06-15-2010, 07:25 AM
A 3-year-old boy is brought for a follow-up examination. He just completed a 10-day course of
amoxicillin that has not resolved his right ear pain. He appears irritable. His temperature is 38.9 C
(102 F). Examination shows downward and lateral displacement of the right auricle with tenderness
to palpation of the posterior auricular area; his neck is supple. Which of the following is the most
appropriate next step in diagnosis?
A
) Bone scan
B
) CT scan of the head
C
) Tympanometry
D
) Lumbar puncture
E
) Tympanocentesis
2)A 77-year-old woman comes to the physician because of low back pain for 3 months. She has
hypertension controlled with a calcium-channel blocking agent and type 2 diabetes mellitus
controlled with diet. Her vital signs are within normal limits. Examination shows no spinal or
costovertebral angle tenderness; straight-leg raising produces pain in the low back at the L2“4
range. Knee jerk and ankle reflexes are 2+ bilaterally. Babinski's sign is absent bilaterally. Urinalysis
shows 5“10 epithelial cells/hpf, 2“5 leukocytes/hpf, and few bacteria. Which of the following is the
most appropriate pharmacotherapy?
A
) Acetaminophen
B
) Gold
C
) Methotrexate
D
) Prednisone
E
) Probenecid
3)A 32-year-old woman who is HIV positive has a CD4+ lymphocyte count of 800/mm3 (Normal ≥
500). Her health maintenance regimen should include immunization against which of the following
pathogens?
A
) Haemophilus influenzae type b
B
) Hepatitis A
C
) Influenza virus
D
) Neisseria meningitidis
E
) Streptococcus pyogenes (group A)
4)For each patient with papilledema, select the most likely diagnosis.
A
) Bacterial meningitis
B
) Cerebral infarction
C
) Cryptococcal meningitis
D
) Glioblastoma multiforme
E
) Herpes simplex encephalitis
F
) Hypertensive encephalopathy
G
) Idiopathic intracranial hypertension
H
) Intracerebral hemorrhage
I
) St. Louis encephalitis
5)19. A 25-year-old man with a history of intravenous drug use comes to the emergency department
because of a progressive diffuse headache, generalized malaise, and low-grade fever for 2 months.
During this period, he has had a poor appetite resulting in a 6.8-kg (15-lb) weight loss. His
temperature is 38 C (100.4 F). Examination shows ¬¬neck stiffness. Mental status examination
shows no abnormalities. Cranial nerve examination shows weakness of the lateral rectus muscle on
the right and bilateral papilledema. A CT scan of the head with and without contrast shows
moderate ventricular enlargement. Examination of cerebrospinal fluid shows:
Opening pressure 220 mm H2O
Glucose 35 mg/dL
Protein 150 mg/dL
WBC 100/mm3
Lymphocytes 100%
RBC 1/mm
6)A 24-year-old man is brought to the emergency department by police 1 hour after his ex-wife
found him stumbling around in the yard. His blood pressure is 100/70 mm Hg, pulse is 90/min, and
respirations are 16/min. The pupils are equal and reactive to light; the sclerae are injected. During
the examination, he laughs without obvious reason, makes religious statements, and asks if there is
anything to eat or drink. Mental status examination shows a broad range of affect; there is no
evidence of thought disorder except for mild paranoia. Which of the following is the most
appropriate next step in management?
A
) Observation in the emergency department
B
) Intramuscular administration of naloxone
C
) Intravenous administration of 50% dextrose
D
) Intravenous administration of lorazepam
E
) Oral administration of chlorpromazine
7)A 30-year-old woman, gravida 2, para 1, is brought to the emergency department in labor. An
episiotomy is performed. Following delivery of the head, the shoulders do not follow with the usual
traction and maternal pushing. Which of the following is the most appropriate next step in
management?
A
) Flexing the woman's knees toward her shoulders
B
) More forceful traction and fundal pressure
C
) Delivering the posterior arm
D
) Rotating the head 180 degrees
E
) Symphysiotomy
8)32-year-old man comes to the physician because of a 3-day history of low back pain, urinary
hesitancy, and pain with urination. He has had several similar episodes over the past 3 years. He
has not had any urethral discharge or recent sexual contacts. His temperature is 37.2 C (98.9 F),
and blood pressure is 126/76 mm Hg. The lungs are clear to auscultation; there is no costovertebral
angle tenderness. Abdominal examination shows no tenderness or masses. There is no tenderness
to palpation of the lower back. Straight-leg raising to 90 degrees is negative. There are no motor or
sensory deficits in the lower extremities. Rectal examination shows a diffuse, minimally enlarged,
tender prostate with no masses. Laboratory studies show:
Serum prostate-specific antigen 6 ng/mL (N
amoxicillin that has not resolved his right ear pain. He appears irritable. His temperature is 38.9 C
(102 F). Examination shows downward and lateral displacement of the right auricle with tenderness
to palpation of the posterior auricular area; his neck is supple. Which of the following is the most
appropriate next step in diagnosis?
