Mock 4

A 40-year-old female complains of acute right upper quadrant pain radiating to the back and low grade fever. Laboratory evaluation indicates the presence of urinary bilirubin and an elevation of serum alkaline phosphatase. Which of the following is the most likely diagnosis?

A 21 year old male presents with progressive pain in the right femur that is worse at night. Exam is unremarkable. X-ray of the leg demonstrates a sunburst like periosteal reaction. The radiologist called it positive Codman’s triangle appearance. What is the suspected diagnosis?

A 33-year-old man has a skiing accident in which he injures his thumb. Examination shows swelling and tenderness on the ulnar side of the joint. Which of the following is most likely injured?

A spouse presents with complaints about her husband, whose behavior has changed in the last six months. At times he just sits quietly in the dark without responding to questions. Other times he becomes agitated over little things that never bothered him before. “He is not abusive or enraged with me”. He does not seem paranoid. He seems cognizant and shows no signs of delusionary behavior. When he goes through these episodes of mild agitation, “he can’t seem to focus on our store business”. The husband’s physical exam is normal. The patient is most likely suffering from:

A 57-year-old man with a history of hypertension has newly-diagnosed gout. Which of the following agents could make his gout worse?

A 13-year-old otherwise healthy boy presents to your office with his parents due to calf pain when he runs outside, he has a blood pressure of 150/100 mm Hg in both arms.  Cardiac exam is unremarkable. Radial femoral pulse lag is noted. What is your suspected diagnosis?

A 72-year-old woman has chronic hypertension. She presents with a 2-week history of exertional dyspnea. Exam reveals blood pressure of 140/90 mm Hg, pulse of 80/min/regular, and a respiratory rate of 18/min. Lung examination is normal. A left ventricular lift is palpated. No murmur is heard, but an S4 gallop is present. The patient’s dyspnea is due to:

A 24-year-old healthy female who does not use illicit drugs has the acute onset of severe anterior chest pain which is increased with recumbency and eased by sitting forward. A pericardial friction rub is heard on auscultation. Which of the following is the most likely etiologic organism?

Evaluation of routine telemetry monitoring of a 76 year old patient admitted to telemetry for pneumonia is shown below. The ectopic beats are occurring 6 times a minute and all have the same shape. Which of the following most appropriately identifies the rhythm below?

A 34-year-old woman has newly diagnosed Cushing’s disease. Which of the following is the least likely dermatologic sign to be present upon examination?

A 44-year-old man has a 3 week history of low grade fever, arthralgia, and easy fatigability. Oral temperature of 101 degrees F. Examination is normal except for a 2/6 apical holosystolic murmur. Which of the following is not considered a major Duke criterion for diagnosis of infective endocarditis?

A 45-year-old retired postal worker, has an average blood pressure of 168/110mmHg which you have confirmed with serial readings over one week. Which of the following treatment options would be most appropriate for this patient?

A 30-year-old woman presents to the ER with paroxysmal supraventricular tachycardia. Her heart rate is 186, vitals are stable and she has no current complaints other than racing heart. The first line drug of choice is which of the following?

Which of the following is the most characteristic murmur associated with patent ductus arteriosus?

A 56-year-old woman has the sudden onset of a cold and painful right foot. Blood pressure is 120/70 mm Hg. Examination shows a cold and pale right foot. No popliteal or distal  pulses are felt on the affected side. Electrocardiography shows atrial fibrillation. Which of the following is the preferred initial therapy?

A 17-year-old man has fever and an incessant dry cough. A diagnosis of Mycoplasma pneumonia is made. Which of the following is the preferred initial therapy?

A 66-year-old woman has had a worsening non-productive cough with malaise for the past week. Her temperature increases to 99.6 degrees F. A chest radiograph reveals diffuse bilateral pulmonary interstitial infiltrates in all lung fields. A sputum gram stain reveals normal flora and few neutrophils. She recovers over the course of the next two weeks. Infection with which of the following organisms most likely caused her illness?

Which of the following is common to patients who have asthma, atopic dermatitis, and allergic rhinitis?

