PACKRAT 2 Exam Questions with 100% Correct Answers | Verified | Updated 2024, Exams of Advanced Education

Download PACKRAT 2 Exam Questions with 100% Correct Answers | Verified | Updated 2024 and more Exams Advanced Education in PDF only on Docsity! PACKRAT 2 Exam Questions with 100% Correct Answers | Verified | Updated 2024 A 23 year-old male with recent upper respiratory symptoms presents complaining of chest pain. His pain is worse lying down and better sitting up and leaning forward. Electrocardiogram shows widespread ST segment elevation. Which of the following is the most likely physical examination finding in this patient? A. Elevated blood pressure B. Subungual hematoma C. Diastolic murmur D. Pericardial friction rub - Correct Answer-D A 75 year-old woman presents to the office with complaint of vision loss. Examination reveals a palpable cord in the temporal region. Which of the following is the most helpful initial test to order on this patient? A. Carotid ultrasound B. Chest x-ray C. Complete blood count pg. 1 professoraxe l D. Erythrocyte sedimentation rate - Correct Answer-D What is the recommended target LDL to reduce the risk of coronary artery disease in a diabetic patient? A. 200 mg/dL B. 160 mg/dL C. 130 mg/dL D. 100 mg/dL - Correct Answer-D Which of the following best describes the purpose of intravenous magnesium sulfate in patients with preeclampsia? A. Prevention of convulsions B. Prevention of HELLP syndrome C. Lowering of blood pressure D. Reversal of proteinuria - Correct Answer-A A 53 year-old male with history of hypertension presents complaining of recent 4/10 left-sided chest pain with exertion that is relieved with rest. He states the pain usually lasts approximately 4 minutes and is relieved with rest. Heart examination reveals regular rate and rhythm with no S3, S4, pg. 2 professoraxe l A 15 year-old girl is hit in the right eye by a golf ball. There is swelling and ecchymosis of the orbit. She complains of double vision. The right eye does not move with downward gaze or right lateral gaze. Which of the following diagnostic tests will provide the most accurate information regarding this injury? A. Facial x-ray B. Schiotz tonometry C. Fluorescein angiography D. Slit lamp biomicroscopy - Correct Answer-A A 68 year-old male with a history of atrial fibrillation treated with warfarin (Coumadin) presents to the emergency department after vomiting large amounts of bright red blood. INR is 3. Which of the following is most appropriate to rapidly lower the patient's INR? A. Discontinue warfarin B. Administer fresh frozen plasma C. Administer protamine sulfate D. Administer heparin sulphate - Correct Answer-B A 48 year-old male with diabetes mellitus presents for routine physical examination. Of note his blood pressure each of his last two follow-up visits was 150/90 mmHg. Today the pg. 5 professoraxe l patient's BP is 148/88 mmHg. The patient denies complaints of chest pain, change in vision, or headache. Which of the following is the most appropriate management for this patient? A. Atenolol (Tenormin) B. Nifedipine (Procardia) C. Hydralazine (Apresoline) D. Lisinopril (Zestril) - Correct Answer-D A 72 year-old farmer comes to the office for evaluation of a pearly ulcerated papule on his right nostril. The papule has been bleeding off and on for the past couple weeks. Which of the following findings would be most concerning on the physical examination of this patient? A. Cherry angioma B. Telangiectasia C. Spider angioma D. Pyogenic granuloma - Correct Answer-B A 24 year-old female presents with complaints of abdominal pain, bloating, and chronic diarrhea. She says she felt worse last month while on vacation in Italy. Despite eating well she pg. 6 professoraxe l lost weight. What would be the most appropriate treatment for this patient? A. Gluten-free diet B. Small bowel resection C. Ciprofloxacin (Cipro) therapy D. Pancreatic enzymes - Correct Answer-A Hypoglycemia in an elderly patient with diabetes is most likely to manifest as which of the following symptoms? A. Tachycardia B. Diaphoresis C. Intense hunger D. Mental confusion - Correct Answer-D An 85 year-old nursing home resident presents with abrupt onset of cough, sore throat, headache, myalgias, and malaise. On examination the patient's temperature is 102 degrees F; the rest of the exam is unremarkable. Nasal smear is positive for Influenza B. Which of the following is the treatment of choice in this patient? A. Amantadine (Symmetrel) B. Oseltamivir (Tamiflu) pg. 7 professoraxe l A 25 year-old female presents for a routine gynecological examination. You palpate a 2 cm breast mass in her right breast. Her menstrual period was last week. She has no family history of breast cancer. What is the modality of choice to further evaluate her breast mass? A. Magnetic resonance imaging (MRI) B. Excisional biopsy C. Ultrasound D. Mammography - Correct Answer-C A 60 year-old right hand dominant male presents to your office complaining of right shoulder pain and progressively worsening arm weakness. His symptoms are aggravated when working above the shoulder level. On physical examination, there is no evidence of muscle atrophy. He has strong (5/5) adduction of his right shoulder but considerable weakness (1/5) with abduction when raising his arm above his head. Passive range of motion is intact. Which of the following is the most likely diagnosis? A. Rotator cuff tear B. Subacromial bursitis C. Adhesive capsulitis D. Supraspinatus tendonitis - Correct Answer-A pg. 10 professoraxe l A newborn weighs 8 pounds at birth. Following established growth indices, what would you expect the infant to weigh at 1 year of age? A. 16 pounds B. 24 pounds C. 32 pounds D. 40 pounds - Correct Answer-B A 3 month-old female presents with her mom for physical examination. The patient's mom denies any complaints. On examination you note a well-developed, well-nourished infant in no apparent distress. There is no cyanosis noted. Heart examination reveals a normal S1 with a physiologically split S2. There is a grade III/VI high-pitched, harsh, pansystolic murmur heard best at the 3rd and 4th left intercostal spaces with radiation across the precordium. Which of the following is the initial diagnostic study of choice in this patient? A. CT angiogram B. Electrocardiogram C. Echocardiogram D. Cardiac catheterization - Correct Answer-C pg. 11 professoraxe l A 62 year-old male smoker presents to the clinic with the complaint of a chronic cough, hemoptysis, and weight loss. Chest CT shows a mass obstructing the bronchus with hilar and mediastinal lymph node abnormalities. Bronchoscopy