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  #101  
Old 02-13-2015
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Quote:
Originally Posted by drpisho View Post
PLEASE I NEED HELP WITH THIS QUESTIONS

A 7-year-old girl is brought to the physician in September because of fever and sore throat for 1 day. She is in the third week of second grade. Her temperature is 38.6 C (101.5 F). Examination shows an erythematous pharynx and slightly enlarged tonsils without exudate. There is no significant cervical lymphadenopathy. A rapid test for group A streptococcus is negative. Which of the following is the most appropriate next step in management?

A) Throat culture
B) Monospot test
C) Intramuscular penicillin therapy
D) Oral erythromycin therapy
E) Oral penicillin therapy

I believe the answer is A. but could someone please explain WHY?

1. a 67-year old man is examined 3 days after undergoing uncomplicated coronary artery bypass grafting. He has HTN, CHF,and hypercholesterolemia. his medications are patient controlled morphine, a laxative, lisinopril, metoprolol, furosemide, and lovastatin. he is alert and fully oriented. his temperature is 37.8, pulse is 67/min, RR are 18/min, and bp is 128/72mmHg. examinations show claen, dry, well-healing surgical incisions over the sternum and right lower extremity. mental status exam shows a bright affect. a urinary catheter is in place. the patient is able to move from the bed to a chair with the help of physical therapy. he will soon be transferred from ICU. Which of the followings is the most appropriate next step to prevent iatrogenic complications in this patient?

a. remove the urinary catheter
b. begin famotidine tx
c. begin subQ heparin tx
d. discontinue furosemide
e. switch from morphine to aap-hydrocodone

ANSWER Is A according to other websites and I just read CDC guidelines concerning indwelling urinary catheters and they have this: Leave catheters in place only as long as needed
– Remove catheters ASAP postoperatively, preferably
within 24 hours,

but why not C?? since its a major heart surgery that can involve thromboembolic complications??
thanks!


An asymptomatic 57-year-old man comes to the physician for a routine health maintenance examination. He has smoked one pack of cigarettes daily for 37 years. His blood pressure is 180/112 mm Hg, and pulse is 82/min. Abdominal examination shows a bruit in the right upper quadrant and no masses. His hematocrit is 42%, serum urea nitrogen (BUN) level is 23 mg/dL, and serum creatinine level is 1.4 mg/dL. Which of the following is the most likely cause of this patient's bruit?

A) Accumulation of lipids in the arterial wall
B) Hypertrophy of the arterial wall media
C) Infiltration of arterial wall by giant cells
D) Infiltration of round cells in the arterial wall
E) Reflex vasodilation

I answered C which is INCORRECT, why not aortic disease due to hypercholesterolemia that weakened the vessel wall and lead to aneurysm??

Q. A previously healthy 16-year-old boy is brought to the physician because of fever and cough with right-sided chest pain for 2 weeks. Six months ago, he visited his grandparents in Albania for 2 weeks. He weighs 54 kg (120 lb) and is 173 cm (68 in) tall. He appears thin and pale. His temperature is 38.2 C (100.8 F), pulse is 76/min, and respirations are 36/min. Examination shows shallow respirations with decreased breath sounds at the right lung base. An x-ray film of the chest shows a right pleural effusion and hilar adenopathy.

A )alphaAntitrypsin deficiency
B ) Cystic fibrosis
C ) Pneumothorax
D ) Pulmonary alveolar proteinosis
E ) Pulmonary aspergillosis
F ) Pulmonary hemorrhage
G ) Pulmonary tuberculosis

incorrect is D
the question about the 67 yr old man s/p CABG
the correct answer is to remove the cathether. I guess the key word is "iathrogenic complication" since "thromboembolic complication" is not "iathrogenic complication".This is what I think.

the question about 57 yr old man with bruit
the answer is the accumulation of lipid in arterial wall.

For the other 2 questions left, I also got them wrong too I chose monospot test and pulmonary aspergillosis, They both are wrong answers
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  #102  
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Hi!
Can anyone please explain these questions to me? Thank you

1 A 24 yr old primigravid woman at 18 Wk with increased bowel movement for 9 weeks. Stool are sometimes covered with mucous and blood. She also has erythematous nodules overthe anterior surface of both lower extremities, some have a violaceous hue. What is the diagnosis?
a amebiasis
b diverticulitis
c heperperistaltic diarrhea
d inflammatory bowel disease
e viral gastroenteritis
(I chose E and it was wrong)

2 A 77 yr old woman with 2 day history of cramping abdominal pain and distension plus nausea and vomiting. She has no history of operation. PE shows abdominal distension and mild diffuse tenderness, bowel sound are high-pitched. Xrays shows air-fluid level throughout the small bowel and air in liver, no gas in the colon. what is the diagnosis?
a adhesive small bowel obstruction
b cecal cancer
c gallstone ileus
d intussusception
(I chose b and it was wrong. I think the correct answer is c right? with the air in liver )

3 a 25 yr old man with IVDU with progressive diffuse headache, malaise, low grade fever for 2 months, poor appetite, weight loss. BT 38C, neck stiffness, lateral rectus weakness, bilateral papilledema. CT: ventricular enlargement.
LP: pressure 220, glu 35, protein 150, WBC 100, Lymph 100%, RBC 1
a bac meningitis
b crytococcal meningitis
c HSV encephlitis
d St.Louise encephlitis
(I chose c and it was wrong. I think the correct one is b)
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Quote:
Originally Posted by missymeihua View Post
Hi!
Can anyone please explain these questions to me? Thank you

1 A 24 yr old primigravid woman at 18 Wk with increased bowel movement for 9 weeks. Stool are sometimes covered with mucous and blood. She also has erythematous nodules overthe anterior surface of both lower extremities, some have a violaceous hue. What is the diagnosis?
a amebiasis
b diverticulitis
c heperperistaltic diarrhea
d inflammatory bowel disease
e viral gastroenteritis
(I chose E and it was wrong)

This is ulcerative colitis + erythema nodosum

2 A 77 yr old woman with 2 day history of cramping abdominal pain and distension plus nausea and vomiting. She has no history of operation. PE shows abdominal distension and mild diffuse tenderness, bowel sound are high-pitched. Xrays shows air-fluid level throughout the small bowel and air in liver, no gas in the colon. what is the diagnosis?
a adhesive small bowel obstruction
b cecal cancer
c gallstone ileus
d intussusception

3 a 25 yr old man with IVDU with progressive diffuse headache, malaise, low grade fever for 2 months, poor appetite, weight loss. BT 38C, neck stiffness, lateral rectus weakness, bilateral papilledema. CT: ventricular enlargement.
LP: pressure 220, glu 35, protein 150, WBC 100, Lymph 100%, RBC 1
a bac meningitis
b crytococcal meningitis
c HSV encephlitis
d St.Louise encephlitis
(I chose c and it was wrong. I think the correct one is b)

yes its B. CSF analysis points to fungi, lets recall that FUNGI looks like "viral" but with decreased glucose.

answers in red bold
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  #104  
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Originally Posted by missymeihua View Post
the question about the 67 yr old man s/p CABG
the correct answer is to remove the cathether. I guess the key word is "iathrogenic complication" since "thromboembolic complication" is not "iathrogenic complication".This is what I think.

the question about 57 yr old man with bruit
the answer is the accumulation of lipid in arterial wall.