Which agent provides the most rapid effect and best therapeutic index in the treatment of acute asthma?

A 55-year-old man with diabetes of 10 years duration develops progressive lower extremity edema bilaterally and shortness of breath over a period of 3 weeks. Decreased tactile fremitus, flat percussion note, and absent breath sounds are heard over the lower 1/4 of both posterior lung fields. Urinalysis reveals 4+ proteinuria. The pulmonary findings are due to which of the following?

A 67-year-old Caucasian female presents for the first time for a “flu shot”. She denies ever receiving the vaccine in the past. Which of the following is a contraindication to the trivalent influenza virus vaccine?

A 49-year-old male presents with a productive cough for the past five days. He denies a history of frequent respiratory infections but did smoke “one pack a day for about twenty years”. He quit fifteen years ago. He denies chest pain, dyspnea, chills, fever, leg edema or odor to the sputum. Pertinent positives include blood-tinged, clear colored sputum and intermittent cough with no relief from Robitussin cough syrup. He is afebrile and has normal vitals. Which one of the following is your most likely diagnosis?

A 22-year-old insulin-dependent diabetic presents due to an altered mental status. His college roommate states that he has been increasingly agitated and combative for the past hour. During your questioning, he is confused and his speech is slurred. His vital signs are stable. Your physical exam reveals no significant abnormalities. Which of the following ancillary studies will most likely aid in your diagnosis of this patient’s condition?

A 65-year-old woman has a 2 month history of anorexia, nausea, and 5 pound weight loss. Blood pressure, sitting, 100/70 mm Hg with pulse 88/min. Blood pressure, standing, 86/66 mm Hg with pulse 102/min. Examination shows generalized hyperpigmentation. Serum sodium is 126 mEq/L. Which of the following is the preferred initial diagnostic test?

Lithium therapy is to be initiated in a 32-year-old woman in treatment of bipolar disorder. Which of the following is appropriate counseling concerning the medication?

An intravenous drug abuser has tricuspid valve endocarditis. Which of the following is the most likely infecting organism?

A 45-year-old man states that he has had severe headaches daily over the past three weeks, each lasting from 15 minutes to about two hours. The pain is over his right eye which becomes red and tears during these attacks. He also experiences nasal congestion at these times. Which of the following symptoms is he also likely to have during his headaches?

A 32-year-old man is diagnosed as having cluster headaches. He should be counseled that intake of which of the following is most likely to provoke the onset of a headache?

The presence of which of the following differentiates cranial nerve VII palsy caused by brainstem infarction from Bell’s palsy?

Donepezil (Aricept) therapy is initiated in an 83-year-old man for treatment of dementia. The caregiver should be counseled that which of the following is the most likely adverse effect of the medication?

A 22-year-old man has the recent onset of severe seborrheic dermatitis. The clinician should suspect which of the following as the underlying diagnosis?

A 25-year-old male presents with high fever, shaking chills, fatigue, headache, vomiting, and malaise since yesterday. Physical exam reveals a red, warm, raised, sharply bordered plaque on his face which has been enlarging peripherally. No crusting, scaling, or discharge is noted. The patient’s temperature is 102 degrees F. What is the most likely diagnosis?

A 3-day-old male infant has multiple, tiny, white, firm white lesions on the upper and lower eyelids. Which of the following is the preferred therapy?

Which of the following is not characteristic of hypomania?

A 16-year old female is transported to the emergency room after she swallowed 50 Tylenol tablets. Which of the following medications should you administer as an antidote?

A 24-year-old male has a pruritic rash of the trunk and extremities which has developed of the last 10 hours. He states that he has never had symptoms like this before and has no known allergies. He reports he had shrimp and strawberries for dinner last night and that the symptoms occurred shortly after he finished dinner. Physical exam finds the patient with a diffuse rash consisting of reddened areas of well demarcated wheals. Which of the following is the most likely diagnosis?

Which of the following is correct regarding the comparison of visual loss from glaucoma and that of macular degeneration?

