Mock 21

A 21-year-old female presents to the ED with diarrhea and abdominal cramping that began acutely last night. She recently arrived back in the US after a weekend trip to Jamaica. You suspect that she has “Traveler’s diarrhea” which is most commonly due to:

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 4-year-old child is brought to the emergency department by his mother due to an acute onset of fever, throat pain, drooling, difficulty speaking, and inspiratory stridor. Which of the following is the most probable diagnosis?

A 4-year-old girl has had a sore throat, difficulty swallowing, and fever up to 39.5 degrees C (103.1 degrees F) for 12 hours. Physical examination reveals an anxious, toxic-appearing child with low-pitched inspiratory stridor, drooling, and mild inspiratory retractions. Which of the following is the most likely diagnosis?

A 31-year-old woman with known HIV infection has a 3 day history of fever and cough productive of brownish-red sputum. Exam shows increased tactile fremitus and dull percussion note over the lower portion of the left posterior chest. Chest radiograph shows lobar consolidation. Which one of the following is the most likely infecting organism?

A 74-year-old female presents complaining of hearing loss for the last 2 to 3 weeks. She has no other complaints, and denies any ear pain or discomfort. Her whisper test is decreased in her right ear and the Weber test lateralizes to her right ear. Which of the following is the most probable underlying cause?

A healthy 24-year-old woman suddenly has severe anterior chest pain that is eased while sitting and bending forward, but increased during recumbency or deep inspiration. A pericardial friction rub is heard. The clinical diagnosis is viral pericarditis. Which of the following is the preferred initial therapy?

A 73-year-old man has nasopharyngeal carcinoma. Which of the following is the most likely cause?

A 29 year-old female with history of IV drug abuse presents to the emergency room with ongoing fevers for three weeks. She complains of fatigue, worsening dyspnea on exertion and arthralgias. Physical examination reveals a BP of 130/60 mmHg, HR 90 bpm, regular, RR 18, unlabored. Petechiae are noted beneath her fingernails. Funduscopic examination reveals exudative lesions in the retina. Heart examination shows regular rate and rhythm, there is a grade II-III/VI systolic murmur noted, with no S3 or S4. Lungs are clear to auscultation bilaterally, and the extremities are without edema. Which of the following is the definitive diagnostic study of choice in this patient?

Which of the following is not a common cardinal finding in all types of shock?

A 66-year-old woman has the sudden onset of palpitations. Electrocardiography shows atrial fibrillation. Presence of which of the following signs is most suggestive of hyperthyroidism as the cause of the arrhythmia?

A 10-year-old boy has a congenital bicuspid aortic valve with a normal aortic root. Which of the following is appropriate counseling to his parents?

An 84-year-old man has angina pectoris. During the anginal discomfort ventricular ectopic beats are noted. Which of the following is the preferred medication in treatment of the cardiac disorder?

Without any premonitory symptoms, a healthy 17-year-old man has 2 syncopal attacks while standing still. Blood pressure is 114/70 mm Hg, pulse 40/min/irregular, and respirations 16/min. Examination shows a single 6 cm round flat rash in the left axilla. It has an erythematous ring with central clearing and a target appearance. The heart size is normal. No murmur or gallop is heard. Electrocardiography shows normal sinus rhythm with Mobitz type 1 atrioventricular block. Which of the following is the most likely diagnosis?

A 66-year-old male suffered a myocardial infarction six weeks ago and underwent angiography with stent placement. He now presents to the ED with chest pain, which he has not had since the MI. He describes the pain as a “pressure” sensation in the retrosternal area. The pain 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 it hurts when he coughs. An initial EKG is obtained demonstration diffuse ST changes in all leads. What is the most likely diagnosis for this patient’s symptoms?

A 66-year-old man has a 10 day history of exertional anterior chest pressure. Angina pectoris is diagnosed. Which of the following co-existing medical conditions is a contraindication to metoprolol therapy?

A 55-year-old man has type 2 diabetes mellitus. Which of the following is the initial sign of the onset of diabetic nephropathy?

A 77-year-old woman has the acute onset of palpitations. Atrial fibrillation is diagnosed upon electrocardiography. Which of the following is the most likely underlying cause?

