Mock 6

You believe a patient who frequently visits your office is being deceptive in her actions to simulate medical disorders. This behavior leads you to perform unnecessary medical investigations and execute unnecessary treatment plans. What is the most likely diagnosis?

A 25-year-old man who is addicted to heroin has a lung abscess caused by an infected vegetation embolus related to acute tricuspid valve endocarditis. Which of the following is the most likely organism causing the lung abscess?

A 31-year-old male presents to the clinic complaining of generalized anterior left upper chest pain that is intermittently dull, sharp, and pleuritic in nature. He relates the symptoms are aggravated with deep respiration and with rotation at the waist. He denies any radiation of symptoms to the neck or upper extremities. Inspection of the chest reveals no rashes or deformities. Palpation of the left upper anterior chest wall reproduces the pain. EKG is NSR and shows no ST changes. Which of the following is the most likely diagnosis?

An 8-year-old boy has a bicuspid aortic valve. He is at greatest risk of developing which of the following?

A 42-year-old construction worker with previously diagnosed stage 1 hypertension and type II diabetes is prescribed a thiazide diuretic but his BP remains poorly controlled. Which of the following treatment options would be the most appropriate to consider for this patient?

Which lab test is used to detect if a patient is in congestive heart failure?

Upon examination of a 10-day-old full term infant you auscultate a “machinery” murmur at the second intercostal space. His pulses are bounding, and pulse pressure is widened. What is the most likely cause of this child’s murmur?

A 16 year old recent immigrant from South America, who had a recent URI with sore throat presents with evidence of congestive heart failure, joint pains, a serpingous rash on his chest, low grade fever and elevated ESR level. Which of the following is the causative agent of his disease?

A 55-year-old man has chronic mitral regurgitation due to rheumatic heart disease. He is most likely to develop which of the following complications?

A young adult patient comes to your office complaining of headache, sweating, palpitations, and anxiety. On physical examination you find hypertension, associated with orthostatic hypotension. Urinary catecholamines are elevated. What is the most likely diagnosis?

A 64 year old male presents with bradycardia, fatigue and mild chest pressure. An EKG is obtained. On review of lead II in his 12 lead EKG you note the rhythm below. Which of the following best describes this rhythm?

A 77-year-old man who has been on ventilator assistance for 2 weeks now has an extensive right lower lobe pneumonia. Which of the following is the most likely organism causing the pneumonia?

A 37-year-old presents after being stung by a wasp. Within 15 minutes he developed a choking sensation in his throat, difficulty breathing, and diffuse wheals. His vital signs are BP: 98/54 mmHg; pulse: 106 bpm; respirations: 28 breaths/min (shallow). Which of the following medications is the best initial choice to order?

A 54-year-old man has asthma for which inhaled albuterol is prescribed. Which of the following is the mechanism of action of this medication?

Which of the following tuberculosis drugs has the side effect of visual disturbances?

A 55-year-old 68-inch tall man weighing 298 pounds with a history of hypertension has excessive daytime sleepiness. He takes Vaseretic (enalapril + hydrochlorothiazide) for his blood pressure, consumes 1-2 beers per day at dinner, and has a 5 pack-year history of smoking. Which of the following is the most likely etiology of his daytime sleepiness?

A 35-year-old male is getting treatment for tuberculosis, he has complaints of peripheral neuropathy, what agent do you suspect is the cause?

The presence of which of the following differentiates central diabetes insipidus from nephrogenic diabetes insipidus?

A 55-year-old man has chronic adrenal insufficiency. A decreased secretion of which of the following is the primary pathophysiologic mechanism that causes the hypotension characteristic of the disease?

A 63-year-old diabetic male presents complaining of blurred vision, weakness, nausea, vomiting, and abdominal pain. Physical exam reveals deep, gasping respirations, tachycardia, and orthostatic blood pressure changes. Lab work reveals a random glucose of 620 and a metabolic acidosis. What is the first step in the management of this patient?

