Ten days after the delivery of a healthy infant a woman presents having a generalized tonic-clonic seizure. During her pregnancy, the patient had elevated blood pressure, hyperreflexia and protein in her urine. She has not known past medical history. Which of the following is the most appropriate agent to treat her seizure?

A 22-year-old college athlete injured his back while doing dead lifts in the weight room. For two weeks, his pain has remained localized to the lumbar region and is aggravated with exercise, specifically movements that involve extension. The past three days the pain has started to progressively radiate into his buttocks, hamstrings and down his right leg. X-rays identify a 30% anterior vertebral displacement of L5 on S1. Which one of the following terms describes the x-ray findings?

Closing of the eyelids is mediated through which of the following cranial nerves?

A G1P0 patient at 32 weeks gestation has been in labor for 3 days with ruptured membranes. She has been hospitalized on bed rest. Today she develops a fever (101.2ºF).

A sterile vaginal exam reveals 9 cm dilation and 50% effacement. What is the best management option at this time?

A 24-year-old female with a history of schizophrenia presents to the clinic for an evaluation of six months of oligomenorrhea and three months of bilateral nipple discharge. She has never been pregnant. She denies sexual activity. She has been admitted to the psychiatric unit three times over the past four months. The patient’s current medications include risperidone, haloperidol, thiothixene, and a tricyclic antidepressant. Serum HCG is negative. Prolactin is 45. MRI is normal; no pituitary enlargement. What is the most appropriate next step in her management?

A 78-year-old patient has a low TSH and a very low FT4. She has a past medical history of a subdural hematoma and compensated congestive heart failure for which she is on hydrochlorothiazide the most appropriate management for her hypothyroid state?

Which of the following symptoms / signs is most suggestive that an orbital wall fracture has occurred following blunt force trauma to the eye?

A 14-month-old male presents with an 18-hour history of vomiting and lethargy. While in the clinic he passes a large, grossly bloody stool. On exam you palpate a right lower quadrant mass. Which diagnostic study should be ordered?

A 44-year-old male presents with fever, cough productive of brown sputum, rigors and lethargy for 7 days. Chest x-ray reveals a right middle lobe infiltrate with a pleural effusion. A thoracentesis is performed. Which of the following results from pleural fluid analysis is expected?

A 64-year-old smoker presents to the clinic with a history of dyspnea, headache, and malaise. CBC report: Hemaglobin 19.2; Hematocrit 59; Platelet count 650,000. The WBC is also slightly elevated at 21,000. What is the most likely diagnosis?

A 33-year-old male presents with fever, dry cough, and progressive dyspnea worsening over the past three weeks. In addition to the pulmonary complaints he has noted profound fatigue and a seven-pound weight loss. The patient has known HIV disease; recent CD4 count 170; viral load undetectable. On examination, his temperature is 102ºF (oral), heart rate 110; respirations 32; blood pressure 135/90 mmHg. Examination: Tachycardia and scattered crackles noted. A chest x-ray shows diffuse bilateral interstitial infiltrates. What is the most appropriate treatment for this patient?

A 69-year-old male presents concerned that he lost vision in his right eye for three minutes earlier today. He describes a curtain being lowered then raised as the vision was lost then returned. He is otherwise healthy and currently without complaints. His visual acuity is 20/40 OD; 20/30 OS; 20/30 OU with corrective lenses. He has early bilateral lenticular opacities. His funduscopic examination is normal. Which of the following is the most likely diagnosis?

Which one of the following is contraindicated during pregnancy?

Which of the following causes of anemia is classically associated with an elevated reticulocyte count?

A tall, thin, healthy 21-year-old college student presents to an urgent care facility with a history of mild shortness of breath. The patient relates that he experienced an episode of coughing about 30 minutes ago while running between classes. The cough was accompanied by pleuritic chest pain which has persisted since that initial episode. He has no fever, no chills, and no sputum production. On physical examination, he appears to be in no respiratory distress, although he does splint during inspiration. His pulse oximetry on room air is 93%. Physical examination of the thorax reveals hyperresonant percussion on the right, with diminished breath sounds. Left lung exam is unremarkable. Chest x-ray identifies a 30-40% pneumothorax of the right lung. How should this situation be handled?

Lamotrigine lists a “Black Box Warning” for which side effect(s)?

Which of the following is the most appropriate initial therapy in Grave’s disease for the cardiac manifestations of palpitations, tachycardia and tremor?

Laxity during valgus stressing of the knee suggests disruption of which of the following?

A patient is in the ICU after having a stent placed for an acute myocardial event. He is currently on lisinopril and hydrochlorothiazde. To optimize his medical care and provide him with the best long-term prognosis; minimizing or delaying the onset of heart failure, which of the following medications would you add to his regimen?

Which one of the following cardiac events is best heard with the bell of the stethoscope, more prominent during ventricular ischemia, and dependent upon atrial contraction to be auscultated?

The biopsy report from a lesion located at the gastroesophageal junction of a patient collected during an esophagogastroduodenoscopy identifies the presence of metaplasia. This patient most likely has which one of the following conditions?

