07-16-2015, 07:58 AM
Here are some qs from the Medicine test form 1. Thanks to @liaison4fun for the help!!!!
For each patient with jaundice, select the most likely diagnosis.
A) Acute hepatitis
B) a1-Antitrypsin deficiency
C) Biliary atresia
D) Cholangiocarcinoma
E) Choledocholithiasis
F) Gi I bert syndrome
® G) Glucose 6-phosphate dehydrogenase deficiency
H) Liver abscess
I) Peptic ulcer disease
1. Two days after undergoing surgical repair of a torn anterior cruciate ligament, a 24-year-old man develops jaundice. He has not had fever, nausea, vomiting, or abdominal pain.
Examination shows no abnormalities except for mild scleral icterus. Laboratory studies show:
Hemoglobin
Serum
Bili rubin, total
Direct
Alkaline phosphatase
AST
ALT
Lactate dehydrogenase
16 g/dL
3.5 mg/dL
0.2 mg/dL
38 U/L
14 U/L
12 U/L
120 U/L
3. A 52-year-old woman with breast cancer is brought to the emergency department 8 hours after the onset of temperatures to 39.4•c (1 03.F), shaking chills, and generalized malaise. She
has been receiving chemotherapy via an indwelling central venous catheter for 2 months; her last treatment was 3 weeks ago. She was treated in the hospital 1 month ago for pneumonia.
She had diarrhea 2 days ago. Current medications include prochlorperazine as needed, lorazepam, and sertraline. She appears acutely ill. Her temperature is 39ZC (1 02SF), pulse is
120/min, respirations are 24/min, and blood pressure is 90/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Examination shows no erythema surrounding the
catheter site. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard best at the upper left sternal border without radiation. Laboratory studies show:
Leukocyte count 3200/mm3
Segmented neutrophils 70%
Bands 10%
Lymphocytes 12%
Monocytes 8%
Urine
RBC
WBC
Bacteria
2/hpf
2/hpf
occasional
An x-ray of the chest shows no abnormalities. In addition to ceftazidime, empiric antibiotic therapy for this patient should include which of the following medications?
A) lmipenem
B) Levofloxacin
C) Metronidazole
D) Nafcillin
E) Vancomycin
@ F) No additional antibiotics are indicated
A 57-year-old man comes to the physician because of a 3-month history of moderate left leg pain that began at the knee and now involves the entire left leg. He has no history of leg trauma.
He has hypertension well controlled with a {3-adrenergic blocking agent. His only other medication is acetaminophen as needed, which does not relieve his pain. His blood pressure is
130/80 mm Hg. Examination shows warmth and tenderness to palpation over the left anterior tibia. Sensation and motor function are intact. Distal pulses are 1 +.An x-ray of the left leg
shows increased cortical thickness along the tibia with slight anterior bowing; there is no periosteal reaction. His serum alkaline phosphatase activity is 100 U/L. A whole-body bone scan
shows several areas of increased uptake, including the tibial region. Which of the following is the most likely cause of these findings?
® A) Areas of spindle cells and dysplastic bone
B) Decreased bone mineralization
C) Decreased osteoid production
D) Increased bone turnover
E) Trabecular microfractures
An unconscious 25-year-old man is brought to the emergency department 15 minutes after his neighbor found him lying in the street. The neighbor reports that the patient was jogging
before falling to the ground. The patient is wearing a medic alert bracelet that states that he has type 1 diabetes mellitus. No other history can be obtained. There is no evidence of trauma.
He does not respond to verbal stimuli but moans and thrashes in response to painful stimuli. His temperature is 3r C (98.6.F), pulse is 90/min, respirations are 12/min, and blood pressure
is 122/70 mm Hg. Examination shows no other abnormalities. Which of the following is the most appropriate next step in management?
A) Urine to xi co logy screening
B) MRI of the brain
C) Administration of a bolus of insulin
D) Admi ni strati on of 50% dextrose in water
@ E) Rapid infusion of 1 L of 0.9% saline
F) Lumbar puncture
10. An African American husband and wife come to the physician for advice concerning their risk for having children with sickle cell disease. The wife has hemoglobin A on screening; the
husband has not been screened. This couple's risk for having offspring with sickle cell disease is closest to which of the following?
A) O%
B) 25%
C) 50%
D) 75%
@ E) Unable to be determined without screening of the husband
12. A 25-year-old man who is HIV positive comes to the physician because of a 3-week history of cough and wheezing. He stopped taking his antiretroviral therapy 6 months ago because of
adverse effects, and he has had an increasing plasma HIV viral load since then. He has required treatment with prednisone for immune thrombocytopenia over the past 2 months with
improvement of his platelet count from 25,000/mm3to 1 OO,OOO/mm3. His temperature is 38.9•c (1 02.F), pulse is 95/min, respirations are 30/min, and blood pressure is 100/60 mm Hg.
Examination shows shotty bilateral cervical adenopathy. There is dullness to percussion over the left upper posterior thorax, and rhonchi are heard over the same area. Laboratory studies
show:
Hematocrit
Leukocyte count
Segmented neutrophils
Bands
Eosinophils
Monocytes
Platelet count
30%
10,000/mm3
70%
5%
10%
15%
1 OO,OOO/mm3
An x-ray of the chest shows a nodular density in the left upper lung field posteriorly. Which of the following is most likely to confirm the diagnosis?
A) Examination of duodenal aspirate
B) Examination of the stool for ova and parasites
C) Toxoplasmosis titers
D) Blood cultures
E) Biopsy and culture of the lung mass
@ F) Lymph node biopsy
For each patient with jaundice, select the most likely diagnosis.