For the other 2 questions left, I also got them wrong too I chose monospot test and pulmonary aspergillosis, They both are wrong answers
--------------------------

are you sure the question about 57 year old is not hypertrophy of media?? I thought it is fibromuscular dysplasia - answer B - ??
thanks!
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Hi Everyone, I have two questions. Please Help!
1. a 20-year-old African American man with sickle cell disease Comes to the physician because of a 1-week history of shortness of breath on exertion, fatigue and generalized weakness. He has had no fever, chills, night sweats, or cough production of Sputum. His only med is oxycodon for Joint pain. tem 36.7, blood pressure 120/70 mmHg, pulse 76/min. Respiration 18/min. Examination shows no abnormalities. Lab:
- hematocrit: 20%
- MCV: 110
- leukocyte Count: 2300
- reticulocyte Count: 1.8%

Which of the following is the most likely mechanism:
1. adverse drug reaction
2. atrophy of gastric mucosa
3. bacterial overgrowth in the small intestine
4. increased demand for folic acid
5. increased demand for Vitamin B12
6. malabsorption
7. Vitamin B1 deficiency

(I picked 5, which was wrong).

2. 25- year- old woman 1 week before a scheduled biopsy of a mass in her right breast. As an Infant, she had four operations to manage necrotizing enterocolitits. No history of serious illness or medication...started a new job as a medical assistant about 1 month ago. examination shows a patchy erythematous rash over the hands. 1.5cm firm, mobile, nontender mass in upper outer Quadrant of right breast.
which of the following is contraindicated during this patient's Operation?

a) Cotton-containing sponges
b) cyanoacrylate topical adhesive
c) iodine preparation solution
d) Latex products
e) silk suture
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  #106  
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Quote:
Originally Posted by apple201 View Post
Hi Everyone, I have two questions. Please Help!
1. a 20-year-old African American man with sickle cell disease Comes to the physician because of a 1-week history of shortness of breath on exertion, fatigue and generalized weakness. He has had no fever, chills, night sweats, or cough production of Sputum. His only med is oxycodon for Joint pain. tem 36.7, blood pressure 120/70 mmHg, pulse 76/min. Respiration 18/min. Examination shows no abnormalities. Lab:
- hematocrit: 20%
- MCV: 110
- leukocyte Count: 2300
- reticulocyte Count: 1.8%

Which of the following is the most likely mechanism:
1. adverse drug reaction
2. atrophy of gastric mucosa
3. bacterial overgrowth in the small intestine
4. increased demand for folic acid
5. increased demand for Vitamin B12
6. malabsorption
7. Vitamin B1 deficiency

ALL patients with sickle cell disease have to have folate supplement on their management plus shows megaloblastic anemia and with the poor reticulocyte response this is the answer

2. 25- year- old woman 1 week before a scheduled biopsy of a mass in her right breast. As an Infant, she had four operations to manage necrotizing enterocolitits. No history of serious illness or medication...started a new job as a medical assistant about 1 month ago. examination shows a patchy erythematous rash over the hands. 1.5cm firm, mobile, nontender mass in upper outer Quadrant of right breast.
which of the following is contraindicated during this patient's Operation?

a) Cotton-containing sponges
b) cyanoacrylate topical adhesive
c) iodine preparation solution
d) Latex products
e) silk suture

she is allergic to LATEX, as she is medical assistant she likely uses gloves thus that explains the rash on her hands.
answers in red bold
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  #107  
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Quote:
Originally Posted by drpisho View Post
--------------------------

are you sure the question about 57 year old is not hypertrophy of media?? I thought it is fibromuscular dysplasia - answer B - ??
thanks!

I got that question right on the test. I think he has AAA with the atherosclerosis risks (smoking and HT). but I could not understand why he has increased BUN/CR. Maybe it comes from his HT?
I think fibromuscular dysplasia would happen with someone younger. In UW, it often mentions that fibromuscular dysplasia happen with middle aged women. Now I am starting to wonder how to differentiate AAA from fibromuscular dysplasiathis(besides using demographic data and risk factors) in this question.

I found this discussion very helpful. It helps me look deep into the questions and points out many things that I had overlooked before. I think besides from knowing the answer keys, we all need to know "WHY" those answers are right and "WHY" our answers are wrong. Thank you everyone. Let's keep it going !!
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Quote:
Originally Posted by drpisho View Post
answers in red bold
I agree with all these answers but I have a question about the reticulocyte count (1.8%) in the question about SCD. I look at the lab reference range and normal reticulocyte count is 0.5-1.5%. It means that in this question the reti count is high but she has megaloblastic anemia from folic def which should have low reti count. Can you explain this to me a little bit more.Thanx!!

I looked it up in Kaplan and it said the usual range of reti count in SCD is 10-20%. So in my understanding, though reti count 1.8% is higher than normal for normal people but it is low for SCD which indicates low RBC production from Folic Def. Am I understanding it right? Thanx
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  #109  
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Hi!

1 Can anyone help explain this question that DrPicho posted before. I found a web that said the answer is CF but I cound not understand WHY. If he has CF, he should not be "previously healthy " and should has history of prior infections and others symptoms. Thanx (I answer aspergillosis and it was wrong)

Q. A previously healthy 16-year-old boy is brought to the physician because of fever and cough with right-sided chest pain for 2 weeks. Six months ago, he visited his grandparents in Albania for 2 weeks. He weighs 54 kg (120 lb) and is 173 cm (68 in) tall. He appears thin and pale. His temperature is 38.2 C (100.8 F), pulse is 76/min, and respirations are 36/min. Examination shows shallow respirations with decreased breath sounds at the right lung base. An x-ray film of the chest shows a right pleural effusion and hilar adenopathy.

A )alphaAntitrypsin deficiency
B ) Cystic fibrosis
C ) Pneumothorax
D ) Pulmonary alveolar proteinosis
E ) Pulmonary aspergillosis
F ) Pulmonary hemorrhage
G ) Pulmonary tuberculosis

incorrect is D

2 a 57 yr old woman with breast ca with neck pain and fall because of muscle weakness. PE: hyperreflexia of all extremities, tender at cervical spine.
Ca 11 mg/dl.
Xray: metastasis to cervical spine.
What is the next step?
a soft cervical collar
b physical therapy
c mithramycin therapy
d tamoxifen
e spinal cord decompression and cervical stabilization
(I chose b and it was wrong. I thought she has an advanced disease so should not do any aggressive procedure)

3 a girl with pharyngitis and negative GAS rapid test.
Can anyone explain to me why we should do throat culture instead of monospot test. Why can this girl has IM? (I know that IM happens in adolescents, should have enlarged LN and splenomegaly....but is there anything else. I always get these 2 diseases(IM and strep throat ) mixed up) Thanx
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  #110  
Old 02-14-2015
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Quote:
Originally Posted by missymeihua View Post
I agree with all these answers but I have a question about the reticulocyte count (1.8%) in the question about SCD. I look at the lab reference range and normal reticulocyte count is 0.5-1.5%. It means that in this question the reti count is high but she has megaloblastic anemia from folic def which should have low reti count. Can you explain this to me a little bit more.Thanx!!

