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    Practice Exam 1

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    Practice Exam 1

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    3. Answered
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    1. Question 1 of 60
      1. Question

      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?

      Correct
      Incorrect
    2. Question 2 of 60
      2. Question

      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?

      Correct
      Incorrect
    3. Question 3 of 60
      3. Question
      A patient has an echocardiogram performed. The echocardiogram report describes a left ventricle that is mildly hypertrophic and grades the stenotic lesion as “high grade”. Which one of the following physical examination findings is most likely to be identified during the examination of this patient?
      Correct
      Incorrect
    4. Question 4 of 60
      4. Question

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

      Correct
      Incorrect
    5. Question 5 of 60
      5. Question

      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?

      Correct
      Incorrect
    6. Question 6 of 60
      6. Question

      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?

      Correct
      Incorrect
    7. Question 7 of 60
      7. Question
      A 52-year-old female that recently moves to the United States from Russia presents with a history of black stools, progressive dyspnea on exertion, weight loss, and post prandial abdominal pain. HGB 5; HCT 19.2. What is the most likely diagnosis?
      Correct
      Incorrect
    8. Question 8 of 60
      8. Question
      In which one of the following scenarios would an LDL of 130 – 160mg/dL be acceptable to reduce the risk of coronary artery disease?
      Correct
      Incorrect
    9. Question 9 of 60
      9. Question
      After consultation with a patient and his spouse about snoring, you determine that the patient likely suffers from obstructive sleep apnea. Which of the following is the best initial management for patients with this condition?
      Correct
      Incorrect
    10. Question 10 of 60
      10. Question

      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?

      Correct
      Incorrect
    11. Question 11 of 60
      11. Question
      Which of the following agents when used in combination with gentamicin increases the likelihood that nephrotoxicity will occur?
      Correct
      Incorrect
    12. Question 12 of 60
      12. Question

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

      Correct
      Incorrect
    13. Question 13 of 60
      13. Question

      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?

      Correct
      Incorrect
    14. Question 14 of 60
      14. Question

      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?

      Correct
      Incorrect
    15. Question 15 of 60
      15. Question

      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?

      Correct
      Incorrect
    16. Question 16 of 60
      16. Question

      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?

      Correct
      Incorrect
    17. Question 17 of 60
      17. Question
      A 40-year-old female presents for evaluation of elevated blood pressure. Her BP at this visit is 164/103 mmHg, and BP readings obtained at a free clinic over the past month confirm this degree of elevation as a consistent finding. Her past medical history is significant for gestational diabetes; otherwise unremarkable. Her family history is significant for diabetes and hypertension. Her mother died at age 70 of a myocardial infarction; father died of a CVA at age 80. She does not smoke; does consume alcohol in moderation. Her BMI is 28. FBS 103 mg/dL; creatinine 0.5 mg/dL. Which of the following would you address first?
      Correct
      Incorrect
    18. Question 18 of 60
      18. Question

      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?

      Correct
      Incorrect
    19. Question 19 of 60
      19. Question

      Which one of the following is contraindicated during pregnancy?

      Correct
      Incorrect
    20. Question 20 of 60
      20. Question

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

      Correct
      Incorrect
    21. Question 21 of 60
      21. Question
      Which of the following medications would be the best choice to reduce the incidence of chest pain caused by Prinzmetal angina?
      Correct
      Incorrect
    22. Question 22 of 60
      22. Question
      A 13-year-old male presents two hours after falling off of his bicycle. He complains of left shoulder pain. On exam, the shoulders appear symmetrical. He is unable to move his arm through a full range of motion with tenderness localized to the region of the distal clavicle. X-rays do not identify a fracture. What is the most likely cause of his painful shoulder?
      Correct
      Incorrect
    23. Question 23 of 60
      23. Question

      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?

      Correct
      Incorrect
    24. Question 24 of 60
      24. Question
      A 61-year-old male with acute shortness of breath arrives via EMS to the emergency department. His blood pressure is 92/58 mm Hg and heart rate is 132; heart sounds are muffled. He is noted to have bilateral jugular venous distention. When he inhales, his systolic blood pressure drops by 16 mm Hg. Which of the following is the most likely explanation for this presentation?
      Correct
      Incorrect
    25. Question 25 of 60
      25. Question

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

      Correct
      Incorrect
    26. Question 26 of 60
      26. Question
      A 19-year-old collegiate swimmer presents with left ear pain. He denies fever. He has not experienced any recent symptoms of an upper respiratory tract infection. There is tenderness with manipulation of the tragus, swelling of the external auditory canal (EAC), and a greenish exudate noted in the EAC. The tympanic membrane cannot be visualized. The antimicrobial agent chosen to treat this condition must include a spectrum of activity that is effective against which likely pathogen?
      Correct
      Incorrect
    27. Question 27 of 60
      27. Question

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

      Correct
      Incorrect
    28. Question 28 of 60
      28. Question

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

      Correct
      Incorrect
    29. Question 29 of 60
      29. Question

      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?

