Mock 23

Which of the following tests will indicate an ACL injury?

Which of the following tests will indicate supraspinatus injury of the rotator cuff?

A 28-year-old woman in the 3rd trimester of pregnancy is in acute systolic heart failure related to peripartum cardiomyopathy.   Which of the following should be excluded in the therapeutic plan?

Which of the following is generally self-limiting with the two most common physical findings being jaundice and hepatomegaly?

Which of the following presents with an almost asymptomatic acute phase, but the chronic phase can lead to cirrhosis and hepatocellular carcinoma?

Which of the following differentiates gastritis from gastropathy?

A 64-year-old male presents with progressive dysphagia to solid foods and weight loss. He has a past history significant for alcohol and tobacco abuse. He admits that his diet consists primarily of meat and potatoes. He is on no medications. Which of the following is the most likely diagnosis?

Which of the following is first line combination therapy for treating sepsis secondary to cholangitis?

A 44-year-old obese female presents to the ED complaining of right upper quadrant pain and increased flatulence after eating a fatty meal. She has had this pain in the past but this is significantly worse. Patient is afebrile and in moderate distress. Physical exam demonstrates a positive Murphy’s sign. Which of the following is the most likely diagnosis?

Pityriasis rosea presents with which of the following presentations?

Acanthosis nigricans is associated with what condition?

Allopurinol therapy is to be initiated in a 63-year-old man to prevent recurrent gout.   The patient should be counseled that which of the following is the most likely adverse effect?

A few minutes after removing a food package from a freezer a 33-year-old woman has the sudden onset of numbness and pallor in the fingers of both hands.   Warming of the hands for 10 minutes causes the hands to become flushed. Which of the following is the most likely diagnosis?

A 36-year-old man has a 2 day history of fever and tenderness along the course of flexor sheaths of the wrist and 3 fingers of the left hand. The tenosynovitis is most likely to be caused by hematogenous spread by which of the following organisms?

An 11-year-old healthy, physically active boy has a 3 week history of gradually worsening bilateral heel pain. Examination shows decreased gastrocnemius-soleus flexibility. Direct digital palpation over the apophysis and the calcaneal compression test bilaterally reproduces the pain. Radiography of the heels shows sclerosis and widening of the growth plate felt to be normal for the patient’s age. Which of the following is the most likely diagnosis?

Which of the following is the agent of choice for treatment of shortness of breath due to an acute pulmonary embolism?

A 44-year-old woman has a 3 week history of intermittent flushing, watery diarrhea, and wheezing.   Examination shows normal vital signs, venous telangiectasia on the nose and upper lip, and an enlarged, nodular liver.   Which of the following is the most likely diagnosis?

Parenteral betamethasone is administered to a 25-year-old woman at 26th week of estimated gestational age (EGA) who is at risk of preterm delivery within the next 7 days.   Which of the following is the physiologic effect on the fetus?

A 59-year-old man with known chronic bronchitis has a 9 day history of increasing dyspnea, productive cough, and bilateral ankle edema. Examination shows elevation of jugular venous pressure, diffuse rhonchi, distant heart tones, and 2+/4 bilateral ankle edema. Which of the following is the primary pathophysiologic abnormality causing the patient’s hemodynamic status?

The presence of which of the following differentiates interstitial pulmonary fibrosis from chronic bronchitis?

A 67-year-old woman with chronic bronchitis who takes inhaled albuterol and ipratropium has a 6 day history of increasing dyspnea and cough productive of purulent sputum. Blood pressure 116/76 mm Hg, pulse 118/min/regular, respirations 30/min, oral temperature 99.3 degrees F. The patient is not cyanotic. Jugular venous pressure is normal.   Scattered rhonchi are heard. The decision is made to treat the patient at home. Which of the following medicines should be added in therapy?

A 40-year-old woman has acute anterior chest pain and suddenly faints.   Blood pressure 96/70 mm Hg, pulse 120/min/regular, respirations 26/min. Examination shows elevation of jugular venous pressure, clear lungs to auscultation, and soft heart sounds without murmur or gallop.   Which of the following is the most likely diagnosis?