I looked it up in Kaplan and it said the usual range of reti count in SCD is 10-20%. So in my understanding, though reti count 1.8% is higher than normal for normal people but it is low for SCD which indicates low RBC production from Folic Def. Am I understanding it right? Thanx
Right! but with a hematocrit of 20% those reticulocytes should be crazy high (8-10%) not just slightly increased,
and Yes in SCD the reticulocyte is likely always high, but without "substrates" (i.e. folate, iron, b12) to make the Reticulocytes, the reticulocytes will be low until the "substrates" are given, hope to make it clear
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  #111  
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Quote:
Originally Posted by missymeihua View Post
Hi!

1 Can anyone help explain this question that DrPicho posted before. I found a web that said the answer is CF but I cound not understand WHY. If he has CF, he should not be "previously healthy " and should has history of prior infections and others symptoms. Thanx (I answer aspergillosis and it was wrong)

Q. A previously healthy 16-year-old boy is brought to the physician because of fever and cough with right-sided chest pain for 2 weeks. Six months ago, he visited his grandparents in Albania for 2 weeks. He weighs 54 kg (120 lb) and is 173 cm (68 in) tall. He appears thin and pale. His temperature is 38.2 C (100.8 F), pulse is 76/min, and respirations are 36/min. Examination shows shallow respirations with decreased breath sounds at the right lung base. An x-ray film of the chest shows a right pleural effusion and hilar adenopathy.

A )alphaAntitrypsin deficiency
B ) Cystic fibrosis
C ) Pneumothorax
D ) Pulmonary alveolar proteinosis
E ) Pulmonary aspergillosis
F ) Pulmonary hemorrhage
G ) Pulmonary tuberculosis

THE ANSWER is Pulmonary TB, TB has very high incidence in Asia and some countries of Europe (mainly southeastern to what ive searched) this question is so vague!! what else could make us think of TB besides the country?

2 a 57 yr old woman with breast ca with neck pain and fall because of muscle weakness. PE: hyperreflexia of all extremities, tender at cervical spine.
Ca 11 mg/dl.
Xray: metastasis to cervical spine.
What is the next step?
a soft cervical collar
b physical therapy
c mithramycin therapy
d tamoxifen
e spinal cord decompression and cervical stabilization
(I chose b and it was wrong. I thought she has an advanced disease so should not do any aggressive procedure)

ANSWER IS E. whenever radiculopathy signs symptoms are progressive it is a must to give high dose steroids and/or decompression first to avoid permanent sequelae.


3 a girl with pharyngitis and negative GAS rapid test.
Can anyone explain to me why we should do throat culture instead of monospot test. Why can this girl has IM? (I know that IM happens in adolescents, should have enlarged LN and splenomegaly....but is there anything else. I always get these 2 diseases(IM and strep throat ) mixed up) Thanx

ANSWER IS throat culture, this also confused me cause it most points to viral although the clues where also vague to differentiate viral and bacterial, the only explanation that made sense to this question is in uworld the algorythm for "pharyngitis" in children, where it says that after a rapid strep test has been done, always follows throat culture to rule out bacterial pharyngitis.


hope I helped, thanks for the info on the question of the arterial wall!
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  #112  
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Dear DrPisho

you are welcome!!
Also, thnax for your explanation.

About thr TB question, I agree with you that it was very vague.
I think besides region, he is thin, febrile and has hilar adenopathy?
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  #113  
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Lady with hx oh TAH BSO taking oestrogen.. having moist and rugated vagina

I picked Increased oestrogen and got it wrong!

what was the answer ??

thanks..
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a girl with acne and want it to resolve in 3 weeks because of a wedding ..

i picked topical steroids and got it wrong !
because i thought it's early to start retinoid acid


case of MVA with severe retrosternal chest pain with dropping of Po2 after giving 4L of fluids ..
i picked MI


elderly woman with vulvular itching .
i picked SCC


thanks guys
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Idea!

Quote:
Originally Posted by Omarhr View Post
Lady with hx oh TAH BSO taking oestrogen.. having moist and rugated vagina

I picked Increased oestrogen and got it wrong!

what was the answer ??

thanks..
answer is decreased androgens (she had low libido)

I guess we all went with the vagina features and picked increased estrogens! I thought they were asking about the vaginal findings
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  #116  
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Quote:
Originally Posted by Omarhr View Post
a girl with acne and want it to resolve in 3 weeks because of a wedding ..

i picked topical steroids and got it wrong !
because i thought it's early to start retinoid acid


case of MVA with severe retrosternal chest pain with dropping of Po2 after giving 4L of fluids ..
i picked MI


elderly woman with vulvular itching .
i picked SCC


thanks guys
The last Q is Lichen Sclerosis. There is a similar Q like this in UW, if you want to look it up. I think I got all these Q right in the test. If you can post the Q choices, I might be able to remember the answers.

About the MVA Q, I am not sure but I think it's aortic rupture or dissection. Are these answers in the Q choices?
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Default Please help with my incorrect Qs, sorry so many...Thanks!!!

Hi all, I have those questions from form6. Not sure the correct answer...Thanks for your help!!

1, A previously healthy 52-year-old man comes to the physician because of a 3-month history of increased urinary volume and increased urinary frequency at night. He has had a 6.8 kg (15lb) weight loss during this period despite no change in appetite. His father has hypertension, and his mother has hypertension and type 2 diabetes mellitus. He currently weighs 95 kg (210 lb) and is 178 cm (70 in) tall. His blood pressure is 160/85 mm Hg in both arms. Examination shows no other abnormalities. His nonfasting serum glucose concentration is 280 mg/dL. Which of the following serum concentrations is most likely to be increased in this patient?
A) Bicarbonate
B) Glucagon
C) HDL-cholesterol
D) Insulin
E) Ketones

2, A 14-month-old girl is brought to the physician because of a 14-hour history of irritability and episodes of drawing her knees toward her chest. During this period, she has vomited nonbilious fluid twice and had bowel movement containing a small amount of blood. She has an upper respiratory tract infection 2 weeks ago. She is listless except for intermittent episode of discomfort. Her temperature is 38°C (100.4°F). Abdominal examination shows right-sided tenderness without guarding or rebound; bowel sounds are present. Rectal examination shows bright red blood and mucus. An X-ray of the abdomen shows no abnormalities. Which of the following is the most appropriate next step in management?
A) X-ray of the upper gastrointestinal tract with contrast
B) Water soluble contrast enema
C) Corticosteroid enemas
D) Admission to the hospital for total parenteral nutrition
E) Immediate laparotomy

3, A 37-year-old woman comes to the physician because of progressive shortness of breath over the past 5 years; she now has fatigue and shortness of breath with mil exertion. She has a history of mitral stenosis secondary to rheumatic fever at the age of 15 years. She was asymptomatic until 5 years ago when she developed severe shortness of breath during pregnancy. She was treated with diuretics, low-sodium diet, and bed rest, and 110/80mm Hg, pulse is 100/min and regular, and respirations are 26/min. Cardiac examination shows an obvious opening snap in S2. A grade 3/6, late diastolic murmur is heard at the apex. A right ventricular lift is palpated along the left sternal border. Which of the following is most likely increased in this patient?
A) Blood flow to the lower lung fields
B) Diastolic filing time
C) Left-to-right shunt of blood
D) Left ventricular end-diastolic pressure
E) Pulmonary artery pressure


