Rosh Internal Medicine Boost Exam EOR

A 40-year-old man presents to the clinic with burning abdominal pain that extends from his navel to his chest for the past couple of days. Loss of appetite is his only other complaint. Physical exam is normal. He smokes one pack of cigarettes per day and drinks two to three beers daily. An ulceration in the gastric lining is seen on upper endoscopy. What is the most likely diagnosis?

A Barrett esophagus

B Gastric cancer

C Peptic ulcer disease

D Ulcerative colitis

C peptic ulcer disease

A 45-year-old hypertensive man presents with a persistent, dry cough. He is currently taking clonidine 0.1 mg three times daily, amlodipine 10 mg daily, lisinopril 40 mg daily, and aspirin 81 mg daily. Which of his medications is most likely contributing to his symptoms?

AAmlodipine

BAspirin

CClonidine

DLisinopril

D lisinopril

A 44-year-old woman with a history of chronic pancreatitis secondary to alcohol use presents to the clinic for routine care. She reports her symptoms are well-controlled. She was last seen a year ago. Which of the following tests is indicated for this patient?

AAbdominal ultrasound

BFasting glucose level

CMagnetic resonance cholangiopancreatography

DSerum amylase and lipase

B fasting glucose level

what is the triad for WPW

short PR

wide QRS

delta wave

Which of the following best represents an appropriate lipid screening protocol for an adult man with no other cardiovascular risk factors?

ALipid profile beginning at age 20

BLipid profile beginning at age 30

CLipid profile beginning at age 35

DLipid profile beginning at age 40

C lipid profile beginning at age 35

Which of the following physical exam findings is most indicative of angina pectoris?

ALeft-sided chest pain associated with a dermatomal vesicular rash

BReproducible chest pain on chest wall palpation

CSubsternal chest pain associated with a new third heart sound

DSubsternal chest pain associated with decreased heart sounds and jugular venous distention

C substernal chest pain associated with a new third heart sound

A 67-year-old man presents to the emergency department with an acute exacerbation of chronic bronchitis and is hospitalized. His home medications include inhaled albuterol and ipratropium. Administration of which of the following is contraindicated?

AAlbuterol 2.5 mg per nebulizer

BLevofloxacin 500 mg IV

CMethylprednisolone 125 mg IV

DTheophylline 200 mg per oral route

D theophylline 200 mg per oral route

A 58-year-old woman, newly diagnosed with Sjӧgren syndrome, returns to the clinic complaining of worsening dry mouth. At her last visit, you recommended she take frequent drinks of water throughout the day and try various over-the-counter products as well as artificial saliva, which she did, but her mouth symptoms persist. What is the most likely medication you would start her on?

ACevimeline

BCyclosporine drops

CLow-dose prednisone

DSulfasalazine

A cevimeline

what are 3 best treatments for CAP without comorbidities or risk factors for MRSA or Paeruginosa

amoxicillin OR

doxycycline OR

macrolide

A 24-year-old woman presents with complaints of excessive thirst over the past several weeks. She also notes waking up in the middle of the night to urinate. She recently underwent transsphenoidal resection of a pituitary adenoma. Which of the following is the most likely diagnosis?

ACentral diabetes insipidus

BNephrogenic diabetes insipidus

CPrimary polydipsia

DType 2 diabetes mellitus

A central diabetes insipidus

A 25-year-old man presents to the emergency department with a knife wound in his chest, located to the left of the sternum. He is minimally responsive and pale. His blood pressure is 80/60 mm Hg and his heart rate is 150 bpm. He has prominent jugular venous distention and his systolic blood pressure drops about 10 mm Hg with inspiration. Breath sounds are normal. What is the most likely diagnosis?

ACardiac tamponade

BPericarditis

CPneumothorax

DPulmonary embolism

A cardiac tamponade

In the treatment of Alzheimer disease, which of the following pharmacologic treatment options is found to be neuroprotective?

ADonepezil

BMemantine

CSelegiline

DVitamin E

B memantine

A 60-year-old man with a history of hypertension, hyperlipidemia, and heavy tobacco use has been compliant with his 80 mg dose of atorvastatin for the past twelve months. His current total cholesterol measurement is 220 mg/dL. You decide to add another lipid lowering agent. Which of the following drugs has proven beneficial for the prevention of adverse cardiovascular disease events when added to statin therapy?

