Mock 8

A 55-year-old man who suffers from a long history of alcohol abuse has cirrhosis with portal hypertension. Which of the following is the least likely sign to be noted upon examination?

Which of the following risk factors is negatively correlated with the development of a thoracic aortic aneurysm?

Which of the following is the most common cause of cardiogenic shock?

Beta blockers would be advisable as antihypertensive therapy for a patient with which of the following co-existing conditions?

A 58-year-old alcoholic came to the emergency room due to progressive dyspnea on exertion. She has fatigue and weakness and no JVD. Exam reveals an S3 gallop and PMI is shifted 3cm to the left. Echocardiogram confirms left ventricular thinning of the wall, and global dysfunction. What is the most likely diagnosis?

A 13-year-old male with a bicuspid aortic valve presents with lethargy, decreased energy, and reduced appetite. 3 weeks ago the patient had a cavity filled. Findings on physical examination include low-grade fever, splinter hemorrhages, splenomegaly, and a new murmur consistent with aortic insufficiency. Which of the following is the best study to confirm the diagnosis?

A 67 year-old male with a CHADS2 score of 4 presents with new onset atrial fibrillation. What is the most serious potential development with atrial fibrillation?

Which one of the following mechanical heart problems is most likely to cause syncope?

An 80-year-old man has a one month history of progressive exertional dyspnea. Blood pressure is 90/70 mm Hg, pulse 90/min/regular and respiratory rate 20/min. An apical lift is felt. A 3/6 ejection murmur is heard in the 2nd right intercostal space. Which of the following is the most likely diagnosis?

A 54 year old male presents for evaluation of chest pain. An EKG is obtained and is shown below. Which of the following disorders is most likely?

A 51-year-old man has hypercortisolism caused by ectopic ACTH production from a small cell carcinoma of the lung. Which of the following is the most likely abnormal laboratory value to be noted?

A 57-year-old man who has suffers from chronic alcohol abuse has a 3 day history of fever and productive cough. Evaluation indicates that the patient has pneumonia with empyema, pus in the thorax. Which of the following is the most likely organism causing the pneumonia?

Which of the following is a physical examination finding that is consistent with a diagnosis of lobar pneumonia?

A patient works as a zoo keeper and presents with shortness of breath, flu like symptoms and he also has chest pain with deep breathing that feels better when he leans forward. Bilateral hilar adenopathy is seen on chest X-ray. What is the treatment of choice for his condition?

A 21-year-old Asian male presents with a one week history of fever and chills, diffuse myalgias, photophobia, and a productive cough. He denies hemoptysis and dyspnea. He also denies any recent travel or sick contacts. He is a non-smoker. His temperature is 100.8 degrees F, and exam reveals slight nasal congestion, retrosternal chest discomfort and cutaneous rash. A chest x-ray shows patchy interstitial infiltrate pattern. The most probable diagnosis is:

Multinodular infiltrates in the apex of the lung accompanied by cavitation as seen on chest x-ray is classically associated with which of the following?

A 59-year-old woman with known chronic bronchitis now has increasing shortness of breath and productive cough. Exam shows a respiratory rate of 36/min, pulse 122/reg/min, and blood pressure 130/80 mm Hg right arm sitting. Central cyanosis, increased central venous pressure, rhonchi are auscultated, poor inspiratory effort and peripheral edema are noted. Which of the following is the most likely diagnosis?

A 71-year-old man who has type 2 diabetes mellitus has a 2 month history of worsening pain with tingling in his toes and feet. Diabetic peripheral neuropathy is diagnosed. Which of the following is the least likely sign to be noted on examination?

A 45-year-old male presents for a routine physical. His mother and father both had ischemic strokes in their 70’s. He is a non- smoker. His blood pressure is 128/80 mmHg, pulse 78/minutes and regular, respiratory rate of 12/minute. He has an unremarkable cardiac exam and no bruits. Which of the following studies should be ordered to further evaluate this patient’s risk of stroke?

A 47-year-old woman has newly diagnosed Cushing’s disease. Which of the following signs is least likely to be noted upon examination?