A 22-year-old woman has a 2 week history of marked polydipsia and polyuria without associated weight loss. Serum sodium is 156 mEq/L. Fasting plasma glucose level is 78 mg/dL. Which of the following is the most likely diagnosis?

A 33-year-old man has recurrent folliculitis on his trunk and thighs. Which of the following is the most likely underlying cause?

A 4-year-old girl has her first febrile seizure characterized as generalized clonic activity lasting 2 minutes. Which of the following is proper management?

Donepezil (Aricept) therapy is initiated in an 82-year-old woman for treatment of dementia. Which of the following is the mechanism of action of the medication?

A 66-year-old woman awakens with painless drooping of the left side of her face. Presence of which of the following differentiates peripheral cranial VII palsy (Bell’s palsy) from a tumor in the brainstem?

The presence of which of the following differentiates ptosis in the patient who has Horner syndrome from ptosis in the patient who has cranial nerve III (oculomotor nerve) palsy?

An 18-year-old man has newly diagnosed, severe seborrhea on his face, chest, and extremities. Which of the following is the most likely associated disorder?

For several days a child has been sick with high fever, vomiting and a sore throat. Today, the parents bring the child to the ER because of the development of a rash. The rash is a discrete, fine, erythematous, maculopapular eruption with a texture like sandpaper. The throat and tonsils are inflamed. The lingual papillae are swollen and red with a white coating. Which of the following is the most likely diagnosis?

Oral isotretinoin therapy is initiated in a 19-year-old man in treatment of acne vulgaris. Which of the following is proper counseling for the patient?

A 33-year-old woman has taken clonazepam for 2 months in treatment of generalized anxiety disorder. Which of the following is the most appropriate counseling for the patient concerning the medication?

A 25-year-old female presents with altered mental status. History provided by her family reveals she has been depressed lately but she is relatively healthy. Vital signs are BP: 98/42 mmHg (right arm, supine); pulse: 114 beats/min (regular); respirations: 8 breaths/min (nonlabored); temp: 97.2 degrees F (oral). Physical examination reveals that she is obtunded with slurred speech. Pupils are 3mm with a sluggish light reaction. Deep tendon reflexes are absent in all extremities. Which of the following is the most likely diagnosis?

Which of the following is the most likely diagnosis in a seven year old girl with a fine red rash over her neck and chest, sore throat, headache and fever for 2-3 days?

An 18-year-old patient presents with severe right ear pain without discharge. Examination reveals an inflamed tympanic membrane with multiple small hemorrhagic blebs. Hearing is not affected. Which of the following is not a common causative organism?

A 5-year-old child presents with a unilateral, foul-smelling nasal discharge. Which of the following is the most likely etiology?

A 54-year-old female presents after being struck in her right eye by a blunt object earlier today. Visual acuity is 20/40 in the left eye and 20/100 in the right eye. Physical exam demonstrates hemorrhaging into the anterior chamber of the right eye. Schiotz tonometry measures 13 mmHg in the left eye and 18mmHg in the right eye. Which of the following are the most appropriate next steps in the management of this patient?

A 34-year-old male presents concerned after experiencing bloody discharge two days ago from his right ear. The patient is unaware of any direct trauma but was recently on a flight. On physical exam you find a small perforation of the right tympanic membrane with slight erythema. The patient presently has no discharge and no evidence of infection. Which of the following is the treatment of choice?

A 42-year-old otherwise healthy male presents to the office complaining of difficulty hearing from his right ear with occasional tinnitus and vertigo. Otoscopic exam is completely normal. Hearing tests find the patient to have a 60 dB hearing loss in four frequencies in his right ear but normal readings in his left ear. Tympanometry testing finds results consistent with a healthy tympanic membrane. Which of the following is the most likely diagnosis?

Which of the following lab values most likely represent a hemolytic anemia?

