03-24-2016, 01:43 PM
PLEASE HELP!!! My medicine shelf exam is tomorrow. Any help (answer and explanation if possible) would be deeply appreciated!!!!!!
1. A 72 year old woman is brought to the ED by her daughter because of a 3 day history of progressive confusion and lethargy. She underwent bilateral hip replacement 6 years ago. She takes no medications except for aspirin as needed for osteoarthritis. She is unable to answer questions. Her temperature is 36.2C, pulse is 110/min and regular, respirations are 20/min and BP is 110/70. Exam shows a supple neck. The lungs are clear to auscultation. Cardiac exam shows no murmurs or gallops. The abdomen is soft with no guarding, bowel sounds are present but hypoactive. Deep tendon reflexes are 1+ bilaterally. Babinski sign is absent. Serum studies show
Na 135
Cl 100
K 4.2
HCO3 22
Urea nitrogen 52
Glucose 602
Creatinine 2.4
Which of the following is the most likely diagnosis?
A alcoholic keotacidosis
B central diabetes insipidus
C diabetic ketoacidosis (wrong)
D lactic acidosis
E myxedema
F nephrogenic diabetic insipidus
G nonketotic hyperosmolar state
H salicylate toxicity
I SIADH
2. 42 year old man is brought to the ED because of sudden onset of worsening headache and L sided weakness 1 hour ago. He has no history of serious illness and has not seen a physician for 10 years. He has smoked one pack of cigarettes daily for 25 years and drinks six beers daily. He is 5 ft 11in and 215Ib. BMI is 30. His pulse is 80/min, BP is 180/120. Exam shows mild to moderate weakness of the L lower aspect of the face. Muscle strength is decreased in the L upper and L lower extremities. Funduscopic exam shows an atervenous ratio of 1:3 and regions of mild focal spasm of some arterioles. Results of a CBC, platelet count and coagulation studies are normal. His serum total cholesterol concentration is 400mg/dL. A CT scan of the head shows a 1.5 x 2 cm region of hyperintensity centered at the R putamen, there is mild surrounding lucency. Which of the following is most likely to decrease this patient's risk for a recurrent stroke of this type?
A alcohol cessation
B smoking cessation
C weight loss
D atorvastatin therapy
E clopidogrel therapy (wrong)
F lisinopril therapy
3. A 22 yo man comes to the physician because of swelling of the neck for 1 month and malaise, fever, fatigue, night sweats, and generalized pruritis for 2 weeks. Acetaminophen has provided only minimal relief of his symptoms. His temperature is 38.3C, pulse is 90, respiration 16, BP 100/67. There is a 3x4cm L anterior cervical lymph node. Conjunctivae are not injected, and the tympanic membranes and pharynx are not erythematous. The lungs are clear to auscultation. A grade 1/6, nonradiating systolic murmur is heard best at the upper R sternal border. Bowel sounds are slightly hyperactive. Lab studies show:
Hg 15
Leukocyte count 6000
- segmented neutrophils 60%
- bands 2%
- eosinophils 1%
- lymphocytes 33%
- monocytes 4%
Which of the following is the most likely diagnosis?
A acute lymphocytic leukemia (ALL)
B cat scratch disease
C CLL
D drug reaction
E gastric carcinoma
F HIV infection
G hodgkin disease
H infectious mononucleosis (wrong)
I rubella
J sarcoidosis
K syphilis
L SLE
M TB
4. A 68 yo man is brought to the ED because of severe substernal chest pain for 2 hours and severe SOB for 30 minutes. He has a history of type II diabetes treated with an oral hypoglycemic agent and hypertension treated with a diuretic. His temp is 37.5C, pulse 104, respirations 28, and BP is 100/78. JVP is increased. Bilateral crackles are heard throughout all lung fields. An S3 and S4 gallop are heard. Pulse oximetry on room air shows an oxygen saturation of 88%. An Xray of the chest shows bilateral perihilar infiltrates and a slightly enlarged cardiac silhouette. An EKG shows ST segment elevation and T wave inversion in leads V2 to V6. Which of the following is the most likely diagnosis?
