The Daily PANCE and PANRE Second Midterm ExamQuestions 30 through 60

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Question 1The most common cause of curable blindness in the United States is:Amacular degeneration.Hint: macular degeneration is not preventable.Bcataracts.Hint: Cataracts are "curable", but the cataract itself is probably not "preventable". Cretinal detachments.Hint: retinal detachments and are not preventable. Dglaucoma.Etrauma. Hint: trauma is not preventable.Question 1 Explanation: Again, the wording is difficult in this question. Macular degeneration, retinal detachments and trauma are not preventable. Cataracts are "curable", but the cataract itself is probably not "preventable". Chronic glaucoma can be treated to prevent blindness this is a matter of semantics.Question 2Which of the following agents is effective in the treatment of Parkinson's?ApenicillinBamantadineCerythromycinDacyclovirEcephalexinQuestion 2 Explanation: Amantadine (Symmetrel) is effective somewhat). It is used in treating Influenza A. Another choice is selegiline, and levodopa/carbidopa. The other antibiotics listed here are not useful in Parkinson's.Question 3Laboratory report: elevated serum free T4 low serum TSH level. Which of the following is the MOST likely diagnosis?Aprimary hypothyroidismHint: Primary hypothyroidism (Hashimoto's) is low T4 with a high TSH. Bsecondary hypothyroidismHint: Secondary hypothyroidism (from pituitary disease) is a low T4 with a low TSH.CT3 thyrotoxicosisDGraves’ diseaseE chronic Hashimoto's thyroiditisQuestion 3 Explanation: High T4 (hyperthyroid), with a low TSH indicates that the pituitary is working normally, and the thyroid is hyperactive, i.e. Grave's disease. Primary hypothyroidism (Hashimoto's) is low T4 with a high TSH. Secondary hypothyroidism (from pituitary disease) is a low T4 with a low TSH.Question 4The results of a barium esophagram reveal esophageal webbing in a woman with long-standing iron deficiency anemia. Her diagnosis is:ABarretts esophagus.Hint: Barrett's causes GERD symptoms and dysplasia of the esophageal mucosa.Bachalasia.CPlummer-Vinson syndrome.DDresslers syndrome.EOgilvies syndrome.Question 4 Explanation: Plummer-Vinson is something to know for those who want a 100% on the exam. There is no need to memorize this. More importantly, webbing in the distal esophagus with no other symptoms but dysphagia would be a Schatzki’s ring (much more common). Barrett's causes GERD symptoms and dysplasia of the esophageal mucosa. Achalasia is a primary neurologic problem of the esophagus causing dysphagia.Question 5Which of the following agents has a mechanism of action that does not involve beta-receptors?AepinephrineHint: Ritodrine and epinephrine cause beta sympathetic stimulationBalbuterolHint: Albuterol is a beta agonist.CpropranololHint: Propranolol is a beta blocker.DprazosinEritodrineHint: Ritodrine and epinephrine cause beta sympathetic stimulationQuestion 5 Explanation: Of these choices, prazosin is an alpha- blocker. Ritodrine and epinephrine cause beta sympathetic stimulation. Albuterol is a beta agonist. Propranolol is a beta blocker.Question 6A 6 year-old male is brought into your office for evaluation of his gait. You note that when ambulatory, the medial aspects of his knees are far apart and his feet are unusually close together. Which of the following best describes this condition?Acubitus valgusBcubitus varusCgenu valgus Hint: Valgus deformity forms an "L" in the knock-kneed child, and has an "L" in the middle of it (try it, it works)Dgenu varum ELegg-Calve-Perthes diseaseQuestion 6 Explanation: This is genu varum (bow legs). Valgus deformity forms an "L" in the knock-kneed child, and has an "L" in the middle of it (try it, it works)Question 7A female presents complaining of a grayish, watery vaginal discharge. The KOH prep does not reveal any hyphae. Clue cells are identified on the wet mount. A paucity of WBCs are noted. What diagnosis is most likely?AGonorrheaBChlamydiaC CandidiasisDbacterial vaginosisETrichomoniasisQuestion 7 Explanation: Clue cells means BVQuestion 8You note polygonal, purple, popular lesions involving the flexor surfaces of a patient's wrists. The patient has no other lesions. The lesions appear to follow a linear pattern of distribution. What is this phenomenon?AAuspitz signHint: Auspitz sign is also present in psoriasis where the scales bleed when removed. BKoebner's phenomenonCDarier's signHint: Darier's sign is in allergic patients who develop urticaria when the skin is rubbed. DGorlin's signHint: Gorlin's sign is seen in Ehlers-danlos when a patient can touch the tip of the nos e with his tongue (I learn something new every day!!)EGottron's papulesHint: Gottron's papules