Question bank

You make the diagnosis of Marfan syndrome in a very tall 22-year-old man with long, thin extremities. The major cause of morbidity and mortality in Marfan patients is cardiac. Which of the following is a common complication?

The results of your study in question 43 find two risk factors associated with the development of the disease that you are studying. Risk factor "X" was found to have an odds ratio for the development of the disease of 2.5 (95% CI: 1.34.0). Risk factor "Y" had an odds ratio of 1.9 (95% CI: 1.13.3). Which of the following statements is true?

A42-year-old man without prior significant medical history comes to your office for evaluation of chronic diarrhea of 12 months duration, although the patient states he has had loose stools for many years. During this time he has lost 25 lbs. The diarrhea is large volume, occasionally greasy, and nonbloody. In addition, the patient has mild abdominal pain for much of the day. He has been smoking a pack of cigarettes a day for 20 years and drinks approximately five beers per day. His physical examination reveals a thin male with temporal wasting and generalized muscle loss. He has glossitis and angular cheilosis. He has excoriations on his elbows and knees and scattered papulovesicular lesions in these regions as well. Which of the following is the most likely diagnosis for this patient?

A 45-year-old woman, mother of four children, comes to the ER complaining of the sudden onset of epigastric and right upper quadrant pain, radiating to the back, associated with vomiting. On examination, tenderness is elicited in the right upper quadrant, bowel sounds are decreased, and laboratory data show leukocytosis as well as normal serum levels of amylase, lipase, and bilirubin Which of the following is the most useful diagnostic test to confirm the diagnosis?

A 72-year-old male with type II diabetes, hypertension, and a history of recurrent pneumonia is admitted to the Medical intensive care unit (ICU) with a diagnosis of septic shock. His vital signs are: BP 80/60 mmHg, RR 24 breaths per minute, pulse 120 beats per minute (bpm), temp. 102.4°F, O2 saturation 99% on room air. Of the choices listed below, what would be your initial management?

One of your responsibilities at the community health center is to serve as director of the tuberculosis (TB) screening and prevention program. Which of the following statements about testing for TB is true?

A 57-year-old man is on maintenance hemodialysis for chronic renal failure. Which of the following metabolic derangements can be anticipated?

A 45-year-old woman presents with a slowly growing mass near the right jaw. You palpate a firm nodule in the parotid gland but find no adenopathy and no other abnormality on examination. A biopsy reveals both epithelial and stromal elements. What is the appropriate treatment for this lesion?

A 19-year-old high school senior complains of feeling "fat and ugly" despite being extremely thin. She takes small amounts of food at meals and occasionally gags herself to induce vomiting after meals. Which of the following is commonly associated with this disorder?

You make the diagnosis of Marfan syndrome in a very tall 22-year-old man with long, thin extremities. Which of the following is the best way to monitor these patients for cardiovascular changes?

A 35-year-old woman with a history of major depressive disorder is brought into the ED by her boyfriend. He believes she may have overdosed on pain medication in an effort to hurt herself. He gives you three medication bottles which he discovered empty and states that they were nearly full before leaving for work earlier that morning. However, the timing of the ingestion is unclear. All three of the bottles apparently held acetaminophen- containing medications. Examination of the patient reveals a tired-appearing woman complaining of nausea and right upper quadrant abdominal pain. Which of the following is the worst prognostic indicator if present in this patient?

A 36-year-old man complains that he cannot sleep at night. "I just can't settle down; my mind is constantly working." He describes being able to complete a lot of work, being highly energized, and having a lot of fun. He is afraid that without sleep he will "crash." Once before, he took a medication for depression. He requests medication at this time. According to the patient's psychiatric symptoms, select the most appropriate medication. Presume no medical problems other than those mentioned. amitriptyline clozapine divalproex fluoxetine hypericum perforatum

For each newborn with vomiting and illustrated radiographs, select the most likely diagnosis. Aneonate with bile-stained vomiting, abdominal distention, dilated loops of bowel on plain radiographs, and a small-caliber colon on contrast enema congenital hypertrophic pyloric stenosis annular pancreas duodenal atresia midgut volvulus intussusception imperforate anus