ACholestyramine

BEzetimibe

CFenofibrate

DNiacin

B ezetimibe

Which of the following is the recommended first-line treatment of generalized convulsive status epilepticus?

ALorazepam

BPhenobarbital

CPropofol

DTopiramate

A lorazepam

A 70-year-old male is beginning treatment for peripheral vascular disease. He has a 50 pack year smoking history and is currently smoking one pack per day. His ankle-brachial index is 0.76, and his dorsalis pedis pulses are diminished bilaterally. His main complaint is a reduction in his ability to continue morning walks with his brother due to pain in his calves that resolves with rest. Which of the following is the most appropriate therapy?

AAspirin, cilostazol, rosuvastatin, smoking cessation, and structured exercise

BAspirin, rosuvastatin, smoking cessation, and surgical referral

CClopidogrel, endovascular reperfusion, rosuvastatin, and smoking cessation

DClopidogrel, structured exercise, and smoking cessation

A aspirin, cilostazol, rosuvastatin, smoking cessation, and structured exercise

A 30-year-old woman presents to the clinic with weight gain, fatigue, and constipation. She has gained 15 lbs during the past three weeks despite no change in her diet. Her heart rate is 50/minute and her blood pressure is 145/95 mm Hg. Physical examination reveals cool and pale skin, periorbital edema, and hair loss. Which of the following is the most likely diagnosis?

AHyperparathyroidism

BHyperthyroidism

CHypoparathyroidism

DHypothyroidism

D hypothyroidism

Which of the following laboratory values is most likely to be elevated in a patient with hypertonic hyponatremia?

ASerum glucose

BSerum potassium

CSerum sodium

DSerum triglycerides

A serum glucose

A 30-year-old woman presents to the ED for evaluation of left lower extremity swelling for the past day. She has not had any associated injury, recent travel, or immobilization. Her medical history is notable for a deep vein thrombosis in the right lower extremity diagnosed 5 years prior and treated with anticoagulation. She also had an unexplained miscarriage at 14 weeks of gestation 2 years ago. Doppler ultrasonography is performed today in the ED, revealing a left lower extremity deep venous thrombosis. Complete blood count is notable for a platelet count of 110,000/mcL. Which of the following is the most likely underlying diagnosis?

AAntiphospholipid antibody syndrome

BAtrial myxoma

CHeterozygous factor V Leiden

DMalignancy associated thrombosis

A antiphospholipid antibody syndrome

A 24-year-old man presents to the emergency department with fever and chills, right upper quadrant pain, and jaundice. Abdominal ultrasound shows dilation of the common bile duct. What is the most likely diagnosis?

AAcute cholangitis

BAcute cholecystitis

CAcute hepatitis

DCholelithiasis

A acute cholangitis

A 45-year-old man presents to the emergency department with ongoing upper abdominal pain that started 24 hours ago. The pain is in the upper abdomen, constant, dull, and radiates to the back. He feels nauseous and has vomited twice. He does not recall blood or brown contents in the vomitus. Past medical history includes depression and schizophrenia, for which he takes aripiprazole, and alcohol use disorder. On physical exam, he has pain to palpation in the epigastric region, and the remainder of physical exam is unremarkable. Vital signs are blood pressure of 125/85 mm Hg, pulse of 110/min, and temperature of 99.5°F. If elevated, which of the following laboratory values would be most sensitive and specific for a diagnosis of acute pancreatitis?

AC-reactive protein level

BSerum amylase level

CSerum creatinine level

DSerum lipase level

D serum lipase level

what lab test has the highest sensitivity for SLE

anti-nuclear antibody

A 35-year-old man with no history of tobacco use, diabetes or hypertension presents with substernal chest discomfort during physical exertion for the past six months. The pain is relieved by rest. His body mass index is 23. Which of the following physical exam findings would suggest a diagnosis of familial hypercholesterolemia?

ABony nodules on the interphalangeal joints

BHepatosplenomegaly

CWidespread flat hyperpigmented macules

DYellow papules on the eyelids

D yellow papules on the eyelids

A 70-year-old man with a history of HIV infection presents to the office for routine testing of his CD4 count. His last CD4 count was 90 cells/mcL and the results from this visit show a CD4 count of 45 cells/mcL. Which of the following opportunistic infections are patients prone to developing when their CD4 count drops below 50 cells/mcL?