Carbamazepine therapy is considered in a 52-year-old woman of Asian ancestry who has recurrent, severe, brief episodes of right facial pain diagnosed as trigeminal neuralgia.   Which of the following is the most appropriate test to be performed prior to the initiation of therapy?

Giant cell arteritis is diagnosed in an 80-year-old woman who has acute visual loss. In addition to prednisone, which of the following should be added in therapy?

The presence of which of the following differentiates oculomotor nerve (cranial nerve III) palsy in the patient who has diabetes mellitus from the patient who has a cerebral aneurysm?

Prednisone therapy is initiated in an 80-year-old woman in treatment of giant cell arteritis. Serial measurement of which of the following is the most appropriate clinical indicator of disease activity?

A patient with which of the following history kidney stones would develop more stones due to drinking grapefruit juice?

An 80-year-old man who has sustained remote myocardial infarctions is now in chronic systolic heart failure. Laboratory values include blood urea nitrogen 45 mg/L and serum creatinine 1.5 mg/L. Which of the following is the primary pathophysiologic basis of the increased BUN/creatinine ratio?

A 39-year-old man has persistent dysuria for 5 weeks.   Multiple urinalyses show a normal specific gravity, 8-10 white blood cells, and 4-8 red blood cells/high power field, but no casts or red blood cells.   Three urine cultures are sterile. Which of the following is the most likely diagnosis?

A 57-year-old healthy man has a 4 month history of erectile dysfunction. Which of the following is the most appropriate diagnostic test to be performed in the management of the patient?

Dutasteride therapy is initiated in a 53-year-old man in treatment of benign prostatic hyperplasia. Which of the following is the pharmacologic class of this medication?

After 10 days of quinine dihydrochloride therapy for falciparum malaria, a 30-year-old woman has intense flushing, tinnitus, bilateral hearing loss, headache, and nausea. Blood pressure 114/76 mm Hg, pulse 110/min; oral temperature 101 degrees F. Examination shows an alert patient who is flushed and sweating. Hearing is moderately decreased in both ears. Which of the following is the most likely diagnosis?

A 52-year-old woman has a 10 day history of night sweats, cough, lumbar back pain, abdominal discomfort, and 4 pound weight loss. Examination shows scattered rhonchi over the lung fields, normal heart sounds, and modest ascites. Urinalysis shows pyuria with sterile urine culture. Chest radiography shows reticulonodular infiltrates throughout the lungs and right hilar adenopathy. Which of the following is the most likely diagnosis?

A 34-year-old woman has acute hypertension and tachycardia. Blood pressure 216/116 mm Hg, pulse 124/min, respirations 20/min. Which of the following is the least likely cause of the hypertensive emergency?

On a prank, an 8-year-old boy ingests a large amount of ethanol. Which of the following is the most likely adverse effect?

Twenty-two hours after an accidental overdose of acetaminophen an 82-year-old man has nausea and vomiting. Serum aminotransferase levels are markedly elevated and hypoprothrombinemia is noted. Which of the following is the preferred initial therapy?

A 24-year-old woman smokes cigarettes throughout her pregnancy.   Which of the following is the most likely adverse effect on her newborn child?

A 44-year-old woman was exposed in-utero to diethylstilbesterol. Which of the following is the most likely condition that the patient may develop?

A 27-year-old woman is taking lithium for bipolar disorder during her pregnancy. She is at greatest risk of having a baby with which of the following conditions?

Despite clear warning, a 31-year-old pregnant woman takes oral retinoin. Which of the the following is the most likely adverse effect on her fetus?

A 33-year-old woman has a 1 week history of dyspnea, palpitations, and ankle swelling. Two years earlier she was stabbed in the right buttocks. Blood pressure 160/64 mm Hg, pulse 108/min/regular, respirations 26/min, oral temperature 99.0 F. Examination shows elevated jugular venous pressure, apical impulse in the 6^th anterior intercostal space, apical S3 gallop, bounding peripheral pulses, and a 3 inch healed scar in the right buttocks. Which of the following is the most likely cause?

Four years after chest irradiation for breast cancer a 56-year-old woman has a 2 week history of dyspnea, fatigue, bilateral ankle edema, and abdominal distention.   Examination shows elevated jugular venous pressure, soft heart sounds, ascites, and 2+/4 bilateral lower extremity edema.   Which of the following is the most likely diagnosis?