A 65-year-old woman with a history of cardiac problems complains that she has lost her appetite, she cries frequently, and has lost interest in her grandchildren, her gardening, and her craft making. She thinks maybe it is time to die. According to the patient's psychiatric symptoms, select the most appropriate medication. Presume no medical problems other than those mentioned. amitriptyline clozapine divalproex fluoxetine hypericum perforatum

A 65-year-old woman presents to the physician's office for evaluation of an abnormal screening mammogram. She denies any breast masses, nipple discharge, pain, or skin changes. Past history is pertinent for hypertension. Family history is positive for postmenopausal breast cancer in a sister. She has a normal breast examination and no axillary adenopathy. The remainder of her examination is unremarkable. An MLO view of the right breast is shown in Figure along with a magnification view of the craniocaudal (CC) film Which of the following is the most appropriate next step in management?

A 67-year-old man is seen in the clinic for a scheduled visit. He complains of walking difficulties that have progressively worsened over many months. He also has noticed "shaking" of his hands, resulting in his dropping objects occasionally. He is greatly upset by these problems and admits to frequent crying spells. His only chronic medical illnesses are gastroesophageal reflux disease and hyperlipidemia. He is currently prescribed a proton pump inhibitor and cholesterol-lowering agent. His MSE is notable for little expression or range of affect. His vitals signs are within normal limits. On physical examination, there is a noticeable coarse tremor of his hands, left greater than right. His gait is slow moving and broad-based. Which of the following brain structures is most likely affected in this man's condition?

A 65-year-old woman presents to the physician's office for evaluation of an abnormal screening mammogram. She denies any breast masses, nipple discharge, pain, or skin changes. Past history is pertinent for hypertension. Family history is positive for postmenopausal breast cancer in a sister. She has a normal breast examination and no axillary adenopathy. The remainder of her examination is unremarkable. An MLO view of the right breast is shown in Figure along with a magnification view of the craniocaudal (CC) film Which of the following is the most likely diagnosis?

A 42-year-old woman returns to the clinic following an uneventful biopsy for a welldefined, mobile mass. The pathology report describes the mass as a fibroadenoma, but LCIS is identified in the breast parenchyma adjacent to the fibroadenoma and extending to the margin of resection. She has no current illnesses, is on no medications, and her family history is negative for breast cancer. Breast imaging studies show fatty breasts with no abnormal findings except for the fibroadenoma. Which of the following is the most appropriate management option? re-excision of the biopsy cavity to gain negative margins of resection

A young White female, age unknown, is brought into the emergency room after being found unresponsive at the bus station. She is obtunded and her vitals signs are temperature 97.8°F, blood pressure (BP) 9 4/60, pulse 55, and respirations 8. Her physical examination is notable for a markedly underweight, poorly groomed woman. She appears pale with cold, dry skin and mucous membranes. She is uncooperative with the examination. Her pupils are pinpoint and minimally reactive to light. Her cardiac examination demonstrates bradycardia without murmurs or rubs. Her lungs are clear with shallow breathing. Her abdomen appears to be slightly distended. Intake of which of the following substances would most likely account for her presentation?

A56-year-old woman presents to the clinic for routine health screening. Her concern is the development of breast cancer. She has no current breast-related complaints. Past history is pertinent for fibrocystic changes with atypical ductal hyperplasia and a single fibroadenoma, both diagnosed by open biopsy 5 years ago. She smokes one pack per day and drinks one can of beer daily. Family history is positive for breast cancer in her mother, diagnosed at the age of 85. Current medications include a cholesterol lowering agent, an antihypertensive, and HRT, which she has taken for 5 years. Physical examination is unremarkable. Mammograms show dense breasts, decreasing the accuracy of the study, but no suspicious findings were noted. Which of the following is the most common risk factor in evaluating women for breast cancer?