A 34-year-old woman has a rib fracture and is found to have pre-menopausal osteoporosis. Which of the following is the most likely underlying disorder?

A 14-year-old girl has a 2 day history of fever and sore throat. Infectious mononucleosis is diagnosed. The Monospot diagnostic test is characterized by which of the following?

A 14-year-old asymptomatic boy has recently immigrated from a country known to have a high incidence of tuberculosis. After evaluation, latent tuberculous infection is diagnosed for which isoniazid therapy is initiated. The patient and parents should be advised that which of the following are the most likely symptoms to represent and adverse effect of the isoniazid?

A 55-year-old man with a 55 pack-year history of smoking cigarettes has recently experienced an episode of hemoptysis along with his usual cough. On physical examination there are no abnormal findings. He has a sputum cytology examination shows atypical cells with hyperchromatic nuclei and orange-pink cytoplasm. Laboratory studies show a serum calcium of 11.3 mg/dL with phosphorus 2.1 mg/dL. Which of the following chest radiographic findings is this man most likely to have?

A 52-year-old woman has paresthesia, cramping, fasciculation, fatigue, patchy hair loss, dry skin and brittle nails. You notice twitching of her facial muscles when you tap just anterior to her ear. Which of the following is the most likely diagnosis?

Which one of the following is most indicative of a pneumothorax?

While sitting in a chair, a tall, thin 20-year-old athletic man suddenly notes the onset of sharp right upper anterior chest pain associated with mild dyspnea. The pain persists for 8 hours so he comes to the office for evaluation. There is no associated fever, cough, or hemoptysis; no history chest trauma. Physical exam is normal except for respiratory rate of 26/min. Which one of the following is the most likely physical exam finding in this patient?

A 67-year-old diabetic man presents at the emergency department (ED) with a deep, 5cm laceration to his non-dominant hand from a kitchen knife while peeling an apple. He is a long-time smoker and is taking aspirin for a heart condition and prednisone for chronic obstructive pulmonary disease. Which one of the following statements regarding wound treatment/healing is correct?

A 78-year-old man has a 2 week history of left-sided headaches. Which of the following laboratory values is most consistent with a diagnosis of giant cell arteritis?

A 64-year-old male presents with recurring episodes of light-headedness, dimming of vision and a fainting sensation over the past several weeks. He states that symptoms usually occur when he gets up after watching television for several hours in the evening. His blood pressure in the left arm is as follows: 134/72 mm Hg (supine) and 98/52 mm Hg (standing). Which of the following is the most likely cause of his symptoms:

A 27-year-old man has the sudden onset of maximal intensity generalized headache with associated nausea and vomiting. Non-contrast computerized tomography (CT) imaging of the brain shows subarachnoid hemorrhage. Which of the following is the most likely associated disorder?

An 8-year-old boy has Tourette syndrome characterized by motor and phonic tics and outbursts of profanity. Which of the following is the most likely associated disorder?

A 24-year-old man returns from a combat zone and is diagnosed with post-traumatic stress disorder. This is considered to be which of the following?

Oral contraceptive therapy is initiated in a 23-year-old woman. Two months later she has irregularly shaped, hyperpigmented macules in the malar areas, cheeks, and nose. Which of the following is the most likely diagnosis?

A 6-year-old boy is brought to the ER complaining of a headache and throat pain which have been present since he awoke this morning. His parents state that he is currently being treated for an ear infection with amoxicillin and acetaminophen. Past medical history is significant for recurrent ear infections. Vital signs are BP: 108/60mmHg; heart rate: 96bpm and regular; respirations: 20 breaths/min, non-labored; temp: 102.4° F (oral). Physical exam reveals a mildly agitated child who is oriented x3. A diffuse purpuric skin rash is present. HEENT exam is significant for neck pain and stiffness. Which of the following is the most likely diagnosis?

A 64-year-old obese female presents with multiple pruritic, tense blisters across both thighs. The blisters are large and fluid filled, range from 1 to 4 cm in size, and have an erythematous base. The patient states the rash has erupted over the last week. Upon examination of the open blisters, you note a negative Nikolsky’s sign. Which of the following is the most likely underlying disorder?

Which of the following disorders has the highest suicide rate?

