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- A 58 year-old male presents complaining of weakness of his grip. Your examination reveals that the problem is bilateral. During the next few office visits, you note the development of hyperactivity of his DTRs, extensor plantar reflexes and dysarthria. The patient's sensory system remains normal and he denies any urinary symptomatology. Which of the following is the most likely diagnosis? A. multiple sclerosis B. Alzheimer's disease C. Huntington's chorea D. ALS
E. myasthenia gravis Answer>> D. ALS
- Which of the following is NOT a risk factor for the development of osteo- porosis? A. low testosterone levels in men B. low levels of physical activity C. inadequate dietary protein D. cigarette smoking
E. chronic corticosteroid use Answer>> C. inadequate dietary protein
Low dietary Calcium, not protein, is a risk factor for osteoporosis. All of the others are risk factors. 3.Question 1 CORRECT A patient presents complaining of severe pain and "burning" in an extremity. You note that the extremity is pale and cool to the touch.You cannot appreciate a palpable pulsation. Which of the following diagnostic modalities will identify the source of this patient's problem in approximately 95% of cases? A chest x-ray B echocardiogram aortic angiogram D abdominal flat plate E aortic ultrasound
Question 1 Explanation Answer>> Angiogram is the "gold standard" for
occlusion of an arterial vessel. Question 2 CORRECT A 31 year-old pharmacist complaining of rectal pain. He describes the pain as "a severe tightness that awakens him from sleep." His bowel activity is normal. He denies rectal bleeding and seepage. He adds that sleep interruption is problematic, because with the number of hours he works, every minute of sleep is important. What is the most likely diagnosis?
A Salter Harris Type I Salter Harris Type II C Salter Harris Type III D Salter Harris Type IV E Salter Harris Type V
Question 5 Explanation Answer>> Salter I = slight increase in Space
between epiphy- seal plate and metaphysis Salter II = fx Above the plate (in the metaphysis) Salter III = fx Lower (in the epiphyseal plate) Salter IV = fit Through (both the metaphysic and epiphysis) Salter V = Really bad (comminuted fx compressing the epiphysis) This spells SALTR and may help you remember. 7365546_orig About Jorge Muniz PA-C (Creator of Medcomic) Question 6 CORRECT A 24 year-old male presents complaining of chest pain. He states that it is worse with swallowing and taking a deep breath. It is improved by sitting up and leaning forward. He denies trauma, a cough and shortness of breath. Which of the following tests would be most compatible with your suspected diagnosis? A a hiatal hernia visualized on chest x-ray B a normal erythrocyte sedimentation rate C calcified "popcorn" lesions in the lung fields bilaterally diffuse ST segment elevation on his electrocardiograph E a widened A-a gradient on his arterial blood gas
Question 6 Explanation Answer>> This is pericarditis (by clinical
presentation) which causes diffuse ST segment elevation on ECG (there can be notching of the R wave as well) Question 7 CORRECT A 2 month-old febrile male is brought to your facility to be evaluated for loss of appetite, irritability, and an acute petechial rash. Rectal temperature is 102.8F. Which of the following diagnostic studies is the most important in this child's evaluation? A white blood cell count and differential B urinalysis CSF analysis D serum glucose E chest X-ray (CXR)
Question 7 Explanation Answer>> Any infant (neonate) with fever and
rash should have a lumbar puncture (LP). While I would certainly do a CBC, even if it was normal, I would want the LP. Question 8 CORRECT
Your 27 year-old sister is visiting and requests you to provide refills of dexam- ethasone and homatropine ophthalmic drops for her. What condition is most likely being treated? A conjunctivitis B glaucoma iritis D Herpes keratitis E blepharitis
Question 8 Explanation Answer>> Iritis is treated with steroid drops
(dexamethasone) and miotic drops *homatropine, like atropine (to constrict and fix the pupil to help the pain and open the angle until the iritis is resolved) Question 9 PARTIAL-CREDIT A 58 year-old male presents complaining of weakness of his grip. Your ex- amination reveals that the problem is bilateral. During the next few office visits, you note the development of hyperactivity of his DTRs, extensor plantar reflexes and dysarthria. The patient's sensory system remains normal and he denies any urinary symptomatology. Which of the following is the most likely diagnosis? A multiple sclerosis B Alzheimer's disease
Huntington's choreaHint Answer>> Huntington's causes a movement
disorder with writhing choreiform movements of the body amyotrophic lateral sclerosis
E myasthenia gravisHint Answer>> Myasthenia causes fatigue of the
ocular muscles typically worsening at the end of the day.
