Q3 Awesomeness!

Front 1

A 65 year old woman complains that over the past 2 months she has developed difficulty pulling herself out of a chair and stretching to put on her coat “because it just hurts too much” On exam she has no atrophy, has normal range of shoulder and hip motion and, though she complains of pain, has normal muscle strength. There is no inflammation of joints. She MOST LIKELY has

Back 1

Polymalgia rheumatica

Front 2

What patient complaint is MOST suggestive of acute angle closure glaucoma.

Back 2

Abrupt onset of pain when watching a movie in the theater

Front 3

The most common complication of a displaced femoral neck fracture is

Back 3

avascular necrosis

Front 4

An 80-year-old female comes into your office complaining that food just don't taste as food. What all should be considered

Back 4

Decreased number of lingual papillae;

decreased salivation;

diminished sense of smell and

vitamin B12 or zinc deficiency

Front 5

Intraocular pressure is produced mainly by

Back 5

aqueous humor

Front 6

In elderly patients, serum albumin levels are commonly decreased, resulting in which effect on pharmacokinetics?

Back 6

Acidic drugs will be less bound, resulting in more free drug to interact with tissue receptors.

Front 7

90% of all hearing loss in the elderly is sensorineural, typically resulting from

Back 7

damage cochlear hair cells

Front 8

Your patient is a 90 year old woman with no signs of dementia. She lives alone, takes multiple medications for hypertension and diabetes, walks with a cane and occasionally gets “dizzy.” She has fallen twice while getting out of the bathtub. The appropriate intervention is to arrange

Back 8

Home health care assistance

Front 9

What type of urinary pattern is seen with anatomic obstruction such as BPH

Back 9

Overflow incontinence

Front 10

What type of urinary pattern is seen by psychological problems such as depression or anger

Back 10

Functional incontinance

Front 11

What type of urinary pattern is seen accompanied by total lack of urinary control

Back 11

Neurogenic bladder

Front 12

Your elderly patient has renal function that is 25% of normal. What medications requires the most caution in dosing this patient

Back 12

NSAID such as ibuprofen

Front 13

What ocular symptoms are MOST common in patients with rheumatoid arthritis

Back 13

Dry Eyes

Front 14

You are seeing an 88 year old patient for routine flu vaccine, brought in by her adult daughter with whom she live. She has lost 2 pounds since her last visit 4 months ago but has no complaints. During your exam, you note that she is dressed in a jogging suit and sneakers and sits quietly in her chair. She frequently look to her daughter before answering questions. Her physical exam shows no abnormalities, and her MMSE score is 18. Your findings suggest

Back 14

Dementia

Front 15

Which drug used for open-angle glaucoma improves uveoscleral outflow, but may cause increased brown pigmentation of the iris

Back 15

Latanoprost (Xalatan)

Front 16

What stage is a patient with 2 lymph node regions below the diaphragm and no symptoms

Back 16

Hodgkins stage IIA

Front 17

What are some common known carcinogens

Back 17

Epstein Barr and other DNA viruses;

tobacco smoke;

ionizing radiation &

asbestos

NOT: Lead

Front 18

What accounts for 80% of leukemias in children

Back 18

Acute lymphoblastic leukemia (ALL)

Front 19

The BEST way to assess a thyroid nodule for malignancy is

Back 19

Fine needle aspiration (biopsy)

Front 20

Your patient just completed a course of chemotherapy for breast cancer. She reports feeling fatigued and has a sore throat. A CBC shoes Hgb 12.0 mg/dL, Hematocrit 35%, MCV 82 fl, platelet count 400,000, WBC 2,100 with 20% neutrophils, 72% lymphocytes, 5% eosinophils, 1% basophils, 2% monocytes. The best treatment for her is?

Back 20

ilgastim (Neupogen)

Front 21

A patient undergoes a lumpectomy for a 1 cm invasive ductal breast cancer; the sentinel node analysis is found to have micrometastases. The next step in her management is

Back 21

Regional lymph node dissection

Front 22

A very effective, primary prevention strategy exists for which cancers?

Back 22

Skin cancer &

Hepatocellular cancer

Explanation: Primary prevention = some supplement, intervention or vaccine applied widely to asymptomatic people that prevents development of the disease. Vaccines are classic examples of primary prevention. Sunscreen and iodine are also classic primary prevention.

Front 23

What is the best way to care effectively for the dying patient’s emotional needs

Back 23

Being aware and empathetic, knowing one’s own limits, and being willing to make referrals

Front 24

Some people receiving parenteral morphine for cancer pain may suffer myoclonus. What is the most appropriate treatment of this condition

Back 24

Administer halperidol (Haldol)

Front 25

A patient with metastatic breast cancer involving the liver tells you she is feeling better about herself now that she lost the 20 extra pounds she always wanted to loose and has a nice golden “tan” and she is looking forward to a cruise to the Bahamas to show off the “new her.” What stage of loss best fits her behavior

Back 25

Denial

Front 26

You are administering a fixed dose of morphine on an “every 4 hours” schedule to an oncology patient and the patient reports the pain is recurring before the 4 hours are up. You should?

Back 26

Increase the dose of morphine at the next dosing interval

Front 27

A patient with prostate cancer has metastatic cancer in his pelvic bones. He cannot take morphine for pain control because of hypersensitivity reaction: urticaria, vasoconstriction, low blood pressure and dyspnea. What would be effective and safe to give instead of morphine?

Back 27

Meperidine

Front 28

You have diagnosed your 18 year old male patient with Factor V Leiden. Understanding its pattern of inheritance, who else in his family needs to be screed for this chronic disease

Back 28

Everyone (autosomal dominant)

Front 29

You are seeing a 75 year old patient with osteoarthritis bilaterally in his knees. He is on maximal medical therapy. He complains that the pain is getting worse, interfering with his ADLs and is wondering what can be done. What is the most appropriate next step

Back 29

Referral to an orthopedic surgeon

Front 30

A patient with inherited disorder of Factor V Leiden would have what chronic hematologic manifestations?

Back 30

Spontaneous thrombosis

Front 31

On exam of an elderly white dude you notice his 4th and 5th fingers are flexed. You palpate a thickened fibrotic cord stretching between palm and each affected finger. What may also be affected

Back 31

Erectile tissue of penis aka leftward sloping penis

Front 32

What patterns of abnormal blood test results is MOST likely seen in chronic renal insufficiency

Back 32

Low calcium, high phosphorous

Front 33

What medication should be prescribed to patients at risk for glomerulosclerosis to preserve and prolong nephron function

Back 33

ACE inhibitors

Front 34

What would MOST LIKELY be deficient in a patient with chronic renal failure?

Back 34

Vitamin D

Front 35

The cause of most chronic renal insufficiency in the United States is

Back 35

diabetes

Front 36

The BEST treatment for nonalcoholic fatty liver disease is

Back 36

gradual weight loss

Front 37

What consequences of inadequately controlled hypertension is INCREASING in the United States

Back 37

Congestive heart failure

Front 38

The major cause of death in patients with Type I diabetes is

Back 38

Compliactions from end-stage renal disase

Front 39

Your 60kg patient with type 2 DM is taking glipizide, exenatide and metformin. Her HgbA1C and fasting blood sugars have increased without signs or symptoms of ketoacidosis. You want to start her on insulin. What is the BEST regimen?

Back 39

Continue only the metformin, start NPH in the morning, 10 units

Front 40

What lab abnormalities is common in patients with untreated hypothyroidism

Back 40

elevated LDL cholestrol

Front 41

A 60 year old patient presents with a complaint of fatigue, cold intolerance and constipation. You suspect hypothyroidism and ask your PA student to examine the patient. The student returns and states that the thyroid is slightly enlarged with no discrete nodules, no lid lad or proptosis is present and extra ocular muscles are intact. Why did the student check the eyes for abnormality?

Back 41

Hyperthyroidism which causes eye findings, can precede hypothyroidism

Front 42

A patient who has a history of hypothyroidism and has been on thyroid supplement consults you for an annoying rash. She has developed patches bilaterally on her shins that are raised, itchy, and look like orange peel. This should alert you to the possibility that she

Back 42

should decrease her levothyroxine

Front 43

What is MOST effective at maintaining constant basal insulin level

Back 43

Insulin glargine (Lantus)

Front 44

What is true regarding kidney function in the elderly

Back 44

Serum creatinine may be within normal range in patient with decreasing renal function;

Renal blood flow declines &

glomerular filtration rate decreases

NOT: Renal mass (number of nephron units) increases to compensate for declining kidney function

Front 45

You see a thin greyish white arc around the outside of the cornea in a 70-year-old woman without visual complaints. This is termed

Back 45

corneal arcus or arcus senilus

Front 46

You are seeing a 4 year old child for the first time for a complete physical. When plotted on the growth curve, her height is 20th percentile, head circumference at 30th percentile and weight at 25th percentile. She most likely

Back 46

has constitutional short stature

Front 47

You are seeing a 7-year old female in your office for her complaint of an “itchy head.” The girls mother states that this has been bothering her for about a week, and she has noticed a lot of “dandruff” in the girls hair that will not come out. She also tells you that several of her daughter’s friends are having the same problem. Based on the MOST LIKELY diagnosis, what is the best treatment for this patient?

Back 47

permethrin 1% shampoo

Front 48

You are seeing a 72 year old male patient for routine follow-up for COPD, type 2 DM, and peripheral vascular disease. The patient has no complaints but his wife says he is driving her crazy: his sleeping is restless and sometimes he can't fall asleep, has to urinate more often at night and often wakes in the morning with a headache. The patient is taking the following medications: ipratroprium (Atrovent) inhaler 2 puffs q 6h, fluticasone/salmeterol 230mcg/21mcg 1 puff BID (Advair) inhaler, metformin (Glucophage), pravastatin (Pravachol), low dose aspirin. What is the BEST treatment at this time?

Back 48

consider home oxygen therapy

Explanation: He is at maximum dose of his inhalers, and his symptoms suggest oxygen desats at night.

Front 49

You are seeing a 93 year old patient who complains of feeling dizzy. She is otherwise well. Her main concern is that she is losing her memory as she keeps getting notices of late and unpaid bills, and last week her electricity was turned off. You discover that her grandson takes care of her bookkeeping and checkbook, but the patient says it must be her fault for not reminding him. The MOST likely diagnosis

Back 49

fiscal abuse of an elder

Front 50

You are seeing a child for his 18-month-old well child check. What examples of information from the mother would be a cause of concern?

Back 50

I just never have any idea what he wants, My child doesn't use mama or other words.
NOT: My child is not completely toilet trained yet.

Front 51

You are seeing an 18-month-old for routine well-child care. What gait findings MOST LIKELY indicates a serious underlying disorder that requires immediate referral?

Back 51

New ataxia in a child who had been walking well

Front 52

You are surprised to learn that your 22 year old male patient in excellent health developed signs of a TIA. Further history indicated that he has had two episodes of deep vein thrombosis. Which disorder would explain this history?

Back 52

Factor V Leiden

Front 53

You are working in a primary care clinic and a 3 week old term infant is brought in for evaluation of fever. The child has a rectal temperature of 38.4C, a runny nose and raspy cough but otherwise is eating and voiding appropriately. There were no complications in his delivery or hospital course as a newborn. What is the BEST step in managing this infant?

Back 53

Emergency Department or hospital for evaluation

Front 54

You evaluate a 2-year-old Caucasian girl who developed diarrhea yesterday. She is still being breast-fed. On physical exam, she is alert; her mucous membranes are moist, and the skin turgor is good. You note that she has liquid stool in her diaper. What advice should you give the mother?

Back 54

She should eat an age-appropriate diet, and continue breast-feeding

Front 55

You examine an elderly patient who has refused to eat for the past day. On abdominal exam he has involuntary guarding in the right lower quadrant and absent bowel sounds. These findings suggest

Back 55

peritonitis

Front 56

You examine the mouth of a 70 year old woman and find a plaque on the inner cheek that is lacy and slightly blue-white. It can't be scraped off. Biopsy rules out oral cancer. For the MOST LIKELY diagnosis, what is the BEST treatment?

Back 56

topical corticosteroid

Front 57

You examine the mouth of a 70 year old woman and find a plaque on the inner cheek that is lacy and slightly bluewhite. It can't be scraped off. The area is not painful. The patient also has symmetric slightly raised plaques scattered on the extensor forearms, 1 cm in diameter, that are extremely itchy. This is MOST likely

Back 57

lichen planus

Front 58

You examine the mouth of an elder and find a white plaque on the tongue that leaves a raw, red surface when scraped off. The area is painful. You notice the patient wears poorly fitting dentures, has dry mouth and cracks at the corners of her mouth. This is most likely

Back 58

candidiasis

Front 59

You have diagnosed a 34 year old woman with Grave's disease; after 8 months she has good symptom control with use of methimazole (Tapazole). What is the MOST LIKELY outcome of her disease?

Back 59

surgical or radioactive iodine ablation will likely be required

Front 60

You receive a PAP smear report back and see "atypia" written. This means

Back 60

The patient has some cellular changes which could be representation of inflammation/infection

Front 61

You screen an 80 year old patient for gait problems by doing the "Up and Go" exam. The patient can stand up from chair without use of hands, but is unsteady for several seconds and feels dizzy. He recovers and can walk and complete the task in less than 20 seconds. He MOST LIKELY has which deficit?

Back 61

Orthostatic hypotension

Front 62

You should suspect a diagnosis of autism in a child less than 12 months old if he shows which behaviors?

Back 62

Poor eye contact with caregiver

Front 63

You suspect your patient has peptic ulcer disease from daily use of Ibuprofen. The patient is stable on exam and reports only one isolated episode of melena. Management today is

Back 63

proton pump inhibitor (omeprazole)

Front 64

You would expect a baby to first become anxious toward you (the examiner) at approximately which age?

Back 64

8 months.

Front 65

You would suspect the Somogyi effect in a patient with Type l Diabetes if

Back 65

midnight blood sugar was low and first A.M. blood sugar was high

Front 66

Your 22 year old patient has polyuria and polydypisa. A random blood sugar is 125 mg/dL.
Urine dip shows:
s.g 1.005
pH: 7.0
glucose, ketones, leukocyte esterase, hemoglobin, bilirubin/urobiliniogen all negative. What additional tests would be MOST useful in making the MOST LIKELY diagnosis?

Back 66

ADH

Front 67

Your 45 year old patient reports an irregularly pigmented lesion on her shoulder that has increased in size in the past month. The BEST approach to diagnosis is

Back 67

excisional biopsy

Front 68

Your 61 year old patient with type 2 diabetes is in clinic for a routine follow-up. She is taking metformin (Glucophage), glipizide (Glucotrol), simvastatin (Zocor), lisinopril (Zestril) and 81mg of aspirin. For this patient, which results would be MOST helpful in determining dosage of the medication change?

Back 68

glucose log from home monitoring

Explanation: You need to start insulin, and the BEST way is to get complete data from home glucose testing that includes a few days of 7 data points per day: fasting, after breakfast, before/ after lunch, before/after dinner and at bedtime.

Front 69

Your 61 year old patient with type 2 diabetes is in clinic for a routine follow-up. She is taking metformin (Glucophage), glipizide (Glucotrol), simvastatin (Zocor), lisinopril (Zestril) and 81mg of aspirin. She has developed weight loss and polyuria. For this patient, which medication changes is BEST?

Back 69

stop glipizide, start insulin

Front 70

Your 61 year old patient with type 2 diabetes is in clinic for a routine follow-up. She is taking metformin (Glucophage), glipizide (Glucotrol), simvastatin (Zocor), lisinopril (Zestril) and 81mg of aspirin.What additional physical exam or history information would BEST indicate a compelling reason to make a medication change?

Back 70

Weight loss
Explanation: Weight loss indicates a serious catabolic state, insufficient insulin to maintain fat and muscle. Decreased vibratory sensation is a consequence of chronic poor glucose control that should be addressed, but not as important as recognizing someone who is slipping toward insulin dependence.

Front 71

Your 62 year old patient with type 2 DM has a 65 year old husband with type 2 diabetes. His blood glucose is not at goal on maximum doses of metformin (Glucophage) and glipizide (Glucotrol). You want to add rosiglitizone (Avandia). On history what is MOST likely to put him at higher risk for adverse effects of Avandia?

Back 71

previous myocardial infarction

Front 72

Your 67 year old patient has had coronary bypass surgery 10 year ago and has recently had coronary stents placed. What drug should he be on to maintain patency of the graft and stents?

Back 72

aspirin

Front 73

Your 68 year old patient has a diagnosis of COPD and has been managed on inhalers and respiratory therapy for the past 5 years. Lately he has complained of increased fatigue, swelling of his ankles and right upper quadrant pain. He denies fever, change in cough or mucus production. Regarding the above patient: What would you MOST LIKELY see on a 12 lead EKG that suggests progression of his disease?

Back 73

peaked P waves with right axis deviation

Front 74

Your 69 year old patient complains that her mouth is dry all the time lately, and she says it feels as if she has "sand in her eyes" when she blinks. Which tests can be easily performed in a primary care office to make the diagnosis of Sjogren's syndrome?

Back 74

Schrimer's test

Front 75

Your 69 year old patient complains that her mouth is dry all the time lately, and she says it feels as if she has sand in her eyes” when she blinks. She says her arthritis is bothering her more as well. The most likely diagnosis is?

Back 75

Sjogren’s disease

Front 76

Your 70 year old patient has osteoarthritis bilaterally in his knees. He is on maximal medical therapy, including acetaminophen and ibuprofen plus oxycodone at bedtime. He has had received corticosteroid joint injections every three months. He complains that the pain is getting worse, interfering with his ADLs and is wondering what else can be done. Recalling the pathophysiology of osteoarthritis, the MOST appropriate next step would be

Back 76

consider knee joint replacement

Front 77

Your college friends all decide to drive to the top of Pikes Peak, height 14,000 feet. At the top you have a snowball fight, during which most of you feel a little short of breath and have mild headaches. One of your friends, an exchange student from Kenya, feels much worse, with acute abdominal pain and deep ache in his bones. The student MOST LIKELY has

Back 77

sickle cell trait

Front 78

Your elder patient has Alzheimer's dementia and has developed frequent agitation. You have ruled out delirium, pain, medication reaction or bowel/bladder problem. Which of intervention should you try FIRST to control the agitation?

Back 78

recognize what sets off the behavior and distract, not confront

Front 79

Your elder patient in a skilled nursing facility has Alzheimer's dementia and agitation. What is the BEST mechanism for controlling the agitation?

Back 79

behavioral interventions

Front 80

Your elderly patient has sensorineural hearing loss. To prevent worsening hearing loss, which drugs requires most caution if prescribed for this patient?

Back 80

Diuretics such as furosemide (Lasix)

Front 81

Your elderly patient is known to have chronic aortic stenosis. Which is the BEST indicator that the stenosis has become severe enough that surgery should be considered?

Back 81

patient develops episodes of syncope

Front 82

Your older male patient complains of "ringing in his ears". What would make you concerned that he has a diagnosis of Meneire's disease?

Back 82

vertigo

Front 83

Your patient has atrial fibrillation and a history of multinodular goiter. What drug is a POOR choice for long-term management her atrial fibrillation as it may affect thyroid function?

Back 83

amiodarone

Front 84

Your patient has been requiring morphine every 6 hours for control of bone pain from metastatic cancer. Unfortunately the patient develops hypersensitivity to the drug. What drug has low cross-allergenicity and is safe and effective for this patient?

Back 84

meperidine

Front 85

Your patient has had an acute cerebrovascular accident (stroke) and has aphasia but is alert and trying to move. You would expect to find on physical exam?

Back 85

right arm weakness

Front 86

Your patient has just completed a course of chemotherapy for breast cancer. She reports feeling fatigued and has a sore throat. A CBC shows Hgb 12.0 mg/dl, Hematocrit 35%, MCV 82 fl, platelet count 400,000, WBC 2,100 with 20% neutrophils, 72% lymphocytes, 5% eosinophils, 1% basophils, 2% monocytes. The BEST treatment for her is

Back 86

ilgastim (Neupogen)

Front 87

Your patient has recently developed ascites and hyponatremia from alcoholic cirrhosis, what intervention can help resolve his condition?

Back 87

Restricted sodium diet;

furosemide (Lasix);

spironolactone (Aldactone) &

bedrest

NOT: ACE inhibitor

Front 88

Your patient is a 59 year old man who is pale and tachycardic. He says he has fatigue when climbing stairs, all of which has come on gradually over the last several months. What labs (available in your clinic) is MOST LIKELY to point to the disorder causing his signs and symptoms?

Back 88

Fecal occult blood test

Front 89

Your patient is a heavy drinker, daily consuming a pint of gin. He decides to quit drinking and on day 2 calls you saying he doesn't feel well, must have the flu. What would be the BEST treatment?

Back 89

screen for symptoms using the CIWA tool

Front 90

Your patient is a heavy drinker, daily consuming a pint of gin. He has developed acute pancreatitis and is severely dehydrated; you hospitalize him for pain control and rehydration. On the second day you get a phone call saying the patient has had a seizure. The patient MOST LIKELY has

Back 90

alcohol withdrawal

Front 91

Your patient is a young woman who developed heavy vaginal bleeding at age 38 and was diagnosed with uterine cancer. She says there is a family history of deaths before age 60 from cancer, but no one wants to talk about it. You suspect she is at risk for inherited cancer risk. Which cancers is she at greatest risk for and for which she should receive early screening?

Back 91

colo-rectal

Front 92

Your patient is an 82 year old patient with controlled congestive heart failure and mild to moderate pain from stage IV prostate cancer. He has a history of significant allergic reaction to sulfa. What pain medication regimen should be tried first?

Back 92

acetaminophen (Tylenol) 500 mg every 4 hours, up to 2,000 mg/day

Explanation Step-wise approach to pain control is to start low and add. Tylenol for mild-moderate pain in lower dose for elderly to avoid liver problems is where to start. Morphine would work but isn't indicated, and there is no cross-allergy between sulfa drugs and sulfate. Sulfa allergy is a problem with Celebrex, which can also worsen CHF. Piroxicam has a lot of gi bleeding and should be avoided.

Front 93

Your patient received high dose doxorubicin in combination with other cancer drugs for successful treatment of leukemia. What organ should you evaluate for damage from the doxorubicin?

Back 93

heart

Front 94

Your patient was treated a month ago with I 0 days of cephalexin (Keflex) for cellulitis of the hand where an insect bit him. Now he has developed profuse watery diarrhea and abdominal cramps. The best treatment for him is

Back 94

oral metronidazole

Front 95

Your patient with alcoholic cirrhosis and ascites develops abdominal pain, fever and worsening ascites. What is the most likely diagnosis?

Back 95

spontaneous bacterial peritonitis

Front 96

Your patient, a 55 year old woman who has a history of systemic lupus erythematosis, comes in to clinic with the chief complaint of "I just got all swollen". She was in her usual state of health on maintenance prednisone 5 mg per day with no signs of a flare of her lupus. Over the course of 2 days she noticed first ankle swelling, then overall feeling of being "puffy". Vital signs confirm that she has gained 8 lbs, her blood pressure is 145/95 mm Hg, temp 98.8F, pulse 92/min, respirations 16/min. Other than widespread edema her physical exam is negative. What is MOST LIKELY the cause of her swelling?

Back 96

glomerulonephritis

Front 97

A 15 year old patient who has recently begun running steps for conditioning has pain at the site indicated by the arrow, worse with knee extension. What is the most likely diagnosis?

Back 97

Osgood Schlatter syndrome

Front 98

The most common formula used to calculate pediatric medication doses is:

Back 98

based on weight of the pediatric patient

Front 99

What is part Dubowitz/Ballard newborn maturity testing tool?

Back 99

Evaluate arm recoil

Front 100

Signs of down syndrome can include?

Back 100

Mental retardation;

congeital heart disease;

protruding tongue &

short broad hands

Front 101

What is a feature of Turner Syndrome?

Back 101

Chromosome pattern is 45, X O(missing one X chromosome)

Front 102

What is a feature of Kleinfelter syndrome?

Back 102

Chromosome pattern is 47 XXY (one extra X chromosome)

Front 103

A 3 year old boy is brought to the clinic with respiratory and GI symptoms that include steatorrhea (foul smelling stools) failure to thrive, airway obstruction, excess mucus production,
and one episode of intestinal obstruction. You suspect

Back 103

cystic fibrosis

Front 104

Benign skin lesions in the newborn include

Back 104

Milia;

Mongolian spots;

Port wine stain;

Nevus flammeus

Front 105

What BEST describes Osgood-Schlatter disease?

Back 105

Tenderness and swelling over the tibial tubercle

Front 106

A 19 year old female college student is concerned she is "fat". She frequently overeats and then fasts, using diuretics and laxatives to prevent weight gain. She is 63 inches tall and weighs 124 lbs. The BEST description of her disorder is ·

Back 106

bulimic

Front 107

What modifiable risk factors is associated with almost 30% of cancer deaths in the US?

Back 107

Tobacco use

Front 108

What has the greatest impact in terms of overall increase in developing malignancy ?

Back 108

Increasing age

Front 109

Damage by UV-B rays to cellular components initates the

Back 109

Integrity of DNA

Front 110

All but one cancer types has a specific screening diagnostic test that is offered as part of a person’s health care maintenance. Which one has no specific test?

Back 110

Lung cancer
Cervical cancer - Pap smear HPV;

Coloncancer - colonoscopy;

Prostate cancer - PSA and DRE &

breast cancer - breast exam, mammogram

Front 111

Which pulmonary cancers is MOST LIKELY to involve the pleura early in the course of the illness?

Back 111

Mesolthelioma

Front 112

A healthy adult patient’s chart says that he was treated for Wilm’s tumor as a child. Which lab value would be most useful in following his status?

Back 112

BUN/Creatinine

Front 113

Radiation therapy alone may be sufficient to treat which cancers

Back 113

Larynx;

Squamous cancer of the mouth

prostate;

oral cavity &

Hodgkins lymphoma

NOT: Non-Hodgkin’s lymphoma

Front 114

When doing the Denver II developmental screening test on a child, a delay is present if

Back 114

he fails two tasks that 90% of same-aged children pass

Front 115

When evaluating a newborn, the inability to pass a small catheter through the nasal cavity is most indicative of which condition?

Back 115

choanal atresia

Front 116

When examining a toddler it is useful to

Back 116

distract him/her with a toy/instrument before auscultating heart/lungs.

Front 117

When performing a knee exam on a patient with a sports injury, a positive posterior drawer sign of the right knee, in the absence of other positive results, is most consistent with what other condition

Back 117

Torn posterior cruciate ligament

Front 118

When smokers are prescribed nicotine as a method for smoking cessation

Back 118

the amount of nicotine replacement can/should be less than the amount they were receiving from cigarettes.

Front 119

Whenever possible, what route of administration is preferred for managing ongoing, chronic, severe pain?

Back 119

Oral is easier to administer at home, is not painful, and imposes no risk from needle exposure.

Near the end of life, rectal, transdermal, subcutaneous, and intravenous administration are frequently used; intrathecal administration is used when necessary (albeit rarely).

Front 120

Which approach to drug dosage calculation in children is MOST precise and will MOST LIKELY generate the correct dose?

Back 120

dose by fraction of adult dose, adjusted for surface area

Front 121

Which cancer chemo-therapy drugs is NOT phase dependent?

Back 121

cis-platinum

Front 122

Which is the leading cause of cancer deaths among adults in the USA?

Back 122

Lung

Front 123

Which medication given for hypertension will MOST LIKELY cause an increase in serum creatinine and potassium in a patient with underlying renal insufficiency

Back 123

ACE inhibitors

Front 124

Which medication is given to patients with hyperthyroidism in order to block conversion of T4 to T3 in peripheral tissues?

Back 124

propythiouricil

Front 125

Which of the following behaviors most strongly suggests childhood attention
deficit/hyperactivity disorder?
A. Failure to develop speech in the first year
B. lack of symbolistic play
C. poor eye contact
D. lack of empathy
E. difficulty in engaging in quiet activities

Back 125

difficulty in engaging in quiet activities

Front 126

Which of the following is considered child abuse and must be reported by a PA?
A. voluntary sexual activity between children under the age of 14
B. a positive toxicology screen in a newborn infant
C. sudden infant death syndrome
D. a fight between 12 year old boys that leads to physical injury
E. frequently withholding food as a punishment of a 4 year old child

Back 126

frequently withholding food as a punishment of a 4 year old child

Front 127

What is given in order to prevent hemorrhagic disease of newborns?

