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A 52 year-old male presents complaining of urinary frequency, with hesitancy, and nocturia for the past few months. During his physical examination, you note a nontender, non-enlarged prostate with an isolated right posterior lobe nodule. Which of the following options is most appropriate? A. order a serum acid phosphatase level B. initiate prazosin and schedule a follow-up appointment in 6 weeks C. refer the patient for an ultrasound of the prostate and order a PSA level D. reassure the patient and schedule a follow-up appointment in six months E. initiate norfloxacin therapy for 7 days and schedule follow-up in two weeks ✔✔Answer: C This patient has an isolated nodule of the prostate gland — cancer until proven otherwise. You should order an ultrasound and a PSA. BPH will present as diffuse enlargement, and not a discrete nodule.
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You are educating a patient that has just been advised that he has "polyps" in his colon. Which of the following statements is FALSE? A. The larger the colonic polyp, the greater the risk of malignant transformation B. Villous adenomas have a 30 - 70% risk of malignant transformation. C. The greater the number of concomitant colonic polyps, the greater the risk of malignant transformatio D. The majority of colonic polyps are hyperplastic in origin E. The majority of colonic polyps are > 3 cm in size. ✔✔Answer: E, The majority of colonic polyps are > 3 cm in size. Most polyps are, in fact, quite small. All the rest of these statements are true Which term is used to describe the characteristic concave or "spoon-shaped" nails of iron deficiency anemia? A. leukonychia B. koilonychias C. clubbing
E. generalized edema ✔✔Answer: B. Hematuria Hematuria is present in NEPHRITIC syndrome. Nephrotic syndrome characteristically includes proteinuria (>3.5 gm/day), with resulting low serum albumin, hyperlipidemia, hypertension, hypercoagulability, and generalized edema (from oncotic third-spacing) A patient describes a history of recurrent bouts of uveitis. Her chemistry panel reveals elevated serum calcium and uric acid levels. Her anergy screen is negative. Her chest x-ray demonstrates bilateral hilar adenopathy. Which diagnosis is most likely? A. Silicosis B. Sarcoidosis C. Alpha- 1 antitrypsin deficiency D. Histoplasmosis E. Tuberculosis ✔✔Answer: B. Sarcoidosis Sarcoid typically presents with hilar lvmphadenopathy and noncaseating granulomas of the lungs (and other organs). In addition, patients may get eye involvement (uveitis). Elevations of ACE, Calcium and uric acid are frequently seen.
A 34 - old female presents complaining of symmetrical redness and swelling of the small joints of her hands (PIPs and MCPs). She has noted that the symptoms are worst in the morning. Her erythrocyte sedimentation rate is elevated and her rheumatoid factor is negative. Which of the following diagnosis is most likely? A. progressive systemic sclerosis B. CREST syndrome C. osteoarthritis D. rheumatoid arthritis E. ankylosing spondylitis ✔✔Answer: D Rheumatoid Arthritis In spite of the negative RF, Rheumatoid arthritis is the most likely diagnosis. RA characteristically includes small joint symmetrical arthritis, with an elevated ESR (therefore inflammatory, and not OA). 80% of patients with RA will have a positive RF, but 20% will be negative. PSS involves squamous cell thickening and sclerosis causing taut skin of the face and hands and difficulty with esophageal motility. CREST syndrome is a subset of PSS; Ankylosing spondylitis would have an elevated ESR and negative RF, but mainly involves the SI joint and lumbar/thoracic spine fusion (bamboo spine)
B. hysterosalpingogram C. laparoscopy D. PAP smear E. pelvic ultrasound ✔✔Answer: B hysterosalpingogram While I would disagree that an invasive procedures like HSG should be done first-line, the thing to remember in this question is that the patient has reason to have tubal scarring from adhesions (and there is no better answer listed to choose), so, for a board exam I would choose this answer. The TSH level would not be indicated (she has not had a pg loss), lap could diagnose the tubal scarring but would be done after an abnormal HSG. Pap smear is screening for cervical cancer and not indicated in this case of infertility; and pelvic US would yield nothing diagnostically about the tubes. 48 year-old nurse, with a body mass index of 31, presents for an evaluation for back pain. She relates that historically, she had a positive PPD test a year ago and did not follow-up as directed. She has recently been experiencing night sweats and coughing. An x-ray of her lumbar spine reveals osteopenia and cortical breakdown of vertebral bodies L4 and L5. Which of the following diagnosis is most suspect? A compression fractures secondary to obesity
B degenerative joint disease C Potts disease D compression fractures secondary to osteoporosis E spondylolisthesis ✔✔Answer: C Potts Disease Pott's disease is TB of the spine. She could have any of the other diseases; but the question states that she had a positive PPD and did not take meds...that is the clue that she has active TB in the spine. While suturing a wound, you opt to use lidocaine with epinephrine. The rationale for your choice is: A an increase in the absorption of the lidocaine. B an increase in the diffusion of the lidocaine into the nerve's myelin sheath. C an increase in the blood flow to the area of injection. D an increase in the duration of anesthesia. E a decrease in the risk of infection at the site of injection. ✔✔Answer: D
A Escherichia coli. B Listeria monocytogenes. C Cytomegalovirus. D Herpesvirus. E Hemophilus influenzae. ✔✔Answer: B Listeria monocytogenes While E. Coli can infect an infant delivered vaginally, AMPICILLIN is given to eliminate Listeria. CMV & HSV are viruses. E. Coli & H. Flu are also typically resistant to amp, and more likely a broader spectrum antibiotic would be used. A 42 year-old female presents after finding a firm, painless bump in her right eyelid. On examination, you note a 6 mm mass within the tarsus of the right eye. The skin is freely movable over the mass. The remainder of the ophthalmoscopic examination is unremarkable. Which of the following is the most likely diagnosis? A pterygium B chalazion C ectropion
D external hordeolum E internal hordeolum ✔✔Answer: B Chalazion A chalazion is a painless chronic mass in the eyelid. Hordeolum are acute and red and painful. Pterygium involves the sclera. Ectropion is when the eyelid sags outwardly and the lid doesn't close well. Which white blood cell disorder is characterized by the presence of the Philadelphia chromosome in 90% of cases? A chronic lymphocytic leukemia (CLL) B acute lymphocytic leukemia (ALL) C chronic myelogenous leukemia (CML) D acute myelogenous leukemia (AML) E multiple myeloma ✔✔Answer: C Philadelphia Chromosome occurs in CML. ALL occurs in children. AML is associated with Auer rods. Multiple myeloma has Bence-Jones protein. CLL has no clear distinguishing feature except increased lymphocytes.
