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Questions and Answers
A 52-year-old man comes to the physician with his wife because of a 1-year history of excessive daytime sleepiness. He does not think the symptoms are problematic, but his wife is concerned because he sometimes falls asleep on the sofa early in the evening when guests are present. He also once fell asleep while driving at night and drove off the road, narrowly avoiding injury. His wife says that he has always snored loudly, and over the past year, he has had episodes of choking or gasping for breath while sleeping. He is 178 cm tall and weighs 105 kg; BMI is 33 kg/m2. His pulse is 76/min, respirations are 14/min, and blood pressure is 150/76 mm Hg. Physical and neurologic examinations show no other abnormalities. Which of the following is most likely to confirm the diagnosis?
A 52-year-old man comes to the physician with his wife because of a 1-year history of excessive daytime sleepiness. He does not think the symptoms are problematic, but his wife is concerned because he sometimes falls asleep on the sofa early in the evening when guests are present. He also once fell asleep while driving at night and drove off the road, narrowly avoiding injury. His wife says that he has always snored loudly, and over the past year, he has had episodes of choking or gasping for breath while sleeping. He is 178 cm tall and weighs 105 kg; BMI is 33 kg/m2. His pulse is 76/min, respirations are 14/min, and blood pressure is 150/76 mm Hg. Physical and neurologic examinations show no other abnormalities. Which of the following is most likely to confirm the diagnosis?
- Laryngoscopy
- Polysomnography (correct)
- CT scan of the head
- 24-Hour ambulatory ECG monitoring
- Multiple sleep latency test
A 67-year-old woman has had fatigue, dry skin, brittle hair, swelling of the ankles, and cold intolerance for 1 year; she has gained 9 kg during this period. Her pulse is 55/min, and blood pressure is 150/90 mm Hg. She appears lethargic. Examination shows dry skin and a nontender thyroid gland that is enlarged to two times its normal size. There is mild edema of the ankles bilaterally. The relaxation phase of the Achilles reflex is greatly prolonged. Which of the following is the most likely diagnosis?
A 67-year-old woman has had fatigue, dry skin, brittle hair, swelling of the ankles, and cold intolerance for 1 year; she has gained 9 kg during this period. Her pulse is 55/min, and blood pressure is 150/90 mm Hg. She appears lethargic. Examination shows dry skin and a nontender thyroid gland that is enlarged to two times its normal size. There is mild edema of the ankles bilaterally. The relaxation phase of the Achilles reflex is greatly prolonged. Which of the following is the most likely diagnosis?
- Chronic lymphocytic thyroiditis (Hashimoto disease) (correct)
- Thyroid cyst
- Thyroiditis
- Multinodular goiter
- Graves disease
A 19-year-old man has had fever, headache, sore throat, and swelling of the cervical lymph nodes for 5 days. His temperature is 40°C, pulse is 120/min, respirations are 20/min, and blood pressure is 125/85 mm Hg. The pharynx is red and swollen with enlarged tonsils and exudate. There is tender cervical adenopathy and palpable lymph nodes in the axillary and inguinal areas. The spleen tip is palpable. Leukocyte count is 14,000/mm3 (25% segmented neutrophils, 60% atypical lymphocytes, and 15% monocytes). A throat culture is obtained. Which of the following is the most likely pathogen?
A 19-year-old man has had fever, headache, sore throat, and swelling of the cervical lymph nodes for 5 days. His temperature is 40°C, pulse is 120/min, respirations are 20/min, and blood pressure is 125/85 mm Hg. The pharynx is red and swollen with enlarged tonsils and exudate. There is tender cervical adenopathy and palpable lymph nodes in the axillary and inguinal areas. The spleen tip is palpable. Leukocyte count is 14,000/mm3 (25% segmented neutrophils, 60% atypical lymphocytes, and 15% monocytes). A throat culture is obtained. Which of the following is the most likely pathogen?