A acute pericarditis (wrong)
B MI
C pericardial tamponade
D pneumonia
E PE
5. A 42 yo woman comes to the physician because of a 3 day history of dizziness and progressive difficulty with balance. She has been supporting herself against walls when she walks. She has not had numbness, weakness or palpitations. She has had nausea and a mild decrease in appetite but is able to drink fluids. There is no history of head trauma. She has mitral valve prolapse. She take no meds. Her sister has multiple sclerosis. Vital signs are normal. The optic disc appear normal and ocular movements are full. Tympanic membranes are dull bilaterally. The light reflex is distorted. There is no exudates on the pharynx. A grade 2/6 systolic murmur is heard best at the lower left sternal border. Muscle strength and deep tendon reflexes are normal. Her gait is unsteady. Which of the following is the most likely diagnosis?
A acoustic neuroma (vestibular schwannoma) (wrong)
B cerebral infarction
C dehydration
D endocarditis
E labyrinthitis
F multiple sclerosis
6. A 64 yo woman with a 4 year history of Type II diabetes controlled with insulin comes to the ED because of exertional chest pressure for 3 weeks. The first episode occurred while she was walking upstairs and was relieved by 5 minutes of rest. The second episode occurred 1 week ago while she was mowing the lawn and was relieved after 10 minutes of rest. She had two episodes yesterday, each lasting 15 minutes, both occurred with exertion and were accompanied by SOB and nausea. Today she had a 10 minute episode starting while she was in the shower and another while she was walking into the ED. Exam and an EKG show no abnormalities. Which of the following is the most appropriate next step in management?
A self monitoring of blood glucose concentration during the next episode of chest pain
B dipyridamole thallium 201 scintography
C exercise stress test within 24 hours (wrong)
D antianginal drug therapy now and an exercise stress test in 5 days
E admit the patient to the hospital
7. A 77 yo woman comes to the Ed because of a 3 month history of SOB when she climbs stairs. Her SOB resolves after 5 minutes of rest. Her last episode was 3 days ago. She has not had chest pain, palpitations, orthopnea, cough, wheezing, swelling, or difficulty sleeping. She has HTN and GERD. Current meds include HCTZ, omeprazole, and a multivitamin. BMI is 23. Her temperature is 37.2, pulse 72, respirations 12 and BP 144/92. Pulsox on room air shows 98%. There are jugular venous pulsations 3 cm above the sternal angle. The remainder of the exam shows no abnormalities. An EKG shows a left bundle branch block and no primary T wave changes, which is unchanged from an EKG 1 year ago. Which of the following is the most appropriate next step to determine the cause of the patient's dyspnea?
A measurement of serum troponin I concentration (wrong)
B EKG exercise stress test
C exercise stress echo
D V/Q lung scan
E coronary angiography
8. A 27 yo man with moderate mental retardation is brought to the physician by his caretaker because of increasingly frequent episodes of intermittent vomiting over the past 3 weeks. The vomiting typically occurs within an hour after eating and usually contains partially digested food, no blood is noted in the vomitus. The patient's appetite seems unaffected, but he stops eating before he completes the meal. He has had a 8Ib weight loss since his last visit 6 mo ago. He takes phenytoin for a seizure disorder but is otherwise healthy. His vital signs are within normal limits. His speech is not intelligible. Exam shows a 3x4 cm area of alopecia in the R occipitoparietal area of the scalp. Bowel sounds are present. The abdominal musculature voluntarily contracts with palpation, no organomegaly or masses are palpated. There are minimal contractures in both upper and lower extremities and increased muscle tone. Which of the following is the most likely diagnosis?