4, A 28-year-old woman at 28 weeks’ gestation reports excessive fatigability and dyspnea. Her blood pressure is 118/74 mm Hg, pulse is 110/min and regular, and lungs are clear to auscultation. The cardiac apex is not palpable. S1 is loud, and there is a sharp sound after S2. A low frequency diastolic murmur is heard at the apex that increases in intensity before S1. Which of following is most likely diagnosis?
A) Aortic regurgitation
B) Ebstein’s anomaly
C) Mitral regurgitation
D) Mitral stenosis
E) Tricuspid regurgitation


5, A 6-month-old girl is brought to the physician because of poor feeding and labored breathing for 2 months. She has had recurrent respiratory tract infections since birth. Examination shows a to-and-fro murmur in the second left intercostal space, a loud S2 bounding peripheral pulses, and a widened pulse pressure. Which of the following is the most likely diagnosis?
A) Atrial septal defect (ostium primum type)
B) Atrial septal defect (ostium secundum type)
C) Atrioventricular canal
D) Coarctation of the aorta
E) Hypoplastic left heart syndrome
F) Patent ductus arteriosus
G) Tetralogy of Fallot
H) Transposition of the great arteries
I) Tricuspid atresia
J) Ventricular septal defect


6, A previously healthy 16-year-old boy is brought to the physician because of fever and cough with right-sided chest pain for 2 weeks. Six months ago, he visited his grandparents in Albania for 2 weeks. He weighs 54 kg (120 bl) and is 173cm (68 in) tall. He appears thin and pale. His temperature is 38.2°C (100.8°F), pulse is 76/min, and respirations are 36/min. Examination shows shallow respirations with decreased breath sounds at the right lung base. An X-ray of the chest shows a right pleural effusion and hilar adenopathy.



7, An 18-year-old man comes to the physician for an intial examination because of a 3-year history of fatigue and migrating joint pain. He has brought a large folder containing information about previous medical consultations, laboratory tests, and x-rays. He takes no medications. He weighs 50 kg (110 lb) and is 173 cm (68 in) tall. Physical examination shows no other abnormalities. On mental status examination, he is preoccupied with his symptoms. When asked about his blood, he states that the future appears bleak, and that he is too tired to think about it. Which of the following is the most appropriate next step in management?
A) Ask about further symptoms of obsessions and compulsions
B) Ask about sexual history including sexual orientation and practices
C) Ask about suicidal feelings
D) Ask about travel history over the past 6 months
E) Obtain a detailed exercise history
F) Measurement of serum Lyme (Borrelia burgdorfen) antibody concentration
G) Urine toxicology screening


8, An 18-year-old man comes for an examination prior to participation in school sports. He states that he has had a dull ache in the scrotum since being hit in that area during a basketball game 2 months ago. Examination shows a 2-cm, hard, nontender mass in the right testicle. The mass does not transilluminate or change in size when the patient is placed in the supine position. Which of the following is the most likely cause?
A) Cystic dilations of the efferent ductules
B) Dilated pampiniform venous plexus
C) Fluid accumulation within the tunica vaginalis testis
D) Germinal cell tumor
E) Vascular trauma

9, A 52-year-old woman comes to the physician because of a 3-month history of intermittent bloody discharge from the right breast. She does not perform regular monthly breast self-examinations. She has a 3-year history of major depressive disorder treated with fluoxetine. Examination of the breasts shows no abnormalities. No masses are noted on palpation. Serosanguineous fluid can be expressed from the nipple of the right breast by pressing on the left side of the areola. Which of the following is the most likely diagnosis?
A) Cystosarcoma phyllodes
B) Fat necrosis
C) Fibroadenoma
D) Fibrocystic changes of the breast
E) Galactorrhea
F) Hyperprolactinemia
G) Intraductal papilloma
H) Mastitis
I) Paget’s disease of the breast


10, A 47-year-old man comes to the physician because of fever and chills for 1 day. He has a 20-year history of alcoholism and cirrhosis of the liver. One month ago, he underwent evacuation of a subdural hematoma. His postoperative course was complicated by generalized tonic-clonic seizures; he has been receiving carbamazepine therapy since then. He continues to drink 12 beers daily. His temperature is 38.9°C (102°F), and blood pressure is 120/80 mm Hg. Examination shows scleral icterus, ascites, and splenomegaly. Laboratory studies show:
Hematocrit 39%
Mean corpuscular volume 102 um3
Leukocyte count 1200/mm3
Segmented neutrophils 6%
Eosinophils 1%
Basophils 1%
Lymphocytes 80%
Monocytes 12%
Platelet count 210,000/mm3
Which of the following is the most likely cause of this patient’s decrease leukocyte count?
A) Carbamazepine therapy
B) Folic acid deficiency
C) Hypersplenism
D) Sepsis
E) Suppression of bone marrow by alcohol

11, A 77-year-old woman is brought to the physician by her son for a routine health maintenance examination. She says she feels well. Her son reports that 1 month ago, she got lost while driving home from local supermarket. Two weeks ago, she forgot to turn off the stove after cooking dinner. She has been wearing bilateral hearing aids since audiometry 2 years ago showed bilateral high-frequency hearing loss. Her visual acuity tremor is not present at rest. Muscle strength is 5/5 in all extremities. Deep tendon reflexes are decrease at the ankles and 2+ elsewhere. Her gait language function is normal. She is oriented to person, place and time and recalls one out of three objects after 10 minutes. Which of the following findings in this patient warrants further evaluation?
A) Decreased deep tendon reflexes at the ankles
B) Decrease sensation to vibration over the toes
C) High-frequency hearing loss
D) Memory loss
E) Tremor of the outstretched hands


12, A 50-year-old woman has had progressive dyspnea over the past 2 weeks and constant, sharp chest pain for 4 days. The pain is localized to the center of the chest and is worse while supine. She underwent a right, modified radical mastectomy and adjuvant chemotherapy for breast cancer 3 years ago. She has a history of hypothyroidism treated with thyroid replacement therapy. She has smoked one pack of cigarettes daily for 30 years and drinks 2 ounces of alcohol daily. She is dyspnic and diaphoretic. Her temperature is 37.2°C (99°F), blood pressure is 90/70 mm Hg with a pulsus paradoxus of 20 mm Hg, pulse is 110/min, and respirations are 28/min. examination shows jugular venous distention to the angle of the mandible. The liver span is 14 cm with 4 cm of shifting abdominal dullness. Arterial blood gas analysis on room air shows a pH of 7.50, Pco2 OF 30 mm Hg, and Po2 of 70 mm Hg. An x-ray of thest shows an enlarged cardiac silhouette with a globular configuration. An ECG shows sinus tachycardia with nonspecific ST-segment changes diffusely. Which of the following is the most appropriate next step in management?
A) Echocardiography
B) CT scan of the abdomen
C) Ventilation-perfusion lung scans
D) Bronchoscopy
E) Paracentesis


13, A 17-year-old boy is brought to the emergency department by his parents because of bizarre behavior for 6 hours. Last night he was out with friends, and since returning he has been confused and has “trashed” his room. His blood pressure is 165/95 mmHg. He is hypervigilant, has little spontaneous speech, and is disoriented to place and time. He appears cataonic but abruptly becomes assaultive two times and needs to be restrained. Which of the following is the most likely substance taken?
A) Cocaine
B) Ecstasy
C) LSD
D) Methaqualone
E) PCP