Back 127

Vitamin K

Front 128

Which of the following is the BEST example of co-dependence?
A. Clinician shares her own medical history with a patient who has a substance abuse problem
B. Clinician refuses to prescribe pain medication to a patient with a history of opiate abuse
C. Clinician extends clinic hours to accommodate a patient whose substance abuse prevents her from keeping appointments
D. Clinician seeks consultation with peers to help develop treatment plans for patients with high use of pain medication
E. Clinician "fires" substance-abusing patient from clinic after multiple failures to honor agreements

Back 128

Clinician extends clinic hours to accommodate a patient whose substance abuse prevents her from keeping appointments

Explanation: While sharing personal history is not the best policy, it doesn’t directly enable the substance-abusing patient to continue his/her habit. Extending clinic hours for a patient whose substance use interferes with life may feel helpful, but it serves to prevent the patient from experiencing consequences of his/her addiction.

Front 129

Which renal-urologic function that is important to consider in prescribing medication is MOST limited in newborns?

Back 129

tubular secretion

Front 130

Which Review of Systems questions are MOST useful in quickly screening for symptoms of occult malignancy and chronic illness?

Back 130

General

Front 131

While examining a 70 year old man you notice the margin of the lower eyelid is turned inward, the lashes irritating the conjunctiva. This is

Back 131

Entropion

Front 132

While seeing a 12-week old female for her well child checkup, you notice that she has tearing from her left eye with a small reddened area that is swollen and tender. The swollen area is just below the medial inferior eyelid. There is also constant tearing from the same eye. Her mother says that it just started two days ago and is getting worse. What is the most likely cause
of this problem?

Back 132

dacryocystitis

Front 133

Who are mandated reporters of child abuse?

Back 133

Teachers;

scout troop leaders;

physician assistant &

chiropractor

NOT: Babysitter

Front 134

Who should routinely receive the vaccine to prevent herpes zoster

Back 134

People at age 60 yrs who are not immuno-compromised

Front 135

Wilm’s tumor is most likely associated with?

Back 135

hematuria

Front 136

Withdrawal after chronic use of which substance is MOST LIKELY to create life-threatening withdrawal symptoms?

Back 136

alcohol

Front 137

Within the context of patient education, the professional should raise the issue of sex education and abuse prevention within families

Back 137

as part of routine health care intervention in all families

Front 138

You are asked to calculate the APGAR score on a newborn at 1 minute of age. He cries spontaneously, has a heart rate of 120/min, flexes all extremities, sneezes in response to stimulus of his nose and is pink except for slightly cyanotic hands and feet. What is his score?

Back 138

9

Front 139

You are attempting to start an IV on a patient and as you insert the angiocath into the antecubital vein a blue colored swelling begins to immediately form at the site and grows quickly. You should

Back 139

remove tournequet and angiocath and apply pressure to the site with elbow extended

Front 140

You are called to the nursery to examine a newborn who is slightly jaundiced on the second day. Your examination is normal and there is nothing significant in the history except that the mother received essentially no prenatal care. She did have a test for syphilis, which was negative; she was immune to rubella; and there is no blood group incompatibility. Upon further questioning of the mother, she admits to having had occasional "recreational" IV drug use during pregnancy. What might this infant be at risk for??

Back 140

Hepatitis B

Front 141

You are counseling a 68 year old patient with COPD newly diagnosed by spirometry. Under what circumstances would you measure an arterial blood gas (ABG)?

Back 141

When clinical signs of right heart failure occur

Front 142

You are doing a physical exam on a 55 year old patient. The patient's blood pressure is 142/94. His physical exam is unremarkable. Screening labs show 3+ protein in the urine and an elevated serum creatinine. What is the BEST assessment and plan?

Back 142

He has Stage 1 hypertension and evidence of target organ disease and should be started on drug therapy

Front 143

You are doing a routine follow-up of hyperlipidemia in a 70 year old retired school teacher. He says he's having trouble concentrating on the crossword puzzles he usually enjoys, and has trouble staying awake. Plus, he thinks he might have an allergy to something because his skin has become dry, flaky and itchy. His fasting lipids are much worse in spite of his daily dose of statin (Lipitor). Which tests would most likely indicate the cause of these changes?

Back 143

TSH

Front 144

You are doing a well-baby exam on a formula fed, 6 week old infant. You notice that the child's birthweight was 7lbs 8 oz; today the child weighs 8 lbs. You should

Back 144

begin a work-up for failure to thrive, including caloric intake, stool analysis, urinalysis

Front 145

You are doing a well-baby exam on a formula fed, 6 week old infant. You notice that the child's birthweight was 7lbs 8oz; today the child weighs 11 lbs. You should

Back 145

reassure the mother that this is a normal rate of weight gain

Front 146

You are evaluating a 2 week old male infant for vomiting, which the mother describes as projectile. You note he has had poor weight gain since birth. On physical exam you detect peristaltic waves and a mid-epigastric "olive". The baby most likely has

Back 146

pyloric stenosis

Front 147

You are evaluating a 2 year old who was home-birthed on a commune in Germany. The parents have declined childhood immunizations, but are worried now that their child doesn't talk, seems hyperactive and has had a few seizures. On exam you find the child is developmentally delayed, and detect a "mouse-like" odor from the wet diaper. The most likely diagnosis is

Back 147

phenyketonwia (PKU)

Front 148

You are evaluating a 77 year old man whose family is worried about him because he seems to be “slowing down”. You notice that he walks in small, shuffling steps, and seems rather stiff and rigid. He scores 26 on the mini mental status exam; you notice he draws tiny pentagons with some difficulty due to right hand tremor. The MOST LIKELY diagnosis is

Back 148

Parkinson's disease

Front 149

You are evaluating a new patient, a 58 year old male smoker who is establishing care and seeking routine health care maintenance. Which smoking-related diseases is diagnosed by clinical history, rather than by imaging, or physiologic measurement?

Back 149

Chronic bronchitis

Clinical diagnosis defined by excessive secretion of bronchial mucus and is manifested by daily productive cough for 3 months or more in at least 2 consecutive years". "Arterial blood gas measurements characteristically show no abnormalities early in COPD other than an increased a–a–Do2. Indeed, measurement is unnecessary unless 1) hypoxemia or hypercapnia is suspected, (2) the FEV1 is < 40% of predicted, or (3) there are clinical signs of right heart failure."

Front 150

You are evaluating an 82 year old man for onset of “influenza” symptoms for the past 24 hours. The patient has a non-productive cough, fever to 100.8F, muscle aches, and appears well-hydrated. His 55 year old daughter, who lives with him, says he got the flu shot a month ago and had an update of the pneumonia vaccine as well. Other than osteoarthritis and benign prostate hyperplasia the man has no chronic illnesses. The BEST treatment for the patient is

Back 150

Oseltamivir (Tamiflu)

Front 151

You are evaluating an 84-year-old patient who fell last night while walking to the bathroom. She denies a loss of consciousness. In gathering further history and doing an exam you should

Back 151

a fracture would be most likely to be discovered in the wrist or hip

Front 152

You are examining an elderly patient and detect loss of vibratory sensation and position sense in both feet. This MOST likely indicates

Back 152

age-releated posterior column degeneration

Front 153

You are examining an elderly patient and detect loss of vibratory sensation and position sense in both feet. This MOST likely indicates

Back 153

degeneration of unmyelinated C fibers

Front 154

You are exmining a 5 year old child for kindergarten and note that he has had a hematocrit of 30% that has not increased despite a year of iron supplement. She is a happy, healthy child with no history of recurring illness. CBC and lab results below:
Normal range
Retic count = I% (0.5 - 1.0 %)
RBC # = 8.0 (4.5-6.2 x 106)
Hct = 30.0% (34 - 37 %)
Hgb = l 0.0 (11 .5 - 12.5 gm/di)
MCV = 60 fl (75 - 85 fl)
Red cell morphology is normal shape and color.
TIBC is low, serum iron is normal

Back 154

beta thalassemia minor

Front 155

You are managing a patient who is on medication to control her type 2 diabetes, hypertension, and hyperlipidemia. She complains of bilateral weakness of her shoulders and hips. Screening blood test is normal except for elevated levels of the muscle enzyme creatine phosphokinase (CPK). What drug is MOST LIKELY the cause of her symptoms?

Back 155

Metformin (Glucophage)

Front 156

You are observing in the emergency department with your preceptor. A 3 year old girl is brought in by her mother complaining of a sore throat, worsening within the past few hours with a high fever. You note that the little girl is sitting hunched forward, with an open mouth, speaking with a hoarseness in her voice, and some drooling because she says it is painful to swallow. The most likely diagnosis would be

Back 156

epiglottitis

Front 157

You are re-evlauating a 4 year old child who has had daily fever to 102 F for the past 10 days in spite of antibiotics. She has cervical lymphadenopathy, conjunctivitis and a rash of her trunk and extremities. She has edema of hands and feet. The MOST LIKELY diagnosis is

Back 157

Kawasaki disease

Front 158

You are seeing a 1 year old for a well child exam. What would most likely explain a low hematocrit or low hemoglobin?

Back 158

diet which includes too much cow's milk

Front 159

You are seeing a 10 year old child for a well child visit. Which problems are most likely to appear at this age?

Back 159

scoliosis

Front 160

You are seeing a 16-year-old boy for a school physical. What is MOST important to do as a screening for age appropriate risk factors?

Back 160

inquire about drug and alcohol use.

Front 161

You are seeing a 3 year old who has had diarrhea for the last four days. What is the BEST test to evaluate the child's level of hydration?

Back 161

Urine dipstick for specific gravity collected via urine bag

Front 162

What is TRUE of breath-holding spells?

Back 162

they are not harmful, a prolonged episode can lead to brief loss of consciousness, they may be a child's response to a strong, emotional stimulus & child may be cyanotic or pale, depending on the episode

Front 163

What is true of croup?

Back 163

Occurs mostly in the winter months

Front 164

What is typical of infant colic

Back 164

Infant draws his knees to his abdomen;

occurs in infants up to age 4 or 5 months old;

prolonged crying in an otherwise well infant &

facial expression is "pained"

NOT: Vomiting

Front 165

What is used to definitively diagnose endometrial cancer

Back 165

endometrial biopsy

Front 166

What is/are appropriate guidance to give for parents whose 4 week old baby has colic?

Back 166

Colic episode will probably stop by age 3 months;

A regular feeding routine may be helpful;

Continuous, monotonous noise or music may help in pacifying the child &

They should arrange for a caregiver to watch the child for a few hours to give the parents a break.

Front 167

What lab finding is most likely a BENIGN finding in elders?

Back 167

elevated post-prandial glucose

Front 168

What lab results suggest a diagnosis of primary hyperthyroidism

Back 168

Decreased TSH, increased free T4

Front 169

What lab values is MOST predictive that a patient with cirrhosis is at high risk of developing liver failure?

Back 169

prothrombin time prolonged

Front 170

What lab values would MOST LIKELY be abnormal in a patient with multiple myeloma?

Back 170

Calcium & Total protein

Front 171

What lung cancers is MOST strongly associated with smoking, and is almost never seen in non-smokers?

Back 171

small cell lung cancer

Front 172

What may present as restrictive lung disease?

Back 172

Pulmonary fibrosis;

phrenic nerve injury;

prior lung resection &

pleural effusion

NOT: Asthma

Front 173

What measurement will likely become abnormal in a child with genu varus?

Back 173

Intercondylar distance

Front 174

What measures are effective in preventing or slowing the progression of osteoporosis

Back 174

Weight bearing exercise;

estrogen;

dietary calcium and Vitamin D supplements &

bisphosphonates such as Fosamax

NOT: non-steroidal anti-inflammatory drugs

Front 175

What medication is given daily to young children with sickle cell disease to help prevent painful sickling crises?

Back 175

Penicillin

Front 176

What memory changes in most older adults?

Back 176

Most memory changes are trivial;

most memory changes are often temporary;

most older adults can compensate for memory changes;

multiple modes of improving memory are effective in older adults

NOT significant changes are inevitable in most older adults

Front 177

What modalities are appropriate for managing chronic pain?

Back 177

Active, progressive exercise;

pharmacologic strategies for managing pain;

use of mind-body complementary medicine techniques &

psychological counseling

NOT: Rest, ice, compression, elevation (RICE)

ACUTE pain is treated with RICE. If used for chronic pain, rest & compression only promotes disuse, deconditioning and disability, which worsens chronic pain.

Front 178

What most likely indicates cancer involving the right (sided) colon

Back 178

fatigue & iron deficiency anemia

Front 179

What most likely indicates cancer involving rectal cancer

Back 179

Tenesmus & hematochezia

Front 180

What most likely indicates cancer involving the descending (left) or sigmoid colon?

Back 180

colicky pain and change in bowel habits

Front 181

What muscle relaxant drug has multiple modes of action and is MOST useful in managing chronic pain?

Back 181

tizanidine (Zanaflex)

Front 182

What needs to be in your differential in a patient who presents with signs of dementia?

Back 182

Subdural hematoma; Hepatic encephalopathy; Hypernatremia & Pernicious anemia

Front 183

What neurologic system is MOST mature at the time of birth?

Back 183

Hearing

Front 184

What on spirometry suggests a patient has restrictive lung disease, possibly acquired from chronic inhalation of inorganic dust?

Back 184

small flow-volume loop

Front 185

What other condition is beta thalassemia minor most likely to initally be confused with?

Back 185

Iron deficiency

Front 186

What pair of tests are often used together as simple screen for cognitive impairment in elders?

Back 186

clock drawing task, three item recall

Front 187

What patients should receive information from their clinician regarding filling out an Advance Directive?

Back 187

Healthy patient age 65 years;

adult patient with cystic fibrosis;

patient with metastatic cancer &

healthy 24 year old women

Front 188

What pediatric derm condition is primarily a disorder of sweat ducts?

Back 188

miliaria

Front 189

What physical exam findings in a newborn infant should cause the clinician to suspect a genetic disorder?

Back 189

Café au lait spots

Front 190

What primitive reflexes should be elected in the physical exam of a normal 4-week old infant

Back 190

Asymmetric tonic neck;

moro’s &

palmar grasp

NOT parachute

Front 191

What reflex would MOST LIKELY be present in a child who is starting to walk?

Back 191

parachute

Front 192

What signs or symptoms in a child suggests low-level mercury exposure in utero?

Back 192

Poor language acquisition

Front 193

What signs/symptoms are commonly associated with Bulimia

Back 193

Complications resulting from frequent vomiting;

periodic episodes of depression;

laxative abuse &

concern about weight

NOT: Extreme adolescent acting out behavior

Front 194

What skin condition is likely to develop distant metastases

Back 194

squamous cell carcinoma

Front 195

What skin disorders of the newborn period is MOST truly immunogenic in nature, mediated by eosinophils?

Back 195

erythema toxic

Front 196

What skin disorders will MOST LIKELY glow greenish color when examined under Wood's light?

Back 196

tinea versicolor

Front 197

What sleeping positions for a healthy infant should be recommended to parents during anticipatory guidance in order to reduce the risk foe sudden infant death syndrome?

Back 197

supine position

Front 198

What strategy has been adopted to decrease the incidence of serious early Group B Strep infection in newborns?

Back 198

Provide IV ampicillin to high risk mothers during labor

Front 199

What substances is Clonidine is useful in managing detoxification from?

Back 199

alcohol; opiates & nicotine
NOT benzodiazapine

Front 200

What tests is done during pregnancy to detect genetic disorders of the fetus and is considered SCREENING rather than diagnostic?

Back 200

Quad marker

Front 201

What tests or procedures is BEST to confirm the diagnosis of bladder cancer?

Back 201

Cystoscopy

Front 202

What tissue is most likely to undergo malignant transformation?

Back 202

Glial cells

Front 203

What type of Elderly patient would benefit most from taking Aricept (donepezil)

Back 203

mild to moderate dementia

Front 204

What type of patient has the highest percent total body water (TBW) which would effect the volume of distribution of water soluble drug?

Back 204

Premature neonate

Front 205

What vision screening tests should be performed in the newborn nursery?

Back 205

Corneal light reflex test,

Red Reflex test &

Penlight exam for corneal clarity

NOT Funduscopic examination

Front 206

What would a school age child with graphomotor dysfunction would be likely to exhibit?

Back 206

Output failure;

poor school performance;

inattentiveness &

a history of being labelled as "lazy"

NOT good handwriting skills

Front 207

What would be appropriate according to the recommended "4 Rs" of discipline and natural consequences?

Back 207

allow a child to decide whether or not to wear a jacket on a cold day
4 Rs of discipline - Respond, Review, Reflect, Right the wrong

Front 208

What would be commonly considered associated with Parkinson's Disease?

Back 208

Slowed intentional movements;

resting tremor;

shuffling gait &

cogwheel rigidity

NOT: Oral-facial dyskinesias

Front 209

What would be the strongest contraindication to prescribing methotrexate to a patient with acute, newly diagnoses rheumatoid arthritis?

Back 209

chronic Hepatitis C

Front 210

What X-Ray finding suggests a child has aspirated a foreign body?

Back 210

Focal air trapping

Front 211

When doing a well child exam on a 3 year old boy, what should you should routinely

Back 211

Do a cover/uncover test,

Palpate the testicles,

Check blood pressure &

Check hearing with standardized hearing test

NOT Check for hip clicks

Front 212

What is noted at the five-minute Apgar?

Back 212

heart rate

Front 213

What is often the first sign or symptom of pancreatic cancer?

Back 213

Vague epigastric pain -> present in 70%; weight loss and depression are later findings.

The triad of vague pain, jaundice and weight loss is common if the mass is in the head of the pancreas and obstructs the common bile duct.

Front 214

What is one of the first signs of puberty in a normal male?

Back 214

enlargement of the testes

Front 215

What is palliative care?

Back 215

Can be offered at any age; at any stage in a serious illness, and can be provided together with curative treatment.

Palliative care includes management of pain, dyspnea, nausea and vomiting, constipation, and agitation; emotional distress, such as depression, anxiety, and interpersonal strain; and existential distress, such as spiritual crisis.

Front 216

What is tested on the Denver Developmental Screening Test

Back 216

Gross motor skills,

fine motor skills,

language &

social skils

NOT intelligence or bow staff skills

Front 217

What is the BEST approach to managing a patient who has drug-seeking behavior complaining of chronic back pain?

Back 217

Develop a contract/agreement setting reasonable goals and treatment strategies

Front 218

What is the BEST intervention for a child suffering acute Kawasaki disease?

Back 218

intravenous immunoglobulin

Front 219

What is the BEST reason to immunize children against Hepatitis A?

Back 219

Children infected with Hepatitis A are often asymptomatic, but can pass it to adults who often have a more severe course

Front 220

What is the BEST test for detecting pinworm (Enterobius vermicularis)?

Back 220

Sticky tape to child’s anus in morning before bathing, examine for eggs

Front 221

What is the BEST treatment for a 4 year old patient with pneumonia due to Chlamydia penumonie?

Back 221

Erythromycin

Front 222

What is the EARLIEST age you would expect a child to be able to throw and kick a ball?

Back 222

18 months

Front 223

What is the MAIN reason physical endurance reduces with aging?

Back 223

Lower pulmonary oxygenation capacity

Front 224

What is the mechanism of action of donepezil (Aricept)?

Back 224

Increases CNS acetylcholine

Front 225

What is the mechanism of action of octreotide (Sandostatin) used in the management of nausea and vomiting in cancer patients?

Back 225

reduces gastrointestinal hormones, secretions & motility

Front 226

What is the mode of action of baclofen (Lioresal), used to treat symptoms of cerebral palsy?

Back 226

GABA agonist that is overall inhibitory in CNS

Front 227

What is the mode of action of oxybutinin (Ditropan) in managing incontinence?

Back 227

reduces detrussor muscle tone via blocking muscarinic receptors

Front 228

What is the MOST COMMON cause of permanent visual loss in elderly patients?

Back 228

age related macular degeneration

Front 229

What is the most common childhood nutritional disorder, in the United States?

Back 229

Obesity

Front 230

What is the most common complaint of patients presenting with NEW diagnosis of lung cancer

Back 230

anorexia and weight loss

Front 231

What is the MOST common presenting sign or symptom of breast cancer?

Back 231

painless lump

Front 232

What is the most common reason for permanent placement of an elder in a skilled nursing facility?

Back 232

Dementia with unmanageable behavior

Front 233

What is the MOST COMMON sign or symptom of cervical cancer?

Back 233

abnormal vaginal bleeding

Front 234

What is the MOST compelling reason to feed children organic fruits and vegetables (rather than conventionally grown produce)?

Back 234

less likely to be contaminated by organophosphate pesticide

Front 235

What is the MOST effective in treating sickle cell anemia

Back 235

Hydroxyurea

Front 236

What is the most frequent cause of epistaxis in children?

Back 236

digital trauma

Front 237

What is the MOST LIKELY be the cause of anemia in a 3 week old infant born at 39 weeks gestation, birthweight 7 lbs 2 oz?

Back 237

perinatal blood loss

Front 238

What is the most likely injury suffered by an 18 year old soccer player who falls directly onto the tip of his shoulder (deltoid region)?

Back 238

acromioclavicular separation

Front 239

What is the most sensitive exam that is now used to screen all hospital newborns for hearing loss.

Back 239

brainstem evoked responses.

Front 240

What is the most useful characteristic to ensure successful aging?

Back 240

degree of resilience in response to life changes

Front 241

What is the most worrisome if detected as an isolated finding on a newborn?

Back 241

head circumference < 5th %

Front 242

What is the normal function of protein created by the RAS gene?

Back 242

acts as on/off switch for phase G1 cell growth

Front 243

What is the prognosis of children with cerebral palsy?

Back 243

Chronic disease of motor function that does not worsen overtime

Front 244

What is the significance of a sacral dimple or tuft of hair detected during the newborn physical exam?

Back 244

defect of neural tube closure

Front 245

What is the source of most childhood lead exposure in the US as of 2014?

Back 245

old paint

Front 246

What is the treatment for most hordeolums?

Back 246

warm moist compresses

Front 247

What is the treatment for phenylketonuria?

Back 247

phenylalanine-free diet

Front 248

What is the usual initial presentation of a patient with Kawasaki disease?

Back 248

Persistent, unexplained fever, rash and lymphadenopathy

Front 249

What is the usual outcome of transient hip synovitis?

Back 249

resolves without sequelae

Front 250

What is true (in general) In comparing issues of ethnic elders compared to white counterparts?

Back 250

Ethnic elders are poorer and less well educated

Front 251

What is true about acute gastroenteritis in young children?

Back 251

Frequently no antibiotic therapy is indicated,

It is usually caused by viruses

Dairy products should be avoided while the symptoms persist &

Breastfeeding infants should continue their feeds

Front 252

What drug used to manage open angle glaucoma should not be given to a patient with AV node heart block?

Back 252

timolol (Timoptic)

Front 253

What drug used to manage open angle glaucoma should not be given to a patient with sulfa allergy?

Back 253

brinzolamide (topical carbonic anhydrase inhibitor)

Front 254

What drug, when combined with tramadol (Ultram), is MOST likely to cause serotonin syndrome?

Back 254

Sumatriptan (Imitrex)

Explanation Sumatriptan is a serotonin agonist. You might be tempted to give this combo for someone with migraine headaches...but don't do it.

Front 255

What drugs selectively blocks serotonin receptors to prevent chemotherapy-induced nausea?

Back 255

ondansetron (Zofran)

Front 256

Patient is told she has lung cancer metastasized to liver and spine; later she can't tell her children exactly what the doctor said her prognosis is

Back 256

Shock

Front 257

What emotional reaction is a patient with metastatic colon cancer asks to meet with his family to discuss plans for hospice and his funeral

Back 257

acceptance

Front 258

Patient with ovarian cancer stops her usual self-care and won't get out of bed, doesn't want to talk to anyone, eating and bathing only if a caretaker initiates it, is most likely suffering which stage of loss

Back 258

Depression

Front 259

What feature of a drug would increase the rate at which it crosses the placenta, and would thus have a rapid effect on the fetus?

Back 259

high lipid solubility

Front 260

What findings on abdominal x-ray of a premature infant is strongest evidence for necrotizing enterocolitis?

Back 260

Presence of air in the bowel wall

Front 261

What foods could likely cause a food allergy if fed to a child under the age of 1 year?

Back 261

Peanuts, shellfish, wheat & strawberries (egg yolk carries the least)

Front 262

What genetic abnormality is associated with Cystic fibrosis?

Back 262

Autosomal recessive disorder

Front 263

What genetic abnormality is associated with Down syndrome

Back 263

Presence of extra chromosome

Front 264

What genetic abnormality is associated with Kleinfelter syndrome

Back 264

Presence of extra X chromosome

Front 265

What genetic abnormality is associated with Neurofibromatosis

Back 265

Autosomal dominant disorder

Front 266

What genetic abnormality is associated with Turner syndrome

Back 266

Absence of one X chromosome

Front 267

What genetic disorder has several degrees of severity based on the possibility of inheriting up to 4 abnormal alleles?

Back 267

Alpha thalassemia

Front 268

What has been associated with an increased risk of squamous cell carcinoma of the esophagus?

Back 268

Smoking

Front 269

What has been shown to protect DNA from changes associated with aging?

Back 269

Increased levels of telomerase

Front 270

What headache syndromes MOST LIKELY indicates intracranial cancer?

Back 270

headache worst first thing in the morning, better as the person gets up

Front 271

What indicates a newborn has a congenital hip dysplasia

Back 271

leg length discrepancy;

asymmetric thigh creases;

positive Ortolani test

positive Barlow test

NOT: Pain and swelling of hip joint

Front 272

What is "socio-genic aging"?

Back 272

expectations and beliefs that label older adults as asexual, slow, unable to learn

Front 273

What is a common adverse effect of morphine that can be managed by adding drugs to control the adverse effect?

Back 273

urticaria; sedation; constipation; myoclonus
Bonus: what drug manages each

Front 274

What is a common adverse effect of prazosin (Minipress)?

Back 274

syncope after the first dose

Front 275

What is a description of the Moro reflex?

Back 275

When head is lowered suddenly infant spreads arms than adducts and flexes
them

Front 276

What is a description of the “placing” reflex?

Back 276

When dorsum of foot is rubbed infant will flex the leg as if stepping

Front 277

What is a feature of mammography in terms of detecting breast cancer?

Back 277

highly sensitive test for detecting breast calcification

Front 278

What is a finding that suggests a child has phenylketonuria?

Back 278

severe mental retardation and seizures

Front 279

What is a is the strong indicator of poor nutrition in an elder?

Back 279

decreased albumin

Front 280

What is a large risk factor for an elder to develop pressure ulcers?

Back 280

immobility

Front 281

What is a likely site of skin cancer formation?

Back 281

forehead

Front 282

What is a MAIN feature of multiple myeloma?

Back 282

"Punched out" bone lesions on skull x-ray

Front 283

What is a major manifestation of Tanner Stage 3?

Back 283

Nocturnal emissions and Menarche

Front 284

What is a manifestation of chronic lead toxicity in a child?

Back 284

Anemia

Front 285

What is a milestone first achieved around 6 months?

Back 285

Able to sit up unassisted

Front 286

What is a normal finding, often seen in the oral cavity of elders, and not generally indicative of disease?

Back 286

Mandibular Tori

Front 287

What is a physical exam finding that suggests coarctation of the aorta

Back 287

brachial pulses stronger than femoral pulses

Front 288

What is a physical sign MOST STRONGLY suggests isolated left ventricular congestive heart failure?

Back 288

rales (crackles)

Front 289

What is a proper strategy for treatment of a 13 year old girl, Cobb angle of 30 degrees, Risser grade of 2?

Back 289

Pt has great risk of progression of scoliosis, and should be referred for management.

Front 290

What is a sign of clinically significant patent ductus arteriosus?

Back 290

wide pulse pressure

Front 291

What is a tool to measure the amount of tibial torsion in a child?

Back 291

thigh-foot angle

Tibial torsion in children is internal rotation of the leg bone between knee and ankle

Front 292

What is a typical finding of a patient with cataracts?

Back 292

color of objects appears changed &

vision is most affected by bright, glaring light

Front 293

What is a typical finding of a patient with narrow angle glaucoma?

Back 293

abrupt onset of nausea, eye pain

Front 294

What is an argument against the feeding of cow's milk to an infant?

