Mock 5

A 68-year-old man has a 3-month history of a “rash” on his neck, 12 pound weight loss, and anorexia. Examination shows acanthosis nigricans on his neck. Which of the following is the most likely diagnosis?

A 34-year-old woman has a 2 week history of recurrent, one second, “electric shock” piercing pain in her left cheek. Trigeminal neuralgia is diagnosed. Which of the following is the preferred initial therapy?

A 14-year-old otherwise healthy boy takes an overdose of benzodiazepam in a suicide attempt. Vital signs are normal. The patient is lethargic with slurred speech. Which of the following is the preferred initial therapy?

An 18-year-old man is brought to the emergency department after inhaling oxycodone. Blood pressure is 94/60 mmHg, pulse is 50/min and regular, respiratory rate is 6/min. The patient is obtunded and pupils are pinpoint. Intravenous administration of which of the following is the preferred initial therapy?

Following a rib fracture, a patient presents with tachypnea and chest pain. On physical exam you reveal decreased tactile fremitus, hyperresonance on percussion and decreased breath sounds on the affected side. Which of the following is most compatible with this presentation?

A 34-year-old male presents with sudden “sharp” chest pain of his right chest and mild dyspnea. These symptoms began suddenly while he was sitting at home watching TV. He denies any trauma or precipitating events but he had been playing basketball as the center earlier today. He denies a history of similar symptoms. He does not take any medications on a regular basis. Vital signs show tachycardia and tachypnea with SpO2 of 87% on room air. Physical examination reveals a nontender chest wall with decreased breath sounds, decreased tactile fremitus, and hyperresonance in the right middle lobe area. What is the most likely cause of this condition?

A woman who is HIV infected has 7 mm induration from a tuberculin skin test. Radiography of the chest is normal. Which of the following is the preferred management?

A 9-month-old presents with a history of a runny nose, low grade fever and “brassy cough” x 1 week. Yesterday, symptoms developed into a barking cough with a high pitched inspiratory noise and fatigue. On physical exam, the child has respiratory stridor with clear lungs. The most probable diagnosis is:

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

Metatarsophalangeal joint aspiration of an acutely inflamed big toe reveals strongly birefringent needle-shaped monosodium urate crystals with negative elongation by laboratory analysis. Synovial fluid cell counts are elevated to 30,000/uL. The most likely diagnosis is which of the following?

After having had 2 weeks of diffuse arthralgia, a 23-year-old woman has the acute onset of severe, diffuse anterior chest pain that is increased by inspiration and eased slightly by leaning forward. A bilateral malar rash is present and a pericardial friction rub is heard. Which of the following is the most likely diagnosis?

A 14-year-old girl suddenly faints as she is running during a basketball game. Fire rescue noted on scene that the patient was in torsades de pointes and had to shock her. Current examination in the ED reveals an alert, pink, asymptomatic girl. BP is 140/90 mm Hg recumbent, pulse 70/min/rig, and respirations 16/min. Cardiac exam is unremarkable and she is in normal sinus rhythm at this time. Which of the following is the most likely diagnosis?

“A low pitched, rumbling, diastolic murmur heard best at the apex with the bell” describes which of the following murmurs?

A 57-year-old woman has an acute retinal detachment of her left eye. Which of the following is the most likely symptom noted by the patient?

A 70-year-old asymptomatic man stopped smoking 20 years earlier but has a 30-pack year history of smoking. Which of the following is the recommendation of the U.S. Preventive Services Task Force regarding abdominal ultrasonography in screening for abdominal aortic aneurysm?

A 66-year-old male with a history of untreated hypertension (HTN) presents with a four months history of bilateral edema in his ankles that is worse at night. Past medical history is otherwise unremarkable. Family history is significant for HTN and diabetes. He admits to a 1 pack/day tobacco habit and occasional alcohol consumption. Vital signs reveal a blood pressure of 164/94mmHg in the left arm seated. Physical exam is significant for 1+ pitting edema in his ankles. Chest X-ray reveals mild cardiomegaly. Which of the following medications would be most appropriate for initial treatment of this patient?

Which of the following medications is the best choice of treatment for hypotension induced from the administration of Verapamil?

A 72-year-old male with a history of atrial fibrillation and an INR of 1.2 presents to your office with a focal neurologic deficit of acute onset. The clinical deficit resolves completely within 2 hours. Your primary diagnosis is:

A 71-year-old man has cramping discomfort in both calves while walking. Which of the following is the preferred initial diagnostic test to confirm peripheral arterial disease?

