyroiditis. Which of the following serum antibodies is most likely to be present?

A 40-year-old female has hyperlipidemia. Her LDL-cholesterol is 200 mg/dL and her triglyceride level is 165 mg/dL. From which of the following lipid-lowering agents is she most likely to benefit?

A 27-year-old Type I diabetic walks into your office with multiple complaints including dizziness and confusion. His blood sugar is 56mg/dL. Which of the following is the treatment of choice for this patient’s hypoglycemia?

A 22-year-old man has cystic fibrosis complicated by recurrent pulmonary infection. Which of the following organisms is most likely to be the infecting organism?

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

A 63-year-old woman has small cell carcinoma of the lung associated with the syndrome of inappropriate anti-diuretic hormone secretion (SIADH). Which of the following is the most likely laboratory abnormality to be noted in the patient?

A 22-year-old woman has asthma. Examination shows nasal polyps. Intake of which of the following is most likely to precipitate acute bronchospasm?

A 33-year-old woman who has never smoked and has never been on oral contraceptives has had 2 episodes of pulmonary embolism in the past year. Presence of which of the following is the most likely underlying cause of the embolism?

What group of pulmonary hypertension does sarcoidosis fall into?

A 23-year old-male with a 1-week history of a URI presents to the office with sharp, lateral chest pain, increasing with inspiration. No history of cough. Lungs are clear to auscultation, no tenderness to palpation. CXR is normal. O2 saturation is 98%. Of the following, choose the best diagnosis and treatment.

A 67 year-old male presents with shortness of breath, a chest x-ray reveals a pleural effusion in the left lung. A pleural effusion will most likely be exudative in which of the following underlying diseases?

A 40-year-old woman has a 3 day history of bilateral, painful purple nodules on her shins. The patient most likely has which of the following underlying disorders?

A 36-year-old man has recurrent folliculitis on his trunk and thighs. Which of the following is the most likely underlying cause?

A 23-year-old man who takes no medicine has a generalized seizure that does not respond to intravenous administration of phenytoin. Which of the following is the most likely cause of the seizure?

Objective signs of nerve root compression such as in cauda equina include all of the following except:

A 22-year-old woman has a 1 week history of intermittent diplopia. Examination shows right ptosis, abnormal medial gaze eye movement, and normal pupil size. Presence of which of the following serum antibodies is most likely to be noted?

A patient is experiencing cannabis intoxication, which of the following symptoms and/or signs are you most likely to discover?

A 77-year-old woman is to undergo major surgery for carcinoma of the pancreas. What is the primary ethical responsibility of the surgeon to the patient?

A 33-year-old woman has a 1 month history of continuous bilateral leg movements associated with unpleasant paresthesias only when lying in bed. Leg movement immediately relieves the symptoms. Restless legs syndrome is diagnosed. Which of the following is the most important serum diagnostic test?

A 24-year-old nursing student presents your office with dryness and cracking her hands with significant erythema and edema. The patient has extreme pruritus in both of her hands and you note a glove pattern distribution. She states this began about four months ago shortly after she started clinical rotations. She has no history of prior eruption or rash and has no past medical history. Which of the following is the most sensitive method for detecting and confirming your diagnosis?

What personality disorder is associated with grandiose thoughts, the need for admiration and heightened concern about what others think?

A 25-year-old woman in her first trimester of pregnancy has acute sinusitis. Which of the following is the preferred antibiotic therapy?

A 14-year-old girl has bilateral nasal polyps. Which of the following is the most likely underlying disease?

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

A 15 year old presents with a diffuse maculopapular rash after being treated recently for pharyngitis. The patient presented 5 days ago with severe sore throat, diffuse cervical lymphadenopathy and fever and was prescribed amoxicillin. Which of the following is the most likely cause of his symptoms?

A 15-year-old female presents the office complaining of severe fatigue. She has recently had onset of severe sore throat, slight fever and a rash on her chest and upper arms. Your exam is positive for significant cervical lymphadenopathy as well as splenic enlargement. Which of the following is the most likely etiology of her illness?

A 30-year-old patient presents complaining of the room “spinning”. She has no other complaints. Which of the following exams is most specific for the diagnosis of benign positional vertigo?

A 35-year-old male presents with fever, chills, “burning” dysuria, perianal pain and micturition urgency. He is most concerned with noticing blood in his ejaculate after coitus. There is no hematuria or casts seen on urinalysis. Patient refuses rectal exam. What underlying condition do you suspect?