Back 294

It can lead to milk protein allergies;

It is intended to meet nutritional needs of calves; It has poor mineral bioavilabity &

it has an excessive amount of protein

Front 295

What is an example of a urologic emergency

Back 295

priapism

Front 296

What is an example of palliative care?

Back 296

pain medication to reduce or eliminate the patient's symptoms related to cancer

Front 297

What is and example of children is at HIGHEST risk for mercury toxicity?

Back 297

child who eats tuna sandwich daily

Front 298

What is appropriate intervention to maintain optimal nutrition in a patient with cystic fibrosis?

Back 298

provide pancreatic enzyme supplement

Front 299

What is associated with reduced statistical risk of developing breast cancer?

Back 299

Patient had a full-term pregnancy before age 18

Front 300

What is considered a secondary problem associated with chronic pain, and can occur within the first few months of onset of chronic pain?

Back 300

Sleep disorders;

deconditioning;

depression &

loss of function and disability

Front 301

What is considered an IADL? (Instrumental activities of daily living)

Back 301

Driving;

Cooking;

Managing medications;

Finances;

Using the telephone;

Reading

Front 302

What is considered an orthopedic emergency, requiring immediate surgical referral

Back 302

Slipped captial femoral epiphysis

Front 303

What is evaluated at the 1 minute Apgar assessment?

Back 303

Breathing effort; heart rate; color; responsiveness & activity and muscle tone

Front 304

What is is considered a cyanotic congenital heart lesion?

Back 304

Teralogy of Fallot

Front 305

What is is true of protein-bound drugs prescribed to term neonates?

Back 305

lower levels of albumin cause increased free drug per given dose

Front 306

What is likely result of X-linked inheritance

Back 306

Duchenne muscular dystrophy

Front 307

What is MOST characteristic of low grade lymphoma?

Back 307

wide spread painless swollen lymph nodes

Front 308

What is most common history in patients who are screened for open angle glaucoma?

Back 308

asymptomatic

Front 309

What is MOST likely due to decreased cell mediated immune response in elders?

Back 309

reactivated latent TB

Front 310

The most appropriate age to introduce solid foods such as rice cereal into a baby's diet is

Back 310

4 to 6 months

Front 311

The most common cause of plagiocephaly is

Back 311

supine positioning of infant

Front 312

The most common cause of respiratory distress in a preterm infant is

Back 312

hyaline membrane disease

Front 313

The most common cause of respiratory distress in a term infant is

Back 313

transient tachypnea of newborn

Front 314

The most common chronic disease of people at age of 70 in the US is

Back 314

Osteoarthritis

Front 315

The most common fracture of newborns is a fracture of the

Back 315

clavicle

Front 316

The most common genetic cause of increased risk of cancer are genes that code for

Back 316

abnormal tumor suppressor genes

Front 317

The most effective treatment for most autism spectrum disorders is

Back 317

Individualized behavior regimens

Front 318

The most significant cause of injury in elders is

Back 318

falls

Front 319

The murmur associated with Patent Ductus Arteriosus has which characteristics?

Back 319

can be heard in both systole and diastole & results from failure of ductus arteriosus to close in the neonate

Front 320

The newborn exam shows a heart rate of 120 bpm, strong cry, some flexion in the upper extremities, sneezing with nasal catheter suction, and bluish hands and feet; but the remainder of the body is pink. What is the APGAR score?

Back 320

8

Front 321

The Philadelphia chromosome, which has been associated with acute lymphoblastic, acute meylogenous (AML) and chronic lymphocytic leukemias (CML) is what kind of chromosomal abnormality?

Back 321

translocation

Front 322

The primary disorder seen in the pneumoconioses such as "coal workers lung" is

Back 322

chronic fibrotic lung disease

Front 323

The primary pathophysiology of Osgood Schlatter’s syndrome is

Back 323

avulsion of bone at tendon insertion

Front 324

The purpose of Apgar testing is to determine if a newborn is

Back 324

physiologically stable

Front 325

The reason to avoid beta blockers for managing hypertension in a patient with type 1 Diabetes is

Back 325

they diminish the adrenergic signs of low blood sugar

Front 326

The USPSTF recently recommended use of low-dose CT scan for an ANNUAL SCREEN of at-risk patients for which cancer

Back 326

Lung

Front 327

The Wernicke-Korsakoff syndrome seen in chronic alcoholics is usually treated with

Back 327

thiamine

Front 328

Transvestism is defined as a when person

Back 328

experiences sexual arousal by cross dressing

Front 329

Treatment for isolated systolic hypertension in elderly patients should include those agents which lower total peripheral resistance (TPR) while maintaining cardiac output (CO). These drugs include

Back 329

angiotension-converting enzyme inhibitors

Front 330

Tuberous sclerosis is primarily a disorder of

Back 330

abnormal soft tissue growths

Front 331

Understanding the classic physical abnormalities of Tetralogy of Fallot, what would you expect the cardiac axis on a 12 lead
EKG to be?

Back 331

right axis deviated

Front 332

Up to 50% of terminally ill patients will experience severe dyspnea, characterized by tightness of chest, shortness of breath and a feeling of suffocation. After evaluating for reversible causes (such as pleural effusion), which medication treats dyspnea effectively at end of life?

Back 332

morphine

Front 333

Weight loss is a significant feature of which drug used to manage diabetes?

Back 333

incretin mimetics (exenatide)

Front 334

What activities and/or procedures are in accordance with the recommendations set forth by the American Academy of Pediatrics as guidelines for Health Supervision

Back 334

measuring height and weight regularly from infancy to 20.; measuring head circumference at well child exams from infancy to 24 months.; & screening for hereditary or congenital metabolic disorders in the first month of life.
NOT measuring blood pressure regularly, beginning at 3 months of age.

Front 335

What anatomical structures is MOST important determining that a malignancy as "carcinoma in situ"?

Back 335

Basement membrane

Front 336

What antihypertensive is associated with causing sedation and difficulty concentrating?

Back 336

Clonidine (Catapress)

Front 337

What appropriate tests in the initial evaluation of a neonate with signs of hemolysis should be done

Back 337

CBC, Coombs test, reticulocyte count, blood smear.
NOT bone marrow aspirate.

Front 338

What are clinical features of inborn errors of metabolism

Back 338

Overwhelming neonatal illness; progressive mental retardation; infantile seizures & failure to thrive
NOT: usually traceable by affected members in family tree

Front 339

What are common causes of visual loss in the elderly

Back 339

Macular degeneration; glaucoma; cataracts & diabetic retinopathy
NOT: Retinal detachment

Front 340

What are common signs or symptoms of anorexia nervosa

Back 340

cessation of menses; downy hair growth of face; distortion of body image & decreased body temperature
NOT: Cyclic weight loss and gain

Front 341

What are common signs or symptoms of delirium tremens?

Back 341

Visual hallucination; Fever; Tachycardia; uncontrolled tremor & Disorientation/confusion
NOT: Vomiting, it is more common with opiate withdrawal and can lead to dehydration

Front 342

What are considered a basic Activity of Daily Living (ADL)

Back 342

Dressing; Transferring from wheelchair to car/bed; Brushing teeth (grooming)

Front 343

What are considered characteristics that predict healthy aging

Back 343

low probability of disease;

active engagement with life;

higher cognitive function;

higher physical function

NOT: socioeconomic class

Front 344

What are considered long-acting opioid agonists used for steady control of pain and infrequent dosing?

Back 344

buprenorphine transdermal (Norspan)

fentanyl transdermal (Duragesic)

methadone oral (Dolophine)

hydromorphone extended release

NOT hydrocodone with acetaminophen (Vicodin)

Front 345

What are signs of congenital hip dislocation in a newborn?

Back 345

Most likely is palpable 'click or clunk’ at hip socket when hips are flexed then abducted

Also can be: limitation of abduction;

asymmetrical leg creases bellow buttocks shortened proximal portion of one leg

NOT: Limitation of hip flexion

Front 346

What are some effects of morphine

Back 346

It causes euphoria and alters the subjective evaluation of pain

Front 347

What are some features/true of advance directives

Back 347

Forms and requirements for Advance Directive may vary from state to state

Front 348

What are some indicators that dialysis should be started?

Back 348

GFR falls to 10 ml/min;

Serum creatinine is greater than 8 mg/dL;

Uremic symptoms such as pericarditis develop &

Metabolic acidosis develops

Front 349

What are some major complications of sickle cell anemia

Back 349

painful thrombotic events;

Infection;

Leg ulcers &

Priapism

NOT bruising

Front 350

What are some physiological changes that may impact how old folks react to medications?

Back 350

a decrease in oxidative metabolism in the liver; a decrease in liver blood flow; a decrease in glomerular filtration rate & a decrease in renal tubular secretion

NOT a decrease in GI absorption by passive transport

Front 351

What are some risk factors for developing pancreatic cancer

Back 351

Increasing age;

obesity;

tobacco use &

chronic pancreatitis

NOT Type 1 diabetes

Front 352

What are the 3 components of "female athlete triad"?

Back 352

1. Disordered eating,

2. amenorrhea,

3. osteoporosis

Front 353

What are the 3 components of Meniere's syndrome?

Back 353

1. vertigo

2. hearing loss

3. tinnitus

Front 354

What are the features of lung disease due to asbestosis?

Back 354

Linear streaking on chest x-ray;

Dyspnea;

Clubbing & Pleural calcification

NOT: Apical cavitation on chest x-ray

Front 355

What are the features of Tetralogy of Fallot

Back 355

Ventricular septal defect;

Right ventricular hypertrophy;

Pulmonary valve stenosis;

Aorta that overrides and receives blood from both right and left ventricle

NOT Coarctation of aorta

Front 356

What are the Five M's to consider when looking for a cause of impaired memory in an elder?

Back 356

Medical illness;

Mood;

Medicines &

Mental disorder

NOT Marital status

Front 357

What are considered "red flags" in a caregiver, increasing the potential for elder abuse?

Back 357

caregiver has personally experienced abuse;

caregiver is ignorant about aging;

caregiver is financially dependent on the elder &

caregiver is socially isolated

NOT caregiver is 45 year old female

Front 358

What behaviors most strongly suggests childhood autistic disorder?

Back 358

failure to develop speech in the first year & failure to respond emotionally to caregivers

Front 359

What best describes the breastfed infant's stool

Back 359

Yellow, soft, several daily

Front 360

What blood tests would MOST LIKELY be abnormal in a child with Duchenne muscular dystrophy?

Back 360

CK-MM

Front 361

What can increase the risk of developing cataracts

Back 361

Cigarette smoking;

inhaled corticosteroids;

congenital rubella &

diabetes

NOT: vitamin C deficiency

Front 362

What cancer has the highest life-time prevalence?

Back 362

prostate

Front 363

What cancer is the most common result of chronic H. pylori infection?

Back 363

gastric adenocarcinoma

Front 364

What cardiac condition likely requires antibiotic prophylaxis during dental procedure?

Back 364

Tetralogy of Fallot

Front 365

What cause of hearing loss in the elderly is most common?

Back 365

Progressive sensorineural loss

Front 366

What changes in the physiology of elders would have the greatest impact on clearance of drug?

Back 366

loss of renal nephrons

Front 367

What class of drugs is currently the best pharmacologic treatment for attention deficit-hyperactive disorder in a child at age 7 years?

Back 367

Amphetamine-based drugs

Front 368

What condition is described as a chronic lung condition with foul-smelling sputum and episodes of hemoptysis?

Back 368

Broncheictasis

Front 369

What condition often evaluated in the emergency department includes a history of rapid onset of symptoms, active visual hallucinations, and the exam reveals that the entire sensorium is clouded with few, if any, focal neurologic deficits?

Back 369

Delirium

Front 370

What conditions are diagnosed by hemoglobin electrophoresis

Back 370

Sickle cell trait;

persistent hemoglobin F &

Beta thalassemia major/minor

NOT G6PD deficiency

Front 371

What confers the GREATEST risk for developing colon cancer?

Back 371

familial polyposis -> 100% progress to crc unless colon is resected

Front 372

What congenital heart disorders are the result of endocardial cushion defects?

Back 372

Atrial septal defect;

ventricular septal defect;

patent foramen ovale &

AV valve abnormalities

NOT: patent ductus arteriousus

Front 373

What congenital heart malformations is MOST LIKELY to present as cyanosis in a 4 month old infant?

Back 373

transposition of great vessels

Front 374

What dermatologic lesions are typically smooth papules 2-3mm with central depression, caused by a virus that, in people with intact immune system, spontaneously clear in 2 months and does not recur?

Back 374

molluscum contangiosum

Front 375

What disease is the most common treatable disease confused with Alzheimer's disease in elderly patients?

Back 375

major depressive disorder

Front 376

What does the group of chronic lung disorders termed "pneumoconioses" include?

Back 376

Byssinnosis

Front 377

What does the T refer too in the T-N-M staging system

Back 377

T refers to the presence and/or size of a tumor
T=Tumor; N= node involvement; M= mets involvement

Front 378

What does treatment for infant colic include?

Back 378

parent education about normal crying behavior;

complete history and physical to rule out underlying disorders;

training parents in effective soothing techniques &

change in feeding technique and frequency

Front 379

What drug if given within 48 hours of onset of acute influenza symptoms, is active against most strains of influenza and can reduce mortality in geriatric patients?

Back 379

oseltamivir (Tamiflu)

Front 380

What drug is effective treatment for urinary incontinence in a man with prostatic hypertrophy?

Back 380

Terazozin (Hytrin)

Front 381

What drug is given specifically for benzodiazepine overdose?

Back 381

flumazenil (Anexate)

Front 382

What drug is notorious for causing episodes of acute hemolysis in a patient with Glucose-6-Phosphate dehydrogenase deficiency?

Back 382

Sulfa

Front 383

What drug is the best first-line agent for a patient with mild (Stage 1) hypertension and mild congestive heart failure with signs of volume overload?

Back 383

Thiazide diuretic

Front 384

What drug is used to treat patent ductus arteriosus in a premature infant?

Back 384

Indomethicin

Front 385

Ear pain, mild fever, unilateral hearing loss and a bulging tympanic membrane with distorted landmarks MOST LIKELY is

Back 385

Acute otitis media.

Visualization shows marked erythema & bulging of the TM. The malleus and light reflex are not visible

Front 386

Early in the history of atrial septal defect, physiologic effects of a large left-to-right shunt include what finding?

Back 386

increased pulmonary artery flow

Front 387

Eisenmenenger's syndrome is curable by which intervention?

Back 387

heart-lung transplant

Front 388

Ejection systolic murmurs in an elderly patient is usually

Back 388

a thickening and sclerosis of the aortic valve

Front 389

Esophageal varices are associated with

Back 389

history of chronic, excessive alcohol intake and cirrhosis

Front 390

Ethanol has what effect on the central nervous system?

Back 390

depressant

Front 391

Failure to pass a urinary catheter in a male patient may be due to

Back 391

Urethral stricture;

bladder neck stenosis; e

nlarged prostate gland &

catheter is too large

Front 392

Fecal incontinence in an elderly patient occurs more commonly in patients with

Back 392

Colorectal disorder such as diverticulosis;

constipation/fecal impaction;

history of laxative abuse &
urinary incontinence

Front 393

For a patient who has become dependent on sedative-hypnotic drugs such as alprazolam (Xanax), the primary concern upon acute discontinuation is

Back 393

seizures

Front 394

For an initial episode of acute otitis media in a 9 month-old child, the drug of choice to use first is

Back 394

Amoxicillin

Front 395

For his New Year’s resolution to lead a healthier life a 45 year old man decides to give up drinking, cigarettes and red meat and start exercising. On the third day of his regimen he is found wandering on the jogging path, confused and yelling to the other runners "Don't step on the snakes!" This behavior is MOST likely due to

Back 395

delerium tremens

Front 396

For P.A.s practicing in the state of California, if elder abuse is suspected, reporting

Back 396

must be made by phone immediately to the police

Front 397

For what disease would you perform the urine test, Free cortisol?

Back 397

Cushing Syndrome

Front 398

Full term infants born via vaginal delivery will MOST LIKELY have which respiratory limitations?

Back 398

obligate nose breathing

Front 399

Generally, what features does dementia have?

Back 399

Gradual/slow onset;

disorientation (not oriented to time/place);

short term memory impairment &

worsening disorientation at night (“sun down” phenomenon)

NOT: decreased level of consciousness

Front 400

Given his history, the 49 year old husband described above would benefit MOST by being on which of the medication?

Back 400

lisinopril (Zestril)
Explanation: He has one kidney; it is reasonable to put him on a low-dose ACE inhibitor to optimize his nephron life.

Front 401

Given the observed occurrence of chronic pain by patient features and complaint, which of the of the following is the MOST common scenario of chronic pain?
A. 30 year old man with recurring migraine headaches
B. 60 year old woman with chronic abdominal pain
C. 32 year old woman with chronic pelvic pain
D. 47 year old woman with chronic back pain
E. 18 year old man with wrist pain typical of carpal tunnel syndrome

Back 401

47 year old woman with chronic back pain

Explanation: chronic pain is reported more commonly in women than men, MSK is the most common type of pain, and back pain the most common site.

Front 402

Gross motor development in an infant progresses in which patterns?

Back 402

cephalic to caudal & proximal to distal

Front 403

HELLP syndrome in pregnant patient stands for

Back 403

hemolysis, elevated liver enzymes, low platelets

Front 404

Hematologic complications associated with cancers include

Back 404

Leukopenia;

DIC (disseminated intravascular coagulation);

thrombocytopenia &

Chronic anemia not corrected with iron supplement

Front 405

How does the BRCA gene that is associated with higher risk of breast cancer actually increase risk?

Back 405

causes lack of normal tumor suppression

Front 406

How is ovarian cancer MOST OFTEN detected?

Back 406

Routine pelvic exam

Front 407

How is the "Law of Parsimony" adjusted when considering differential diagnosis of disease in elders?

Back 407

disease findings may have multiple co-morbid causes instead of one unifying cause

Front 408

Hydrocoele is

Back 408

fluid filled mass in newborn scrotum

Front 409

Hyperthyroidism in the elderly may present as?

Back 409

Congestive heart failure, diarrhea, weight loss & angina

Front 410

If a patient presents with a thyroid nodule, what is a worrisome as a finding and suggests cancer?

Back 410

The person has recently noticed change in voice.

Front 411

If you choose to treat, what is a safe, low risk treatment to hasten disappearance of capillary hemangioma that develops in the neonatal period?

Back 411

oral beta blocker

Front 412

In a case of child abuse or neglect, the health professional must

Back 412

make a phone report immediately, and a written report within 36 hours.

Front 413

In a patient who is jaundiced, which lab tests MOST STRONGLY suggests excessive alcohol intake is the cause?

Back 413

serum AST is elevated and double the serum ALT value

Front 414

In addition to long thing limbs, people with Marfan syndrome are MOST likely to have?

Back 414

mitral valve prolapse

Front 415

In addition to the usual childhood vaccines, a premature infant at two months old should receive immunization to prevent which of the disease?

Back 415

RSV

Front 416

In an asthmatic child, which signs might alert you that the child is getting worse?

Back 416

cyanosis;

restlessness;

decreasing wheezing &

tachypnea

Front 417

In an elder, history of lifestyle or habit increases all-cause mortality, and should be part of screening in all elders?

Back 417

protein calorie malnutrition

Front 418

In an otherwise well 77 year old woman you detect a 3/6 systolic ejection murmur that is heard in the right 2nd intercostal space and along the carotids. The MOST LIKELY cause of this finding is

Back 418

Aortic valve stenosis

Front 419

In counseling a patient with Marfan's syndrome you state that the most serious manifestation is

Back 419

proximal aortic aneurysms

Front 420

In counseling a woman with diabetes who is considering getting pregnant, you would advise that

Back 420

She should optimize glucose control, weight and nutritional status before conception

Front 421

In evaluating a patient with a solitary thyroid nodule found on routine exam, what is MOST LIKELY the most important item of patient history?

Back 421

irradiation to the head and neck during infancy or childhood

Front 422

In geriatric patients, age-related changes that can affect the physiological response to drugs include?

Back 422

a decrease in plasma proteins

Front 423

In poorly managed diabetes, microvascular disease is the primary contributor to?

Back 423

Peripheral neuropathy;

plantar foot ulcer;

erectile dysfunction &

glomerulosclerosis

Front 424

In regarding sleep in older adults?

Back 424

sleep quality declines

Front 425

In starting an elder on an antidepressant?

Back 425

Start at lower dose; titration over a longer period of time is to be expected

Front 426

In the newborn nursery a 12 hour old infant has copious oral secretions, choking, with episodes of respiratory distress and cyanosis. The infant most likely has

Back 426

Tracheo-esophageal fistula

Front 427

In the state of California minors of any age may consent to?

Back 427

medical care for pregnancy;

contraception;

abortion &

medical evaluation for rape

Front 428

In the US, what pathogen is MOST commonly the cause of hemolytic uremic syndrome?

Back 428

toxigenic E. coli

Front 429

In the USA, what causes the most morbidity & mortality in childhood?

Back 429

accidents and injuries

Front 430

In treating uncomplicated, comedonal acne (open and closed comedones) in adolescents, what is the best treatment?

Back 430

topical keratolytics

Front 431

In which ways does the Physician Order for Scope of Treatment (POST) form differ from an Advance Directive?

Back 431

It does not require 2 witnesses;

It is universal and valid as patient travels state to state;

It must be signed by a physician &

it may be created even if the person it affects is incapacitated

Front 432

In-Toeing is likely to occur in which disorders?

Back 432

Metatarsus adductus;

internal tibial torsion;

medial tibial torsion &

internal femral torsion

Front 433

Increased risk of what is a major concern with injectable medroxyprogesterone (DepoProvera) that limits its use in young women?

Back 433

loss of bone density

Front 434

Infants are most likely to present with iron deficiency anemia at what age?

Back 434

8 month.

Front 435

Isolated systolic hypertension is a disease found MOST OFTEN in

Back 435

the elderly

Front 436

It has been observed that people who have chronic rheumatoid arthritis have a higher mortality rate than those who don't. What is the excess mortality caused by?

Back 436

cardiovascular disease from chronic systemic inflammation

Front 437

Knowing the availability in environment and disease process, what is the MOST common anemia that an alcoholic will develop due to nutritional deficits?

Back 437

Folic acid deficiency

Front 438

Metabolism of drugs by the liver usually occurs by a two-step process, (1) oxidation and (2) conjugation + glucuronidation. Is there a change in this process with age?

Back 438

decrease in oxidation but no change in conjugation/glucuronidation.

Front 439

Metastasis refers to cancer cells that

Back 439

disseminate from the primary site and grow independently.

Front 440

Most of the long-term care of the elderly in the U.S. is provided by

Back 440

non-professionals, such as family members

Front 441

Of all the laboratory or diagnostic testing, which is most specific for diagnosing rheumatoid arthritis?

Back 441

radiographic changes: joint space narrowing, erosion and demineralization

Front 442

On a home visit you are doing a newborn assessment on a 2 day old infant who was discharged from the hospital at age 12 hours; the baby is jaundiced to the level of her mid abdomen. The mother has the delivery record. What on the birth record may indicate the cause of the child's jaundice?

Back 442

Baby's blood is positive for Coomb's antibodies;

Mom is RH negative, baby is RH positive;

Baby has a large cephalohemtoma &

Mom is blood type O, baby is blood type A

Front 443

On a routine exam of a 3 year old child you palpate a smooth, firm, well demarcated mass approximately 4 cm in diameter, deep in the abdomen, on the right side lateral to the umbilicus. It is nontender and the child has no complaints. The rest of the exam is otherwise normal. The MOST LIKELY diagnosis is

Back 443

Wilm’s tumor (nephroblastoma)

Front 444

On a well child exam of an 8 year old boy you discover that he is doing poorly in school, has no close friends. His mother says it's because he's physically clumsy in games and "too smart" for the rest of the kids. When you ask the child what interests him he says "dinosaurs" and proceeds to tell you" the complete plot of "Jurassic Park" and the scientific names of all the animals. This child shows signs typical of

Back 444

Asperger’s Syndrome

Front 445

On exam of an 11 month old child you note that she has a neat pincer grasp of her left hand, can pass blocks hand-to-hand but won't use her right hand for pincer grasp or picking the block up off the floor in front of her. She most likely

Back 445

needs a thorough neurologic exam

Front 446

On exam of an elderly white male patient you notice his 4th and 5th fingers are flexed. You palpate a thickened fibrotic cord stretching between palm and each affected finger. Although this disorder occurs with increased frequency in many chronic systemic diseases, which chronic diseases is especially associated with this condition?

Back 446

cirrhosis

Front 447

On exam your elderly patient is found to have normal ankle DTRs, Babinski negative, normal light touch and 2 point discrimination on sole, normal graphesthsia but decreased position sense to toes bilaterally. The anatomical location of her deficit is MOST LIKELY

Back 447

Posterior columns

Front 448

On newborn exam you note that the infant has epicanthal folds, low-set ears and short broad hands with a single palmar crease. What is associated with this syndrome

Back 448

Increased risk for leukemia also associated with congenital heart disease and down syndrome

Front 449

One of your patients, an 8 year old girl, is having trouble focussing in school. The other children have discovered that whenever they make a loud noise, such as dropping a book or slamming a door, the girl will crouch under her desk in terror. She is constantly watching the doors and windows, and if asked says she thinks something might ''blow up". These are features of

Back 449

post-traumatic stress disorder

Front 450

One year after chemotherapy and radiation treatment for invasive breast cancer your 65 year old patient complains of gradual onset of shortness of breath with daily activities. Her weight is stable and she feels well otherwise. A peak flow check in-office shows a normal peak flow (FEV1) but decreased total lung capacity. What is a likely explanation

Back 450

pulmonary fibrosis

Front 451

Osteogenic sarcoma is MOST LIKELY to occur at which site?

Back 451

metaphysis of leg or arm bones

Front 452

Out-toeing is likely to occur in which disorders

Back 452

femoral retroversion

Front 453

Parents are encouraged to position the baby in the supine position for sleep in order to prevent

Back 453

sudden infant death syndrome

Front 454

Parents of an autistic child approach a pediatrician after noticing that the child is drinking unusually large quantities of water and urinating frequently. Urine and plasma osmolality are low. Water deprivation increases urine osmolality, and the serum sodium concentration is not elevated. However, subsequently administered subcutaneous vasopressin analog does not change osmolality. What disorder is most likely to be present?

Back 454

Psychogenic polydipsia

Front 455

Patients with diabetes often develop a neuropathy that leads to delayed stomach emptying and bloating. Which drug works BEST to relieve this condition?

Back 455

metoclopramide (Reglan)

Front 456

Patients with Parkinson's disease usually do what signs/symptoms?

Back 456

Bradykinesia; muscle rigidity; depression & postural and gait abnormalities.
NOT: Intention tremor

Front 457

Patients with type 2 diabetes who are taking Avandia (rosiglitazone) should be monitored for what adverse effects of the drug?

Back 457

congestive heart failure

Front 458

Polyhydramnios, the condition of more amniotic fluid than normal, is MOST likely caused by what fetal anomalies?

Back 458

Esophageal atresia

Front 459

Polymyalgia rheumatica is a chronic soft tissue disease of older patients, and often precedes the occurrence of what other serious disorder?

Back 459

temporal arteritis

Front 460

Pregnant women who are at risk for recurring deep vein thrombus and pulmonary embolism are managed by daily injection of low molecular weight heparin. What is the MAIN physiologic reason that the fetus doesn't develop bleeding and hemorrhage?

Back 460

heparin is a large molecule that doesn't cross the placenta

Front 461

Prevnar (conjugate pneumococcal vaccine) is

Back 461

is given as a series of vaccines to infants beginning at 2 months

Front 462

Rapid inflow and retention of blood in the penis (boner) or vagina (dripping wet) occurs during which phase of the human sexual response?

Back 462

arousal

Front 463

Reduction of which hormone is MOST related to decreased libido in older women?

Back 463

Testosterone

Front 464

Regarding prognostic factors and risk points for an elder living at home, which of the following chronic conditions or habits
contributes LEAST to 4 year mortality rate?
A. congestive heart failure
B. cancer
C. emphysema
D. diabetes
E. current smoker

Back 464

diabetes

Front 465

Respiratory distress syndrome in a premature infant is BEST prevented by

Back 465

inhaled surfactant delivery

Front 466

Retinopathy of prematurity is caused primarily by

Back 466

retinal vascular hypoxia

Front 467

Risk of chronic Hepatitis B infection progressing the hepatocellular carcinoma is highest if the child is exposed during which age?