A
) Bone scan
B
) CT scan of the head
C
) Tympanometry
D
) Lumbar puncture
E
) Tympanocentesis
2)A 77-year-old woman comes to the physician because of low back pain for 3 months. She has
hypertension controlled with a calcium-channel blocking agent and type 2 diabetes mellitus
controlled with diet. Her vital signs are within normal limits. Examination shows no spinal or
costovertebral angle tenderness; straight-leg raising produces pain in the low back at the L2“4
range. Knee jerk and ankle reflexes are 2+ bilaterally. Babinski's sign is absent bilaterally. Urinalysis
shows 5“10 epithelial cells/hpf, 2“5 leukocytes/hpf, and few bacteria. Which of the following is the
most appropriate pharmacotherapy?
A
) Acetaminophen
B
) Gold
C
) Methotrexate
D
) Prednisone
E
) Probenecid
3)A 32-year-old woman who is HIV positive has a CD4+ lymphocyte count of 800/mm3 (Normal ≥
500). Her health maintenance regimen should include immunization against which of the following
pathogens?
A
) Haemophilus influenzae type b
B
) Hepatitis A
C
) Influenza virus
D
) Neisseria meningitidis
E
) Streptococcus pyogenes (group A)
4)For each patient with papilledema, select the most likely diagnosis.
A
) Bacterial meningitis
B
) Cerebral infarction
C
) Cryptococcal meningitis
D
) Glioblastoma multiforme
E
) Herpes simplex encephalitis
F
) Hypertensive encephalopathy
G
) Idiopathic intracranial hypertension
H
) Intracerebral hemorrhage
I
) St. Louis encephalitis
5)19. A 25-year-old man with a history of intravenous drug use comes to the emergency department
because of a progressive diffuse headache, generalized malaise, and low-grade fever for 2 months.
During this period, he has had a poor appetite resulting in a 6.8-kg (15-lb) weight loss. His
temperature is 38 C (100.4 F). Examination shows ¬¬neck stiffness. Mental status examination
shows no abnormalities. Cranial nerve examination shows weakness of the lateral rectus muscle on
the right and bilateral papilledema. A CT scan of the head with and without contrast shows
moderate ventricular enlargement. Examination of cerebrospinal fluid shows:
Opening pressure 220 mm H2O
Glucose 35 mg/dL
Protein 150 mg/dL
WBC 100/mm3
Lymphocytes 100%
RBC 1/mm
6)A 24-year-old man is brought to the emergency department by police 1 hour after his ex-wife
found him stumbling around in the yard. His blood pressure is 100/70 mm Hg, pulse is 90/min, and
respirations are 16/min. The pupils are equal and reactive to light; the sclerae are injected. During
the examination, he laughs without obvious reason, makes religious statements, and asks if there is
anything to eat or drink. Mental status examination shows a broad range of affect; there is no
evidence of thought disorder except for mild paranoia. Which of the following is the most
appropriate next step in management?
A
) Observation in the emergency department
B
) Intramuscular administration of naloxone
C
) Intravenous administration of 50% dextrose
D
) Intravenous administration of lorazepam
E
) Oral administration of chlorpromazine
7)A 30-year-old woman, gravida 2, para 1, is brought to the emergency department in labor. An
episiotomy is performed. Following delivery of the head, the shoulders do not follow with the usual
traction and maternal pushing. Which of the following is the most appropriate next step in
management?
A
) Flexing the woman's knees toward her shoulders
B
) More forceful traction and fundal pressure
C
) Delivering the posterior arm
D
) Rotating the head 180 degrees
E
) Symphysiotomy
8)32-year-old man comes to the physician because of a 3-day history of low back pain, urinary
hesitancy, and pain with urination. He has had several similar episodes over the past 3 years. He
has not had any urethral discharge or recent sexual contacts. His temperature is 37.2 C (98.9 F),
and blood pressure is 126/76 mm Hg. The lungs are clear to auscultation; there is no costovertebral
angle tenderness. Abdominal examination shows no tenderness or masses. There is no tenderness
to palpation of the lower back. Straight-leg raising to 90 degrees is negative. There are no motor or
sensory deficits in the lower extremities. Rectal examination shows a diffuse, minimally enlarged,
tender prostate with no masses. Laboratory studies show:
Serum prostate-specific antigen 6 ng/mL (N