Mock 7

A 21-year-old presents to your emergency department for evaluation of a prolonged penile erection for the past 5 hours. He is in moderate discomfort and has had no relief from self-treatment with an ice pack. Which of the following is the least likely cause of this problem?

A 77-year-old woman has an acute dissection of a thoracic aortic aneurysm. Which of the following is the most likely underlying cause of the aneurysm and dissection?

A 72-year-old Caucasian male, with a history of mild, untreated HTN presents to your office because he has noticed some mild swelling in his ankles for the past month. He reports that his ankles are normal in the morning, when he first gets out of bed, but as the day goes on the swelling worsens and by evening his shoes are very tight. His physical exam is remarkable for blood pressure of 152/98mmHg in the right arm seated and he has 1+ pitting edema in his ankles B/L. His chest X-ray does not show signs of cardiac or pulmonary abnormalities. Which of the following medications should not be part of your initial treatment?

Which of the following is the most sensitive serologic test used to indicate myocardial necrosis?

Which of the following dysrhythmias is most likely to result from long QT syndrome?

Which of the following heart valves closing make up the S2 heart sound?

A 42-year-old  male presents to your office complaining of substernal pain, which had awakened him from sleep at 3 AM, last night. Skin is cool and clammy. Exam revealed an S4 gallop and a murmur of mitral regurgitation. The ECG revealed ST elevation and peaked T waves in leads II, III and avF. What is your diagnosis?

A 51-year-old woman has weakness and fever for two and a half weeks. She has been taking over the counter cold remedies at home for symptoms of the “flu” with no improvement. Her temperature is 100.9F orally. She is pale and is noted to have a petechial rash on her arms and chest. You note some painful lesions on the palms of her hands. Examination of the heart reveals a new harsh midsystolic ejection murmur radiating to both carotids, and her spleen is palpable 4 cm below the left costal margin. Which of the following is the most likely diagnosis?

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 female is undergoing a routine evaluation. On review of lead II in her 12 lead EKG you note the rhythm below. Which of the following best describes this rhythm?

A 77-year-old man who worked with asbestos in shipbuilding is at greatest risk of developing which of the following?

A 66-year-old man who has been on ventilator assistance for 10 days now has an extensive right lower lobe pneumonia. Which of the following is the most likely organism causing the pneumonia?

A 21-year-old pregnant female G2P1A0 presents with a sudden onset of sharp, right-sided chest pain one hour ago and becomes apprehensive, tachypneic, and diaphoretic while in the ER. Which of the following studies is the most useful diagnostic modality for this patient’s presentation?

A 22-year-old man with asthma has a 2 week history of worsening dyspnea, cough productive of brownish plugs, and malaise. Blood pressure 120/80 mm Hg, pulse 90/min/regular, and respirations 18/min. Scattered wheezes are heard. Chest radiography shows bilateral upper lobe infiltrates. Serum IgE level is elevated. Which of the following is the most likely diagnosis?

A 22-year-old male presents to the ER with severe respiratory distress.  X-ray demonstrates a deviated trachea to the left. Which of the following should be your first action?

Which of the following is the most common etiologic agent of community-acquired pneumonia in the general population?

Which of the following pneumoconiosis has an increased risk of tuberculosis infection?

Which of the following is the preferred therapy for hypertension in a 57-year-old diabetic man who has proteinuria?

Niacin therapy is initiated in a 67-year-old man in treatment of dyslipidemia. The patient should be counseled that which of the following is the most likely adverse effect?

A 61-year-old man has diabetic autonomic neuropathy manifest by orthostatic hypotension. Which of the following is the preferred initial therapy?

A 42-year-old woman has paresthesias of the fingers and hands. Presence of which of the following differentiates hypoglycemia from hypocalcemia?

Metronidazole therapy is not indicated in the patient who has which of the following conditions?

A 78-year-old woman has a 2 week history of right-sided headaches and pain in the jaws while chewing. She now has a 5 minute episode of painless blurred vision in her right eye. Which of the following is the most likely diagnosis?

A 28-year-old woman has a 2 day history of diplopia and drooping of her eyelids. Examination shows right ptosis, bilaterally weak extraocular muscle movements and weakness of neck flexor muscles. Pupil size is equal bilaterally. Presence of which of the following serum antibodies is most likely to be noted?

Which of the following is the most common complication of a lumbar puncture?

The presence of which of the following differentiates a tic from a seizure?

The presence of which of the following differentiates acne vulgaris from acne rosacea?

A 36-year-old woman with a 10-year history of psoriasis now has bipolar disorder in a manic phase. Which of the following has the greatest likelihood of worsening (flaring) the psoriasis?

Lithium therapy is initiated in a 24-year-old woman in treatment of bipolar disorder. Which of the following is proper counseling for the patient?

A 20-year-old was brought in after competing in a “beer chugging” contest. The patient is belligerent and combative. There is no history of head trauma; vital signs are stable. After an IV access is established, what would be the most effective chemical restraint for this patient?

A 48-year-old male presents concerned about an area on his lateral ankle which has been persistently pruritic over the last four months. He has noted that the area has become slightly pigmented and the skin has become thick and rough to the touch. He reports that the lesion began as a mosquito bite that he persistently scratched. Which of the following is the most likely disorder?

