MOCK 24

A 67-year-old female is hospitalized with crushing chest pain after witnessing her daughter nearly drown at the beach. Initial EKG demonstrated ST elevations of the anterior leads. Cardiac catheterization revealed left ventricular apical ballooning and clean coronary arteries. What is the most likely diagnosis?

A 75-year-old female presents complaining of weakness and lack of energy for 3 days. She has no past medical history and takes no medications. Vitals signs are a BP of 142/62 mm Hg and a HR of 38. An EKG is done and shows a rate of 38 with irregularly spaced PR intervals and wide QRS complexes. What is the initial management for this patient?

A 45-year-old male decides to get a checkup for the first time since he was a teenager.  Exam reveals a systolic ejection murmur best heard in the right second intercostal space and radiates to his neck. He is sent for Echocardiogram and it reveals a calcified, bicuspid aortic valve with severe stenosis. What is the next step in his management?

A 23-year-old female presents to your clinic for a routine exam. She has no complaints and maintains an active lifestyle.  She does have a history of mitral valve prolapse and a midsystolic click is noted during cardiac auscultation, the remainder of the exam is normal.  Echocardiography demonstrates normal heart function and no regurgitation. Which of the following recommendations should be provided to this patient?

A newborn child is found to have right ventricular hypertrophy, right ventricular outflow obstruction, and an overriding aorta on bedside echocardiogram. What additional finding on the echocardiogram would you expect to find?

A 37-year-old male presents for the fourth time in the past week complaining of a racing heart and palpitations. He has been successfully treated in the emergency room with a variety of treatments and discharged home with a follow up cardiac appointment. What is the recommended definitive treatment?

A 14-year-old male presents with a 1 day history of sore throat and fever but denies cough. Exam reveals elevated temperature, tender anterior cervical adenopathy, and pharyngeal exudate. What is the most likely diagnosis?

A 58 year old female patient presents with chronic bilateral eye irritation and pruritus. The eyes appear “red-rimmed” with scales clinging to the eyelashes. Conjunctivae are clear. What is the most likely diagnosis?

A 6-year-old boy presents with cold symptoms and “pinkeye” for 2 days. Exam reveals conjunctival erythema, watery eye discharge, clear rhinorrhea, and a tender preauricular adenopathy. What is the most likely diagnosis?

A 37 year old female comes to your office complaining of nasal congestion and decreased sense of smell. Physical exam reveals a small, mucosal covered, pale, edematous mass in the left nostril. What is the initial treatment of choice for this patient?

A 32-year-old male presents to your office with complaints of 15-20 lbs weight gain in the last year, puffy eyes and coarse, dry skin. Laboratory analysis reveals TSH of 7.2 U/mL (normal 0.5 to 4.5 U/mL) and free T4 of 0.1 ng/dL (normal 0.7 to 1.9 ng/dL) He does report a history of chest radiation therapy 15 years ago for acute lymphocytic leukemia (ALL). Which of the following drugs is indicated at this time?

Which of the following glucose-lowering agents acts by decreasing peripheral tissue resistance to insulin?

A 21-year-old female presents to your office with a 1 year history of amenorrhea and milky discharge from her nipples. Prior to the last year, she had regular menses and denies previous nipple discharge. She is not taking any medications. She is sexually active but does not wish to become pregnant. Serum hCG level is negative. Serum prolactin level is 300 mg/dL; MRI reveals a 2-mm mass in the pituitary. Which of the following is the most appropriate therapy at this time?

A 66-year-old male was found wandering in the streets by the police. There are no signs of trauma. He is brought to the ED for further evaluation. BP is 90/54 mm Hg, pulse rate is 115 BPM and respiratory rate is 12 breaths/min. Physical exam reveals mild dehydration, as well as decreased mental state without focal neurological findings. Initial laboratory findings include glucose of 750 mg/dL, Na of 124 mEq/L, K of 3.0 mEq/L, Cl of 102 mEq/dL, CO2 of 37 mEq/L, BUN of 101 mg/dL, creatinine of 1.0 mg/dL, blood pH of 7.3. Which of the following is the most appropriate first step in managing this patient?

64-year-old male presents to your clinic for evaluation. He complains of a daily productive cough over the last 4 months. He states that this has been a recurring pattern for him over the last few years. He is overweight but otherwise normal vital signs. Physical exam reveals perioral cyanosis without use of accessory muscles and auscultation demonstrates scattered rhonchi with occasional wheezing that change in location and intensity after a cough. What is the most likely diagnosis?

A 12-year-old boy presents to your office with acute onset of dyspnea and wheezing. His mother reports similar prior episodes after exposure to cats but he denies any recent exposure. He does not take any medications regularly. Physical exam reveals a respiratory rate of 28 breaths/min, normal blood pressure, patent airway, 1+ tonsils with clear throat, no pharyngeal erythema and diffuse expiratory wheezing. What is the most likely diagnosis?

