M2015A-1-50-41-50.pdf Past Paper PDF

## 88 A 57-year-old woman presents to the emergency department with right leg numbness, tingling, and weakness 1 week after coronary angiography. On examination, there is a pulsatile nontender mass in the right groin (the side of the arterial puncture). The mass is getting bigger each day. What is...

## 88 A 57-year-old woman presents to the emergency department with right leg numbness, tingling, and weakness 1 week after coronary angiography. On examination, there is a pulsatile nontender mass in the right groin (the side of the arterial puncture). The mass is getting bigger each day. What is this patient's most likely diagnosis? * Acute arterial occlusion * Arteriovenous fistula * Expanding pseudoaneurysm * Femoral nerve injury after angiography * Infected pseudoaneurysm ## 89 A 57-year-old woman with morbid obesity is incidentally noted to have mildly elevated AST (SGOT) levels. She does not take any medications nor any alcohol and a workup for viral hepatitis and hemochromatosis is negative. Which one of the following is most likely to improve her hepatic condition? * Clopidogrel * Simvastatin * L-carnitine * Vitamin E * Weight loss ## 90 You suspect that he has asthma in a 15-year-old healthy male with nighttime cough and wheezing for the past several months. Which one of the following would be most appropriate at this point? * Treat empirically with a short-acting beta-agonist * Perform spirometry * Order a chest X Ray * Start an inhaled corticosteroid * Start a leukotriene inhibitor ## 91 Which one of the following is the best treatment for a 36-year-old female presents with a several-week history of polyuria and intense thirst, a urinalysis with low specific gravity and low osmolality and a 24-hour urine output more than 5 liters. All other lab and exam findings are normal. * angiotensin II * aldosterone * renin * insulin * vasopressin ## 92 Routine vaccination against which one of the following organisms has significantly reduced the risk of bacterial meningitis among young children? * Borrelia burgdorferi * Escherichia coli * Haemophilus influenzae * Listeria monocytogenes * Mycoplasma pneumoniae ## 93 To prevent joint damage from gout, uric acid levels should be lowered by medication to * <6.0mg/dL * <8.0mg/dL * <10.0mg/dL * a level that keeps the patient symptom-free for 6 months ## 94 A 50-year-old male presents with gynecomastia. Which one of the following antihypertensive medications is most likely to cause this problem? * Doxazosin * Hydrochlorothiazide * Lisinopril * Losartan * Spironolactone ## 95 Which one of the following intravenous agents is the best INITIAL management for hypercalcemic crisis? * Furosemide * Pamidronate * Hydrocortisone * Saline ## 96 A postmenopausal female presents with a recent onset of painless vaginal bleeding. Her pelvic examination is normal and all previous PAP smears were normal. Which one of the following management options is the preferred next diagnostic step? * Colposcopy with endocervical curettage * Transvaginal ultrasonography * Saline infusion sonohysterography * Hysteroscopy ## 97 Which one of the following is true about acute COPD exacerbation * Systemic corticosteroid therapy reduces the hospital length of stay in patients * Oral therapy has been shown to be much less effective as the intravenous route * A randomized, controlled trial has demonstrated that 5-day courses of systemic corticosteroid therapy are less effective than 14-day courses * nebulizers generally offer significant advantages over metered-dose inhalers in most patients. ## 98 A 75-year-old woman is admitted because of mild heart failure. She is acutely symptomatic with dyspnea. Her heart rate is 96 beats/min, blood pressure of 140/90 mm Hg, and an oxygen saturation of 94% on room air. A chest radiograph shows mild pulmonary congestion. What is your recommendation regarding placement of an indwelling urinary catheter for accurate measurement of urine output and for patient comfort? * Avoiding indwelling urinary catheter placement * Placement of an indwelling urinary catheter only until initial diuresis is completed * Placement of an indwelling urinary catheter overnight * Placement of an indwelling urinary catheter and removal within 24 hours ## 99 A 75-year-old male with a history of hypertension has a TIA episode resolved spontaneously within 20 minutes. Carotid Doppler ultrasonography and cerebral angiography both reveal significant carotid stenosis. In addition to starting aspirin, which one of the following would be the most appropriate next step for this patient? * Aggressive lowering of blood pressure * Clopidogrel * Carotid artery stenting * Evaluation for occult patent ductus arteriosus * High-dose statin therapy ## 100 Which one of the following is the most accurate imaging study for assessing early osteomyelitis? * Plain radiography * Ultrasonography * CT * MRI * A bone scan ## 101 Which one of the following should be ordered to evaluate the patient for hereditary hemochromatosis? * A serum iron panel, including a serum ferritin level and transferrin saturation * An a-fetoprotein (AFP) level * HFE genetic testing * Hepatic ultrasonography * A liver biopsy ## 102 Which one of the following is recommended for the initial management of a 4 year old male child with ADHD? * Behavioral treatment alone * Methylphenidate (Ritalin) alone * Atomoxetine (Strattera) alone * Methylphenidate combined with behavioral treatment * Methylphenidate combined with atomoxetine ## 103 Azithromycin should be used with caution in a 65-year-old male with coronary artery disease due to an increased risk for * an adverse effect on left ventricular function * peripheral edema * elevation of systolic blood pressure * fatal arrhythmias ## 104 Which one of the following intranasal medications is considered optimal treatment for a young man with known seasonal allergic rhinitis every autumn who presents to you in September with runny nose. * Glucocorticoids * Cromolyn sodium * Decongestants * Antihistamines ## 105 A 30 year old construction worker fell down on his anterolateral leg from a 3 meter high scaffold 5 hours prior to presentation to emergency. On exam the anterolateral lower leg is quite tender but only slightly swollen, and there is exquisite pain in that area with passive plantar flexion of the great toe. X-Rays and rest of the exam are negative. Which one of the following would be most appropriate? * Scheduled oral muscle relaxants * A 6-day oral corticosteroid taper * Physical therapy referral for early mobilization and ultrasound therapy * A short leg splint and non-weight bearing for 5-7 days * Urgent orthopedic referral for possible fasciotomy ## 106 Which one of the following diseases is associated with Erythema Nodosum? * Celiac disease * Crohn's disease * Diverticular disease * Irritable bowel syndrome * Clostridium difficile colitis ## 107 Postmenopausal hormonal therapy with estrogen and progesterone results in a decrease in which one of the following * Ischemic heart disease * Dementia * All-cause mortality * Breast cancer * Hip fracture ## 108 TSH receptor site antibodies would indicate which one of the following as the cause of thyroid gland enlargement? * Toxic multinodular goiter * Toxic adenoma * Hashimoto's (lymphadenoid) thyroiditis * Subacute (giant cell) thyroiditis * Graves disease ## 109 You suspect a patient to be low risk for deep vein thrombosis, which test is preferred to rule it out? * Compression ultrasonography * D-dimer assessment * Contrast venography * Impedance plethysmography ## 110 A 4-month-old female is brought to your office by her parents for a 3-day history of fever up to 38.7°C. She is fussy and her oral intake is down. She has no rash, no emesis, and no diarrhea. Her urine output is normal. On examination she is alert but fussy. Her rectal temperature is 38.4°C. The examination is otherwise normal and there are no focal findings of infection. The parents are reliable and you choose to manage the baby as an outpatient. Which one of the following tests is likely to be most helpful in this situation? * A CBC with manual differential * A urinalysis and urine culture * A chest radiograph * C-reactive protein * A lumbar puncture