AHistoplasmosis

BKaposi sarcoma

CMycobacterium avium complex

DToxoplasmosis

C mycobacterium avium complex

A 42-year-old woman presents to the clinic with a history of stage I differentiated papillary thyroid carcinoma that was treated five years ago with thyroidectomy and had an excellent clinical response. The patient requests monitoring for recurrent thyroid disease. A serum thyroid-stimulating hormone (TSH) level is ordered. Which of the following is the recommended range to maintain in this patient?

A< 0.1 mU/L

B0.1-0.5 mU/L

C0.1-2.0 mU/L

D0.5-5.0 mU/L

C 0.1 - 2.0mU/L

Which of the following classes of medications has been shown to increase survival the most in patients with early to middle stages of heart failure with reduced ejection fraction?

ABeta-blockers

BCalcium channel blockers

CLoop diuretics

DThiazide diuretics

A beta blockers

A 47-year-old woman presents to the clinic reporting bilateral swelling of her cheeks, as well as dry mouth and eyes. She reports insidious progression of the symptoms, with no distinct date of onset. Physical exam reveals dry mucous membranes and bilateral parotid gland swelling. Lab results indicate elevated rheumatoid factor, elevated antinuclear antibody with a speckled staining pattern, and a positive anti-Ro antibody test. Which of the following is the most likely diagnosis?

ALymphoma

BRheumatoid arthritis

CSjögren syndrome

DSystemic lupus erythematosus

C sjogren syndrome

Which of the following is the mode of genetic transmission for hemophilia B?

AAutosomal dominant

BAutosomal recessive

CX-linked dominant

DX-linked recessive

D x-linked recessive

A 24-year-old woman presents to the clinic with sudden onset of fever, chills, dry cough, malaise, substernal soreness, coryza, nasal congestion, and myalgias. Her symptoms came on suddenly yesterday while she was at work. Her husband was recently sick with similar symptoms. Physical exam reveals a temperature of 38.6°C, pharyngeal injection, conjunctival injection, and facial flushing. A chest X-ray is obtained and is negative for any acute cardiopulmonary process. What is the most likely diagnosis?

AAdenovirus

BInfluenza

CLegionella

DPertussis

B influenza

A 66-year-old man presents to the emergency department complaining of abdominal pain. He reports being very constipated in the last week. He was diagnosed with prostate cancer five years ago and is currently receiving hormonal therapy. His pulse is 70, blood pressure is 120/81 mm Hg, respiratory rate is 15, and temperature is 98.5°F. Serum analysis shows a potassium concentration of 4.1 mEq/L, a sodium of 136 mmol/L, calcium of 12.3 mg/dL, and glucose of 141 mg/dL. Which of the following is most likely to be found on physical exam?

ACarpal spasm upon occlusion of the brachial artery

BContraction of facial muscles upon tapping the facial nerve

CDecreased muscle strength in the extremities

DLower extremity edema

C decreased muscle strength in the extremities

A 44-year-old woman presents to the clinic for evaluation of a syncopal episode that occurred while walking her dog two days ago. She denies amnesia or head trauma. She has had increasing dyspnea on exertion and pedal edema. Physical examination reveals clubbing of her fingers and central cyanosis. Auscultation of the heart reveals tricuspid insufficiency, split second heart sound with a palpable P2. Echocardiogram reveals a large ostium secundum atrial septal defect with bidirectional flow. Which of the following is the most likely diagnosis?

AAcute pericarditis

BAtrial myxoma

CPulmonary hypertension

DTakotsubo cardiomyopathy

C pulmonary hypertension

Which of the following occurs with multiple sclerosis?

AAbnormality in the genetic code for specific muscle proteins

BAxonal degeneration in the peripheral nervous system

CBlocking of receptors at the neuromuscular junction of skeletal muscles

DDestruction of myelinated axons in the central nervous system

D destruction of myelinated axons in the central nervous system

A 55-year-old man presents to the clinic, reporting progressive pain in his lower back, pelvis, and right hip that started eight months ago. He reports pain while walking and it feels worse at night. Ibuprofen provides some relief. On physical exam, he has tenderness and warmth at the lumbar spine, right iliac wing, and right greater trochanter. A mild varus deformity of the right thigh is noted. Lab analysis reveals high serum alkaline phosphatase and radiographs show lytic lesions. Which of the following is the most likely cause of these findings?