A) Acute hepatitis
B) a1-Antitrypsin deficiency
C) Biliary atresia
D) Cholangiocarcinoma
E) Choledocholithiasis
F) Gi I bert syndrome
® G) Glucose 6-phosphate dehydrogenase deficiency
H) Liver abscess
I) Peptic ulcer disease
1. Two days after undergoing surgical repair of a torn anterior cruciate ligament, a 24-year-old man develops jaundice. He has not had fever, nausea, vomiting, or abdominal pain.
Examination shows no abnormalities except for mild scleral icterus. Laboratory studies show:
Hemoglobin
Serum
Bili rubin, total
Direct
Alkaline phosphatase
AST
ALT
Lactate dehydrogenase
16 g/dL
3.5 mg/dL
0.2 mg/dL
38 U/L
14 U/L
12 U/L
120 U/L
3. A 52-year-old woman with breast cancer is brought to the emergency department 8 hours after the onset of temperatures to 39.4•c (1 03.F), shaking chills, and generalized malaise. She
has been receiving chemotherapy via an indwelling central venous catheter for 2 months; her last treatment was 3 weeks ago. She was treated in the hospital 1 month ago for pneumonia.
She had diarrhea 2 days ago. Current medications include prochlorperazine as needed, lorazepam, and sertraline. She appears acutely ill. Her temperature is 39ZC (1 02SF), pulse is
120/min, respirations are 24/min, and blood pressure is 90/50 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 99%. Examination shows no erythema surrounding the
catheter site. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard best at the upper left sternal border without radiation. Laboratory studies show:
Leukocyte count 3200/mm3
Segmented neutrophils 70%
Bands 10%
Lymphocytes 12%
Monocytes 8%
Urine
RBC
WBC
Bacteria
2/hpf
2/hpf
occasional
An x-ray of the chest shows no abnormalities. In addition to ceftazidime, empiric antibiotic therapy for this patient should include which of the following medications?
A) lmipenem
B) Levofloxacin
C) Metronidazole
D) Nafcillin
E) Vancomycin
@ F) No additional antibiotics are indicated
A 57-year-old man comes to the physician because of a 3-month history of moderate left leg pain that began at the knee and now involves the entire left leg. He has no history of leg trauma.
He has hypertension well controlled with a {3-adrenergic blocking agent. His only other medication is acetaminophen as needed, which does not relieve his pain. His blood pressure is
130/80 mm Hg. Examination shows warmth and tenderness to palpation over the left anterior tibia. Sensation and motor function are intact. Distal pulses are 1 +.An x-ray of the left leg
shows increased cortical thickness along the tibia with slight anterior bowing; there is no periosteal reaction. His serum alkaline phosphatase activity is 100 U/L. A whole-body bone scan
shows several areas of increased uptake, including the tibial region. Which of the following is the most likely cause of these findings?
® A) Areas of spindle cells and dysplastic bone
B) Decreased bone mineralization
C) Decreased osteoid production
D) Increased bone turnover
E) Trabecular microfractures
An unconscious 25-year-old man is brought to the emergency department 15 minutes after his neighbor found him lying in the street. The neighbor reports that the patient was jogging
before falling to the ground. The patient is wearing a medic alert bracelet that states that he has type 1 diabetes mellitus. No other history can be obtained. There is no evidence of trauma.
He does not respond to verbal stimuli but moans and thrashes in response to painful stimuli. His temperature is 3r C (98.6.F), pulse is 90/min, respirations are 12/min, and blood pressure
is 122/70 mm Hg. Examination shows no other abnormalities. Which of the following is the most appropriate next step in management?
A) Urine to xi co logy screening
B) MRI of the brain
C) Administration of a bolus of insulin
D) Admi ni strati on of 50% dextrose in water
@ E) Rapid infusion of 1 L of 0.9% saline
F) Lumbar puncture
10. An African American husband and wife come to the physician for advice concerning their risk for having children with sickle cell disease. The wife has hemoglobin A on screening; the
husband has not been screened. This couple's risk for having offspring with sickle cell disease is closest to which of the following?
A) O%
B) 25%
C) 50%
D) 75%
@ E) Unable to be determined without screening of the husband
12. A 25-year-old man who is HIV positive comes to the physician because of a 3-week history of cough and wheezing. He stopped taking his antiretroviral therapy 6 months ago because of
adverse effects, and he has had an increasing plasma HIV viral load since then. He has required treatment with prednisone for immune thrombocytopenia over the past 2 months with
improvement of his platelet count from 25,000/mm3to 1 OO,OOO/mm3. His temperature is 38.9•c (1 02.F), pulse is 95/min, respirations are 30/min, and blood pressure is 100/60 mm Hg.
Examination shows shotty bilateral cervical adenopathy. There is dullness to percussion over the left upper posterior thorax, and rhonchi are heard over the same area. Laboratory studies
show:
Hematocrit
Leukocyte count
Segmented neutrophils
Bands
Eosinophils
Monocytes
Platelet count
30%
10,000/mm3
70%
5%
10%
15%
1 OO,OOO/mm3
An x-ray of the chest shows a nodular density in the left upper lung field posteriorly. Which of the following is most likely to confirm the diagnosis?
A) Examination of duodenal aspirate
B) Examination of the stool for ova and parasites
C) Toxoplasmosis titers
D) Blood cultures
E) Biopsy and culture of the lung mass
@ F) Lymph node biopsy