06-10-2014, 08:15 AM
1)A 4-year-old boy develops chickenpox 8 hours after visiting his newborn sister in the nursery. Six other full-term newborns were also exposed. all of the mothers have a history of chickenpox prior to pregnancy. Which of the following is the most appropriate recommendation to prevent chickenpox in the newborns ?
A Acyclovir therapy for all exposed newborns
B Administration of varicella vaccine to all exposed newborns
C Administration of varicella vaccine to newborns with negative varicella titers
D Isolation of the newborns from each other
2)A 4-year-old girl is brought to the physician because of cough and a 2.3-kg (5-lb) weight loss during the past 2 months. There is no history of serious illness, and she takes no medications. Immunizations are up-to-date. She is at the 50th percentile for height and 25th percentile for weight. Occasional crackles are heard over the right middle lung field. Intradermal skin testing with PPD, tetanus toxoid, and antigens for Candida Albicans and Trichophyton Tonsurans is nonreactive at 72 hours. Her leukocyte count is 5100/mm3. Nucleic acid hybridization testing of gastric aspirates shows Mycobacterium tuberculosis. Which of the following is the most likely explanation for this patient's findings ?
A ) Antibody deficiency
B ) Complement deficiency
C ) Impaired chemotaxis
D ) Impaired respiratory burst
E ) Neutropenia
F ) Splenic dysfunction
G ) T-lymphocyte dysfunction
E No intervention is necessary
3)An afebrile 32-year-old woman comes to the physician because of cramping abdominal pain and watery stools for 4 days. Examination shows no abnormalities. Her hemoglobin concentration is 12.5 g/dL, and leukocyte count is 8500/mm3. Examination of the stool shows no neutrophils. Which of the following is the most likely causal organism ?
A ) Enterotoxic Escherichia coli
B ) Listeria monocytogenes
C ) Shigella species
D ) Staphylococcus aureus
E ) Yersinia enterocolitica
4)A 42year-old woman comes to the physician because of intermittent loss of small amounts of urine over the past 3 weeks. Her symptoms occur only after voiding; she is otherwise asymptomatic. Pelvic examination shows a 3cm, midline, cystic, tender mass in the midthird of the vagina. Urinalysis is within normal limits. Her postvoid residual volume is 50 mL. Which of the following is the most likely diagnosis ?
A ) Interstitial cystitis
B ) Neurogenic bladder
C ) Stress incontinence
D ) Urethral diverticulum
E ) Urethral syndrome
F ) Urinary tract infection
G ) Vesicovaginal fistula
5)Three days after undergoing total hip replacement, a 50year-old man is unable to move his legs and has urinary incontinence. His symptoms began immediately following removal of an epidural catheter that was inserted for pain control. His medications include Ketorolac, Enoxaparin, and Morphine. Which of the following is the most likely diagnosis ?
A ) Centrally herniated nucleus pulposus
B ) Dural laceration
C ) Epidural hematoma
D ) Residual neurologic blockade from long-acting anesthetic agents
E ) Transverse myelitis
6)A 77year old man is brought to the physician by family members because of progressive forgetfulness over the past 2 years. He rarely leaves the house and will no longer care for himself. His temperature is 36.2°C (97.2°F), pulse is 52/min, and blood pressure is 110/90 mm Hg. Abdominal examination shows no ascites. The liver is palpable 3 cm below the right costal margin. There is 2+ nonpitting edema of the lower extremities. Deep tendon reflexes are 1+, and sensation is intact. His gait is slow. He appears uninterested and responds to questions slowly. His Mini-Mental State Examination score is 20/30. Serum studies show -
Na+ 131 mEq/L
K+ 3.9 mEq/L
Creatinine 1.2 mg/dL
Alkaline phosphatase 160 U/L
AST 80 U/L
Which of the following is the most likely cause of this patient's symptoms?
A ) Huntington disease
B ) Hypothyroidism
C ) Multi-infarct (vascular) dementia
D ) Pernicious anemia
E ) Syphilis
7)A previously healthy 82year old woman comes to the physician because she is concerned that she has Parkinson disease. Over the past 6 months, she has had occasional difficulty finding the word that she wants to use, and her ability to distinguish smells has decreased. She reports that her reaction time to shifts in posture seems slow, and she needs to use a handrail to steady herself while walking on stairs. She lives alone and is able to manage her own finances. The pupils are 3 mm. There is mild reduction of upward gaze and brisk rotatory nystagmus on left lateral gaze. Audiometry shows mild high-frequency hearing loss. There are no tremors or rigidity. Her gait is normal. Her Mini-Mental State Examination score is 29/30. Which of the following neurologic findings warrants further evaluation ?