are purple papules on the fingers seen in dermatomyositis. Question 8 Explanation: Koebner's phenomenon is described - it suggests psoriasis. Auspitz sign is also present in psoriasis where the scales bleed when removed. Darier's sign is in allergic patients who develop urticaria when the skin is rubbed. Gottron's papules are purple papules on the fingers seen in dermatomyositis. Gorlin's sign is seen in Ehlers-Danlos when a patient can touch the tip of the nose with his tongue (I learn something new every day!!) These last two are not important to know.Question 9A 6 year-old female presents complaining of right ear pain. The tympanic membrane cannot be well visualized. She complains of pain when the tragus is manipulated. Several periauricular lymph nodes are easily palpable. Which of the following is the most likely diagnosis?Aacute otitis media Hint: OM would not cause periauricular nodes and tragal tenderness. Bacute otitis externaCeustachian tube dysfunctionHint: Eustachian tube dysfn would cause middle ear pain (like when you're up in a plane). DRamsey-Hunt syndromeHint: Ramsey- Hunt is herpes zoster of the ear canal and would be visible. Eperforated tympanic membraneHint: A perforated TM would cause middle ear, not external ear pain (typically).Question 9 Explanation: OE is described here. OM would not cause periauricular nodes and tragal tenderness. Eustachian tube dysfn would cause middle ear pain (like when you're up in a plane). Ramsey- Hunt is herpes zoster of the ear canal and would be visible. A perforated TM would cause middle ear, not external ear pain (typically).Question 10A 51 year-old male with renal artery stenosis and an elevated BUN and creatinine, is newly diagnosed as hypertensive. Which of the following agents should be avoided?Ahydrochlorothiazide-triamtereneBprazosinCnifedipineDverapamilEfurosemideQuestion 10 Explanation: This is a potassium sparing diuretic and should be avoided in anyone with renal disease. ACEI should be avoided as well (but none of these are ACEI's).Question 11A patient at a Christmas party on a cruise ship develops a terrible headache. His blood pressure is 224/158 mm Hg. Which of the following agents is this patient most likely taking regularly?A tricyclic antidepressantsBbarbituratesCbenzodiazepinesDmonoamine oxidase inhibitorsEphenothiazinesQuestion 11 Explanation: This is a typical scenario for MAOI induced malignant hypertension from eating the "wrong" foods, which are frequently found on a Christmas buffet, (cheese, sausages, red w ine, etc.).Question 12A patient with known hyperlipidemia, taking clofibrate, presents to your office complaining of severe myalgias and weakness. He has noted a dark color to his urine. The laboratory calls with a panic value CPK of 8500. He was recently started on a new medication, four days earlier. Which of the following is most likely the new medication?AlovastatinBhydrochlorothiazide.CdexamethasoneDphenytoinEampicillinQuestion 12 Explanation: Statin + fibrate = suspicion for rhabdomyolysis in a patient with myalgias, ALWAYS order a CPK. (statin alone, or fibrate alone may cause it too, but the combination is most likely)Question 13A female patient presents for an evaluation for primary amenorrhea. She is noted to be short of stature and have short fourth metacarpals. What diagnosis do you suspect?AXOBXXYHint: XXY is the genotype for Klinefelter's (which is a tall, mildly retarded male). CXXXHint: Trisomy 21 is Down's. DXXXYETrisomy 21Question 13 Explanation: This is the genotype for Turner's syndrome. XXY is the genotype for Klinefelter's (which is a tall, mildly retarded male). Trisomy 21 is Down's. The other two are not common genotypes.Question 14An 18 year-old female presents after completing her freshman year at college. Two months ago, she developed "bronchitis" which has persisted. She has become increasingly tired and has frequent night sweats. A chest x-ray today reveals a left mediastinal mass. What is the next step in her evaluation?Arepeat the chest x-ray in six monthsBultrasound of the left hemithoraxCbone scanDCT scan of the chestEproceed directly to bronchoscopy with biopsyQuestion 14 Explanation: Any patient presenting with mediastinal nodes should have a CT. This patient may have sarcoid or Hodgkin's or another type of cancer - CT is indicated.Question 15An elderly patient is recovering from a pneumonia caused by Influenza.  