A woman has an acute infection of an eyelid diagnosed as a hordeolum. Which of the following is the most likely infecting organism?

A 77-year-old man takes dabigatran in therapy of non-valvular atrial fibrillation. Which of the following is the mechanism of action of dabigatran?

A concerned mother presents with her six-month-old infant after his recent treatment with antibiotics for acute otitis media. She states the child is feeding poorly and she is concerned the infection is not better. Physical exam finds the infant with white plaques on his buccal mucosa, tongue and palate. Which of the following is the most appropriate initial management?

A 24-year-old female presents with excruciating pain to her left ear and what she describes as a “yellow discharge” for the last five days. Inspection of the external canal finds macerated tissue with a yellowish discharge consistent with a severe bacterial otitis externa. Despite multiple attempts, you are unable to visualize the tympanic membrane. You are able to place an otowick. In addition to oral antibiotics, which of the following would be an appropriate treatment choice?

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?

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?

Six months after a surgical splenectomy, a 32-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?

The presence of which of the following differentiates chronic pancreatitis from type 1 diabetes mellitus?

A 68 year old male with a history of PVD and CAD, presents complaining of diffuse, dull aching abdominal pain which occurs within an hour of eating. The patient has stable vital signs and in afebrile. Which of the following is the most likely cause of his symptoms?

A 19-year-old female fell on her outstretched left hand. She presents with swelling to the wrist, palmar abrasions, and marked tenderness over the anatomic snuffbox. X-ray is negative. Which of the following is the most appropriate treatment?

A 22-year-old man has a 2 month history of low back pain that extends into the buttocks area. Radiography of the spine shows calcification of the anterior and lateral spinal ligaments. Which of the following is the most likely diagnosis?

Danazol is often used in the treatment of which of the following conditions?

How early can a hCG level be detected in the serum?

A 17-year-old female with no previous medical history, presents complaining of right lower quadrant abdominal pain for the last six hours. She has been unable to eat, feels nauseous and vomited once. Exam finds right lower quadrant tenderness with guarding and positive bowel sounds. Her last period was 3 weeks ago and her pregnancy testing is negative. Complete blood count shows a white blood cell count of 18,000. She is noted to have a temperature of 102°F and a positive iliopsoas sign. Which of the following is the most likely diagnosis?

A 72-year-old female with a 10 year history of symmetric joint pain and swelling in both hands is complaining of morning stiffness and weight loss. On examination you noticed subcutaneous nodules over the right forearm. Which of the following is the most likely diagnosis?

A 7-year-old boy has intermittent pain in the right thigh for 3 weeks. Exam shows a limp and atrophy of the proximal thigh muscles. Radiographic study of the hip shows fragmentation of the femoral head. Which of the following is the most likely diagnosis?

A 19-year-old female presents the emergency room complaining of vaginal bleeding. She is 12 weeks pregnant and is visibly concerned about the bleeding. She also reports some severe lower abdominal cramping. Upon your pelvic exam you find a large amount of blood in the vagina and placental tissue and an open cervical os. Which of the following best describes the patient’s

A healthy 52-year-old postmenopausal woman with a history of treated breast cancer presents to your office for a routine examination. Physical exam is unremarkable. Which of the following should the patient avoid because of her history?

A 22-year-old woman has a 2 week history of pallor and numbness in her fingers and hands when walking in cold weather. With warming of the hands for fifteen minutes, the pallor disappears and the fingers and hands become red. Which of the following is the most likely diagnosis?

A 77 year old female suffers a fall down a flight of 3 stairs. She breaks her fall with an out stretched hand and presents with pain and deformity of her wrist. X-rays are obtained and are shown below. Which of the following best describes the findings?

What infectious agent is often the cause of diarrhea and outbreaks on cruise ships?

A 65 year old male is undergoing evaluation for weakness in the ER. He has a BP of 148/92 and has no chest pain. Which of the following is the correct evaluation of the EKG below?

A 6-year-old child has bloody diarrhea and abdominal pain caused by enterohemorrhagic E. coli (EHEC) colitis related to eating undercooked beef. Which of the following is the most likely complication?

Which of the following laboratory tests assesses the “intrinsic” coagulation pathway?