Mock 22

A 28 year old female with newly diagnosed hyperthyroidism presents to the Er with “palpitations”, feeling anxious. Her BP is 210/110 mmHg, pulse 120 regular. Which of the following is the best initial choice?

Which of the following is the most common cause of a positive stool guaiac test?

A 44 year-old male has frequent GERD symptoms and he undergoes a routine upper endoscopy for evaluation. Which of the following hernias is most likely the cause of his GERD?

Several days after having painless, non-tender swelling and erythema of his face, a 22-year-old man awakens with bilateral Bell’s palsy. Which of the following is the most likely infectious organism causing the palsy?

A 71-year-old woman has a 2-day history of an inflamed, painful and swollen left knee. Synovial fluid examination is diagnostic for pseudogout. Which of the following in joint fluid distinguishes this diagnosis from acute gout?

An apprehensive 32-year-old female presents with an acute onset of tachypnea, dyspnea, and chest pain 2 days after a C-section. The chest x-ray is unremarkable and her ECG reveals an S wave in lead I, Q wave with inverted T waves in lead III. Which of the following is the most likely diagnosis?

A mother brings in her six-month-old infant because “he has been wheezing for the past couple of days”. He is noted to have a low-grade fever, tachypnea, and mild expiratory wheezes. His nostrils are mildly congested with clear nasal drainage, the throat is pink without exudates, and the TM’s are pearly gray without fluid levels and the cone of light is intact bilaterally. Which of the following tests would you order to confirm your assessment?

A 25 year old female presents with significant anxiety after witnessing a violent crime 2 days ago. Which of the following best describes her condition?

A 50-year-old man has a 3 day history of tingling and burning discomfort in the left medial malleoli, sole of the foot, and great toe. Examination shows decreased sensation in the plantar aspect of the foot. Which of the following is the most likely diagnosis?

A 46-year-old man presents with acral enlargement, hypertension and coarse facial features and doughy feeling skin. He stands 5’9″ tall. Laboratory testing confirms an increased growth hormone. Which of the following best describes his disorder?

A 14-year-old boy suddenly faints while playing basketball. Upon examination in the emergency department, the patient is awake and oriented. Vital signs are normal. Carotid upstroke is normal. Lungs are clear to auscultation. There is an apical lift, but no murmur or gallop is heard. Which of the following maneuvers should be used to increase suspicion of hypertrophic obstructive cardiomyopathy?

An infant is born with an atrioventricular septal defect. The infant most likely has which of the following conditions?

A 55-year-old man has aortic valve stenosis. Which of the following is the primary pathophysiologic abnormality in this valvular disorder?

A 27-year-old woman is in the second semester of pregnancy. She should be counseled that which of the following medicines is absolutely contraindicated during the pregnancy?

A 74-year-old woman who is receiving multiple medications as therapy for chronic systolic heart failure has a 1 week history of weakness. Presence of which of the following electrocardiographic abnormalities is most suggestive of hypokalemia?

Which of the following is the basic mechanism of action of nitroglycerin in the treatment of angina pectoris?

A 67-year-old known hypertensive male with extensive smoking history, presents to the ED with “sharp” substernal chest pain. A plain-film chest x-ray reveals a widened mediastinum. CT scan without contrast shows an aortic intimal flap. Which of the following is the most likely diagnosis?

A 14-year-old boy has hypertrophic obstructive cardiomyopathy with dyspnea. Which of the following is the pathophysiologic abnormality that causes the dyspnea?

A 10-year-old girl has congenital long QT interval syndrome. Which of the following is most likely to precipitate polymorphous ventricular tachycardia (torsades de pointes)?

A 66-year-old woman has a 2 month history of anorexia, nausea, and 5 pound weight loss. Blood pressure, sitting, 102/74 mm Hg with pulse 90/min. Blood pressure, standing, 80/66 mm Hg with pulse 108/min. Examination shows generalized hyperpigmentation. Serum sodium is 126 mEq/L. Which of the following is the most likely diagnosis?

A 62-year-old woman has marked lightheadedness when arising from bed. Sitting blood pressure is 114/74 mm Hg sitting with pulse rate of 80/min. Standing blood pressure is 86/52 mm Hg and pulse rate is 106/min. Which of the following is the most likely diagnosis?