with biopsy is performed. On reviewing pathology results you explain to the patient that his type of lung cancer is prone to early hematogenous spread, is rarely amenable to surgical resection and has a very aggressive course. What type of lung cancer is most likely in this patient? A. Squamous cell B. Small cell C. Large cell D. Adenocarcinoma - Correct Answer-B Otitis externa can be differentiated from uncomplicated otitis media by which of the following physical examination findings? A. Erythematous tympanic membrane B. Mastoid tenderness C. Normal pneumatic otoscopy D. Posterior auricular adenopathy - Correct Answer-C pg. 12 professoraxe l C. Upper endoscopy D. Barium swallow - Correct Answer-C A 45 year-old male presents to the clinic complaining of morning sluggishness, daytime fatigue, headaches. He admits to drinking two cocktails each evening. His bed partner reports his loud cyclical snoring, breath cessation and thrashing movements of his extremities during sleep. BMI is 40. Heart examination reveals regular rate and rhythm without S3, S4, or murmur and lungs are clear to auscultation. Polysomnography shows apneic episodes lasting as long as 60 seconds. Which of the following clinical interventions would most likely provide for the acute cessation of apneic episodes? A. Avoidance of alcohol B. Weight loss C. Nasal continuous positive airway pressure D. Supplemental oxygen - Correct Answer-C A 45 year-old female presents with her daughter who is concerned because her mom will not leave the house. The patient describes feeling anxious in crowds and places where there are no easy means of escape. Which of the following is the most likely diagnosis in this patient? pg. 15 professoraxe l A. Agoraphobia B. Generalized anxiety disorder C. Obsessive-compulsive disorder D. Panic attack - Correct Answer-A Which of the following is a cause of acute kidney failure due to prerenal azotemia? A. Excessive diuresis B. Urinary tract obstruction C. Radiologic contract media D. Aminoglycosides - Correct Answer-A A 19 year-old male presents to the ED complaining of a sudden onset of dyspnea and left sided chest pain. He denies fever, chills, cough or sore throat. General survey shows that he is 6 feet 2 inches tall and weighs 135 lbs. Vital signs are BP 86/60 mmHg, HR 130 bpm, RR 28, temp. 98.6 degrees F. Which of the following would you likely find on examination of his thorax? A. Left-sided hyperresonance B. Increased tactile fremitus of left base C. Scattered rales throughout pg. 16 professoraxe l D. Increased anterior/posterior diameter - Correct Answer-A A 60 year-old female recently discharged after an 8 day hospital stay for pneumonia presents complaining of pain and redness in her right arm. The patient thinks this was the area where her IV was placed. The patient denies fever or chills. Examination of the area reveals localized induration, erythema and tenderness. There is no edema or streaking noted. Which of the following is the most likely diagnosis? A. Acute thromboembolism B. Thrombophlebitis C. Cellulitis D. Lymphangitis - Correct Answer-B A 57 year-old male with history of hypertension presents with acute gouty arthritis. Which of the following antihypertensive classes should be avoided in this patient? A. Thiazide diuretics B. Beta-blockers C. ACE inhibitors D. Calcium channel blockers - Correct Answer-A pg. 17 professoraxe l left adnexa. Cervical culture is positive for Chlamydia. Ultrasound reveals a complex tubular structure in the left adnexal area. What is the recommended treatment? A. Outpatient treatment with IM ceftriaxone and oral doxycycline B. Oral doxycycline C. IM procaine penicillin D. Hospitalization with parenteral doxycycline and cefoxitin - Correct Answer-D A 2 year-old presents with sudden onset of cough and stridor. On examination the child is afebrile and appears nontoxic with a respiratory rate of 42 breaths per minute. What is the next step in the evaluation of this patient? A. Lateral soft tissue x-ray of the neck B. Indirect laryngoscopy C. Finger sweep D. Chest x-ray - Correct Answer-D A 3 year-old patient is brought in with a 10 day history of clear nasal drainage and cough which has now developed into otalgia and fever exceeding 101 degrees F for the last 5 days. Mom denies other chronic medical problems. The patient has pg. 20 professoraxe l had similar complaints three times in her life. Which of the following is the most likely causative organism? A. Mycoplasma pneumoniae B. Pneumocystis jiroveci C. Pseudomonas aeruginosa D. Streptococcus pneumoniae - Correct Answer-D A 7 year-old is evaluated for episodes of unresponsiveness in which she stares, blinking into space. Episodes last only 10-20 seconds but may happen several times daily. There are no abnormal movements, sensory loss or headaches reported. Which of the following is considered first-line therapy for this disorder? A. Carbamazepine (Tegretol) B. Ethosuximide (Zarontin) C. Gabepentin (Neurontin) D. Topiramate (Topamax) - Correct Answer-B Which of the following treatments is used to reduce the hepatic complications of hemochromatosis? A. Penicillamine B. Paracentesis pg. 21 professoraxe l C. Albumin D. Phlebotomy - Correct Answer-D A 29 year-old female with history of IV drug abuse presents with ongoing fevers for three weeks. She complains of fatigue, worsening dyspnea on exertion and arthralgias. Physical examination reveals a BP of 130/60 mmHg, HR 90 bpm, regular, RR 18, unlabored. Petechiae are noted beneath her fingernails. Fundoscopic examination reveals exudative lesions in the retina. Heart examination shows regular rate and rhythm, there is a grade II-III/VI systolic murmur noted, with no S3 or S4. Lungs are clear to auscultation bilaterally, and the extremities are without edema. Which of the following is the diagnostic study of choice in this patient? A. Electrocardiogram B. CT angiogram of the chest C. Cardiac catheterization D. Transesophageal echocardiogram - Correct Answer-D An 18 year-old female with diabetes presents to the emergency department with altered level of consciousness, deep breathing and fruity odor to her breath. Which of the following medications is indicated for this patient? pg. 22 professoraxe l A. Advise him to discontinue use of cotton swabs B. Encourage jet irrigator (i.e. WaterPik) to clean ears C. Instruct in ear irrigation with cold water D. Refer to dermatologist - Correct Answer-A Dysmenorrhea would most likely occur in which of the following patients? A. A young teenager who just started having her menses B. A woman on birth control pills C. A marathon runner with one