Mock 18

An 83-year-old woman has an acute anterior wall myocardial infarction complicated by pulmonary edema. Blood pressure 126/90 mm Hg, pulse 110/min, and respirations 38/min. Which of the following medications should not be administered to the patient?

A newborn pre-term infant has tachypnea. Examination shows a continuous murmur in the left supraclavicular area. Which of the following is the preferred initial therapy?

A 62-year-old man sustains blunt trauma to his chest and abdomen in a vehicular accident. Focal Assessment with Sonography for Trauma (FAST) is most valuable in the diagnosis of which of the following conditions?

A 77-year-old woman has severe anterior chest pressure. ST segment elevation myocardial infarction (STEMI) is diagnosed. Vital signs are normal. 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?

Daily amiodarone therapy is initiated in prevention of recurrent atrial fibrillation n a 55-year-old man with history of remote myocardial infarction. She should be counseled that which of the following is the most likely adverse effect?

A 67-year old man is brought to the emergency room via EMS secondary to a syncopal episode at work. Physical exam reveals a diminished intensity of S2 and a prominent S4. There is a Grade III/VI crescendo-decrescendo systolic murmur best heard at the second intercostal space in the right upper sternal border; it is harsh at the base and radiates to both carotid arteries. Which of the following valvular problems is the most likely cause of his symptoms/findings?

A 71-year-old man has cramping discomfort in both calves while walking. Which of the following is the preferred initial diagnostic test to confirm peripheral arterial disease?

Which of the following heart sounds is likely to be heard in a patient with active angina and no evidence of heart failure?

A 68-year-old man who has chronic hypertension has the acute onset of severe, tearing anterior chest pain. Ten minutes later, blood pressure is 70/40 mm Hg, pulse 140/min/regular, and respirations 40/min. Jugular venous pressure is elevated. Which of the following is preferred initial diagnostic test for pericardial tamponade?

A 46-year-old female is being evaluated for a new-onset hypertension that was discovered on screening at her workplace. The patient had several readings revealing systolic and diastolic hypertension. Patient is currently on no medications. Physical examination is unremarkable. A complete laboratory evaluation revealed hypokalemia as the only abnormality. Which of the following is the most likely diagnosis for this patient?

A 54-year-old female returns to the office for radiographic and laboratory results you sent her for recently. The radioactive iodine uptake is elevated while the TSH levels are suppressed. Which of the following is the most likely diagnosis?

A 30-year-old woman has a 1 week history of sore throat and increasing soreness in her anterior neck. Examination shows a small goiter that is very tender. Subacute thyroiditis is diagnosed. Which of the following is the most likely outcome?

A 64-year-old woman has a 4 month history of cold intolerance, worsening fatigue and constipation. Examination shows dry skin, thick hair and periorbital edema. A decreased serum concentration of thyroid stimulating hormone is most likely to be noted in which of the following?

Therapy is to be initiated for chronic hepatitis C in a 42-year-old woman. Which of the following is the preferred initial therapy?

A 22-year-old non-pregnant woman has gonococcal urethritis. Which of the following is the least appropriate antibiotic therapy?

Which of the following are the organisms most likely to produce epiglottitis in children under the age of three years?

A 39-year-old woman presents with 2 months of dry cough and intermittent low-grade fever. She is a non-smoker and has no significant family history or past medical history. A purified protein derivative (PPD) test and HIV test were recently performed at work and was negative. On physical examination she is afebrile with stable vital signs. Lung auscultation reveals crackles in bilateral upper lobes. Chest x-ray shows hilar and mediastinal adenopathy, mild interstitial disease in the upper lung zones, and several small granulomas in both lungs. What is the most likely diagnosis?

The presence of which of the following differentiates chronic bronchitis from interstitial pulmonary fibrosis?

Isoniazid therapy is initiated in a 17-year-old man in treatment of latent tuberculosis. Which of the following is the most appropriate counseling during the therapy?

The most common cause of respiratory distress in the preterm infant is hyaline membrane disease (infant respiratory distress syndrome). This condition is due to which of the following?

Which of the following is the drug of choice for Mycoplasma pneumonia infection in a eight year old child?

An 18-year-old college freshman has flu like symptoms for a week, he comes to your office telling you he feels horrible and has never been so sick. Exam reveals clear lung sounds, low grade fever, and myringitis in the left ear. Which of the following is the suspected infecting organism?

