Question bank

A 53-year-old fisherman develops pain and swelling of the right hand 8 hours after suffering a fish hook injury to the finger. On physical examination, the patient's temperature is 102.8°F and the patient ap pears septic. The patient's hand and a Gram stain of material aspirated from a bulla are shown in Figures below. After appropriate wound care and debridement of necrotic tissue as necessary, which antibiotics should be started in this patient?

You receive a call from the nurse at a nursing home for a 70-year-old patient of yours who was febrile overnight and had blood cultures, CXR, and urinalysis ordered by the housestaff. The patient was started empirically on a fluoroquinolone orally. The nurse informs you that the CXR and urinalysis were normal but the blood culture grew out Enterococcus faecalis. The patient has been on oral fluoroquinolone for 36 hours and patient is still febrile but appears stable. Which of the following is most appropriate?

A24-year-old male medical student is admitted to the hospital for the evaluation of a 3-month history of bloody stools. The patient has approximately six blood stained or blood streaked stools per day, associated with relatively little, if any, pain. He has not had any weight loss, and he has been able to attend classes without interruption. He denies any fecal incontinence. He has no prior medical history. Review of systems is remarkable only for occasional fevers and the fact that the patient quit smoking approximately 8 months ago. A colonoscopy is performed and reveals a granular, friable colonic mucosal surface with loss of normal vascular pattern from the anal verge to the hepatic flexure of the colon. Biopsies reveal prominent neutrophils in the epithelium and cryptitis with focal crypt abscesses, and no dysplasia. The patient is diagnosed with ulcerative colitis. In addition to an increased lifetime risk of colon cancer, the patient is also at increased risk for which of the following tumors?

A54-year-old woman is brought to the ER with palpitations and dizziness. She has a history of arrhythmia. Adenosine is given and the patient converts to a sinus rhythm. With which of the following rhythms did this patient most likely present to the ER?

A30-year-old female presents to your office for the evaluation of a rash on her back. It has been present and growing for about a week. Along with this rash, she has had a fever, headache, myalgias, and fatigue. Her symptoms started about a week after returning from a camping trip to New England. She denies having any bites from ticks or other insects and exposure to poison ivy and has had no wounds to her skin. On examination, her temperature is 99.5°F and her v ital signs are otherwise normal. Her rash is shown in Figure. Her examination is otherwise unremarkable. You order IgM and IgG ELISA testing for Borrelia burgdorferi and the results return as negative. Which of the following management options would be most appropriate?

A 48-year-old man complains of fatigue and shortness of breath. His hematocrit is 32% and hemoglobin is 10.3 g/100 mL. Peripheral blood smear reveals macrocytosis. His serum vitamin B12 level is 90 pg/mL (normal, 170940); serum folate level is 6 ng/mL (normal, 214). Which of the following is the most likely cause of this patient's symptoms?

A 39-year-old HIV-positive male presents for routine follow-up. He is on highly active antiretroviral therapy. A CD4 count is 250/L. His vital signs are within normal limits and his examination is normal. Which of the following management options is most appropriate at this time?

A62-year-old man presents with weakness and aching in his hips and shoulders which has progressed over the last few months. He reports generalized fatigue and malaise. Workup includes a normal complete blood count, kidney and liver tests, and a sedimentation rate of 102. Which of the following is the most likely diagnosis?

A 33-year-old woman complains of generalized, throbbing headache that is worse in the morning and with coughing. She occasionally feels dizzy and nauseated. Examination is significant only for obesity and bilateral papilledema. ACT scan of the head is normal. At lumbar puncture, the opening pressure is 220 mmH2O; CSF is clear, with protein of 12 mg/100 mL (normal, 1545), glucose of 68 mg/100 mL (normal, 4580), and no cells are seen. Which of the following is the most likely diagnosis? migraine headache

A55-year-old man is being evaluated for gradually increasing shortness of breath. He does not smoke and does not have any significant environmental exposures. Cardiac workup is unremarkable and pulmonary function tests reveal decreased lung volumes and decreased total lung capacity (TLC) and vital capacity. Which of the following is the most likely diagnosis?

A56-year-old man complains of fatigue, dyspnea on exertion, and palpitations. He has had a murmur since childhood. Examination reveals a lift at the left sternal border, split S1, and fixed splitting of S2. There is a grade 3/6 midsystolic pulmonic murmur and a 1/6 middiastolic tricuspid murmur at the lower left sternal border. CXR shows right ventricular enlargement and prominent pulmonary arteries. An ECG demonstrates atrial fibrillation with a RBBB. Which of the following is the most likely diagnosis?

A 30-year-old woman is visiting you in your primary care office as a new patient. Overall, she is healthy. On taking a family history, you learn that her mother was diagnosed with colorectal cancer at the age of 50. When should this patient start being screened for colorectal cancer?

Select the ONE best lettered option that is most closely associated with the question below. A 38-year-old African American female with shortness of breath and bilateral hilar adenopathy on CXR. rheumatoid arthritis SLE Wegener's granulomatosus polyarteritis nodosa

A62-year-old female with a history of a recent pulmonary embolus presents to your office for follow- up on anticoagulation treatment. She takes warfarin on a daily basis. She reports that for the last week she has noticed mild rectal bleeding and multiple bruises over the extremities with minimal trauma. She is comfortable appearing with normal vital signs and is not orthostatic. You ordered a stat CBC and PT/INR which revealed a mildly decreased Hgb at 11 g/dL and an elevated INR of 7. Which of the following would be the most appropriate intervention?

Select the ONE best lettered option that is most closely associated with the question below. A 45-year-old female with pain and visible swelling in her metacarpal-phalangeal joints bilaterally. Her distal interphalangeal joints (DIPs) appear normal. rheumatoid arthritis SLE Wegener's granulomatosus polyarteritis nodosa

Select the ONE best lettered option that is most closely associated with the question below. A 60-year-old obese male with Heberden's nodes on his hands and chronic, severe leftsided knee pain. rheumatoid arthritis SLE Wegener's granulomatosus polyarteritis nodosa Goodpasture syndrome

A 4-year-old girl presents to the emergency department with fever and a petechial rash. A sepsis workup is performed, and IV antibiotics are administered. Gram-negative diplococci are identified in the CSF. Which of the following is true of this condition?

A 64 year old woman presents with bilateral symmetric arthralgias and morning stiffness for several years. She says that she has been worked up for RA in the past. On review of her records as well as the examination you note subcutaneous nodules, positive rheumatoid factor, and radiographs of the hands that revealed joint erosions. Which of her findings has the highest positive likelihood ratio (LR) for the diagnosis of RA?

A92-year-old man is referred from his nursing home for evaluation of lethargy. Examination is unrevealing, but laboratory results are significant for a serum sodium level of 118 meq/L (normal, 135 148). Serum osmolality is 260, urine osmolality is 450, and urine sodium is 80. Which of the following is the most likely cause of this patient's lethargy?

Which of the following is the most common cause of nephrotic syndrome?