14, A 62-year-old woman is broght to the physician by her husband because of a 2-day history of fatigue and 1-hour history headache and confusion. She has not had fever, nausea, or vomiting. She has a 6-year history of hypertension treated with htdrochlorothiazide and lisinopril. Her temperature is 36.1 °C (97°F), pulse is 90/min, respirations are 22/min, and blood pressure is 250/135 mm Hg. Funduscopic examination shows bilateral papilledema. The lungs are clear to auscultation. Cardiac examination show an S4 and no murmurs. An ECG shows left ventricular hypertrophy with strain pattern. Which of the following is the most appropriate initial pharmacotherapy?
A) Clonidine
B) Hydralazine
C) Nifedipine
D) Nitroglycerin
E) Nitroprusside


15, A 42-year-old man comes to the physician because of a 3-month history of progressive shortness of breath with exertion that began after he had an upper respiratory tract infection. He says he has had progressive respiratory difficulty during the past 5 years. He has no other history of serious illness and takes no medications. His father and paternal grandfather had “lung and liver problems.” The patient has smoked one pack of cigarettes daily for 25 years. He drinks one beer daily. He works as an automobile mechanic. Respirations are 16/min. pulse oximetry on room air shows an oxygen saturation of 90%. On pulmonary examination, expiratory wheezes are heard bilaterally. The remainder of the examination shows no abnormalities. Serum studies show an alkaline phosphatase activity of 100U/L, AST activity of 60U/L, and ALT activity of 76U/L. which of the following is the most likely diagnosis?
A) Asbestosis
B) Asthma
C) Emphysema
D) Hypersensitivity pneumonitis
E) Lung cancer


16, A 67-year-old man is brought to the emergency department 4 hours agter the onset of severe midlumbar back pain. He is anxious, pale, and diaphoretic. His temperature is 37.1°C (98.8°F), blood pressure is 105/65 mm Hg, and pulse is 120/min. examination shows no other abnormalities. X-ray of the lumbar spine show degenerative disc disease with calcifications anterior to the vertebral bodies. Which of the following is the most likely diagnosis?
A) Aortoiliac occlusion
B) Herniated nucleus pulposus
C) Lumbar discitis
D) Lumbar strain
E) Pyelonephritis
F) Reptured aortic aneurysm
G) Spinal stenosis
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  #118  
Old 01-20-2016
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Originally Posted by gogo View Post
Hi all, I have those questions from form6. Not sure the correct answer...Thanks for your help!!

1, A previously healthy 52-year-old man comes to the physician because of a 3-month history of increased urinary volume and increased urinary frequency at night. He has had a 6.8 kg (15lb) weight loss during this period despite no change in appetite. His father has hypertension, and his mother has hypertension and type 2 diabetes mellitus. He currently weighs 95 kg (210 lb) and is 178 cm (70 in) tall. His blood pressure is 160/85 mm Hg in both arms. Examination shows no other abnormalities. His nonfasting serum glucose concentration is 280 mg/dL. Which of the following serum concentrations is most likely to be increased in this patient?
A) Bicarbonate
B) Glucagon
C) HDL-cholesterol
D) Insulin
E) Ketones

Definition
• HbA1c ≥6.5 or fasting glc ≥126 mg/dL × 2 or random glc ≥200 mg/dL × 2 (× 1 if severe hyperglycemia and acute metabolic decomp)
Patients at risk for type 2 diabetes initially develop insulin resistance alone,
accompanied by augmented pancreatic insulin secretion. Because of the resulting hyperinsulinemia, plasma glucose levels are maintained in the normal range. In most patients, however, pancreatic beta cell function ultimately falters, with deterioration of endogenous insulin secretory capacity over time

2, A 14-month-old girl is brought to the physician because of a 14-hour history of irritability and episodes of drawing her knees toward her chest. During this period, she has vomited nonbilious fluid twice and had bowel movement containing a small amount of blood. She has an upper respiratory tract infection 2 weeks ago. She is listless except for intermittent episode of discomfort. Her temperature is 38°C (100.4°F). Abdominal examination shows right-sided tenderness without guarding or rebound; bowel sounds are present. Rectal examination shows bright red blood and mucus. An X-ray of the abdomen shows no abnormalities. Which of the following is the most appropriate next step in management?
A) X-ray of the upper gastrointestinal tract with contrast
B) Water soluble contrast enema
C) Corticosteroid enemas
D) Admission to the hospital for total parenteral nutrition
E) Immediate laparotomy
Approximately 75 percent of cases of intussusception are considered "idiopathic", although some of these episodes may be triggered by viral infections.
Intussusception typically presents with the sudden onset of intermittent, severe, crampy, progressive abdominal pain, sometimes with vomiting and grossly bloody stools. In a minority of cases, the initial presenting sign may be lethargy or altered consciousness alone, without apparent abdominal symptoms
Ultrasonography is the method of choice to detect intussusception in most institutions. A "bull's eye" or "coiled spring" lesion is seen, representing layers of the intestine within the intestine
For stable patients with no evidence of bowel perforation perform nonoperative reduction of the intussusception rather than surgery or observation. The reduction can be guided by fluoroscopy or ultrasound, and either hydrostatic or pneumatic enemas may be used
3, A 37-year-old woman comes to the physician because of progressive shortness of breath over the past 5 years; she now has fatigue and shortness of breath with mil exertion. She has a history of mitral stenosis secondary to rheumatic fever at the age of 15 years. She was asymptomatic until 5 years ago when she developed severe shortness of breath during pregnancy. She was treated with diuretics, low-sodium diet, and bed rest, and 110/80mm Hg, pulse is 100/min and regular, and respirations are 26/min. Cardiac examination shows an obvious opening snap in S2. A grade 3/6, late diastolic murmur is heard at the apex. A right ventricular lift is palpated along the left sternal border. Which of the following is most likely increased in this patient?
A) Blood flow to the lower lung fields
B) Diastolic filing time
C) Left-to-right shunt of blood
D) Left ventricular end-diastolic pressure
E) Pulmonary artery pressure
The primary hemodynamic consequence of MS is a pressure gradient between the left atrium and left ventricle in diastole. The elevated left atrial pressure is reflected backward, causing an increase in pulmonary venous, capillary, and arterial pressures and resistance.
With isolated MS, the left ventricular systolic and diastolic pressures are usually normal. However, when the stenosis is very severe, there may be a decrease in left ventricular filling and end-diastolic volume (ie, preload), leading to reductions in stroke volume and cardiac output
Pulmonary hypertension is a common complication of MS. The elevation in pulmonary artery pressure can be divided into two components: the passive increase in pressure due to backward transmission of the elevated left atrial pressure; and reactive pulmonary vascular disease with sequential changes

4, A 28-year-old woman at 28 weeks’ gestation reports excessive fatigability and dyspnea. Her blood pressure is 118/74 mm Hg, pulse is 110/min and regular, and lungs are clear to auscultation. The cardiac apex is not palpable. S1 is loud, and there is a sharp sound after S2. A low frequency diastolic murmur is heard at the apex that increases in intensity before S1. Which of following is most likely diagnosis?
A) Aortic regurgitation
B) Ebstein’s anomaly
C) Mitral regurgitation
D) Mitral stenosis
E) Tricuspid regurgitation
As a result of the elevated left atrial pressure, the stenotic (but noncalcified) mitral leaflets are still widely separated at the onset of ventricular contraction. Thus, the first heart sound (S1) is loud, reflecting the increased excursion of the leaflets. As the leaflets become more rigid and calcified, their motion is limited and S1 becomes soft. (See "Auscultation of heart sounds" .)