A ) Brisk rotatory nystagmus on left lateral gaze
B ) Decreased sense of smell
C ) Decreased upward gaze
D ) High-pitched tone hearing loss
E ) Small symmetric pupils
A Acyclovir therapy for all exposed newborns
B Administration of varicella vaccine to all exposed newborns
C Administration of varicella vaccine to newborns with negative varicella titers
D Isolation of the newborns from each other
2)A 4-year-old girl is brought to the physician because of cough and a 2.3-kg (5-lb) weight loss during the past 2 months. There is no history of serious illness, and she takes no medications. Immunizations are up-to-date. She is at the 50th percentile for height and 25th percentile for weight. Occasional crackles are heard over the right middle lung field. Intradermal skin testing with PPD, tetanus toxoid, and antigens for Candida Albicans and Trichophyton Tonsurans is nonreactive at 72 hours. Her leukocyte count is 5100/mm3. Nucleic acid hybridization testing of gastric aspirates shows Mycobacterium tuberculosis. Which of the following is the most likely explanation for this patient's findings ?
A ) Antibody deficiency
B ) Complement deficiency
C ) Impaired chemotaxis
D ) Impaired respiratory burst
E ) Neutropenia
F ) Splenic dysfunction
G ) T-lymphocyte dysfunction
E No intervention is necessary
3)An afebrile 32-year-old woman comes to the physician because of cramping abdominal pain and watery stools for 4 days. Examination shows no abnormalities. Her hemoglobin concentration is 12.5 g/dL, and leukocyte count is 8500/mm3. Examination of the stool shows no neutrophils. Which of the following is the most likely causal organism ?
A ) Enterotoxic Escherichia coli
B ) Listeria monocytogenes
C ) Shigella species
D ) Staphylococcus aureus
E ) Yersinia enterocolitica
4)A 42year-old woman comes to the physician because of intermittent loss of small amounts of urine over the past 3 weeks. Her symptoms occur only after voiding; she is otherwise asymptomatic. Pelvic examination shows a 3cm, midline, cystic, tender mass in the midthird of the vagina. Urinalysis is within normal limits. Her postvoid residual volume is 50 mL. Which of the following is the most likely diagnosis ?
A ) Interstitial cystitis
B ) Neurogenic bladder
C ) Stress incontinence
D ) Urethral diverticulum
E ) Urethral syndrome
F ) Urinary tract infection
G ) Vesicovaginal fistula
5)Three days after undergoing total hip replacement, a 50year-old man is unable to move his legs and has urinary incontinence. His symptoms began immediately following removal of an epidural catheter that was inserted for pain control. His medications include Ketorolac, Enoxaparin, and Morphine. Which of the following is the most likely diagnosis ?
A ) Centrally herniated nucleus pulposus
B ) Dural laceration
C ) Epidural hematoma
D ) Residual neurologic blockade from long-acting anesthetic agents
E ) Transverse myelitis
6)A 77year old man is brought to the physician by family members because of progressive forgetfulness over the past 2 years. He rarely leaves the house and will no longer care for himself. His temperature is 36.2°C (97.2°F), pulse is 52/min, and blood pressure is 110/90 mm Hg. Abdominal examination shows no ascites. The liver is palpable 3 cm below the right costal margin. There is 2+ nonpitting edema of the lower extremities. Deep tendon reflexes are 1+, and sensation is intact. His gait is slow. He appears uninterested and responds to questions slowly. His Mini-Mental State Examination score is 20/30. Serum studies show -
Na+ 131 mEq/L
K+ 3.9 mEq/L
Creatinine 1.2 mg/dL
Alkaline phosphatase 160 U/L
AST 80 U/L
Which of the following is the most likely cause of this patient's symptoms?
A ) Huntington disease
B ) Hypothyroidism
C ) Multi-infarct (vascular) dementia
D ) Pernicious anemia
E ) Syphilis
7)A previously healthy 82year old woman comes to the physician because she is concerned that she has Parkinson disease. Over the past 6 months, she has had occasional difficulty finding the word that she wants to use, and her ability to distinguish smells has decreased. She reports that her reaction time to shifts in posture seems slow, and she needs to use a handrail to steady herself while walking on stairs. She lives alone and is able to manage her own finances. The pupils are 3 mm. There is mild reduction of upward gaze and brisk rotatory nystagmus on left lateral gaze. Audiometry shows mild high-frequency hearing loss. There are no tremors or rigidity. Her gait is normal. Her Mini-Mental State Examination score is 29/30. Which of the following neurologic findings warrants further evaluation ?
A ) Brisk rotatory nystagmus on left lateral gaze
B ) Decreased sense of smell
C ) Decreased upward gaze
D ) High-pitched tone hearing loss
E ) Small symmetric pupils