A 74 year old man presents after suffering a syncopal event. He is now conscious but feels weak and is notable pale and diaphoretic. You note a thready and bradycardic pulse. On review of lead II in his 12 lead EKG you note the rhythm below. Which of the following best describes this rhythm?

A 15-year-old asymptomatic girl has recently immigrated from a country known to have a high incidence of tuberculosis. Her tuberculin skin test shows 10 mm induration. Chest radiography is normal. Which of the following is the most appropriate management?

What is the most common cause of acute respiratory distress syndrome (ARDS)?

A 55-year-old man, who works as a stonecutter, has progressively worsening shortness of breath without cough, over a period of 6 months. He has never smoked. Exam shows a respiratory rate of 26/min and pulse of 116/min/regular. Lung exam is unremarkable. Which of the following is the most likely diagnosis?

A 55-year-old woman has a 3 month history of worsening constipation, cold intolerance, dry skin and forgetfulness. Examination shows dry skin, periorbital edema and slow relaxation of deep tendon reflexes. Which of the following is the most likely electrocardiographic abnormality to be noted in the patient?

A 16-year-old boy who has type 1 diabetes mellitus now is a competitive athlete on his high school football team. Which of the following is proper counseling concerning diabetic management?

A 61-year-old man 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 hyperpigmentation of skin creases. Serum sodium is 126 mEq/L. Which of the following is the most likely laboratory value to be noted?

A 22-year-old insulin dependent diabetic presents with profound weakness. History reveals that for the past week he has had fever and a productive cough. For the past 2 days he has noted excessive thirst and frequent urination. Blood pressure is 80/60 mmHg (right arm, supine); pulse is 120 bpm (regular), respirations are 28 breaths/min (deep and slightly labored), temperature is 99.0 degrees F (oral). Exam reveals an acutely ill man with a fruity breath odor. An accucheck glucometer reading measures 580 mg/dL. Arterial blood gas reveals metabolic acidosis. Which of the following results would you also expect to find?

The presence of which of the following differentiates peripheral cranial nerve VII palsy in Ramsay Hunt syndrome from the typical Bell’s palsy?

An 80-year-old man has recent-onset headaches and scalp tenderness when brushing his hair. Erythrocyte sedimentation rate is 90 mm/hr. Giant cell arteritis is diagnosed. Which of the following is the preferred initial therapy?

A 78-year-old man has a 2 week history of left-sided headaches. Giant cell arteritis is suspected. Which of the following is the most likely associated symptom to be noted by the patient?

The presence of which of the following differentiates a complex partial seizure from a simple partial seizure?

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

Two children, ages 5 and 7, have intensely pruritic rash (especially at night). Mom has been applying Calamine lotion and hydrocortisone cream with minimal relief. They rarely play outside and mom denies changes in their hygiene products. They recently returned from a slumber party at their best friend’s house. There are several tiny linear, reddened, raised lesions between their fingers and on the ventral aspect of the wrists. Which of the following is the most likely diagnosis?

A 37-year-old woman has a dry cough. Chest radiography shows bilateral hilar adenopathy. Serum angiotensin converting enzyme level is elevated. Which of the following is the most likely abnormality to be noted on physical examination?

Which of the following disorders is caused only by an adverse reaction to a medication?

A four-year-old girl presents with well demarcated, erythematous patches on both cheeks which resemble a handprint. She was seen by her pediatrician two weeks ago with generalize flulike symptoms and was treated with over-the-counter palliation. The patient’s mother also notice that she seems to have pain when walking and is complaining of knee pain. Which of the following is most likely?

A 14-year-old girl has a 2 day history of fever and intense sore throat. Blood pressure 90/72 mm Hg, pulse 102/min, and oral temperature 101 degrees F. Examination shows pharyngeal erythema and palatal petechiae. Posterior cervical and axillary nodes are felt bilaterally. Which of the following is the most likely diagnosis?

A 44 year old male is found to have a cup to disk ratio of 0.7 on routine funduscopic exam. Tonometry finds a pressure of 22 mmHg. Which of the following is the most likely diagnosis?

A 32-year-old woman in her 3rd trimester of pregnancy has abruptio placenta. She now has severe vaginal bleeding, oozing around venipuncture sites, hypotension, and tachycardia. Prothrombin time, aPTT, and thrombin times are all prolonged. Which of the following is the most likely diagnosis?

Your patient presents to the clinic with what you believe to be von Willebrand disease. What examination finding would be expected?

Which of the following is the most common site of anterior epistaxis?

A 38-year-old patient presents to the office with sustained vertigo nausea and vomiting which suddenly onset four days ago. The patient has a past medical history which is positive for both hypertension and diabetes. The patient denies any hearing loss. Cold calorics are performed in the office and the patient has a normal result. Which of the following is the most likely disorder?