- Toxoplasma gondii
- Epstein-Barr virus (correct)
- Group A streptococcus
- Cytomegalovirus
- Adenovirus
A healthy 16-year-old boy comes to the physician for an examination prior to participation in school sports. He is at the 90th percentile for height and 75th percentile for weight. His temperature is 37°C (98.6°F), pulse is 66/min, respirations are 16/min, and blood pressure is 145/95 mmHg. Examination shows no other abnormalities. Which of the following is the most appropriate next step in management?
A healthy 16-year-old boy comes to the physician for an examination prior to participation in school sports. He is at the 90th percentile for height and 75th percentile for weight. His temperature is 37°C (98.6°F), pulse is 66/min, respirations are 16/min, and blood pressure is 145/95 mmHg. Examination shows no other abnormalities. Which of the following is the most appropriate next step in management?
A 15-month-old girl is brought to the emergency department after a generalized tonic-clonic seizure at home. The seizure stopped spontaneously after 2 minutes, and she seemed sleepy afterward. Her temperature prior to arrival was 39.6°C, and paramedics administered rectal acetaminophen. Her parents state that yesterday she had a mild runny nose but otherwise has been well. There is no personal or family history of serious medical illness or seizures. Development has been appropriate for age. On arrival, she is afebrile, alert, and interactive. Physical examination shows a supple neck. Neurologic examination shows no focal findings. Which of the following is the most appropriate next step in management?
A 15-month-old girl is brought to the emergency department after a generalized tonic-clonic seizure at home. The seizure stopped spontaneously after 2 minutes, and she seemed sleepy afterward. Her temperature prior to arrival was 39.6°C, and paramedics administered rectal acetaminophen. Her parents state that yesterday she had a mild runny nose but otherwise has been well. There is no personal or family history of serious medical illness or seizures. Development has been appropriate for age. On arrival, she is afebrile, alert, and interactive. Physical examination shows a supple neck. Neurologic examination shows no focal findings. Which of the following is the most appropriate next step in management?
A 3-month-old boy is brought to the emergency department because of a 3-day history of vomiting and diarrhea. He has a low-pitched cry and responds only to painful stimuli. His temperature is 35.2°C, pulse is 203/min, respirations are 48/min, and blood pressure is 52/35 mm Hg. Peripheral pulses are barely palpable. Capillary refill time is delayed. Administration of 100% oxygen by nasal cannula is begun. Multiple attempts at establishing peripheral intravenous access are unsuccessful. Which of the following is the most appropriate next step in management?
A 3-month-old boy is brought to the emergency department because of a 3-day history of vomiting and diarrhea. He has a low-pitched cry and responds only to painful stimuli. His temperature is 35.2°C, pulse is 203/min, respirations are 48/min, and blood pressure is 52/35 mm Hg. Peripheral pulses are barely palpable. Capillary refill time is delayed. Administration of 100% oxygen by nasal cannula is begun. Multiple attempts at establishing peripheral intravenous access are unsuccessful. Which of the following is the most appropriate next step in management?
A 72-year-old female presents with a 6-week history of "carrot colored skin." She denies fever, malaise, or abdominal pain. Her only medications are hydrochlorothiazide and a baby aspirin daily. On examination she has icteric sclera and a single enlarged left supraclavicular lymph node which is nontender. Which one of the following is the most likely diagnosis?
A 72-year-old female presents with a 6-week history of "carrot colored skin." She denies fever, malaise, or abdominal pain. Her only medications are hydrochlorothiazide and a baby aspirin daily. On examination she has icteric sclera and a single enlarged left supraclavicular lymph node which is nontender. Which one of the following is the most likely diagnosis?
Hyperbaric oxygen treatment has been shown to be beneficial for which one of the following conditions?
Hyperbaric oxygen treatment has been shown to be beneficial for which one of the following conditions?
Which one of the following medications should be discontinued in pregnancy?
Which one of the following medications should be discontinued in pregnancy?
A 25-year-old female reports the absence of menses for the past 6 months. She has an elevated prolactin level and all her other labs and exams are normal. Which one of the following would be most appropriate at this point to further evaluate her pituitary gland?