Suddenly, the patient's condition deteriorates. You order a chest x-ray that demonstrates an air-fluid level, suggestive of an abscess. You empirically begin treatment for:AStreptococcal pneumoniae.BChlamydia.CHemophilus influenzae.DStaphyl ococcus aureus.ELegionella pneumophila.Question 15 Explanation: Empyema (lung abscess) is almost always staph aureus. While strep pneumo is the most common CAP, when a complication like empyema occurs, it is almost always staph.Question 16A 17 year-old male is stabbed in the anterior chest with an ice pick. He quickly becomes hypotensive, tachycardic and obtunded. His breath sounds are equal, his neck veins are distended, and his chest x-ray is normal. What condition is most likely?ASimple pneumothorax Hint: The "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.)BTension pneumothoraxHint: The "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.CPericardial TamponadeDaortic laceration distal to the origin of the left common carotid arteryEinferior vena cava lacerationQuestion 16 Explanation: This is the typical clinical presentation of tamponade (hypotension, JVD). He was stabbed and probably has a mediastinal bleed (so, I think the mediastinum would be widened on his chest film — but the "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.Question 17A 48 year-old male presents with crushing chest pain for 45 minutes. He is diaphoretic, nauseous and short of breath. His EKG demonstrates 4 mm of ST segment depression in leads I, aVL, V5 and V6. What is the most likely diagnosis?Aesophageal spasmBhiatal herniaCacute lateral wall subendocardial myocardial ischemiaDacute inferior wall myocardial subendocardial ischemiaHint: Inferior AMI is leads II, III, avFEacute anterior wall myocardial transmural ischemiaHint: Anterior wall AMI is leads +- VI, with V2-V4, and maybe V5 It is obvious this patient is having an AMI. The ECG lead abnormalities suggest occlusion of the high lateral and low lateral walls of the LV - typically supplied by the circumflex - there are no Q waves - so subendocardial. Inferior AMI is leads II, III, avF. Anter ior wall AMI is leads +- VI, with V2-V4, and maybe V5 This is a typical presentation of varicella (chicken pox)Question 19A 35 year-old male complains of acute left eye pain immediately after he struck a nail with a hammer. On examination, you note that the left pupil is elliptical. What diagnostic test/procedure will most likely confirm your diagnostic suspicion?Afluorescein staining of the eyeHint: Fluorescein staining is for a corneal abrasion - it should not be done if the globe is penetratedBpressing on the globe to assess intraocular pressureCan X-ray of the orbitsDtesting the extra-ocular eye musclesEhaving the patient finger countQuestion 19 Explanation: This patient struck a nail (think metal splinter), pain was immediate (as the splinter entered his eye). His pupil is elliptical, indicating penetration of the globe. He needs X-ray of the globe to look for the metal splinter. Fluorescein staining is for a corneal abrasion - it should not be done if the globe is penetrated Question 20This drug causes gingival hyperplasia and hirsutism. At high doses it can cause nystagmus, ataxia and diplopia. Which drug is best described by these statementsAaspirinBacetaminophenCacyclovirDphenytoinEvalproic acidQuestion 20 Explanation: Dilantin (phenytoin) causes these typical symptomsQuestion 21Which of the following choices is associated with meconium staining of the amniotic fluid?Abowel obstructionBpeeling of the infant's skinCaspiration pneumonitis and respiratory distress syndromeDinfection with E. coliEintrauterine cataract formation and sensorineural hearing lossQuestion 21 Explanation: When the infant has meconium in the amniotic fluid, he has been in distress, and the meconium is frequently aspirated prior to delivery and can cause pneumonitis and respiratory distress syndrome in the neonate.Question 22A 32 year-old male presents after slipping and falling off the roof of his home and striking his head. He suffered a brief loss of consciousness. Since that t ime, he has noted increasing urination and thirst. His serum chemistries reveal an elevated sodium level. His urine specific gravity is 1.003. Which of the following is the most likely diagnosis?Acerebral contusionBsubarachnoid hemorrhageCepidural hematomaDdiabetes insipidusErenal contusionQuestion 22 Explanation: Diabetes insipidus (ADH deficiency) can occur after acute head trauma. ADH is secreted by the posterior pituitary gland and causes the body to retain fluid (to increase volume). In a patient who has damaged the posterior pituitary, ADH is not secreted, so the body urinates "water". There is frequent large volume urination with a very low specific gravity, and will cause hypernatremia unless the patient is given large quantities of water to drink.Question 23You are educating a patient that has just been advised that he has "polyps" in his colon. Which of the following statements is FALSE?AThe larger the colonic polyp, the greater the risk of malignant