A. cirrhosis B. nephrotic syndrome C. congestive heart failure D. cystitits E. pyelonephritis ✔✔Answer: B, nephrotic syndrome This is a classic presentation of nephrotic syndrome. Question 21 of 60 This papulosquamous eruption is most common in young adults. A single oval patch is generally noted several days before a more generalized, fawn-colored rash erupts. This rash is most prevalent on the trunk, and the proximal upper and lower extremities. The rash spontaneously disappears over 5 to 6 weeks. The diagnosis is: A. pityriasis rosea. B. tinea corporis C. psoriasis. D. atopic dermatitis.
E. sporotrichosis ✔✔Answer: A This is the classic presentation of pityriasis rosea. Remember that the differential diagnosis includes secondary syphilis, so if a positive sexual history - consider ordering a VDRL/RPR. The "herald" patch which is described is pathognomonic for pityriasis. A female in her third trimester of pregnancy developed hypertension, diffuse edema, proteinuria and hyperreflexia. She was treated with intravenous magnesium sulfate and is now hyporeflexic and drowsy. What do you prescribe now? A. calcium B.diazepam C. an amphetamine D. additional magnesium E. oxygen ✔✔Answer: A, calcium Pre-eclampsia causes hyper-reflexia. Magnesium is the treatment. The sign of Mg toxicity is loss of reflexes...this is treated with Calcium
A 6 year-old child falls onto his right arm. An x-ray demonstrates a buckle in the cortices of the distal radius, proximal to the growth plate, without angulation. What is the term used to describe this fracture? A. Salter-Harris Type III B. Salter Harris Type IV C. Salter Harris Type V D. torus E. greenstick ✔✔Answer: D, torus Torus or buckle fracture is most common in a child. This is proximal to the epiphyseal plate and so is not a Salter-Harris issue. Greenstick fracture is also common in children in long bones and is a fracture which "bends" the bone without fracturing it. A patient warrants antihypertensive medication use for the duration of her pregnancy. Which of the following is the antihypertensive recommended for such patients? A alpha-methyldopa B captopril
C nifedipine D propranolol E clonidine ✔✔Answer: A Methyl Dopa (Aldomet) is indicated in pregnancy. ACEI's (captopril) are contraindicated in pg. B-Blockers can be used but may cause growth restriction. Diuretics are not used in pg. CCB's and centrally acting agents (while not contraindicated) should be avoided. All of the following are factors that predispose a patient to the development of gastroesophageal reflux EXCEPT: A hiatal hernia. B pregnancy C scleroderma. D an incompetent esophageal sphincter E pernicious anemia. ✔✔Answer: E
A. albuterol B. cromolyn sodium C. prednisone D. theophyline E. epinephrine ✔✔Answer: B, cromolyn sodium Cromolyn is a mast cell stabilizer and must be present in the system PRIOR to the symptoms. It would be useless in a patient already having symptoms. 34 year-old female patient presents to the ER with sharp pleuritic-type chest pain. An x-ray reveals pericarditis. On more careful questioning, the patient admits to a polyarticular arthritis involving the small joints of her hands. Her obstetrical history is positive for two third trimester spontaneous abortions. At this point, you would suspect which autoimmune process as the cause of her symptoms: A. Rheumatoid arthritis B. Systemic Lupus Erythematosis C. Wegener's granulomatosis D. Sjogren's Syndrome
E. Scleroderma ✔✔Answer: B 40 - 60% of patients with SLE have serositis (pleuritis and pericarditis). That, combined with joint pains, habitual AB - should cause you to order an ANA. A patient with AIDS develops severe headaches. A CT scan demonstrates multiple ring- enhancing lesions of the brain. What diagnosis is most likely? A. Toxoplasmosis B. Histoplasmosis C. lymphoma D. Cytomegalovirus E. Herpes encephalitis ✔✔Answer: A Toxo occurs commonly in HTV, and is a parasitic infection causing ring-enhancing lesions (but lots of things can cause ring-enhancing lesions). CMV is common as well and typically causes retinitis. Herpes encephalitis can happen frequently too, but causes a diffuse encephalitis.