A 25-year-old female reports the absence of menses for the past 6 months. She has an elevated prolactin level and all her other labs and exams are normal. Which one of the following would be most appropriate at this point to further evaluate her pituitary gland?
Which one of the following EKG abnormalities would dictate the use of a pharmacologic stress test as opposed to an exercise stress test?
Which one of the following EKG abnormalities would dictate the use of a pharmacologic stress test as opposed to an exercise stress test?
An elderly immunosuppressed woman has not been feeling well for the last week. She is hospitalized and noted to have an increased respiratory rate. She has no fever or cough. A chest radiograph reveals diffuse bilateral interstitial infiltrates. Which one of the following is the most likely diagnosis?
An elderly immunosuppressed woman has not been feeling well for the last week. She is hospitalized and noted to have an increased respiratory rate. She has no fever or cough. A chest radiograph reveals diffuse bilateral interstitial infiltrates. Which one of the following is the most likely diagnosis?
Which one of the following medications is most likely cause of viamin B12 deficiency?
Which one of the following medications is most likely cause of viamin B12 deficiency?
Tramadol should be avoided in patients with a history of which one of the following?
Tramadol should be avoided in patients with a history of which one of the following?
For patients on lithium monotherapy for bipolar disease, monitoring should include periodic blood levels of lithium, creatinine, and:
For patients on lithium monotherapy for bipolar disease, monitoring should include periodic blood levels of lithium, creatinine, and:
A 35-year-old otherwise healthy male who is not on any medications complains of 3-4 episodes of watery diarrhea that started 2 days earlier. The diarrhea is accompanied by some nausea and abdominal cramping. He denies fever, dehydration, and bloody stool.
Which one of the following is indicated at this time?
A 35-year-old otherwise healthy male who is not on any medications complains of 3-4 episodes of watery diarrhea that started 2 days earlier. The diarrhea is accompanied by some nausea and abdominal cramping. He denies fever, dehydration, and bloody stool. Which one of the following is indicated at this time?
A 6-year-old boy has right anterior cervical chain lymph node that was noted a week ago after he had recovered from an upper respiratory infection. It measures 2 cm in diameter and is somewhat firm, mobile, and nontender. The remainder of the examination is normal.
Which one of the following would be most appropriate at this point?
A 6-year-old boy has right anterior cervical chain lymph node that was noted a week ago after he had recovered from an upper respiratory infection. It measures 2 cm in diameter and is somewhat firm, mobile, and nontender. The remainder of the examination is normal. Which one of the following would be most appropriate at this point?
Which one of the following is the treatment of choice for Campylobacter resistant to quinolones?
Which one of the following is the treatment of choice for Campylobacter resistant to quinolones?
Diabetic retinopathy can be distinguished from hypertensive retinopathy by which one of the following?
Diabetic retinopathy can be distinguished from hypertensive retinopathy by which one of the following?
Post-thyroidectomy high dose radio-iodine therapy improves long-term survival in:
Post-thyroidectomy high dose radio-iodine therapy improves long-term survival in:
Absolute indications for dialysis include:
Absolute indications for dialysis include:
A 30 years old woman with subacute Streptococcus viridans endocarditis, has penicillin allergy. Which of the following would be the most appropriate alternative?
A 30 years old woman with subacute Streptococcus viridans endocarditis, has penicillin allergy. Which of the following would be the most appropriate alternative?
A low-risk patient is discharged from hospital after an acute coronary syndrome. His condition is stable. When can he resume driving for short distances?
A low-risk patient is discharged from hospital after an acute coronary syndrome. His condition is stable. When can he resume driving for short distances?
For most patients, which one of the following modalities is the safest to confirm cirrhosis diagnosis?
For most patients, which one of the following modalities is the safest to confirm cirrhosis diagnosis?
High intake of which one of the following foods has been most strongly linked to the development of colorectal cancer?
High intake of which one of the following foods has been most strongly linked to the development of colorectal cancer?
Which one of the following is most sensitive for detecting alcohol use disorders?
Which one of the following is most sensitive for detecting alcohol use disorders?
