Mock 2

A 34-year-old woman has iron deficiency anemia caused by menorrhagia. She is most likely to have which of the following symptoms related to the iron deficiency?

A 59-year-old diabetic woman, whose only medication is Lente insulin, had a 30-minute episode of weakness and heaviness of the right arm and right leg approximately 2 ½ hours ago. She is brought to the emergency department via EMS for evaluation. At the time of examination she is alert and asymptomatic. BP 150/94 mm Hg. Pulse 86 bpm/irregular. Respirations are 16 breaths/minute and nonlabored. Cardiac exam reveals normal intensity of S1 and S2 with a Grade IV/VI systolic ejection murmur in the mitral area but no rubs or gallops are heard. A left carotid bruit is heard. No neurologic or speech deficits are noted by exam. The most appropriate next step is:

One hour after major surgery, a 59-year-old woman has generalized muscular rigidity and high fever. Malignant hyperthermia is diagnosed. Which of the following is the preferred initial therapy?

A 77-year-old man has nerve deafness. His examination shows an enlarged skull. The serum alkaline phosphatase level is elevated, but serum gamma-glutamyl transpeptidase is normal. Which of the following laboratory values is most suggestive of Paget’s disease of bone?

A 77-year-old woman has chronic shoulder girdle pain. Polymyalgia rheumatica is diagnosed. The patient now has a 1 week history of right sided headaches associated with scalp tenderness. Which of the following is the most likely additional diagnosis?

A 74-year-old female presents with an abrupt onset of confusion and memory loss. Her sister says she was fine a week ago when they saw each other. She is alert and oriented to person only. Her mini-mental state examination score is 18. She is difficult to interview due to her disorganized thinking and periods of irrelevant speech. Which of the following is the most likely diagnosis?

A known HIV seropositive patient presents to the emergency center with abrupt onset of pleuritic chest pain, fever, and a productive cough with blood-tinged sputum. Which of the following organisms would you most likely suspect?

A 45-year-old man who has suffers from chronic alcohol abuse has a 5 day history of fever and productive cough. Evaluation indicates that the patient has pneumonia with empyema, pus in the thorax. Which of the following is the preferred antibiotic treatment?

Which of the following is a common reaction from the use of Albuterol?

An 82 year old man presents for routine annual follow up. He has no present complaints and feels well. His BP is 128/86 and his physical exam in benign. An EKG is obtained as part of his routine testing and is shown below. Which of the following is the correct evaluation of the EKG below?

A 43-year-old woman has a 3 week history of worsening generalized pruritus. Examination shows only scratch marks scattered on the trunk and extremities. Serum alkaline phosphatase is elevated, but serum aminotransferases are normal. Which of the following is the most likely diagnosis?

A 71-year-old male with a 20+ year history of poorly controlled hypertension presents with dyspnea with minimal exertion and chronic fatigue. He has intermittent, brief episodes of left sided chest pain that resolves with rest. Vital signs are within normal limits. Physical exam reveals muffled heart sounds with an S4 gallop and an apical lift. 2+ pitting edema is noted in the lower extremities bilaterally. BNP is 1844 pg/ml. An echocardiogram reveals an ejection fraction of 54%. Which of the following is the most likely diagnosis?

The target LDL levels for a 59-year-old male who is a 40-pack year smoker with HTN, diabetes mellitus, and a family history which includes the death of his father from MI at 54 years of age should be which of the following?

A 29-year-old male presents with complaints of “persistent left chest pain” of two days duration. He relates the pain is worse when lying down and is somewhat relieved with sitting up and leaning forward. He relates that he is “just getting over the flu”. The chest pain radiates to the left shoulder, but not to the neck, jaw, or left arm. The pain is sharp in nature. He denies nausea or vomiting, significant shortness of breath, or diaphoresis. An ECG reveals non-specific ST segment changes in most leads. There are no specific findings on chest x-ray. Of the following tests/procedures, which should you order or perform next as part of the evaluation of this patient?

A 6-month-old infant presents to the office for a well-baby check-up. Cardiac exam reveals a systolic thrill palpated along the left sternal border. In addition a loud systolic murmur is auscultated at the right sternal border. Which of the following is the most likely diagnosis?

A 45 year-old new onset diabetic with hypertension needs medical therapy after lifestyle changes were unable to improve blood pressure, which medication would be best to start?

A 29-year-old woman has new onset atrial fibrillation. Which of the following underlying conditions is most likely the cause?

Which of the following is the characteristic abnormality of hypokalemia on an electrocardiogram?

