Question bank

A14-year-old boy presents with sudden onset of pain and swelling of his right testicle. There was no history of trauma, he is not sexually active, and denies any history of penile discharge. On examination, the scrotum is swollen and tender. The cremasteric reflex is absent. A testicular flow scan shows a "cold spot" or absent flow to the affected side. Which of the following is the most likely cause?

A55-year-old man with hepatic cirrhosis from alcohol abuse presents with a massive hematemesis. This is his third admission for upper GI hemorrhage in the past 2 months. He is currently receiving appropriate therapy for liver failure, including a beta-blocker and diuretics. He is lethargic and confused. His pulse is 100 and blood pressure is 85/40. His initial hematocrit is 20. Endoscopic attempts to control the bleeding are initially successful, but the patient has a recurrent bleed 2 days later. The medicine team obtains a surgical consultation for placement of a shunt.Which of the following statements is true?

Which of the following statements is true concerning Meckel's diverticulum?

A full-term newborn develops cyanosis a few hours after birth. Oxygen administration does not improve color or oxygen saturations. Which of the following is the most likely diagnosis?

A55-year-old man with hepatic cirrhosis from alcohol abuse presents with a massive hematemesis. This is his third admission for upper GI hemorrhage in the past 2 months. He is currently receiving appropriate therapy for liver failure, including a beta-blocker and diuretics. He is lethargic and confused. His pulse is 100 and blood pressure is 85/40. His initial hematocrit is 20. After fluid resuscitation, which of the following is the most appropriate management strategy?

A 4-year-old child was brought in for evaluation of sleep problems. He cried and screamed within an hour of falling asleep. He seemed disoriented and confused; he did not seem aware of his parents' presence. They were unable to arouse him to comfort him. This resolved spontaneously, and he had no recollection of the event the next morning. You informed the parents that he was most likely experiencing which of the following?

During a routine checkup, a 45-year-old executive is found to have hypercalcemia. Subsequent workup reveals elevated parathormone, decreased phosphorus, elevated chloride, and normal blood urea nitrogen (BUN), and creatinine in serum. Urinary calcium is above normal levels. What is the most likely etiology? multiple myeloma

A 3-year-old boy was bitten while teasing a neighborhood cat. On examination, there are two puncture wounds on the right hand and some superficial scratch marks. There is erythema, warmth, and induration around the puncture sites. Which of the following organisms most likely caused the infection?

Which of the following is a contraindication to sentinel lymph node biopsy in breast cancer?

A5-week-old bottle-fed boy presents with persistent and worsening projectile vomiting, poor weight gain, and hypochloremic metabolic alkalosis. Of the following diagnostic modalities, which would most likely reveal the diagnosis?

A 45-year-old male was involved in a motor vehicle collision. He was a restrained passenger in a high speed, head-on collision with a death at the scene. He is brought to the ED unresponsive with a pulse of 140, a BP of 70/30, and a SpO2 of 80%. He has multiple facial lacerations, a dilated right pupil, a contusion on his chest, and a distended abdomen. The medic team has placed two large-bore IVs and given him 2 L of lactated Ringer's solution. The initial step in the care of this patient is:

A1-year-old child with ALL in remission for 3 months is in the office for a health maintenance visit. He is due for multiple vaccinations including hepatitis B vaccine, inactivated polio vaccine (IPV), varicella vaccine H. influenzae B vaccine (Hib), and pneumococcal vaccine (PCV). You remember that some of these vaccines are live attenuated viruses and are contraindicated in immunocompromised patients. Which vaccine will you not give to this patient?

A9-year-old boy presents with a several-day history of progressive arm and leg weakness. He has been well except for an upper respiratory infection 2 weeks ago. The patient is alert and oriented. On repeated examination, the heart rate varies between 60 and 140 beats/min, and the blood pressure (BP) varies between 90/60 and 140/90 mmHg. Respirations are shallow, with a rate of 50/min. There is symmetric weakness of the face and all four extremities. Deep tendon reflexes are absent. Sensation is intact. Which of the following is the most likely diagnosis? polymyositis

A 7-year-old boy presents with a rash. His mother states that he was well until 3 days ago when he developed fever and malaise. The next day, the rash started as papules on the trunk, which rapidly changed to vesicles. The lesions have spread all over the body. On physical examination, he has no fever and seems well. You note numerous vesicles all over the body, some of which have crusted over. Which of the following is the most likely diagnosis?

A 45-year-old male receives a cadaveric liver transplant for alcoholic cirrhosis. Postoperatively, the patient is taken to the surgical intensive care unit (SICU). There is concern for primary nonfunction of the allograft. Which of the following is a sign of this?

An 18-month-old girl is brought to the hospital with a history of 6 days of bloody diarrhea. She has been drinking well but has not been wetting her diaper. She has been irritable. On physical examination, she has periorbital edema. She appears pale and is tachycardic. Her CBC shows a hemoglobin of 6 g/dL and a platelet count of 100,000/mm3. Her blood urea nitrogen (BUN) is 50 mg/dL and creatinine is 5.5 mg/dL. Her urinalysis shows gross hematuria. Which of the following is the most likely causative organism for her clinical problem?

A50-year-old man undergoes a sigmoid colectomy and colostomy for perforated diverticulitis of the midsigmoid colon. The surgeon reports a difficult dissection in the pelvis secondary to adhesions of the sigmoid colon to the abdominal wall. On postoperative day 1, the patient reports appropriate abdominal pain. His pulse is 100 and BP 120/60. He has made 400 mL of urine over the past 8 hours. The urine in the Foley bag is blood-tinged. He reports no problems with his urination preoperatively. What is the appropriate management?

A 22-year-old male presents complaining of a 1-month history of progressive dysphagia. He reports occasional regurgitation of undigested food at night. His past medical history is noncontributory. The condition has worsened to the point that he is on a liquid diet. A contrast swallow study is shown in Figure. What is the best treatment for this patient?

An infant is due for her first dose of polio vaccine.Her parents have heard that there are two different types of vaccine for polio. They want to know why their daughter needs to get another shot rather than just taking the oral form of the vaccine. You tell the parents the major advantage of the injectable vaccine is which of the following?

A 45-year-old woman undergoes an uncomplicated thyroidectomy for a goiter. Later that night, she becomes agitated and complains of difficulty breathing. The surgeon notices some neck swelling at the incision site, but the dressing is clean. What should the next step be?