Mock 17

An 82-year-old woman who does not drink alcohol has a 1 hour history of severe abdominal and back pain without nausea or vomiting. Blood pressure 74/50 mm Hg, pulse 114/min, respirations 22/min, and axillary temperature 98.6 degrees F. Examination shows mild abdominal distention and tenderness, but no mass. Hemoglobin is 10.2 g/dL and white blood count 6700/microL. Which of the following is the most likely diagnosis?

An elevated serum level of which of the following is a predictor of future cardiovascular events?

An 84-year-old woman has an acute ST segment elevation (STEMI) anterior wall myocardial infarction. She is in normal sinus rhythm. Blood pressure 110/70 mm Hg, pulse 98/min/reg. Auscultation of the lungs is normal. Cardiac examination is normal except for the presence of an S4 gallop. Chest radiography shows no evidence of heart failure. In addition to aspirin, nitrates, and a beta adrenergic blocker, which of the following classes of medicines should be given?

A 74-year-old man has the acute onset of anterior chest pressure lasting 1 hour. ST segment elevation myocardial infarction is diagnosed. At the time of presentation in the emergency department the patient is taking simvastatin and sildenafil. Blood pressure is 114/78 mm Hg, pulse 98/min/regular, respirations 18/min. Lungs are clear to auscultation. Heart size is normal with an apical S4 gallop. Which of the following should not be administered in the therapeutic regimen?

An 81-year-old woman has increasing frequency of angina pectoris now awakening him from sleep. Vital signs are normal. Examination of the lungs and heart is normal except for an apical S4 gallop. In addition to aspirin, metoprolol, and heparin, which of the following should be administered?

A 60-year-old male suffered a myocardial infarction 6 weeks ago. He now presents to the ED with dyspnea, a low grade fever, and chest pain. He describes the pain as a “sharp” retrosternal discomfort that 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 states it hurts when he coughs or takes a deep breath. What is the most likely etiology of his pain?

Which one of the following valvular heart problems is most likely to cause a systemic emboli?

The second heart sound (S2) marks the onset of what cardiac event and consists of what valve closures?

A 72-year-old woman has a 3 week history of weakness. Blood pressure 92/74 mm Hg, pulse 102/min/regular. Examination shows the apical impulse to be in the 6th intercostal space in the anterior axillary line. A 3/6 apical holosystolic murmur is heard. Which of the following medicines should not be taken by the patient?

A 52-year-old woman has a 3 month history of easy bruising and rounded face. Examination shows hypertension, buffalo hump in the back of the neck, abdominal striae, and hirsutism. Which of the following is the preferred initial diagnostic test?

A 63-year-old obese man has gastroesophageal reflux with frequent heartburn. He now has newly diagnosed hyperlipidemia. Which of the following medicines should not be prescribed?

A 48 year old male has recently been diagnosed with secondary hyperparathyroidism. Which of the following is the most likely underlying disorder responsible for his condition?

Six months after a surgical splenectomy, a 22-year-old man has the acute onset of generalized abdominal pain and fever. Peritonitis with bacteremia is diagnosed. Which of the following is the most likely infecting organism?

A 60-year-old man has a 2 week history of progressive weakness without nausea or vomiting. Serum sodium concentration is 124 mEq/L. Chest radiography shows a hilar mass with mediastinal adenopathy. Which of the following is the most likely diagnosis?

Pulse oximetry may produce falsely high (normal) readings in the presence of what condition?

A 50-year-old man has a 3 day history of fever, productive cough, and pleuritic chest pain. Examination shows a flat percussion note, increased tactile fremitus, and bronchial breath sounds over the lower left posterior chest. Which of the following is the most likely diagnosis?

Ten hours earlier a 75-year-old man was bitten by a stray dog on the left leg. Which of the following is the preferred antibiotic to be given in prevention of infection?

An 18-year-old woman has asthma, she has been doing well on her albuterol inhaler but is now having nighttime episodes of wheezing once or twice a week. What agent should be added to her regimen?

Which of the following conditions often is associated with a high hematocrit?

