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Questions and Answers
A 62 year-old homeless patient presents complaining of fever, weight loss, anorexia, night sweats and a chronic cough that recently became productive of purulent sputum that is blood streaked. On physical examination, the patient appears chronically ill and malnourished. Which of the following chest x-ray findings supports your suspected diagnosis?
A. Hyperinflation and flat diaphragms
B. Interstitial fibrosis and pleural thickening
C. Cavitary lesions involving the upper lobes
D. “Eggshell” calcification of hilar lymph nodes C. This patient most likely has tuberculosis.
A chest x-ray finding of cavitary lesions involving the upper lobes would support this suspected diagnosis.
Abduction of the shoulder against resistance helps localize pain in which of the following muscles of the shoulder girdle?
C. Teres minor
A. Abduction against resistance tests the supraspinatus.
What is the recommended method for screening pregnant women for gestational diabetes?
A. Fasting blood sugar and 2 hour post prandial
B. 50 gram glucose load followed by a blood sugar in 1 hour
C. 75 gram glucose load followed by a blood sugar in 2 hours
D. 100 gram glucose load followed by a blood sugar at 1 hour, 2 hours, and 3 hours
B. One hour Glucola is the screening test for gestational diabetes. It is a 50 gram glucose load, with a serum glucose obtained 1 hour after the dose. Normal value is less than 140 mg/dL.
A 45 year-old smoker presents with a sore mouth and increasing difficulty eating for two weeks. Physical examination reveals a 1 cm white lesion on the buccal mucosa that cannot be rubbed off. Which of the following is the most likely diagnosis?
A. Oral cancer
B. Oral candidiasis
C. Aphthous ulcer
D. Necrotizing ulcerative gingivitis
A. The presence of leukoplakia in a smoker over the age of 40 should be biopsied to rule out the presence of oral cancer.
A 25 year-old female presents to the emergency department after an episode of substernal chest pain with radiation to the middle of her back that came on suddenly and lasted for about four minutes this morning while in bed. She denies previous episodes. Examination is unremarkable, but she appears jittery. Toxicology screen is positive for cocaine. Which of the following medications is contraindicated in this patient?
A. Lorazepam (Ativan)
B. Diltiazem (Cardizem)
C. Nitroglycerin (Nitrostat)
D. Propanolol (Inderal)
D. Pure Beta blockers, such as propranol, can cause a paradoxical hypertension because of unopposed alpha-adrenergic effects.
Which immunoglobulin is the first to respond during the primary immune response for a gram positive bacterial infection?
A. IgM is the first immunoglobin to respond during the acute exposure. This immunoglobulin promotes opsonization and phagocytosis. IgG is the immunoglobulin that responds during the secondary exposure. IgE is the immunoglobulin that responds during an allergic response as well as during a parasitic infection. IgA is an antibody found in colostrums and GI secretions.
A patient with obsessive compulsive disorder would most likely have which of the following findings?
A. Raw, red hands
C. Memory impairment
D. Abdominal pain
A. Common manifestations of obsessive compulsive disorder include phobias of germ and contaminants which results in frequent handwashing leading to chafed and reddened hands. The other answers are inconsistent with obsessive compulsive disorder.
As a rule, solid foods such as cereal and fruits are best introduced into an infant’s diet at approximately
A. 1 to 3 weeks.
B. 4 to 8 weeks.
C. 4 to 6 months.
D. 10 to 14 months.
C. The inclusion of solid foods in the diet is best done at approximately 4-6 months. Before 4 to 6 months of age does not contribute significantly to the infant’s health and it increases their risk of allergies and atopy.
A 56 year-old female four days post myocardial infarction presents with a new murmur. On examination the murmur is a grade 3/6 pansystolic murmur radiating to the axilla. She is dyspenic at rest and has rales throughout all her lung fields. Blood pressure is 108/68 mmHg, pulse 70 bpm. Which of the following would be the definitive clinical intervention?
A. Intra-aortic balloon counterpulsation
B. Mitral valve replacement
C. Coronary artery bypass surgery
D. Immediate fluid bolus
B. MVR is the definitive intervention to correct MR caused by papillary muscle rupture.
During an influenza epidemic, a 6 year-old male is seen with fever and a severe sore throat. The parents report that his symptoms have not improved despite administration of aspirin. The next day, the parent calls to report that the child has persistent vomiting and increased lethargy. On examination, he is found to be delirious and disoriented with hyperactive reflexes. The liver edge is 3 cm below the right costal margin in the midclavicular line. Which of the following is the most likely diagnosis?
A. Reye’s syndrome
B. Measles encephalitis
C. Guillain-Barre syndrome
D. Acute bacterial meningitis
A. The suspected influenza associated with development of vomiting, progressive mental status changes, hyperreflexia, and hepatomegaly are consistent with a diagnosis of Reye’s syndrome.
What is the treatment of magnesium sulfate toxicity?
C. Potassium carbonate
D. Calcium gluconate
D. 10% calcium gluconate is used to treat magnesium sulfate toxicity.