Which of the following medications is likely to produce wheezing and cough in a patient with a history of asthma?

An 8-month-old female infant, up to date on all of her recommended vaccinations, is brought to your office for evaluation. Her mother states she has had a low grade fever with rhinorrhea, sneezing and cough for 3 days. On physical exam, you note nasal flaring, tachypnea, retractions and wheezing. Chest radiography reveals air trapping and peribronchial thickening. What is the most likely diagnosis?

A 6-year-old girl is brought to your office for annual physical exam. She reports intermittent episodes of wheezing. Exam reveals expiratory wheezing, no rales or rhonchi. She is talking in complete sentences without dyspnea or accessory muscle use. She is developing well and is cooperative with the exam. She responds well to an albuterol treatment given in your office. What is the most effective method to monitor the patient’s respiratory status at home?

A 37-year-old African American female presents to your office with a dry cough for 4 months. Vital signs are normal.  Physical exam reveals erythema nodosum of the anterior surface of the legs. Chest x-ray shows enlargement of bilateral hilar lymph nodes. Which of the following is the most likely diagnosis?

A 72-year-old man has claudication of the legs due to isolated peripheral artery disease. Addition of which of the following medications is most likely to make the symptoms worse?

A 44-year-old woman has recurrent chest discomfort diagnosed as variant (Prinzmetal) angina. Which of the following is the preferred therapy for prevention?

A 42-year-old man has a 2 month history of recurrent palpitations and diffuse sweating. Blood pressure is 200/118 mm Hg, pulse 102/min/regular. Presence of which of the following signs is most suggestive of pheochromocytoma?

A 74-year-old patient with diabetes and peripheral vascular disease presents with pain and erythema of her right lower extremity. The patient states that the redness and pain have slowly progressed in the last two days to involve the entire lower half of her leg. Exam finds a brightly erythematous lower extremity which is warm and painful to the touch. You note the overlying skin to have a tight, glossy appearance. The patient is febrile with a temperature of 101°F. Which of the following is the most likely diagnosis?

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?

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?

What vitamin deficiency can cause night blindness, Bitot’s spots and keratomalacia?

Pathology results on your patient revealed that numerous colon polyps were removed during a recent screening colonoscopy. For which of the following histologic types of polyps would a surveillance colonoscopy be recommended?

A 32-year-old male presents to the emergency department with severe upper abdominal pain, nausea, and vomiting. It started suddenly while he was watching football at a bar with friends. He admits to drinking a “few” beers and eating spicy chicken wings. Included in your differential diagnoses for this patient is acute pancreatitis. If this is the diagnosis, what findings would you expect on lab results?

An 18-year-old male presents to your office with the chief complaint of abdominal pain for 24 hours. The history is significant for constant periumbilical abdominal pain that started after lunch yesterday. He vomited once. Physical exam is significant for a low-grade fever and moist and clammy skin. Abdominal exam reveals normal active bowel sounds throughout. There is tenderness to light palpation in the right lower quadrant. In addition to blood work, which of the following diagnostic tests would be the most accurate next step in your workup for this patient?

A 22-year-old man presents to your office with complaints of increased stool frequency, sometimes bloody diarrhea, abdominal cramping, and weight loss. You refer him for further evaluation, and colonoscopy findings are consistent with normal mucosa, focal areas of ulcerations, and acute and chronic inflammation especially in the cecum and terminal ileum. Which of the following is the most likely diagnosis?

A 47-year-old woman with a long history of constipation presents to your office with left lower abdominal pain, diarrhea, bloating, low-grade fever, and chills for the past day. On physical exam, she is very tender to palpation in the left lower abdomen, and there is a palpable mass. Stool on DRE is brown and hemoccult positive. What would be the reasonable medical management for this patient?

Which of the following lab results may indicate an etiology for erectile dysfunction?

Too rapid a correction of a patient’s serum sodium results in:

Central diabetes insipidus is associated with which of the following?

A 35-year-old man is evaluated in the emergency department complaining of chest pain, nausea, chills, and sweats. During his initial evaluation, the patient’s affect ranges broadly from anger to crying to euphoria. He is hypervigilant with mild psychomotor agitation and excessive perspiration. Physical examination further discloses the following: temperature = 100°F, pulse = 120 RRR, R = 20 RR, and BP = 200/110. The patient’s pupils are dilated but responsive to light. His ECG and cardiac enzymes are all normal. The most likely diagnosis is:

Which of the following is the most worrisome indicator of suicide potential?