menses per year D. A 35 year-old woman with regular cycles - Correct Answer- D A 49 year-old female presents complaining of several episodes of chest pain recently. Initial ECG in the emergency department shows no acute changes. Two hours later, while the patient was having pain, repeat electrocardiogram revealed ST segment elevation in leads II, III, and AVF. Cardiac catheterization shows no significant obstruction of the coronary arteries. Which of the following is the treatment of choice in this patient? A. Nifedipine (Procardia) pg. 25 professoraxe l B. Metoprolol (Lopressor) C. Lisinopril (Zestril) D. Carvedilol (Coreg) - Correct Answer-A A 62 year-old male presents with complaints of dyspepsia, early satiety, and dysphagia. What diagnostic study would be indicated in his initial workup? A. PET CT scan B. Abdominal ultrasound C. Gastric emptying studies D. Upper endoscopy - Correct Answer-D A 6 year-old male, a recent immigrant from Latin America, is brought to the emergency department with difficulty swallowing and breathing. On physical examination you note a gray-tan pseudomembrane in the back of the pharynx. There is also tender cervical lymphadenopathy. What physical examination finding is most specific for diagnosis in this patient? A. Difficulty swallowing B. Respiratory compromise C. Pseudo-membrane in pharynx pg. 26 professoraxe l D. Cervical adenopathy - Correct Answer-C A 40 year-old male nonsmoker in good health undergoes a routine chest x-ray for an insurance physical. Results show an isolated, well-defined, coin lesion 1 cm in size. Which of the following is the next step in the evaluation of this problem? A. Review old radiographs B. Order chest CT C. Schedule lung biopsy D. Prepare for surgical lung resection - Correct Answer-A Lesions of the optic chiasm will produce which of the following conditions? A. Amaurosis fugax B. Bitemporal hemianopia C. Unilateral blindness D. Homonymous hemianopia - Correct Answer-B A 75 year-old female with a history of long-standing hypertension presents with shortness of breath. On examination you note a diastolic murmur at the left upper pg. 27 professoraxe l ventricular dilatation and an ejection fraction of 30%. Which of the following is the most likely diagnosis in this patient? A. Hypertrophic cardiomyopathy B. Dilated cardiomyopathy C. Restrictive cardiomyopathy D. Tako-Tsubo cardiomyopathy - Correct Answer-B A 25 year-old female with a history of diarrhea presents to the emergency department with Guillian-Barre syndrome. What is the most likely causative pathogen in this patient? A. Shigella dysenteriae B. Yersinia enterocolitica C. Entamoeba histolytica D. Campylobacter jejuni - Correct Answer-D A 32 year-old female presents with an 8-week history of a burning sensation deep in the chest, which starts about 30 minutes after she eats and worsens when she lays down at night. She has had some relief with an antacid and denies dysphagia. Which of the following interventions would be beneficial for this patient? A. Raising the foot of the bed pg. 30 professoraxe l B. Taking Cimetidine (Tagamet) 30 minutes after a meal C. Eating 3 large meals per day D. Avoiding mint - Correct Answer-D A 45 year-old female presents complaining of the worst headache of her life. Which of the following is the most appropriate initial diagnostic study? A. Magnetic resonance imaging (MRI) B. Computed tomography (CT) C. Electroencephalogram (EEG) D. Lumbar puncture (LP) - Correct Answer-B Which physical examination finding distinguishes allergic rhinitis from other rhinitis etiologies? A. Clear rhinorrhea B. Erythematous pharynx C. Nasal flaring D. Pale nasal turbinates - Correct Answer-D A 56 year-old female with a 35 pack year smoking history presents to the clinic with shortness of breath and cough. On pg. 31 professoraxe l examination, she is thin with no recent weight loss. She appears uncomfortable, breath sounds are diminished without adventitious sounds. Pulmonary function tests show a marked increase in total lung capacity (TLC) and a decreased FEV1. What is the most likely diagnosis for this patient? A. Persistent asthma B. Chronic obstructive pulmonary disease C. Idiopathic fibrosing interstitial pneumonia D. Sarcoidosis - Correct Answer-B Which of the following Rh genotypes in a mother and father would represent a risk for hemolytic disease of the newborn? A. Mother Rh-positive, father Rh-negative B. Mother Rh-positive, father Rh-positive C. Mother Rh-negative, father Rh-positive D. Mother Rh-negative, father Rh-negative - Correct Answer-C A 76 year-old active female with history of hypertension and hypothyroidism presents with complaints of palpitations and dyspnea on exertion. On examination vital signs are BP 120/80 mmHg, HR 76 bpm, irregular, RR 16. Heart pg. 32 professoraxe l D. Constrictive pericarditis - Correct Answer-A Which of the following is recommended to reduce the risk for perinatal transmission of HIV in a patient with a viral load of >1000 copies/mL? A. Vaginal delivery with female condom B. Episiotomy to shorten second stage of labor C. Use of forceps or vacuum extractor to shorten second stage of labor D. Cesarean section prior to onset of labor and rupture of membranes - Correct Answer-D A 48 year-old male with a recent episode of nephrolithiasis comes to the office to discuss prevention of further urinary stone disease. Which of the following dietary recommendations can reduce recurrence of nephrolithiasis? A. Increase fluid intake B. Decrease dietary fiber C. Increase salt intake D. Decrease calcium intake - Correct Answer-A pg. 35 professoraxe l A 70 year-old male is admitted to the ICU with fever, leukocytosis and purulent sputum. Sputum culture shows methicillin-resistant gram-positive cocci in clusters. Which of the following medications should be ordered for this patient? A. Vancomycin (Vancocin) B. Clindamycin (Cleocin) C. Azithromycin (Zithromax) D. Astreonam (Azactam) - Correct Answer-A A 75 year-old female with history of coronary artery disease and dyslipidemia presents for routine follow-up. Physical examination reveals loss of hair on the lower extremities bilaterally with thinning of the skin. Femoral pulses are +2/4 bilaterally, pedal pulses are diminished bilaterally. Ankle brachial index is reduced. Which of the following signs or symptoms is this patient most likely to have? A. Lower extremity edema B. Calf pain with walking C. Numbness of the lower extremities D. Itching of the lower extremities - Correct Answer-B A 37 year-old right-handed male presents with daily headaches for the past 2 months. They are worse in the pg. 36 professoraxe