Which one of the following psychiatric conditions is associated with acquired long QT interval?
Which one of the following psychiatric conditions is associated with acquired long QT interval?
In chronic subdural hematoma, one is wrong:
In chronic subdural hematoma, one is wrong:
In case of acute headache presenting to the emergency room. The first thing to do:
In case of acute headache presenting to the emergency room. The first thing to do:
All the following are features of salicylates intoxication except one:
All the following are features of salicylates intoxication except one:
All the following are critical features in accidental drug poisoning except one:
All the following are critical features in accidental drug poisoning except one:
Which of the following tests has a high positive predictive value for Juvenile Rheumatoid Arthritis?
Which of the following tests has a high positive predictive value for Juvenile Rheumatoid Arthritis?
Flashcards
What is the most likely test to confirm a diagnosis of obstructive sleep apnea?
What is the most likely test to confirm a diagnosis of obstructive sleep apnea?
Polysomnography (PSG) is a sleep study that records brain waves, eye movements, muscle activity, and heart rate during sleep. It is the gold standard for diagnosing obstructive sleep apnea (OSA).
What is the most likely diagnosis for a 67-year-old woman with fatigue, dry skin, brittle hair, weight gain, cold intolerance, and a slow heart rate?
What is the most likely diagnosis for a 67-year-old woman with fatigue, dry skin, brittle hair, weight gain, cold intolerance, and a slow heart rate?
Chronic lymphocytic thyroiditis (Hashimoto's disease) is an autoimmune disorder that causes hypothyroidism. Symptoms include fatigue, dry skin, brittle hair, weight gain, cold intolerance, and a slowed heart rate. The thyroid gland is often enlarged and nontender.
What is the most likely pathogen causing fever, headache, sore throat, swollen lymph nodes, and fatigue in a 19-year-old man with atypical lymphocytes on a blood smear?
What is the most likely pathogen causing fever, headache, sore throat, swollen lymph nodes, and fatigue in a 19-year-old man with atypical lymphocytes on a blood smear?
Epstein-Barr virus (EBV) is the most likely pathogen causing the patient's symptoms, which are consistent with infectious mononucleosis. Classic symptoms include fever, headache, sore throat, swollen lymph nodes, and fatigue. The presence of atypical lymphocytes on a blood smear is highly suggestive of EBV infection.
What is the most appropriate next step in management for a healthy 16-year-old boy with a blood pressure reading of 145/95mmHg?
What is the most appropriate next step in management for a healthy 16-year-old boy with a blood pressure reading of 145/95mmHg?
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What is the most appropriate next step in management for a 15-month-old girl with a generalized tonic-clonic seizure after a mild runny nose, who is now afebrile and alert?
What is the most appropriate next step in management for a 15-month-old girl with a generalized tonic-clonic seizure after a mild runny nose, who is now afebrile and alert?
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What is the most appropriate next step in management for a 3-month-old boy with severe dehydration, shock, and poor peripheral perfusion, in whom peripheral venous access is difficult?
What is the most appropriate next step in management for a 3-month-old boy with severe dehydration, shock, and poor peripheral perfusion, in whom peripheral venous access is difficult?
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What is the most likely diagnosis for a 72-year-old female with jaundice and an enlarged supraclavicular lymph node?
What is the most likely diagnosis for a 72-year-old female with jaundice and an enlarged supraclavicular lymph node?
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What condition is hyperbaric oxygen treatment known to benefit?
What condition is hyperbaric oxygen treatment known to benefit?
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Which medication should be discontinued in pregnancy?
Which medication should be discontinued in pregnancy?
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What is the most appropriate next step to further evaluate the pituitary gland in a 25-year-old woman with elevated prolactin levels and a normal physical exam?
What is the most appropriate next step to further evaluate the pituitary gland in a 25-year-old woman with elevated prolactin levels and a normal physical exam?
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Which EKG abnormality would dictate the use of a pharmacologic stress test instead of an exercise stress test?
Which EKG abnormality would dictate the use of a pharmacologic stress test instead of an exercise stress test?