A 35-year-old presents requesting treatment for her chronic anxiety. She admits to consistently worrying and feeling anxious, nearly on a daily basis, about her completion of work and home related tasks. Her symptoms are so significant that she has been having difficulty concentrating on her work and is missing deadlines for her work assignments. The patient states that she tries to just ignore the worrying and anxious feelings, but has been unable to control the symptoms. In addition to her anxiety, she admits to feeling on edge, being easily fatigued, is irritable, and has been having difficulty sleeping. Her symptoms have been in place for more than 6 months and she presents today as her employer has threatened her job if her work does not improve. She denies taking any illicit substances or using alcohol and has no significant medical history other than the above. The most likely diagnosis for this patient is:

A 35-year-old woman arrives at the office saying that she feels “worried all the time.” She relates that she always feels “keyed up and on edge” no matter what is going on. “I can be watching a funny show on television, and I just feel afraid that something bad is going to happen.” The patient reports that she is easily fatigued but cannot sleep because she is worrying about things. She sometimes experiences palpitations and shortness of breath or dizziness when she is really worried about something. “I guess I’m just like my mother. She was always a worrier,” the woman says. Which of the following medications would not be best indicated in this patient’s treatment?

A patient is first seen with complaint of an episode of left arm “heaviness,” paresthesias, and the sensation of a “window shade” being pulled over his eye. The episode lasted approximately 10 minutes and resolved completely. Which of the following is the most likely diagnosis?

Which of the following is the visual disturbance typically described during a transient ischemic attack (TIA)?

The pathology associated with the late stages of neurosyphilis includes all of the following except:

Higher than expected levels of serum β-hCG may indicate which of the following?

Which of the following is the most common site of ectopic pregnancy?

Which of the following scenarios in ABO and Rh typing requires no intervention?

Which of the following is indicated in the management of mild preeclampsia?

A 64-year-old male with a diagnosis of multiple myeloma is being seen for routine follow-up and appears somewhat confused. His wife states that he has also complained of constipation and nausea over the past few days and has been urinating frequently. Chemistry panel results are within normal limits, with the exception of serum calcium level of 11.6 mg/dL and a decreased serum albumin level of 2.0 mg/dL. Based on this information, calculate the corrected calcium level for this patient.

A 36-year-old female patient presents with complaints of fatigue, and her CBC results are as follows:
WBC: 3000
Hgb: 8.5
HCT: 26%
MCV: 126
Plt: 98,000
The most recent prior CBC results documented 2 years ago were entirely normal. On further questioning, the patient reports that, over the past month, she has been having difficulty “feeling the floor with her feet” when walking. Past medical history is significant for ileal resection 5 years ago due to Crohn’s disease. Based on this information, which of the following diagnoses is most likely for this patient?

A 6-year-old child is brought to the emergency room for a complaint of high fevers and a rash. His mother reports that she thought he had “just a cold” approximately one week ago—he had a mild fever, runny nose, conjunctivitis and cough. Then he developed a rash that started on his face and gradually spread downward. The child has no significant past medical history, however he was adopted from Russia at age 5, and his medical history prior to adoption is unknown. On examination the child appears lethargic, and has a temperature of 104.3o. There is mild injection of his conjunctiva and a generalized macular rash. White macules are noted on his buccal mucosa. Which of the following is the most likely diagnosis?

A 5-year-old female is brought to the clinic for evaluation of a rash. Her mother reports the child was previously well, but a few days ago was acting very tired, had a low grade fever, and the mother noticed that the child had some enlarged cervical lymph nodes. She noted the rash on the face the next day, which faded over the course of a day, then appeared on her trunk. Today the rash is on her extremities. On examination you observe a generally well child, but there is a fine, pink, maculopapular rash on the extremities, and patchy erythema on the oropharynx. You suspect that the child may have rubella and the mother is presently 6 months pregnant. Which of the following represents the most appropriate course of action?

A 25-year-old man arrives at the office with urethral discharge, sudden onset of left knee pain, and blurry vision in the right eye. Physical examination discloses purulent penile discharge, swelling in the left knee, buccal ulceration, and infection in the right eye. Which of the following is the most likely diagnosis?

Which of the following clinical characteristics is seen most commonly in osteoarthritis?

Which of the following relationships between joint diseases and radiographic findings is correct?

Which of the following nerves is most likely to be damaged by a Monteggia fracture?

Which of the following is the mechanism of injury for scaphoid fracture?

An x-ray of the shoulder with and without weights assists in diagnosing:

A 64 year old male presents complaining of worsening dry cough and exertional dyspnea. Physical exam finds inspiratory crackles on auscultation and you note clubbing of his fingers. After initial work up, a CT scan of the chest is ordered and is shown below. Which of the following is the most likely diagnosis?

Presence of Babinski sign is an indication of which of the following?

A 27-year old man presents to the ED complaining of scrotal pain. The pain began 4 days ago and gradually worsened. The patient states his scrotum is too tender to allow for an adequate examination. Rectal exam is normal. Which of the following is the most probable diagnosis?

A 7-year-old boy presents with bilateral parotid enlargement and orchitis. He has no past medical history, however has not received his vaccines as his mother believes they cause autism. Which of the following is the recommended treatment?