Medical Questions PDF

## 147 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 on...

## 147 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? - 24-Hour ambulatory ECG monitoring - Multiple sleep latency test - Polysomnography - CT scan of the head - Laryngoscopy ## 148 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) - Graves disease - Multinodular goiter - Thyroid cyst - Thyroiditis ## 149 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? - Adenovirus - Cytomegalovirus - Epstein-Barr virus - Group A streptococcus - Toxoplasma gondii ## 150 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? - Repeat blood pressure measurement in 2 weeks - Recommend a low-sodium diet - Recommend a weight loss program - Begin diuretic therapy - No further intervention indicated ## 151 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? - Reassurance - CT scan of the head - Oral administration of phenobarbital - EEG - Lumbar puncture ## 152 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? - Oral rehydration - Intramuscular injections of antibiotics - Intubation and mechanical ventilation - Placement of a nasogastric tube - Placement of an intraosseous catheter ## 153 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? - Biliary cirrhosis - Ascending cholangitis - Obstructing pancreatic pseudocyst - Carcinoma of the head of the pancreas - Hepatocellular carcinoma ## 154 Hyperbaric oxygen treatment has been shown to be beneficial for which one of the following conditions? - Tinnitus - Malignant otitis externa - Crush injury wounds - Nonunion of bone fractures - Vascular dementia ## 155 Which one of the following medications should be discontinued in pregnancy? - Atenolol - Bupropion - Fluoxetine - Glargine - Metformin ## 156 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 follow-up serum prolactin level in 4 weeks - A prolactin-stimulating hormone level - MRI of the pituitary - Head CT with intravenous contrast ## 157 Which one of the following EKG abnormalities would dictate the use of a pharmacologic stress test as opposed to an exercise stress test? - First degree atrioventricular block - Left bundle branch block - Poor R-wave progression in leads V1 through V3 - Q-waves in the inferior leads - Ventricular trigeminy ## 158 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? - Pneumococcal pneumonia - Staphylococcal pneumonia - Pneumocystis pneumonia - Pulmonary tuberculosis - Pneumothorax ## 159 Which one of the following medications is most likely cause of vitamin B12 deficiency? - Hydrochlorothiazide - Lisinopril - Amlodipine - Simvastatin - Omeprazole ## 160 Tramadol should be avoided in patients with a history of which one of the following? - Seizures - Heart failure - Ventricular dysrhythmias - Hypertension ## 161 For patients on lithium monotherapy for bipolar disease, monitoring should include periodic blood levels of lithium, creatinine, and: - Calcium - Hemoglobin A1C - Lipids - Testosterone - TSH ## 162 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? - Testing for fecal leukocytes - A stool culture - A stool examination for ova and parasites - A stool test for Clostridium difficile toxin - No testing ## 163 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? - Ultrasound evaluation of the lymph node - A fine-needle biopsy of the node - An excisional biopsy of the node - A 10-day course of antibiotics - Follow-up examination in 1 month ## 164 Which one of the following is the treatment of choice for Campylobacter resistant to quinolones? - Amoxicillin - Azithromycin - Metronidazole - Rifaximin ## 165 Diabetic retinopathy can be distinguished from hypertensive retinopathy by which one of the following? - Retinal "exudates" - Macular "stars" - Flame-shaped hemorrhages - Microaneurysms ## 166 Post-thyroidectomy high dose radio-iodine therapy improves long-term survival in: - Papillary thyroid carcinoma - Colloid thyroid carcinoma - Medullary thyroid carcinoma - Anaplastic thyroid carcinoma ## 167 Absolute indications for dialysis include: - Metabolic acid with PH 7.2 - Hyperkalemia with K 6.5 mEq/L - Uremic pericarditis - Volume overload with good urinary output. ## 168 A 30 years old woman with subacute Streptococcus viridans endocarditis, has penicillin allergy. Which of the following would be the most appropriate alternative? - Intravenous piperacillin - Intravenous cefazolin - Intravenous gentamicin - Intravenous vancomycin - Intravenous azithromycin ## 169 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? - 6 months - Immediately after discharge - In 4 to 6 weeks - In about 1 week - Not until undergoing a postdischarge exercise stress test to confirm adequate exercise capacity. ## 170 For most patients, which one of the following modalities is the safest to confirm cirrhosis diagnosis? - Computed tomography scan - Liver biopsy - Magnetic resonance imaging study - Radionuclide imaging - Ultrasound ## 171 High intake of which one of the following foods has been most strongly linked to the development of colorectal cancer?: - Eggs - Red meat - Roasted sesame seeds - Spicy fetta cheese - Tuna from Japan ## 172 Which one of the following is most sensitive for detecting alcohol use disorders?: - Carbohydrate-deficient transferrin - Elevated gamma-glutamyl transferase - Macrocytosis on hemogram - Screening questionnaires ## 173 Which one of the following psychiatric conditions is associated with acquired long QT interval? - Agoraphobia - Anorexia nervosa - Bipolar disorder - Munchausen syndrome - Schizophrenia ## 174 In chronic subdural hematoma, one is wrong: - More frequent at extreme ages - Can mimic any neurological disease - Increase by osmosis - Increase by bleeding between the membranes ## 175 In case of acute headache presenting to the emergency room, the first thing to do is: - CT brain - Brain MRI - Assessment for nucchal rigidity - Fundoscopy ## 176 All the following are features of salicylates intoxication except one: - Convulsions - Hyperventilation - Respiratory alkalosis - Aciduria - Dehydration ## 177 All the following are critical features in accidental drug poisoning except one: - Decreased consciousness and respiration - Convulsions - Cardiac arrhythmia - Hyperthermia - Vomiting ## 178 Which of the following tests has a high positive predictive value for Juvenile Rheumatoid Arthritis?: - Erythrocyte sedimentation rate - C-reactive protein - HLA-B27 - Antinuclear antibody - None of the above ## 179 When is adenoidectomy recommended? - Upper airway obstruction - Recurrent otitis media - Sleep apnea - All of the above - None of the above ## 180 Which of the following are the most important and clinically useful risk factors for breast cancer? - Fibrocystic disease, age and gender - Cysts, family history in immediate relatives and gender - Age, gender and family history in immediate relatives - Obesity, nulliparity and alcohol use