A 22-year-old intravenous drug abuser who is HIV-infected has completed antibiotic therapy for tricuspid valve endocarditis. Which of the following is the most appropriate counseling?

A 59-year-old woman with a long history of cigarette smoking has newly diagnosed angina pectoris. Which of the following is the preferred inhaled medication for treatment of breathlessness from her lung disease?

A 57-year-old man has a 2 week history of progressive weakness without nausea or vomiting. Chest radiography shows a hilar mass with mediastinal adenopathy suspicious for small cell lung cancer. Which of the following lab abnormalities will be noted if the patient has a paraneoplastic syndrome associated with the cancer?

This 67-year-old female has been brought by her daughter complaining of abrupt onset of dyspnea and severe chest pain. The daughter states that the patient has been bed-ridden due to a right hip replacement approximately 3 weeks ago. Vital signs are BP: 140/88 mmHg right arm supine; pulse: 120 bpm (regular); respirations: 26 breaths/min (labored); temp: 99.2 degrees F (oral). Physical examination reveals an apprehensive female with a persistent cough and scant hemoptysis. Increased respiratory effort with slight intercostal retractions are noted. The chest wall is nontender. Auscultation reveals accentuation of P2 and right-sided, unilateral crackles with expiratory wheezing. No calf tenderness is present and Homan’s sign is negative. Which of the following is the most likely diagnosis?

A 32-year-old female presents to your office with a dry cough, fever, sore throat, headache, myalgia and weakness for the past two days. The remainder of the history and physical exam is unremarkable. Which of the following is the most likely diagnosis?

A 12-year-old asymptomatic immigrant from a developing country has a routine tuberculin skin test. The reaction is 12 mm of induration. Chest X-Ray is normal. Proper management is:

A 75-year-old female with a history of congestive heart failure, hypertension and rheumatoid arthritis for many years complains of burning sensations and pain in the left side of her chest above the third rib. The patient had a myocardial infarction 5 years ago. Her blood pressure is 158/78 mmHg, pulse rate 89 bpm and respirations 28/min. On exam you observe a few vesicle-like lesions in the area of reported pain. EKG does not show any new ischemic changes and chest x-ray is normal. Which of the following would be the most appropriate treatment for this patient?

A 36-year-old woman has a 2 week history of generalized headaches. The presence of which of the following is a danger sign raising suspicion that the patient has a serious disorder?

A 33-year-old epileptic patient was brought to the ER via ambulance after having a witnessed tonic-clonic seizure. The patient is currently conscious and not actively seizing but is unaware of his situation. The patient has a history of seizures since he suffered a closed head injury when he was 17 years old. He used to take 200mg of Tegretol twice daily but ran out of his medication a month ago. Vital signs are stable. Physical examination is unremarkable. You should initiate treatment of this patient with a loading dose of which of the following medications?

A 14-year-old boy has migratory arthritis and is diagnosed with acute rheumatic fever. Which of the following is the most likely skin disorder to be noted?

Bupropion therapy is initiated in a 50-year-old woman in treatment of depression. The patient should be counseled that which of the following is the most likely adverse effect?

A 7-year-old patient is brought to the ED by his parents due to an acute onset of nausea and emesis today. They note several episodes of emesis and “dry heaves” since awakening. The patient has also been “very sleepy” for the past two days. He “seems confused” and is irritable when they talk to him. He was treated for bronchitis with OTC medications and was getting better prior to today. Vital signs are stable and he is afebrile. Mental Status Examination reveals mild confusion. Physical exam is unremarkable except for moderate epigastric tenderness. This patient is most likely suffering from which of the following conditions?

A 74-year-old female with a long-standing history of poorly controlled diabetes and hypertension, presents to your office. Her family has brought her concerned as the patient is having difficulty speaking since last night. The patient states she had been feeling well before last night at which time the symptoms suddenly occurred. The patient was unable to get dressed unassisted and specifically was having difficulty buttoning her shirt. The patient states that she feels her mouth and hands are not doing what she wants them to. Which of the following is the most likely diagnosis?

A 43-year-old female presents to the emergency department with burns sustained during a house fire. As you examine the patient you notice that her head, and the anterior surface of her body trunk have extensive burns. What percent of total body area is burned?