transformationBVillous adenomas have a 30-70% risk of malignant transformation.CThe greater the number of concomitant colonic polyps, the greater the risk of malignant transformatioDThe majority of colonic polyps are hyperplastic in originEThe majority of colonic polyps are > 3 cm in size.Question 23 Explanation: Most polyps are, in fact, quite small. All the rest of these statements are true.Question 24Wolf-Parkinson-White (WPW) and Lown-Ganong-Levine (LGL) syndrome are both characterized by:Aleft ventricular dysfunction.Ba shortened PR interval.Cthe presence of delta waves.Dlarge pericardial effusions.Emarked left ventricular hypertrophy.Question 24 Explanation: WPW The fifth finger is ALWAYS innervated by the ulnar nerve, and would not be affected in a true carpal tunnel syndrome.Question 26A 22 year-old female complains of vaginal bleeding for 24 hours. Her last menstrual cycle was seven weeks ago. She has had an IUD, but currently uses no form of contraception.   Her HCG is positive. She denies f ever, chills and vaginal discharge, prior to the onset of the vaginal bleeding. You order a pelvic ultrasound to rule out:Acervicitis.Bpelvic inflammatory disease.Cdysfunctional uterine bleeding.Dan ectopic pregnancy.Evaginitis.Question 26 Explanation: Any patient with an IUD, or with a tubal ligation, or known obstruction of a tube, who has a positive HCG needs an ultrasound to r/o ectopic pregnancy.Question 27The examination of a 26 year-old male demonstrates a "bag of worms" consistency within the left hemiscrotum. This finding is suggestive of a(n):Aacute case of balanitisBvaricocele.Chydrocele.Hint: Hydrocele is just a water collection in the scrotum. Dspermatocele.Hint: Spermatocele is just a fluid collection which happens to contain sperm (sperm are not palpable).Eparaphimosis.Question 27 Explanation: This is a description of varicocele (varicose veins of the scrotum). Hydrocele is just a water collection in the scrotum. Spermatocele is just a fluid collection which happens to contain sperm (sperm are not palpable).Question 28A patient presents with a recurrent history of swelling on the right side of the jaw that begins while eating and subsides within two hours postprandially. You suspect:AhypochondriasisBsialolithiasisCparotitis.Hint: Parotitis would be inflammation and infection of the parotid gland (usually due to a stone that is stuck in the duct). A parotitis patient would be acutely ill with redness of the gland and fever.Dan abscessed tooth.Econjunctivitis manibularis.Question 28 Explanation: Sialo(salivary gland) lithiasis (stone) is described in this question. Parotitis would be inflammation and infection of the parotid gland (usually due to a stone that is stuck in the duct). A parotitis patient would be acutely ill with redness of the gland and fever.Question 29Which of the following is the earliest manifestation of diabetic nephropathy?AproteinuriaBa progressive decline in the creatinine clearanceCan elevated serum haptoglobinDrenal insufficiencyEmicroalbuminuriaQuestion 29 Explanation: Tiny amounts of albumin (microalbumin) show up first - but need a special test ordered to detect it. Intervention at this point with an ACEI prolongs the length of time before the patient progresses to albuminuria (noted on a typical urine "dip")Question 30Fluid from a thoracentesis is grossly purulent. The effusion from which this fluid was aspirated is best described as a(n):Aloculated effusionBchylothorax.Hint: Chylo thorax suggest a transudative effusion (not purulent).Cempyema.Dhydrothorax.Hint: hydro thorax suggest a transudative effusion (not puru lent).Ehemothorax.Hint: hemothorax is blood.Question 30 Explanation: A grossly purulent tap would suggest staph (empyema). Loculated effusion does not describe either a trans or exudative effusion. Chylo and hydro thorax suggest a transudative effusion (not purulent). And hemothorax is blood. Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results There are 30 questions to complete. List Return Shaded items are complete. 123456789101112131415161718192021222324252627282930End Return You have completed questions question Your score is Correct Wrong Partial-Credit You have not finished your quiz. If you leave this page, your progress will be lost. Correct Answer You Selected Not Attempted Final Score on Quiz Attempted Questions Correct Attempted Questions Wrong Questions Not Attempted Total Questions on Quiz Question Details Results Date Score Hint Time allowed minutes seconds Time used Answer Choice(s) Selected Question Text All doneNeed more practice!Keep trying!Not bad!Good work!Perfect! The Daily PANCE and PANRE Second Midterm ExamQuestions 30 through 60 Questions 30-60 Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Start Congratulations - you have completed Questions 30-60. You scored %%SCORE%% out of %%TOTAL%%. 