A 12-year-old girl has post-streptococcal acute glomerulonephritis. Presence of which of the following is most likely to be noted on microscopic examination of the urine?

The nitrite dipstick test is used in the assessment of which of the following?

A 63-year-old man has hypertension and benign prostatic hyperplasia manifest by urinary frequency and nocturia five to six times a night. Which of the following is the preferred management of the patient?

After 1 week of sulfonamide therapy, a 32-year-old woman has fever and a maculopapular rash. Eosinophilia is noted on peripheral blood examination. Urinalysis shows pyuria and eosinophiluria. Which of the following is the most likely diagnosis?

What is the most common cause of small bowel obstruction in an adult?

A 22-year-old woman predictably has bloating, gas, and diarrhea after ingesting milk or ice cream. Which of the following is the preferred diagnostic test for lactose intolerance?

Which of the following is the best approach in management of a patient who is infected with an uncomplicated case of acute hepatitis A?

A 20-year-old female college student gives you a history of recurrent bouts of crampy abdominal pain that are relieved with defecation. During these periods, stools are loose and frequent. She denies fever, weight loss, and blood or mucus in her stools. The rest of her history is unremarkable. Physical exam, including abdominal exam, is normal. Stool Hemoccult test is negative. Which of the following is the best next step in the evaluation and management of this patient?

A 76-year-old man has a 10 day history of pain in his left ribs. Examination shows local tenderness without crepitation. Radiography of the ribs shows osteolytic lesions. Hemoglobin is 9 g/dL. Serum calcium is 11.4 mg/dL. Which of the following is the most likely diagnosis?

A woman has systemic sclerosis with the CREST syndrome. Which of the following is not a clinical manifestation of CREST?

A 26-year-old woman has a 1 month history of aching in the left parotid area of her face that radiates to the ipsilateral posterior neck, preauricular area, and temporal area. The pain is worse when chewing. Examination shows tenderness of the left masseter muscle. The ears and oropharynx are normal. There is no temporal artery tenderness nor clicking with jaw movement. Which of the following is the most likely diagnosis?

A 29-year-old woman has a 2 month history of diffuse pain in muscles and joints, tingling in the arms and legs, and fatigue. Fibromyalgia is diagnosed. Which of the following is the preferred initial medicinal therapy?

A 19-year-old female complains of a slight vaginal discharge. Pelvic exam reveals a moderate amount of foamy, gray homogeneous vaginal discharge. A wet mount shows vaginal epithelial cells coated with round to rod-shaped organisms, pH 6.0 and 0-1/hpf white blood cells. What is the most likely diagnosis?

A 39-year-old woman has intense vulvar itching associated with a white, cheesy vaginal discharge. Candidiasis is diagnosed. Which of the following is the least likely associated condition?

A newborn infant has meconium ileus. Which of the following is the most likely diagnosis?

Ospemifene therapy is initiated in a 67-year-old woman in treatment of vaginal atrophy. Which of the following is the class of this medication?

What is the most likely diagnosis in a patient who initially presents with forceful vomiting followed by sudden onset of chest pain and the development of subcutaneous emphysema?

A 13-year-old boy is in your office complaining of painful knees. He complains of increasing pain with activity. On exam you note tenderness and swelling of the tibial tuberosities of each knee. Which of the following is the most likely diagnosis?

Which of the following medications is indicated in the rheumatoid arthritis patient who fails to respond to nonsteroidal anti-inflammatory medications?

A 28-year-old female, who is in her third trimester, presents with sudden profuse bleeding accompanied by uterine contractions and abdominal pain. Which of the following is the most likely condition?

An 82-year-old woman has an acute ST segment elevation anterior wall myocardial infarction (STEMI). Vital signs are normal. Examination shows clear lungs to auscultation. An apical S4 gallop is heard. Cardiac monitoring shows sinus rhythm without ectopy. Which of the following medications should be administered?

A reticulocyte count is an indicator of which of the following?