Which of the following findings suggests hypocalcemia as the underlying cause?

Which of the following findings suggests hyperkalemia as the underlying cause?

Which of the following findings suggests hypermagnesemia as the underlying cause?

A 62-year-old woman has a 6 week history of vague upper abdominal discomfort radiating through to the back, anorexia, and 7 pound weight loss. Examination shows a 2 cm hard, non-tender left supraclavicular node. The abdomen is flat, soft, non-tender without mass. Which of the following is the most likely diagnosis?

Helicobacter pylori infection is considered to be a risk factor for which of the following disorders?

Despite careful attentiveness to his diet and activity, a 57-year-old man with type 1 diabetes mellitus has frequent hypoglycemic episodes. Which of the following is the most likely cause?

A 38-year-old male patient was involved in an alcohol-induced altercation which resulted in blunt trauma to the abdomen. He currently complains of left side abdominal pain. Vital signs reveals BP: 97/40 mmHg; pulse: 116 bpm, regular; respirations: 24 breaths/minute. Abdominal exam reveals hypoactive bowel sounds on the left side with diffuse tenderness and guarding. Plain film chest and abdominal X-rays show an elevated left hemidiaphragm, fractures of ribs 11 and 12, and loss of the psoas shadow. CT of the abdomen is shown. Which of the following is the most likely diagnosis?

Eighteen hours after having sustained a traumatic fracture of the pelvis, a 27-year-old woman has dyspnea and confusion. A generalized petechial rash is noted. Systemic arterial oxygen level is 56 mm Hg. Which of the following is the most likely diagnosis?

A 37-year-old woman has a reduced serum ferritin level. Which of the following is the most likely associated symptom?

A 37-year-old woman has chronic aching pain in the low back, hips, shoulders, and neck. Trigger points are noted on examination. Fibromyalgia is diagnosed. Which of the following is the preferred initial therapy?

A 19-year-old woman has unprotected sexual intercourse. Which of the following may be taken as an emergency measure to prevent pregnancy?

Post-menopausal women who receive estrogen as their sole hormone replacement therapy, are at an increased risk for which of the following conditions?

A 34-year-old male presents with a three-day history of worsening colicky right upper quadrant abdominal pain, which radiates to his right scapula. The patient’s history is positive for Crohn’s disease, but he has no other pertinent medical history. Physical exam reveals a positive Murphy’s sign. Which of the following is the preferred initial diagnostic imaging procedure for this patient?

Martha is a 45-year-old woman who comes to the ED complaining of several weeks of worsening foot pain. The pain is aggravated with weight bearing in the morning and worsens throughout the day. She has point tenderness at the medial calcaneal tubercle. Which of the following is the most likely diagnosis?

A 62-year-old man complains of six months of gradual pain in his right TMJ, occasional stiffness, and some crepitation. He is able to fully open his jaw. X-rays are normal. ESR is normal. What is the most likely diagnosis?

In an infant, unequal posterior thigh skin folds is suggestive of which of the following?

A 24-year-old female presents to the office for evaluation of her first pregnancy at 20 weeks gestation. Ultrasound shows a twin pregnancy. Upon palpation of the abdomen, where would you expect to find her fundal height?

A 27-year-old female who is 19 weeks pregnant, came to the emergency department complaining of abdominal pain and uterine cramping with vaginal bleeding. Serum beta hCG is obtained. Results are below expected values. Ultrasound is performed and finds that the uterus is empty. Which of the following is the most likely diagnosis?

What vitamin deficiency can leading to spontaneous bleeding?

An otherwise healthy 34 year old female presents for evaluation concerned about frequent “palpitations”. She is very concerned she has a heart problem and seems anxious. Which of the following would be the most appropriate next step?

A 59-year-old woman has a 3 month history of cold intolerance, constipation, and memory loss. Examination shows pale, dry skin, periorbital edema, and slow relaxation phase of deep tendon reflexes. An elevation of which of the following serum values is most likely to be noted?

A concerned mother brings her four-year-old son for evaluation of his complaints of pain in his legs and limping for the last four weeks. On exam you find him to have scattered petechiae and a mild pallor. Laboratory evaluation shows an elevated white count with a predominance of lymphoblasts and anemia. The patient is noted at the time of exam have a temperature of 101°F. Which of the following is the most likely diagnosis?