P1247176256SZaxM

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1. A 40-year-old female is evaluated in the ER
with right upper quadrant pain. She has recently
intentionally lost 40 pounds over the last
month and states that her pain has increased
within the last two months. Prior to her weight
loss, the patient had a BMI of 33. Her BMI is now
26. The pain is worse with food intake. She
denies any change in her bowel habits. Her
medical history is notable for hypertension
diagnosed 5 years ago. She is on
hydrochorothiazide. She has no allergies. The
best test to order to make the diagnosis in this
patient would be which of the following? A.
ALT B. Upper endoscopy C. Abdominal ultrasound
D. CT of the Abdomen E. Lipase
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2. A 70 y/o gentleman is being evaluated in
clinic. His medical history is signifcant for
coronary artery disease, atrial fibrillation, and
diverticulosis. These illnesses are stable. He
currently has stiffness and pain in his shoulders
and quadriceps muscles. He has more pronounced
symptoms in the early morning. He is fatigued and
notes a 10-pound weight loss over the past month.
His physical exam is normal except for minimal
decreased range of motion in the shoulders. An
ESR is elevated at 70. A. Polymyalgia
RheumaticaB. OsteoarthritisC. Reactive
ArthritisD. Psoriatic ArthritisE. Pseudogout
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3. A 23 y/o man is being evaluated in the
Emergency Room. He has been healthy most of his
life. Currently, he has been experiencing
diffuse, migratory joint pains for the past 6
months. He notes stiffness most evident in the
morning. He has not traveled outside of the
country. His family history is only notable for
his mother with osteoporosis. His exam is notable
for synovitis in the DIP and MCP joints of the
hands. He also has onycholysis and pitting of his
nails. Otherwise his exam is unremarkable. A.
Polymyalgia RheumaticaB. OsteoarthritisC.
Reactive ArthritisD. Psoriatic ArthritisE.
Pseudogout
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4. Which of the following characteristics of a
solitary pulmonary nodule is most suggestive of
malignancy A. Spiculations and/or an irregular
border B. Diffuse calcification C. Doubling in
size in 1-2 weeks D. Upper lobe location
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5. A 22 y/o lady comes in after an evaluation of
syncope. She explains that she has been healthy
all her life except for two previous episodes of
passing out. She has been told it is just her
nerves. This episode occurred on a hot, summer
day, but she does not remember feeling faint,
lightheaded, or dizzy. She also explains that her
heart will occasionally beat faster and stronger,
but she attributes that to stress. Her physical
exam is normal. You obtain a 12-lead EKG. She is
in normal sinus rhythm with a rate of 70. There
is no hypertrophy or bundle branch block. Her QRS
complexes are .16 seconds, and her PR interval is
lead V4. What is the reason this patient has QRS
complexes of .16 seconds? A. She has an aberrant
pathway from the SA node to the AV node B. She
has delayed ventricular activation C. She has
premature ventricular activation D. She has
increased vagal tone to her myocardium E. She is
healthy
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6. You are seeing a patient in the Emergency
Room. In the next room, a fourth year colleague
of yours rotating in the intensive care unit is
evaluating a patient. Your colleague explains
that his patient is in diabetic ketoacidosis, and
his blood sugar is 500. He shows you the rest of
his labs, and you are not as surprised as he is
to note the patients sodium level. Which of the
sodium levels is the best approximation for this
patient? A. 114 124 B. 125 134 C. 135
144 D. 145 154 E. 155 164
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7. Acting out of the desire to do well for a
patient describes A. JusticeB. BeneficenceC.
AutonomyD. Non-maleficenceE. Paternalism
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8. Respecting the informed desires of a patient
describes A. JusticeB. BeneficenceC.
AutonomyD. Non-maleficenceE. Paternalism
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A 42-year-old alcoholic is evaluated by you and
the ER attending because of mid-epigastric
abdominal pain that radiates to the back. The
patient has been vomiting for the past 3 days.
