Question bank

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?

A dentist asks you to evaluate a 42-year-old woman before tooth extraction. Which of the following would prompt you to prescribe prophylactic antibiotics?

A 19-year-old previously healthy man is an unbelted driver of a motor vehicle involved in a front-end collision. On arrival in the emergency department, the patient is noted to have stridor, with marked respiratory distress, and an oxygen saturation of 88% despite 100% oxygen by mask. He has obvious extensive facial injuries, a flail chest, and poor chest expansion. Bag-mask-valve ventilation is ineffective. 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. Some time after initiation of treatment with the proper medication, he becomes agitated and is noted to be hallucinating. Which of the following medications would be the most appropriate to treat these new symptoms?

A 45-year-old male comes to your office for his first annual checkup in the last 10 years. On first impression, he appears overweight but is otherwise healthy and has no specific complaints. He has a brother with diabetes and a sister with high blood pressure. Both of his parents are deceased and his father died of a stroke at age 73. He is a long-standing heavy smoker and only drinks alcohol on special occasions. On physical examination, his blood pressure is 166/90 in the left arm and 164/88 in the right arm. The rest of the examination is unremarkable. He is concerned about his health and does not want to end up on medication, like his siblings Which of the following describes the patient's blood pressure status?

A 29-year-old married male is seen in the emergency room with the chief complaint of, "I'm afraid I'm having a heart attack." He states a 2-month history of experiencing recurrent episodes of chest pain and shortness of breath that last 1020 minutes. He also describes associated tachypnea, lightheadedness, tingling in his extremities, nausea, diaphoresis, anxiety, and fears that he may die. These symptoms are now occurring almost daily but are not provoked by any situations or activities such as exertion or exercise. He is significantly worried about having future episodes and is genuinely concerned that he will suffer a myocardial infarction. He denies having any medical illnesses or taking any medications. He drinks three beers on the weekends only and does not use illicit drugs. His physical examination reveals a slightly elevated BP and pulse. An ECG demonstrates sinus tachycardia Which of the following medications would be most appropriate in the long-term management of this patient's symptoms?

A 35-year-old woman is involved in a motor vehicle crash, sustaining a severe pelvic fracture, with disruption of the pelvic ring. In the trauma resuscitation room, she is confused and tachypneic, with a blood pressure of 90 mmHg systolic and a heart rate of 130/min. Laboratory investigations include serum electrolyte analysis, revealing a sodium of 139, a chloride of 103, and a bicarbonate of 14 meq/L. This patient demonstrates which of the following?

A 65-year-old man presents to the emergency department with an abrupt onset of excruciating chest pain 1 hour ago. The pain is localized to the anterior chest, but radiates to the back and neck. On examination, the patient is afebrile, with a BP of 210/110 mmHg, pulse rate of 95/min, and a respiratory rate of 12/min. He appears pale and sweaty. Unequal carotid, radial, and femoral pulses are noted. An electrocardiogram (ECG) shows nonspecific ST-T segment changes. Chest x-ray shows a slightly widened mediastinum and normal lung fields. Which of the following is the first step in management of this patient?

A 35-year-old woman is involved in a motor vehicle crash, sustaining a severe pelvic fracture, with disruption of the pelvic ring. In the trauma resuscitation room, she is confused and tachypneic, with a blood pressure of 90 mmHg systolic and a heart rate of 130/min. Laboratory investigations include serum electrolyte analysis, revealing a sodium of 139, a chloride of 103, and a bicarbonate of 14 meq/L. Which of the following is the most appropriate management of this acid-based derangement?

A42-year-old male presents to the office for a refill of the nasal steroid medication that he uses every spring to control his allergies. You notice on the vital signs taken by the nurse that his blood pressure is 150/95. Except for some sneezing and nasal congestion, the patient has no symptoms. He has no other medical history and his only medication is a nasal steroid. He does not smoke cigarettes, does not drink alcohol, and does not exercise. His body mass index is 24 kg/m2. Initial management at this time should include which of the following?