AChronic soft tissue degeneration

BHypervascular bone

COsteolytic infectious process

DSoft tissue mass effect

B hypervascular bone

A 75-year-old man presents with complaints of difficulty breathing when exercising. He notes he was able to walk two miles a day but recently has been experiencing increased shortness of breath and dizziness during daily walks. On physical examination, the patient is found to have a harsh midsystolic ejection murmur, best heard in the second right intercostal space, radiating to the neck. Which of the following is the most likely diagnosis?

AAortic regurgitation

BAortic stenosis

CMitral regurgitation

DMitral stenosis

B aortic stenosis

Which of the following represents the most common type of gallstone disease in the United States?

ABlack pigment

BBrown pigment

CCalcium carbonate

DCholesterol

D cholesterol

A 28-year-old woman presents to her gastroenterologist to follow up on her abdominal pain, diarrhea, and weight loss. Her abdominal pain has been worsening. After an extensive evaluation including ileocolonoscopy, she is diagnosed with an initial acute flare of high-risk, severe Crohn disease affecting the ileum and proximal and distal colon. Past medical history is notable for smoking. Vital signs and lab work are consistent with mild dehydration. Physical exam is notable for moderate to severe diffuse abdominal tenderness. Serum C-reactive protein is elevated. Which of the following therapies is recommended at this time?

AAzathioprine

BBudesonide

CMesalamine

DPrednisone

D prednisone

A 67-year-old man presents to the clinic for evaluation of cough, wheezing, malaise, and shortness of breath. His social history is positive for daily cigar smoking for 30 years. He reports his symptoms have been present for four months. He had a similar presentation one year ago and was diagnosed with bronchitis. Which of the following is most likely on physical examination?

ABarrel chest

BDiastolic murmur

CPectus carinatum

DScaphoid abdomen

A barrel chest

A 74-year-old man presents to the clinic with a three-day history of symmetrical stiffness and aching, especially in the shoulders, neck, and torso. He states that his symptoms are worse in the morning. Physical examination reveals no joint effusions and normal muscle strength, but a limited range of motion of the shoulders with an inability to actively abduct past 90 degrees. Laboratory findings demonstrate an elevated erythrocyte sedimentation rate of 84 mm/hour and an elevated serum C-reactive protein of 6.5 mg/L. Which of the following is the best treatment?

AIbuprofen

BMethotrexate

CPhysical therapy

DPrednisone

D prednisone

A 73-year-old man with a history of atrial fibrillation and hypertension presented to the emergency department with a severe headache and change in mental status beginning suddenly two hours prior to arrival. Given patients acute presentation and history of known dysrhythmia, stroke protocol was initiated and an ischemic stroke was confirmed on a non-contrast CT scan of the head. If the patient had an embolic event in his left anterior cerebral artery, which of the following findings would be expected on physical examination?

ABroca aphasia

BIncontinence

CLeft-sided upper extremity weakness

DMacular-sparing homonymous hemianopsia

B incontinence

An otherwise healthy 20-year-old man suddenly collapses and dies while playing intramural basketball. The patient's brother died two years ago while playing soccer. Which of the following is the most likely diagnosis?

ADilated cardiomyopathy

BHypertrophic cardiomyopathy

CRestrictive cardiomyopathy

DTakotsubo cardiomyopathy

B hypertrophic cardiomyopathy

A 65-year-old man presents to the clinic reporting fever, nausea, diffuse joint pains, and a rash. He states his symptoms began four days ago after a camping trip in Tennessee. He denies any sore throat, cough, vomiting, diarrhea, or itching. Physical examination reveals a painless maculopapular rash on his wrists and palms, diffuse joint tenderness, and mild upper abdominal tenderness. His temperature is 100.5°F, but the rest of his vital signs are within normal limits for his age. Which of the following is the most likely diagnosis?