Question 9 Explanation Answer>> ALS (Lou Gehrig's disease) is a
progressive bilateral muscle disease which causes fasciculations (lower motor neuron), and hy- per-reflexia, plantar reflexes (upper motor neuron) and dysarthria. Sensation is normal as is bladder function. MS may have dysarthria, but reflexes are normal, sensation is impaired and bladder function is frequently affected. Alzheimer's has normal neuro exam with cognitive disability. Huntington's causes a movement disorder with writhing choreiform movements of the body. Myasthenia causes fatigue of the ocular muscles typically worsening at the end of the day. Question 10 CORRECT Which of the following is NOT a characteristic feature of multiple myeloma? A elevated serum calcium
D plasma cell infiltration of bone marrow hypogammaglobulinemia
Question 10 Explanation Answer>> MM is a HYPERgammaglobulinemia -
all of the other findings occur in MM. Question 11 PARTIAL-CREDIT Which of the following is NOT a risk factor for the development of osteoporo- sis? low testosterone levels in men low levels of physical activity inadequate dietary protein cigarette smoking E chronic corticosteroid use
Question 11 Explanation Answer>> Low dietary Calcium, not protein, is a
risk factor for osteoporosis. All of the others are risk factors. Question 12 A 12 year-old male presents complaining of no appetite for 24 hours and pain near his navel. During the night, the pain moved to the right lower abdomen. He is now nauseated and vomiting and has a low-grade fever. In the operating room, a normal appendix is discovered. What is the most likely diagnosis? A mesenteric ischemia B diverticulitis C mesenteric adenitis D cholecystitis E proctitis Question 13 A patient that must be on a beta-blocking agent has reactive airway disease and commonly experiences central nervous system side effects from medica- tions. Which of the following beta-blockers would most likely be tolerated by this patient? A. atenolol B. metoprolol C. nadfilol D. propranolol
E. pindolol Answer>> B. metoprolol
Of these Beta-blockers (which are usually AVOIDED) in reactive airway disease - metoprolol is the most "cardioselective", so theoretically could be used. ......................................................................................................
although, on an exam, I would avoid beta-blockers in general.
A. conjunctivitis B. glaucoma C. iritis
D. Herpes keratitis
E. blepharitis Answer>> C. iritis
Iritis is treated with steroid drops (dexamethasone) and miotic drops *homatropine, like atropine (to constrict and fix the pupil to help the pain and open the angle until the iritis is resolved)
- A middle-aged man is found to have a small pulsating mass at the level of the umbilicus during a routine abdominal examination. What is the best initial test to establish the diagnosis? (A) Aortography (B) Ultrasound (C) Computed tomography (CT) (D) Magnetic resonance imaging (MRI)
(E) Plain films of the abdomen Answer>> (B) Ultrasound
Although aortography, CT, and MRI can all establish the diagnosis of abdominal aortic aneurysm, ultrasound remains the best screen- ing test.
- A 45-year-old woman undergoes cardiac catheterization through a right femoral approach. Two months later, she complains of right lower extremity swelling and notes the appearance of multiple varicosities. On examination, a bruit is heard over the right groin. What is the most likely diagnosis? (A) Femoral artery thrombosis (B) Superficial venous insufficiency (C) Arteriovenous (AV) fistula (D) Pseudoaneurysm
(E) Deep vein insufficiency Answer>> (C) Arteriovenous (AV) fistula
- A middle-age woman has right leg and foot nonpitting edema associated with dermatitis and hyperpigmentation. The diagnosis of chronic venous in- sufficiency is made. What is the treatment of choice? (A) Vein stripping (B) Pressure-gradient stockings (C) Skin grafting (D) Perforator vein ligation
(E) Valvuloplasty Answer>> (B) Pressure-gradient stockings
- Four days after suffering MI, a 78-year-old woman suddenly develops severe diffuse abdominal pain. Her ECG shows atrial fib. On examination, the abdomen is soft, minimally tender, and slightly distended. Hyperactive bowel sounds are present. What is the most likely diagnosis? (A) Mesenteric embolus
Both zinc and vitamin C (ascarbate) deficiency, impair wound healing. Vitamin A deficiency is also implicated in would heal- ing and supplemental Vitamin A has been shown in experimental studies to prevent radi- ation included defects in wound healing. Incision through the same abdominal wall scar incision actually promotes wound healing, because the initial lag interval after creation of the wound is avoided (unless the whole scar of the incision is removed). Increase in local oxygen tension actually promotes wound healing.
- A 60-year-old male presents with an inguinal hernia of recent onset. Which of the following statements are TRUE? (A) The hernia is more likely to be direct than indirect. B) Presents through the posterior wall of the inguinal canal, lateral to the deep inguinal ring. (C) Is covered anteriorly by the transversalis fascia. (D) Is more likely than a femoral hernia to strangulate.