A 65 year old male presents to the ER with chest pain, shortness of breath and stable vital signs. He suddenly begins to complain of worsening chest pain and becomes notable pale and diaphoretic. His BP is now 74/44, he has a weak pulse and is conscious but slow to respond. His EKG had been normal sinus rhythm upon arrival, and now has changed as shown below. Which of the following is the most appropriate initial step?

A 14-year-old girl has asthma that is triggered by exposure to certain pollens. Which of the following is the mechanism of action of cromolyn sodium?

A patient presents to the clinic with occasional wheezing and chest tightness that occurs approximately once a week and at night only about once a month. Peak expiratory flow is performed and demonstrates 85% of predicted. Which of the following is the most appropriate initial treatment?

A stocky, 40-year-old male with a 20-pack/year cigarette history presents with a persistent severe cough for the past 3 months, productive of copious mucopurulent sputum. History reveals a similar cough as well as pneumonia twice last year. Physical exam reveals prolonged capillary refill in his nail beds, a normal AP chest diameter and scattered wheezes and rhonchi to auscultation. He is afebrile but EKG reveals evidence of right axis deviation, right ventricular hypertrophy. Chest films show increased markings. Your impression is:

A 65-year-old Caucasian male presents with a progressive, constant and severe history of dyspnea for the last few weeks. There is a 40 pack-year history of smoking. Physical examination reveals a thin, wasted-appearing gentleman. No cyanosis present. The AP chest diameter is increased. Percussion note over the lung fields is hyperresonant. Laboratory studies reveal increased total lung capacity and absent respiratory acidosis. This is a presentation of which of the following?

Hemoglobin A1C is an indicator of which of the following in a patient who has diabetes?

Niacin therapy is initiated in a 44-year-old man in treatment of dyslipidemia. He should be counseled that which of the following is the most likely adverse effect?

A 52-year-old woman has a 3 month history of cold intolerance, forgetfulness, constipation, and dry skin. Hypothyroidism is diagnosed. Which of the following is the most likely sign to be noted upon examination?

A 63-year-old woman has a 2 month history of fatigue and weakness. She now has the sudden onset of palpitations. Electrocardiography shows new atrial fibrillation. Which of the following is the most likely diagnosis?

A 26-year-old man is diagnosed with Guillain Barre syndrome. The patient most likely had a preceding infection by which of the following organisms?

An 18-month-old presents to the ER with a fever of 104.2 degrees F. rectally. His medical history is obtained from the mother and reveals a 48-hour duration of upper respiratory symptoms, acute onset of a fever two hours ago and then a seizure lasting ~5 minutes. The child is up to date on his immunizations and sees his pediatrician regularly for well checkups. The mother denies any developmental delays or recent trauma. The mother is concerned about epilepsy but you know that a simple febrile seizure is distinguished by which of the following?

A 62-year-old man has a 2 week history of stumbling when walking in the dark. Which of the following neurologic signs is most suggestive of neuropathy caused by vitamin B12 deficiency?

A normal, healthy 18-month-old child would be expected to demonstrate which of the following developmental milestones?

A 7-year-old boy has a 1 day history of fever, headache, photophobia, and vomiting. Vital signs are normal except that axillary temperature is 102.8 degrees F. The patient is alert and oriented. Examination shows nuchal rigidity without localizing neurologic signs. Examination of the cerebrospinal fluid shows 32 mononuclear cells/micro, normal glucose, and slightly elevated protein. Which of the following is the most likely diagnosis?

After 5 weeks of oral contraceptive therapy, a 27-year-old woman has painful, purplish nodules in both pretibial areas. Which of the following is the most likely diagnosis of the skin lesions?

A 54-year-old man with psoriasis has pain and stiffness in his fingers that eases during physical activity. Which of the following findings is the most likely to be noted upon radiography of the fingers and hands?

American biomedical ethics is primarily based upon which of the following principles?

A seven-year-old male presents with a rash on his face for three days. The mother states that the child has been complaining of itching and has scratched often. Review of his record finds that all of his immunizations are up to date including his chickenpox vaccine. Physical exam reveals pustules with an erythematous base and a yellow honey crusted appearance. Which of the following is the most likely etiological agent for these lesions?

