Mock 20

An 83-year-old woman has exertional dyspnea and angina pectoris caused by severe aortic valve stenosis. In addition to an ejection murmur in the aortic area, which of the following signs is most likely to be noted on examination?

A newborn infant has transposition of the great arteries. The mother most likely has which of the following conditions?

Dabigatran therapy is initiated in a 66-year-old woman in treatment of non-valvular atrial fibrillation. Which of the following is proper counseling?

A 44-year-old woman awakens at 3 AM with severe anterior chest pressure. Electrocardiography shows ST segment elevation in the anterior precordial leads. Variant angina is diagnosed. In addition to nitrates which of the following is the preferred medication to be administered?

A 77-year-old man has a 3 week history of progressively worsening edema of his feet, ankles, and legs. In the past week increasing abdominal swelling is noted. Blood pressure 90/66 mm Hg, pulse 110/min/regular, and respirations 24/min. Constrictive pericarditis is diagnosed. Which of the following signs is most likely to be noted upon examination?

A 44-year-old male presents via paramedic EMS with a 40-minute history of chest pain unrelieved by nitroglycerin. Onset occurred after several episodes of emesis and he has developed cervical subcutaneous emphysema . His vital signs are significant for a blood pressure of 92/46 mmHg (right arm supine); heart rate of 104 beats/minute (regular) and a respiratory rate of 24 breaths/minute. Which of the following is the most likely diagnosis for his symptoms?

A 49-year-old woman has the sudden onset of a cold and painful left arm. Blood pressure is 120/70 mm Hg. Examination shows a cold and pale left arm. No brachial or distal arm pulses are felt on the affected side. Electrocardiography shows atrial fibrillation. Which of the following is the preferred initial therapy?

When performing a pre-sports physical in the adolescent age group, a murmur with which of the following qualities indicates a risk for sudden death during exercise?

Amlodipine therapy is to be initiated in a 66-year-old woman in treatment of hypertension. Which of the following is appropriate counseling concerning the medication?

Glyburide therapy is initiated in a 66-year-old man in treatment of type 2 diabetes mellitus. He should be counseled that which of the following is the most likely adverse effect of this therapy?

A 40-year-old non-obese male has been running blood pressures averaging 165/108 mmHg despite treatment with atenolol (a beta blocker), amlodipine (a calcium channel blocker) and enalapril (an ACE inhibitor). His serum potassium is 3.0 mg/dL. Which of the following diagnoses is the most likely cause of these findings?

You have just diagnosed Graves’ disease in a 25-year-old female who is in her first trimester of pregnancy. Which of the following is the preferred treatment for this patient?

A newborn infant of a diabetic mother has recurrent hypoglycemic spells. Which of the following is the least likely manifestation of hypoglycemia in the patient?

A patient states that he has been camping in the mountains of North Carolina for the past two weeks. He presents to the clinic complaining of “flu-like” symptoms for the past 10-14 days however he notes that he started to develop a slight rash on his wrist and ankles about seven days ago. Which of the following tests would provide a confirmatory diagnosis?

After 7 days of levofloxacin therapy, a 33-year-old woman has diffuse abdominal cramps and recurrent, watery diarrhea. Blood pressure 112/70 mm Hg, pulse 100/min. Pseudomembranous enterocolitis is diagnosed. Which of the following is the preferred initial therapy?

A 15-year-old boy who has asthma is advised to use an inhalation spacer device when inhaling medication. Using the spacer will decrease the incidence of which of the following?

You are evaluating a patient whom you suspect has asthma. You perform spirometry before and after administration of an inhaled short-acting bronchodilator. After administration of the bronchodilator, which of the following spirometry results would suggest reversibility?

A 4-year-old presents with fever, drooling and inspiratory retractions. The child sits leaning forward. Which of the following is initially indicated?

A 2-year-old child presents with a bark-like cough. Patient is afebrile, has inspiratory stridor, and subglottic narrowing on the soft tissue neck x-ray. Patient is otherwise alert and cooperative. Which of the following is the most likely diagnosis?

Which of the following is the most valuable procedure in evaluating the efficacy of treatment in an asthmatic patient?