She has a temperature of 100F, and she is
tachycardic. Her BP is 92/50 in upper and lower
extremities. She is orthostatic. She has dried
blood at the corners of her mouth. Her lung exam
reveals decreased breath sounds at the bases, and
her cardiovascular exam is notable for the
tachycardia. She will not let you exam her
abdomen because it hurts her too much. You order
baseline labs and the following radiology film
(next slide). 9. What is the most likely
diagnosis? A. Ruptured esophagus B. Perforated
duodenal ulcer C. Decompensated liver failure
with ascites D. Bilateral pulmonary edema E.
Pancreatitis
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A 42-year-old alcoholic is evaluated by you and
the ER attending because of mid-epigastric
abdominal pain that radiates to the back. The
patient has been vomiting for the past 3 days.
She has a temperature of 100F, and she is
tachycardic. Her BP is 92/50 in upper and lower
extremities. She is orthostatic. She has dried
blood at the corners of her mouth. Her lung exam
reveals decreased breath sounds at the bases, and
her cardiovascular exam is notable for the
tachycardia. She will not let you exam her
abdomen because it hurts her too much. You order
baseline labs and the following radiology film
(prior slide). 10. What is the next most
appropriate step? A. CV surgery consult B.
Abdominal ultrasound C. NG tube and surgical
consult D. Fleets enemas E. CT scan of the
thorax
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11. You are evaluating a 32 y/o previously
healthy female in the ER who is writhing in
discomfort. She has been vomiting for the past 24
hours after experiencing excruciating abdominal
pain. She describes the pain as beginning in her
right flank with radiation to her right
suprapubic region. The pain is intermittent. When
the pain is most intense, she experiences nausea
and vomiting. Her exam is only notable for a BP
of 154/93 and diffuse abdominal tenderness. Her
laboratory evaluation is notable for 10-25 red
blood cells on urinalysis. Her radiology film is
shown (next slide). What is the most likely
diagnosis? A. Cholelithiasis B.
Pyelonephritis C. Nephrolithiasis D.
Pancreatitis E. Diverticulitis
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12. You are evaluating a 22 y/o gentleman with
cystic fibrosis. He is tired and fatigued. He has
increased sputum production over the past week,
and he has lost 5 pounds. He is saturating 90 on
RA, and he is in moderate respiratory distress.
CXR reveals bronchiectasis and increased
consolidation in the left lower lung field. Which
of the following antibiotics is essential to his
antibiotic regimen? A. Ceftazidime B.
Ceftriaxone C. Clindamycin D. Azithromycin E.
Amphotericin
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13. What is the significance of red blood cell
casts found on urinalysis? A. Prostatic injury
B. Urinary bladder damage C. Urethral
inflammation D. Glomerular injury E. Tubular
damage
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A 42 y/o female is evaluated in the ER with the
acute onset of shortness of breath and left-
sided pleuritic chest pain. She experienced these
symptoms early this morning while she was walking
her dog. She has never experienced these symptoms
before. She describes herself as otherwise
healthy. She smokes 1 pack/day of cigarettes, but
she doesnt drink. She recently had a
laparoscopic cholecystectomy 2 weeks ago, and she
had an appendectomy at age 10. She is on Prempro
(estrogen .625mg/day) and a multivitamin. She
denies any allergies. Her Physical Exam T 38, P
107, RR 24, BP 123/89 The remainder of her
physical exam is normal. A 12-lead EKG (next
slide) is obtained? 14. What is the most likely
diagnosis? A. Pulmonary embolus B. Acute
myocardial infarction C. Costochondritis D.
Aortic Dissection E. Pericarditis
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15. An 82 y/o lady is evaluated for palpitations
and shortness of breath. Her symptoms have been
progressively worse over the past week. She is
tachycardic and tachypneic. A 12-lead EKG is
obtained (next slide). What is the most common
etiology for this condition? A. Mitral Valve
Disease B. Aortic Valve Disease C. Pericarditis
D. Myocardial Infarction E. Hypertension
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16. Which of the following primary cancers would
most commonly metastasize to bone? A. Colon B.