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Question 1The most common cause of curable blindness in the United States is:Amacular degeneration.Hint: macular degeneration is not preventable.Bcataracts.Hint: Cataracts are "curable", but the cataract itself is probably not "preventable". Cretinal detachments.Hint: retinal detachments and are not preventable. Dglaucoma.Etrauma. Hint: trauma is not preventable.Question 1 Explanation: Again, the wording is difficult in this question. Macular degeneration, retinal detachments and trauma are not preventable. Cataracts are "curable", but the cataract itself is probably not "preventable". Chronic glaucoma can be treated to prevent blindness this is a matter of semantics.Question 2Which of the following agents is effective in the treatment of Parkinson's?ApenicillinBamantadineCerythromycinDacyclovirEcephalexinQuestion 2 Explanation: Amantadine (Symmetrel) is effective somewhat). It is used in treating Influenza A. Another choice is selegiline, and levodopa/carbidopa. The other antibiotics listed here are not useful in Parkinson's.Question 3Laboratory report: elevated serum free T4 low serum TSH level. Which of the following is the MOST likely diagnosis?Aprimary hypothyroidismHint: Primary hypothyroidism (Hashimoto's) is low T4 with a high TSH. Bsecondary hypothyroidismHint: Secondary hypothyroidism (from pituitary disease) is a low T4 with a low TSH.CT3 thyrotoxicosisDGraves’ diseaseE chronic Hashimoto's thyroiditisQuestion 3 Explanation: High T4 (hyperthyroid), with a low TSH indicates that the pituitary is working normally, and the thyroid is hyperactive, i.e. Grave's disease. Primary hypothyroidism (Hashimoto's) is low T4 with a high TSH. Secondary hypothyroidism (from pituitary disease) is a low T4 with a low TSH.Question 4The results of a barium esophagram reveal esophageal webbing in a woman with long-standing iron deficiency anemia. Her diagnosis is:ABarretts esophagus.Hint: Barrett's causes GERD symptoms and dysplasia of the esophageal mucosa.Bachalasia.CPlummer-Vinson syndrome.DDresslers syndrome.EOgilvies syndrome.Question 4 Explanation: Plummer-Vinson is something to know for those who want a 100% on the exam. There is no need to memorize this. More importantly, webbing in the distal esophagus with no other symptoms but dysphagia would be a Schatzki’s ring (much more common). Barrett's causes GERD symptoms and dysplasia of the esophageal mucosa. Achalasia is a primary neurologic problem of the esophagus causing dysphagia.Question 5Which of the following agents has a mechanism of action that does not involve beta-receptors?AepinephrineHint: Ritodrine and epinephrine cause beta sympathetic stimulationBalbuterolHint: Albuterol is a beta agonist.CpropranololHint: Propranolol is a beta blocker.DprazosinEritodrineHint: Ritodrine and epinephrine cause beta sympathetic stimulationQuestion 5 Explanation: Of these choices, prazosin is an alpha- blocker. Ritodrine and epinephrine cause beta sympathetic stimulation. Albuterol is a beta agonist. Propranolol is a beta blocker.Question 6A 6 year-old male is brought into your office for evaluation of his gait. You note that when ambulatory, the medial aspects of his knees are far apart and his feet are unusually close together. Which of the following best describes this condition?Acubitus valgusBcubitus varusCgenu valgus Hint: Valgus deformity forms an "L" in the knock-kneed child, and has an "L" in the middle of it (try it, it works)Dgenu varum ELegg-Calve-Perthes diseaseQuestion 6 Explanation: This is genu varum (bow legs). Valgus deformity forms an "L" in the knock-kneed child, and has an "L" in the middle of it (try it, it works)Question 7A female presents complaining of a grayish, watery vaginal discharge. The KOH prep does not reveal any hyphae. Clue cells are identified on the wet mount. A paucity of WBCs are noted. What diagnosis is most likely?AGonorrheaBChlamydiaC CandidiasisDbacterial vaginosisETrichomoniasisQuestion 7 Explanation: Clue cells means BVQuestion 8You note polygonal, purple, popular lesions involving the flexor surfaces of a patient's wrists. The patient has no other lesions. The lesions appear to follow a linear pattern of distribution. What is this phenomenon?AAuspitz signHint: Auspitz sign is also present in psoriasis where the scales bleed when removed. BKoebner's phenomenonCDarier's signHint: Darier's sign is in allergic patients who develop urticaria when the skin is rubbed. DGorlin's signHint: Gorlin's sign is seen in Ehlers-danlos when a patient can touch the tip of the nos e with his tongue (I learn something new every day!!)EGottron's