Mock 9

An epiphyseal plate fracture that extends transversely through the epiphyseal plate and nearest the joint is classified as a:

A 75-year-old man has a large aneurysm of his ascending aorta. Which of the following is the most likely symptom to be noted by the patient?

Which of the following is the recommended initial step in the treatment/management of cardiogenic shock after an acute myocardial infarction?

A 71-year-old woman returns to your clinic after a three-year stay with her family in Italy. She has a history of NIDDM, hypertension, and hyperlipidemia. She will now be living with family in the area. Three years ago you prescribed HCTZ (25mg daily) for her hypertension which she stopped taking when she ran out of medication. Today, her blood pressure (verified on repeat measurement) is 172/106mmHg. Which of the following is the recommended treatment for this patient?

A 36-year-old construction worker is brought to the ER after a fall at work. Upon PE you note a small puncture wound at the medial edge of the right sternal border, just inferior to the sternum. He is tachycardic, anxious, having severe dyspnea, pulsus paradoxus, and hypotension (90/50 mmHg). You note JVD, breath sounds are clear and equal bilaterally but the heart sounds are muffled. Which of the following would be the most likely diagnosis?

Which of the following is the most common congenital cardiac malformation in infants and children?

A patient with systolic heart failure is discharged on furosemide, digoxin, captopril, and carvedilol.  He does well at home for a week but then passes out. Fire rescue finds the patient in ventricular tachycardia and appropriately stabilizes him. Which of the following electrolyte imbalances is most associated with his ventricular tachycardia?

Which of the following is the primary pathophysiologic abnormality in a patient who has left ventricular diastolic heart failure?

A 44-year-old woman has recurrent chest discomfort diagnosed as variant (Prinzmetal) angina. Which of the following is the preferred therapy for prevention?

An 82 year old female presents for evaluation of vague abdominal discomfort. She states it is primarily epigastric and has not subsided. She has no other complaints. Which of the following disorders is most likely?

A 56-year-old man has palpitations. Electrocardiography shows tachycardia at 110/min with 3 different, discrete P wave morphologies. Which of the following is the most likely underlying cause of the palpitations?

A 52-year-old woman with known systemic sclerosis has a 3 week history of increasing dyspnea, bilateral peripheral edema, anorexia, and nausea. Blood pressure 110/72 mm Hg, pulse 122/min/regular, and respirations 32/min. Examination shows elevated jugular venous pressure, bilateral peripheral edema, and tender smooth hepatomegaly. Which of the following is the most likely diagnosis?

A 68-year-old woman has a central venous catheter for ongoing chemotherapy. She now has a 2 week history of facial and bilateral arm swelling. Vital signs are normal. Examination shows facial edema, bilateral arm edema, and distention of arm and chest veins. Jugular venous pressure is elevated. Which of the following is the most likely diagnosis?

A 46-year-old woman has a 2 week history of worsening dyspnea and dry cough. Sarcoidosis is diagnosed. Which of the following is the most likely cause of the dyspnea?

A 22-year-old female presents with sudden onset of shortness of breath, circumoral and carpopedal paresthesia and carpopedal spasm. She also complains of vague chest pain. Review of systems is unremarkable except for recent increase in stress at work. Vital signs are BP- 110/70 mmHg, R- 32 breaths/min and shallow, P- 82 beats/ min, and an oral temperature of 98.6 degrees F. ECG shows a normal sinus rhythm. Exam reveals tachypnea, although the patient’s breath sounds are normal, and the exam is otherwise normal. Which of the following is the most likely diagnosis?

Histoplasmosis is caused by:

Which of the following conditions is a risk factor for community acquired pneumonia caused by Staphylococcus aureus?

A 27-year-old woman who has type 1 diabetes mellitus gives birth to a 12 pound infant. Which of the following is most likely to be noted in the newborn infant?