Back 467

Birth to 6 months

Front 468

Seizures that begin in childhood, characterized by alteration in consciousness with abrupt onset and termination, and often cease by age 20 years are

Back 468

Absence seizures

Front 469

Separation anxiety normally resolves by what age?

Back 469

2 years

Front 470

Some patients receiving parenteral morphine for cancer pain may suffer from dementia-like symptoms. What is the most appropriate treatment of this condition?

Back 470

Administer halperidol (Haldol)

Front 471

Strabismus can cause severe vision problems in a child. How can this condition be best managed?

Back 471

Early detection through cover-uncover test at well child exam at 6-10 months.

Front 472

Sudden onset of fatigue, fever, bleeding and pancytopenia is MOST typical of

Back 472

acute lymphoblastic leukema (ALL)
NOTE: Also associated with down syndrome and age <15 yo

Front 473

Survival in hypoxemic patients with COPD treated with supplemental oxygen is directly proportional to

Back 473

number of hours per day oxygen is administered

Front 474

Syndrome of inappropriate ADH secretion (SIADH) is suggested by what lab value

Back 474

hyponatremia

Front 475

Systolic murmur in a child with Down Syndrome, with loud pulmonary component of S2 is MOST likely

Back 475

Atrial septal defect

Front 476

The "shaken baby syndrome" is

Back 476

a pattern of child abuse injuries that includes retinal hemorrhages

Front 477

The Amsler grid is used to detect which eye disorders?

Back 477

macular degeneration

Front 478

The BEST intervention for prevention of morbidity due to phenylketonuria in children is

Back 478

universal newborn blood testing

Front 479

The best screening procedure to detect the presence of congenitally dysplastic hip in newborn infants is

Back 479

Ortolani maneuver

Front 480

The bone marrow responds to anemia caused by accelerated loss or destruction of RBC's by becoming hyperproliferative. This can be most clearly detected in the

Back 480

reticulocyte count.

Front 481

The child mentioned above has a 49 year old husband (also your patient). The man had one episode of acute coronary syndrome at age 47; he has been well since then, taking atorvastatin (Lipitor) plus aspirin 81 mg per day. On recent labs he is not at goal for LDL and HDL. You want to add fenofibrate (Tricor) to improve his lipid profile. On history what would make you cautious about adding this medication?

Back 481

Patient is Native American;

history of rhabdomyolysis after running a marathon;

patient has one kidney (other lost to trauma) &

patient has gallstones

Front 482

The cornerstone of a unified approach to managing chronic pain syndromes is

Back 482

comprehensive behavioral program

Front 483

The couple mentioned above has a child age 41. Results of recent screening (comprehensive metabolic panel, lipid panel, and TSH) were normal EXCEPT for low HDL, high LDL. On the child's history would be the MOST compelling reason to be cautious in prescribing a statin?

Back 483

child is trying to get pregnant

Front 484

The drug bupropion (Zyban/Wellbutrin) is an antidepressant that when used in smoking cessation:

Back 484

reduces withdrawal symptoms and craving for nicotine

Front 485

The DTaP primary series provides what type of immunity?

Back 485

Active & Long term (8-10 years)

Front 486

The first child of a couple, a boy, has cystic fibrosis. They want to know the risk of having another child with the disease. You advise them

Back 486

the risk is 25%

Front 487

The following pairs match a drug with a common adverse effect seen in elder patients. Which one is INCORRECT?
A. diphenhydramine (Benadryl): confusion
B. digoxin (Lanoxin): anorexia
C. phenylephrine (Sudafed-PE): urinary retention
D. verapamil (Calan): diarrhea
E. furosemide (Lasix): urinary incontinence

Back 487

D. verapamil (Calan): diarrhea

Front 488

The Gleason grading system is applied to determine the stage and prognosis of which cancer?

Back 488

prostate

Front 489

The glomerular filtration rate is HIGHEST in which type of patient, which may require adjustment dosing of a drug that is
eliminated by renal secretion?

Back 489

3 year old toddler

Front 490

The intestinal and renal bleeding and purpric rash seen in patients with Henoch Schonlein purpura is due to

Back 490

IgA immune complex vasculitis

Front 491

The main feature of Paget's disease of the breast

Back 491

Scaly itchy skin changes of nipple

Front 492

A child is born with 8 light brown spots, each about 2 cm in diameter, on her trunk. Her mother says that other family members have the same kind of “birthmarks”. Given the most likely diagnosis, what would be true of this family?

Back 492

At least one of the parents likely has similar birth marks

Front 493

A child is born with an "ash leaf" spot on his torso and develops seizures in the new born period. What disorder is MOST likely?

Back 493

Tuberous sclerosis

Front 494

A child normally begins to speak in 2-3 word phrases by age

Back 494

two years

Front 495

A child was born at 34 weeks gestation and is now 23 months old. Hemoglobin check today was decreased and a CBC shows an MCV of 76%. What is the most likely cause of her anemia

Back 495

Deficiency of iron in the diet

Front 496

A child who demonstrates two-finger "pincer grasp" in picking up a raisin from the examiner’s palm is showing

Back 496

an example of fine motor skill

Front 497

A child with history of frequent bouts of respiratory infection has been noted to have mushy, foul smelling stools. His growth is at the 3rd percentile. What tests would MOST LIKELY discern the cause for these findings?

Back 497

sweat chloride test

Front 498

A child with lung disease from cystic fibrosis is MOST LIKELY to have what associated finding?

Back 498

Malabsorption

Front 499

A child with the following growth patterns: 10th percentile height, weight, head circumference at birth, all dropping below 3rd % indicates?

Back 499

failure to thrive due to intrauterine insult or genetic abnormality?

Front 500

A common condition in the elderly resulting in the sagging and outward turning of the lower eyelid so that the conjunctiva is visible is called

Back 500

ectropion

Front 501

A elderly patient new to your clinic wants to establish care and shows you his bag of prescription medications which he takes daily, listed below. Based on his medications which of the following chronic conditions does he most likely NOT have?
metformin (Glucophage)
terazosin (Hytrin)
gemfibrozil (Lopid)
clopidogrel (Plavix).

Back 501

angina

Front 502

A female infant born premature at 33 weeks gestation would most likely have what on physical exam?

Back 502

Smooth pink skin with visible veins

Front 503

A mother brings her 1 year old child in concerned because of rapid growth of a birth mark on her child's shoulder. She says the spot was "tiny" at birth, but is now the size of a half dollar. On exam you find a raised, red nodule that blanches partially with pressure, 3 cm diameter. This is MOST LIKELY

Back 503

capillary hemangioma

Front 504

A new elderly patient comes in and shows you her bag of prescription medication which she takes daily. They include:

metformin,

Synthroid,

celecoxib,

Calcium + Vitamin D,

aledronate (Fosamax).

Based on her medications which chronic conditions does she have?

Back 504

Diabetes,

hypothyroidism,

osteoarthritis and

osteoporosis

NOT Dyslipidemia

Front 505

A new elderly patient comes in and shows you her bag of prescription medications which she takes daily. They include the following:

Coumadin,

Digoxin,

Lovastatin,

Glipizide,

Calcium + Vitamin D,

Reloxifen.

Based on her medications what chronic conditions does she have?

Back 505

Atrial fibrillation,

diabetes,

osteoporosis &

dyslipidemia

Front 506

A new patient comes to clinic complaining of weeks of fatigue, polyuria and thirst. A random blood sugar is 375 mg/dl, her urine is positive for glucose and 3+ ketones. Her physical exam is significant only for BMI of 32 and Candida dermatitis in skin folds under breasts. What is the single MOST appropriate treatment today?

Back 506

Insulin

Front 507

A newborn baby is cyanotic and he is not feeding well. Diagnostic tests are done which confirm that he has Tetralogy of Fallot. What are the components of Tetralogy of Fallot

Back 507

Pulmonic stenosis

Ventricular septal defect,

Overriding aorta &

Right ventricular hypertrophy.

Front 508

A one-month-old infant has an erythematous rash in the diaper area, prominent in the skin folds with satellite lesions. What commonly used rash treatment will make the rash worse?

Back 508

Cornstarch powder

Front 509

A one-month-old infant has an erythematous rash in the diaper area, prominent in the skin folds with satellite lesions. What is the single best treatment.

Back 509

anti-fungal cream

Front 510

A patient "fires" his doctor who told him he has lung cancer, complaining "the guy is a quack" is MOST LIKELY suffering which stage of loss?

Back 510

Anger

Front 511

A patient develops an acute attack of narrow angle glaucoma. The INITIAL, rapid-acting treatment aimed at control of intraocular pressure is

Back 511

diuretics such as acetazolamide (Diamox)

Front 512

A patient has been managing her Type 2 diabetes for the past 10 years on a combination of glipizide, metformin (Glucophage) and rosiglitizone (Avandia). She is on maximum doses of these medications, maintains a normal weight and follows diet and exercise routine. Over the past 6 months, her fasting blood sugars have been running over 250 mg/dl. Her hemoglobin A1C is 10.0. You want to start her on NPH insulin. What drug should she continue to take along with her insulin?

Back 512

metformin (Glucophage)

Front 513

A patient has been using prednisone for months in order to control his rheumatoid arthritis. He ran out last week and comes to you for a refill. On exam he is febrile, has nausea, blood pressure is low and he says he feels weak. He MOST LIKELY has

Back 513

adrenal suppression from the chronic prednisone use

Front 514

A patient has had a lumpectomy for breast cancer; the tumor has been found to be "estrogen receptor positive." This means

Back 514

estrogens may stimulate tumor growth and should be avoided

Front 515

A patient has relapsing, remitting multiple sclerosis. What drug should you give to help resolve acute attacks?

Back 515

prednisolone

Front 516

A patient is seen at the clinic for her health maintenance checkup. She claims to have started her first menstrual period. On physical exam, her breast development shows the areola and papilla, forming a secondary mound. Her genital exam reveals an
abundance of coarse, curly pubic hair covering the labia and mons pubis. According to the Tanner stages of sexual maturation, at what stage would you assess her sexual maturity?

Back 516

Tanner Stage IV

Front 517

A patient is told he has pancreatic cancer and the prognosis is not good. In response he begins a regimen of vitamins and vegetarian diet and starts going to church every weekend. These behaviors are typical of which stage of emotional reaction to death and dying?

Back 517

Bargaining

Front 518

A patient perforated her tympanic membrane by inappropriate use of a cotton swab. She wants to know about long-term consequences of this damage. You advise her that the usual long-term consequence is

Back 518

None, it usually heals

Front 519

A patient presents with Isolated lymphocytosis on CBC in asymptomatic older patients, what disorder are these findings MOST TYPICAL of?

Back 519

chronic lymphocytic leukemia (CLL)

Front 520

A patient presents with painless lymphadenopathy confined to one region what disorder is the MOST LIKELY to be?

Back 520

Hodgkin's lymphoma

Front 521

A patient presents with widely disseminated sites of painless lymphadenopathy what disorder would this MOST LIKELY be?

Back 521

non-Hodgkin's lymphoma

Front 522

A patient returns from a trip to Africa and develops an annoying cough. His PPD test for tuberculosis is negative. His chest x-ray shows pulmonary infiltrates. A complete blood count shows elevated eosinophils. What would be MOST USEFUL in making the diagnosis?

Back 522

stool analysis for ova and parasites

Front 523

A patient suffering anorexia nervosa is MOST LIKELY to manifest which gastrointestinal complications?

Back 523

hypomotility of gut

Front 524

A patient suffers a stroke of the left cerebellar hemisphere. You would expect to find what on physical exam?

Back 524

poor finger-to-nose testing of left hand

Front 525

A patient who had a recent episode of fever and diarrhea complains that he has tender sacro-iliac joints. On physical exam would MOST support the diagnosis of reactive arthritis?

Back 525

Rash on glans

Front 526

A patient who suffered an acute attack of narrow angle glaucoma has responded well to the INITIAL, rapid-acting treatment to control his intra-ocular pressure. What is a common medication for reversing the underlying angle closure?

Back 526

pilocarpine

Front 527

A patient with anorexia nervosa is hospitalized and caloric intake is monitored and increased. Which metabolic disturbances is seen in the "Refeeding Syndrome"?

Back 527

heart failure

Front 528

A patient with chronic venous insufficiency has developed a stasis ulcer on her ankle above the medial malleolus. What is the appropriate initial management of this condition at this
point?

Back 528

Unna paste boot compression

Front 529

A patient with hyperlipidemia has been diagnosed with atherosclerotic carotid artery narrowing and frequent transient ischemic attacks (TIA) in spite of taking daily aspirin. She is not a candidate for carotid surgery. What is the BEST treatment to prevent additional TIAs?

Back 529

dipyridamole + aspirin (Aggrenox)

Front 530

A patient with known renal insufficiency from years of hypertension complains that he has increasing spasms in his legs with muscle cramping. Disorder of which serum ion is the most likely cause?

Back 530

calcium

Front 531

A patient with metastatic breast cancer has been on morphine for pain. She tells the home hospice nurse that in the past week she has more pain and has tried doubling the dose. As her care provider you should be MOST concerned that this is a sign of

Back 531

disease progression

Front 532

A patient with severe pain from metastatic cancer gets good pain relief from morphine, but develops sedation. It is important to her to be alert to be with her children as the end of her life nears. What is the BEST management to meet her wishes?

Back 532

add dextroamphetamine
Explanation: methadone may be less sedating, but achieving equi-analgesic dose is complicated.

Front 533

A patient with type 1 DM presents a written home glucose log that shows her fasting blood sugars ranged from 99 mg/dL to 140 mg/dL. What test would be MOST USEFUL in confirming that her log results are truthful?

Back 533

Hemoglobin A1C

Front 534

A patient with type 2 diabetes develops cough while taking lisinopril (Prinvil) for blood pressure control. What BP drug would be best to prescribe in place?

Back 534

Losaartan (Cozaar)

Front 535

A patient with type 2 diabetes is on a regimen of 70/30 NPH/Regular twice a day, breakfast and dinner. He tests his blood glucose once a day--when he first gets up in the morning. He has noticed that his blood glucose has begun running high. What may be causing his high morning readings?

Back 535

Not enough insulin the night before;

Too many carbohydrates the night before;

The somogyi effect &

Occult infection

Front 536

A patient's family has decided they won't tell their elderly father, who speaks little English, that he has liver cancer and only weeks to live. You don't understand his language well, but while you are attending him he grasps your hand and you believe that he asked you if he is going to die. As his clinician you should

Back 536

Get a non-family translator to clarify what he said

Front 537

A post-dates infant would most likely have which findings on physical exam?

Back 537

Leathery, wrinkled skin

Front 538

A pregnant couple has heard that someone in their community suffered a stillbirth because of alpha thalassemia disease. They want to be screened for the risk of this disorder. What is the effective screen to do?

Back 538

Extended family history looking for stillbirth and severe childhood anemias

Front 539

A skin finding at birth of flat, pale pink macule on the forehead and nape of neck is MOST likely

Back 539

midline nevus flammeus

Front 540

A structured intervention would not be appropriate in what circumstances?

Back 540

Presence of potential harm to concerned others;

Presence of major medical concerns;

Presence of suicide risk &

Absence of intact relationships

Front 541

A two year old child develops mild URI symptoms and fever, followed by small, intensely pruritic red papules on her torso and limbs, which progress to vesicles that ulcerate, crust and heal. The MOST LIKELY diagnosis is

Back 541

Varicella

Front 542

A young child from Africa who has a history of anemia, elevated reticulocyte count and jaundice, with recurring episodes of musculoskeletal pain and abdominal pain most likely has

Back 542

Sickle cell anemia

Front 543

A young couple is concerned about their 9 month old boy and fear that he might be developmentally delayed. According to their recollection, his sister could already feed herself with a spoon by that age. As they speak, you see him playing peek-a-boo with his sister, pull himself up to standing position and pluck at his sister's fingers with his thumb and first finger. His physical exam is normal. What would be most appropriate for you to do at this time?

Back 543

Explain to the parents that he has reached the developmental milestones appropriate for his age.

Front 544

A young mother brings her 3-week old daughter for care of a rash in her mouth. The mother indicates the baby was doing fine until 2 days ago when she noticed white spots in the infant’s mouth. On exam, they do not scrape off with a tongue blade. She is bottle feeding the infant without any problem. What is the most likely diagnosis of this problem?

Back 544

oral candidiasis

Front 545

According psychologist Erikson the main ego development task from age 3 to age 5 years is

Back 545

developing positive sense of initiative and self-worth

Front 546

According to the 2004 study presented by Dr. Fordyce ("Successful Aging") what were rated by older adults as important

Back 546

Good health until close to death;

being able to meet needs and most wants;

having family and friends &

staying involved with world and people

NOT living a very long time

Front 547

According to the law in the state of California, if a 13 year old girl comes to you asking for referral for abortion, you as a provider of health care must

Back 547

ensure that she has access to abortion referral information

Front 548

Acute alcohol withdrawal is BEST treated with what medication?

Back 548

diazepam (Valium)

Front 549

Acute onset of vomiting and diarrhea symptoms 1-6 hours following ingestion of custard at a church dinner is most suggestive of ingestion of

Back 549

Staphylococcus bacterial toxin

Front 550

Adenocarcinomas arise from glandular cells. Knowing this, what sites is most at risk for developing adenocarcinoma?

Back 550

Respiratory tract

Front 551

Advance Directives in the State of California require what signatures in order to be legally effective?

Back 551

Patient signature witnessed by two adults

Front 552

After a NSVD at 40 weeks, bleeding from the uterus is still brisk minutes after delivery of an intact placenta. The uterus is soft and not responding to firm external massage. What is given to increase uterine tone and stop bleeding?

Back 552

Oxytocin (pitocin)

Front 553

After a prolonged febrile course and the typical rash, coronary arteritis and subsequent coronary aneurysms are a sequelae to which childhood diseases?

Back 553

Kawasaki's disease

Front 554

After introducing solid food, which foods should parents avoid giving to their babies less than the age of 1 year?

Back 554

Egg white; peanuts; shellfish & wheat

Front 555

Age-related changes in this organ are probably the single most important physiological factor that results in adverse drug reactions in the elderly

Back 555

Kidney

Front 556

All of the following in a patient's history suggest addictive use of a substance EXCEPT
A.Patient uses cocaine twice a year when he travels to Hollywood on business
B.Patient has been arrested 3 times for public intoxication
C.Patient with cirrhosis continues to drink
D. Patient blames his divorce and economic trouble on "bad luck" rather than his heavy drinking
E.Patient tells you he is allergic to naloxone (Narcan)

Back 556

Patient uses cocaine twice a year when he travels to Hollywood on business
Explanation: You need to consider the drug, its addictive/abuse potential, and pattern of use. Alcohol is legal but profoundly abused. Allergy to naloxone suggests patient has direct experience of it from opiate overdose; the only way the person would encounter it again is if he continues to use. Episodic use of an illicit drug may be unwise, but doesn't show a pattern that interfere with life or is escalating in use.

Front 557

What is the cause of most chronic renal insufficiency in the United States?

Back 557

untreated hypertension

Front 558

An 18 year old patient suffers collapse while playing soccer. He is conscious during your evaluation in the emergency department 20 minutes later. His blood pressure and pulse are normal, with a systolic murmur which increases during valsalva. What part of the heart is the MOST LIKELY site for cardiac pathology causing these findings?

Back 558

left interventricular septum

Front 559

An 18-month-old girl is brought into your office with history of sudden onset of respiratory distress and barking cough at 3 a.m., (6 hours ago). The child had been well with no signs of URI symptoms prior to the event. The mother provided cool mist and the episode passed. Child is presently afebrile, breathing normally, playing happily in your office. Vital signs are normal and she has no URI symptoms. What is the likely diagnosis

Back 559

Spasmodic croup

Front 560

An 52 year old white male patient is on lisinopril (Prinvil) for blood pressure control and is not at goal. You want to add a second medication. According to the JNC 8, which medication should you AVOID adding to his regimen?

Back 560

cozaar (Losartan)

Front 561

An 60 year old obese diabetic patient complains that his legs fell full and ache at the end of the day. He says they feel better if he drapes them over the back of the sofa. What is the MOST likely disorder causing this?

Back 561

venous insufficiency

Front 562

An 8 year old boy is brought to your primary care office with complaints of fatigue, intermittent fevers and a deep aching pain in the sternum. He has lost 4 pounds in the past month. What physical exam finding would you specifically look for in this patient?

Back 562

Swollen, bleeding gums

Front 563

An 8 year old child daydreams in class, has the habit of tapping and drumming the edge of his desk MOST likely has which behavior disorder?

Back 563

ADD/ADHD, hyperactivity predominant

Front 564

An 8 year old patient from Japan complains of worsening intention tremor, excessive salivation and poor school performance. What is the MOST LIKELY dietary cause of her symptoms?

Back 564

eats a lot of predator fish, like tuna

Front 565

An 80 year old patient with which complaints will MOST LIKELY have the most rapid mental and physical decline and reduced life expectancy?

Back 565

Dementia with Lewy bodies

Front 566

An 80-year-old female comes into your office complaining that food just doesn’t taste as good. She states that she feels burning of the tongue. The MOST LIKLEY cause of both problems is

Back 566

riboflavin B2 deficiency

Front 567

An 80-year-old female comes into your office complaining that food just doesn’t taste as good. Exam of her mouth shows normal mucus membranes and a healthy tongue. What supplement should she try to see if her sense of taste improves?

Back 567

zinc

Front 568

An 80-year-old female comes into your office complaining that food just doesn’t taste as good. She states that she feels burning of the tongue. The MOST LIKLEY cause of both problems is

Back 568

Zinc deficiency

Front 569

An 82 year old female patient has stress urinary incontinence and hates the idea of wearing adult diapers. What interventions would be effective, well tolerated, and used chronically with the fewest side effects?

Back 569

intravaginal pessaries to relieve prolapse

Front 570

An 82 year old man was recently discharged from the hospital for management of acute pneumonia. What changes MOST reduces his 1 year risk of mortality of any cause?

Back 570

adequate diet, especially protein calories

Front 571

An 82 year old man was recently discharged from the hospital for management of acute pneumonia. Which of the following
confers the greatest risk in terms of assessing his 1 year mortality rate?
A. age
B. gender
C. albumin < 3 mg/dL
D. performs ADLs independently
E. creatinine < 1.0 mg/dL

Back 571

albumin < 3 mg/dL

Front 572

An 84 year old man presents with complaint of increased “shakiness” of both hands which seems better after a glass of wine. On physical exam he has bilateral fine tremor at rest in both hands; gait is normal, remaining neurologic exam is nonfocal. What would be the FIRST drug to try to manage his tremor?

Back 572

propranolol (Inderal)

Front 573

An 84 year old man presents with complaint of increased “shakiness” of both hands. It has been a problem much of his adult life but is worse since the death of his wife 6 months ago. The patient reports that it seems better after a glass of wine. He denies any other neurological symptoms. He answers “no” to your CAGE questions. On physical exam he has bilateral fine tremor at rest in both hands; gait is normal, remaining neurologic exam is nonfocal. the MOST LIKELY diagnosis is

Back 573

essential tremor

Front 574

An 85-year-old woman asks you about a spot on her face which has been present for 8 months. On exam it is a 1 x 1 cm raised nodular lesion with pearly borders and a small central ulceration. She MOST LIKELY has

Back 574

basal cell carcinoma

Front 575

An elder patient has been hospitalized for 8 days for pneumonia. Her albumin level is 2.8 g/dL. This MOST likely indicates

Back 575

protein malnutrition

Front 576

An elder patient is brought to your clinic by his adult daughter, with whom he lives. She says that over the past week his blood pressure, which she monitors, has been high and he has had a few episodes of irregular heart rate. Which over-the-counter drug is MOST likely the cause?

Back 576

phenylephrine (Sudafed PE)

Front 577

An elder patient is brought to your clinic by his adult daughter, with whom he lives. She says that he became suddenly confused over the past week. What over-the-counter drug is MOST likely the cause?

Back 577

diphenhydramine (Benadryl)

Front 578

An elderly patient with a history of congestive heart failure develops a febrile urinary tract infection with acute worsening of his cardiac status. Which changes in his neurologic status is MOST likely?

Back 578

Delirium

Front 579

An infant is born at 32 weeks gestation and develops dyspnea in the hours after delivery. On exam you detect a loud biphasic murmur present in both systole and diastole. X-ray shows increased pulmonary flow. For the MOST LIKELY diagnosis, what should be given.

Back 579

Indomethicin

Front 580

An older woman who has vision loss due to glaucoma and needs help with meals, bathing, and supervision of her medications. She is afraid to answer the door because her vision is so poor she doesn't recognize strangers. What is the best recommendation for her?

Back 580

residential care facility

Front 581

An overweight female child is at increased risk for what disorder

Back 581

Early menarche

Front 582

As of 2014, what is the BEST reason to order a prostate specific antigen (PSA) test?

Back 582

monitor response to treatment of prostate cancer

Front 583

As people age the manifestations of disease change. What are typical alterations in the disease presentation in elders

Back 583

complications co-exist;

mental status changes often accompany disease;

failure to thrive;

loss of function in daily living

NOT: often abrupt onset

Front 584

Aside from avoiding anti-platelet drugs, which medication can be given to control significant bleeding problems from von Willebrand's disease

Back 584

DDAVP

Front 585

At what age would you expect a child to master dual representation of symbols?

Back 585

2-3 years

Front 586

Biphasic murmur in an active 4 year old, musical, heard best in the right supraclaviclar and neck area is MOST likely

Back 586

Venous hum

Front 587

Blowing systolic murmur in left axilla with pulse lag in lower extremities is MOST likely

Back 587

Coarctation of the aorta

Front 588

Blue or slate grey macular lesions found especially on the presacral area of a neonate is called

Back 588

Mongolian spot

Front 589

Breast milk is usually sufficient as the sole source of iron for infants until the age of

Back 589

6 months.

Front 590

Bulimia nervosa has what gastrointestinal complications?

Back 590

acute pancreatitis

Front 591

Cessation after prolonged use of which drugs results in withdrawal symptoms featuring hyperphagia, lassitude, sleep disturbances and severe depression?

Back 591

Cocaine

Front 592

Cessation after prolonged use of which drugs results in withdrawal symptoms featuring insomnia, myalgia, nausea?

Back 592

Cannabis

Front 593

Cessation after prolonged use of which drugs results in withdrawal symptoms generally limited to headache, nausea and irritability?

Back 593

Caffeine

Front 594

Children normally start to sit up alone without support at age

Back 594

6 months

Front 595

Clonidine (Catapres) is used in opiate detoxification because it

Back 595

suppresses the CNS locus ceruleus, decreasing sympathetic autonomic activity

Front 596

Compared to formula fed infants, breastfed infants

Back 596

have fewer allergic diseases.

Front 597

Compared to formula feeding, what are some advantages of breastfeeding?

Back 597

May decrease the frequency of childhood asthma;

has antimicrobial and anti-inflammatory factors;

vitamins are more bioavailable &

improves neurodevelopmental outcome

Front 598

Congenital and neonatal infections should be considered as etiologic agents in infants who have

Back 598

low birthweight, poor feeding, fever & splenomegaly

Front 599

Considering pharmacokinetics, is there a "first pass" phenomenon that occurs in the fetus?

Back 599

Yes: maternal drugs enter umbilical vein which has significant first pass through the fetal liver

Front 600

Continuous murmur in an active 4 year old, musical, heard best in the right supraclaviclar and neck area is MOST likely

Back 600

Venous hum

Front 601

Cow's milk intolerance is common in infants with gastroenteritis (diarrhea or vomiting) because the inflamed mucosa does not produce enough

Back 601

lactase

Front 602

Cyanosis at birth with rapid onset of shock and congestive heart failure by day 3 of life is MOST likely

Back 602

Hypoplastic left heart syndrome

Front 603

Damage to the corticospinal tract would result in?

Back 603

spasticity

Front 604

Dehydration may be manifested by?

Back 604

Sunken eyeballs;

High urine specific gravity;

Dry mucus membranes &

Orthostatic hypotension

NOT: Low hematocrit

Front 605

Dementia that features complex visual hallucinations

Back 605

Lewy body disease

Front 606

Dementia that most often occurs in patients with a history of hypertension and after cortical stroke, often with signs and symptoms of motor, cognitive and emotional dysfunction.