A 23-year-old motorcyclist, in excellent health, is admitted to the hospital after a cycling accident in which he lost consciousness due to blunt head trauma. On the third hospital day, the patient develops a temperature of 103 degrees F and he is noted to be confused. Exam further reveals a new cranial nerve IV palsy and stiff neck. Chest X-ray demonstrates a right middle lobe infiltrate. Cerebrospinal fluid gram stain reveals gram positive cocci. Diagnosis:

A short time after breaking up with her boyfriend, a 23 year old woman has acute dyspnea, perioral paresthesia and bilateral cramping of her hands. Arterial blood gas values include arterial pCO2 at 28 mm Hg and pH 7.48. Which of the following is the preferred initial therapy?

A 26-year-old man has multiple café au lait spots. Which of the following is the most likely associated condition?

A patient is concerned she has condyloma acuminata. Which of the following tests is most appropriate to perform in order to better identify these lesions?

A 60-year-old man comes to you accompanied by his wife who is concerned about his health. A few months ago he started “acting out his dreams”, kicking, hitting and crying out in his sleep. More recently, he has developed a resting tremor of his hand which has interfered with his eating and handwriting. On exam, you observe his tremor and also note bradykinesia and a paucity of spontaneous arm movements when testing his gait. Which of the following is the most likely diagnosis?

A 57-year-old woman has a 2 month history of tingling and numbness in the first 3 fingers of each hand. Symptoms are worse at night. There is no associated weakness of the hand. Carpal tunnel syndrome is suspected. The clinician should specifically perform which of the following on a focused neurologic examination?

A 19-year-old male is brought in to the ED by his friends who state that the patient ingested some pills. Physical exam findings include a stuporous mental status, hypotension, pinpoint pupils, and slow/shallow respirations. Which of the following agents will most likely improve the patient’s signs and symptoms?

From a national perspective, which of the following is a significant limitation of a living will?

A 33-year-old female reports that since she was in her 20’s she has experienced brief, recurrent, unpredictable episodes of intense anxiety. Recently, these episodes have been occurring frequently and have been accompanied by palpitations, headaches and self-monitored high blood pressure. Which of the following is the most likely diagnosis?

Which of the following conditions has a high-incidence of associated thymus abnormalities?

A 30-year-old male has a three month history of an erythematous, oily yellowish rash which has occurred on the nasolabial folds, around his eye brows and his hairline. Which of the following is the most likely diagnosis?

What is the key difference between binge eating and bulimia nervosa patients?

A scopolamine patch (Transderm Scop) is prescribed for a 66-year-old man who is to embark on a cruise. The patient should be advised that which of the following is the most likely side-effect of the medication?

The mother of a 15-year-old boy seeks counseling because she is concerned that her son is smoking marijuana at the end of the school day. She should be advised that which of the following is the most likely manifestation of marijuana use within 2 hours of use?

The leukocyte esterase dipstick test is used in the assessment of which of the following?

Which of the following is the initial step when a male presents with dysuria, fever, perineal pain and diminished urinary flow?

A 60-year-old patient presents to your clinic feeling tired. He has an elevated blood pressure, and peripheral edema. Laboratory testing reveals a BUN of 58 mg/dl and a creatinine of 4.5 mg/dl, these results are unchanged over the last year. Urinalysis today is negative except for the following, specific gravity of 1.002, 2+ protein, and trace glucose. Which of the following additional laboratory findings would be most consistent for this patient?

The presence of which of the following symptoms best differentiates heat stroke from heat exhaustion?

Which of the following is part of Samter’s triad, and is related to asthma and aspirin allergy?

A 22-year-old presents with a one month history of sneezing, watery rhinorrhea and itchy eyes. Physical exam reveals pale boggy turbinates and mildly injected conjunctiva. The patient has had no fever and has a normal pharyngeal exam. Auscultation of her lungs finds clear fields throughout. The patient is afebrile. Which of the following is the most likely diagnosis?