Breast C. Ovarian D. Liver
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17. Which of the following conditions would most
likely cause a normocytic anemia? A. Chronic
renal failure B. Iron deficiency C. Chronic
alcoholism D. B-thallasemia E. Colon cancer
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18. You are evaluating a 52 y/o homeless woman in
the ER. The paramedics brought her in after being
found on the sidewalk. She is unkempt and smells
of alcohol. She is febrile to 38.7C and
tachycardic. The remainder of her exam is notable
for cachexia and decreased breath sounds at the
right base of the lung. Initial serum chemistries
are pending. Her CXR (next slide) is shown. From
her story and the radiology film, what is the
clinical diagnosis? A. Right lower lobe
pneumonia B. Right middle lobe pneumonia C.
Right lower lobe atelectasis D. Right middle
lobe atelectasis E. Right pleural effusion
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19. An otherwise healthy 24-year-old lady is
admitted to your service with a 3-day history of
profuse, frequent diarrhea and diagnosed with
gastroenteritis. She had two episodes of vomiting
on the first day of her illness but none since
then. She describes 10 episodes of diarrhea per
day. She is not on any medicines. She was noted
to be orthostatic on exam. Prior to administering
IV fluids, what would you expect from her
following laboratory values?
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20. A blowing, grade 3/6 diastolic murmur is
heard throughout the precordium but best over the
left upper sternal border. It is more pronounced
with the patient sitting forward. This
description of a murmur heard in a patient being
evaluated for acute chest pain is most likely to
be which of the following A. Mitral
insufficiency B. Mitral valve prolapse C.
Aortic insufficiency D. Innocent ejection murmur
E. Aortic stenosis
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21. A 78-year-old African-American male is
admitted to the hospital with increasing
shortness of breath and chest pain. His symptoms
have been increasing over the past 3 months. He
denies any significant medical or family history.
His vital signs are normal. His exam is notable
for pallor and a soft II/IV murmur heard best at
the left-lower sternal border. Lung exam is
normal. He is saturating 95 on room air. His EKG
reveals normal sinus rhythm. His CBC is as
follows WBC 2,000 with a normal
differentialHgb 7.7 g/dLPlts 160,000MCV
87RDW 13Corrected Reticulocyte Ct 2 Which
of the following is the best explanation for his
anemia? A. Hemolytic anemia B. Splenic
sequestration C. Decreased production from the
bone marrow D. Gastrointestinal blood loss
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A 62-year-old man is evaluated in the Emergency
Room with increasing shortness of breath and
accompanying cough. He has a 15-year history of
hypertension and a 60-pack year history of
smoking cigarettes. His family history is
significant for a brother who died at the age of
54 from an acute myocardial infarction. He denies
any chest pain, fevers, or chills. His wife
states he has been losing weight. These symptoms
have been increasing over the past month. On
exam, his vital signs are normal. He has
decreased breath sounds in the left lower lung
field. The remainder of his exam is normal.
Initial serum chemistries are normal. His CXR
(next slide) is shown. 22. Which of the
following diagnosis is best supported by the
clinical picture and ancillary studies? A.
Pulmonary Edema secondary to left ventricular
dysfunction B. Hemothorax C. Acute myocardial
infarction D. Primary lung cancer E.
Tuberculosis
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A 62-year-old man is evaluated in the Emergency
Room with increasing shortness of breath and
accompanying cough. He has a 15-year history of
hypertension and a 60-pack year history of
smoking cigarettes. His family history is
significant for a brother who died at the age of
54 from an acute myocardial infarction. He denies
any chest pain, fevers, or chills. His wife
states he has been losing weight. These symptoms
have been increasing over the past month. On
exam, his vital signs are normal. He has
decreased breath sounds in the left lower lung
field. The remainder of his exam is normal.
