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- A 52 year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the past few months. During his physical examination, you note a nontender, non-enlarged prostate with an isolated right posterior lobe nodule. Which of the following options is most appropriate? A. order a serum acid phosphatase level B. initiate prazocin and schedule a follow-up appointment in 6 weeks C. refer the patient for an ultrasound of the prostate and order a PSA level D. reassure the patient and schedule a follow-up appointment in six months E. initiate norfloxacin therapy for seven days and schedule follow-up in twoweeks โโ1. C. This patient has an isolated nodule of the prostate gland โ cancer until proven otherwise. You should order an ultrasound and a PSA. BPH will present as diffuse enlargement, and not a discrete nodule.
- Which term is used to describe the characteristic concave or "spoon-shaped" nails of iron deficiency anemia? A. leukonychia B. koilonychias
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C. clubbing D. onycholysis E. paronychia โโ2. B. Koilonychia is a spoon-shaping of the nail itself. Clubbing is a thickening of the nail bed which "lifts" the nail - it is a sign of increased TNF (tissue necrosis factor), most likely occurring in cystic fibrosis, bronchiectasis or lung cancer. A & D are not real words, (onychomycosis is the real term for fungal infection of the nail)..E is paronychia and is an infection of the nailbed.
- Which of the following is NOT a characteristic feature of the nephotic syndrome? A. proteinuria B. hematuria C. hypoalbuminemia D. hyperlipidemia E. generalized edema โโ3. B. Hematuria is present in NEPHRITIC syndrome. Nephrotic syndrome characteristically includes proteinuria (>3.5 gm/day), with resulting low serum albumin, hyperlipidemia, hypertension, hypercoagulability, and generalized edema (from oncotic third-spacing)
D. rheumatoid arthritis E. ankylosing spondylitis โโ5. D. In spite of the negative RF, Rheumatoid arthritis is the most likely diagnosis. RA characteristically includes small joint symmetrical arthritis, with an elevated ESR (therefore inflammatory, and not OA). 80 of patients with RA will have a positive RF, but 20 will be negative. PSS involves squamous cell thickening and sclerosis causing taut skin of the face and hands and difficulty with esophageal motility. CREST syndrome is a subset of PSS; Ankylosing spondylitis would have an elevated ESR and negative RF, but mainly involves the SI joint and lumbar/thoracic spine fusion (bamboo spine)
- A 27 year-old nulliparous female presents because she's been trying to get pregnant for two years, but has failed. She relates a history ofamisdiagnosis of appendicitis that lead to abscess formation when she was 14 years old. Which of the following diagnostic studies would be most helpful at this point in her evaluation? A. TSH level B. hysterosalpingogram C. laparoscopy D. PAP smear
E. pelvic ultrasound โโ6. B. While I would disagree that an invasive procedures like HSG should be done first- line, the thing to remember in this question is that the patient has reason to have tubal scarring from adhesions (and there is no better answer listed to choose), so, for a Board exam I would choose this answer. The TSH level would not be indicated (she has not had a pg loss), lap could diagnose the tubal scarring but would be done after an abnormal HSG. Pap smear is screening for cervical cancer and not indicated in this case of infertility; and pelvic US would yield nothing diagnostically about the tubes.
- A 14 year-old is experiencing a severe asthma attack. Although he is using accessory muscles to breath, auscultation of his chest reveals no audible wheezing. His heart rate is 160 and his respiratory rate is 52. Which of the following arterial blood gases represents the worst prognosis? A. pH = 7.52; pC02 = 28; p02 = 80 B. pH = 7.44; pC02 =38; p02 = 70 C. pH = 7.60; pC02 = 18; p02 = 60 D. pH = 7.40; pC02 = 40; p02 = 60 E. pH = 7.27; pC02 = 62; p02 = 64 โโ7.E. This patient has a RR of 52. If she is ventilating, she is blowing of C02 (an acid)
A. an increase in the absorption of the lidocaine. B. an increase in the diffusion of the lidocaine into the nerve's myelin sheath C. an mcrease in the blood flow to the area of injection. D. an increase in the duration of anesthesia. E. a decrease in the risk of infection at the site of injection. โโ9. D. Lidocaine with epinephrine both increases duration of anesthesia and decreases blood flow to the area of injection, i.e. penis, nose, fingers, toes
- An EKG demonstrates a PR interval ofOJ6 seconds, a P to QRS relationship of 1:1, a variable heart rate and an R to R interval that is noted to accelerate and decelerate during the respiratory cycle. What is the diagnosis? A. Wenckebach B. third degree heart block C. atrial fibrillation D. sinus arrhythmia E. atrial flutter โโ10. D. This is sinus arrhythmia. Wenckebach & third degree AVB would have a non- conducted P wave. A fib would have no P waves and an irregularly irregular rhythm. A flutter would have "flutter waves" or a regular rhythm of 150.
- Combinations of antimicrobial agents are commonly employed in the treatment of meningitis in infants less than three months old. Ampicillin is commonly an agent included in this regimen. Ampicillin is used empirically for the possible presence of: A. Escherichia coli. B. Listeria monocytogenes. C. Cytomegalovirus. D. Herpes virus. E. Hemophilus influenzae. โโ11. B. While E. Coli can infect an infant delivered vaginally, AMPICILLIN is given to eliminate Listeria. CMV & HSV are viruses. E. Coli & H. Flu are also typically resistant to amp, and more likely a broader spectrum antibiotic would be used.