A 70-year-old woman presents to your clinic with a ten-day history of a unilateral, temporal headache. She has no history of similar headaches. Her temporal arteries are prominent and appear indurated when palpated. Which one of the following would you expect to find with a probability of approximately 50%?

Which one of the following findings is the most suggestive that a child is experiencing acute, increased expiratory effort?

A full-term infant is noted to be at the 95th percentile for weight and the 55th percentile for length and head circumference. Which of the following conditions is most likely the cause of this triad of physical findings?

Which of the following is a potassium-sparing diuretic?

During the landing of a 17-year-old gymnast who jumped from the balance beam to the floor, the patient describes hearing a pop and experiencing immediate pain in her foot. She is unable to bear weight. The patient denies any other injury. Exam demonstrates a swollen foot with significant ecchymosis. There is no tenderness over the lateral or medial malleoli. There is no tenderness over the lateral aspect of the foot. The Achilles tendon is intact and not tender. X-rays of foot reveal no fractures; a 3 mm displacement of the first and second tarsometatarsal joints. What is this patient’s diagnosis?

A 49-year-old patient with long-standing alcohol use and cirrhosis is admitted to the hospital with rapid onset jaundice, nausea, and weakness. He admits to drinking alcohol up until the time of admission. His transaminases are significantly elevated, and INR is 2.5. An abdominal ultrasound shows moderate ascites; no masses or biliary obstruction. Which of the following interventions would most improve the short-term survival of this patient?

A 76-year-old female with a history of congestive heart failure well-controlled on digoxin and furosemide presents for recurring shortness of breath. Her examination reveals sinus tachycardia (rate = 104), bibasilar crackles and 2+/4+ pretibial edema. Of the following therapeutic choices which one would add the most benefit to her treatment plan?

A 34-year-old male presents with a urethral discharge. He reports that five days earlier he had intercourse with a new partner. A gram stain identifies > 50 WBC/HPF (high power field). Pending culture results which of the following therapeutic treatments is the best option?

A 29-year-old male with no past medical history who is a chef at a local restaurant presents claiming that he is US senator. After the initiation of treatment, he has a generalized tonic-clonic seizure. Which of the following medications was he most likely prescribed?

A 55-year-old male with known alcoholic cirrhosis presents with a laceration. When deciding how to address this patient’s wound care needs, which one of the following local anesthetics should be avoided as it has the greatest potential to cause toxicity?

Enlargement of which lymph nodes is most suggestive that a patient with pharyngitis has infectious mononucleosis?

A 76-year-old male presents with a four month history of progressive difficulty swallowing solid foods. He has lost 12 pounds. He has a history of 2-pack per day smoking and usually drinks 4 alcoholic beverages a day. Which of the following is the most likely diagnosis?

A 28-year-old patient presents for an ankle sprain. When you enter the room, the patient is sitting with the gown open in the front without any clothes. The office staff reports that the patient likes to wear colorful clothing with matching accessories. The patient is often inappropriately loud in the waiting room and likes to be noticed. Which of the following personality disorders is the most likely diagnosis?

Three hours after an automobile accident, a 36 year-old male presents because of feeling lightheaded when he stands up. He denies striking his head on the windshield or steering wheel. He is noted to have diffuse abdominal pain and notable tenderness in the left upper quadrant during his examination. After lying on the gurney for a while he begins to complain of left shoulder pain. Which of the following organs are you most concerned that he has injured?

Chest x-rays with consolidation limited to the posterior segment of the right upper lobe or the superior segment of either lower lobe (left or right) suggest what type of pneumonia?

A 3-year-old male presents to the emergency department for the evaluation of a persistent fever for five days, as high as 103ºF (tympanic). He was seen in an outpatient clinic three days ago; the diagnosis at that time was viral syndrome. Today, he woke with bilateral “pink eye”, cracked bleeding lips, and peeling skin on both the palms of his hands and soles of his feet. He has a bright red tongue, bilateral cervical adenopathy, injected conjunctivae and dry fissured lips. Which of the following is the most significant complication of this condition?

Which of the following findings in a patient’s urinalysis is most suggestive that an infection exists in the kidney?

Which one of the following findings is most suggestive that a viral etiology is the cause of a patient’s conjunctivitis?

A 12-year-old is playing with his four-year-old brother. After forcibly pulling the younger brother up from the ground by grasping his wrists, the younger brother won’t move his right arm and complains of pain at the elbow. Physical examination identifies localized pain at the radial head. X-ray fails to identify a fracture or any fat pad displacement. What is the most likely diagnosis?

Which of the following infections classically occurs prior to the development of guttate psoriasis?

A 59-year-old patient presents with crushing chest pain for 45 minutes. He took four baby aspirin prior to arrival. The pain is not altered with respiration or movement. An EKG reveals ST segment depression in leads I, aVL, and V5-V6. Which of the following medications should be administered as soon as possible to reduce the possibility of acute mortality?