papulesHint: Gottron's papules are purple papules on the fingers seen in dermatomyositis. Question 8 Explanation: Koebner's phenomenon is described - it suggests psoriasis. Auspitz sign is also present in psoriasis where the scales bleed when removed. Darier's sign is in allergic patients who develop urticaria when the skin is rubbed. Gottron's papules are purple papules on the fingers seen in dermatomyositis. Gorlin's sign is seen in Ehlers-Danlos when a patient can touch the tip of the nose with his tongue (I learn something new every day!!) These last two are not important to know.Question 9A 6 year-old female presents complaining of right ear pain. The tympanic membrane cannot be well visualized. She complains of pain when the tragus is manipulated. Several periauricular lymph nodes are easily palpable. Which of the following is the most likely diagnosis?Aacute otitis media Hint: OM would not cause periauricular nodes and tragal tenderness. Bacute otitis externaCeustachian tube dysfunctionHint: Eustachian tube dysfn would cause middle ear pain (like when you're up in a plane). DRamsey-Hunt syndromeHint: Ramsey- Hunt is herpes zoster of the ear canal and would be visible. Eperforated tympanic membraneHint: A perforated TM would cause middle ear, not external ear pain (typically).Question 9 Explanation: OE is described here. OM would not cause periauricular nodes and tragal tenderness. Eustachian tube dysfn would cause middle ear pain (like when you're up in a plane). Ramsey- Hunt is herpes zoster of the ear canal and would be visible. A perforated TM would cause middle ear, not external ear pain (typically).Question 10A 51 year-old male with renal artery stenosis and an elevated BUN and creatinine, is newly diagnosed as hypertensive. Which of the following agents should be avoided?Ahydrochlorothiazide-triamtereneBprazosinCnifedipineDverapamilEfurosemideQuestion 10 Explanation: This is a potassium sparing diuretic and should be avoided in anyone with renal disease. ACEI should be avoided as well (but none of these are ACEI's).Question 11A patient at a Christmas party on a cruise ship develops a terrible headache. His blood pressure is 224/158 mm Hg. Which of the following agents is this patient most likely taking regularly?A tricyclic antidepressantsBbarbituratesCbenzodiazepinesDmonoamine oxidase inhibitorsEphenothiazinesQuestion 11 Explanation: This is a typical scenario for MAOI induced malignant hypertension from eating the "wrong" foods, which are frequently found on a Christmas buffet, (cheese, sausages, red w ine, etc.).Question 12A patient with known hyperlipidemia, taking clofibrate, presents to your office complaining of severe myalgias and weakness. He has noted a dark color to his urine. The laboratory calls with a panic value CPK of 8500. He was recently started on a new medication, four days earlier. Which of the following is most likely the new medication?AlovastatinBhydrochlorothiazide.CdexamethasoneDphenytoinEampicillinQuestion 12 Explanation: Statin + fibrate = suspicion for rhabdomyolysis in a patient with myalgias, ALWAYS order a CPK. (statin alone, or fibrate alone may cause it too, but the combination is most likely)Question 13A female patient presents for an evaluation for primary amenorrhea. She is noted to be short of stature and have short fourth metacarpals. What diagnosis do you suspect?AXOBXXYHint: XXY is the genotype for Klinefelter's (which is a tall, mildly retarded male). CXXXHint: Trisomy 21 is Down's. DXXXYETrisomy 21Question 13 Explanation: This is the genotype for Turner's syndrome. XXY is the genotype for Klinefelter's (which is a tall, mildly retarded male). Trisomy 21 is Down's. The other two are not common genotypes.Question 14An 18 year-old female presents after completing her freshman year at college. Two months ago, she developed "bronchitis" which has persisted. She has become increasingly tired and has frequent night sweats. A chest x-ray today reveals a left mediastinal mass. What is the next step in her evaluation?Arepeat the chest x-ray in six monthsBultrasound of the left hemithoraxCbone scanDCT scan of the chestEproceed directly to bronchoscopy with biopsyQuestion 14 Explanation: Any patient presenting with mediastinal nodes should have a CT. This patient may have sarcoid or Hodgkin's or another type of cancer - CT is indicated.Question 15An elderly patient is recovering from a pneumonia caused by Influenza.  