l morning and awaken him from sleep. In the past week, he has noticed a tendency to drop things. Neurologic examination reveals upper extremity strength of 4/5 on the right and 5/5 on the left. Which of the following is the most appropriate next step in the evaluation of this patient? A. Lumbar puncture (LP) B. Electroencephalogram (EEG) C. Magnetic resonance imaging (MRI) D. Electromyelogram (EMG) - Correct Answer-C Which of the following histories is most consistent with rheumatoid arthritis (RA)? A. Acute onset, morning stiffness, monoarticular joint swelling and tenderness B. Insidious onset, morning stiffness, symmetrical joint swelling and tenderness C. Insidious onset, morning stiffness, monoarticular joint swelling and tenderness D. Acute onset, morning stiffness, symmetrical joint swelling and tenderness - Correct Answer-B Low molecular weight heparin (LMWH) dosage is based on which of the following? pg. 37 professoraxe l A 19 year-old man comes to the office because he has had a fever, frequent urination, urgency, dysuria and scrotal pain for the past 2 days. On physical examination, he has a temperature of 101 degrees F, scrotal swelling, and purulent urethral discharge is visible on penile examination. Gram stain of the discharge shows gram negative intracellular diplococci. Which of the following is the most appropriate antibiotic therapy? A. Ampicillin (Principen) B. Ciprofloxacin (Cipro) C. Ceftriaxone (Rocephin) D. Nitrofurantoin (Macrobid) - Correct Answer-C A 74 year-old male with a history of coronary artery disease and atrial fibrillation presents to the clinic for follow-up of his shortness of breath. Patient's medications include amiodarone (Cordarone) and metoprolol (Lopressor). His chest x-ray reveals patchy ground-glass infiltrates. Which of the following is the most likely diagnosis? A. COPD B. Tuberculosis C. Bronchiectasis D. Pulmonary fibrosis - Correct Answer-D pg. 40 professoraxe l What patient demographic is at highest risk for the development of anorexia nervosa? A. College aged swimmer B. High school football player C. Married, 50 year old, heterosexual female D. Single, 20 year old, homosexual male - Correct Answer-D A 58 year-old female comes to the office because she noticed a white spot on her tongue. She has a 42 pack/year smoking history. On examination, she has an 8 mm white thickened, keratinized lesion on the ventral tongue. The lesion cannot be removed by rubbing the mucosal surface. Which of the following studies is most appropriate to confirm the suspected diagnosis? A. Incisional biopsy B. Tzanck smear C. Gram stain D. Potassium hydroxide wet prep - Correct Answer-A A patient undergoes biopsy for suspected myocarditis. Which of the following is the most likely etiologic agent? pg. 41 professoraxe l A. West Nile virus B. Rhinovirus C. Coxsackie B virus D. Cytomegalovirus - Correct Answer-C A 26 year-old male was lifting a heavy object two weeks ago when he felt a sudden onset of low back pain. He describes pain in the low mid back at the belt line aggravated with movement. Radicular symptoms are noted in the left buttock down the leg to the dorsal aspect of the foot. He denies any urine or bowel complaints His examination demonstrates an inability to stand on his toes and a positive straight leg raise. Which of the following is most appropriate diagnostic study in this patient? A. Computed tomography (CT) B. Magneti resonance imaging (MRI) C. Discography D. Electromyelogram - Correct Answer-B Household contacts of a patient with bacterial meningitis are best treated with which of the following? A. Amoxicillin (Amoxil) pg. 42 professoraxe l What behavior would be most typical for a patient diagnosed with schizoid personality disorder? A. Chooses solitary activities B. Odd thinking and speech C. Reckless disregard for safety of others D. Uses physical appearance to draw attention - Correct Answer-A A 65 year-old male with coronary artery disease, hypertension, and diabetes mellitus is admitted with dyspnea and lower extremity edema. The chest x-ray reveals small bilateral pleural effusions. Echocardiogram shows an ejection fraction of 30% with no valvular heart disease. The patient is treated in the hospital with furosemide (Lasix) and lisinopril (Zestril). What education should be given to this patient upon discharge to help prevent readmission? A. Elevate the head of bed at home B. Avoid physical activity C. Monitor daily weights D. Restrict fluid intake - Correct Answer-C pg. 45 professoraxe l A 67 year-old African American male presents for a new patient evaluation. History reveals an aphasic CVA which limits his history. Funduscopic examination reveals an abnormal vessel light reflex described as a silver or copper- wire appearance. Where the vessels intersect, there appears to be some nicking. He has no carotid bruits, and his cardiac exam is normal. What is the most likely cause of his ocular findings? A. Cytomegalovirus retinitis B. Diabetic retinopathy C. Hypertensive retinopathy D. Sickle cell retinopathy - Correct Answer-C A 14 year-old male presents to the ED experiencing a severe asthma attack. His respiratory effort is shallow and he is using accessory muscles to breathe. Auscultation of his chest reveals no audible wheezing. Vital signs include BP 90/60 mmHg, P 160 bpm, RR 52. An arterial blood gas (ABG) is ordered. Normal ABG values at your institution are pH 7.35- 7.45, CO2 35-45, pO2 80-95. Which of the following ABG findings suggests the poorest prognosis? A. pH = 7.27 pCO2 = 46 pO2 = 56 B. pH = 7.60, pCO2 = 18 pO2 = 80 C. pH = 7.44, pCO2 = 38 pO2 = 90 pg. 46 professoraxe l D. pH = 7.52, pCO2 = 28, pO2 = 80 - Correct Answer-A A 22 year-old male presents to the emergency department complaining of right hand pain after punching a brick wall. His pain is noted at the ulnar aspect of his hand and worsens with touch and movement. On examination, you notice obvious swelling and tenderness over the dorsum of the right hand proximal to the metacarpal phalangeal (MCP) joint of the fifth digit. Skin is intact. X-ray reveals a fracture of the proximal fifth metacarpal with good alignment. Which of the following is the treatment of choice? A. Immediate orthopedic consult for surgical fixation B. Long finger splint extending beyond the MCP C. Ulnar gutter splint to immobilize fracture site D. Referral for casting - Correct Answer-C A 22 year-old female presents with onset of right eye vision loss 24 hours ago which has partially improved. She has experienced various widespread paresthesias, regional weakness and fatigue over the past six months. Episodes vary in