Back 606

Vascular dementia

Front 607

Dementia that primarily features progressive psychomotor slowing

Back 607

Dementia of Parkinson's disease

Front 608

Development of a type of lymphoma called Burkitt's lymphoma is strongly associated with which chronic infection?

Back 608

Epstein Barr Virus
NOTE: Occurs in adolescents/young adults and characterized by “Sarry sky” appearance on Histology

Front 609

Do Advance directive forms and requirements vary from state to state

Back 609

Yes

Front 610

Dr. Berry decides to test your understanding of the mechanisms of anemia. She hands you some lab values to evaluate; the only information about the patient is that he is a young male with no chronic disease. On CBC you note a low Hgb/Hct with normal MCV and normal shapes and coloration of the red blood cells. Serum ferritin and total iron binding capacity (TIBC) are both normal. What describes this pattern of anemia?

Back 610

Acute blood loss

Front 611

During physical exam of an elderly patient a painless brown-colored ulceration is noted on the ankle superior to the medial malleous. What is the MOST LIKELY diagnosis

Back 611

Venous insufficiency

Front 612

During the first year of life, the most frequent cause of severe bronchiolitis and pneumonia in an infant who was born premature at 30 weeks is

Back 612

Respiratory syncytial virus

Front 613

Each of the drugs below is listed with an important adverse effect. One is INCORRECT. Which one?
A. morphine: nausea and itching
B. diazepam (Valium): impaired cognition, amnesia and increased falls
C. propoxyphene (Darvon):use banned in US for cardiac arrhythmias
D. methylphenidate (Ritalin): appetite suppression
E. pentobarbital (Nembutal): seizures

Back 613

Pentobarbital (Nembutal): seizures

Explanation: barbiturates such as pentobarbital have inherent anti-seizure activity (they increase GABA inhibition of the CNS).

FYI: Nembutal has been used in capital punishment to carry out death sentences, and in liquid form is utilized in Oregon assisted suicide/death with dignity

Front 614

Each of the following congenital cardiovascular malformations is likely to have measurable left-to-right shunting EXCEPT
A. ventricular septal defect
B. patent foramen ovalc
C. patent ductus arteriosus
D. coarctation of the aorta
E. atrial septal defect

Back 614

coarctation of the aorta

Front 615

"Anticipatory guidance" is done at well-child exams by advising parents on normal development changes their child will undergo in the next weeks and months. What is the MOST APPROPRIATE timing for the issue discussed?

Back 615

Discussion at the 2 month well-child exam on safety regarding the baby rolling off surfaces.

Front 616

5 fluorouracil works as a cancer chemotherapy; what it its mechanism of action?

Back 616

causes nucleotide substitution in cancer RNA transcription

Front 617

60 year old woman complains of fatigue, burning tongue and numbness in the lower extremities. Her tongue is red and fissured. A CBC shows MCV of 110 fl, decreased platelets and the presence of hypersegmented neutrophils. What tests will confirm the most likely diagnosis?

Back 617

B12/folate level

Front 618

A 1-month-old infant is examined in the office. On hip exam the right hip is nontender, no redness or warmth but does not abduct and externally rotate fully. The MOST likely diagnosis is

Back 618

hip dysplasia with dislocation

Front 619

A 12 year old boy presents with sudden onset of dry cough and difficulty breathing for the past 24 hours. He reports that he adopted a stray cat a month ago. Vitals signs: temp 98.8F, BP 126/77, Pulse 102/min, Respirations 40/min. He appears in moderate respiratory distress. On physical exam his chest is hyper resonant to percussion bilaterally, he has prolonged expirations and on auscultation you hear diffuse expiratory wheezes. The BEST treatment for him is?

Back 619

Inhaled albuterol (Ventolin)

Front 620

A 12 year old patient has a recurring "pimple" in the midline of his anterior neck. The spot gets inflamed, drains pus, then heals with antibiotics. On exam it moves upward when the patient sticks out his tongue. He most likely has?

Back 620

Thyrogolassal duct cyst

Front 621

A 12-year old male presents to the urgent care clinic complaining of burning pain in his lower extremities with weakness. On exam, the clinician notes symmetric weakness with severely decreased active range of motion of the lower extremities, additionally decreased position and vibratory sensation in the distal portions bilaterally. Upon further questioning, the patient recalls being diagnosed with mononucleosis 2 weeks ago. What is the most likely diagnosis?

Back 621

Guillain-Barre syndrome

Front 622

A 13-year old child is brought to the office by her mother who states that the child is still wetting the bed at night. She is worried that there is something wrong with the child. Upon examination there is no abnormality. Urinalysis is negative. What is the treatment of choice for this disorder?

Back 622

Bed-wetting alarm

Front 623

A 15 year old boy comes to clinic complaining of 24 hours of left scrotal pain which he says is somewhat better with wearing tight underwear. The physical examination, reveals swelling, warmth and tenderness of the upper pole of the left testicle. The most likely diagnosis is

Back 623

epididymitis

Front 624

A 15 year old boy is brought to the ER due to the abrupt onset of severe left scrotal pain with associated symptoms of nausea and vomiting. The physical examination, reveals a tender testicle; cremaster reflex on the affected side is absent. He MOST LIKELY has

Back 624

Testicular torsion

Front 625

A 15 year old child who is academically bright but lacks ability to imagine other’s feelings MOST likely has which behavior disorder?

Back 625

Asperger's form of autism spectrum

Front 626

A 15 year old girl has several 1 to 2 cm salmon-red oval slightly scaly, slightly raised plaques on her trunk. There are no lesions on her extremities, palms or soles. It started with one larger lesion and then multiple smaller ones appeared over the course of l week. The lesions do not itch. The most likely diagnosis is

Back 626

pytiriasis rosea

Front 627

A 19 year old man has a painless, hard nodule that is palpable deep in the left testicle that has been present for 2 months. It is not cystic on ultrasound. The MOST APPROPRIATE analysis of the mass is

Back 627

Removal of the testicle

Front 628

A 19 year old woman comes to you with the complaint of increasing fatigue. She had been active and well until 2 weeks ago, when she developed URI symptoms, and says she just never got better. On exam you find her tachycardic with a PMI displaced to the left and an S3 gallop with a few crackles heard at lung bases. EKG shows only nonspecific changes, and the chest X-ray shows an enlarged heart. The MOST LIKELY diagnosis is

Back 628

acute post-viral myocarditis

Front 629

A 2 week old infant has increasing episodes of projectile vomiting after feeding and now is irritable with shallow respirations. He is afebrile and acts hungry. Based on the most likely diagnosis, what acid base disorder is present?

Back 629

Metabolic alkalosis

Front 630

A 2 year old child has had delay in acquiring language. On physical exam you note a yellowish tympanic membrane with decreased motion and a fluid level present. What is the BEST management?

Back 630

pressure equalization tubes

Front 631

A 2 year old child is seen in office with a 24 hour history of swelling of upper and lower lids of her left eye. She can barely open the eye; her eye movements are intact. She has temperature of 101F, redness and tenderness of the tissues surrounding the eye. She MOST likely has

Back 631

orbital cellulitis

Front 632

A 2 year old child with wheezing and eczema, her third episode in the past three months most likely has?

Back 632

Asthma

Front 633

A 2-week old male is being seen in your clinic for a profuse mucoid discharge from both eyes, with some associated tearing. On exam, you notice that both eyes are hyperemic and the eyelids are red and swollen. What is the most likely cause of this patient’s ophthalmia neonatorum (conjunctivitis in the newborn)?

Back 633

chlamydial

Front 634

A 20-month-old male is brought into your office with a low-grade fever, URI symptoms x 3 days, barking cough and stridor. Symptoms are worse at night. No drooling. No pulling at ears. Appetite has been poor for 2 days. What is the likely diagnosis

Back 634

Laryngotracheobronchitis (LTB)

Front 635

A 21 year old woman complains of pain and a clicking sound located at the posterior lateral malleolus. A fullness is palpated beneath the lateral malleolus. The most likely diagnosis is

Back 635

peroneal tenon subluxation with tenosynovitis

Front 636

A 22 year old patient is seen in the clinic with acute onset of chest pain that has persisted for 2 days. The pain is retrosternal, described as sharp and stabbing, worse with deep breathing, better if sitting up and leaning forward. On clinical exam would be most consistent with the clinical diagnosis?

Back 636

pericardial friction rub

Front 637

A 23 year old otherwise fit and healthy man helped his friend move a piano. The next day he is complaining of aching lumbar back with no neurologic signs. Knowing only the above, what would be the BEST management?

Back 637

rest, ice, NSAIDs

Front 638

A 23 year old patient has had a single palpable enlarged lymph node in the axilla for the past 3 months. She says lately whenever she drinks alcohol it is briefly but intensely painful. On biopsy you see typical Reed Sternberg cells. What is the MOST LIKELY diagnosis?

Back 638

Hodgkin's lymphoma

Front 639

A 24 year old female patient has all of the clinical features of hyperthyroidism. A blood test shows elevated T4 and elevated TSH. What is the most likely cause of the hyperthyroidism?

Back 639

pituitary tumor

Front 640

A 24-year-old man has two days of right ear discomfort radiating to his jaw with decreased hearing on the right. He has just returned from camping in the mountains. He has no other symptoms. Physical exam: Temp: 98.7 F, Weber lateralizes to the right; bone conduction on the right is greater than air conduction. The right tympanic membrane is grey and retracted. Bony landmarks are sharp, no fluid is seen. Nose and throat are normal. The MOST LIKELY diagnosis is

Back 640

eustachian tube dysfunction.

Front 641

A 25 year old man with type 1 diabetes says he feels unwell during a basketball game and goes to sit on the bench. After sitting for a moment, he falls down and experiences a generalized seizure with loss of consciousness. He is most likely experiancing?

Back 641

Hypoglycemia

Front 642

A 26 year old women who works with oil paint presents with dryness, itching and cracking of her fingers. What best describes this condition

Back 642

Contact dermatitis

Front 643

A 28 year old woman has developed spontaneous white discharge leaking from both nipples. You confirm by testing that she is not pregnant. What is most likely to be abnormal?

Back 643

prolactin

Front 644

A 29 year old male patient with a 6 week history of intermittent fevers, fatigue and weight loss has no unusual findings on physical exam, CBC is normal, and he has a negative PPD and Quantiferon test. His chest x-ray is read as "normal except for widened mediastinum". What would be HIGHEST on your differential?

Back 644

Hodgkins lymphoma

Front 645

A 3 year old child has very limited social verbal skills and is fascinated by flickering movements or turning wheels MOST likely has which behavior disorder?

Back 645

Autism

Front 646

A 3 year old child presents to the clinic with the symptoms of malaise, rapid breathing, accompanied by nasal flaring, retraction of intercostal muscles, cough, fever and chills. Physical examination reveals increased fremitus with dullness to percussion in the lower posterior lung fields. A complete blood count indicates WBC of 18,000 with 5% bands, 80 % neutrophils, 15% lymphocytes. The child MOST LTKEL Y has

Back 646

pneumonia.

Front 647

A 3 year old child presents to the clinic with the symptoms of malaise, rapid breathing, accompanied by nasal flaring, retraction of intercostal muscles, cough, fever and chills. Physical examination reveals increased fremitus with dullness to percussion in the lower posterior lung fields. A complete blood count indicates WBC of 18,000 with 5% bands, 80% neutrophils, 15% lymphocytes. The child MOST LIKELY has

Back 647

pneumococcal pneumonia

Front 648

A 3 year old child rhad influenza A 2 weeks ago and now has developed vomiting, enlarged liver and increasing lethargy and disorientation. Labs show elevated liver enzymes, normal bilirubin and prolonged INR. The most likely diagnosis is

Back 648

Reye Syndrome

Front 649

A 3 year old child rhad influenza A 2 weeks ago and now has developed vomiting, enlarged liver and increasing lethargy and disorientation. Labs show elevated liver enzymes, normal bilirubin and prolonged INR. What drug has been associated with an increased risk of developing this post-viral syndrome?

Back 649

salicylates

Front 650

A 3 year old patient is brought to the clinic by her mother who notes the child woke up this morning with her left eyelid swollen and lashes matted together with dried yellow crust. On exam the conjunctiva is red with purulent discharge. A gram stain shows numerous neutrophils. What is the most likely diagnosis?

Back 650

bacterial conjunctivitis

Front 651

A 3-week old male is being seen in your clinic for a profuse mucoid discharge from both eyes, with some associated tearing; the child had no symptoms in the newborn nursery and developed this eye problem 3 days ago. On exam, you notice that both eyes are hyperemic and the eyelids are red and swollen; the child has an occasional raspy cough. What is the most likely cause of this patient’s ophthalmia neonatorum (conjunctivitis in the newborn)?

Back 651

Chlamydia trachomatis

Front 652

A 3-year old male presents to the clinic for a cough that his mother says occurs only after he has been running. She says that she first noticed this about 6 months ago, after he had one of his usual winter colds, and his cough persisted for about a week. Based upon this history, what is the most likely diagnosis?

Back 652

asthma

Front 653

A 30-year-old male presents with multiple scattered, discrete vesicular lesions on the right leg for 5 days. There are golden-yellow honey-colored "stuck-on" crusts and erosions in some of those lesions. The most likely diagnosis is

Back 653

impetigo

Front 654

A 33 year old man has signs and symptoms that suggest alcohol abuse. Which panels of lab tests will be MOST useful?

Back 654

blood alcohol level, liver panel, electrolytes, CBC

Front 655

A 33 year old woman comes in for evaluation of a breast lump that she says developed after starting on birth control pills. On exam you detect a 4 cm round, rubbery, mobile nontender mass in the left breast. There are no skin or nipple changes or nipple discharge. This is MOST LIKELY

Back 655

fibroadenoma

Front 656

A 36-year-old female patient is diagnosed with breast cancer. The patient has a family history of malignant breast carcinoma in the mother and 2 aunts. The patient is a smoker. She has been on fluoxetine 9 months for the treatment of depression. The FDA requires that all adverse drug events be reported. The physician

Back 656

Is obligated to immediately report the carcinoma as a serious adverse event even though the event is attributed to smoking and a genetic predisposition

Explanation The patient was on fluoxetine at the time of diagnosis; therefore, the physician is obligated to report the carcinoma as an adverse drug event. The event is classified as serious and should immediately be reported to the FDA using a Medwatch form

Front 657

A 42-year-old woman is found unconscious with an empty bottle of propoxyphene hydrochloride (Darvon) at her side. She is a known case of severe depression. After a patient airway is ensured and artificial respiration instituted, what would be most helpful in treating this patient's respiratory depression?

Back 657

Naloxone

Front 658

A 45 year old male patient is new to your clinic and wants to something more for his back pain. He has been taking diazepam (Valium) 10 mg twice a day as a muscle relaxant for back pain since an injury 6 years ago. A friend gave him some oxycontin and he says "It was amazing! I just didn't care about my back anymore" and would like you to prescribe it. You should

Back 658

discuss commitment to a comprehensive program of evaluation & treatment

Front 659

A 48 hour old infant is noted to have a soft area of skull in the parietal region that is easily depressed then springs back after pressure is released, like a ping-pong ball. What condition is it MOST likely to be?

Back 659

craniotabes

Front 660

A 48 hour old infant is noted to have a superficial swelling over the right parietal-temporal region that does not cross the suture line. What condition is this MOST likely to be?

Back 660

cephalohematoma

Front 661

A 5 year old patient with HIV has had multiple episodes of acute otitis media that are slow to heal. Today she has another episode, the 4th in 6 months, and the mother says "Amoxil doesn’t work, Septra doesn't work, Pediazole doesn't work. I'm so tired of all these antibiotics!" What is the best course of action at this time?

Back 661

tympanocentesis, culture & sensitivity

Front 662

A 5-year old boy is seen in your office for his kindergarten physical exam. Assuming that the patient’s immunizations have been up to date, which immunizations should the patient will receive at the end of today’s visit?

Back 662

DTaP, IPV and MMR

Front 663

A 5-year old girl has had a sore throat and fever for 5 days. She is diagnosed with acute pharyngitis. What is the MOST common cause?

Back 663

adenovirus

Front 664

A 52 year old male patient takes several medications to control high blood pressure, cholesterol and angina. He calls to say that he has acute onset of a painful big toe, reporting it is hot, swollen, and rates a 9 on the pain scale. He says he can't event tolerate wearing a sock on it. Which of his medications is MOST LIKELY the cause of his symptoms?

Back 664

hydrochlorothiazide (Diuril)

Front 665

A 55 year old patient with long-standing alcoholic cirrhosis and ascites develops mild cognitive impairment, difficulty concentrating, and has started staying awake at night and sleeping during the day. What abnormal lab value would MOST LIKELY be associated as the CAUSE of these symptoms?

Back 665

high serum ammonia

Front 666

A 55 year old woman had a mammogram done as a routine screen. Clustered microcalccifications were detected. Biopsy is positive for ductal carcinoma in situ. The most appropriate management would be

Back 666

surgical excision of the area and radiation

Front 667

A 55 year old woman has a history of facial flushing and papules surrounding her nose and chin. She now feels as if she has started to develop pitting and swelling of the soft tissue of the nose. What is the most appropriate treatment

Back 667

topical metronidazole

Front 668

A 55 year old woman has had 3 episodes of symptomatic kidney stones which were clearly visible as white specks on x-ray, and which she eventually passed. Analysis of the stones showed they were primarily calcium phosphate. She should be evaluated for which chronic disorders?

Back 668

parathyroid adenoma

Front 669

A 55 year old woman with a history of osteopenia and peptic ulcer has been using ergotamine to abort her migraine headaches, but is now having one or two headaches a week. Which drug strategy in this patient is MOST APPROPRIATE as preventive therapy?

Back 669

propranolol (Inderal)

Front 670

A 56 year old male non-smoker is found on routine exam to have a hematocrit of 29%, MCV of 72fl and hypochromia. Except for mild fatigue he is asymptomatic and his physical exam is unremarkable. The MOST IMPORTANT follow-up procedure is

Back 670

evaluate for colorectal cancer

Front 671

A 56-year-old woman complaining of six months of progressive weakness, increased weight, and increase in body hair comes to your office. On physical exam she has a BP of 190/100 very thin arms and legs and central obesity and a puffy, round face. A blood test shows her ACTH level is extremely LOW. The MOST LIKELY cause of her symptoms is

Back 671

Tumor of the adrenal cortex

Front 672

A 56-year-old woman complaining of six months of progressive weakness, increased weight, and increase in body hair comes to your office. On physical exam she has a BP of 190/100, very thin arms and legs and central obesity and a puffy, round face. A blood test shows her ACTH level is remarkably elevated. The MOST LIKELY cause of her symptoms is

Back 672

tumor of the anterior pituitary

Front 673

A 58 year old man has significant obstructive urinary symptoms from an enlarged prostate. He has tried finasteride (Proscar) and after 2 months has received only modest improvement in symptoms. He wants to know what options he should pursue at this time. You advise

Back 673

waiting, as it takes 6 months for full effect of this drug

Front 674

A 6 year old girl is brought to her primary care provider with complaint of low grade fever and colicky abdominal pain for the past 2 days. She had upper respiratory symptoms 5 days ago which mostly resolved. Her appetite is less due to the abdominal pain, but she has had 2 formed stools daily. On physical exam she is alert and non-distressed, temperature 100.8 F, systolic blood pressure slightly high for age. Her lung and heart exam is unremarkable; abdomen is soft without organomegaly, masses or rebound; active bowel sounds are heard in all quadrants. You note non-blanching 4mm red spots on her lower legs and thighs. Stool is positive for occult blood and there is both microhematuria and proteinuria in her urine. The MOST LIKELY diagnosis is

Back 674

Henoch-Schonlein purpura

Front 675

A 6 year old girl is seen in the emergency department with a 2 day history of bloody diarrhea, fever and new onset of jaundice. The parent said the symptoms began within 24 hours of eating at a barbecue. CBC shows decreased hematocrit with schistocytes and helmet cells and decreased platelets;Other labs are significant of increased creatinine. The MOST LIKELY diagnosis is

Back 675

Hemolytic uremic syndrome

Front 676

A 6 year old girl is seen in the emergency department with a 2 day history of bloody diarrhea, fever and new onset of jaundice. The parent said the symptoms began within 24 hours of eating at a barbecue. CBC shows decreased hematocrit with schistocytes and helmet cells and decreased platelets. Other labs are significant of increased creatinine. For the MOST LIKELY diagnosis what is appropriate treatment?

Back 676

plasmapharesis

Front 677

A 60 year old woman describes jerking sensations in her legs that frequently awaken her from sleep at night. The BEST treatment for this condition is

Back 677

lorazepam (Ativan)

Front 678

A 60 year old woman describes jerking sensations in her legs that frequently awaken her from sleep at night. The most likely

Back 678

restless leg syndrome

Front 679

A 60 year old woman describes jerking sensations in her legs that frequently awaken her from sleep at night. What should she should be screened for?

Back 679

renal insufficiency;

iron deficiency anemia;

Parkinson's disease &

diabetic neuropathy

Front 680

A 61-year-old man is on amlodipine for the treatment for hypertension. What is a common side effect of amlodipine?

Back 680

Edema

Front 681

A 62 year old male patient complains of gradual onset of painful erections and says his penis now curves when erect. On palpation you detect thickened scar tissue in the shaft of the penis. Your diagnosis is

Back 681

Peyronie's disease

Front 682

A 62 year old man has noticed that he has developed a tremor of his head and hands. The head tremor is present at rest, and consists of barely perceptible nodding. The hand tremor is most obvious when he is holding a newspaper open to read it. It seems to get worse when he is anxious or stressed. He is otherwise in good health, plays tennis 3 times a week and eats a healthy diet with minimal alcohol. What is the BEST treatment for him?

Back 682

low dose propranolol

Front 683

A 62 year old patient is evaluated in the emergency department for left-sided chest pain which began the night before and has been constant, burning in quality. On exam her BP is 132/80, HR 90/min, Temp 98.8 F, RR 20/min. Her physical exam is significant for hyperaesthesia and dysaesthesia along the entire T5 dermatome. On closer exam you find a tiny cluster of vesicles in the skin fold under the breast. What is most likely the cause of this finding? And what is the BEST treatment?

Back 683

Varicella
Treat with an oral antiviral such as acyclovir

Front 684

A 62 year old patient with a history of smoking develops acute onset of muscle weakness, falling several times at home. He denies cough, fevers or weight loss, but says he is troubled recently by constipation and just feels depressed and his bones are achy. Although your differential of these symptoms is broad, what would explain ALL his symptoms?

Back 684

hypercalceima

Front 685

A 63 year old man with atrial fibrillation due to rheumatic heart disease has developed frequent cardio-embolic TIAs. The preferred mode of long-term anticoagulation is?

Back 685

Warfarin (Coumadin)

Front 686

A 64-year-old Caucasian woman develops an ulcer on her upper lip that won’t heal. On exam it is 6mm in diameter, round, regular, has an eroded central area with pearly raised borders. This is MOST LIKELY

Back 686

Basal cell carcinoma

Front 687

A 64-year-old female has a blood pressure of 190/50 and exaggerated "bounding" pulses and a diastolic murmur heard along the left sternal border. The cardiac lesion that would MOST LIKELY cause this blood pressure finding is

Back 687

aortic insufficiency (regurgitation).

Front 688

A 64-year-old woman with a history of polymyositis, hyperlipidemia, hypothyroidism, all managed on oral medication, comes in complaining of six months of progressive weakness, increased weight, and urinary frequency. On physical exam she has a BP of 165/100. Adverse effect of which medications is MOST likely the cause of these findings?

Back 688

oral prednisone

Front 689

A 65 year old patient who has long-standing type 2 diabetes and hypertension comes in for routine follow-up. Which labs BEST evaluate his renal function?

Back 689

creatinine clearance

Front 690

A 65 year old patient with a history of smoking 1 pack a day for 30 years presents for his first physical exam in 15 years. His chief complaint is cough productive of stringy mucus. He is slightly obese and somewhat plethoric. His lung sounds in all lung fields are noisy with rhonici and some wheezes. He MOST LIKELY has

Back 690

COPD, bronchitis predominant

Front 691

A 65-year-old woman asks you about a spot on her face which has been present for 2 months. On exam it is a 1 x 1 cm slightly raised nodular lesion with irregular borders, mixed pigmentation and lack of symmetry. You are most concerned that this is

Back 691

malignant melanoma

Front 692

A 66 year old female patient claims that for the last several months she "wets herself". On further questioning you determine that she leaks urine when she coughs, the amount is small, never happens at night, and she has no sense of urge to urinate. This is MOST LIKELY

Back 692

Stress incontinence

Front 693

A 66 year old female patient claims that for the last several months she "Wets herself." On further questioning you determine that she can't predict when these episodes will happen, just that she feels her bladder start to contract and she has to run to the bathroom. This is most likely? And what is the best treatment?

Back 693

Urge incontinence
Treat with Oxybutynin (Detrol)

Front 694

A 66 year old woman complains of frequent episodes of aching shoulders and hips. She has no loss of strength, but it hurts so much that she avoids some maneuvers such as combing her hair and sitting in soft chairs that are hard to get out of. For the MOST likely diagnosis, what is the BEST treatment?

Back 694

prednisone

Front 695

A 66 year old woman complains of frequent episodes of aching shoulders and hips. She has no loss of strength, but it hurts so much that she avoids some maneuvers such as combing her hair and sitting in soft chairs that are hard to get out of. For the most likely diagnosis, what other complication is she at risk for?

Back 695

Acute loss of vision

Front 696

A 67 year old Black woman is well, no complaints, but is found to have a TSH less than 0.1 mU/L with a normal FT4 and T3. Over the next 2-5 years, what is she at MOST risk of developing due to her subclinical thyroid condition?

Back 696

atrial fibrillation

Front 697

A 68 year nonsmoking old man whose job is crafting violins finally gets health insurance and comes to you for the first complete physical of his adult life. Other than osteoarthritis and mild hearing loss he has no medical illness. In order to update his vaccines, what should he receive?

Back 697

Tdap;

Pneumococcal vaccine;

Influenza;

Varicella zoster

NOT: Hepatitis B vaccine

Front 698

A 68 year old smoker complains that she has increasing difficulty doing crossword puzzles due to the small boxes looking distorted and the letters blurred. She also notices that when she comes in from working in the garden it takes several minutes for her eyes to adapt to dim light. What is her MOST likely diagnosis accounting for these symptoms?

Back 698

macular degeneration

Front 699

A 69 year old man has intermittent episodes of dizziness, tinnitus and hearing loss in the right ear for the last 6 months. He describes a sensation of the "room spinning around him," with the episodes lasting for 2 to 4 hours. Physical exam is significant only for right hearing loss and horizontal nystagmus. The MOST LIKELY diagnosis is

Back 699

Meniere's syndrome

Front 700

A 7-week-old male infant is brought in by his mother. You recall that the infant's examination in the newborn nursery was normal. The mother has not had any problems with the infant's breast-feeding, and his height and weight are at the 60th percentiles. On physical exam, the infant appears pink and well, and there are no intercostal recessions with breathing. A thrill is noted when you place your hand on the child's chest. There is a harsh, pansystolic murmur heard loudest over the lower left sternal border. The murmur is transmitted widely. What is the most likely diagnosis?

Back 700

Ventricular septal defect

Front 701

A 70 year old patient is brought in by family members concerned that he is "not all there". They have noticed a sudden behavior change, with the man becoming lethargic and acting disoriented. However, the symptom seems to come and go, and he seems better first thing in the morning. Results of a screening CBC and chem panel are significant only for a low sodium level. What additional lab value and cancer would you consider highest on your list?

Back 701

ADH & lung cancer

Front 702

A 70 year old patient new to your practice complains of pain and bony enlargement of the distal interphalangeal (DIP)
finger joints of both hands. She complains of aching spine as well. You note inflamed DIPs with nail changes. What findings would MOST LIKELY be found in this patient?

Back 702

psoriatic plaques

Front 703

A 72 year old man is seen in your clinic with a complaint of increasing episodes of angina that require sublingual nitroglycerine to control. On exam he is in no acute distress, vital signs are Pulse 98/min, BP 100/60 with orthostatic drop noted, respiratory rate of 16/min. His pulse oxygenation is 95% on room air. A 12 lead EKG shows no significant changes. What is the diagnostic study of choice to further evaluate his cardiac status?

Back 703

Coronary angiography

Front 704

A 72 year old patient has a history of frequent transient ischemic attacks (TIAs) without syncope. She cannot predict when they occur, and denies palpitations or chest pain. Her cardiac exam is normal and no carotid bruits are heard. What is the BEST test to further evaluate her problem?