The wife describes her husband’s behavior as follows: “For the past 6 months he rises in the morning and takes his temperature and quite frequently goes back to bed. He calls in sick more and more. He insists that he is weakening, physically and he fears he has some terminal disease. He recently started refusing to meet his social obligations. He has gone to three different physicians all of whom have not been able to find cause for his complaining, after all of their extensive testing”. Which of the following conditions seems to be the most likely?

A patient is diagnosed with chronic malignant otitis externa. This ear disorder is most likely to be present in a patient who has which of the following?

A 25-year-old male presents with painful swelling under his left eye. Your exam reveals a tender chemosis in the region of the nasal canthus. Which of the following terms is the correct diagnosis for this condition?

A 34-year-old woman has newly diagnosed multiple sclerosis. She is most likely to have which of the following eye disorders?

A 14-year-old boy has sickle cell disease complicated by impaired splenic function. He is at increased risk of infection caused by which of the following organisms?

One of your patients brings his 30-year-old nephew who is visiting from Greece to see you because of fatigue. On exam, he has conjunctival and nail bed pallor. His hemoglobin is 11 gm/dL, MCV is 60 fL and his peripheral blood smear shows hypochromia, microcytosis, and target cells. Which of the following tests is most likely to establish this patient’s diagnosis?

A 30-year-old male working on a construction site stepped off a ladder into a pile of debris and suffered a puncture wound in the bottom of his foot. The patient is unsure if, or when he has had a tetanus shot. After properly cleaning and dressing the wound, which of the following would be most appropriate action?

A 23-year-old female presents your office ill appearing, complaining of three days of severe sore throat which has worsened as of this morning. The patient has difficulty speaking, is leaning forward and drooling and has a “hot potato” voice. Physical exam finds in acutely febrile patient with a temperature of 103°F. Exam of the pharynx finds an erythematous pharynx with uvular deviation. Which of the following would be the most appropriate treatment?

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

After 1 week of lisinopril therapy a 69-year-old woman has weakness of both legs. Which of the following electrocardiographic abnormalities is most suggestive of hyperkalemia?

A 55-year-old man has the typical symptoms of urinary outflow obstruction due to benign prostatic hyperplasia. Which of the following is the preferred medicinal therapy?

Six hours after ingestion of excess alcohol, a 56-year-old woman has acute, severe, abdominal pain, nausea, and vomiting. Serum amylase and lipase levels are increased. Which of the following is the radiographic abnormality on plain film of the abdomen that is most likely to be noted?

Which of the following is the most likely source of gallstone formation?

The presence of which of the following differentiates obstructive jaundice from jaundice caused by hemolysis?

A 38-year-old female complains of 3 weeks of gradually worsening pain at the base of the thumb and radial aspect of the wrist. She and her husband have been renovating their home for the past 2 months and it has become increasingly difficult for her to hold a hammer. She denies numbness or tingling. She denies any history of previous trauma to the wrist. On examination, there is tenderness over the distal radial styloid and pain reproduced with ulnar deviation of a fist clenched over the abducted thumb. Which of the following is the most likely diagnosis?

Angiotensin receptor blockers are contraindicated in patients who have which of the following?

An anovulatory cycle is characterized by which of the following?

A 4-week-old male infant has a 1 week history of postprandial vomiting. Infantile hypertrophic pyloric stenosis is diagnosed. Which of the following medicines was most likely administered to the patient in the first week of his life?

A 36-year-old woman has painless lesions in the vulvovaginal area. They are pink and have a verrucous, papilliform appearance. Condyloma acuminata is suspected. Application of which of the following to the lesion is the initial diagnostic test?

A concerned mother presents with her three-year-old daughter who is had four days of watery diarrhea. The mother reports that 7 of the 13 children in her daycare are also out with similar symptoms. Which of the following is the most likely agent causing her symptoms?

A 32-year-old professional basketball player experienced sudden pain in the posterior region of his ankle and heel after attempting to change direction and drive for a layup shot. The Thompson test is positive on the affected side and he is unable to stand on the ball of his foot. The most likely diagnosis is:

Of the following, the most common cause of osteoporosis in women is?

A 65-year-old man has acute pain, swelling and warmth in the right knee that began 24 hours after gastric resection for carcinoma. Which of the following is the most likely diagnosis?

A 34-year-old obese patient is 29 weeks pregnant and now has presented for the third time to the office with the persistent hypertension. Which of the following agents may not be used in this patient?

A 67-year-old woman has a 1 month history of aching and morning stiffness in her hips and shoulders bilaterally. Examination is normal. Hemoglobin is 9.6 g/dL and erythrocyte sedimentation rate is 88 mm/hr. Which of the following is the most likely diagnosis?

A 44-year-old woman has a 3 week history of worsening dyspnea and dry cough. Sarcoidosis is diagnosed. An increased serum level of which of the following is most likely to be noted?

A 44 year-old male has frequent GERD symptoms and he undergoes a routine upper endoscopy for evaluation. Which of the following hernias is most likely the cause of his GERD?

The presence of which of the following differentiates pericardial tamponade from constrictive pericarditis?

Four days after scraping his leg on a sports locker at school, a 14-year-old boy has a furuncle on his right lower leg. Which of the following is the most likely infecting organism?