location, severity and duration but invariably lead to recovery. Her exam is completely normal but MRI reveals numerous areas of periventricular gadolinium uptake. For this pg. 47 professoraxe l B. Surgical intervention C. Nocturnal splinting D. Gabapentin (Neurontin) - Correct Answer-C A 34 year-old man comes to the urgent care with fever of 102 degrees F, chills, and perineal pain for the past 2 days. In addition, he has difficulty voiding, dysuria, frequency, urgency, and nocturia. Which of the following physical examination findings are consistent with this history? A. Mild suprapubic tenderness B. Scrotal swelling and tenderness C. Prostate tender, warm, swollen D. Costovertebral angle tenderness - Correct Answer-C A patient was treated for community acquired pneumonia with amoxicillin-clavulanate (Augmentin). On day 7 of therapy he develops fulminate diarrhea. The diarrhea is described as greenish and foul-smelling. He admits to associated abdominal cramps. Which of the following is the treatment of choice for this patient? A. Metronidazole (Flagyl) B. Diphenoxylate/atropine (Lomotil) pg. 50 professoraxe l C. Clindamycin (Cleocin) D. Ciprofloxacin (Cipro) - Correct Answer-A A 48 year-old G3P3003 female presents to the office complaining of severe secondary dysmenorrhea and menorrhagia over the last 6 months. On physical examination her uterus feels enlarged and irregular. Which of the following is the most likely diagnosis? A. Endometritis B. Endometriosis C. Uterine leiomyomata D. Endometrial hyperplasia - Correct Answer-C What is the most common anatomical location of anterior bleeding from the nose? A. Kiesselbach plexus B. Maxillary sinus ostia C. Nasal pyramid D. Superior turbinate - Correct Answer-A A 9 year-old boy comes to the office with his mother to discuss treatment for chronic dry skin, and pruritic pg. 51 professoraxe l inflammatory lesions of the flexor surfaces of the neck, hands and wrists. Past medical history is significant for allergic rhinitis in the spring and fall. On physical examination the skin lesions are excoriated, and lichenified with crusted patches. Which of the following prevention strategies can help minimize the symptoms in this patient? A. Avoid rubbing or scratching B. Limit sun exposure C. Take hot baths D. Consume hot liquids - Correct Answer-A A 60 year-old female with a 30 pack year smoking history complains of new onset shortness of breath. On physical examination, dullness is noted on percussion with dimished breath sounds over her left base. Chest x-ray shows a new left pleural effusion. Which of the following is the next step in the management of this patient? A. Repeat chest x-ray in two months B. Perform diagnostic thoracentesis C. Order MRI of the chest D. Treat with antibiotic - Correct Answer-B pg. 52 professoraxe l suicidal tendencies or signs of self harm. What is the most likely personality disorder? A. Narcissistic B. Borderline C. Dependent D. Obsessive-compulsive - Correct Answer-C A 52 year-old female is diagnosed with chronic myeloid leukemia (CML). Which of the following would you expect to find on physical examination of this patient? A. Hepatomegaly B. Splenomegaly C. Posterior cervical lymphadenopathy D. Inguinal lymphadenopathy. - Correct Answer-B Screening for hypothyroidism is indicated in which of the following patients?? A. Newborn B. Young female with anxiety C. Patient with new onset of atrial fibrillation D. Patient with heat intolerance - Correct Answer-A pg. 55 professoraxe l A construction worker presents with severe eye pain after splashing concrete in his eye. Examination is complicated by the patient's difficulty opening his eye. What is the most appropriate therapy - remembering that cement is an alkali? A. Irrigation with saline B. Instill corticosteroids drops C. Neutralize with acidic solution D. Prescribe local anesthetic drops - Correct Answer-A A 57 year-old man is being evaluated for shortness of breath. The following spirometric data are obtained: VC 4.90 L (predicted), 5.15 L (observed) 105% predicted FRC 3.99 L (predicted), 4.37 L (observed) 110% predicted RV 2.47 L (predicted), 3.17 L (observed) 128% predicted FEV1 3.50 L (predicted), 2.35 L (observed) 67% predicted These findings are consistent with which of the following? A. No demonstratable abnormality B. Restrictive lung disease C. Obstructive lung disease D. A ventilation/perfusion mismatch - Correct Answer-C pg. 56 professoraxe l Your patient has just delivered her baby vaginally without difficulty. The patient has a laceration of the vaginal mucosa including the perineal body. You repair it without difficulty. On the chart you document this as what type of tear? A. First degree B. Second degree C. Third degree D. Fourth degree - Correct Answer-B A 36 year-old male presents for follow-up of his hypertension. The patient is currently on three anti-hypertensive medications without improvement of his blood pressure. On examination his BP is 170/86mmHg and his HR is 60bpm and regular. His heart examination reveals a regular rate and rhythm without S3, S4 or murmur and his lungs are clear to auscultation bilaterally. Abdominal examination reveals a bruit over his left upper abdomen. Which of the following is the most likely underlying etiology for this patient's hypertension? A. Pheochromocytoma B. Renal artery stenosis C. Cushing syndrome pg. 57 professoraxe l hematochezia. Which of the following is the most likely diagnosis? A. Celiac disease B. Lactose intolerance C. Short bowel syndrome D. Irritable bowel syndrome - Correct Answer-A A 9 year-old patient presents with conjunctivitis after swimming at the local pool. On examination, there is visible lid edema with redness of the palpebral conjunctiva, copious watery discharge, and scanty exudate. The sanitation system of the public pool is through the use of a salt water system; therefore, the possibility of a chemical induced conjunctivitis is almost non-existent. Which of the following should be instituted to prevent the sequalae of the condition? A. Ketorolac tromethamine (Acular) B. Dexamethasone opthalmic C. Naphazoline HCL (Naphcon A) D. Sulfacetamide opthalmic - Correct Answer-D A 36 year-old male who is hospitalized because of severe injuries from a motor vehicle accident develops rapid onset of profound dyspnea. Initial chest x-ray shows a normal heart pg. 60 professoraxe l size with diffuse bilateral infiltrates. Follow-up chest xray shows confluent bilateral infiltrates that spare the costophrenic angles. Which of the following is the best clinical intervention for this patient? A. Provide supplemental oxygen