An 82-year-old man has an acute inferior wall myocardial infarction complicated by right ventricular infarction. Blood pressure 82/64 mm Hg, pulse 112/min/reg. Examination shows normal jugular venous pressure, clear lung fields, and apical S4 gallop. Chest radiography is normal. Intravenous administration of which of the following is the preferred initial therapy?

A 26-year-old man has a 2 week history of dyspnea, palpitations, and ankle swelling. Two years earlier he was stabbed in the left thigh. Blood pressure 156/60 mm Hg, pulse 110/min/regular, respirations 22/min. Examination shows the apical impulse in the 6^th anterior intercostal space, apical S3 gallop, and bounding peripheral pulses. A bruit is heard over a left thigh scar. Which of the following is the preferred initial management?

A 50-year-old man has a 3 week history of increasing dyspnea, fatigue, bilateral ankle edema, and abdominal distention.   Evaluation demonstrates restrictive cardiomyopathy.   Which of the following is the most likely underlying cause?

An 80-year-old woman has an acute inferior wall myocardial infarction. Six hours later blood pressure 82/62 mm Hg, pulse 114/min/regular, respirations 28/min. Examination shows elevated jugular venous pressure, clear lung fields, and apical S4 gallop. No murmur is heard. Which of the following is the most likely complication of the inferior infarction?

A 24-year-old man has hypertrophic obstructive cardiomyopathy. She has recurrent syncopal episodes caused by left ventricular outflow obstruction that is unresponsive to medicinal therapy. Which of the following is the most appropriate next step in management?

A 69-year-old man has newly diagnosed isolated systolic hypertension.   Which of the following should be excluded as first-line therapy?

A full-term infant male has a patent ductus arteriosus causing heart failure. Which of the following is the preferred initial therapy?

A 67-year-old asymptomatic black man has newly diagnosed hypertension.   Blood pressure 152/96 mm Hg, pulse 84/min.   Physical examination is otherwise normal. Which of the following is the preferred initial therapy?

A 34-year-old woman awakens with painless double vision.   Examination shows cranial nerve III palsy.   Which of the following is the least likely underlying cause?

A 26-year-old pregnant woman takes carbamazepine as an epileptic drug. Her infant is most likely to have which of the following abnormalities?

Thirty minutes after inhaling cocaine a 22-year-old woman has generalized seizures. Which of the following is the preferred initial medicine?

A 37-year-old woman has fatigue. Several blood pressure measurements average 140/102 mm Hg. Pulse rate ranges from 64 to 68/min.   Which of the following is the most likely underlying disorder?

The presence of which of the following differentiates the clinical manifestations of hypoglycemia from hypocalcemia?

A 68-year-old woman has hyperthyroidism complicated by high cardiac output heart failure.   Which of the following is the preferred initial therapy for the hyperthyroidism?

A 41-year-old woman who has gram negative sepsis from cholangitis now has diffuse ecchymoses, confusion, and worsening azotemia.   Blood pressure 88/70 mm Hg, pulse 120/min/regular, oral temperature 102 degrees F. Examination shows diffuse ecchymoses and altered mental state.   Plasma fibrinogen level is low. The prothrombin time and activated partial thromboplastin time are prolonged. Which of the following is the most likely diagnosis?

A 32-year-old pregnant woman has an amniotic fluid embolism complicated by disseminated intravascular coagulation. Which of the following is the expected laboratory value to be noted?

One week after initiation of primaquin therapy for anti-malarial prophylaxis a 22-year- old man has red-brown urine and jaundice. Glucose-6 phosphate dehydrogenase deficiency is diagnosed. Which of the following is the cause of the red-brown urine?

A 59-year-old female is transported to the emergency department by EMS after a motor vehicle accident. She was the restrained driver of a stationary vehicle that was struck from behind by another vehicle traveling approximately 45mph. She complains of neck pain and weakness in her arms and legs. Physical exam reveals that she is incontinent of urine. Strength against resistance is 2+ in the upper extremities and 4+ in the lower extremities. Based on these findings, which of the following is the most likely diagnosis?