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Which of the following factors in patients with chronic venous insufficiency predisposes them to development of skin ulcers?
A. Increased intravascular oncotic pressure
B. Leakage of fibrinogen and growth factors into the interstitial space
C. Decreased capillary leakage
D. Inherited deficiency of protein C B. Leakage of fibrinogen and growth factors into the interstitial space, leukocyte aggregation and activation, and obliteration of the cutaneous lymphatic network can predispose a patient to skin ulcers
A 26 year-old monogamous female presents with cyclic pelvic pain that has been increasing over the last 6 months. She complains of significant dysmenorrhea and dyspareunia. She uses condoms for birth control. On physical examination her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. Which of the following is the most likely diagnosis?
A. Ovarian cancer
B. Endometriosis
C. Functional ovarian cyst
D. Pelvic inflammatory disease B. With endometriosis, the uterus is often fixed and retroflexed in the pelvis. The palpable mass is an endometrioma or “chocolate cyst”. The patient with endometriosis also often has dysmenorrhea, dyspareunia, and dyschezia.
At what age does the first tooth usually erupt in an infant?
A. 2-4 months
B. 6-8 months
C. 10-12 months
D. 14-16 months B. The first tooth in an infant to erupt is the central incisor at the average age of 6-8 months.
A 7 year-old boy wets the bed on most nights. Which of the following is the preferred pharmacological agent to decrease the incidence of bed wetting episodes?
A. Imipramine (Tofranil)
B. Phenytoin (Dilantin)
C. Pramipexole (Mirapex)
D. Hyoscyamine (Urised) A. Imipramine is an anti-cholinergic and when given before bedtime has been shown to decrease the incidence of bed wetting.
A newborn is being evaluated for perioral cyanosis while feeding associated with sweating. Vital signs are rectal temperature, 37.8 degrees C (100 degrees F), blood pressure 80/45 mmHg, pulse 180/min, and respirations 40/min. A grade 3/6 harsh systolic ejection murmur with a single loud S2 is heard at the left upper sternal border. Electrocardiogram (ECG) shows right ventricular hypertrophy with right axis deviation. Chest x-ray shows a boot-shaped heart and decreased pulmonary vascular markings. Which of the following is the most likely diagnosis?
A. Atrial septal defect
B. Total anomalous pulmonary venous return
C. Coarctation of the aorta
D. Tetralogy of Fallot D. This is a common presentation for tetralogy of fallot.
Which of the following is considered to be the modality of choice for the identification of a pituitary macroadenoma that is suspected on the basis of a visual field deficit?
A. Skull x-ray
B. PET scan
C. CT of the brain
D. MRI of the brain D. MRI of the brain provides the best visualization of pituitary tumors.
A 2 year-old male presents with a four day history of fever and general malaise. On examination the vitals reveal an oral temperature of 102 degrees F. The child appears to have rubor on the trunk which started one day prior to this visit. Physical examination reveals a maculopapular rash with defervescence. Which of the following is the most appropriate management at this time?
A. Ibuprofen (Motrin)
B. Aspirin
C. Amoxicillin
D. Valacyclovir (Valtrex) A. Motrin is indicated for management of the fever in Roseola infantum caused by the herpesvirus.
A 42 year-old female experiences pain on the plantar surface of her left foot in the area of the third metatarsal head. The pain is associated with wearing tight shoes and is relieved by removing shoes. Examination reveals a palpable mass and reproduction of pain with deep palpation of the third intermetatarsal space. The patient has tried wearing wider shoes with metatarsal cushions and taking NSAIDS but her symptoms persist. What is the best therapeutic option at this point?
A. Casting of the involved foot
B. Physical therapy
C. Steroid injection
D. Surgical excision C. Steroid injection is the treatment of choice for Morton’s neuroma when conservative measures fail.
Which of the following is the most likely to develop into a persistent cough in the adult patient?
A. Pertussis
B. Allergic rhinitis
C. Pharyngitis
D. Heart failure A. Pertussis is suspected in patients with persistent cough that lasts longer than 2-3 weeks. Allergic rhinitis, pharyngitis and heart failure are all potential causes of acute cough.
A 30 year-old patient presents with weight loss, diarrhea, and steatorrhea. Labs reveal that the antiendomysial antibody (AEA) is positive. What is the most likely diagnosis?
A. Celiac sprue
B. Ulcerative colitis
C. Whipple’s disease
D. Zollinger-Ellison syndrome A. Celiac sprue is not only characterized by these classic symptoms. The antiendomysial antibody has a 90-95% sensitivity and 90-95% specificity for celiac sprue.
A patient sustained a 6 cm laceration on his anterior tibia that was primarily closed in the emergency department. What is the most appropriate time frame for removal of these sutures?
A. 1-2 days
B. 3-5 days
C. 6-8 days
D. 7-14 days D. Suture removal is based upon the area of the body that was sutured. Facial sutures are placed for 3-4 days, scalp sutures for 5-7 days, trunk sutures are placed for 6-8 days, and sutures on the extremity are placed for 7-14 days. Sutures on the extremities can stay for longer periods of time if the area is under maximal tension.
A hospitalized patient is found with confirmed pulseless ventricular tachycardia. IV access is obtained following the second shock given. Which of the following medications is to be administered immediately?
A. Amiodarone
B. Magnesium
C. Atropine
D. Epinephrine D. Epinephrine should be given as soon as IV access is obtained before or after the second shock.
A patient with advanced AIDS complicated by toxoplasmosis presents with altered mental status, recent onset of seizures, and focal neurologic deficits. Which of the following diagnostic studies is most helpful?
A. Toxoplasma gondii antibody titers
B. CT scan of the brain
C. Lumbar puncture
D. MRI of brain D. An MRI showing multiple isodense or hypodense ring-enhancing mass lesions is the most useful test for such a patient.