Back 704

Carotid doppler study

Front 705

A 72 year old patient has been taking levothyroxine (Synthroid) for several years for management of hypothyroidism. Which skin findings indicates that her does is too high?

Back 705

symmetric pink plaques on lower extremities

Front 706

A 72 year old patient new to your practice complains of pain and bony enlargement of the distal interphalangeal (DIP) finger joints of the dominant hand, without signs of inflammation. The MOST LIKELY diagnosis is

Back 706

osteoarthritis

Front 707

A 72 year old patient with moderate to severe pain from degenerative disc disease would benefit from the long acting control of methadone. What pretreatment screening exam should be done?

Back 707

baseline EKG to follow QT interval

Front 708

A 72 year old woman has had Pap smears done every 3 years since menopause at age 48. All have been normal, including the last one at age 69. She has sex twice a month with her 71 year old husband and has no complaints of pain, discharge or bleeding. At her next physical exam, you should do a?

Back 708

Genital and bimanual pelvic exam

Front 709

A 72 year old woman presents to clinic with a history of two recent episodes of "fainting" when she was walking up two flights of stairs. On exam you note a harsh systolic murmur, 4/6, loudest at the apex and radiating up the carotids bilaterally. The MOST LIKELY cause of her syncope is

Back 709

aortic stenosis

Front 710

A 74 year old patient was in hospital for 3 weeks to treat congestive heart failure that develop after an acute MI. After discharge her family members complain that her hearing seems much worse. Which medication is the MOST likely cause of her hearing loss?

Back 710

furosemide (Lasix)

Front 711

A 74 year old woman has several years of trouble remembering recent events. Two years ago her long term memory began to decline and her reasoning became chaotic. Lately she is disoriented to time and place and has withdrawn from conversation and socializing. A physical exam shows some sensory loss and muscle weakness of her extremities. Results of a complete blood count
are:
Hgb: 9.9 mg/dL, Hct 29%, MCV 107 fl, V/BC 7,000, Neutrophils 65%, lymphocytes 35%
From the above information, which is MOST LIKELY contributing to her dementia?

Back 711

Macrocytic anemia with likely B12 deficiency

Front 712

A 78 year old woman who lives alone and independently consults you for a problem with her mouth. She wonders if she is allergic to her toothpaste as she has developed gradual onset of "burning" in her mouth. On exam you notice a red, rather smooth tongue, cracking at the corners of her mouth, and moist, scaly skin around her naso-labial folds. The MOST LIKELY diagnosis is

Back 712

riboflavin (B2) deficiency
Best intervention - B vitamin supplement plus ensure she gets daily whole grains, leafy vegetables

Front 713

A child in your practice has had several episodes of otitis media treated with amoxicillin; you have doubts that the child's caregiver completes the antibiotics as prescribed. The parent calls frustrated and says the child is sick again, with a spiking fever, postauricular pain, redness and swelling. The child MOST LIKELY has

Back 713

mastoiditis

Front 714

A normal term infant is doing well in the newborn nursery. He is noted to have jaundice of the face and chest; a total serum bilirubin level at 18 hours of life is 10 mg/dL. Consult the attached graph; what is the BEST advice to give the parent?

Back 714

serial bilirubin testing should be done for the next 3 days
Explanation: The total bilirubin at 18 hours is just at the upper limit of normal for a term newborn. The two options are serial bilirubin or treatment; the footnotes give you an option to treat. In this situation the infant would probably be treated with phototherapy while waiting for his next bilirubin check. It would be unfortunate to lose 6-12 hours of potential treatment while waiting for the bilirubin check, especially since the treatment is easy and well-tolerated. As for this being breastmilk jaundice, this is too early to claim that as the diagnosis.

Front 715

Pain is a helpful reminder to force rest of an injured body part. Refer to the image below of a Charcot foot. What is the PRIMARY underlying problem that resulted in the development of the observed changes?

Back 715

impaired pain sensation
Explanation: Charcot joints, most often seen in the foot but can occur elsewhere, are the consequence of loss of protective sensation of pain. The neuropathy is seen often in diabetes, and may be due to microvascular disease. Macrovascular would cause claudication, cool foot, loss of soft-tissue, gangrene, poor healing. Foot ulcers are the combo of microvascular nerve damage (can't feel the stone you stepped on) with macro vascular impairment of healing the hole from the stone you stepped on.

Front 716

Refer to the attached flow-volume loops. Which one of the patterns BEST describes restrictive pulmonary disease?

Back 716

E
Explanation: Restrictive lungs "resist" air being pulled into them, but are quite good at emptying. Restrictive has a normal or above normal peak flow, but because the total volume starts off small the FEV1 is smaller than normal.

Front 717

Refer to the attached piece of a family pedigree. Of the siblings listed (Q, W, X, Z), by convention, who is the oldest and what gender are they?

Back 717

Z, a boy

Front 718

Refer to the attached set of graphs. What is a CORRECT interpretation of the information?

Back 718

On average, a 95 year old woman has about the same life expectancy as a 95 year old man

Front 719

Refer to the diagram of the ear. Which structure is MOST likely to be involved in the most common form of hearing loss in
elders?

Back 719

C
Explanation: Sensorineural hearing loss in elders involves the hair cells in the cochlea. There may be additional primary neuron loss in the acoustic nerve, but hair cells are more common.

Front 720

Your 61 year old patient with type 2 diabetes is in clinic for a routine follow-up. She is taking

metformin (Glucophage), glipizide (Glucotrol), simvastatin (Zocor), lisinopril (Zestril) and 81mg

of aspirin. What in-office lab values would be MOST compelling for making a

medication change?

Back 720

3+ ketones in urine

Front 721

For the 62 year old woman, why was her in-office blood glucose on fingerstick sample so much different from the one done in lab on a venous sample?

Back 721

Home glucose devices used in clinics are allowed a 20% range of error; meter may not have been calibrated; glucose testing strips may have expired and/or poor sampling technique

Front 722

Paramedics are called to the home of a 40 year old Asian man whose family says he came back

from jogging 5 miles and rapidly became unable to move his limbs or sit up. The patient is alert

but has symmetric flaccid paralysis, especially of limb muscles. Vital signs are stable, with a heart

rate of 100/min. Blood glucose is 95 mg/dL. Family says he has been very healthy lately, starting an exercise routine and losing 15 pounds in the past 6 months. What is the BEST immediate treatment for this patient?

Back 722

propranolol

Front 723

A 32 year old patient has been diagnosed with hyperthyroidism due to subacute (DeQuervain's)

thyroiditis. What is the BEST medication to manage this disorder?

Back 723

Propranolol

Front 724

It has been observed that people who have chronic rheumatoid arthritis have a higher mortality rate than those who don't. What is the excess mortality caused by?

Back 724

cardiovascular disease from chronic systemic inflammation

Front 725

Your 68 year old patient has a diagnosis of COPD and has been managed on inhalers and

respiratory therapy for the past 5 years. Lately he has complained of increased fatigue, swelling

of his ankles and right upper quadrant pain. He denies fever, change in cough or mucus production. What is the MOST LIKELY diagnosis?

Back 725

cor pulmonale

Front 726

Regarding the above patient: His oxygen saturation at rest in your office is 89%. Which of the following would be the BEST indicator that his disease has progressed to the point of requiring

supplemental oxygen?

Back 726

Dependent edema is present

Front 727

What causes of chronic liver disease is primarily an autoimmune problem?

Back 727

primary biliary cirrhosis

Front 728

Which hematologic manifestation is MOST associated with chronic, poorly controlled

rheumatoid arthritis?

Back 728

normocytic anemia

Front 729

A 55 year old patient with long-standing alcoholic cirrhosis and ascites develops mild

cognitive impairment, difficulty concentrating, and has started staying awake at night and

sleeping during the day. What other neurologic finding would be MOST LIKELY present?

Back 729

asterixis

Front 730

Your patient with alcoholic cirrhosis and ascites develops abdominal pain, fever and worsening

ascites. What laboratory/diagnostic procedures will MOST LIKELY generate a diagnosis?

Back 730

paracentesis and fluid analysis

Front 731

Describe the pathophysiology of Hemophilia A?

Back 731

Congenital deficiency of clotting factor VIII impairs hemostasis and promotes bleeding crises

Front 732

A 62 year old patient is evaluated in the emergency department for left-sided chest pain which began the night before and has been constant, burning in quality, worse with a deep breath. On exam her BP is 132/80, HR 90/min, temp 98.8 F, RR 20/min. Her physical exam is significant for hyperesthesia and dysaesthesia along the distal left T5 dermatome. No vesicular rash or other skin change is visible. What is likely the cause of her pain

Back 732

Herpes zoster

Front 733

What patient-specific risk factor is the STRONGEST predictor for post-operative pulmonary complication, such as pneumonia?

Back 733

Advanced age

Front 734

It is essential that patients use a metered-dose inhaler properly because drug effectiveness may be reduced considerably by poor technique. What are the recommended techniques for using a metered-dose inhaler in order to achieve maximum benefit?

Back 734

Exhale. Place inhaler in mouth. Begin inhaling slowly. Actuate inhaler while continuing to inhale then hold breath for 10 seconds and exhale

The recommended technique for the proper use of a metered-dose inhaler includes exhalation. Hold inhaler upright and place lips around mouthpiece or spacer. Inhale slowly and activate inhaler while continuing to inhale. Inhale completely and hold breath for 10 seconds or as long as possible. Repeat treatment if more than 1 inhalation is prescribed, allowing 1 to 2 minutes between inhalations. Rinse mouth with water and expel contents when steroidal inhaler is used.

Front 735

A 45-year-old overweight man presents for a routine physical. He relates that he is always thirsty and urinates frequently at night. You order several blood tests, including a test for hemoglobin A1C. The levels of hemoglobin A1C level are 8.0, and you conclude that he has type II diabetes mellitus. You prescribe Glyburide, a sulfonylurea drug. After 3 months, his hemoglobin A1C level is 7.5. You add the drug Metformin, which drops the hemoglobin A1C to 6.8. What is the primary cause of the reduction in the patient’s hemoglobin A1C level?

Back 735

The ability of metformin to decrease the production of glucose by the liver

Front 736

Amphetamines have a number of behavioral effects, such as increased alertness, decreased fatigue, and insomnia. In addition, it also produces cardiovascular effects. What characteristic of amphetamines is most likely to be responsible for increasing blood pressure?

Back 736

Release of intracellular catecholamines

Front 737

What physiologic effects are associated with aging?

Back 737

A decrease in oxidative metabolism in the liver; a decrease in liver blood flow; a decrease in glomerular filtration rate & a decrease in renal tubular secretion NOT a decrease in GI absorption by passive transport

Front 738

Your elder patient has Alzheimer's dementia and agitation. Which of the following agents has been shown to demonstrate consistent efficacy in controlling the agitation?

A. acetylcholinesterase inhbitor (donepezil)

B. antipsychotic medication

C. antidepressents

D. benzodiazepines

E. none of the above

Back 738

None of the above

Front 739

What drug would be best treatment for incontinence due to overactive detrussor muscle?

Back 739

Oxybutynin (Detrol)

Front 740

An elder patient was prescribed sustained-release verapamil (Calan-SR) a month ago when she had to discontinue her lisinopril (Zestril). She comes to the clinic complaining that she is unhappy with the medication as for the past 2 weeks she has developed “diarrhea". She reports abdominal distension and watery stools in the morning, sometimes incontinent, instead of her usual firm stool. What is the MOST likely diagnosis?

Back 740

Constipation caused by verapamil with leakage of liquid feces

Front 741

If you plan to prescribe a benzodiazepine such as diazepam (Valium) for a geriatric patient

Back 741

Consider the half life, duration, and whether there are active metabolites

Front 742

What is the major use for the drugs zolpidem (Ambien)?

Back 742

Initiates but does not maintain or prolong sleep

Front 743

Which of the following is prone to misreading and unapproved in prescription writing, especially when writing for opiates and sedatives?

A. using the abbreviation MSO4 for morphine

B. indicating a dose of .25 mg of alprazolam (Xanax)

C. indicating a dose of 2.0 mg of morphine

D. indicating an every-other-day dose as"QOD"

E. All of the above are confusing and shouldn't be used

Back 743

All of the above are confusing and shouldn't be used

Explanation MSO4 could be magnesium sulfate. The lack of a zero before a period could lead to dispensing 25 mg of Xanax, and a "trailing zero" could lead to 20 mg of morphine. QOD looks too much like QD (everyday).

Front 744

All of the following are TRUE of cocaine EXCEPT

A. causes local vasoconstriciton

B. readily induces tolerance

C. may cause life-threatening withdrawal symptoms

D. produces significant psychological dependence

E. induces local anesthesia

Back 744

may cause life-threatening withdrawal symptoms

Front 745

Which drug used to manage open angle glaucoma is dangerous to give during an attack of acute closed angle glaucoma?

Back 745

brimonidine (Alphagan)

Front 746

Which DEA classification of scheduled substances has "no acceptable medical use"?

Back 746

Schedule I

Front 747

A patient comes to your office complaining of being very nervous and having trouble sleeping. She says that she recently lost her mother and her death marks when these problems started. You decide to prescribe diazepam (Valium) for her on a short-term basis. Diazepam is a benzodiazepine and binds to a receptor that is involved in the movement of which of the following ions?

Back 747

Chloride ion

Front 748

A 65-year-old African-American man presents in your office for a follow-up for hypertension. Three months earlier you prescribed furosemide. He checks his blood pressure daily and states that it is markedly lower since he has been on the medication. However, it feels like his heart is skipping a beat once in a while. What deficiency is most likely?

Back 748

Potassium

Front 749

A 16-year-old, slightly overweight girl presents because she wants to lose weight. She has learned from the internet that diet pills called amphetamine salts (Adderall) are available to lose weight. She wants to know if these are safe to take. You tell her to avoid them because they can become habit-forming and their effectiveness is short-lived. They are short-lived due in part to what mode of action?

Back 749

Release of dopamine and norepinephrine

Front 750

A 10-year-old boy was diagnosed with ADD and put on methylphenidate, which he takes daily with his afternoon snack. He has been having difficulty sleeping since beginning the medication. In what way do you respond to this concern?

Back 750

The medication should be given early in the day

Front 751

A 36-year-old male reports to your office for a physical examination. In the course of the interaction with the patient, you find out that he has been smoking for the last 10 years. The patient would like to quit smoking and asks for your advice. You offer the patient 3-week nicotine replacement with a patch that provides 21, 14, and 7mg of nicotine respectively.The rationale for such step-wise approach is the

Back 751

Slowing the delivery of nicotine

Explanation The rationale for the stepwise approach with using the nicotine patch is in the slowing of the delivery of nicotine. It is the speed of delivery of the drug that determines how addictive the drug is.

Front 752

A 60-year-old man you have been treating for congestive heart failure symptoms has been diagnosed with diabetes mellitus. The endocrinologist who made the diagnosis decided to treat the patient with glipizide 5 mg daily since his blood glucose readings are 280 mg/dl. You manage the patient’s congestive heart failure with enalapril 10 mg daily, and he takes a furosemide 20 mg daily if he needs it. What kind of effect on the patient’s hyperglycemia may be expected in these settings?

Back 752

Increase of hypoglycemic effect

Explanation: Co-administration of ACE inhibitors (captopril, enalapril) and oral sulfonylurea hypoglycemics results in an increase of the hypoglycemic effect, for which more careful monitoring of blood glucose is advised to avoid pronounced hypoglycemia. Co-administration of thiazide, but not loop diuretics, results in a decrease of hypoglycemic effect. There are no documented interactions of furosemide and sulfonylureas.

Front 753

A 16-year-old girl presents to your office concerned about being obese. On physical exam you note that she is about 5 pounds under the average weight for her height. She says she is chronically fatigued and believes her thyroid gland is not working properly Upon palpation, you find nothing abnormal with her thyroid. RIA reveals normal levels of thyroid hormone in her plasma. She is insistent that she be placed on L-thyroxine therapy. Suspecting the patient desires L-thyroxine for weight loss, you explain the potential deleterious side effects of hyperthyroidism.Question:What is a common sign or symptom of hyperthyroidism?

Back 753

Diarrhea

Front 754

A patient is seen by an oncologist and diagnosed with a breast tumor. The oncologist prescribes the antibiotic doxorubicin as a first treatment. This antibiotic is an effective anticancer drug because it:

Back 754

Interferes with DNA replication

Front 755

A patient with GERD made life-style changes and was treated for 6 weeks using omeprazole (Prilosec) daily. Two weeks after stopping the medication he has recurrence of symptoms. What is the next step in his management?

Back 755

Resume intermittent use of omeprazole (Prilosec) at lowest effective dose

Explanation This question addresses the phenomenon of rebound after discontinuing, and whether 6 weeks is long enough for life-style changes to be effective. CMDT says to try another course and move to imaging if symptoms are not controlled with drug adjustments.

Front 756

A patient is taking clopidogrel (Plavix) as an antiplatlet drug for heart disease; it is a pro-drug that relies on the liver CYP enzyme 2C19 to activate it. What PPI would be relatively safer to use if you needed to prescribe one to this patient?

Back 756

Pantoprazole (Protonix) or rabebrazole (AcipHex)

Front 757

What is the treatment for acute biliary colic?

Back 757

Indomethicin (Indocin)

Front 758

What is effective in the treatment of acute cluster headache, but not acute uncomplicated migraine headache?

Back 758

Inhaled 100% oxygen

Front 759

A woman has a history of migraine headaches that worsened at the time of her menstrual period. She was given low-dose combined estrogen/progesterone contraceptives, which provided great relief. She complains that she still gets 1-2 headaches during the week of “blank" pills. What management could BEST help prevent these headaches?

Back 759

Topical estrogen throughout menses

Explanation The key word is prevention. The best approach is to try to prevent the estrogen swings that are triggering the headaches. In this case the woman has good control with OCPs, but the lack of estrogen in the blank pills causes her headache to recur.

The ACUTE treatment is triptans, but the prevention is to add back a little estrogen that avoids first pass issues.

Front 760

Which drugs that you are likely to prescribe as a primary care provider, and which has been associated with development of a peripheral neuropathy?

Back 760

colchicine

metronidazole (Flagyl)

phenytoin (Dilantin)

isonaizid (INH)

Front 761

What is a potentially life-threatening effect of dopamine replacement therapy (Levodopa/carbidopa)?

Back 761

Neuroleptic malignant syndrome if stopped abruptly

Front 762

An elder patient who recently had a successful hip replacement admits that she has had problem with urinary incontinence, which she describes as frequent small volume voids. Before the surgery she had normal voiding only occasional leaking with coughing or sneezing. She is using acetaminophen during the day for hip and arthritis pain, and takes one dose of Tylenol/Codeine at night because she sleeps better if she rolls on her hip. On exam she is afebrile, abdomen significant for a nontender distended bladder and normal rectal tone with stool present. What is a LIKELY cause of her incontinence?

Back 762

Constipation from codeine affecting bladder emptying

Explanation Elder on narcotic: think constipation, especially if rectal exam finds stool. Constipation is an under appreciated cause of incontinence, in this case compressing bladder outlet.

Front 763

What drug would be MOST useful in a patient with urge incontinence who also had inability to relax the urinary sphincter (mixed incontinence)?

Back 763

Imipramine (Tofranil)

Front 764

You have a patient who has an autoimmune disorder that leaves her mouth dry, causing and increase in dental caries. Unfortunately she also has urge incontinence. What treatment would BEST address her incontinence without worsening her dry mouth?

Back 764

Tolterodine (Detrol)

Front 765

A patient on warfarin (Coumadin) calls you to say she got confused and thinks she must have taken extra doses of her medication. She notes pink urine without clots as well as prolonged bleeding of a scratch that she got. What is the BEST management to do FIRST?

Back 765

Check her INR and treat based on results

Explanation: In this case she has signs of prolonged clotting time; get data and treat the acute problem, then later address the renal-urologic bleed, since she may have fortuitously uncovered a malignancy that is prone to bleeding.

Front 766

What drug is a prostate selective alpha 1 blocker?

Back 766

tamulosin (Flomax)

Front 767

What is likely to have a strong effecting reducing prostate specific antigen (PSA) levels, an effect that needs to be adjusted for in interpreting PSA values?

Back 767

Finasteride (Proscar)

Front 768

What treatment regimens would be effective for a woman who has BOTH trichamonas vaginitis and bacterial vaginosis (BV)?

Back 768

Metronidazole (Flagyl) 500 mg twice a day for 7 days

Front 769

A patient has had several episodes of vaginal “yeast infection" which she has self-treated with over the counter intravaginal medications, including clotrimazole, miconazole. She consults you for yet another infection, which you confirm by microscopy. You rule out diabetes or immune compromise as an underlying condition. What should you try next?

Back 769

fluconazole (Difulcan) oral

Front 770

What cardiac drugs causes flushing and feeling of warmth, mimicking menopause symptoms?

Back 770

Diltiazem (Cardizem)

Front 771

What is a strong reason to avoid hormone replacement therapy in a post-menopausal woman?

Back 771

History of coronary artery disease

Front 772

What drugs may be used to treat hot flashes in a post-menopausal woman in whom estrogen/progesterone is contraindicated?

Back 772

Venlafaxine (Effexor)

Front 773

Which hormone-based contraceptive methods has the HIGHEST level of systemic estrogen exposure?

Back 773

Transdermal patch (Ortho Evra)

Front 774

A healthy, non-smoking woman without hypertension who takes combined estrogen/progesterone oral contraceptives has a 3-4x increased risk for?

Back 774

Venous thromboembolism

Front 775

A 14 year old girl consults you for "pimples" that appear in crops across her forehead and shoulders. (See attached picture). What is the BEST treatment to try FIRST for this skin condition?

Back 775

Topical tretinoin (Retin-A) 0.025%

Explanation This is comedonal acne without significant inflammation. It looks a little like molluscum, so consider her age and the distribution.

Front 776

What is the appropriate treatment for cough due to Bordatella pertussis infection?

Back 776

azithromycin (Zithromax)

Front 777

The step-wise treatment of mechanical low back pain with minimal signs of sciatica routinely includes all of the following EXCEPT

A. acetaminophen (Tylenol)

B. ibuprofen (Advil)

C. cyclobenzaprine (Flexeril)

D. tramadol (Ultram)

E. oxycodone (OxyContin)

Back 777

oxycodone (OxyContin)

Front 778

Concerns about development of lymphoma has resulted in a “black box warning" on which drugs used to treat atopic dermatitis and other skin conditions?

Back 778

pimecrolimius (Elidel) -> Increased risk of lymph node or skin cancer

Front 779

Which of the following treatments is reserved only for patients with severe seborrhea?

A. shampoos and body wash containing selenium 2.5% or coal tar

B. topical ketoconazole 2% ( Nizoral)

C. topical hydrocortisone 1%

D. topical tacrolimus 1%

E. Oral terbinafine (Lamisil)

Back 779

Oral terbinafine (Lamisil)

Explanation The major side effect of terbinafine is hepatotoxicity. Others are induction of auto-immune reactions such as cutaneous lupus-like reactions and autoimmune destruction of RBCs, WBCs, platelets.

Front 780

What group or class of topical corticosteroids is considered MOST potent?

Back 780

Group 1

Front 781

What is effective in the treatment of acute cluster headache, but not acute uncomplicated migraine headache?

Back 781

Inhaled 100% oxygen

Front 782

You are evaluating a 42 year-old nonsmoking man who has had cough for the past 10 days. He says it began after an upper respiratory “cold" that "moved into his chest". He denies dyspnea, wheezing or hemoptysis, but says his cough is frequent but brief, keeps him awake at night and produces a small amount of cloudy phlegm. Vitals: temperature 99.0F oral, RR 16/min, Pulse 82/min, BP 127/82. Pulse oxygenation 98% on room air. Physical exam detects central rhonci that clear with cough. What is the BEST treatment at this time?

Back 782

Encourage hydration and consider cough suppression at night

Front 783

What is recommended for the initial treatment of seborrheic dermatitis has a mode of action of reducing production of sebum?

Back 783

Pyrithione zinc shampoo (Head and Shoulders)

Front 784

What patient education should be given when you prescribe gabapentin (Neurontin) for management of low back pain that has a neuropathic component?

Back 784

it can take weeks for clinical benefit

Front 785

What is recommended for the initial treatment of seborrheic dermatitis has a primary mode of action of reducing T-lymphocyte directed inflammation?

Back 785

tacrolimus (Protopic)

Front 786

Initial treatment of acute rhinosinusitis includes all of the following EXCEPT

A. topical decongestant

B. oral decongestant

C. topical nasal corticosteroid

D. topical antihistamine

E. narrow spectrum antibiotic (amoxicillin)

Back 786

Narrow spectrum antibiotic (amoxicillin)

Front 787

If you choose to treat bacterial rhinosinusitis, which is the preferred medication for a patient who is allergic to penicillin?

Back 787

Levofloxacin (Levaquin)

Front 788

What is the mechanism of action of guaifenesin?

Back 788

oral mucolytic

Front 789

What has a low side-effect profile and can decrease nasal secretions by up to 30% in patients with symptomatic viral upper respiratory infection, but has little effect on congestion?

Back 789

Nasal ipratropium

Front 790

A 28 year old patient develops acute bilateral watery discharge of eyes, and says the itching is intense. He does not wear contact lenses. On exam his vision is normal in each/both eyes without photophobia; pupils are equal, round and reactive; tearing is present and conjunctivae are slightly red. The BEST treatment is

Back 790

Topical antihistamine

Front 791

What is the mechanism of action of fluorescein drops instilled in the eye?

Back 791

Dye to detect corneal injury

Front 792

You diagnosed a 42 year old woman smoker with iron deficiency anemia, attributed to her peri-menopausal dysfunctional menstrual bleeding. Which is the BEST treatment?

Back 792

give ferrous sulfate 325 mg three times a day, with vitamin C

Front 793

IN CHILDREN, what is the maximum dose of iron supplement to correct severe iron deficiency anemia?

Back 793

Ferrous sulfate elixier, elemental iron, 6 mg/kg/day, in divided doses

Explanation Note that the oral iron will stain teeth, and the chewable is the worst!

Front 794

What imaging study is best for the urgent/emergent evaluation of headache that has features suspicious for intracranial abnormality?

Back 794

CT scan without contrast

Front 795

Which is considered a secondary headache?

Back 795

hypertension-associated headache

Front 796

What is a rebound headache?

Back 796

Headache that occurs as a result of chronic use of analgesics and missing a dose

Front 797

In peripheral neuropathy, what is the difference between axonal degeneration and demyelinating disease?

Back 797

Demyelination causes loss of myelin and relatively preserved neuronal axon processes

Front 798

Your precepting physician asks you to check reflexes on at patient. What findings would MOST support a diagnosis of axonal disease?

Back 798

Absent R ankle DTR, decreased R knee DTR

Front 799

A patient has signs of peripheral nerve dysfunction, complaining of sensory loss. Which of the following results on electromyography (EMG) or nerve conduction velocity (NCV) would BEST support the diagnosis of axonal disease?

Back 799

EMG: amplitude of action potential is decreased

Note: Distal lower motor neuron syndromes - amyloidosis, trigeminal sensory, ataxis sensory; NCV - axon loss, asymmetric with sensory loss

Front 800

A patient seems to have features of a PERIPHERAL demyelinating disease that started distally and is ascending. Which would be MOST useful?

Back 800

The BEST one to do for GB is CSF analysis and nerve conduction studies.Can also do B12/homocysteine; CSF protein electrophoresis; methylmalonic acid levels; serum protein electrophoresis & Hemoglobin A1C

Front 801

What BEST describes the tremor of Parkinson's disease?

Back 801

Tremor at rest that diminishes with movement

Front 802

You are watching an elder man crossing the street; he takes increasingly short, shuffling steps and nearly falls as he reaches the curb. When you stop to help him he has a decreased facial expression and says “thank you" on a low, odd voice. What neurologic disorder is he most likely to have?

Back 802

Parkinson't disease

Front 803

What is the cause of the dementia of Parkisnon's disease?

Back 803

Lewy body formation in the cortical neurons

Front 804

What increases the risk of developing Parkinson's disease?

Back 804

pesticide exposure

Front 805

A patient complains of heartburn, which he describes as a burning pain after meals that starts in the epigastrium and ascends behind the breastbone. What additional history item, if occurring at the time of his heartburn, can allow you to diagnose GERD with 90% accuracy?