ACellulitis

BLyme disease

CRocky Mountain spotted fever

DSyphilis

C rocky mountain spotted fever

A 52-year-old man presents to the emergency department for dyspnea and cough for the past day that has progressively worsened. The cough is nonproductive, and he describes it as an urge to cough when he feels he is unable to catch his breath. He also has chest pain on the right side when he takes a deep breath. He had knee replacement surgery 1 week ago without any complications. Medical history includes obesity, diabetes, and hypertension. Medications include metformin, lisinopril, metoprolol, and hydrochlorothiazide. Allergy history includes a documented severe anaphylactic reaction to iodinated contrast. Review of systems is positive for dyspnea, cough, and chest pain and negative for sputum production, fever, congestion, rhinorrhea, gastrointestinal, or genitourinary symptoms. He is afebrile, blood pressure is 130/80 mm Hg, pulse is 106 beats/min, respiratory rate is 16/min, and oxygen saturation is 94%. Physical examination is unremarkable. Creatinine is 1.1 mg/dL. There are nonspecific ST segment and T wave changes on an ECG. Partial pressure of oxygen on an arterial blood gas is 60 mm Hg. Chest X-ray is normal. Which of the following is the best test to establish the diagnosis in this patient?

ACT pulmonary angiography

BD-dimer

CRepeat chest X-ray

DVentilation-perfusion scan

D ventilation-perfusion scan

Which of the following factors may help reduce the risk of kidney stone formation?

AIncreasing citrate intake

BIncreasing oxalate intake

CIncreasing sodium intake

DIncreasing sucrose intake

A increasing citrate intake

A 26-year-old pregnant woman presents to the office to discuss her concerns regarding genetic conditions that may affect her child. She states that her father was diagnosed with Huntington disease twelve years ago. Patient reports the only other individual in her family known to have Huntington disease was her paternal grandmother. The patient has not personally been tested. Which of the following values indicates the likelihood that the patient received the abnormal gene from her father if it was passed down in an autosomal dominant disorder?

A100%

B25%

C50%

DThe patient cannot receive the abnormal gene from her father

C 50%

A 26-year-old man presents with an acute severe asthma exacerbation. You decide to perform rapid sequence endotracheal intubation due to impending respiratory failure. The patient has no known medication allergies. Which of the following agents is most appropriate for induction in this case?

AEtomidate

BKetamine

CMidazolam

DPropofol

B ketamine

A 65-year-old woman presents for evaluation. Sarcoidosis is suspected. An abnormality in which of the following electrolyte levels would indicate sarcoidosis?

ABicarbonate

BCalcium

CPotassium

DSodium

B calcium

A 32-year-old man with a history of inherited hemolytic anemia along with a methicillin-resistant Staphylococcus aureus (MRSA) presents to the office complaining of an abscess. Physical exam reveals a 4 cm fluctuating abscess in the left axilla with extensive surrounding cellulitis. Foul smelling purulent material is expressed during incision and drainage. Patient reports a history of a hemolytic episode last year after being given an antibiotic by another provider for a similar abscess. What antibiotic was likely given for the patient's previous abscess?

ACephalexin

BDoxycycline

CNitrofurantoin

DTrimethoprim-sulfamethoxazole

D TMP SMX

Which of the following is the most appropriate for a 33-year-old healthy man with a history of episodic tension-type headache in the setting of a normal neurological examination?

ACT scan

BMRI with contrast

CMRI without contrast

DNo diagnostic study is necessary

D no diagnostic study is necessary

A 21-year-old woman presents to the clinic with several large, anterior and posterior cervical lymph nodes. She complains of weight loss and night sweats for the past four months. Which of the following is the most effective next step in the diagnosis of Hodgkin lymphoma?

ACT scan of neck, chest and abdomen

BFluorescence immunophenotyping

CLymph node excisional biopsy

DLymph node fine needle aspiration

C lymph node excisional biopsy

A 37-year-old woman with a two-year history of rheumatoid arthritis presents to the clinic for worsening joint pain. Previously her disease had been well controlled on 10 mg weekly of methotrexate. You decide to advance her dose to 20 mg weekly to help control her synovitis. What changes in her health maintenance might you have to make with this change?

ACheck a complete blood count and blood chemistry profile within six weeks

BDecrease how much folic acid she is supplementing

CHave her screened for tuberculosis before increasing her methotrexate

DReferral to eye provider for a baseline visual field test

A check CBC and CMP in 6 weeks

A 54-year-old man presents to the clinic with a complaint of a productive cough and progressive dyspnea on exertion. His cough was initially dry, 12 years ago, but progressed to productive one year ago. He denies any smoking history, and has otherwise been healthy. He is a mason by trade and enjoys stone sculpting with his wife as a hobby. Which of the following is most likely to confirm the suspected diagnosis?