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What is the most likely diagnosis for an elderly immunosuppressed woman with diffuse bilateral interstitial infiltrates on chest radiograph?
What is the most likely diagnosis for an elderly immunosuppressed woman with diffuse bilateral interstitial infiltrates on chest radiograph?
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Which medication is most likely to cause vitamin B12 deficiency?
Which medication is most likely to cause vitamin B12 deficiency?
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Tramadol should be avoided in patients with a history of what?
Tramadol should be avoided in patients with a history of what?
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What should be monitored periodically in patients taking lithium for bipolar disease?
What should be monitored periodically in patients taking lithium for bipolar disease?
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What is indicated at this time for a 35-year-old male with 3-4 episodes of watery diarrhea, nausea, and abdominal cramping?
What is indicated at this time for a 35-year-old male with 3-4 episodes of watery diarrhea, nausea, and abdominal cramping?
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What would be the most appropriate next step for a 6-year-old boy with a 2cm right anterior cervical lymph node that appeared after an upper respiratory infection?
What would be the most appropriate next step for a 6-year-old boy with a 2cm right anterior cervical lymph node that appeared after an upper respiratory infection?
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What is the treatment of choice for Campylobacter resistant to quinolones?
What is the treatment of choice for Campylobacter resistant to quinolones?
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What helps differentiate diabetic retinopathy from hypertensive retinopathy?
What helps differentiate diabetic retinopathy from hypertensive retinopathy?
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Post-thyroidectomy, high dose radioiodine therapy improves long-term survival in which type of thyroid carcinoma?
Post-thyroidectomy, high dose radioiodine therapy improves long-term survival in which type of thyroid carcinoma?
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What is an absolute indication for dialysis?
What is an absolute indication for dialysis?
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What is the most appropriate alternative antibiotic for a patient with penicillin allergy and subacute Streptococcus viridans endocarditis?
What is the most appropriate alternative antibiotic for a patient with penicillin allergy and subacute Streptococcus viridans endocarditis?
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When can a low-risk patient resume driving after discharge from the hospital following an acute coronary syndrome?
When can a low-risk patient resume driving after discharge from the hospital following an acute coronary syndrome?
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What is the safest modality for confirming a diagnosis of cirrhosis?
What is the safest modality for confirming a diagnosis of cirrhosis?
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Which food is most strongly linked to the development of colorectal cancer?
Which food is most strongly linked to the development of colorectal cancer?
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Which modality is most sensitive for detecting alcohol use disorders?
Which modality is most sensitive for detecting alcohol use disorders?
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Which psychiatric condition is associated with an acquired long QT interval?
Which psychiatric condition is associated with an acquired long QT interval?
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Which of the following is incorrect regarding chronic subdural hematoma?
Which of the following is incorrect regarding chronic subdural hematoma?
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What is the first thing to do for a patient with acute headache presenting to the emergency room?
What is the first thing to do for a patient with acute headache presenting to the emergency room?
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What is not a feature of salicylates intoxication?
What is not a feature of salicylates intoxication?
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What is not a critical feature in accidental drug poisoning?
What is not a critical feature in accidental drug poisoning?
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Which test has a high positive predictive value for Juvenile Rheumatoid Arthritis?
Which test has a high positive predictive value for Juvenile Rheumatoid Arthritis?
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When is adenoidectomy recommended?
When is adenoidectomy recommended?
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Which of the following are the most important and clinically useful risk factors for breast cancer?
Which of the following are the most important and clinically useful risk factors for breast cancer?
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Study Notes
- Medical cases and questions are presented.
- Patient demographics, symptoms, and physical exam findings are detailed for each case.
- Relevant diagnostic tests and management approaches are suggested.
- The questions posed are designed to assess the student's understanding of medical diagnoses and appropriate treatment plans.
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Description
This quiz presents a series of medical cases that include patient demographics, symptoms, and physical exam findings. Students will need to interpret the information and apply their knowledge of diagnostic tests and management approaches to answer the questions. This assessment is designed to enhance understanding of medical diagnoses and appropriate treatment plans.