- A 42 year-old female presents after finding a firm, painless bump in her right eye. On examination you note a 6 mm mass within the tarsus of the right eye. The skin is freely movable over me mass. The remainder of the ophthalmoscopic examination is unremarkable. Which of the following is the most likely diagnosis? " A. pterygium B. chalazion C. ectropion
- Which white blood cell disorder is characterized by the presence of the Philadelphia chromosome in 90 of cases? A. chronic lymphocytic leukemia (CLL) B. acute lymphocytic leukemia (ALL) C. chronic myelogenous leukemia D. acute myelogenous leukemia E. multiple myeloma โโ14.C. Philadelphia Chromosome occurs in CML. ALL occurs in children. AMLis associated with Auer rods. Multiple myeloma has Bence-Jones protein. CLL has no clear distinguishing feature except increased lymphocytes.
- Which of the following thyroid profiles is most compatible with a diagnosis of primary hypothyroidism? A. a low TSH (thyroid stimulating hormone) level and a high T B. a low TSH level and a normal T C. a low TSH level and a low T D. a high TSH level and a low T
E. a high TSH and a high T4 โโ15. D. Low T4 is diagnostic for low thyroid function. If the pituitary is normal (as in primary thyroid disease) the TSH should be high as the pituitary tries to stimulate the failing thyroid gland.
- All of the following are factors that predispose a patient to the development of gastroesophageal reflux EXCEPT: A. hiatal hernia. B. pregnancy. C. scleroderma. D. an incompetent esophageal sphincter E. pernicious anemia. โโ16.E. Pernicious anemia has no correlation with GERD. It is an autoimmune destruction of the gastric parietal cells that make intrinsic factor. Signs & symptoms are not present until B12 levels are very low (and include peripheral neuropathies & ataxia)
- A patient warrants antihypertensive medication use for the duration of her pregnancy. Which of the following is the antihypertensive recommended for such patients? A. alpha-methyldopa
- A 55 year-old male presents complaining of "difficulty writing" using his dominant hand and some "slurred" speech. He has a h/o hypertension, DM type II, and hypertriglyceridemia. Which of the following would you anticipate to find on a CT scan of his head, as the explanation for hischief complaint? A. hemorrhage in the distribution of his posterior cerebral artery B. hemorrhage in the distribution of the middle cerebral artery C. hypodensity measuring 12 mm by 21 mm in the distribution of the posterior cerebral artery D. hypodensity measuring 4 mm by 4 mm in the internal capsule E. calcifications bilaterally, in the third ventricles โโ19. D. The main clue in this question is that most strokes are ischemic - especially with THIS patient's history (ruling out hemorrhagic infarct - A & B). Calcifications (E) are not indicative of stroke at all. When trying to decide between C & D - the size of the area needs to correlate with the patient's sxs. If the patient had a HUGE infarct (12x21) he would have significantly more sxs than just some slurred speech and difficulty writing. (In addition, as it turns out, the internal capsule is supplied by the MCA - which is the most common vessel involved in an ischemic stroke)
- A female in her third trimester of pregnancy developed hypertension, diffuse edema, proteinuria and hyperreflexia. She was treated with intravenous magnesium sulfate and is now hyporeflexic and drowsy. What do you prescribe now? A. calcium B. diazepam C. an amphetamine D. additional magnesium E. oxygen โโ20. A. Pre-eclampsia causes hyper-reflexia. Magnesium is the treatment. The sign of Mg toxicity is loss of reflexes. ... this is treated with Calcium.
- This papulosquamous eruption is most common in young adults. A single oval patch is generally noted several days before a more generalized, fawn-colored rash erupts. This rash is most prevalent on the trunk, and the proximal upper and lower extremities. The rash spontaneously disappears over 5 to 6 weeks. The diagnosis is: F. pityriasis rosea. G. tinea corporis. H. psoriasis. I. atopic dermatitis.
D. theophylline E. epinephrine โโ23. B. Cromolyn is a mast cell stabilizer and must be present in the system PRIOR to the symptoms. It would be useless in a patient already having symptoms.
- A 34 year-old female patient presents to the ER with sharp pleuritic-type chest pain. An x-ray reveals pericarditis. On more careful questioning, the patient admits to a polyarticular arthritis involving the small joints other hands. Her obstetrical history is positive for two first trimester spontaneous abortions. At this point, you would suspect which autoimmune process as the cause of her symptoms: A. Rheumatoid arthritis B. Systemic Lupus Erythematosis C. Wegener's granulomatosis D. Sjogren's Syndrome E. Scleroderma โโ24. B. 40 - 60 of patients with SLE have serositis (pleuritis and pericarditis). That, combined with joint pains, habitual AB - should cause you to order an ANA.
- A patient with AIDS develops severe headaches. A CT scan demonstrates multiple ring- enhancing lesions of the brain. What diagnosis is most likely?
A. Toxoplasmosis B. Histoplasmosis C. lymphoma D. Cytomegalovirus E. Herpes encephalitis โโ25. A. Toxo occurs commonly in HTV, and is a parasitic infection causing ring-enhancing lesions (but lots of things can cause ring-enhancing lesions). CMV is common as well and typically causes retinitis. Herpes encephalitis can happen frequently too, but causes a diffuse encephalitis.
