Mock 19

A 14-year-old boy has newly-diagnosed hypertension. The presence of which of the following signs is most suggestive of coarctation of the aorta?

Marfan syndrome is diagnosed in an asymptomatic 18-year-old man. Which of the following is the most appropriate management?

A 75-year-old man who has type 2 diabetes mellitus and chronic hypertension has new-onset atrial fibrillation. Blood pressure 130/82 mm Hg; pulse is 112/min. Lung examination is normal. The heart size is normal. No murmur or gallop is heard. Which of the following is the most appropriate management?

A 76-year-old man has a 2 week history of worsening generalized fatigue and weakness. Blood pressure is 94/68 mm Hg, pulse 98/min/regular, respirations 18. Auscultation of the lungs is normal. The apical impulse is in the 6th intercostal space in the mid-clavicular line. An apical S3 gallop is heard. Which of the following medications should not be administered?

An 80-year-old woman has increasing frequency of angina pectoris now awakening her from sleep. Vital signs are normal. Examination of the lungs and heart is normal except for an apical S4 gallop. Which of the following should be excluded in the treatment regimen?

A 90-year-old male presents to the emergency department with anxiety, confusion, and altered mental status. He denies chest pain and dyspnea. Vital signs are BP = 92/50 mmHg, right arm (seated); pulse = 124 beats/min (regularly irregular); resp. = 32 breaths/min (non-labored); temp = 97.8 degrees F (oral). Physical examination reveals postural hypotension, delayed capillary refill, cool/clammy skin, and collapsed neck veins. Cardiac exam reveals normal intensity of S1 and S2 with an irregular rhythm. Lungs are clear bilaterally. What is your most likely preliminary diagnosis?

Which of the following medications is most likely to cause muscle aches and pains when initially started?

Documentation of heart murmurs should include all of the following except?

A 20-year-old male using cocaine, has the acute onset of severe, tearing anterior chest pain. Ten minutes later, blood pressure is 64/40 mm Hg, pulse 136/min/regular, and respirations 34/min. Jugular venous pressure is elevated at 7 cm. Which of the following is the most likely diagnosis?

The “dawn phenomenon”, an increase in morning blood glucose levels, is caused by which of the following?

Glyburide is added to metformin in therapy of a 66-year-old man in treatment of type 2 diabetes mellitus. The patient should be counseled that which of the following is the most likely adverse effect?

A premature infant born at 32 weeks gestation has recurrent hypoglycemic spells. Which of the following is the pathophysiologic basis for the hypoglycemia?

As part of the long-term management of a patient with type 1 diabetes mellitus, the glycosylated hemoglobin (HgbA1C) level should be ideally maintained at

Which of the following patients should receive recombinant hepatitis B vaccine?

A 14-year-old boy has sickle cell disease complicated by impaired splenic function. He is at increased risk of infection caused by which of the following organisms?

A 19-year-old man who has cystic fibrosis has a 1 week history of increasing breathlessness, weight gain, and bilateral peripheral edema. Examination shows increased jugular venous pressure, bilateral scattered rhonchi, an enlarged, smooth, and tender liver, and 2+/4 bilateral ankle edema. Which of the following is the most likely diagnosis?

Which of the following disease processes is most likely to cause the development of a lung abscess?

The presence of which of the following on examination of a 29-year-old man who has asthma is most likely to be associated with aspirin-induced wheezing?

An 80-year-old woman with known squamous cell carcinoma of the lung now has unilateral right ptosis, decreased facial sweating and miosis. Which of the following is the pathophysiologic mechanism causing these facial abnormalities?

Chronic respiratory disease, failure to thrive and meconium ileus is most consistent with which of the following diagnoses?

Which of the following lung function test results would be expected in a person suffering from COPD?

A 32-year-old asthmatic on chronic steroids develops worsening cough and pulmonary infiltrates. The serum IgE is elevated. Chest x-ray shows an “air crescent sign”. Which of the following is the most likely diagnosis?

A 25-year-old man has severe seborrhea on his face, chest, and extremities. Which of the following disease process is the most likely associated disorder?

A 32-year-old man has facial folliculitis with scattered pustular lesions. Which of the following is proper counseling?

A 46-year-old malnourished, alcoholic arrives from home via EMS. His wife states that he drinks every day but he drank heavy last night and consumed an entire bottle of vodka. It is now approximately 6 hours after his heavy drinking episode and he is stuporous. Vital signs are BP: 92/42 mmHg (right arm, supine); pulse: 64 bpm (regular); respirations: 12 breaths/min (nonlabored); temp: 97.1 degrees F (oral). Which one of the following conditions requires immediate intervention?

A 37-year-old man is newly diagnosed with chronic fatigue syndrome. Which of the following physical signs is most likely to be noted on examination?

A 57-year-old man has a mood disturbance disorder lasting 3 years characterized by periods of hypomania and periods of depressive symptoms. Which of the following is the most likely diagnosis?

A 54-year-old male presents with ptosis, facial muscle weakness, diplopia, and dysphagia which has been progressively worsening for the past year. Based on his symptomology, he is most likely suffering from which of the following conditions?

A 74-year-old patient with diabetes and peripheral vascular disease presents with pain and erythema of her right lower extremity. The patient states that the redness and pain have slowly progressed in the last two days to involve the entire lower half of her leg. Exam finds a brightly erythematous lower extremity which is warm and painful to the touch. You note the overlying skin to have a tight, glossy appearance. The patient is febrile with a temperature of 101°F. Which of the following is the most likely diagnosis?

A 16-year-old overweight male is noted by his parents to frequently sneak out of the house in order to buy large amounts of snacks several times a week, of note he eats everything in one sitting. What underlying condition do you suspect?