B. Insert chest tube C. Tracheal intubation D. Administer corticosteroids - Correct Answer-C A 16 year-old male presents with complaint of syncope after basketball practice today. Physical examination reveals a systolic murmur along the left sternal border that increases with Valsalva maneuver. An electrocardiogram reveals left ventricular hypertrophy. Echocardiogram shows asymmetric left ventricular hypertrophy with a hypercontractile left ventricle. Which of the following is the initial medication of choice in this patient? A. Metoprolol (Lopressor) B. Losartan (Cozaar) C. Lisinopril (Zestril) D. Hydrochlorothiazide (Diuril) - Correct Answer-A pg. 61 professoraxe l A 37 year-old right-handed landscaper comes to the office for evaluation of recurrent itching and stinging of the skin on his right hand. Physical examination reveals confluent papules, vesicles, erosions and crusts on the dorsum of his right hand. Which of the following is the most appropriate initial diagnostic study in this patient? A. Skin scraping and microscopy B. Patch testing C. RAST testing D. Skin biopsy - Correct Answer-B What phase of the female menstrual cycle occurs at the time of elevated estrogen and LH/FSH surge? A. Follicular phase B. Proliferative phase C. Ovulation D. Secretory phase - Correct Answer-C A 27 year-old male nonsmoker is diagnosed with upper extremity venous thrombosis. What is the most likely factor abnormality found in this patient? A. Factor VIII pg. 62 professoraxe l arm is extremely weak. There are no other areas of involvement, sensory deficit or altered consciousness. What is the most likely seizure diagnosis? A. Absence B. Complex-partial C. Simple-partial D. Myoclonic - Correct Answer-C A 15 year-old man comes to the office with acute onset of nausea, severe pain and swelling within the right testis. He has no fever or irritative voiding symptoms. Which of the following scrotal physical examination findings would you expect in this patient? A. Nodular mass within the testis B. High-lying testis C. Transilluminated fluid mass D. Palpation of a soft bag of worms - Correct Answer-B A 56 year-old diabetic male with a three-month history of epigastric pain after eating says he gets full really fast now. His test for Helicobacter pylori is negative. Which of the following is the recommended medication to treat this patient? pg. 65 professoraxe l A. Calcium carbonate (Tums) B. Ranitidine (Zantac) C. Omeprazole (Prilosec) D. Metoclopramide (Reglan) - Correct Answer-D Which of the following is the most appropriate management of acute psychosis in a patient with schizophrenia? A. Amitriptyline (Elavil) B. Fluphenazine (Prolixin) C. Lithium (Eskalith) D. Sertraline (Zoloft) - Correct Answer-B An asymptomatic 60 year-old female with a 30 pack year history of smoking presents to the clinic requesting a chest x- ray to check for lung cancer. Which of the following do you recommend? A. A low-dose helical computed tomography (CT) B. Carcinoembryonic antigen (CEA) C. Serial chest radiographs to identify early stage malignancy D. No testing and referral for smoking cessation - Correct Answer-D pg. 66 professoraxe l Colposcopic examination of the cervix of a 38 year-old woman with a high-grade lesion on Papanicolaou (Pap) smear yields a positive endocervical canal curettage (ECC) as its only abnormality. Which of the following is the most appropriate next step in this patient? A. Repeat the Pap smear in 3 months B. Perform a conization of the cervix C. Repeat the colposcopic examination in 3 months D. No follow-up is required - Correct Answer-B Which of the following would be expected on physical examination of a newborn diagnosed with Tetrology of Fallot? A. Palpable right ventricular lift B. Pulse discrepancy between arms and legs C. Mid-diastolic murmur with opening snap D. Polymorphous exanthema - Correct Answer-A Which of the following is the rationale for the utilization of beta blocker therapy in a patient with hyperthyroidism? A. Reduce goiter size B. Alleviate symptoms pg. 67 professoraxe l C. Diverticulitis D. Nephrolithiasis - Correct Answer-D An 18 year-old female presents to the office with fever, fatigue and sore throat. Physical examination reveals an erythematous pharynx, cervical lymphadenopathy and splenomegaly. CBC reveals an increased white blood cell count with atypical lymphocytes, normal hemoglobin and hematocrit and normal platelet count. What additional laboratory test will help you make the diagnosis in this patient? A. Heterophile test B. Lymph node biopsy C. Serum antibody screening D. Serum transaminase - Correct Answer-A A 67 year-old male with history of mitral valve stenosis undergoes a mechanical valve replacement. Which of the following is the appropriate duration of anticoagulation therapy if the patient has no other risk factors for thromboembolic events or significant bleeding risks? A. One month B. Three months pg. 70 professoraxe l C. Six months D. Lifelong - Correct Answer-C What nail finding is most consistent with cirrhotic liver disease? A. Clubbing B. Pitting C. Terry's nails D. Beau's lines - Correct Answer-C A 30 year-old male presents with sudden onset of chills, fever, chest pain and a cough productive of greenish-brown sputum. On examination his temperature is 102 degrees F. He appears acutely ill and his respirations are shallow. Chest x-ray demonstrates left lower lobe consolidation. Which of the following findings would most likely be present on examination of his left lower lung? A. Hyperresonance B. Vesicular breath sounds C. Increased tactile fremitus D. Wheezing - Correct Answer-C pg. 71 professoraxe l A 26 year-old female reports progressive distal to proximal spread of extremity weakness over the last 36 hours without fever, headache or syncope. Examination reveals symmetrical, paresis of the hands and feet with loss of the brachioradialis and Achillis reflexes. Biceps and knee reflexes are present but diminished. Sensory exam is normal. What are the most likely findings on cerebral spinal fluid (CSF) analysis? A. Decreased glucose, increased WBC count and decreased protein B. Increased glucose, normal WBC count and normal protein C. Normal glucose, decreased WBC count and elevated protein D. Normal glucose, normal WBC count and elevated protein - Correct Answer-C Which of the following physical examination findings is present in a 12 week singleton pregnancy? A. Chadwick's sign B. Uterus palpable at the level of the umbilicus C. Blood pressure lower than non-pregnant state D. Hyperreflexia - Correct Answer-A A blacksmith presents to your clinic after feeling like something went