AChest X-ray

BComplete blood count with differential

CPulmonary function test

DTuberculin skin test

A chest xray

A 17-year-old girl with a history of severe menorrhagia was admitted for a blood transfusion after fainting at school. Her history is positive for fatigue, exertional dyspnea, and increased cravings for ice over the past several weeks. Laboratory findings show hemoglobin 6 g/dL, hematocrit 22%, mean corpuscular volume 72 fL, total serum iron 23 mcg/dL, and total iron binding capacity 92 micromol/L. The patient was found to have conjunctival pallor and koilonychia on physical examination. What additional physical exam finding would you expect?

AFacial plethora

BJaundice

CLoss of tongue papillae

DPetechiae

C loss of tongue papillae

A 28-year-old male presents to the clinic with a four-year history of abdominal bloating, flatulence, diarrhea, and a pruritic rash on his buttocks and knees. He states his symptoms are worse with the consumption of pasta. Which of the following is most likely to confirm the diagnosis?

A25-hydroxyvitamin D

BDuodenal biopsy

CHLA-DQ genotyping

DTissue transglutaminase IgA antibody

B duodenal biopsy

A 46-year-old man presents with a painful, red first toe on his right foot. His symptoms came on suddenly one day ago. He states that even light touch is almost unbearable. He denies this ever happening in the past. His vital signs are within normal limits. Erythrocyte sedimentation rate and white blood cell count are normal. Synovial fluid analysis reveals negatively birefringent intra- and extracellular crystals. Which of the following is the most likely diagnosis?

AGout

BPseudogout

CRheumatoid arthritis

DSeptic arthritis

A gout

A 68-year-old man presents to clinic complaining of abdominal pain in the upper right quadrant. The pain is dull, constant, and started two weeks ago. He has a 32-pack-year smoking history and was diagnosed with chronic bronchitis 10 years ago. He also has a history of obstructive sleep apnea and osteoarthritis. Auscultation of the heart reveals a split S2, a sharp systolic ejection murmur, and a faint diastolic murmur heard best over the left second intercostal space. Auscultation of the lungs reveals wheezing and crackles. Jugular venous distention and hepatomegaly are present on exam. Echocardiography shows right ventricular hypertrophy and no other abnormalities. Which of the following is the most likely diagnosis?

ACongestive heart failure

BCor pulmonale

CCoronary artery disease

DVentricular septal defect

B cor pulmonale

You are treating a 62-year-old man who is seven days status-post coronary angiogram and stent placement, following an acute myocardial infarction. He has been on a heparin drip for five days. Lab calls to notify you that his previously normal platelet count is now 48,000/mcL. Which of the following is the most likely diagnosis?

ADisseminated intravascular coagulation

BHeparin-induced thrombocytopenia

CImmune thrombocytopenia

DThrombotic thrombocytopenic purpura

B heparin induced thrombocytopenia

A 53-year-old patient presents to your clinic with a chief complaint of persistent hematuria. Further workup reveals a mass in the left kidney consistent with renal cell carcinoma. Which of the following is a significant risk factor for the development of renal cell carcinoma?

AAlcohol intake

BFemale sex

CLow body mass index

DSmoking

D smoking

A 39-year-old woman presents to her primary care physician for evaluation of a rash and arthritis. Over the past several months, she has noticed pain in her knees and wrists. She is also finding it increasingly difficult to eat due to recurrent oral ulcers. She is most concerned about the changes she has noticed in her skin. Which one of the following physical exam findings is most suggestive of systemic lupus erythematosus?

AChronic eczematous dermatitis

BInvolvement of the extensor surfaces of the hands and arms

CInvolvement of the nasolabial folds

DInvolvement of the skin overlying the knuckles

B involvement of the extensor surfaces of the hands and arms

A 27-year-old man presents with complaints of tearing pain while having a bowel movement. He notes bright red blood on the toilet paper after wiping. Physical examination reveals a superficial tear without a track in the posterior midline of the anus. Which of the following is the most likely diagnosis?

AAnal fissure

BAnorectal fistula

CAnorectal ulcer

DHemorrhoid

A anal fissure

A 67-year-old woman presents to the emergency department for evaluation of a productive cough for five days. She is alert and oriented. Physical exam reveals crackles at the left lung base. Blood pressure is 102/68, temperature is 100.9°F, respirations are 33 per minute, heart rate is 105 beats per minute, and oxygen saturation is 93% on room air. Labs reveal a BUN of 18 mg/dL and creatinine of 1.0 mg/dL Her chest X-ray shows an infiltrate in the left lower lobe. What is the most appropriate course of action?