The second heart sound is initially normal but, with the development of pulmonary hypertension, P2 becomes increased in intensity and may be widely transmitted. As pressure increases further, splitting of S2 is reduced and ultimately S2 becomes a single sound.

Opening snap — An opening snap (OS) of the mitral valve is heard at the apex when the leaflets are still mobile. The OS is due to the abrupt halt in leaflet motion in early diastole, after rapid initial rapid opening, due to fusion at the leaflet tips. It is best heard at the apex and lower left sternal border.
As the MS progresses and left atrial pressure is higher, the OS occurs earlier after S2 or A2. Thus, the shorter the A2-OS interval, the more severe the mitral stenosis.

5, A 6-month-old girl is brought to the physician because of poor feeding and labored breathing for 2 months. She has had recurrent respiratory tract infections since birth. Examination shows a to-and-fro murmur in the second left intercostal space, a loud S2 bounding peripheral pulses, and a widened pulse pressure. Which of the following is the most likely diagnosis?
A) Atrial septal defect (ostium primum type)
B) Atrial septal defect (ostium secundum type)
C) Atrioventricular canal
D) Coarctation of the aorta
E) Hypoplastic left heart syndrome
F) Patent ductus arteriosus
G) Tetralogy of Fallot
H) Transposition of the great arteries
I) Tricuspid atresia
J) Ventricular septal defect

Moderate PDA - Patients with moderate size PDAs (Qp:Qs between 1.5 and 2.2 to 1) may present with exercise intolerance. In these patients, the moderate left-to-right shunt increases the volume load on the left atrium and ventricle, which results in left ventricular dilation and dysfunction.

The characteristic continuous murmur (usually grade 2 or 3, occasionally grade 4) in the left infraclavicular area, which is louder than that associated with a small PDA, is typically accompanied by a wide systemic pulse pressure and signs of left ventricular overload, such as a displaced left ventricular apex

6, A previously healthy 16-year-old boy is brought to the physician because of fever and cough with right-sided chest pain for 2 weeks. Six months ago, he visited his grandparents in Albania for 2 weeks. He weighs 54 kg (120 bl) and is 173cm (68 in) tall. He appears thin and pale. His temperature is 38.2°C (100.8°F), pulse is 76/min, and respirations are 36/min. Examination shows shallow respirations with decreased breath sounds at the right lung base. An X-ray of the chest shows a right pleural effusion and hilar adenopathy.

Tuberculous pleural effusions are usually small to moderate in size, unilateral, and occur slightly more frequently on the right side than the left. Parenchymal disease may be observed in association with pleural effusion. Most often parenchymal disease is in the upper lobe, suggestive of reactivation TB; in some cases parenchymal disease is in the lower lobe and resembles primary disease.
Diagnostic evaluation of pleural effusion in the setting of suspected tuberculous pleuritis begins with thoracentesis. The pleural fluid is generally exudative with protein concentration >3.0 g/dL and lactate dehydrogenase level commonly exceeding 500 IU/L. Low pH and low glucose concentration may be observed; these findings are more characteristic of chronic tuberculous empyema than tuberculous pleural effusion. The pleural fluid nucleated cell count is usually lymphocyte-predominant. Check ADA.

7, An 18-year-old man comes to the physician for an intial examination because of a 3-year history of fatigue and migrating joint pain. He has brought a large folder containing information about previous medical consultations, laboratory tests, and x-rays. He takes no medications. He weighs 50 kg (110 lb) and is 173 cm (68 in) tall. Physical examination shows no other abnormalities. On mental status examination, he is preoccupied with his symptoms. When asked about his blood, he states that the future appears bleak, and that he is too tired to think about it. Which of the following is the most appropriate next step in management?
A) Ask about further symptoms of obsessions and compulsions
B) Ask about sexual history including sexual orientation and practices
C) Ask about suicidal feelings
D) Ask about travel history over the past 6 months
E) Obtain a detailed exercise history
F) Measurement of serum Lyme (Borrelia burgdorfen) antibody concentration
G) Urine toxicology screening



Suicide risk — All depressed patients must be queried specifically about suicidal ideation


8, An 18-year-old man comes for an examination prior to participation in school sports. He states that he has had a dull ache in the scrotum since being hit in that area during a basketball game 2 months ago. Examination shows a 2-cm, hard, nontender mass in the right testicle. The mass does not transilluminate or change in size when the patient is placed in the supine position. Which of the following is the most likely cause?
A) Cystic dilations of the efferent ductules
B) Dilated pampiniform venous plexus
C) Fluid accumulation within the tunica vaginalis testis
D) Germinal cell tumor
E) Vascular trauma
Testicular cancer usually presents as a painless mass discovered by the patient or clinician on physical examination, although rapidly growing germ cell tumors may cause acute scrotal pain secondary to hemorrhage and infarction. Other common signs are testicular enlargement or swelling. Many patients also report an aching feeling in the lower abdomen or scrotum.

On examination, intrascrotal malignancies usually are firm, nontender masses that do not transilluminate unless accompanied by a reactive hydrocele

Varicocele also does NOT trasluminate, but will increase with Valsalva maneuver.


9, A 52-year-old woman comes to the physician because of a 3-month history of intermittent bloody discharge from the right breast. She does not perform regular monthly breast self-examinations. She has a 3-year history of major depressive disorder treated with fluoxetine. Examination of the breasts shows no abnormalities. No masses are noted on palpation. Serosanguineous fluid can be expressed from the nipple of the right breast by pressing on the left side of the areola. Which of the following is the most likely diagnosis?
A) Cystosarcoma phyllodes
B) Fat necrosis
C) Fibroadenoma
D) Fibrocystic changes of the breast
E) Galactorrhea
F) Hyperprolactinemia
G) Intraductal papilloma
H) Mastitis
I) Paget’s disease of the breast
Pathologic discharge is characterized by spontaneous, persistent, unilateral discharge limited to one duct (uniductal). The discharge can be either serous (straw-colored or clear), sanguinous (bloody), or serosanguineous (blood-tinged). An intraductal papilloma is the cause of pathologic discharge in over half the cases, while underlying malignancy is the cause of nipple discharge in 5 to 10 percent of cases

10, A 47-year-old man comes to the physician because of fever and chills for 1 day. He has a 20-year history of alcoholism and cirrhosis of the liver. One month ago, he underwent evacuation of a subdural hematoma. His postoperative course was complicated by generalized tonic-clonic seizures; he has been receiving carbamazepine therapy since then. He continues to drink 12 beers daily. His temperature is 38.9°C (102°F), and blood pressure is 120/80 mm Hg. Examination shows scleral icterus, ascites, and splenomegaly. Laboratory studies show:
Hematocrit 39%
Mean corpuscular volume 102 um3
Leukocyte count 1200/mm3
Segmented neutrophils 6%
Eosinophils 1%
Basophils 1%
Lymphocytes 80%
Monocytes 12%
Platelet count 210,000/mm3
Which of the following is the most likely cause of this patient’s decrease leukocyte count?
A) Carbamazepine therapy
B) Folic acid deficiency
C) Hypersplenism
D) Sepsis
E) Suppression of bone marrow by alcohol
carbamazepine Adverse Effects Hemopoietic system: Aplastic anemia, agranulocytosis, pancytopenia, bone marrow depression, thrombocytopenia, leukopenia, leukocytosis,