A 24-year-old male presents complaining of dark, tea colored urine for the past three days. The patient is an otherwise healthy young man whose only history includes a pharyngitis which he recovered from two weeks ago. Urinalysis is performed, and shows the presence of red blood cell casts. Which of the following laboratory tests would be most useful in diagnosing this patient?

A 45-year-old woman is diagnosed with pernicious anemia. Which of the following laboratory results is most likely to be noted?

A patient presents to the office with difficulty swallowing solids and liquids. Which of the following disease processes would be in your differential diagnosis?

A 42-year-old woman has a 1 month history of abdominal gas and diarrhea without associated weight loss. Vital signs are normal. Physical examination is normal. Which of the following is the most likely cause of the patient’s symptoms?

A 22-year-old woman has anorexia nervosa. She is most likely to have which of the following clinical disorders?

You are called to examine a 24-year-old male patient who had several episodes of bright red hematemesis 30 minutes prior to arrival. He appears pale. It is estimated that the patient lost 18% of his total blood volume. Which of the following tests or procedures is most sensitive in determining the degree of blood loss within this time frame?

After a fall, a patient presents with right distal forearm pain. PA and lateral x-ray reveals a transverse fracture through the radial styloid process. These findings are consistent with which of the following?

A 46-year-old man has a 4 week history of heartburn and dysphagia to both liquids and solids. He now has Raynaud phenomenon in both hands when they are exposed to frozen food packages. Which of the following is the most likely diagnosis?

The most common location for an ectopic pregnancy what anatomic location?

A 63-year-old woman has intense itching in the vulvar area without discharge. Examination shows the vulva to be thin, wrinkled, and white. The anterior portions of the labia minora have agglutinated. Which of the following is the most likely diagnosis?

Which of the following is the most likely disorder in a child who is suffering diarrhea, weight loss, nutritional deficiency and abdominal bloating after eating bread and pasta?

A 22-yr-old black female presents with a 3 month history of progressive worsening fatigue, myalgias, and arthralgias. Over the past 24 hours, she has had a low grade fever, maximum to 101 degrees F. Treatment has been with over the counter NSAID’s without benefit. Examination shows aphthous oral lesions, palmar erythema and mild synovitis of the hands and feet. Laboratory studies were pertinent for a mild normocytic normochromic anemia, WBC count 3,000 with lymphopenia and ESR 50 mm/hr. ANA is 1:1,280 homogenous and double stranded DNA 1:40. C3 and C4 are mildly decreased. The most likely diagnosis is:

A 24-year-old male presents with the feeling of intense knee pain he describes as if he had glass in his knee, he denies trauma. Exam reveals and oval shaped lesion over the knee. What is the diagnosis?

A 23-year-old female who is 22 weeks pregnant, presents or her monthly prenatal visit. This is her first pregnancy and she is concerned that she urinating much more than usual and that she feels that she must eat all the time. Her friends have told her this is normal, however specifically she’s concerned that she also has an insatiable thirst and feels she has to drink water constantly. She’s also noted a significant amount of weight gain which is greater than that expected for her gestation. Which of the following would be the most appropriate next step in her management?

A 61-year-old female with a history of five vaginally deliveries, presents for evaluation from her primary care in response to her complaint of stress incontinence and urinary frequency. Urological examination and evaluation was negative. On examination you find reducible mass bulging into the anterior wall of the vagina. What is the most likely diagnosis?

Hypertension is diagnosed in a 57-year-old man who has asymptomatic hyperuricemia. Which of the following is contraindicated in treatment of the hypertension?

A 14 year old male presents complaining of pain in his right hand after punching a wall during an argument. X-rays are obtained and are shown below. Which of the following best describes the findings?

Thiamine and Vitamin E deficiency both cause what similar symptoms?

A 25-year-old female with known mitral valve prolapse accompanied by a grade 2 regurgitant murmur is scheduled to have her teeth cleaned by her dentist and asks you about antibiotic prophylaxis. She is allergic to penicillin. Which of the following do you prescribe?

A 6-year-old boy who lives in a Mediterranean country eats fava beans. Six hours later he has headache, nausea, and dark red-brown urine. Which of the following is the most likely diagnosis?