A 36-year-old man has celiac disease. He is most likely to have which of the following skin disorders?

A 13-year-old girl complains of severe itching and burning pain in her earlobes. She gives a history of wearing new ear studs for the past 3 days. On examination, there is redness and inflammation of both ear lobules with a few blisters. You suspect allergic contact dermatitis to one of the metals in the ear studs. What metal is the most likely cause?

A 63-year-old man has low back pain radiating around the anterior aspect of his right thigh to the knee. Which of the following signs upon examination is most suggestive of L2/L3/L4 radiculopathy?

A 10-year-old boy has a 1 day history of photophobia, headache, fever, and vomiting. Examination shows a lethargic, but oriented, patient with nuchal rigidity. No localizing neurologic signs are present. Which of the following is the most likely diagnosis?

A 9-year-old girl has excessive mood swings at home and in school causing behavioral disturbances. Her appetite is excellent. Blood pressure is 150/50 mm Hg, pulse 112/min/regular, and respirations 14/min. A fine tremor is present. Which of the following is the most likely diagnosis?

An 8-year-old boy has continuing motor and phonic tics. Tourette syndrome is diagnosed. Which class of medication is the preferred initial therapy?

A 73-year-old female is transported via EMS to the emergency department at your hospital due to progressively worsening left side weakness that began approximately two hours ago. Vital signs are: BP-194/106mmHg; pulse-88bpm, irregular; respirations-16, non-labored; SaO2-94% on room air. Physical examination reveals left side facial drooping, dysphasia, and 1/5 muscle strength in left side extremities. Non-contrast CT scan of the head is negative for intracranial hemorrhaging. Which of the following medications is the best choice to treat this patient’s condition?

A 34-year-old woman presents concerned about a darkening in the skin which is occurring at the back of her neck and her axilla. She states that the hyperpigmentation began about eight months ago and is slowly worsening. Exam finds hyperpigmented areas with a velvety feel. Which of the following is the most likely associated disease process?

A 17-year-old female is brought to the office by her mother, she appears extremely thin and after weight was checked is found to be 75% of her normal weight expected weight. The mother has noticed that her daughter has been using laxatives, and eats very little of her lunch and dinner and when asked the patient feels she is overweight. What underlying condition do you suspect?

Which of the following is the most likely organism causing otitis media in a child?

A 62-year-old woman has the sudden onset of painless drooping of the right side of her face. Examination shows weakness of facial muscles on the right side and excessive tearing of the right eye. No skin lesions are noted. Which of the following is the most likely underlying cause?

Which of the following is the most common cause of acute epididymitis in men under the age of 35?

A 59-year-old woman has severe postoperative pain. Laboratory data includes hemoglobin 13 g/dL, blood urea nitrogen 46 mg/dL, and serum creatinine 2.2 mg/dL. Which of the following is the preferred medication for relief of pain?

A 22-year-old woman has a 1 day history of fever, chills, dysuria, and urinary frequency. Presence of which of the following on urine examination is most suggestive of pyelonephritis?

A 66-year-old woman has diabetic nephropathy for which captopril therapy is prescribed. Which of the following is the primary mechanism by which this medication reduces albuminuria?

A 20-year-old male presents complaining of sudden attacks of “the room spinning”. These episodes last only seconds and they occur when the patient looks up or lies down. The patient has no symptoms in the intervals between his attacks. Which of the following is the most likely diagnosis?

A nine-year-old male presents with bilateral parotid enlargement. He complains of some pain when eating but has no other complaints. The mother states that the patient’s vaccines are not up-to-date as she does not believe in vaccinating her children. Which of the following is the most likely complication of this patient’s disorder?

A seven-year-old boy presents to the office with severe pain to his right ear which is become progressively worse over the last 14 days. The patient’s mother states that he is not eaten in the last 24 hours, feels very fatigued and has had a fever. Physical exam finds a sick appearing child and otoscopic exam finds signs of acute otitis media. You note that the patient’s right ear is significantly protruded when compared to his left and he has significant pain on percussion of the mastoid process. Which of the following is the best diagnostic tool for this patient?

In a patient who has alcohol-related cirrhosis, an increasing serum value of which of the following is most suggestive that hepatocellular carcinoma has developed?

A 12-year-old boy who has acute appendicitis. He has no allergies. Which of the following should be administered 30 minutes before operation?