in his eye while he was grinding on a piece of pg. 72 professoraxe l D. Tako-Tsubo cardiomyopathy - Correct Answer-C A 4 month-old infant is brought to the clinic by his mother with complaints of a cough for the past 3 weeks. Initially, symptoms included running nose, sneezing and an irritating cough. Over the past week the cough has changed to persistent staccato, paroxysmal forceful coughs ending with a loud inspiration. WBC is 20,0000/mcl with 72% lymphocytes. Which of the following is the drug of choice for managing this patient? A. Azithromycin (Zithromax) B. Ceftriaxone (Rocephin) C. Ampicillin (Unasyn) D. Gentamicin (Garamycin) - Correct Answer-A A 28 year-old female comes to the office with fever, flank pain, and dysuria for the past two days. Which of the following urinalysis results are suggestive of acute pyelonephritis? A. Hyaline casts B. Red cell casts C. White cell casts D. Granular casts - Correct Answer-C pg. 75 professoraxe l What is the initial treatment of choice for inflammatory bowel disease? A. Ondansetron (Zofran) B. Sulfasalazine (Azulfidine) C. Metronidazole (Flagyl) D. Azothioprine (Imuran) - Correct Answer-B A patient is traveling to Africa on a church mission trip. The area he is traveling to has a high incidence of chloroquine- resistant malaria. What drug is indicated for prophylaxis in this patient? A. Atovaquone (Malarone) B. Hydroxychloroquine sulfate (Plaquenil) C. Quinine sulfate (Qualaquin) D. Lumefantrine (Benflumetol) - Correct Answer-A What spinal nerve root is most likely affected in a patient with weak wrist extension, thumb and index finger paresthesias and diminished triceps reflex? A. Cervical 4 B. Cervical 5 pg. 76 professoraxe l C. Cervical 6 D. Cervical 7 - Correct Answer-C A 13 year-old female presents to the office with right knee and thigh pain and the inability to bear weight since waking yesterday morning. The mother states the child had a fever of 100.9 degrees F this morning and continues to be non-weight bearing. Examination reveals a warm, erythematous, swollen knee. Which of the following tests would be most beneficial in the diagnosis and treatment of this patient? A. Plain x-ray of the femur B. Antistreptolysin O titer C. Magnetic resonance imaging (MRI) of the femur D. Culture of joint aspirate - Correct Answer-D A 59 year-old male with history of hypertension and dyslipidemia presents with complaint of substernal chest pain for two hours. The pain woke him from sleep, does not radiate, and is associated with nausea and diaphoresis. Electrocardiogram reveals ST segment elevation in leads II, III, and AVF. Which of the following walls of the ventricle is most likely at risk? A. Anterior pg. 77 professoraxe l photophobia and phonophobia. There have been no concomitant sensory or motor deficits. Her physical examination and brain MRI are normal. What treatment would be best to reduce the frequency of the headaches? A. Sumatriptan (Imitrex) B. Isometheptene (Midrin) C. Propranolol (Inderal) D. Hydrocodone (Vicodin) - Correct Answer-C A 24 year-old female presents complaining of palpitations described as occasional "skipped" beats. The patient denies chest pain, lightheadedness, syncope, or dyspnea. On examination you note a midsystolic click without murmur. Which of the following is the most likely diagnosis in this patient? A. Mitral valve prolapse B. Aortic stenosis C. Atrial septal defect D. Pulmonic stenosis - Correct Answer-A A 14-year old male active in sports, has been complaining of intermittent anterior right knee pain for several months.He denies any specific injuries. On examination, there is no pg. 80 professoraxe l erythema, swelling, deformities, joint laxity, or crepitus. Palpation reveals tenderness over the tibial tubercle and bursa of the right knee. This finding is characteristic of which of the following disorders? A. Discoid meniscus B. Osgood-Schlatter disease C. Chondromalacia patella D. Osteochondritis dissecans - Correct Answer-B A 28 year-old man comes to the office for his yearly follow up of testicular cancer. He was successfully treated with an orchiectomy two years ago. Which of the following tumor markers can be used to identify early relapse in testicular cancer? A. Carcinoembryonic antigen (CEA) B. Prostate specific antigen (PSA) C. CA 125 glycoprotein D. Alpha fetoprotein (AFP) - Correct Answer-D A 6 year-old boy is brought to the pediatric clinic by his mother for an evaluation of his asthma. He coughs about 3 days out of the week with at least 2-3 nights of coughing. pg. 81 professoraxe l Which of the following would be the most appropriate treatment for this patient? A. Mast cell stabilizer B. Long acting beta agonist C. Leukotriene receptor antagonist D. Low dose inhaled corticosteroid - Correct Answer-D A 68 year-old male with a history of alcohol abuse presents with coffee-ground emesis. He denies vomiting prior to this episode. What is the most likely cause of his bleeding? A. Erosive gastritis B. Gastric neoplasm C. Mallory-Weiss tear D. Zenker diverticulum - Correct Answer-A What class of medications has been found most beneficial in the treatment of alcoholism not associated with a concomitant psychiatric illness? A. Antipsychotics B. Benzodiazepines C. Melatonin agonists pg. 82 professoraxe l A. Carotid Doppler B. Dix-Hallpike maneuver C. Epply maneuver D. Magnetic resonance imaging - Correct Answer-D A 13 year-old male with known cystic fibrosis presents to the emergency department, accompanied by his parents, with increased coughing, wheezing and low grade fever. Rales are audible on auscultation of the lungs. Treatment should target which of the following organisms? A. Pneumocystis jiroveci B. Haemophilus influenza C. Mycoplasma pneumoniae D. Pseudomonas aeruginosa - Correct Answer-D A 68 year-old woman comes to the office for evaluation of urinary incontinence. For the past few months, she has had an intense urgency to urinate, followed by leakage of urine. Which of the following is the most appropriate intervention for this patient? A. Intravaginal estrogen cream (Premarin cream) B. Terazosin (Hytrin) pg. 85 professoraxe l C. Oxybutynin (Ditropan) D. Intravaginal miconazole cream (Monistat cream) - Correct Answer-C What is the recommended initial first trimester screening test for fetal aneuploidy? A. Amniocentesis B. Pregnancy-associated plasma protein A (PPA), beta-hCG, and ultrasound of nuchal transparency C. Maternal serum alpha feto protein, beta-hCG, estriol, and inhibin-A D. Level II ultrasound - Correct Answer-B A 26 year-old patient is brought to the emergency department after a head on collision. The