A achalasia
B brain tumor
C bulimia nervosa
D cholecystitis
E diabetic gastroparesis
F drug toxicity (wrong)
G food poisoning
H gastric bezoar
I gastric carcinoma
J pyloric channel ulcer
K small bowel obstruction
L uremia
1. A 72 year old woman is brought to the ED by her daughter because of a 3 day history of progressive confusion and lethargy. She underwent bilateral hip replacement 6 years ago. She takes no medications except for aspirin as needed for osteoarthritis. She is unable to answer questions. Her temperature is 36.2C, pulse is 110/min and regular, respirations are 20/min and BP is 110/70. Exam shows a supple neck. The lungs are clear to auscultation. Cardiac exam shows no murmurs or gallops. The abdomen is soft with no guarding, bowel sounds are present but hypoactive. Deep tendon reflexes are 1+ bilaterally. Babinski sign is absent. Serum studies show
Na 135
Cl 100
K 4.2
HCO3 22
Urea nitrogen 52
Glucose 602
Creatinine 2.4
Which of the following is the most likely diagnosis?
A alcoholic keotacidosis
B central diabetes insipidus
C diabetic ketoacidosis (wrong)
D lactic acidosis
E myxedema
F nephrogenic diabetic insipidus
G nonketotic hyperosmolar state
H salicylate toxicity
I SIADH
2. 42 year old man is brought to the ED because of sudden onset of worsening headache and L sided weakness 1 hour ago. He has no history of serious illness and has not seen a physician for 10 years. He has smoked one pack of cigarettes daily for 25 years and drinks six beers daily. He is 5 ft 11in and 215Ib. BMI is 30. His pulse is 80/min, BP is 180/120. Exam shows mild to moderate weakness of the L lower aspect of the face. Muscle strength is decreased in the L upper and L lower extremities. Funduscopic exam shows an atervenous ratio of 1:3 and regions of mild focal spasm of some arterioles. Results of a CBC, platelet count and coagulation studies are normal. His serum total cholesterol concentration is 400mg/dL. A CT scan of the head shows a 1.5 x 2 cm region of hyperintensity centered at the R putamen, there is mild surrounding lucency. Which of the following is most likely to decrease this patient's risk for a recurrent stroke of this type?
A alcohol cessation
B smoking cessation
C weight loss
D atorvastatin therapy
E clopidogrel therapy (wrong)
F lisinopril therapy
3. A 22 yo man comes to the physician because of swelling of the neck for 1 month and malaise, fever, fatigue, night sweats, and generalized pruritis for 2 weeks. Acetaminophen has provided only minimal relief of his symptoms. His temperature is 38.3C, pulse is 90, respiration 16, BP 100/67. There is a 3x4cm L anterior cervical lymph node. Conjunctivae are not injected, and the tympanic membranes and pharynx are not erythematous. The lungs are clear to auscultation. A grade 1/6, nonradiating systolic murmur is heard best at the upper R sternal border. Bowel sounds are slightly hyperactive. Lab studies show:
Hg 15
Leukocyte count 6000
- segmented neutrophils 60%
- bands 2%
- eosinophils 1%
- lymphocytes 33%
- monocytes 4%
Which of the following is the most likely diagnosis?
A acute lymphocytic leukemia (ALL)
B cat scratch disease
C CLL
D drug reaction
E gastric carcinoma
F HIV infection
G hodgkin disease
H infectious mononucleosis (wrong)
I rubella
J sarcoidosis
K syphilis
L SLE
M TB
4. A 68 yo man is brought to the ED because of severe substernal chest pain for 2 hours and severe SOB for 30 minutes. He has a history of type II diabetes treated with an oral hypoglycemic agent and hypertension treated with a diuretic. His temp is 37.5C, pulse 104, respirations 28, and BP is 100/78. JVP is increased. Bilateral crackles are heard throughout all lung fields. An S3 and S4 gallop are heard. Pulse oximetry on room air shows an oxygen saturation of 88%. An Xray of the chest shows bilateral perihilar infiltrates and a slightly enlarged cardiac silhouette. An EKG shows ST segment elevation and T wave inversion in leads V2 to V6. Which of the following is the most likely diagnosis?