11, A 77-year-old woman is brought to the physician by her son for a routine health maintenance examination. She says she feels well. Her son reports that 1 month ago, she got lost while driving home from local supermarket. Two weeks ago, she forgot to turn off the stove after cooking dinner. She has been wearing bilateral hearing aids since audiometry 2 years ago showed bilateral high-frequency hearing loss. Her visual acuity tremor is not present at rest. Muscle strength is 5/5 in all extremities. Deep tendon reflexes are decrease at the ankles and 2+ elsewhere. Her gait language function is normal. She is oriented to person, place and time and recalls one out of three objects after 10 minutes. Which of the following findings in this patient warrants further evaluation?
A) Decreased deep tendon reflexes at the ankles
B) Decrease sensation to vibration over the toes
C) High-frequency hearing loss
D) Memory loss
E) Tremor of the outstretched hands
Presbycusis (age-related, gradual, bilateral, symmetric, and predominantly high-frequency hearing deficits
A diminished or absent Achilles reflex, present in nearly half of elderly patients, may be normal. It occurs because tendon elasticity decreases and nerve conduction in the tendon’s long reflex arc slows
Memory loss by itself would not worry you, since it will fall under category of Mild cognitive impairment. However, if somebody has DEMENTIA you should be concerned.
Diminished vibratory sensation + Dementia => B12 def
12, A 50-year-old woman has had progressive dyspnea over the past 2 weeks and constant, sharp chest pain for 4 days. The pain is localized to the center of the chest and is worse while supine. She underwent a right, modified radical mastectomy and adjuvant chemotherapy for breast cancer 3 years ago. She has a history of hypothyroidism treated with thyroid replacement therapy. She has smoked one pack of cigarettes daily for 30 years and drinks 2 ounces of alcohol daily. She is dyspnic and diaphoretic. Her temperature is 37.2°C (99°F), blood pressure is 90/70 mm Hg with a pulsus paradoxus of 20 mm Hg, pulse is 110/min, and respirations are 28/min. examination shows jugular venous distention to the angle of the mandible. The liver span is 14 cm with 4 cm of shifting abdominal dullness. Arterial blood gas analysis on room air shows a pH of 7.50, Pco2 OF 30 mm Hg, and Po2 of 70 mm Hg. An x-ray of thest shows an enlarged cardiac silhouette with a globular configuration. An ECG shows sinus tachycardia with nonspecific ST-segment changes diffusely. Which of the following is the most appropriate next step in management?
A) Echocardiography
B) CT scan of the abdomen
C) Ventilation-perfusion lung scans
D) Bronchoscopy
E) Paracentesis
Patients with subacute, low pressure, or regional cardiac tamponade most commonly present with one or more of the following: fatigue, dyspnea, chest pain, and edema.A number of findings may be present on physical examination, depending upon the type and severity of cardiac tamponade. These may include sinus tachycardia, elevated jugular venous pressure, hypotension, and an exaggerated inspiratory decrease in systolic blood pressure (pulsus paradoxus).Cardiac tamponade can be suspected based on the history and physical examination, electrocardiogram (tachycardia, low voltage, electrical alternans), chest x-ray (enlarged cardiac silhouette with clear lung fields), and echocardiogram (chamber collapses, abnormal venous flows, exaggerated respiratory variation of cardiac and venous flows).

13, A 17-year-old boy is brought to the emergency department by his parents because of bizarre behavior for 6 hours. Last night he was out with friends, and since returning he has been confused and has “trashed” his room. His blood pressure is 165/95 mmHg. He is hypervigilant, has little spontaneous speech, and is disoriented to place and time. He appears cataonic but abruptly becomes assaultive two times and needs to be restrained. Which of the following is the most likely substance taken?
A) Cocaine
B) Ecstasy
C) LSD
D) Methaqualone
E) PCP
Psychomotor symptoms related to PCP intoxication were grouped into major and minor patterns. Major symptoms, including acute brain syndrome, psychosis, catatonia, and coma, were associated with a more severe course and poorer outcomes. Don't forget that PCP causes multi directional nystagmus.

14, A 62-year-old woman is broght to the physician by her husband because of a 2-day history of fatigue and 1-hour history headache and confusion. She has not had fever, nausea, or vomiting. She has a 6-year history of hypertension treated with htdrochlorothiazide and lisinopril. Her temperature is 36.1 °C (97°F), pulse is 90/min, respirations are 22/min, and blood pressure is 250/135 mm Hg. Funduscopic examination shows bilateral papilledema. The lungs are clear to auscultation. Cardiac examination show an S4 and no murmurs. An ECG shows left ventricular hypertrophy with strain pattern. Which of the following is the most appropriate initial pharmacotherapy?
A) Clonidine
B) Hydralazine
C) Nifedipine
D) Nitroglycerin
E) Nitroprusside

A hypertensive emergency is defined as severe hypertension that is associated with acute end-organ damage. There are many IV drugs available to manage HTN emergency, though for whatever reason USMLE wants nitroprusside from you.

15, A 42-year-old man comes to the physician because of a 3-month history of progressive shortness of breath with exertion that began after he had an upper respiratory tract infection. He says he has had progressive respiratory difficulty during the past 5 years. He has no other history of serious illness and takes no medications. His father and paternal grandfather had “lung and liver problems.” The patient has smoked one pack of cigarettes daily for 25 years. He drinks one beer daily. He works as an automobile mechanic. Respirations are 16/min. pulse oximetry on room air shows an oxygen saturation of 90%. On pulmonary examination, expiratory wheezes are heard bilaterally. The remainder of the examination shows no abnormalities. Serum studies show an alkaline phosphatase activity of 100U/L, AST activity of 60U/L, and ALT activity of 76U/L. which of the following is the most likely diagnosis?
A) Asbestosis
B) Asthma
C) Emphysema
D) Hypersensitivity pneumonitis
E) Lung cancer
People with AATD are predisposed to obstructive pulmonary disease and liver disease (eg, cirrhosis and hepatocellular carcinoma in children and adults). AATD is one of the most common inherited disorders among white persons. Its primary manifestation is early-onset panacinar emphysema.

16, A 67-year-old man is brought to the emergency department 4 hours agter the onset of severe midlumbar back pain. He is anxious, pale, and diaphoretic. His temperature is 37.1°C (98.8°F), blood pressure is 105/65 mm Hg, and pulse is 120/min. examination shows no other abnormalities. X-ray of the lumbar spine show degenerative disc disease with calcifications anterior to the vertebral bodies. Which of the following is the most likely diagnosis?
A) Aortoiliac occlusion
B) Herniated nucleus pulposus
C) Lumbar discitis
D) Lumbar strain
E) Pyelonephritis
F) Reptured aortic aneurysm
G) Spinal stenosis
Abdominal aortic aneurysms (AAAs) are relatively common and are potentially life-threatening. Patients at greatest risk for AAA are men who are older than 65 years and have peripheral atherosclerotic vascular disease.
AAAs are usually asymptomatic until they expand or rupture. An expanding AAA causes sudden, severe, and constant low back, flank, abdominal, or groin pain.