A 62-year-old man has a 3 month history of nausea, anorexia, and 7 pound weight loss. Blood pressure 100/62 mm Hg, pulse 102/min/regular. Examination shows a thin man with hyperpigmentation of skin creases. Which of the following is the most likely diagnosis?

A mother brings her 10-year-old son to see because of a one-day history of low-grade fever accompanied by red, flushed cheeks, circumoral pallor and a lacy erythematous pruritic rash on his body, most notable over the upper arms and legs. Some of his classmates have also developed the same illness in the past week. Which of the following is the most likely diagnosis?

A 34-year-old woman has newly diagnosed migraine headaches. Which of the following is the mechanism of action of her prescribed sumatriptan?

A 72-year-old man with a long-standing history of diabetes mellitus, renal insufficiency, and hypertension presents to the clinic complaining of burning and tingling pain in his feet. Which of the following medications would help control pain in this patient?

A 44-year-old woman has the acute onset of foot drop caused by weakness of right foot dorsiflexion. Injury to which of the following nerves is the underlying cause?

A 33-year-old woman has a 2 week history of recurrent, one second, “electric shock” piercing pain in her left cheek. The pain does not radiate. There are no associated ear or eye symptoms. Which of the following is the most likely diagnosis?

A healthy 26-year-old man is bitten on the thumb by a stray dog. Which of the following organisms is most likely to cause infection of the bite wound?

A 36-year-old woman has lentigines on her upper back and dorsum of the hands. Which of the following is the preferred therapy?

A 32-year-old man has a papulosquamous eruption on his face, scalp, and chest. Examination shows oily yellowish scales in these areas. Which of the following is the most likely diagnosis?

A 5-year-old boy has difficulty remaining seated in his kindergarten class. Further, he is disruptive because interrupts the activities of others and he frantically searches for his lost toys. Attention deficit hyperactivity disorder is diagnosed. Which of the following is the preferred initial therapy?

A 54 year old had had declining performance at work over the last 2 months. He spends less time with friends, has lost interest in his hobbies and spends much of his free time sleeping. His neurological exam is unremarkable. Which of the following is the most likely diagnosis?

Flesh colored, non-pruritic, dome-shaped papules with central umbilication are most indicative of which of the following?

A 28 year old housewife complains of a fear of thunderstorms and becomes fearful even when anticipating the storm. She has no fear of rain; however the darkening sky suggests a storm and that frightens her. She is completely aware of her behavior, but she just cannot explain it nor stop it. She focuses purely on the storm, to the degree that it interferes with whatever routine she is engaged in. She enjoys a healthy relationship with her husband and three children. Her physical exam is unremarkable. These conditions suggest which of the following disorders?

A 37-year-old woman has a 2 day history of vertigo and nausea. The diagnosis of benign positional vertigo is made based upon symptoms and a positive Dix-Hallpike maneuver. Which of the following is considered to be the most likely cause of the disorder?

Your patient is a 33-year-old male who presents with a globus sensation while eating a steak. He is drooling and is unable to swallow solids or liquids. Vital signs are blood pressure = 118/74 mmHg (right arm, sitting); heart rate = 94 beats/minute (regular); respirations = 24 breaths/min (shallow). Which of the following treatments should be your initial step in managing this patient’s condition?

The presence of which of the following on examination of a 32-year-old man that has asthma is most likely to be associated with aspirin-induced wheezing?

The presence of which of the following differentiates infectious mononucleosis from Hodgkin’s disease?

Hairy leukoplakia of the tongue is most likely in a patient who has which of the following diseases?

A 34-year-old patient complains of intermittent episodes of vertigo, nausea and vomiting that began three days ago. He noticed symptoms worsened significantly when he tried to sit up or get out of bed. The patient has no tinnitus, however has noted some mild hearing loss. His past medical history is unremarkable except for an upper respiratory tract infection which resolved two weeks ago. Which of the following is the most likely diagnosis?