A 25-year-old healthy patient cleaning out an old storage unit that has been untouched in the dry desert air for 10 years. While sweeping he inhaled a lot of dust. He felt fine for a few days but then became acutely short of breath and required intubation in the Emergency room.  His chest X-ray shows bilateral congestive changes.  What do you suspect caused the acute respiratory distress?

Ipratropium therapy is initiated in a 62 year old man for treatment of chronic bronchitis. Which of the following is the mechanism of action of this medication?

A 31-year-old man has an acute allergic contact dermatitis. He most likely had contact with which of the following?

A 27-year-old female presents with complaints of dysuria associated with fever, malaise, myalgias and headache for the past 4 days. Today she noticed some lesions on her genitalia. Physical examination reveals the presence of multiple clear vesicles and erythematous ulcers with tender bilateral inguinal adenopathy. Which of the following is the most appropriate treatment for this patient?

A 40-year-old man has recently diagnosed cluster headaches. During a headache, which of the following is least likely to be noted on examination?

A 49-year-old patient had a 45-minute episode of weakness, numbness and heaviness of the left arm and left leg approximately 5 hours ago. She is brought to the ER for evaluation, while there she is given aspirin 325mg orally. At the time of examination she is alert and asymptomatic. BP 142/88 mmHg (right arm; sitting). Pulse is 74 bpm (regular). Examination of the heart is normal. A left carotid bruit is heard. No neurologic deficits are noted. CT scan of the brain is negative for hemorrhage. The most appropriate next step is:

A 59-year-old man has pain extending from his back down the posterior aspect of the left leg to the foot. Examination shows weakness of plantar flexion and weakness of toe flexion on the affected side. A radiculopathy affecting which of the following nerves is most likely?

A 30-year-old woman has taken clonazepam for 3 months in treatment of generalized anxiety disorder. Which of the following is the most likely effect if the medication is withdrawn too rapidly?

A 42-year-old woman who is an executive in an advertising agency has acute fear of riding in an elevator. Which of the following is the most likely diagnosis?

An 86-year-old man has Alzheimer’s disease. Which of the following classes of medicine is the preferred initial therapy?

Target lesions appearing after exposure to a drug are most likely representative of which of the following?

A mother reports that her 19-year-old son has multiple compulsions he has to do before completing a task, such as knocking on the door four times before entering, checking to see if the stove is off nine times before leaving the house which is interfering with his daily functioning. Furthermore, if he is unable to perform the task such as checking the stove 9 times before leaving he gets extremely agitated and fearful the house will burn down. What underlying disorder do you suspect?

A 66-year-old obese woman has a 2 month history of hoarseness. She has never smoked. Which of the following is the most likely cause?

What is the most likely mechanism responsible for retinal hemorrhages and neurologic complications in a patient with infective endocarditis?

The term “left shift” in hematology refers to which of the following in the peripheral blood?

In a patient with acute kidney injury secondary to a post renal cause, lab findings in the first one to two days will show all of the following, except:

In a patient with post-renal AKI, what treatment will most likely correct the problem?

A 53 year old male presents to your clinic concerned about an enlarged right testicle. There is no pain and he is afebrile. He first noticed a slight enlargement after he slid into a saddle horn while riding his horse five years ago. He did not seek treatment, but he recalls it caused significant pain. The same testicle now seems to be getting larger. What is the most likely cause of the enlarged testicle?

A 60 year old male presents to your clinic with a painless, enlarged left testicle. It has been enlarged for years, but he thinks he ought to have it checked, “Just to be sure it’s not cancer.” Of the following options, which is the next best diagnostic tool?

A 49-year-old patient presents with a four-month history of purulent discharge from her left ear and a two week history of a left seventh nerve palsy. On inspection, the external ear canal is significantly narrowed, edematous and filled with bright red granulation tissue. The patient’s past medical history is positive only for diabetes and she has no other somatic complaints. Which of the following is the most likely causative organism?