A 32-year-old man who is a successful accountant comes into your office complaining of abdominal discomfort. He tells you that he experienced similar symptoms 2 days ago at which time he had to pull his car off the road because he started to sweat profusely, experienced nausea, felt his heart beat stronger and faster, and experienced “difficulty in breathing”. He had a strange feeling of being “alone and out of control”. He remembers trembling, feeling chills and had fleeting thoughts of dying. Your tests (EKG, X-rays, blood, urine, GI, etc.) are all normal. Episodes last 10-15 minutes. Which of the following is the most likely diagnosis?

A 76-year-old man has progressive sensorineural deafness in both ears. Examination shows an enlarged skull and bowing of the lower legs. The serum alkaline phosphatase level is elevated. Which of the following is the most likely diagnosis?

Which of the following is true regarding an acute chemical splash to the eye?

A 52-year-old female has vertigo for 3 days. Presence of which of the following differentiates vertigo due to central vestibular dysfunction from vertigo due to peripheral dysfunction?

A 33-year-old amateur wrestler presents concerned about swelling of his right ear that occurred five days ago during a wrestling match. Exam finds ecchymosis and edema of the external ear which is painful with manipulation. Which of the following is the most appropriate course of action?

A 64 year old female with multiple medical problems presents for evaluation of anemia. Review of her lab values finds a hemoglobin of 9.4, an MCV of 84, an MCH of 28 pg, a TIBC of 205 mcg/dL and a ferritin of 310 ng/mL. Which of the following is the most likely etiology of her anemia?

A 55-year-old patient with long-standing treated hypertension complains of impotence. Which of the following should not be suspected as a cause of this problem?

A 68-year-old man with symptomatic benign prostatic hypertrophy asks you to prescribe a drug that will make him less symptomatic. You prescribe tamsulosin. Which of the following is the mechanism of action of this drug?

A 22-year-old man has right flank pain and gross hematuria. Polycystic kidney disease is diagnosed. Which of the following is the most likely physical sign to be noted upon examination?

A 72-year-old woman has isolated systolic hypertension. Which of the following is the most important advantage of chlorthalidone over hydrochlorothiazide in therapy?

A 59-year-old man who takes no medication has ecchymoses on his body. The prothrombin time is abnormally prolonged. Which of the following is the most likely underlying disorder?

A 28-year-old male patient presents with melena for the past two days. Blood pressure in the supine position is 110/70 mmHg with a pulse of 98 bpm. In the sitting position, his blood pressure is 96/72 mm Hg with a pulse of 110 bpm. Nasogastric (NG) tube aspirate is negative for blood. The most likely location of this bleed is the:

A 77-year-old man has just recovered from diverticulitis. A diet rich in which of the following should be recommended?

An 89-year-old woman has had 3 episodes of blurred vision, each in her left visual field, and lasting 10 to 15 minutes. Which of the following laboratory values is most suggestive of giant cell arteritis?

Two weeks after completing a course of clindamycin therapy a 55-year-old man has watery diarrhea. Which of the following is the most likely diagnosis?

A 36-year-old female presents with a complaint of food getting stuck in her esophagus while she’s eating and drinking. She has no past medical history that she is aware of, but has had difficulty with her skin in the last two years. Which of the following is the most likely related to this patient symptoms?

Which of the following describes the correct positioning for a patient that requires the odontoid view of the cervical spine?

Two weeks after having had urethritis a 24-year-old man has painful swelling and redness of his left knee and right ankle, soreness in his mouth, and a rash on his penis. Examination shows an erosion on the hard palate, conjunctivitis, erythema of the conjunctivae, and warm swelling of the affected joints. Which of the following is the most likely diagnosis?

Which of the following is the definition of infertility?

A 37-year-old woman seeks counseling concerning treatment of hypertension during pregnancy. She should be advised that which of the following medications should not be taken during pregnancy?

A 34-year-old woman has a 3 month history of bilateral mobile masses in her breasts. The masses become more painful during the premenstrual phase of her cycle. Fibrocystic breast changes is diagnosed. Which of the following is the preferred initial therapy?

A 25-year-old female presents complaining of right breast swelling redness and pain while she’s breast-feeding. Exam finds the patient with an indurated right breast no overt fluctuant area, warm to the touch with an erythematous area of 5 X 6 centimeters. Which of the following is the most likely organism?

A 55-year-old woman has a 3 month history of dry skin, forgetfulness, and constipation. Evaluation demonstrates hypothyroidism. Which of the following is the most likely cardiovascular abnormality to be present?

A 24 year old patient presents with mild irritation of his eyelids at the base of his eyelashes. Exam finds the picture below. Surrounding areas are unaffected and the conjunctiva are clear. Which if the following disorders is likely to be associated with this eyelid disorder?