AAdmission to the ICU and start treatment with levofloxacin

BAdmission to the medical ward and start treatment with ceftriaxone and azithromycin

CDischarge the patient home with a five-day course of azithromycin and instructions to follow up with primary care in 48-hours

DDischarge the patient home with a seven-day course of doxycycline and instructions to follow up with primary care within three days

B admission to the medical ward and start treatment with ceftriaxone and azithromycin

A 76-year-old man presents for an examination. After a discussion with his physician, they decide to order a prostate-specific antigen to screen for prostate cancer. The prostate-specific antigen is 4.0. Which of the following, if elicited on history, would increase the concern for prostate cancer?

AAfrican-American race

BExposure to nickel

CHistory of benign prostatic hyperplasia

DHistory of smoking

A african american race

An 80-year-old woman with a 36-pack-year history of smoking tobacco presents with a chief complaint of increasing dyspnea on exertion over the past six months. Physical exam reveals clubbed digits and bilateral lower lung crackles. Computed tomography shows honeycombing of the lung parenchyma. What is the most likely diagnosis?

ABronchiectasis

BChronic obstructive pulmonary disease

CIdiopathic pulmonary fibrosis

DSarcoidosis

C idiopathic pulmonary fibrosis

A 65-year-old woman presents to the urgent care clinic with a two-day history of decreased vision, headache, and severe eye pain. She denies any trauma and says her symptoms are worse in the evening. She has no significant past medical history and takes no medications. Ophthalmic examination shows a dilated right pupil, a red eye, corneal cloudiness, narrowing of the anterior chamber angle, and increased intraocular pressure. Which of the following is the most likely diagnosis?

AAcute uveitis

BAngle-closure glaucoma

CCorneal abrasion

DOpen-angle glaucoma

B angle closure glaucoma

A 20-year-old woman with a history of cystic fibrosis presents for evaluation of a two year history of multiple episodes of what she describes as "bronchitis". She complains of chronic cough productive of foul-smelling sputum. Auscultation reveals crackles at the lung bases. Chest X-ray is notable for airway dilatation and thickening. Which of the following is the most likely diagnosis?

AAsthma

BBronchiectasis

CChronic bronchitis

DEmphysema

B bronchiectasis

A 57-year-old woman presents to the clinic to establish care and reports seven months duration of sudden, abrupt onset of diarrhea. She also reports occasionally experiencing a "fluttery feeling" in her chest accompanied with facial flushing. Her medical history includes hypertension and a significant cough that has been present for two years. She has a 25 pack year tobacco use history. Chest X-ray reveals left lower lobe atelectasis. Which of the following is the most likely diagnosis?

AAngioedema

BCarcinoid tumor

CCardiac dysrhythmia

DIrritable bowel syndrome

B carcinoid tumor

Which of the following is a classic sign of acute adrenal insufficiency?

AAbdominal pain

BBluish-black discolorations of the mucous membranes

CProfound bradycardia

DSevere headache

A abdominal pain

what EKG is seen with pericarditis

diffuse ST elevations

what is the first line treatment for pericarditis

colchicine and NSAID

An otherwise healthy 24-year-old woman presents with a cough. The cough is productive of white to yellow sputum and has been present for the last three weeks. She states that it began with a fever, sinus pressure, and fatigue, but those symptoms have since resolved. She has never had similar symptoms in the past. Her vital signs are all within normal limits. Lung auscultation is clear bilaterally, although deep breaths induce coughing. What is the most likely diagnosis?

AAcute bronchitis

BAsthma

CChronic bronchitis

DCommunity-acquired pneumonia

A acute bronchitis

A 35-year-old woman presents to the clinic complaining of worsening symptoms related to her recently diagnosed scleroderma (systemic sclerosis). Which of the following symptoms is most consistent with the diagnosis of scleroderma?

ADry mouth and dry eye complaints

BSkin tightening around the fingers with pitting at the fingertips

CTenderness at the temporal areas

DWeakness of proximal muscles without pain

B skin tightening around the fingers with pitting at the fingertips

A 38-year-old, previously healthy woman presents with pedal edema, dyspnea, fever and fatigue. Electrocardiogram reveals non-specific ST-T wave changes. Cardiac troponin and CK-MB are elevated. Echocardiogram shows segmental wall motion defects. Cardiac catheterization is negative for perfusion defects and the chest radiograph shows bilateral pleural effusions. Which of the following is the most likely diagnosis?