A acute pericarditis (wrong)
B MI
C pericardial tamponade
D pneumonia
E PE
5. A 42 yo woman comes to the physician because of a 3 day history of dizziness and progressive difficulty with balance. She has been supporting herself against walls when she walks. She has not had numbness, weakness or palpitations. She has had nausea and a mild decrease in appetite but is able to drink fluids. There is no history of head trauma. She has mitral valve prolapse. She take no meds. Her sister has multiple sclerosis. Vital signs are normal. The optic disc appear normal and ocular movements are full. Tympanic membranes are dull bilaterally. The light reflex is distorted. There is no exudates on the pharynx. A grade 2/6 systolic murmur is heard best at the lower left sternal border. Muscle strength and deep tendon reflexes are normal. Her gait is unsteady. Which of the following is the most likely diagnosis?
A acoustic neuroma (vestibular schwannoma) (wrong)
B cerebral infarction
C dehydration
D endocarditis
E labyrinthitis
F multiple sclerosis
6. A 64 yo woman with a 4 year history of Type II diabetes controlled with insulin comes to the ED because of exertional chest pressure for 3 weeks. The first episode occurred while she was walking upstairs and was relieved by 5 minutes of rest. The second episode occurred 1 week ago while she was mowing the lawn and was relieved after 10 minutes of rest. She had two episodes yesterday, each lasting 15 minutes, both occurred with exertion and were accompanied by SOB and nausea. Today she had a 10 minute episode starting while she was in the shower and another while she was walking into the ED. Exam and an EKG show no abnormalities. Which of the following is the most appropriate next step in management?
A self monitoring of blood glucose concentration during the next episode of chest pain
B dipyridamole thallium 201 scintography
C exercise stress test within 24 hours (wrong)
D antianginal drug therapy now and an exercise stress test in 5 days
E admit the patient to the hospital
7. A 77 yo woman comes to the Ed because of a 3 month history of SOB when she climbs stairs. Her SOB resolves after 5 minutes of rest. Her last episode was 3 days ago. She has not had chest pain, palpitations, orthopnea, cough, wheezing, swelling, or difficulty sleeping. She has HTN and GERD. Current meds include HCTZ, omeprazole, and a multivitamin. BMI is 23. Her temperature is 37.2, pulse 72, respirations 12 and BP 144/92. Pulsox on room air shows 98%. There are jugular venous pulsations 3 cm above the sternal angle. The remainder of the exam shows no abnormalities. An EKG shows a left bundle branch block and no primary T wave changes, which is unchanged from an EKG 1 year ago. Which of the following is the most appropriate next step to determine the cause of the patient's dyspnea?
A measurement of serum troponin I concentration (wrong)
B EKG exercise stress test
C exercise stress echo
D V/Q lung scan
E coronary angiography
8. A 27 yo man with moderate mental retardation is brought to the physician by his caretaker because of increasingly frequent episodes of intermittent vomiting over the past 3 weeks. The vomiting typically occurs within an hour after eating and usually contains partially digested food, no blood is noted in the vomitus. The patient's appetite seems unaffected, but he stops eating before he completes the meal. He has had a 8Ib weight loss since his last visit 6 mo ago. He takes phenytoin for a seizure disorder but is otherwise healthy. His vital signs are within normal limits. His speech is not intelligible. Exam shows a 3x4 cm area of alopecia in the R occipitoparietal area of the scalp. Bowel sounds are present. The abdominal musculature voluntarily contracts with palpation, no organomegaly or masses are palpated. There are minimal contractures in both upper and lower extremities and increased muscle tone. Which of the following is the most likely diagnosis?
A achalasia
B brain tumor
C bulimia nervosa
D cholecystitis
E diabetic gastroparesis
F drug toxicity (wrong)
G food poisoning
H gastric bezoar
I gastric carcinoma
J pyloric channel ulcer
K small bowel obstruction
L uremia