A 56-year-old woman has received one month of prednisone in treatment of chronic adrenal insufficiency. She continues to have orthostatic hypotension and hyperkalemia. Which of the following is the preferred management?

A 58-year-old patient is being treated with long-term glucocorticoid therapy for rheumatoid arthritis. He stopped taking the medicine because he was “feeling better”. 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 36-year-old male has been complaining of insomnia, visual difficulties, hand tremors, and increased sweating for 1 year. Today he presents to the emergency department tremulous and tachycardic. He states he is always hungry and eats regularly but you note that he has lost eight pounds in the last six months. Vital signs are BP: 138/76 mmHg; P: 96 beats/minute, regular; R: 12 breaths/minute; nonlabored. He is afebrile. Your physical examination is significant for lid lag and hyperreflexia. Which of the following is the most likely cause of his condition?

Which of the following diseases is caused by infection by anaerobic or microaerophilic bacteria?

During venipuncture, a 52-year-old construction worker has cold sweat, pallor, nausea followed by fainting. Blood pressure 70/44 mm Hg, pulse 42/min. Which of the following is the pathophysiologic mechanism causing the faint?

A patient with a known brain tumor presents with marked change in his personality and difficultly with simple calculations. Which area of the brain is his lesion most likely in?

A normal, healthy 12-month-old child would be expected to demonstrate which of the following developmental milestones?

Which of the following is considered to be the most serious complication of lumbar puncture in the patient who has increased intracranial pressure?

Oral isotretinoin therapy is initiated in an 18-year-old man in treatment of acne vulgaris. He should be counseled that which of the following is most likely to be noted?

A 19-year-old boy presents with redness, itching, and burning of the back of his hands, arms and face. He gives a history of falling into some bushes yesterday. You ask him to describe the “bushes,” and he says that they had a cluster of 3 leaves. There are several tiny blisters with a linear distribution noted. What is the most likely diagnosis?

Somatic manifestations of an acute panic attack typically include which of the following of symptoms?

A 33-year-old woman has panic-agoraphobia. She is most likely to also have which of the following disorders?

A 22-year-old female presents with complaints of dry skin to her elbows and knees which has become worse over the last six months. The dryness has now progressed to include lesions that are red, sharply defined plaques and are covered with a silvery scale. Upon further inspection you find that the patient’s fingernails have small pits. Which of the following is the most likely diagnosis?

Axis IV category relates to what section?

A 70-year-old man notes the slow progression of visual loss in his left eye over a 6 month period. There is no history of trauma or of pain in the eye or periorbital area. Exam reveals a white pupil on visual inspection and the retina is not seen on funduscopic exam. Which of the following is the most likely diagnosis?

A 5-year-old girl had her deciduous front central incisor (tooth #8) knocked out. She arrives in the emergency department 40 minutes after the injury. What is the best action to take at this time?

A 6-year-old child in moderate respiratory distress is brought to the ER and is noted to have mild drooling and a low-grade fever. The mother of the child relates that he has had a sore throat and difficulty swallowing for the past few days. Today he started complaining of dyspnea. There is no history to suggest foreign body aspiration. Vital signs are stable except for a tympanic temperature of 101.2° F. Slight stridor is noted on lung auscultation. Which of the following is the best next step to confirm your suspected diagnosis?

Heparin therapy is initiated in a 40-year-old woman in treatment of pulmonary embolism. Which of the following values should be obtained on the 5th day of therapy?

The presence of which of the following differentiates polycythemia rubra vera from secondary polycythemia caused by chronic bronchitis?

A 21-year-old female has purulent nasal discharge, nasal congestion and facial pain. The pain is made worse by looking downward. She states that her initial symptoms started 14 days ago and have progressively worsened. On physical exam you find tenderness to her maxillary sinuses. Which of the following is the most likely diagnosis?

A nine-year-old male presents status post upper respiratory infection with a fluctuant mass on the right side of his neck just anterior to the sternocleidomastoid muscle. The mass is painless on palpation and does not change in position with protrusion of the tongue or swallowing. Which of the following is the most likely diagnosis?