patient complains of chest pain, dyspnea and cough. Examination reveals the patient to be tachypneic and tachycardic with a narrow pulse pressure. Jugular venous distension is noted. Electrocardiogram reveals nonspecific t wave changes and electrical alternans. Which of the following is the most appropriate management plan for this patient? A. Serial echocardiograms B. Pericardiocentesis pg. 86 professoraxe l C. Cardiac catheterization D. Pericardiectomy - Correct Answer-B A 23 year-old male comes to the office with an intensely itchy rash, especially at night for the past week. His roommates have similar symptoms but have not been evaluated. On physical examination, the wrists, web spaces of the hands, and axillae have thin linear markings, tiny vesicles, and excoriations. Which of the following is the most likely diagnosis? A. Pediculosis B. Folliculitis C. Impetigo D. Scabies - Correct Answer-D A 55 year-old male presents with a three month history of progressive weakness in the extremities without associated sensory changes or deficits. Examination reveals widespread muscle atrophy, fasciculations and bilateral hyperactive reflexes with Babinski sign. Which of the following is the most likely diagnosis? A. Amyotrophic lateral sclerosis B. Polymyalgia rheumatica pg. 87 professoraxe l A 69 year-old male presents with complaint of increasing dyspnea over the past 6-8 months. The patient denies cough, chest pain or smoking history. Physical examination reveals inspiratory crackles at the bases and clubbing of the nails. Chest x-ray reveals interstitial fibrosis of the lower lungs, thickened pleura and calcified pleural plaques of the lateral chest wall. Pulmonary function testing shows a restrictive pattern with a decreased diffusing capacity. What information is most likely noted in this patient's history? A. Coal mining B. Silica exposure C. Textile work D. Asbestos exposure - Correct Answer-D A 54 year-old type 2 diabetic male presents for follow up evaluation of previously diagnosed persistent otitis externa. Early in the disease process, a CT scan was obtained secondary to non-improvement on antibiotics. Results showed osseous erosion of the floor of the ear canal. He has been on ciprofloxacin 1000mg twice daily for two months since the CT scan and currently has no further edema, erythema, or exudate from the external auditory canal or surrounding tissue. Which of the following is an appropriate treatment plan? A. Continue prophylactic antibiotics for an additional 6 weeks pg. 90 professoraxe l B. Immediately discontinue antibiotics C. Obtain gallium scan to ensure reduction of inflammatory process D. Skin swab culture of healthy tissue - Correct Answer-C A person with type 2 diabetes who requires insulin brings in a home monitoring record for review. The current insulin regimen is 15 units of NPH with 5 units of regular in the morning, and 10 units of NPH with 5 units of regular in the evening. A trend of elevated blood sugar readings occurring at noon should prompt an insulin increase of which of the following? A. Morning NPH dose B. Morning regular dose C. Evening NPH dose D. Evening regular dose - Correct Answer-B In which of the following conditions would human chorionic gonadotropin (hCG) level be lower than expected for gestational age? A. Choriocarcinoma B. Hydatidiform mole pg. 91 professoraxe l C. Ectopic pregnancy D. Twin gestation - Correct Answer-C A 26 year-old woman comes to the office for her first prenatal visit at 9 weeks gestation. During evaluation, her urinalysis reveals asymptomatic bacteriuria. Which of the following antibiotics is the preferred treatment in this patient? A. Doxycycline (Vibromycin) B. Trimethoprim (Monotrim) C. Nitrofurantoin (Macrobid) D. Erythromycin (Ery-tab) - Correct Answer-C What physical examination finding is most specific for acute cholecystitis? A. Psoas sign B. Rovsing's sign C. Murphy's sign D. Cullen's sign - Correct Answer-C Which of the following medications is the initial treatment of choice for suppressing the progression of rheumatoid arthritis (RA)? pg. 92 professoraxe l C. Topical estradiol (Estrace) cream D. Oral metronidazole (Flagyl) - Correct Answer-D A 30 year-old female presents with left wrist pain after slipping on the ice while walking to her car. On examination, pain is noted on palpation over the anatomical snuff box. X- ray of her wrist shows no identifiable fracture. Which of the following is the most appropriate treatment in this patient? A. No treatment necessary B. ACE wrap application C. Splint application D. Immediate orthopedic referral - Correct Answer-C In what region of the brain are cerebrovascular lesions most likely to cause post-event depressive symptoms? A. Cerebellum B. Occipital C. Pons D. Temporal - Correct Answer-D A 70 year-old female with history of hypertension, diabetes, and hypothyroidism presents with complaint of sudden onset pg. 95 professoraxe l of left lower extremity pain. Examination reveals a cool left lower extremity with a mottled appearance. Dorsalis pedis and posterior tibialis pulses are absent. Which of the following is the most likely diagnosis? A. Acute arterial occlusion B. Thromboangiitis obliterans C. Deep vein thrombosis D. Peripheral neuropathy - Correct Answer-A A 54 year-old woman with history of lupus comes to the office with increasing significant peripheral edema over the past four days. Laboratory findings include marked proteinuria, hypoalbuminemia and hyperlipidemia. Which of the following diagnostic studies is the best for determining the cause of the proteinuria? A. Renal ultrasound B. Renal biopsy C. Cystoscopy D. Computed tomography scan - Correct Answer-B For patients undergoing highly emetogenic chemotherapy regimens, which of the following would be the first-line antiemetic medication? pg. 96 professoraxe l A. Ondansetron (Zofran) B. Lorazepam (Ativan) C. Dronabinol (Marinol) D. Prochlorperazine (Compazine) - Correct Answer-A A 26 year-old female comes to the office for evaluation of a painful lump on her right buttock for the past week. Initially, it was a firm, tender nodule that has increased in size and tenderness in the past two days. On physical examination of the right buttock, there is a 3-cm fluctuant tender red nodule. Which of the following is the most appropriate initial intervention? A. Incision and drainage B. Mupirocin ointment C. Systemic antibiotics D. Moist compresses - Correct Answer-A A mean corpuscular volume (MCV) of less than 80 cubic microns is a manifestation of which of the following diagnoses? A. Iron deficiency B. Vitamin B12 deficiency pg. 97 professoraxe l