Question bank

You are called to the trauma bay to evaluate a 42-year-old male who suffered a blow to his knee at the construction site where he works. He is awake, alert, and his vital signs have been stable in transport. After completing your primary survey, you continue with your secondary survey and determine that his only injury is to his right leg. It is clear that he has suffered a posterior knee dislocation. As part of your examination, you determine that you cannot feel a pulse in his right foot. Realizing that there is compromised blood supply to the patient's right foot, you immediately do which of the following?

A 45-year-old male living in a homeless shelter is exposed to TB from a fellow resident. He is found to have a 15 mm of induration on the Mantoux skin test. Which of the following risk factors will increase the man's likelihood of developing active TB subsequent to his infection? history of cough variant asthma

You are called to the trauma bay to evaluate a 42-year-old male who suffered a blow to his knee at the construction site where he works. He is awake, alert, and his vital signs have been stable in transport. After completing your primary survey, you continue with your secondary survey and determine that his only injury is to his right leg. It is clear that he has suffered a posterior knee dislocation. As part of your examination, you determine that you cannot feel a pulse in his right foot. Later that night after the patient had been treated and stabilized, you are called to the patient's room to evaluate severe pain in his right lower leg. Upon examining the patient, you determine that he has a bounding pulse in his right foot. However, the patient does state that he has a tingling sensation in his foot and he is in excruciating pain when you flex his foot. Which of the following should be the next step in his treatment?

The causative organism of cholera, Vibrio cholerae, was first isolated by Koch in 1883. There have been seven pandemics of cholera, with the most recent subsiding only in the 1980s. With humans as the usual reservoir, the organism spreads as man travels. Which of the following is the most likely mode of spread?

You are called to the ER to assist with a series of trauma patients who arrived following a multiple vehicle accident. You are assigned to a 22-year-old male who was an unrestrained driver involved in a head-on collision. After you confirm the presence of an adequate airway and equal breath sounds bilaterally, you address his hypotension and tachycardia by giving 2 L of lactated Ringer's solution. His pulse remains elevated at 130 and his blood pressure is 92/55. His pelvic x-ray returns and demonstrates a widening of the pubic symphysis. In addition to continued fluid resuscitation, what is your next step in management?

A 4-year-old child presents to his pediatrician with a complaint of a mild rash and fevers. His travel history is positive for a camping trip 2 weeks prior. The parents do not recall a tick bite on the child and do not remember if there were ticks in the area. No other members of the family complain of similar symptoms and the child does not attend day care. Physical examination is positive for a temperature of 100.9°F with an erythe matous rash noted over the child's trunk. Which of the following factors would significantly increase the possibility that the child has Lyme disease?

For which of the following circumstances would you consider initiating chelation, such as with CaEDTA, to treat workers for workplace exposure to lead and other heavy metals?

You are asked to see a 74-year-old man who has been admitted for evaluation of abdominal pain. During his workup, he was found to have hemoccult positive stool and a CT scan that was concerning for a mass in his sigmoid colon. Which should be the next step in his treatment?

Six hundred asymptomatic men with prostatic nodules are given a PSA test to screen for prostate cancer. With a cutoff of 5 ng/mL, the PSA results are positive in 200 cases. Of these, 100 persons are confirmed on biopsy and follow-up testing to have the disease; however, 50 of the individuals who had negative test results are also shown to have the disease based on biopsy. You have been asked to screen another similar group of 50 men using the PSA test. What proportion of persons having prostatic cancers will you correctly identify in the new group?

You are seeing a 48-year-old female in followup in your clinic. She originally presented for evaluation of a suspicious nonpalpable lesion in her right breast that was seen on her annual mammogram. A stereotactic core biopsy was done. She now returns to your office to review the results of the pathology report that confirms the presence of lobular carcinoma in situ (LCIS). How do you counsel her at this time?

A large segment of the population in your community smokes. In order to convince your patient population that it would be beneficial to quit smoking in order to prevent lung cancer, you conduct a casecontrol study of cigarette smoking and lung cancer. The results from that study can be found in the table below. Which of the following is most true concerning ORs and relative risk calculations, as pertaining to this study?

A 52-year-old female has been referred to you for consultation following a core biopsy of an area of calcifications seen on a screening mammogram. She has no family history of breast or ovarian cancer. She has not been taking hormone replacement therapy and has no reproductive risk factors. On physical examination, there is no palpable mass. The core biopsy results demonstrate atypical ductal hyperplasia. What should be the next step in her treatment?

You had previously seen a 24-year-old male in your office for evaluation of a suspicious looking mole. He had undergone a punch biopsy, which demonstrated a melanoma. He has no prior history of skin cancer, no family history of skin cancer, nor any history of blistering sunburns. Which of the following results in the pathology report are most predictive of outcome?

A group of male workers between the ages of 20 and 39 years are being screened for lung disease by spirometry. Nine subjects are examined. Their forced expiratory volume in 1 second (FEV1) divided by forced vital capacity (FEV1/ FVC %) results are 80, 76, 73, 61, 64, 79, 64, 64, and 78. What is the mean? 61

You are asked to see a 64-year-old man with left lower quadrant abdominal pain that was admitted to the medicine service after a CT scan demonstrated diverticulitis of the sigmoid colon. There was no evidence for gross perforation and no abscess was identified. He had been admitted 6 months ago for the same problem and had an uneventful recovery. Which treatment do you recommend?

A group of male workers between the ages of 20 and 39 years are being screened for lung disease by spirometry. Nine subjects are examined. Their forced expiratory volume in 1 second (FEV1) divided by forced vital capacity (FEV1/ FVC %) results are 80, 76, 73, 61, 64, 79, 64, 64, and 78. What is the modal reading?

Which of the following is the most appropriate treatment for a 32-year-old male with a toxic nodular goiter and compressive airway symptoms?

A group of male workers between the ages of 20 and 39 years are being screened for lung disease by spirometry. Nine subjects are examined. Their forced expiratory volume in 1 second (FEV1) divided by forced vital capacity (FEV1/ FVC %) results are 80, 76, 73, 61, 64, 79, 64, 64, and 78. What is the median value?

Several days following an uneventful laparoscopic cholecystectomy, the pathology report reveals gallbladder cancer that is invasive into the submucosa of the specimen. The most appropriate management is which of the following?

A 5-year-old male is admitted to the hospital following a 3-week history of spiking fevers and fatigue. Your examination reveals pale mucous membranes and skin. You also find splenomegaly. This child has an extensive evaluation by the Hematology-Oncology consultants. Their evaluation excludes the presence of a malignancy. The extensive evaluation did reveal that the child has a WBC count of 22,000 with 41% monocytes and 12% "atypical" lymphocytes. His hematocrit is 28% and erythrocyte sedimentation rate (ESR) is 5. This child likely has which of the following diseases?