      Correct
      Incorrect
    30. Question 30 of 60
      30. Question
      A 19-year-old man presents to the emergency department in police custody following an arrest for disorderly conduct for aggressive behavior. He has been yelling in the street in the middle of the night. His family reports that he is a generally well-mannered. They add that he has not slept for the past few days. He tells you that he has a plan to make millions in the next few months. There is no history of similar episodes. His behavior is most characteristic of:
      Correct
      Incorrect
    31. Question 31 of 60
      31. Question

      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?

      Correct
      Incorrect
    32. Question 32 of 60
      32. Question

      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?

      Correct
      Incorrect
    33. Question 33 of 60
      33. Question

      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%?

      Correct
      Incorrect
    34. Question 34 of 60
      34. Question

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

      Correct
      Incorrect
    35. Question 35 of 60
      35. Question

      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?

      Correct
      Incorrect
    36. Question 36 of 60
      36. Question

      Which of the following is a potassium-sparing diuretic?

      Correct
      Incorrect
    37. Question 37 of 60
      37. Question

      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?

      Correct
      Incorrect
    38. Question 38 of 60
      38. Question

      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?

      Correct
      Incorrect
    39. Question 39 of 60
      39. Question

      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?

      Correct
      Incorrect
    40. Question 40 of 60
      40. Question

      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?

      Correct
      Incorrect
    41. Question 41 of 60
      41. Question
      A 46-year-old male presents with a history of weight gain and proximal muscle weakness. His exam identifies prominent dorsocervical adipose tissue. His urinary free cortisol level is elevated and does not suppress with administration of dexamethasone. His serum ACTH level is non-detectable. What study should be ordered next?
      Correct
      Incorrect
    42. Question 42 of 60
      42. Question

      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?

      Correct
      Incorrect
    43. Question 43 of 60
      43. Question
      Of the following diagnostic studies, which one has the highest specificity for detecting and evaluating the extent of coronary artery disease?
      Correct
      Incorrect
    44. Question 44 of 60
      44. Question

      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?

      Correct
      Incorrect
    45. Question 45 of 60
      45. Question

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

      Correct
      Incorrect
    46. Question 46 of 60
      46. Question

      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?

      Correct
      Incorrect
    47. Question 47 of 60
      47. Question

      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?

      Correct
      Incorrect
    48. Question 48 of 60
      48. Question

      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?

      Correct
      Incorrect
    49. Question 49 of 60
      49. Question

      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?

      Correct
      Incorrect
    50. Question 50 of 60
      50. Question

      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?

      Correct
      Incorrect
    51. Question 51 of 60
      51. Question
      The report of a CBC includes the following values: Hemoglobin = 10.2 Gm/dL, MCV = 70 and RDW = 17 suggests which of the following anemias?
      Correct
      Incorrect
    52. Question 52 of 60
      52. Question

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

      Correct
      Incorrect
    53. Question 53 of 60
      53. Question
      In a patient with an elevated serum uric acid level and a single, acutely erythematous, warm, painful joint that did not suffer a traumatic insult, the most important reason to perform a joint fluid aspiration is to:
      Correct
      Incorrect
    54. Question 54 of 60
      54. Question
      A 76-year-old female presents to the emergency department with acute shortness of breath. Her examination reveals a sinus tachycardia, respiratory rate of 32, crackles bilaterally that involve more than 60% of the lung fields, an S3 gallop, and hepatojugular reflux. Which of the following is the best initial step in her management?
      Correct
      Incorrect
    55. Question 55 of 60
      55. Question

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

      Correct
      Incorrect
    56. Question 56 of 60
      56. Question

      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?

      Correct
      Incorrect
    57. Question 57 of 60
      57. Question
      A patient with a serum blood glucose > 400mg%, acute confusion and an elevated respiratory rate is admitted to an ICU. Which of the following is the best determinant of this patient’s prognosis?
      Correct
      Incorrect
    58. Question 58 of 60
      58. Question

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

      Correct
      Incorrect
    59. Question 59 of 60
      59. Question

      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?

      Correct
      Incorrect
    60. Question 60 of 60
      60. Question
      A 53-year-old man presents with the “same pain” he had last year when he had a bleeding gastric ulcer. He has been taking his omeprazole twice a day as instructed. His abdomen is soft; he has mild midepigastric discomfort on palpation. His fecal occult blood test is positive. What is your clinical intervention for this patient?
      Correct
      Incorrect
    cmeresources2024-01-22T11:22:54-06:00

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