A 73-year-old unconscious female arrives in the ED via EMS after a fall injury at home. She opens her eyes when asked to and responds verbally to your questions but is confused and disoriented. You notice a large hematoma on the left side of her scalp and deformity of her right wrist. She grimaces when you palpate the scalp injury and attempts to pull her arm away when you palpate the injured wrist. What is her initial Glasgow coma scale (GCS)?

A 55-year-old patient presents with an acute onset of a painful, burning sensation in her face with periorbital edema. She denies anything coming into contact with her face, but recently started a medication for her blood pressure. Vital signs are stable. HEENT exam is unremarkable except as noted in the photo below. No respiratory distress is seen and the lungs sounds are clear. Which of the following conditions is the most likely diagnosis?

An 82-year-old man has had 3 episodes of painless blurred vision in his right eye in the past 10 days. He now presents with complete loss of vision in the right eye. Which of the following is the most likely diagnosis?

The presence of which of the following differentiates chronic myelogenous leukemia from chronic lymphocytic leukemia?

An 82-year-old woman has chronic systolic heart failure for which she takes lisinopril, metoprolol, and furosemide. Which of the following serum values is most likely to precipitate ventricular ectopy?

Which of the following is the most important risk factor for carcinoma of the urinary bladder?

A 24-year-old male has fever, irritative voiding symptoms, and perineal/ suprapubic pain for the last two days. Rectal examination elicited exquisite prostate tenderness. Complete blood count revealed leukocytosis with a left shift. Urinalysis showed pyuria and mild hematuria. What is the most likely diagnosis?

A 57-year-old woman has acute, colicky flank pain with microscopic hematuria. Spiral computerized tomography shows the presence of a ureteral stone. Which of the following disorders is least likely to be the underlying cause of the stone?

A 22-year-old woman has a 1 week history of drenching night sweats and fatigue. Examination shows generalized lymphadenopathy, splenomegaly, but no scleral icterus. Which of the following is the most likely diagnosis?

Which of the following is the most likely concern regarding chronic serous otitis media in children?

A two-year-old boy is brought to the emergency room by his mother with unilateral, foul smelling nasal discharge which she states has been going on for the last few days. The patient has no prior medical history and this is the first episode of this type for the mother. She reports that the discharge is progressively getting worse. Which of the following is the most likely diagnosis?

In evaluation of a patient, you note the MRI reports bilateral acoustic neuromas. Which of the following is the most likely underlying disorder?

The presence of which of the following serum antibodies is most likely to be noted in a patient who has primary biliary cirrhosis?

Physical examination in a normal newborn infant will most likely show which of the following?

In addition to having chronic bloating and gas, a 34-year-old woman now has a compression fracture of a vertebra caused by osteoporosis. Vital signs are normal. Complete blood count and fasting plasma glucose level are normal. Which of the following is the most likely underlying disorder?

Oral prednisone is not a primary medication in treatment of which of the following conditions?

A 42-year-old woman who has sarcoidosis has a 2 day history of a painful red eye and blurred vision in her left eye. She is most likely to have which of the following eye disorders?

A 57-year-old man has gout. Which of the following is the expected cutaneous sign to be noted on examination?

An 85-year-old woman has had 3 episodes of blurred vision, each in her left visual field, and lasting 10 to 15 minutes. Examination shows left temporal artery tenderness. Which of the following is the definitive diagnostic procedure?

Which of the following is a characteristic of HELLP syndrome?

A 21-year-old female who is Rh negative presents for her first prenatal visit. Which of the following is the time frame for initial screen of Rh antibody in the fetus?

A 32-year-old male presents the emergency room after four days of diarrhea. The patient reports persistent high fever, nausea, vomiting, abdominal discomfort and loose stools. The patient reports that he’s noted blood and mucus in his stool. His physical exam is grossly unremarkable other than diffuse abdominal pain which is mild on palpation. A complete blood count is obtained and reveals a mild leukocytosis. Which of the following is the most likely organism?

A 24-year-old female fell on her outstretched hand. She presents with swelling to the wrist, palmar abrasions, and marked tenderness over the anatomic snuffbox area. X-rays of the wrist are negative for fracture. Which of the following is the most appropriate treatment?

Alendronate (Fosamax) therapy is initiated in a 56 year old woman for treatment of osteoporosis. Which of the following instructions should be given to the patient?

A 12-year-old male presents with complaints of right knee pain that is aggravated with playing basketball and tennis. He is noted to have mild to moderate swelling distal to the right patella. X-ray reveals ossification at the right tibial tubercle. Which of the following is the most likely to be included in the management of this patient?

A 24-year-old female presents with vaginal and vulvar burning, pruritus, and a vaginal pH of 4.2. She is concerned about some white discharge she has had for the last week. Her past medical history is significant for diabetes but otherwise she is a healthy individual. Which of the following is the most likely diagnosis?

Which of the following most closely defines primary dysmenorrhea?

What vitamin deficiency can cause Wernicke’s encephalopathy?

A 77 year old patient presents for evaluation of “palpitations” and is found to have the EKG below. She had no chest pain, a BP of 128/72 and has an oxygen saturation of 94% on room air. Her past medical history includes diabetes. Review of her EKG from 1 week ago finds the same rhythm. Which of the following is the correct evaluation of the EKG below?

A 29 year old male presents to the ER after he slipped and fell, striking the back of his head. His wife states that after he suffered an initial loss of consciousness, he was “himself” and seemed fine. A few hours ago he became drowsy and began to complain of headache, prompting his visit to the ER. A CT of the brain is performed and is shown below. What is this patient’s diagnosis?