(E) The sac is congenital. Answer>> (A) The hernia is more likely to be
direct than indirect. Hernias, which present in adult life are most often direct and aquired, rather than indirect. They protrude through the transversalis fascia, which forms the medial half of the posterior wall of the inguinal canal and is located medial to the deep inguinal ring and deep epigastric vessels. Strangulation of direct inguinal herniae is uncom- mon, probably because the neck of the sac tends to be wide, rather than narrow and constricting
- A 70-year-old cigarette smoker presents with a right inguinal mass that has enlarged and has caused discomfort in recent months. He com- plains of recent difficulty with micturition and nocturia. The swelling, which does not extend to the scrotum, reduces when resting. What is the likely diagnosis? (A) Direct inguinal hernia (B) Strangulated indirect inguinal hernia (C) Hydrocele (D) Aneurysm of the femoral artery
(E) Cyst of the cord Answer>> (A) Direct inguinal hernia
- A 65-year-old female requires emergency surgery for a strangulated in- guinal hernia. Which of the following is correct? (A) The sac is formed by an unobliterated processus vaginalis. (B) The hernia is direct rather than indirect. (C) Such herniae never contain small intestine.
D) Strangulation never results in bowel ischemia and gangrene requiring resection.
carcinoma of the stomach 6 days ago. She had been recovering well except for persistent ileus. On morning rounds, you notice a large amount of serosan-
guinous drainage on her gown. The most likely diagnosis is Answer>>
(A) Wound dehiscence (B) Wound infection (C) Leak at the gastrojejunostomy anastomosis (D) Leak from the duodenal stump
(E) Ascites Answer>> (A) Wound dehiscence
A large amount of seroanguinous drainage from the abdominal wound that occurs 5 to 7 days post-op is usually the result of dehiscence of the abdominal wound closure. A wound infection is heralded by erythema, swelling, and thick pus. Leaks from either enteric suture line would probably be bilious. Ascites is not commonly blood tinged.
- A 49-yo man presents after he fainted while running on his treadmill at home. He has been having exertional dyspnea and angina for the past several months. Which of the following cardiac diseases is most likely to cause these symptoms? A. Aortic stenosis B. Atrial septal defect C. Mitral incompetence D. Pulmonary stenosis
E. Tricuspid incompetence Answer>> A. Aortic stenosis
- The hypertensive emergency that is most easily reversible with
pharma- ceutical management is Answer>>
A. Acute coronary syndrome B. Aortic dissection C. Eclampsia/preeclampsia D. Encephalopathy
E. Intracranial hemorrhage Answer>> D. Encephalopathy
- Which of the following statements regarding posterior wall infarction is correct? A. Associated with ST-segment depression in V B. ECG shows an inverted T wave in V C. ECG shows large S waves in V D. Occurs in 5% of all acute MIs
E. Results from occlusion of the left anterior descending artery Answer>>
A. Associated with ST-segment depression in V
- A 46-yo woman presents with constant abdominal pain with associated nausea that started 8 hours earlier. She appears nontoxic and is lying still on the bed. BP is normal; pulse rate 95, RR is 16, and temp is 37.8°C (100°F). Phys- ical examination is remarkable for RUQ and epigastric tenderness to palpation without rebound or guarding. Lab test results reveal elevated ALT, AST, and
alkaline phosphatase, normal lipase and total bilirubin, and a negative urine
hCG. The next most appropriate management step is Answer>>
A. Acute abdominal series B. CT scan C. General surgery consultation D. Oral cholecystography
E. RUQ ultrasonography Answer>> E. RUQ ultrasonography
- Which of the following statements regarding ingested foreign bodies is correct? A. All children with a suspected foreign body ingestion should undergo x- ray B. Ipecac can be used safely to dislodge a button battery in the esophagus C. Meat tenderizer can be used safely to dissolve an impacted meat bolus D. Most common site of esophageal foreign body entrapment in pediatric patients is the thoracic inlet E. Objects longer than 5 cm and wider than 2 cm should be removed before
they pass through the stomach Answer>> E.Objects longer than 5 cm
and wider than 2 cm should be removed before they pass through the stomach
- A 40-year-old man presents with severe chest and neck pain. He is other- wise healthy but says that he "threw up really bad" 6 hours earlier at a tailgate party. The neck pain is made worse by swallowing and by flexing his neck. What is the appropriate next management step? A. Broad-spectrum antibiotics B.Endoscopy C. Laboratory testing, to include lipase D. Soft-tissue neck x-ray
E. Treatment with H2 blockers Answer>> A. Broad-spectrum antibiotics
This patient has Boerhaave syndrome, an esophageal perforation following a sud- den rise in intraesophageal pressure. The mechanism is sudden, forceful emesis in about 75% of cases.
- A 53-yo man with cirrhosis presents with a 12-hr history of diffuse ab- dominal pain. Physical examination reveals a positive fluid wave, mild diffuse abdominal tenderness, and a temperature of 38°C (100.4°F). Paracentesis reveals 2,000 WBCs/microliter and 280 PMNs/microliter. Which