A 64-year-old male presents for evaluation of a hoarse voice which he states has become progressively worse over the last three months. He denies any pain and has had no signs of upper respiratory infection. His history is remarkable for a three pack a day history of smoking for the last 24 years. This patient’s presentation and history is most concerning for which of the following?

A 14-year-old presents with complaints of a sudden onset of pain in the groin, followed by nausea and vomiting. He was riding horses this past weekend for several hours both days. He denies urinary urgency and frequency. On physical examination, he is febrile and is noted to have scrotal swelling on the left with absent cremasteric reflex. Which of the following is the most likely diagnosis?

A patient is followed regularly in the office after having prostate cancer. Which of the following tests would be used to monitor possible recurrence of prostate cancer?

An 18-year-old man has a new penile lesion. Examination shows a non-tender ulcer with a clean base and indurated margin. Bilateral rubbery, non-tender inguinal nodes are palpated. Which of the following is the most likely diagnosis?

A 49-year-old woman with diabetes mellitus now has recent-onset nephrotic syndrome. Which of the following is the least likely clinical manifestation of the nephrotic syndrome?

A 42-year-old woman has a 2 week history of epigastric pain and diarrhea. Upper gastrointestinal endoscopy shows a 2 cm ulcer distal to the duodenal bulb. An increased serum level of which of the following is most likely to be noted?

A 32-year-old man has chronic abdominal bloating and gas. A positive assay for which of the following is most specific in diagnosis of celiac disease?

The primary use of focused abdominal sonography in trauma (FAST) after blunt abdominal trauma is to identify which one of the following?

A 78-year-old man has a 2 week history of pain in his left heel where the back of his hard shoe hits the heel. Examination shows tenderness, slight redness, and mild swelling of the posterior heel. Which of the following is the most likely diagnosis?

Simvastatin therapy is to be initiated in a 57-year-old man in treatment of dyslipidemia. He should be counseled that which of the following is a likely adverse effect requiring urgent evaluation?

A 56-year-old woman has newly diagnosed breast cancer that is hormone receptor negative. Which of the following is appropriate counseling to the patient concerning the hormone receptor analysis?

A 24-year-old female presents at 20-weeks gestation. The fundal height would be expected to be palpated:

A newborn infant has meconium ileus. Which of the following is the preferred initial test to confirm a diagnosis of Hirschsprung’s disease?

A 32-year-old woman has painless lesions in the vulvovaginal area. They are pink and have a verrucous, papilliform appearance. Condyloma acuminata is diagnosed. This disease is caused by infection by which of the following organisms?

A 54-year-old male with a long-term history of alcohol abuse presents with severe pain in the epigastric region which radiates to his left scapula. Physical exam reveals a positive Cullen’s sign. Which of the following would be most useful in the diagnosis of this patient?

On a radiograph, calcification of the spinal ligaments reveals so-called “bamboo spine”. This is a manifestation of:

Which of the following periodic examinations is indicated in a rheumatoid arthritis patient who takes hydroxychloroquine?

A 20-year-old female presents complaining of pain in her breasts. The pain has become worse over the last few months and is worse prior to and during her menstruation. She’s noticed a few lumps which are quite large and is concerned about breast cancer. She does report that these lumps change in size in relation to her menstruation. Which of the following is most likely diagnosis?

A 62-year-old patient is being treated with long-term glucocorticoid therapy for rheumatoid arthritis. He stopped taking the medicine because he was doing great and wanted to stop them. He now presents with weakness, fatigue, abdominal pain, severe nausea & vomiting, and altered mental status. Lab findings reveal hyponatremia and hyperkalemia. Which of the following is the most likely diagnosis?

A 52-year-old man has a 3 week history of weight gain, abdominal distention, and bilateral peripheral edema. Examination shows elevated jugular venous pressure, ascites, and bilateral ankle edema. No heart murmur is heard. Kussmaul sign is present. Which of the following is most likely to be noted in his past medical history?

A fracture which crosses through the shaft of the bone, the epiphyseal plate and then through the end of the bone, as shown in the picture below, best describes which of the following?