A 31-year-old woman with known polycystic kidney disease has the sudden onset of maximal intensity generalized headache. Vital signs are normal. Neurologic examination shows a mildly confused patient without localizing signs. Computerized tomography (CT) imaging of the brain is normal. Which of the following is the preferred next step in management?

A 23-year-old female presents to you with a two-day history of frequent painful urination and suprapubic pain. She is afebrile and otherwise healthy but notes that she has had similar episodes a couple of times over the past few years. A urinalysis is compatible with a urinary tract infection. Which of the following organisms is most likely responsible?

A 56-year-old man has end stage renal disease for which he is on chronic hemodialysis. Which of the following is the least likely symptom to be present?

A 44-year-old boy has post-streptococcal glomerulonephritis with nephritic syndrome. Which of the following is the most likely complication?

Three days after binge drinking of alcohol, a 44-year-old man has the acute onset of epigastric pain that radiates to the back, nausea, and vomiting. Blood pressure 110/76 mm Hg, pulse 122/min/regular. Examination shows epigastric tenderness without rebound. Bowel sounds are generally hypoactive. The patient is not icteric. Which of the following is the most likely diagnosis?

A 55-year-old male presents complaining of abrupt onset 2 days ago of deep epigastric pain with “boring” radiation to his back. He also complains of sweating, weakness, nausea, and one episode of vomiting since symptoms began. He admits to heavy alcohol intake last night and also to a similar episode of pain 2 years ago. Which of the following laboratory studies would be the most beneficial in establishing this patient’s diagnosis?

What is appropriate first line medication for a patient with GERD symptoms despite lifestyle and diet modifications?

Administration of which of the following to a 2-week-old infant is most likely to increase the risk of infantile hypertrophic pyloric stenosis?

A 25-year-old man had an acute inversion injury to his left ankle 10 days earlier. Which of the following maneuvers determines whether an anterior talofibular ligament tear has occurred?

A 32-year-old woman who recently moved to the United States from the Caribbean has vaginal discomfort. Examination shows genital ulcers. Infection by which of the following is least likely to cause the genital ulcerations?

Which of the following is a conclusion related to hormone replacement therapy (HRT) based upon the Women’s Health Initiative study?

A 33-year–old woman is diagnosed with black hairy tongue. Which of the following is proper management?

A 26-year-old woman with known Marfan syndrome wishes to become pregnant. Which of the following is the most appropriate management?

A 52-year-old male presents the emergency room concerned about 1 to 2 weeks of persistent abdominal pain in his left lower quadrant. He has noted a low grade fever, has generalized malaise and is noted a change in bowel habits over the last week. On physical examination, the patient has left lower quadrant tenderness. Rectal exam reveals generalized tenderness and no frank bleeding. Guaiac tests are positive. Which of the following is the most likely diagnosis?

A passenger involved in a head-on collision is brought into the emergency room for evaluation and treatment. In addition to other exam findings, you note that the left leg is adducted, internally rotated, and shortened. Which of the following is the most likely diagnosis?

A 42-year-old female comes to the office of the complaint of menorrhagia. She’s also concerned as she has noted an increased girth over the last 12 months and is unable to fit in her pants. She has been followed by her internal medicine physician for a chronic but worsening iron deficiency anemia. Pregnancy testing is negative. On exam you palpate an enlarged firm uterus. The most likely diagnosis for her condition is:

A 33-year-old woman has acute pericarditis. The presence of which of the following serum antibodies is most specific for systemic lupus erythematosus?

A 42-year-old woman who has sarcoidosis has a 2 day history of a painful red eye and blurred vision in her left eye. She is most likely to have which of the following eye disorders?

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

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 22-year-old man has a painless, indurated ulcer on his penis. Primary syphilis is diagnosed. Which of the following is the preferred initial therapy?