Initial serum chemistries are normal. His 12-lead
EKG (next slide) is obtained. 23. What is the
most likely etiology for the findings on his
12-lead EKG? A. Pericarditis B. Hyperkalemia
C. Ischemic Heart Disease D. Valvular Heart
Disease E. Congenital Heart Disease
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24. A 25 y/o previously healthy carpenter comes
into the ER with a 12-hour history of shortness
of breath and left-sided subscapular pain. The
pain began acutely while he was working earlier
that day. The pain is worse with deep breaths. He
does not have a cough or fever. He does not smoke
or drink, and his review of systems is negative.
He oxygen saturation on room air is 96. His
heart rate is 105, and he is breathing 22 times
per minute. His blood pressure is 118/72. He has
decreased breath sounds on the left side. You
review his CXR (next slide). From the clinical
scenario and radiology film, what is the most
likely diagnosis? A. Pneumonia B.
Costochondritis C. Sarcoidosis D. Pneumothorax
E. Gastroesophageal reflux disease
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25. Which of the following is the most important
strategy in reducing nosocomial infections? A.
Hand washing before examining the patient B.
Pulmonary toilet (suctioning, positioning, etc.)
C. Discharging patients within 48 hours of
admission D. Removing catheters within 72 hours
of placement
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26. A previously healthy 25 y/o female is seeing
you in clinic for evaluation. She had been
previously healthy but now has anorexia,
alopecia, and photosensitivity. She denies any
prescription or over-the-counter medicines. She
has not traveled recently. Her exam is only
notable for alopecia areata and a soft, II/IV
murmur over the right upper sternal border. She
has a normocytic anemia on laboratory evaluation.
You believe she has systemic lupus erythematosus.
Which of the following tests is most specific
for diagnosing systemic lupus erythematosus? A.
ANA B. Heterophile Antibody C. dsDNA D. p-ANCA
E. ssDNA
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27. You are called to evaluate a patient who has
altered mental status. She explains that she is a
diabetic. She has no additional medical
illnesses. She is orthostatic, and her breath has
a fruity smell. She is only able to tell you that
she is tired and her stomach hurts. She has
Kussmauls respirations, and her abdominal exam
is notable for diffuse abdominal tenderness
without any palpable masses. Her finger stick
glucose level reads 500. She has large ketones
in her urine. You glance at her labs at note the
following Na 127Cl-103BUN 32ABG 7.23 /
PaCO2 28 / PaO2 93 / 97K 6.2 HCO3- 6Cr
2.8 Her EKG shows normal sinus rhythm without
peaked T waves. The most appropriate initial step
in her management is which of the following A.
IV .9NS 1 liter bolus B. D5W with 3 amps sodium
bicarbonate at 200cc/hour C. Intubations for
respiratory failure and airway protection D. CT
of the abdomen and pelvis E. CT of the head
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28. In evaluating a patient who has a neutropenic
fever, the most likely source of infection is
which of the following A. microorganisms on
the hands of medical care givers B. respiratory
viruses C. airborne molds D. viruses latent in
the patients tissues E. autoinoculation from
patients bacterial and fungal flora
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29. Chronic therapy with loop diuretics (i.e.
furosemide) creates which of the following
profiles A. hyperkalemic metabolic acidosis
B. hyperkalemic metabolic alkalosis C.
hypokalemic metabolic acidosis D. hypokalemic
metabolic alkalosis
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30. Which of the following conditions would most
likely result in a 91 oxygen saturation reading
on convential pulse oximetry (cooximeter) when
the ABG is pH 7.4, pCO2 40, pa O2 98, O2 sat 97?
A. A patient with a hemoglobin of 6 B. A
patient with heavily pigmented skin C. A patient
with a blood pressure of 90/60 mm/Hg D. A
patient with carbon monoxide poisoning
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34. For patients to qualify for acute
rehabilitation as opposed to subacute
rehabilitation, they must meet which of the
following parameters? A. They must be at their
baseline prior to hospitalization B. They must
be able to actively participate in physical
therapy for at least 3 hours/day C. Their length
of stay must be less than ten days D. They have
to pay for the service separately from the cost
of the additional hospital services