Back 805

regurgitation

Front 806

A slightly overweight 32 year old male smoker complains of heartburn and hoarseness, especially after he eats certain foods (cheese lasagna with tomato sauce or chocolate ice-cream), but is otherwise well. What evaluation does he need before you can prescribe pharmacologic treatment?

A. breath or stool test for Helicobacter pylori

B. endoscopy

C. stool guaiac

D. 12 lead EKG

E. none of the above; a trial of empiric treatment is warranted

Back 806

E. none of the above; a trial of empiric treatment is warranted

Explanation Classic history of GERD with no worrisome symptoms can be treated empirically with life-style changes and PPI (or H2 blockers). If the patient gets better, it confirms the diagnosis of GERD.

Front 807

What symptoms or signs suggests that a patient with GERD needs endoscopy?

Back 807

Odynophagia

Front 808

Increased risk of acquiring which infections has been associated with chronic use of PPI?

Back 808

Clostridium difficile

Front 809

What lab values is MOST LIKELY abnormal in a patient suffering and acute attack of biliary colic?

Back 809

labs are usually normal in biliary colic

Front 810

What is the main cause of most gallstone formation?

Back 810

stasis and poor emptying of gallbladder

Front 811

A patient with a history of biliary colic is evaluated in the Emergency Department; an ultrasound is ordered and shows thickened gallbladder wall and periicholistic fluid; common bile duct is normal diameter. What is the MOST likely diagnosis?

Back 811

acute cholecystitis

Front 812

Under what circumstances would cholescintigraphy (HIDA) scan be done?

Back 812

biliary colic with no stone detected by ultrasound

Front 813

Which causes of incontinence is MOST associated with post-menopausal women with lax pelvic muscles?

Back 813

Stress incontinence

Front 814

An 66 year old female patient who has a new onset of urgent need to void, who passes small frequent amounts of urine, associated with burning bladder pain at the end of bladder emptying MOST LIKELY has

Back 814

Cystitis

Explanation Incontinence of mechanical or neurologic cause is not painful. Pain suggests inflammation, which requires an evaluation for urinary tract infection.

Front 815

What is the first goal of bladder retraining?

Back 815

Void at scheduled intervals, and suppress urge between scheduled voids

Front 816

What features are associated with urge incontinence?

Back 816

Variable volume of voiding, patient can’t suppress voiding and rushes to toilet, normal emptying and residual

Front 817

A 32 year old male PA student with no risk factors for urinary tract malignancy was found to have microscopic hematuria during an in-class exercise on learning to use urine dip sticks. What is the appropriate next step in his management?

Back 817

Repeat the test to see if the hematuria is persistent

Front 818

Suppose you had a patient with persistent microhematuria. What other abnormality on in-office urinalysis would suggest the glomerulus is the source of the blood?

Back 818

Persistent, significant protein

Front 819

A 60 year old patient with COPD and atrial fibrillation is taking warfarin (Coumadin) for prevention of clots, and develops rare intermittent episodes of visible blood in urine. It happens at most once every couple of weeks. She has no complaints of petechiae, nosebleeds or easy bruising, and has been well maintained on her current dose for years, and her last INR done a week ago is in target range. What is the best management of this patient?

Back 819

Refer for cystoscopy

Front 820

For a patient with benign prostatic hyperplasia, all of the following are considered lower urinary tract symptoms EXCEPT

A. frequency

B. nocturia

C. dysuria

D. urgency

E. weak stream

Back 820

Dysuria

Front 821

A 65 year old patient complains of nocturia. What one question, if positive, would indicate this is a problem with excessive urine volume, rather than symptomatic prostatic hyperplasia?

Back 821

Do you have a strong urine stream?

Front 822

A 72 year old man complains that "his prostate is giving him trouble". He reports that over the past month: he never feels as if he has completely emptied his bladder, he gets up 3 times a night to urinate and during the day on most days he has the feeling of needing to urinate about every 2 hours. He hasn’t noticed much problem with starting and stopping the stream or being able to hold it if he can't get to the toilet, and denies straining to start the stream. His stream is strong, just short. He says he is unhappy with the current situation, and just wishes he could get a good night's sleep. According to the IPSS what is his score, and what symptom category is he in?

Back 822

18 -moderately symptomatic

Front 823

Which surgical procedures is appropriate for a healthy man who has significant obstruction due to prostate hyperplasia that is localized to and surrounding the prostatic urethra?

Back 823

Transurethral resection of the prostate (TURP)

Laser prostatectomy

Transurethral microwave thermopathy (TUMT)

Transurethral incision of the prostate (TUIP)

Transurethral needle ablation of prostate (TUNA)

Explanation the minimal treatment needed for a prostate that isn't globally enlarged, just affecting the area around the prostatic urethra. For that, TUIP could be the minimal needed.

Front 824

What is MOST reliable in arriving at a diagnosis of cause of vulvovaginitis?

Back 824

Saline microscopy

Front 825

For which patients should you dispense medication so that the male partner can be simultaneously treated?

Back 825

Woman with trichamonas being treated with oral metronidazole (Flagyl)

Front 826

Which causes of vaginitis are MOST likely to have significant presence of white blood cells on microscopic exam

Back 826

Trichamonas vaginitis

Front 827

You recently treated a 20 year old woman for chlamydia cervicitis, confirmed by PCR testing. Due to an allergy to macrolides you treated her with 7 days of doxycyline 100 mg twice a day. She contacts you and says she now has another problem. On exam she has an inflamed vagina with small amount of white-grey discharge but no odor. She admits that she was uncomfortable and douched earlier that day. Microscopy shows a few white blood cells, and pH is 4.5. Given her history, what is the MOST LIKLEY diagnosis at this point?

Back 827

Candida vaginitis

Front 828

A 46 year old woman has developed irregular menses, fatigue and night sweats. Which is required to diagnose menopause?

A. low estradiol level

B. high follicle stimulating hormone (FSH)

C. normal TSH, ruling out thyroid disease

D. lack of mid cycle surge in luteal hormone

Back 828

None of the tests mentioned is required as menopause is a clinical diagnosis

Front 829

A 47 year old woman in perimenopause says she has had irregular periods since she stopped her birth control pills a year earlier, and now complains of breast tenderness and occasional feeling of warmth. Her last menstrual period was 9 weeks previously. Which of the following is the BEST plan for evaluating her symptoms?

Back 829

Do a urine pregnancy test

Front 830

What is a common, serious adverse effect that has been linked to use of oral isotretinoin (Accutane), resulting in strict limits on who can prescribe and receive this medication?

Back 830

Fetal malformations

Oral retinoids are used to treat pancreatic cancer

Front 831

What condition, that occurs most often in fat young women (teens and twenties) has features of elevated intracranial pressure that causes headache, nausea, vomiting, double vision

Back 831

Pseudo tumor cerebri also known as idiopathic hypertension

Has been associated with three of the treatments for acne: birth control pills, tetracycline and oral retinoids.

Front 832

What is the most typical presentation of skin findings of seborrheic dermatitis?

Back 832

Scaly rash on erythematous skin of scalp, eyebrows, naso-labial folds

Front 833

A 35 year old man new to your practice complains of a scaly, red rash that began suddenly and rapidly spread to involve his scalp, beard area and face. (See attached pictures). The man has never had anything like this before, and denies any new medications, skin or hair products or exposures. Which underlying conditions is MOST likely linked with this finding?

Back 833

HIV infection with low CD4 count, Seborrheic dermatitis

Front 834

What organism has been associated as an infectious disease factor in seborrheic dermatitis?

Back 834

Malassezia furur

Front 835

A 17 year old young woman consults you for acne. She reports “ rops of pimples" on her face, chest and back since shortly after menarche at age 13. She has never established a normal menstrual cycle, noting several months lapse between menses. Physical exam is significant for a BMI of 27, BP 124/80, normal female secondary sexual characteristics. On exam of skin you note shaved stubble on her chin with a few areas of folliculitis, and numerous inflamed papules, closed and open comedones across her shoulders and along her jaw. A urine B-HCG pregnancy test is negative. What lab value would MOST likely be associated with this cause of acne?

Back 835

High serum androgens

Explanation The woman has features of polycystic ovary syndrome. In young women whose pancreas is healthy, glucose tolerance testing paired with insulin testing shows exaggerated insulin response; often a 2 hour post test is lower that fasting blood glucose.

Front 836

What is the only dietary advice that seems to be helpful in some cases of acne vulgaris?

Back 836

Eat low glycemic index foods that promote weight loss

Front 837

What organism has been associated as an infectious disease factor in acne vulgaris?

Back 837

Propionibacterium acnes

Front 838

What is recommended for skin cleansing in managing acne vulgaris?

Back 838

Mild soap and astringent to remove excess sebum

Front 839

What is recommended for skin cleansing in managing acne vulgaris?

Back 839

Mild soap and astringent to remove excess sebum

Front 840

What is the underlying disorder that causes atopic dermatitis?

Back 840

genetic defect in proteins supporting the epidermal barrier

Front 841

Which of the following is MOST likely a feature of chronic atopic dermatitis?

A. erythema

B. pruritus

C. vesicles

D. serous fluid “weeping”

E. lichenification

Back 841

Lichenification

Front 842

Where on an infant would you MOST LIKELY see initial manifestation of atopic dermatitis?

Back 842

Crusting facial erythema

Front 843

How is atopic dermatitis different from contact dermatitis?

Back 843

Atopic dermatitis is genetically abnormal skin and present from early age

Front 844

A 22 year old woman comes to clinic with a swollen left eye. Physical exam shows soft tissue swelling of the area under the eye; the left maxilla is tender to percussion. The eye itself is intact, eye movements normal, pupil reaction is normal. She MOST LIKELY has

Back 844

Maxillary sinusitis

Front 845

You are evaluating a person with chronic and recurring sinusitis in spite of several courses of antibiotic treatment. She has signs and symptoms indicate involvement of left maxillary, frontal and ethmoid sinuses. Which organism is the MOST likely cause?

Back 845

Aspergillus species

Front 846

Your patient has signs and symptoms of acute rhinosinustitis for the past 3 days. Which findings indicates it is appropriate to give antibiotics?

Back 846

None, Day 3 of symptoms without other overwhelming signs does not warrant antibiotics.

Front 847

10 days after an uncomplicated viral URI a patient has pain around her left eye and pain with eye movement. On exam she is afebrile, her eyes are symmetric and show full range of motion, vision is intact; no swelling of eyelids is present. What is the MOST likely cause of her symptoms?

Back 847

Ethmoid sinusitis

Front 848

A 28 year old non-smoking patient reports acute onset 12 hours ago of sneezing, runny nose and congestion with headache and mild cough productive of clear phlegm. Which of the following in the differential diagnosis is LEAST LIKELY?A. viral upper respiratory infectionB. allergic rhinitisC. influenzaD. bacterial sinusitis

E. irritant non-allergic rhinitis

Back 848

Bacterial sinusitis

Explanation When you sneeze and develop congestion from sniffing pepper or eating spicy food, that is a non-allergic rhinitis. It takes time to develop a bacterial sinusitis.

Front 849

Appropriate patient education for "common cold" (URI) includes all of the following EXCEPT

A. adults normally get at least 2 URI per year

B. symptoms peak 2-3 days after onset

C. patients who are not symptomatic are not infectious

D. symptoms usually last 10-14 days

E. symptoms last 3-4 days longer in smokers

Back 849

Patients who are not symptomatic are not infectious

Front 850

Which of the following is appropriate patient education for treatment of the common cold (URI)?

A. decongestants shorten the duration of the illness

B. decongestants shorten the duration of the illness

C. antihistamines shorten the duration of the illness

D. saline nasal irrigation shortens the duration of the illness

Back 850

All of the above can reduce symptoms, but none short the duration of the illness

Front 851

What is the hallmark sign or symptom of allergic conjunctivitis?

Back 851

itching

Front 852

A 22 year old college student complains that his right eye has become increasing red with crusting discharge over the past 7 days; it started gradually; he denies itching. On exam he has a right reddened conjunctiva with a small amount of discharge present, no photophobia and no loss of vision. His pupil is round and reactive. A palpable pre-auricular node is present on the right. The left eye is unaffected. The diagnosis that BEST fits this presentation is

Back 852

Chlamydia conjunctivitis

Front 853

A 55 year old patient complains of sudden severe pain in the right eye that began after he came out of a movie theater into the bright afternoon sun. He is sitting in the office, looks miserable, with one hand over his affected eye. On exam his vision is decreased, sclera is red and pupil is mid-dilated (4-5 mm). What test will confirm the most likely diagnosis?

Back 853

Intraocular pressure

Front 854

A 60 year old post-menopausal woman on no medications complains of “ cratchy" eyes, worse first thing in the morning. She has noticed it for the past couple of months. She is otherwise well, takes no medications, and uses over the counter “ eaders" for her presbyopia. Exam shows normal vision, eye movements, pupil size and reaction; no inflammation, tearing or discharge is noted. The MOST likely diagnosis is

Back 854

Dry eye syndrome

Front 855

Acute bronchitis is mostly a self-limited condition that gets better with time and support; antibiotics should be avoided to prevent over-subscribing and bacterial resistance. Which of the following patients with acute bronchitis has a significant risk factor that makes treatment with antibiotics a reasonable choice?

A. 55 year old with a history of Parkinson's disease

B. patient over age 65 who has type 2 diabetes

C. 72 year patient who was admitted 6 months ago for pneumonia

D. 33 year old patient on glucocorticoid for systemic lupus erythematosis

E. all of the above have a significant risk factor

Back 855

all of the above have a significant risk factor

Front 856

What viral cause of acute bronchitis will MOST likely cause upper respiratory signs and symptoms?

Back 856

adenovirus

Front 857

Assume a 33 year old patient came to clinic with complaint of acute onset of cough. Which one of the following additional symptoms would be INSUFFICIENT cause to order a chest x-ray?A. pulse > 100/minB. wheezing on forced expirationC. ralesD. pulse oxygenation of 90%

E. respiratory rate 24/min or greater

Back 857

Wheezing on forced expiration

Explanation Wheezing is a small airways problem which causes little change on x-ray. Forced expiration accents the wheeze. In a young adult patient with cough and wheeze a trial of albuterol treatment and reassessment would be indicated. The other features all suggest pneumonia or oxygenation problems.

Front 858

To provide protection from serious infection that is often fatal to newborns, pregnant women should receive a dose of WHICH of the following immunizations during each pregnancy regardless of prior vaccination history?

A. measles, mumps, rubella

B. Tetanus, diphtheria, pertussis

C. Hepatitis B

D. Streptococcus pneumonia

E. Oral polio vaccine

Back 858

Tetanus, diphtheria, pertussis

Explanation Vaccination to boost pertussis immunity is recommended for each pregnancy. The acellular form of the vaccine is less immunogenic, causing immunity to wane in adults, who are the main pool for infecting young children.

It is potentially dangerous to give live vaccine (MMR) to pregnant women.

Front 859

What would be considered a “visceral (organ)” cause of low back pain?

Back 859

Pelvic inflammatory disease

Front 860

A 62 year old patient complains of one week of severe back pain that has interfered with his ability to go to work. He says it started after he helped a friend move his sectional sofa. He denies previous episodes of back pain, is not overweight and has healthy habits; he denies drug use. He complains that his typical “old man prostate" symptoms have gotten worse as well, with more dribbling and leaking than previously. What is the MOST worrisome condition you should consider in this patient?

Back 860

Cauda equina syndrome

Front 861

A patient with acute back pain has a decreased knee tendon reflex on the right compared to the left. What level of spinal cord is most likely involved?

Back 861

L4

Front 862

When should an imaging modality (CT scan or MRI) be introduced in evaluating/managing low back pain?

Back 862

If no improvement after 4 weeks of treatment

Front 863

What imaging study is best for the urgent/emergent evaluation of headache that has features suspicious for intracranial abnormality?

Back 863

CT scan without contrast

Front 864

What is a rebound headache?

Back 864

Headache that occurs as a result of chronic use of analgesics and missing a dose

Front 865

What is effective behavior change to prevent migraine headaches?

Back 865

Regularity of sleep and meals;

Recognize and avoid triggers (foods, fumes, drugs);

Stress management through cognitive behavioral feedback & relaxation training such as yoga or biofeedback

Front 866

What is considered a secondary headache?

Back 866

Hypertension-associated headache

Front 867

What is considered a primary headache?

Back 867

Cluster Headache, Migraine with aura & Migraine with out aura

Front 868

Although a low ferritin indicates low iron stores and supports the diagnosis of iron deficiency anemia, which patient population may have higher ferritin levels, even if iron deficient?

Back 868

Elderly patients

Front 869

Your patient is a non-smoking post-menopausal woman age 52 with a new history of iron deficiency anemia. All of the following exams/procedures are reasonable EXCEPT

A. colonoscopy

B. Schilling Test I&II

C. upper endo-gastro-duodenoscopy (EGD)

D. small bowel biopsy during EGD

E. urinalysis for microscopic hematruia

Back 869

Schilling Test I&II -> used for B12 deficiency anemia

Front 870

Which of the following has been associated with subclinical iron deficiency, and may improve with iron supplement?

A. depression

B. acne vulgaris

C. restless leg syndrome

D. oligomenorrhea

E. menopausal hot flashes

Back 870

Restless leg syndrome

Front 871

In the progression of changes in iron deficiency, which is the LAST laboratory value to become abnormal?

Back 871

Mean corpuscular volume (MCV)

Front 872

Which of the following is LESS likely to be seen in a child who is dehydrated?

A. Slow capillary refill

B. Low hematocrit

C. High urine specific gravity

D. Dry mucus membranes

E. Orthostatic hypotension

Back 872

Low hematocrit

Front 873

What is the BEST test for detecting pinworm (Enterobius vermicularis)?

Back 873

Sticky tape to child’s anus in morning before bathing, examine for eggs

Front 874

A term infant on day 1 of life develops periods of apnea, grunting and regurgitation of formula feeds. His core temperature is 36 C. You are concerned that these are signs of a serious bacterial infection. What is MOST likely the cause of these signs and symptoms?

Back 874

Group B streptococcus (S. agalacticae)

Front 875

What is the MOST likely source for Escherichia coli bacteremia in a 2 month old infant male?

Back 875

E. coli urinary tract infection

Front 876

You are working in a primary care clinic and a 3 months old term infant is brought in for evaluation of fever. The child has a rectal temperature of 38.4C, respiratory rate of 30, pulse 104/min and appears pink and active. He has a runny nose and raspy cough but otherwise is eating and voiding appropriately. There were no complications in his delivery or hospital course as a newborn. He got appropriate vaccines at age 2 months. What is the BEST step in managing this infant?

Back 876

Fever control and saline nasal suction and recheck in 24 hours

Explanation: Child has no worrisome behaviors and features of a typical upper URI as cause for his fever. His temperature is not even very elevated. He has no respiratory distress to warrant even a pulse-ox.

Front 877

What causes of severe bronchiolitis and pneumonia are preventable by immunization?

Back 877

Streptococcal pneumonia

Hemophilus influenza b

Respiratory syncytial virus

Influenza B

NOT Coxsackie B enterovirus

Front 878

What measurement will MOST LIKELY be abnormal in a child with genu valgum?

Back 878

Intermalleolar distance

Front 879

What disorders of the newborn period is MOST truly immunogenic in nature, mediated by eosinophils?

Back 879

Erythema toxicum

Front 880

What physical exam findings in a newborn infant should cause the clinician to suspect a genetic disorder that is often associated with seizures, developmental delay and autism?

Back 880

Ash leaf spots suggest tuberous sclerosis, which has a strong component of developmental delay.

Front 881

Isolated skin finding of axillary freckling is MOST LIKLEY

Back 881

Neurofibromatosis type 1

Front 882

An 11 month-old child is examined in the office after the mother noticed the child refusing to walk x 1 day. The child had been well with all vaccines up to day; . her vitals are significant for a temperature of 102.0 F. On hip exam the child holds the hip flexed and externally rotated, and cries loudly when you try to manipulate the hip. There is warmth palpable over the joint. Which is the BEST test to determine the cause of the hip findings?

Back 882

Tap joint for fluid analysis -> Differential is either transient hip synovitis or septic joint; fluid analysis will be quick and diagnostic.

Front 883

A 2-year old infant was admitted for failure to thrive. The infant suffered from 4 episodes of respiratory tract infection since birth. During neonatal period, the child had intestinal obstruction due to inspissated meconium. The child is asthenic with little subcutaneous tissue and has a protuberant abdomen. Both the parents of the child are normal.

Which laboratory test will be enable you to establish a diagnosis in this case?

Back 883

Sodium chloride content of sweat

Cystic fibrosis is a generalized autosomal recessive disorder of the exocrine glands due to defective production of transmembrane conductance regulator protein

Cystic fibrosis should be suspected in young adults suffering from a history of: Chronic lung disease (esp. bronchiectasis); Pancreatitis or Infertility

Front 884

Which agents causing acute infectious diarrhea can be paired with the pathogenic mechanism of enterotoxic, enteropathogenic, enteroinvasive and enterohemorrhagic effects?

Back 884

E. coli -> a gram negative rod commensal in the gastrointestinal tract, has various pathogenic strains which cause illness on various ways. Enterotoxic E. coli (ETEC) causes the travelers disease; enteropathogenic (enteroadherent) E. coli (EPEC) causes childhood diarrhea, enteroinvasive E. coli (EIEC) causes dysentery-like disease, and enterohemorrhagic E. coli (EHEC) causes hemorrhagic colitis and hemolytic uremic syndrome in children.

Front 885

A 4-day-old male infant is seen by the pediatric resident in the newborn nursery for bilious vomiting and abdominal distention. The child had been feeding poorly and has been difficult to console according to the mother. He passed meconium shortly after birth and has passed several seedy, yellow stools per day since then. Physical examination reveals abdominal distention. What is the most likely explanation for these findings?

Back 885

Midgut volvulus -> Bilious vomiting is caused by intestinal obstruction distal to the ampulla of Vater. In the newborn period, midgut volvulus is a common cause of obstruction

They should be stabilized by administration of intravenous fluids, antibiotics, and initiation of nasogastric suction. Radiologic evaluation to confirm the diagnosis should be undertaken after the infant is stabilized. The radiologic findings of intestinal obstruction due to volvulus include gastric and proximal duodenal dilatation, paucity of intestinal air, and corkscrew-like appearance of the duodenum.

Front 886

An 11-year-old girl has a 3-day history of worsening left ear pain, itchiness, and slight decreased hearing, though she has not noted any drainage. She also denies any swimming recently, but her mother says she likes to take long showers. Otherwise she has been well. On exam, her vitals are normal. Her left ear is very tender, with any manipulation near the external ear causing severe pain. Her left ear drum is occluded by deep, whitish, thick discharge with the ear canal being pink and mildly swollen. The left mastoid area also seems tender though not swollen and there is no displacement of the external ear. Based on these findings, what is the most likely diagnosis?

Back 886

Otitis externa (OE)

Inflammation and loss of skin integrity of the external ear canal, caused predominately by Pseudomonas aeruginosa and Staphylococcus aureus. The peak occurrence is between 7 and 12 years of age and results most commonly from increased moisture in the ear canal due to high humidity, warm temperatures, and swimming.

Front 887

A 2-year-old girl is brought to an otolaryngologist by her mother for chronic ear infections. The patient is otherwise healthy, with the exception of recurrent episodes of otitis media (OM). Examination and history show that the child has had average growth and development; she has not had invasive infections, skin disorders, or hospitalization. The child’s mother is concerned about the risk of hearing loss and its effects on development. What effect might this have on the child?

Back 887

Hearing loss during OM may adversely affect cognition and language.

Conductive and sensorineural hearing loss are complications of chronic otitis media (OM). Acute and chronic suppurative OM usually results in conductive hearing loss.

Chronic infection may result in conductive hearing loss from a perforation of the tympanic membrane; however, sensorineural hearing loss can occur, especially when herpes zoster is the etiologic agent.

Front 888

A newborn female infant on physical exam has the following features: hypotonia, flattened facies with upslanting palpebral fissures, simian crease, and protruding tongue. Chromosome analysis would most likely yield what abnormal karyotype?

Back 888

47,XX,+21

Down syndrome (trisomy 21) occurs in approximately 1 out of every 600 newborns. These infants have distinctive dysmorphic facies that vary somewhat.

The other cardinal signs of Down syndrome include poor Moro reflex, joint hyperflexibility, excess nuchal skin, anomalous auricles, pelvic dysplasia and dysplasia of the fifth finger mid-phalanx. The level of mental retardation ranges from mild to moderate.

Front 889

A newborn female infant on physical exam has the following severe mental retardation and failure to thrive. Chromosome analysis would most likely yield what abnormal karyotype?

Back 889

47,XX,+18 or 47,XX,+13

Trisomy 13 and 18 newborns all have severe mental retardation and failure to thrive. The vast majority do not survive beyond infancy. Nearly all have major malformations that affect the organ systems, including cardiac, renal, urogenital, and CNS.

Front 890

A newborn female infant on physical exam presents with edema on the dorsum of the foot.

Chromosome analysis could yield what abnormal karyotype?

Back 890

45,X -> Turner syndrome that involves female gonadal dysgenesis (streak ovaries), webbed neck, and low posterior hairline with occasional renal and cardiac defects.

Occasionally, these infants present at birth with edema of the dorsum of the foot.

Front 891

An adolescent boy is brought to clinic because the other boys are making fun of him in gym because he "still has baby parts."

Chromosome analysis could yield what abnormal karyotype?

Back 891

47,XXY boys/males have Klinefelter syndrome. Generally, these boys/men are normal appearing.

They are most likely diagnosed when they do not develop secondary sexual characteristics and the testes remain small.

Front 892

A female child presents for a routine physical exam. The child is able to walk with 1 hand held. She picks up a pellet with a pincer movement of forefinger and thumb and releases it upon request; she says “mama” and "dada", and she is able to play a simple ball game. How old is this child?

Back 892

12 months

Front 893

A female child presents for a routine physical exam. She is able to lift his head in the prone position, reach toward and grasp objects and bring them to his mouth; he or she has no head lag on pull to sitting position, pushes with feet when held in standing position, and can laugh out loud. How old is this child?

Back 893

4 months

Front 894

A female child presents for a routine physical exam. The child can roll over both ways, is able to sit briefly without assistance, reaches out and grabs large objects, rakes at a pellet, and babbles. How old is this child?

Back 894

6 months

Front 895

A female child presents for a routine physical exam. The child is able to sit alone, pick up small objects, begins to pull to a stand (and may crawl), and babbles with polysyllabic sounds. How old is this child?

Back 895

8 months

Front 896

A female child presents for a routine physical exam. The child is able to sit alone indefinitely and walk while holding onto furniture (cruising); he or she can also pick up pellets with assisted pincer movement, uncover hidden toys, play peek-a-boo, and wave 'bye-bye'. How old is this child?

Back 896

10 months

Front 897

A 4-year-old male presents to your office for follow-up of a fever he has had now for the past eight days. He was seen six days ago for the fever and at the time was felt to have a viral syndrome, with a slight runny nose as his only symptom. He has continued to be febrile, with temperatures running between 101o and 104o F. He has had occasional vomiting, diarrhea and abdominal pain. Medications include acetaminophen. His physical examination is significant for bilateral conjunctivitis; diffuse oropharyngeal erythema and fissuring of the lips, erythematous palms and soles, enlarged cervical lymph nodes, and an erythematous maculopapular rash located on the trunk, face, and extremities. A complete blood count shows a leukocytosis with a predominance of neutrophils and a platelet count of 850,000/mm3. Erythrocyte sedimentation rate is 65 mm/hr. Pyuria and proteinuria are noted on urinalysis. The most important next step in the management of the patient's condition is evaluation for

Back 897

Coronary artery vasculitis

Explanation: Kawasaki disease is a multisystem disease that can result in significant morbidity due to involvement of the coronary arteries. It is the leading cause of acquired heart disease in the United States.

Front 898

What are the six major (of which 5 are needed) to confirm diagnosis of kawasaki disease?