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  #119  
Old 02-20-2016
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Quote:
Originally Posted by rohit39 View Post
The one where a lady as bloating, crampy pain and intermittent diarrhea for 5 years thats been exacerbated by starting a yoghurt and cottage cheese rich diet? I stupidly chose secretory diarrhea thinking lactose intolerance, but on retrospect i realise that A) Lactose intolerance isnt really precipitated by curd or cottage cheese (i looked it up) and B) Lactose intolerance is osmotic diarrhea, not secretory diarrhea! (D'oh!). So what IS the answer?!
It is lactose intolerance. But the process behind it is malabsorption of lactose, which is the correct answer. I chose malabsorption and it is correct
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  #120  
Old 02-20-2016
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Quote:
Originally Posted by Omarhr View Post
a girl with acne and want it to resolve in 3 weeks because of a wedding ..

i picked topical steroids and got it wrong !
because i thought it's early to start retinoid acid


case of MVA with severe retrosternal chest pain with dropping of Po2 after giving 4L of fluids ..
i picked MI


elderly woman with vulvular itching .
i picked SCC


thanks guys
1st one is retinoic acid. It's in UW, look for acne treatments.
2nd is mycocardial contusion, it's again UW question.
3rd is lichen sclerosus
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  #121  
Old 07-01-2016
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A 32 year old woman who is HIV positive has a CD4+ T-lymphocyte count of 800/mm3 (Mormal>=500). Her health maintenance regimen should include immunization against which of the following pathogens?

A) Haemophilus influenzae type B
B) Hepatitis A
C) Influenza virus
D) Neisseria meingitidis
E) Streptococcus pyogenes (group A)
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  #122  
Old 07-01-2016
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A 42 year old woman comes to the physician for evaluation of persistently increased blood pressures. At her last two office visits during the past 3 months, her blood pressure has ranged between 150-170/105-115 mmHg. During this period, she has had occasional headaches. In addistion, she has had an increased urine output over the past 6 weeks that she attributes to a diet high in sodium. She is otherwise healthy and takes no medications. Her blood pressure today is 168/115 mmHg, pulse is 68/min, and respirations are 14/min. Funduscopic examination shows mild arteriovenous nicking. The point of maximal impulse is not displaced. There is not edema, abdominal bruits, or masses. Serum studies show:

Na+ = 144 mEq/L
Cl- = 90 mEq/L
K+ = 2.9 mEq/L
HCO3- = 32 mEq/L
Urea nitrogen = 20 mg/dL
Creatinine = 1.2 mg/dL

Which of the following is the most likely underlying cause of this patient's hypertension?

A) Autonomous production of aldosterone
B) Catecholamine-producing tumor
C) Decreased arterial distensibility caused by atherosclerosis
D) Excess production of natriuretic peptide
E) Juxtaglomerular cell hypertrophy and sclerosis
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  #123  
Old 07-01-2016
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A previously healthy 67 year old man comes to the physician because of a 3 month hystory of right leg pain after walking two blocks. He has smoked two packs of sigarettes daily for 50 years. He is 165 cm tall and weighs 77 kg; BMI is 28 kg/m2. Examination of the lower extremity shows shiny skin and decreased hair growth. Pripheral pulses are:

femoral popliteal dorsalis pedis posterior tibial
right: 3+ 2+ 0 0
left: 3+ 2+ 2+ 2+

The right ankle brachial index is 0.6 (N>1), and the left is 0.9. In addition to smoking cessation, which of the following is the most appropriate next step in magement?

A) daily exercise program
B) angioplasty
C) arteriography
D) femoropopliteal bypass grafting
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Old 07-21-2016
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Quote:
Originally Posted by drpisho View Post
please i need help with this questions

a 7-year-old girl is brought to the physician in september because of fever and sore throat for 1 day. She is in the third week of second grade. Her temperature is 38.6 c (101.5 f). Examination shows an erythematous pharynx and slightly enlarged tonsils without exudate. There is no significant cervical lymphadenopathy. A rapid test for group a streptococcus is negative. Which of the following is the most appropriate next step in management?

a) throat culture
b) monospot test
c) intramuscular penicillin therapy
d) oral erythromycin therapy
e) oral penicillin therapy

i believe the answer is a. But could someone please explain why?

1. a 67-year old man is examined 3 days after undergoing uncomplicated coronary artery bypass grafting. He has htn, chf,and hypercholesterolemia. His medications are patient controlled morphine, a laxative, lisinopril, metoprolol, furosemide, and lovastatin. He is alert and fully oriented. His temperature is 37.8, pulse is 67/min, rr are 18/min, and bp is 128/72mmhg. Examinations show claen, dry, well-healing surgical incisions over the sternum and right lower extremity. Mental status exam shows a bright affect. A urinary catheter is in place. The patient is able to move from the bed to a chair with the help of physical therapy. He will soon be transferred from icu. Which of the followings is the most appropriate next step to prevent iatrogenic complications in this patient?

a. Remove the urinary catheter
b. Begin famotidine tx
c. Begin subq heparin tx
d. Discontinue furosemide
e. Switch from morphine to aap-hydrocodone

answer is a according to other websites and i just read cdc guidelines concerning indwelling urinary catheters and they have this: Leave catheters in place only as long as needed
– remove catheters asap postoperatively, preferably
within 24 hours,

but why not c?? Since its a major heart surgery that can involve thromboembolic complications??
Thanks!


an asymptomatic 57-year-old man comes to the physician for a routine health maintenance examination. He has smoked one pack of cigarettes daily for 37 years. His blood pressure is 180/112 mm hg, and pulse is 82/min. Abdominal examination shows a bruit in the right upper quadrant and no masses. His hematocrit is 42%, serum urea nitrogen (bun) level is 23 mg/dl, and serum creatinine level is 1.4 mg/dl. Which of the following is the most likely cause of this patient's bruit?

a) accumulation of lipids in the arterial wall
b) hypertrophy of the arterial wall media
c) infiltration of arterial wall by giant cells
d) infiltration of round cells in the arterial wall
e) reflex vasodilation

i answered c which is incorrect, why not aortic disease due to hypercholesterolemia that weakened the vessel wall and lead to aneurysm??

q. A previously healthy 16-year-old boy is brought to the physician because of fever and cough with right-sided chest pain for 2 weeks. Six months ago, he visited his grandparents in albania for 2 weeks. He weighs 54 kg (120 lb) and is 173 cm (68 in) tall. He appears thin and pale. His temperature is 38.2 c (100.8 f), pulse is 76/min, and respirations are 36/min. Examination shows shallow respirations with decreased breath sounds at the right lung base. An x-ray film of the chest shows a right pleural effusion and hilar adenopathy.

a )alphaantitrypsin deficiency
b ) cystic fibrosis
c ) pneumothorax
d ) pulmonary alveolar proteinosis
e ) pulmonary aspergillosis
f ) pulmonary hemorrhage
g ) pulmonary tuberculosis

incorrect is d
WHAT IS THE ANS OF THE LAST QUESTION HERE... THANKS IN Advance
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