A 42-year-old woman has a 4 week history of fatigue and, now, diffuse itching. Examination shows diffuse hyperpigmentation, scratches on the skin, and hepatomegaly. Serum alkaline phosphatase is 322 units/L, total bilirubin 1.0 mg/dL, and hemoglobin is 12 g.dL. Which of the following is the most likely diagnosis?

A 29-year-old male ate at a seafood buffet dinner last night; he ate a lot of shrimp and scallops. Current symptoms include numbness or tingling around the mouth, abdominal cramps, nausea, vomiting, and diarrhea, All of the following are common pathogens of shellfish poisoning except:

A 7-year-old boy has a 2 week history of pain in both hips without trauma. Vital signs are normal. The patient walks with a limp. Plain radiography of the hips is normal, but bone scan shows reduced perfusion to the femoral heads. Which of the following is the most likely diagnosis?

Two days after major abdominal surgery, a 66-year-old man has the acute onset of painful swelling of his left knee. Pseudogout is diagnosed. Which of the following is the preferred initial therapy?

A 67-year-old man has acute knee pain with swelling. Presence of which of the following radiographic signs is most suggestive of pseudogout?

A 29-year-old infertile woman has had episodic lower abdominal and pelvic pain for 2 years. A physical examination, including pelvic exam, reveals no abnormalities. A Pap smear shows only a few trichomonads and no dysplastic cells. A laparoscopy is performed, and the gynecologist notes the presence of several blue to red 0.2 to 0.4 cm slighted raised lesions scattered on the pelvic peritoneum in the cul-de-sac and broad ligaments. Which of the following is the most likely diagnosis?

A 56-year-old woman has newly diagnosed breast cancer. The tumor is estrogen receptor negative and progesterone receptor negative. Which of the following is appropriate counseling for the patient?

A 27-year-old female presents complaining of anorexia, persistent nausea over the last month with epigastric pain exacerbated by food. She is presently most concerned by an episode of vomiting yesterday in which she vomited what she describes as ”coffee grounds”. The patient is a busy executive who denies any medical history, however states she has taken ibuprofen daily to help with stress headaches for the last 5 months. Which of the following is the most likely diagnosis?

Which of the following structures is the most commonly involved in a rotator cuff tear?

A 35 year-old male presents with joint pains in his hands. Exam reveals symmetric pitting of the nails, sausage fingers and a history of psoriasis.  X-ray demonstrates a cup and saucer appearance. What is the diagnosis?

A 7-year-old boy fell while learning to ride his two wheel bicycle. Several days later, he develops fever of 104 degrees F, orally and he complains of severe localized pain in the lower right leg near the ankle. The painful area is very tender, swollen, with overlying erythema of the skin. White blood count is 26,000 with 94% polys. X-ray of the lower leg demonstrates periosteal elevation. Which of the following is the most diagnosis?

A 27-year-old female presents with a three-day history of vaginal discharge and vaginal pruritus. Physical exam reveals profuse grey-white malodorous discharge. A wet prep is performed and shows flagellated protozoa. Which of the following is the most likely diagnosis?

A 27-year-old pregnant female presents at 30 weeks gestation concerned as she had a sudden gush of clear fluid from her vagina. The patient denies any pain, and overall is well appearing with no other complaints. She is very concerned for the well-being of her baby. Which of the following is least important in aiding the diagnosis of this patient?

What vitamin deficiency can cause Pellagra and psychosis?

A 55 year old male patient is found to have the EKG below during evaluation for bradycardia. Which of the following is the correct evaluation of the EKG below?

A 66 year old male with a history of atrial fibrillation presents to the ER with headache, nausea and vomiting. Nuchal rigidity is appreciated during his exam. His medications include warfarin, diltiazem and simvastatin. His BP is 159/94, pulse 84 and irregular and temperature is 99.8 degrees Fahrenheit. CT of the brain is obtained and is shown below. Which of the following is the most likely diagnosis?

A 44-year-old male presents with fatigue, night sweats and low-grade fever for the last month. On physical examination the patient is found to have splenomegaly. Lab results show the patient with a total white blood cell count of 150,000/microL with significant neutrophilia. The laboratory also reports the presence of a Philadelphia chromosome. Which of the following is the most likely diagnosis?

Which of the following laboratory findings differentiates anemia due to iron deficiency from anemia due to thalassemia?