Suddenly, the patient's condition deteriorates. You order a chest x-ray that demonstrates an air-fluid level, suggestive of an abscess. You empirically begin treatment for:AStreptococcal pneumoniae.BChlamydia.CHemophilus influenzae.DStaphyl ococcus aureus.ELegionella pneumophila.Question 15 Explanation: Empyema (lung abscess) is almost always staph aureus. While strep pneumo is the most common CAP, when a complication like empyema occurs, it is almost always staph.Question 16A 17 year-old male is stabbed in the anterior chest with an ice pick. He quickly becomes hypotensive, tachycardic and obtunded. His breath sounds are equal, his neck veins are distended, and his chest x-ray is normal. What condition is most likely?ASimple pneumothorax Hint: The "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.)BTension pneumothoraxHint: The "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.CPericardial TamponadeDaortic laceration distal to the origin of the left common carotid arteryEinferior vena cava lacerationQuestion 16 Explanation: This is the typical clinical presentation of tamponade (hypotension, JVD). He was stabbed and probably has a mediastinal bleed (so, I think the mediastinum would be widened on his chest film — but the "normal CXR" is what rules out the pneumothorax - another common problem in a stabbing injury.Question 17A 48 year-old male presents with crushing chest pain for 45 minutes. He is diaphoretic, nauseous and short of breath. His EKG demonstrates 4 mm of ST segment depression in leads I, aVL, V5 and V6. What is the most likely diagnosis?Aesophageal spasmBhiatal herniaCacute lateral wall subendocardial myocardial ischemiaDacute inferior wall myocardial subendocardial ischemiaHint: Inferior AMI is leads II, III, avFEacute anterior wall myocardial transmural ischemiaHint: Anterior wall AMI is leads +- VI, with V2-V4, and maybe V5 It is obvious this patient is having an AMI. The ECG lead abnormalities suggest occlusion of the high lateral and low lateral walls of the LV - typically supplied by the circumflex - there are no Q waves - so subendocardial. Inferior AMI is leads II, III, avF. Anter ior wall AMI is leads +- VI, with V2-V4, and maybe V5 This is a typical presentation of varicella (chicken pox)Question 19A 35 year-old male complains of acute left eye pain immediately after he struck a nail with a hammer. On examination, you note that the left pupil is elliptical. What diagnostic test/procedure will most likely confirm your diagnostic suspicion?Afluorescein staining of the eyeHint: Fluorescein staining is for a corneal abrasion - it should not be done if the globe is penetratedBpressing on the globe to assess intraocular pressureCan X-ray of the orbitsDtesting the extra-ocular eye musclesEhaving the patient finger countQuestion 19 Explanation: This patient struck a nail (think metal splinter), pain was immediate (as the splinter entered his eye). His pupil is elliptical, indicating penetration of the globe. He needs X-ray of the globe to look for the metal splinter. Fluorescein staining is for a corneal abrasion - it should not be done if the globe is penetrated Question 20This drug causes gingival hyperplasia and hirsutism. At high doses it can cause nystagmus, ataxia and diplopia. Which drug is best described by these statementsAaspirinBacetaminophenCacyclovirDphenytoinEvalproic acidQuestion 20 Explanation: Dilantin (phenytoin) causes these typical symptomsQuestion 21Which of the following choices is associated with meconium staining of the amniotic fluid?Abowel obstructionBpeeling of the infant's skinCaspiration pneumonitis and respiratory distress syndromeDinfection with E. coliEintrauterine cataract formation and sensorineural hearing lossQuestion 21 Explanation: When the infant has meconium in the amniotic fluid, he has been in distress, and the meconium is frequently aspirated prior to delivery and can cause pneumonitis and respiratory distress syndrome in the neonate.Question 22A 32 year-old male presents after slipping and falling off the roof of his home and striking his head. He suffered a brief loss of consciousness. Since that t ime, he has noted increasing urination and thirst. His serum chemistries reveal an elevated sodium level. His urine specific gravity is 1.003. Which of the following is the most likely diagnosis?Acerebral contusionBsubarachnoid hemorrhageCepidural hematomaDdiabetes insipidusErenal contusionQuestion 22 Explanation: Diabetes insipidus (ADH deficiency) can occur after acute head trauma. ADH is secreted by the posterior pituitary gland and causes the body to retain fluid (to increase volume). In a patient who has damaged the posterior pituitary, ADH is not secreted, so the body urinates "water". There is frequent large volume urination with a very low specific gravity, and will cause hypernatremia unless the patient is given large quantities of water to drink.Question 23You are educating a patient that has just been advised that he has "polyps" in his colon. Which of the following statements is