Back 898

Fever last at least five days duration;

Bilateral nonpurulent conjunctival injection;

Mucosal changes of the oropharynx, strawberry tongue, or dry fissured lips;

Changes in the peripheral extremities, such as erythema or edema of the hands or feet, desquamation of tips of fingers and toes;

Erythematous, polymorphous rash spreading from extremities to the trunk;

Cervical lymphadenopathy

Front 899

You are seeing a 93 year old patient who is brought in for a regular visit by her daughter, with whom she lives. The patient is sitting in a wheelchair and has no complaints. You note that the patient’s hair is uncombed and food particles are spilled on her blouse and lap. There is a strong odor of urine; on physical exam you discover that the patient has used duct tape to mend a hole in her underwear. During the interview she talks in animated fashion about the joys of getting to know her great-grandchildren. Her mini-mental status exam score is 27. The MOST likely diagnosis is

Back 899

Physical neglect of an elder

Front 900

A 62 year old patient is evaluated in the emergency department for unilateral headache which began the night before and has been constant since then. He describes the pain as sharp, 4/10 on the pain scale, located around his left eye and radiating up his forehead and into his hair. On exam his BP is 132/80, HR 90/min, Temp 98.8 F, RR 20/min. His physical exam is significant for hyperaesthesia and dysaesthesia along the left CN5 ophthalmic dermatome. For the MOST LIKELY diagnosis, what other physical exam finding would you find?

Back 900

vesicles along the dermatome

Front 901

An 68 year old patient has a history of COPD and you are concerned he may have developed pulmonary hypertension. Which of the following on cardiac auscultation would BEST support that diagnosis?

Back 901

high-pitched diastolic murmur at left 2nd ICS

Front 902

In an otherwise well 77 year old woman you detect a 3/6 systolic ejection murmur that is heard in the right 2nd intercostal space and along the carotids. The MOST LIKELY cause of this finding is

Back 902

aortic stenosis

Front 903

Hypothyroidism in the elderly may present as?

Back 903

Dementia

Front 904

What symptom is the earliest manifestation of Alzheimer's dementia?

Back 904

short term memory deficits

Front 905

The most common sign or symptom of thyroid cancer is

Back 905

painless nodule

Front 906

Restrictive pattern on spirometry 1 year after radiation treatment for localized breast cancer MOST LIKELY represents

Back 906

pulmonary fibrosis

Front 907

A 42 year old patient has had increasing episodes of heavy bleeding with menses. She is concerned as her mother required a hysterectomy at about the same age, though she does not know for what reason. Which of the following is MOST worrisome as an indicator for possible uterine cancer?

Back 907

endometrial thickness measures 6 mm

Front 908

Patients with personal and family history of endometrial cancer in their 30s are at high risk for which other cancer (Lynch Syndorme)?

Back 908

colon cancer

Front 909

What stage is a patient with findings of 2 lymph node regions above the diaphragm, night sweats & weight loss

Back 909

Hodgkin’s stage IIB

Front 910

Squamous carcinoma of the oropharynx is MOST strongly associated with?

Back 910

smoking

Front 911

A 66 year old man who works in an auto shop comes in complaining of shortness of breath. His chest x-ray shows only thickened pleura with calcified pleural plaques. He MOST LIKELY has

Back 911

asbestosis

Front 912

A patient who drinks a six pack of beer every night claims he isn’t at risk of alcoholism because "it's only beer, not hard liquor." This is an example of

Back 912

denial

Front 913

Families who have a member who is alcoholic should know that

Back 913

they can help the alcoholic move beyond the denial stage.

Front 914

A 60-year-old woman is awaiting surgery for an anterior pituitary tumor diagnosed several months ago. She has no other medical problems. Pre-operatively, she is given no diuretics or contrast dye; her fasting blood glucose is 80 mg/dl. Urinalysis at that time indicates no glucose, cells, nitrate, blood, leukocyte esterase, or casts; the patient has ready access to fluids, but she is not aggressively hydrated intravenously. What polyuric syndrome is a potential complication of her surgery, secondary to the location of her tumor?

Back 914

Central diabetes insipidus (CDI)

Explanation Following pituitary surgery, there may be an inhibition of vasopressin (ADH) release from the hypothalamus into the posterior pituitary and then systemically. ADH usually mitigates water reabsorption in the distal renal tubules, so its deficiency may cause polyuria.Other potential causes of polyuria could include mannitol-induced diuresis (not described in this case) or aggressive intravenous hydration (not described in this case).Following surgery, stored ADH may be released and the intermittent DI may resolve.

Front 915

A 45-year-old African-American woman presents with a weight gain of 50 pounds; she attributes the weight gain to her hard-working lifestyle as a corporate attorney. She usually eats out and rarely exercises. She has a fasting blood glucose of 220mg/dl and has 40mg urinary albumin/g creatinine. These are new findings since her visit 5 years ago. She has been following a high protein diet, primarily consisting of animal proteins, for the past couple of days. What dietary and lifestyle interventions should you make due to her blood glucose and urinary albumin readings?

Back 915

Encourage a low calorie diet, modest protein and carbohydrate restriction with exercise

Front 916

A 19-year-old woman presents with weight loss, tiredness, and a decreased appetite. She mentions some nausea, and she vomited “once”, but she denies diarrhea, illicit alcohol, and drug use, palpitations, tremor, and skin changes. Her urine dips positive for glucose and ketones. What would you likely see on physical exam?

Back 916

Rapid deep breathing

Front 917

A 24-year-old woman has recently been diagnosed with insulin-dependent diabetes. The disease is being managed on a split dose of 60/40 insulin suspension, which she injects herself at 8:00 a.m. and 5:00 p.m. She was told to call in if she experiences any strange symptoms, which she does this afternoon. At 2:45 p.m., she is not feeling well and notices that her skin is cool and damp. Her hands are shaking and she is very anxious. What do you tell her to do right away, before having somebody take her to your office?

Back 917

Drink four ounces of fruit juice

Front 918

A 17-year-old girl presents because her heart is beating "funny". She describes episodes of a racing intense heartbeat. Her mother notes that the girl has seemed down and emotional. There has been significant weight loss over the past year. On physical examination, there is exophthalmos and a fine tremor on extension of the hand. Her pulse rate is about 100/minute. What is the most likely diagnosis?

Back 918

Hyperthyroidism

Front 919

A 13-year-old boy has a 3-year history of type I diabetes mellitus without significant problems; he presents for an acute visit. The patient states his morning glucose readings have risen from an average of 100 mg/dL to over 200 mg/dL over the past 2 weeks. He is currently taking 25 units of glargine (Lantus) at bedtime and 8 units of aspart (Novolog) before meals. The patient states that he has been compliant with his insulin and diet. His mother states that he recently has been having nightmares and night sweats, but he denies any other complaints. ROS and physical exam are otherwise unremarkable. What is the patient most likely experiencing?

Back 919

Somogyi effect

Front 920

A 58-year-old man presents to discuss his recent annual screening blood work results. His past medical history includes obesity and hypertension. He wants to discuss whether he has additional risk factors for Coronary Heart Disease (CHD). His Total Cholesterol is 240mg/dL, his Low-Density Lipoprotein Cholesterol (LDL) is 191mg/dL, his High-Density Lipoprotein Cholesterol (HDL) is 32mg/dL, and his Triglycerides are 140mg/dL.Question:

What is the most likely diagnosis?

Back 920

Hypercholesterolemia with high risk for CHD

Front 921

A 24-year-old woman presents with a 2-week history of persistent fatigue and decreased functional capacity. The woman has been consuming a strict total vegan diet (without dairy products or eggs) for the past 8 years. She also has a 3-week history of numbness and pins and needle sensation in her feet. The patient is having other problems, such as increased irritability and forgetfulness. Physical exam reveals pallor, peripheral neuropathy of her lower extremity, and memory deficits. CBC shows a macrocytic, normochromic anemia. There is also an elevation in the levels of methylmalonic acid.Question:

What therapy is indicated?

Back 921

Vitamin B12 supplementation

Front 922

A 46-year-old man presents with severe insomnia and anxiety. While hospitalized, an overnight polysomnogram was performed over 2 consecutive nights. Sleep latency was 60 minutes; REM latency was 45 minutes. He reports feeling paresthesias deep within his legs while lying in bed, especially while falling asleep. He denies recent illness or illicit drug use.His physical exam and lab work were within normal limits.Question:

What is the most likely cause of the patient's symptoms?

Back 922

Restless legs syndrome

Front 923

A 64-year-old university professor presents because he is unable to care for himself; he was forced to retire recently. There is no evidence of aphasia, apraxia, or agnosia. His wife tells you that, until he was 58, he drank about a case of beer every night after work. Based on this history, what is your provisional diagnosis?

Back 923

Dementia due to alcohol abuse

Front 924

A 60-year-old woman presents for evaluation of loss of recent and remote memory and has psychomotor slowing with difficulty in complex tasks. On examination, the patient also shows some tremors in the hands and face. She also presents with a shuffling gait. Family history reveals 2 of her brothers had a movement disorder; they are now deceased. What would be your provisional diagnosis?

Back 924

Parkinson's disease

Front 925

A 48 year old man consults you for erectile dysfunction. His health is good; the only medication he takes is lisinopril (Prinvil) for high blood pressure. He says that for several years he had penile pain whenever he got an erection. Now he notices that it is difficult for him to get an erection, with the distal penis being more affected that the proximal. He tried some sildanafil (Viagra) that he borrowed from a friend, but that didn’t help much. The MOST LIKELY diagnosis is

Back 925

Peyronie's disease

Front 926

Somatization is most likely seen in patients with a diagnosis of

Back 926

chronic pain

Front 927

You are doing a physical exam with blood tests on a 44 year old man for insurance purposes.

Results on the CBC show a very low total white blood cell count. Which of the following drugs is the MOST LIKELY cause of this finding?

Back 927

Carbamazepine (Tegretol)

Front 928

What is the purpose of adding epinephrine to lidocaine before anesthetizing a wound for suturing?

Back 928

Epinephrine controls capillary oozing.

Front 929

An 8 year old child cut his finger on an aluminum soda can 3 hours ago while trying to reach inside. Neurovascular is intact and you close it with 4 sutures. His mother says he had all the routine childhood vaccines and his last DTaP was 3 years ago. Which is the correct procedure for tetanus prophylaxis?

Back 929

No tetanus prophylaxis is needed at this time

Front 930

"In-toeing" in a small child

Back 930

may be unilateral or bilateral and often corrects itself with increased weight-bearing and walking during the second year of life.

Front 931

In a patient with depression, what is considered a vegetative sign or symptom

Back 931

Weight loss

Front 932

A child is born with neurologic dysfunction and seizures. The CT scan demonstrates finding of which parasitic infection?

Back 932

Toxoplasmosis

Front 933

What is the MAIN abnormality in this X-ray?

Back 933

Genu Varus

Front 934

You are doing a physical exam with blood tests and EKG on a 44 year old man for insurance

purposes. Results of the EKG show first degree heart block. Which of the following drugs is the MOST LIKELY cause of this finding?

Back 934

Nortryptilline (Elavil)

Front 935

An elderly woman presents to the emergency room after falling at home. She complains of right thigh pain. An x-ray shows a femoral neck fracture. On physical exam, typical deformities that suggest this type of hip fracture include

Back 935

External rotation, Abduction and Shortening

Front 936

A 6 year old child presents with the following rash. What is the MOST LIKELY diagnosis?

Back 936

Hookworm

Front 937

The best way to determine the exact degree of spinal curvature in a child with scoliosis is from the

Back 937

Calculation of Cobb angle on x-ray

Front 938

What disorders of childhood may cause a child to limp

Back 938

Synovitis of the hip

Foreign body embedded in the plantar surface

Legg-Calve-Perthe's Disease

Osteomyelitis of the proximal tibia

NOT Genu Valgum

Front 939

What is the appropriate treatment for most newborn infants diagnosed with congenital hip dislocation?

Back 939

Brief splinting of hips in flexion to prevent adduction

Front 940

What drug given to control seizures has the side effect of hyperplasia of the gingiva?

Back 940

Phenytoin (Dilantin)

Front 941

Use of what substances in providing local anesthesia should be avoided prior to suturing wounds of the ear, finger, nose or penis?

Back 941

Epinephrine (also cocaine)

Front 942

What is a contraindication for urinary catheterization?

Back 942

Acute prostate bacterial infection

Front 943

A 45 year old patient developed a new workout regimen on an extremely hot day and presents 24 hours later with a complaint of "blood in his urine." On exam he has diffuse tenderness in both thighs and lower legs. Urine specimen is red and dipstick is positive for blood, but no red cells are noted on microscopy. For the MOST UK.ELY diagnosis what is the BEST diagnostic

procedure to perform and what drug is likely contributing to his problem?

Back 943

Test Serum creatine kinase

Atorvastain (Lipitor)

Front 944

Determining the Risser Grade is important in assessing

Back 944

Risk of progression of scoliosis

Front 945

According to the law in the State of California, if a 13 year old girl comes to you asking for a referral for abortion, you as a provider of health care must

Back 945

Ensure that she has access to abortion referral information

Front 946

A 24-month-old female is brought into your office with sudden onset of difficulty breathing. Mother insists the child was fine until a few moments prior. Child had been sitting on the floor playing with toys. No fever. No cough. No history of URI symptoms. No history of other episodes like this. Child does not have an appointment. What is the MOST likely diagnosis

Back 946

Foreign body aspiration

Front 947

Congenital infection with what has been MOST STRONGLY associated with structural heart malformations?

Back 947

Rubella

Front 948

A study in which the researchers identify a certain number of people who already have a given condition and a certain number of people who don't have that condition, then comparison between the groups is made of factors/habits/exposures that the people experienced before developing the condition

Back 948

Case control study

Front 949

Which of the following p values is the MOST significant and indicates the lowest probability that the observed happened by chance?

A. p < .10

B. p < .05

C. p < .001

D. p < .0001

Back 949

p < .0001

Front 950

In terms of the economics of medical care, which is the better statistic to use in making decisions about recommending a treatment over a large population?

Back 950

Absolute risk reduction

Front 951

What type of study compares a number of well-structured studies on a given topic?

Back 951

Meta-analysis

Front 952

In the USA, primary cancers of the liver (hepatocellular carcinoma) are most often the consequence of

Back 952

Cirrhosis

Front 953

What type of study was used for the following:

Study compares the chalmydia tests: urine

DNA probe with urethral swab chlamydia culture

Back 953

Comparison to gold standard

Front 954

What type of study was used for the following:

5,000 PA students and 5,000 medical students are followed for development of depression during the first year of their training

Back 954

Case series

Front 955

What type of study was used for the following:

2,000 patients newly diagnosed with HIV are asked about their sexual practices in the 5 years prior to their diagnosis, results compared to 2,000 people without HIV and their sex practices in the previous 5 years

Back 955

Case control study

Front 956

What type of study was used for the following:

Journal article reports on 3 American Indian patients who developed Guillan-Barre syndrome after getting inactivated influenza vaccine

Back 956

Cohort Study

Front 957

What is the most common type of primary intracranial neoplasm in adults?

Back 957

Glioma

Front 958

In terms of symptoms, prostate cancer is most often

Back 958

Is asymptomatic

Front 959

A 25-year-old man felt a lump in his scrotum while in the shower. Examination reveals a 1 cm hard nontender nodule affixed to the lower pole of the testis. The most likely diagnosis is?

Back 959

Testicular tumor

Best confirmation of diagnosis is surgical removal of the testicle for biopsy

Front 960

A patient has an ovarian mass detected by ultrasound. Elevated levels of which of the following indicates a greater likelihood that the tumor is malignant?

Back 960

Cancer antigen 125 (CA-125)

Front 961

What medications/supplements have been shown to REDUCE the risk of developing ovarian cancer?

Back 961

Combined estrogen-progesterone birth control pills

Front 962

An eighteen year old woman has chief complaint of fatigue and fevers for the past month. Physical exam detects a 3 cm firm, rubbery, right supraclavicular mass. On chest x-ray the lungs are unremarkable; a mediastinal mass is seen. The BEST procedure to further evaluate her is

Back 962

Biopsy of the supraclavicular mass

Front 963

A 64 year old woman has developed intermittent episodes of visible hematuria with RBCs confirmed on clean voided midstream specimen. Which of the following is most likely to determine the cause of her hematuria?

Back 963

Cystoscopy

Front 964

Your patient is a 50 year old man with 15 pack year history of smoking cigarettes. He stopped smoking 20 years ago. As part of health care maintenance, you order fecal occult blood testing cards. He does the tests as instructed; 2 of the six samples are positive for occult blood. You should

Back 964

Order colonoscopy

Front 965

A 70-year-old post menopausal G2 P2 woman has taken Prempro (conjugated estrogens + medroxyprogesterone) once a day for 20 years. She says that starting three months ago she devloped vaginal spotting of blood 4-5 times a month. If you had to pick only ONE procedures to evaluate her, you would pick

Back 965

Cervical & endometrial biopsy

Front 966

A 22 year old woman complains of painful swelling in both breasts that seems to come and go. When she has it she says the upper outer area of each breast is "firm, like little pebbles" and painful. The breast condition that BEST fits this description is

Back 966

Fibrocystic breast disease

Front 967

What is the most common site for cervical cancer to arise

Back 967

Squamo-collumnar junction

Front 968

You are doing a routine physical on a 79 year old woman whose only complaint is a feeling of pelvic pressure. She had a total abdominal hysterectomy at age 52 for fibroids, and was told she still had ovaries. She has not had a peivic exam since that time. On exam today you detect a 5cm hard, nontender mass in the pelvis. This is MOST LIKELY

Back 968

Ovarian Cancer

Front 969

What is the best approach to managing a patent who has drug-seeking behavior complaining of chronic back pain?

Back 969

Refer the patient to a pain specialist

Front 970

What are some common features of controlled substances?

Back 970

Preferred over placebo, especially in patients with addiction history

Trigger dopamine as the common "reward pathway"

Cause a state of physiologic dependance if taken long enough &

Have psychoactive effects

Front 971

An 82 year old female patient has stress urinary incontinence and hates the idea of wearing

adult diapers. Which of the following interventions would be effective, well tolerated, with the fewest side effects?

Back 971

Oxybutinin (Ditropan) to relax detrussor muscle

Front 972

Your patient in a skilled nursing facility thinks someone is stealing her clothes and jewelry, but is hesitant to talk to staff because she knows she is getting forgetful and may be losing things, and is afraid the staff will become angry with her. You should

Back 972

set up an appointment with an ombudsman

Front 973

When given to older men, what is a common benefit of alpha blockers such as terazosin (Hytrin)?

Back 973

reduces urinary obstruction

Front 974

Reduction in which hormone is MOST related to vaginal dryness and uncomfortable intercourse in older women?

Back 974

Estrogen

Front 975

While many of these pulmonary function tests may be abnormal in a patient with COPD, the one that is MOST useful in evaluating and following the progress of their disease is

Back 975

FEV 1

Front 976

A 65 year old patient with a history of smoking 1 pack a day for 30 years presents for his firstphysical exam in 15 years. His chief complaint is that for the last year he has had increaseddifficulty breathing. He denies cough. He is thin, his face is flushed, he is using accessorymuscles to breathe and his expiratory phase is prolonged. His lung sounds in all lung fieldsare distant, his diaphragms are symmetric and low with poor inspiratory excursion. He MOST

LIKELY has

Back 976

emphysema

Front 977

What is the initial drug used to manage pain of osteoarthritis in an elder patient?

Back 977

celecoxib (Celebrex)

Front 978

Polymyalgia rheumatica has what deficit as a potential serious complication?

Back 978

Acute loss of vision

Front 979

A 60-year-old man with COPD has recently developed ankle swelling during the day thatrecedes overnight. On exam he has right upper quadrant abdominal tenderness, a liver spanof 15 cm. by percussion, and jugular vein distension on the right. Breath sounds are distant but otherwise unremarkable. The MOST LIKELY diagnosis would be

Back 979

Right Ventricular failure, probably for pulmonale

Front 980

A 44 year old woman complains of episodes of pressure-type chest pain that wake her fromsleep. She plays tennis every morning and never gets the pain while exercising. Her totalcholesterol is 150 mg/dl, her LDL is 75 and her HDL is 60. Her resting 12-lead EKG isunremarkable. At her last episode of pain she borrowed some of her husband's sublingual

nitroglycerine and got relief within 1 to 2 minutes. The MOST likely diagnosis is

Back 980

atypical (Prinzmetal's) angina

Front 981

Oligohydramnios, the condition of less amniotic fluid than normal, is MOST likely caused by which fetal anomalies?

Back 981

ureteral obstruction

Front 982

Which lab results indicate lead poisoning?

Back 982

Basophillic stippling

Front 983

A 3 week old infant is brought in by parents who say the child isn’t eating well. On exam thechild is well formed and at 58th percentile for height and weight. She had been seen for herroutine 2 week check up and was doing well. Now she is lethargic, irritable and uninterestedin feeding. Which of the following would most strongly suggest “shaken baby” syndrome is

the cause?

Back 983

Retinal hemorrhages

Front 984

What is a characteristic of "innocent" or "functional" murmur in childhood?

Back 984

often change with change of child’s position

Front 985

Which pulmonary cancer is MOST LIKELY to cause hemoptysis early in the course of the illness?

Back 985

Mesolthelioma

Front 986

What is associated with INCREASED statistical risk of developing breast cancer?

Back 986

Patient had early surgical menopause

Front 987

A patient has a slightly raised, slightly irregular, itchy dark brown "mole" that recently appeared on her shoulder. The BEST mode to evaluate it is

Back 987

excisional biopsy

Front 988

What clinical finding is a classic feature of inflammatory breast cancer?

Back 988

edematous skin (peau d'orange)

Front 989

A fracture of which bones has the higher likelihood of being caused by child abuse rather than by accident?

Back 989

Posterior rib

Front 990

A 2 year old child had symptoms of viral upper respiratory infection last week, with clear runny nose, sneezing and dry cough . Today 10 days after onset of the symptoms mother says the child feels warm and is acting fussy. Vital signs: HR: 98/min, RR: 20/min, Rectal temp 102.8 F. Her general appearance: no respiratofy distress, cough or drooling; sitting quietly in mother’s lap. What you will MOST LIKELY find on further exam is

Back 990

red immobile tympanic membrane

Front 991

10 year old swimmer complains of onset of bilateral ear pain that has worsened over the past 5 hours. His pinnae are very tender to touch. What will you MOST LIKELY see on physical exam?

Back 991

Swollen inflamed ear canals

Front 992

A 5 year old patient with developmental delay, a 3 cm hypo-pigmented ellipse-shaped macule on the torso and fibrous nodules around the nose and mouth MOST LIKELY has

Back 992

Tuberous sclerosis

Front 993

A female infant born premature at 33 weeks gestation would most likely have which of the following on physical exam?

Back 993

Vernix and smooth pink skin with visible veins

Front 994

Your patient is a 2 week old healthy male infant; you cannot palpate the left testicle and the left scrotum appears small and unwrinkled. Ultrasound detects an undescended left testicle in the abdomen . What is the MAIN urgency for scheduling surgery to relocate the testicle before the age of 2 years?

Back 994

reduce risk of infertility

Front 995

In a patient with hepatitis C infection, which of the following factors is MOST STRONGLY associated with an increase in the rate of fibrosis progression and liver failure

Back 995

Active inflammation is present on liver biopsy

Front 996

Which flow volume loop best supports the diagnosis of chronic obstructive pulmonary disease?

Back 996

B

Front 997

In May 2012, expert agencies recommended which of the following changes to screening and management of chronic disease? .

A. USPSTF: men should not be routinely screened for prostate cancer via PSA testing

B. CDC: people born between 1945 and 1965 (''baby boomers") should have a one time blood test for evidence of infection by Hepatitis C .

C. Task Force on Community Preventive Services (TFCP): team based care (primary care

provider supported by a pharmacist, nurse, dietitian, social worker, or community health

worker) of patients with hypertension resulted in improved blood pressure control.

D. Sigmoidoscopy lowers the risk of getting a colon cancer diagnosis by 21 percent and the

chances of dying from the disease by 26 percent, and cause fewer adverse effects than

colonoscopies

E. All of the above

Back 997

A. USPSTF: men should not be routinely screened for prostate cancer via PSA testing

Front 998

Levodopa is given to manage the symptoms of Parkinson's disease. What conditions is a contraindication to using levodopa?

Back 998

Narrow angle glaucoma

Front 999

On exam of an elderly patient you notice his 4th and 5th fingers are flexed. You palpate a thickened fibrotic cord stretching between palm and each affected finger. The other deficit you may be able to elicit is

Back 999

decreased palmar grip

Front 1000

You have diagnosed a 55 year old woman with acute onset of moderately severe rheumatoid arthritis. What medications would be the BEST management?

Back 1000

Methotrexate plus an NSAID

Front 1001

A patient with a known allergy to bee sting is found in his backyard in respiratory distress with edema of face and urticaria (hives) on his arms. He is tachycardic, wheezing and combative. In managing anayphylaxis, the BEST treatment to give FIRST is

Back 1001

epinephrine

Front 1002

You are interviewing a 24 year old female patient with a history of migraine headaches with aura who says they are getting more frequent. They respond to medication (sumatriyptan/Imitrex) Which MOST indicates the need for further evaluation such as CT or MRI?

Back 1002

unilateral facial weakness persists after the headache

Front 1003

A 50 year old patient presents with an acutely painful right toe. The exam reveals an erythematous edematous toe painful to the touch. There are no other affected joints. He was recently started on a medication for hypertension. What is drug is the MOST likely cause of his findings?

Back 1003

hydrochlorothiazide (Diuril)

Front 1004

Describe the pathophysiology of idiopathic thrombocytopenic purpura (ITP)?

Back 1004

IgG autoantibody binds to platelets and promotes their destruction by spleen

Front 1005

A 45 year old patient in clinic complains that he has felt his heart "skipping beats" intermittently for 2 weeks. He notices it most at rest, less when briskly walking. He denies chest pain, syncope or difficulty breathing. His physical exam is significant only for 23

irregular beats per minute. The twelve lead EKG (attached) indicates which of the following?

Back 1005

quadrigeminy

Front 1006

If contraindications are not otherwise present, a patient who has had an acute myocardial infarction can reduce cardiovascualr risk by taking daily which medications

Back 1006

Aspirin

ACE inhibitor

statin (such as lovastatin/Mevacor

Beta Blocker

NOT Potassium-sparing diuretic

Front 1007

You are evaluating a 28 year old patient for hypertension. He is normal BMI, active, eats a healthy diet and does not smoke or use alcohol or illicit drugs. No one in his family has hypertension; his mother was treated for hyperthyroidism and has type 2 DM. His lab and diagnostic results show a normal CBC and TSH; his HDL/LDL ratio is in the healthy range. His electrolytes (Na, K, CL, CO2 ) are normal; his creatinine is slightly elevated. What, if any, additional evaluation would be helpful to clarify the cause of his hypertension?

Back 1007

Creatinine clearance

Front 1008

What is the most important inital† step in the emergent treatment of diabetic ketoacidosis?

Back 1008

Volume replacement

Front 1009

A patient cut his thumb when he broke a glass while washing dishes 8 hours ago. The wound bled freely and the patient stopped the bleeding by applying direct pressure. What MOST LIKELY indicates a foreign body remains in the wound?

Back 1009

Wound oozes fluid and pain increases

Front 1010

Two bones most commonly factured during a fall on outstretched hand (FOOSH) are

Back 1010

scaphoid and distal radius

Front 1011

The purpose of fluorescein in examining a painful eye is to

Back 1011

make visible the area of corneal damage

Front 1012

Acute infarction ofthe small bowel (ileum, jejunum) would MOST LIKELY invovle which of the following vessels?

Back 1012

superior mesenteric artery

Front 1013

Of the following dermatologic lesions, which one would be safest† to evaluate by shave biopsy?

A melanoma

B atypical nevus

C lesion that extends into the dermis

D pigmented lesion

E superficial basal cell carcinoma

Back 1013

superficial basal cell carcinoma

Front 1014

What is an appropriate maneuver to remove a dried kidney bean stuck in a child's ear?

Back 1014

direct instrumentation to pull it out

Front 1015

What is the BEST sign of return of normal intestinal function after abdominal surgery

(such as cholecystectomy)?

Back 1015

borborygmi

Front 1016

Patients who are living with cystic fibrosis are MOST likely to have recurring lung infections from what organism?

Back 1016

Pseudomonas aeruginosa

Front 1017

An elder woman living in a care facility develops a change in her mental status over the course of 12 hours, not remembering her family or what day it is. Her physical exam is non-focal; vitals are normal except for a core temperature of 98.0 degrees. Given the MOST LIKELY cause for her change in status, what should your workup pursue FIRST?

Back 1017

Check urine and lungs for occult infection