A 62-year-old presents with the classic symptoms for Meniere’s disease. Your history and physical exam would have discovered which of the following symptom triads?

A 56-year-old man suddenly has diplopia associated with pain in the eye and supraorbital area. Examination shows cranial nerve VI palsy. Which of the following is the most likely underlying cause?

A 76-year-old woman who is on chronic hemodialysis has hemoglobin of 8 g/dL. Evaluation shows a normochromic normocytic anemia. Serum ferritin level is 300 mg/mL. Which of the following is the preferred therapy for the anemia?

An 82-year-old woman is to undergo a major orthopedic surgical procedure. Which of the following is an advantage of low molecular weight heparin over unfractionated heparin?

An 18-year-old female presents with concern over pressure in her neck when she swallows. On physical exam you find a mildly enlarged right lobe of her thyroid. Ultrasound is performed and finds a 1.2 cm nodule. Which of the following is the most appropriate next step?

A 44-year-old male presents complaining of a persistent ringing in his ears. He has no previous medical history, but was recently started on medication after a trip to his general physician. Which of the following medications is most likely responsible for symptoms?

Which of the following is the primary physiologic mechanism by which an angiotensin converting enzyme inhibitor (ACEI) reduces proteinuria?

An angiotensin converting enzyme inhibitor is contraindicated in which of the following conditions?

A 24-year-old woman is in her first trimester of pregnancy. Which of the following medications may be prescribed at this time?

A 55-year-old woman with diabetes mellitus has developed nephrotic syndrome. Which of the following is the most likely abnormality to be found on examination of the urine?

A 44-year-old woman has chronic pancreatitis caused by chronic alcohol abuse. Which of the following is the most likely complication?

The presence of which of the following differentiates megaloblastic anemia in pernicious anemia from vitamin B12 deficiency megaloblastic anemia in Crohn’s disease?

Methotrexate therapy is initiated in a 40-year-old woman in treatment of rheumatoid arthritis. Which of the following is proper counseling for the patient?

Which of the following in a first time pregnancy does not occur during the first trimester?

Which of the following is the most frequent cancer diagnosed in women?

A 50-year-old woman has the acute onset of vomiting induced by chemotherapy. Which of the following is the preferred initial therapy?

A 34-year-old woman has taken an estrogen-progestin oral contraceptive pill for 4 years. She is at greatest risk of developing an adenoma in which of the following organs?

A 45-year-old female with a history of multiple prior abdominal surgeries, and no significant medical history, presents to the emergency room complaining of diffusive abdominal pain, nausea and loss of appetite. The patient states her last bowel movement was five days ago. Physical exam finds the patient with hypoactive bowel sounds in a diffuse the tender abdomen. Flat and upright abdominal series x-rays are obtained and showed dilated loops of bowel with air fluid levels. Which of the following is the most likely cause of this patient’s disorder?

Which of the following is the most common complication associated with fractures of the proximal humerus?

A 15-year-old boy who is a pitcher on a baseball team has a 2-day history of painful swelling of the left medial elbow area. Examination shows local tenderness without swelling. Pain is increased during wrist flexion and extension. Which of the following is the most likely diagnosis?

A 37-year-old woman complains of a sudden onset of sciatic pain on the right side. Her pain worsens with cough and movement. She also complains of some numbness in her right leg. On physical examination, her DTR’s are slightly diminished in the right lower extremity. A straight leg raise causes pain in her right leg. Which of the following is the most likely diagnosis?

A 20-year-old sexually active female presents the office with lower abdominal pain that is been present for the last six days and is getting worse. She had her last normal period six weeks ago and has a positive home pregnancy test. She is presently clinically stable with the normal blood pressure and is afebrile. Physical exam finds diffusive abdominal tenderness which is localized to the right side. Pelvic exam finds increased pain on the right adnexa. Which of the following is the most likely diagnosis?

A 26-year-old woman has pallor and pain when taking a frozen package from the freezer. Raynaud’s phenomenon is diagnosed. Which of the following is the most likely underlying disorder?