An 18-year-old male presents with a history of a “penile infection” self-treated with Neosporin ointment. He is an uncircumcised male who now presents with inability to retract the foreskin. Which of the following describes this presentation?

An 80-year-old female was placed on hydrochlorothiazide 12.5 mg per day for hypertension. Two weeks later she presents with unsteady gait, decreased concentrating ability, headaches and mild nausea. Which of the following is the most likely cause for her symptoms?

A 40-year-old man sees you shortly after passing a calcium oxalate stone. Over the past 10 years he has had six similar episodes. A 24-hour urine collection shows that his calcium excretion is 500 mg/day (top normal 400 mg/day). Chemistry profile, including electrolytes, calcium and phosphorus, is normal. Which of the following would provide the best prophylaxis against future stones?

Lisinopril therapy is initiated in an 82-year-old man in treatment of systolic heart failure. Which of the following is the mechanism by which the angiotensin converting enzyme inhibitor therapy causes hyperkalemia?

A 56-year-old man who suffers from chronic alcohol abuse has an acute attack of severe pancreatitis. Blood pressure 72/44 mm Hg, pulse 138/min, respirations 26/min. Examination shows an acutely ill, but non-icteric patient. The abdomen is flat with epigastric tenderness. Which of the following is the most likely cause of the hypotension?

Necrotizing enterocolitis is diagnosed in a 1-month-old male who has vomiting, diarrhea, and abdominal distention. Which of the following is the most likely abnormality to be noted on radiography of the abdomen?

A 47-year-old female patient with a history of gallstones presents to the emergency department with an acute onset of right upper quadrant abdominal pain and vomiting. Vital signs are stable and she is afebrile. Physical examination reveals hyperactive bowel sounds and tenderness on palpation, Murphy’s sign is equivocal. Her lipase is found to be grossly elevated. Which of the following is the primary objective of treatment?

A 34-year-old man has a vertebral fracture and is found to have osteoporosis. Which of the following is the most likely underlying condition causing the osteoporosis?

A 10-year-old boy has painful swelling of his right knee that started 3 days after having fallen off his skateboard. Oral temperature 101.6 degrees Fahrenheit. Examination shows swelling, redness, and increased temperature over the knee. White blood count is 16,000/microL. Which of the following is the most likely diagnosis?

A 32-year-old woman who is being evaluated for infertility has microscopic examination of her cervical mucus. A fern frond pattern of the mucus indicates which of the following?

A 32-year-old woman in her 3rd trimester of pregnancy has the acute onset of severe, generalized bleeding. Disseminated intravascular coagulation is diagnosed. Which of the following is the least likely obstetric cause of the coagulation disorder?

Metoclopramide therapy is initiated in a 62-year-old woman who has gastroparesis caused by diabetic autonomic neuropathy. The U.S. Food and Drug Administration has a Black Box warning that this medication may cause which of the following adverse effects?

Ethinyl estradiol and drospirenone oral contraceptive therapy is initiated in a 30-year-old woman who has a history of post-streptococcal glomerulonephritis. Blood urea nitrogen is 29 mg/dL and serum creatinine is 1.2 mg/dL. Which of the following is the most likely adverse effect to occur?

A 68-year-old man who is a retired school teacher has chronically abused alcohol. He has bilateral painless contractures of the 4th and 5th fingers of his hands. Which of the following is the most likely diagnosis of his disorder?

A 21-year-old daycare worker presents to the emergency room with malaise, nausea, anorexia and arthralgias. She has noted a low grade fever throughout the last five days as well as a tea color to her urine. On physical exam you find some mild right upper quadrant tenderness, jaundice and scleral icterus. The patient has a negative Murphy’s sign. Lab work is unremarkable except for elevated AST and ALT. Which of the following is the most likely diagnosis?

Burning or tingling sensation in the 4th and 5th digits of the hand is most commonly seen in which of the following?

A 22-year-old female presents concerned that she cannot get pregnant despite two years of trying. She has no present somatic complaint. You notice her to be mildly obese, is hirsute and has acne. Results of her ultrasound show a “string of pearls appearance” in both ovaries. Which of the following is the most likely disorder?

An 18-year-old man has a 2 day history of fever, diffuse muscle aches, and mild anterior chest discomfort. Blood pressure 102/74 mm Hg, pulse 116/min with frequent premature beats, oral temperature 101 F., and respirations 23/min. Examination shows clear lung fields to auscultation. Heart size is indeterminate. A 1/6 apical holosystolic murmur is heard along with an apical S3 gallop. White blood count is 4900/microL. Which of the following is the most likely diagnosis?