A 13-year-old patient presents with a complaint of three months of pain in his right ear. Examination of the external canal reveals fluffy white debris and exfoliated scales of blackish material. You also note punctate black colonies on the tympanic membrane. Which of the following is the most likely diagnosis?

A 32-year-old scuba diver presents to the office concerned about four days of pain, decreased hearing and slightly bloody drainage from his left ear after returning from a dive trip to the Bahamas. Physical exam finds an erythematous tympanic membrane with a small area of perforation and serous discharge. Which of the following is the most likely diagnosis?

A 63-year-old man has ascites and peripheral edema due to advanced cirrhosis with portal hypertension. In addition to furosemide, addition of which of the following is most effective in promoting diuresis?

Which of the following is the diagnostic test of choice in the emergency department for suspected cholelithiasis in an adult?

An 11-year-old boy who has sickle cell disease has the acute onset of right upper quadrant abdominal pain, nausea, and vomiting. Blood pressure 90/72 mm Hg, pulse 106/min, respirations 22/min, oral temperature 99.6 degrees F. The patient is in moderate distress without icterus. Examination of the lungs and heart is normal. The abdomen is flat and soft. Right upper quadrant tenderness without rebound is noted. Bowel sounds are generally hypoactive. Which of the following is the most likely diagnosis?

A 23-year-old male presents with a 9-hour history of worsening generalized, “crampy” lower abdominal pain with associated nausea, vomiting, fever, and chills. Blood pressure = 92/62 mmHg (right arm; supine); pulse = 114 beats/min (regular); respirations = 28 breaths/min; temp = 103° F (oral). On physical exam he is noted to have moderate right lower quadrant tenderness with guarding and rebound tenderness. Which of the following tests would be the most useful in establishing your diagnosis?

A 22-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?

A 20-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?

A mother presents with her 10 day old daughter and states that the child has been vomiting after feeding for the past three days. The mother is concerned as the vomiting has become progressively worse and more forceful. She states that the baby is always hungry and wishes to eat. Which of the following is the most likely diagnosis?

A 12-year-old baseball player jammed his index finger while trying to catch a ball. He now has a disruption of the extensor tendon at the point of insertion on the dorsal aspect of the distal phalanx. This type of injury is referred to as a:

A 2-year-old child is brought to you because he refuses to use his right arm. He is holding the arm in a semi-flexed adducted and pronated position. Any attempt to touch it is met with a cry and the child will not hold objects in the right hand. The mother denies trauma but she did pull the child by the arm recently when he refused to go into an elevator. Which of the following is the most likely diagnosis?

A 48-year-old woman with rheumatoid arthritis has a 1-day history of hot and painful erythematous swelling of the right knee. White blood cell count is 22000/mm3. Which of the following is the most likely diagnosis?

Which of the following is the most common infecting organism in osteomyelitis?

A 24-year-old female presents with a history of regular menses until four months ago. Since then she has menstruated every 6 to 8 weeks but lasting only 3 to 5 days. Which of the following terms best describes this patient symptoms?

A 22-year-old patient presents requesting birth control. She is presently involved with several sexual partners and frequently has unprotected sex. She has a history of one elective abortion and one episode of pelvic inflammatory disease. Which of the following forms of birth control would you be least likely to recommend for her?

A 32-year-old woman has an acute inflammatory arthritis. Malar rash is present. Which of the following serum antibodies is considered to be most specific for systemic lupus erythematosus?

A young woman has early, moderately active rheumatoid arthritis. Which of the following medicines is the preferred initial disease-modifying anti-rheumatic medication?

What vitamin deficiency can cause fatigue, bleeding gums and impaired wound healing?

A 41 year old male while in the ER suddenly develops “palpitations”. He has no chest pain. His BP is 148/84 mmHg and his oxygen saturation on room air is 98%. An EKG is obtained and is show below. Which if the following is the most appropriate initial therapy?

A 41 year old male while in the ER suddenly develops “palpitations”. He has no chest pain. His BP is 148/84 mmHg and his oxygen saturation on room air is 98%. An EKG is obtained and is show below. Which if the following is the most appropriate initial therapy?

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