A 70-year-old man is admitted to the ICU after repair of an abdominal aortic aneurysm. He has a prior history of hypertension and mild congestive heart failure, which were adequately controlled with digoxin and diuretics. To facilitate perioperative management, a Swan-Ganz (multilumen pulmonary artery) catheter was inserted in the operating room. During the first few hours postoperatively, the patient is noted to have a blood pressure of 140/70 mmHg, heart rate of 110/min, flat neck veins, a pulmonary arterial wedge pressure of 9 mmHg, and poor urine output. Several hours after this intervention, the patient is reassessed. The blood pressure is 150/85 mmHg, heart rate is 90/min, neck veins are distended, and the pulmonary arterial wedge pressure is 17 mmHg. Urine output is still low in volume. At this point, management should be which of the following? IV furosemide

A 70-year-old man is admitted to the ICU after repair of an abdominal aortic aneurysm. He has a prior history of hypertension and mild congestive heart failure, which were adequately controlled with digoxin and diuretics. To facilitate perioperative management, a Swan-Ganz (multilumen pulmonary artery) catheter was inserted in the operating room. During the first few hours postoperatively, the patient is noted to have a blood pressure of 140/70 mmHg, heart rate of 110/min, flat neck veins, a pulmonary arterial wedge pressure of 9 mmHg, and poor urine output. Which of the following is the most appropriate next step in management of this patient?

You make the diagnosis of Marfan syndrome in a very tall 22-year-old man with long, thin extremities. What other finding is associated with this disease? family history in 100% of the patients

A 40-year-old male comes to your office as a new patient to get established for care, as he recently moved into your city from another state. He has been on medical therapy for type 2 diabetes mellitus for 3 years and has had good glycemic control. He takes metformin 500 mg bid and reports having fasting glucose levels of less than 100 on home monitoring. He has records from his previous physician that show that he had a dilated eye examination 6 months ago that was normal and a hemoglobin A1C (HgbA1C) level of 6.2 that was taken 3 months ago. He has no known history of coronary artery disease. His last fasting lipid measurement was 14 months ago. You order a fasting lipid panel today and get the following results: Total cholesterol: 235 mg/dL Triglycerides: 210 mg/dL HDL cholesterol: 45mg/dL LDL cholesterol: 162 mg/dL Your management today should include which of the following?

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?

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. Administration of which of the following would be most appropriate?

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?

A42-year-old male presents to the office for a refill of the nasal steroid medication that he uses every spring to control his allergies. You notice on the vital signs taken by the nurse that his blood pressure is 150/95. Except for some sneezing and nasal congestion, the patient has no symptoms. He has no other medical history and his only medication is a nasal steroid. He does not smoke cigarettes, does not drink alcohol, and does not exercise. His body mass index is 24 kg/m2. Of the options listed, which would be the most appropriate management at this point?

You are evaluating a journal article describing a test for the diagnosis of congestive heart failure (CHF). In the study described, 250 consecutive patients were given the test. Of the 250 subjects, 106 tested positive for CHF and 144 tested negative. All 250 subjects were then evaluated by expert cardiologists who were blinded to the results of the experimental test. These cardiologists determined that of the 106 persons who tested positive, 95 actually had CHF. Further, the cardiologists found that of the 144 who tested negative, 2 truly had CHF. What is the sensitivity of this test for the diagnosis of CHF?

A 53-year-old Black male, with a history of hypertension, hepatitis C, and newly diagnosed nonsmall cell lung cancer, undergoes his first round of chemotherapy, which includes cisplatin. You are called to see this patient 5 days into his hospitalization for oliguria and laboratory abnormalities. Other than the chemotherapy, he is receiving lansoprazole, acetaminophen, and an infusion of D5-- 0.9% normal saline at 50 mL/h. On examination, his BP is 98/60 and heart rate is irregular, between 40 and 50 bpm. His physical examination shows a middle-aged male in no acute distress. His cardiac examination is unremarkable, his lungs show bibasilar crackles, and the abdominal examination is positive for a palpable spleen tip without any hepatomegaly or abdominal tenderness. He has trace bilateral ankle edema. His distal pulses are irregular. The neurologic examination was unremarkable. His laboratory (serum sample) results are as follows What is the mechanism that best explains this patient's hyperkalemia?