Which of the following disorders is commonly associated with cardiac abnormalities such as mitral valve prolapse pericardial effusions and myocardial atrophy?

A 58-year-old man acutely develops floaters, flashing lights and a scotoma in the peripheral visual field of his right eye one week following a cataract extraction in that eye. Which of the following is the most likely diagnosis?

A 32-year-old African American man is at increased risk to develop which of the following disorders?

Genetic testing in a 32-year-old woman shows the presence of mutations in the tumor suppressor genes, breast cancer type 1 and type 2 susceptibility genes (BRCA-1 and BRCA-2). The patient should be counseled that she is at increased risk of having which of the following conditions?

A 14-year-old patient presents with sore throat, fatigue and fever of 101°F. On physical exam you find bilaterally enlarged tonsils with white exudate and cervical lymphadenopathy. The patient has a history which includes allergy to penicillin. Which of the following would be the best treatment choice?

A five-year-old boy is brought in by his mother for evaluation of recurrent nosebleeds. Physical exam finds a red raw surface with fresh clots in old crusts. Which of the following is the most common cause of this patient’s condition?

A 79-year-old man has a 3-week history of fever, night sweats and fatigue. Examination shows diffuse lymphadenopathy involving the axillary, cervical and inguinal chains. No petechiae are noted. Results of the CBC show a white blood count of 112,000/microL. Which of the following is the most likely diagnosis?

A 44 year old male presents with vertigo, low frequency hearing loss, tinnitus and aural fullness. Meniere’s disease is diagnosed. In addition to meclizine for symptomatic relief, which of the following medications may be added?

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?

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?

Peptic ulceration in Zollinger-Ellison syndrome is mainly due to excessive production of which of the following?

The proton pump inhibitor omeprazole may cause which of the following clinical responses?

A 33-year-old woman has a 4 month history of recurrent abdominal bloating, cramping abdominal pain, but without nausea, vomiting, or weight loss. Which of the following is most consistent with a diagnosis of irritable bowel syndrome?

A patient presents complaining of an acute onset of severe low back pain. It started while bending to lift a heavy box and he describes it as a 10 on a scale of one to ten. There is no radiation of the pain. There are no neurological deficits. This is his second “attack” of back pain in the last six months. Which of the following is the recommended treatment for this patient’s condition?

A 67-year-old woman has a 1 month history of aching and morning stiffness in her hips and shoulders bilaterally. Examination is normal. Hemoglobin is 9.6 g/dL and erythrocyte sedimentation rate is 88 mm/hr. Polymyalgia rheumatica is diagnosed. Which of the following is the preferred initial therapy?

A Papanicolaou cytology examination should not be performed in which of the following patients?

Which of the following is the most common type of cervical cancer?

A 29-year-old woman who gave birth to a healthy baby six months ago presents to your office complaining of rectal bleeding and perianal pruritus which began four days ago after a large bowel movement. She states she seen small amounts of bright red blood on the toilet tissue, but has seen no bleeding in the toilet bowl. The patient denies any other complaints and overall is a healthy individual. On physical exam you find a fluctuant rectal mass is mildly painful on palpation. Which of the following is the most likely diagnosis?

The presence of which of the following differentiates rheumatoid arthritis from osteoarthritis?

A 27-year-old nulliparous patient comes to your office to discuss pregnancy. She has been attempting to get pregnant for 15 months and is now concerned she is unable to conceive. She is an overall healthy individual with a history of polycystic ovarian syndrome. Her vaginal exam and ultrasound showed no signs of structural abnormality and her husband has had a full analysis and no issues have been found. Initial management for this patient would be which of the following?

A 27-year-old female, who is 36 weeks pregnant and has had a history of preeclampsia, presents to the emergency room after suffering a seizure at a local restaurant. She has had no further seizure activity. Her blood pressure is 150/92 mmHg. Which of the following is the most appropriate management for this patient?

A patient suffers a blow to the back of the hand and wrist and presents with wrist pain and deformity. X-rays are obtained and are shown below. Which of the following best describes the findings?

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 is benign. An EKG is obtained as part of his routine testing and is shown below. Which of the following is the most appropriate step?