FALSE?AThe larger the colonic polyp, the greater the risk of malignant transformationBVillous adenomas have a 30-70% risk of malignant transformation.CThe greater the number of concomitant colonic polyps, the greater the risk of malignant transformatioDThe majority of colonic polyps are hyperplastic in originEThe majority of colonic polyps are > 3 cm in size.Question 23 Explanation: Most polyps are, in fact, quite small. All the rest of these statements are true.Question 24Wolf-Parkinson-White (WPW) and Lown-Ganong-Levine (LGL) syndrome are both characterized by:Aleft ventricular dysfunction.Ba shortened PR interval.Cthe presence of delta waves.Dlarge pericardial effusions.Emarked left ventricular hypertrophy.Question 24 Explanation: WPW The fifth finger is ALWAYS innervated by the ulnar nerve, and would not be affected in a true carpal tunnel syndrome.Question 26A 22 year-old female complains of vaginal bleeding for 24 hours. Her last menstrual cycle was seven weeks ago. She has had an IUD, but currently uses no form of contraception.   Her HCG is positive. She denies f ever, chills and vaginal discharge, prior to the onset of the vaginal bleeding. You order a pelvic ultrasound to rule out:Acervicitis.Bpelvic inflammatory disease.Cdysfunctional uterine bleeding.Dan ectopic pregnancy.Evaginitis.Question 26 Explanation: Any patient with an IUD, or with a tubal ligation, or known obstruction of a tube, who has a positive HCG needs an ultrasound to r/o ectopic pregnancy.Question 27The examination of a 26 year-old male demonstrates a "bag of worms" consistency within the left hemiscrotum. This finding is suggestive of a(n):Aacute case of balanitisBvaricocele.Chydrocele.Hint: Hydrocele is just a water collection in the scrotum. Dspermatocele.Hint: Spermatocele is just a fluid collection which happens to contain sperm (sperm are not palpable).Eparaphimosis.Question 27 Explanation: This is a description of varicocele (varicose veins of the scrotum). Hydrocele is just a water collection in the scrotum. Spermatocele is just a fluid collection which happens to contain sperm (sperm are not palpable).Question 28A patient presents with a recurrent history of swelling on the right side of the jaw that begins while eating and subsides within two hours postprandially. You suspect:AhypochondriasisBsialolithiasisCparotitis.Hint: Parotitis would be inflammation and infection of the parotid gland (usually due to a stone that is stuck in the duct). A parotitis patient would be acutely ill with redness of the gland and fever.Dan abscessed tooth.Econjunctivitis manibularis.Question 28 Explanation: Sialo(salivary gland) lithiasis (stone) is described in this question. Parotitis would be inflammation and infection of the parotid gland (usually due to a stone that is stuck in the duct). A parotitis patient would be acutely ill with redness of the gland and fever.Question 29Which of the following is the earliest manifestation of diabetic nephropathy?AproteinuriaBa progressive decline in the creatinine clearanceCan elevated serum haptoglobinDrenal insufficiencyEmicroalbuminuriaQuestion 29 Explanation: Tiny amounts of albumin (microalbumin) show up first - but need a special test ordered to detect it. Intervention at this point with an ACEI prolongs the length of time before the patient progresses to albuminuria (noted on a typical urine "dip")Question 30Fluid from a thoracentesis is grossly purulent. The effusion from which this fluid was aspirated is best described as a(n):Aloculated effusionBchylothorax.Hint: Chylo thorax suggest a transudative effusion (not purulent).Cempyema.Dhydrothorax.Hint: hydro thorax suggest a transudative effusion (not puru lent).Ehemothorax.Hint: hemothorax is blood.Question 30 Explanation: A grossly purulent tap would suggest staph (empyema). Loculated effusion does not describe either a trans or exudative effusion. Chylo and hydro thorax suggest a transudative effusion (not purulent). And hemothorax is blood. Once you are finished, click the button below. Any items you have not completed will be marked incorrect. Get Results There are 30 questions to complete. List Return Shaded items are complete. 123456789101112131415161718192021222324252627282930End Return You have completed questions question Your score is Correct Wrong Partial-Credit You have not finished your quiz. If you leave this page, your progress will be lost. Correct Answer You Selected Not Attempted Final Score on Quiz Attempted Questions Correct Attempted Questions Wrong Questions Not Attempted Total Questions on Quiz Question Details Results Date Score Hint Time allowed minutes seconds Time used Answer Choice(s) Selected Question Text All doneNeed more practice!Keep trying!Not bad!Good work!Perfect!