AEndocarditis

BMyocardial infarction

CMyocarditis

DPneumonia

C myocarditis

A 42-year-old woman presents with right upper quadrant abdominal pain that began four hours prior to arrival in the emergency department. She has associated nausea and has had one episode of emesis. An ultrasound is ordered of the right upper quadrant which shows pericholecystic fluid and thickening of the gallbladder wall. Which of the following signs or symptoms would be consistent with this patient's diagnosis?

AAbdominal distention

BJaundice

CRight scapular pain

DShaking chills

C right scapular pain

A 62-year-old man presents to the emergency room complaining of acute onset hematuria and facial edema. Patient reports that he was out of work for several days due to having a sore throat about two weeks ago but he seemed to have recovered until these new symptoms began earlier today. Urine examination reveals hematuria with red blood cell casts and a decreased glomerular filtration rate. What is the most likely diagnosis?

AAcute poststreptococcal glomerulonephritis

BIdiopathic hematuria

CImmunoglobulin A nephropathy

DMinimal change disease

A poststreptococcal glomerulonephritis

A 59-year-old woman presents to the clinic reporting numbness in her hands and around her mouth, as well as muscle cramps, fatigue, and intermittent hoarseness. Her medical history includes hypertension, hyperlipidemia, diabetes, and a thyroid malignancy which was recently treated by surgical excision. On physical examination, she is noted to have an ataxic gait, hyperresponsive deep tendon reflexes, and appears to be anxious. Additionally, carpal spasms are noted when her blood pressure is taken. Her vital signs are within normal limits for her age. Results of a complete blood count and complete metabolic profile are notable for a low total calcium. Which of the following is the most likely diagnosis?

AHyperparathyroidism

BHypoparathyroidism

CHypophosphatemia

DHypothyroidism

B hypoparathyroidism

A 40-year-old woman, diagnosed three months ago with fibromyalgia, returns to the clinic complaining of persistent overall diffuse pain. She followed your previous advice of starting a regular exercise routine, making better dietary choices, and joining a support group. Energy levels have improved but her pain is unchanged. What is the most likely medication you would start her on?

AAmitriptyline

BCarisoprodol

CCelecoxib

DPrednisone

A amitriptyline

Which of the following patients meets the criteria for diagnosis of diabetes mellitus?

AA patient with a fasting plasma glucose of 125 mg/dL and a hemoglobin A1C of 6.0 percent

BA patient with polyuria, blurry vision, and a random glucose of 200 mg/dL

CAn asymptomatic patient with a fasting glucose of 130 mg/dL (day 1) and 80 mg/dL (day 2)

DAn asymptomatic patient with a random glucose of 250 mg/dL

B a patient with polyuria, blurry vision, and a random glucose of 200 mg/dL

A 49-year-old woman with a history of primary hypertension presents to clinic complaining of recurrent headaches in addition to episodic sweating, palpitations, and tremors. She takes chlorthalidone 25 mg PO daily for her hypertension and denies use of any additional medications. Pertinent findings on initial physical exam include hypertension, mild tachycardia, and flushing. Fractionated metanephrines and catecholamines are increased in a 24-hour urine collection, and computed tomography of the abdomen and pelvis reveals a unilateral right adrenal mass. Which of the following medications is indicated as preoperative pharmacologic therapy in this patient?

AEnalapril

BLosartan

CPhenoxybenzamine

DPropranolol

C phenoxybenzamine

Which of the following is the gold standard for initial diagnosis and staging of bladder cancer?

ACT of the abdomen and pelvis

BCystoscopy

CIntravenous pyelogram

DUrine cytology

B cystoscopy

A 44-year-old man presents for a follow-up visit for his known gastroesophageal reflux disease. He has been taking a histamine-2-receptor antagonist twice a day. He continues to have symptoms at least three times per week. Which of the following is the next best therapy?

ACalcium carbonate

BFamotidine

COmeprazole

DSucralfate

C omeprazole

A 60-year-old man with intermittent claudication returns to the clinic for interpretation of the results of his ankle-brachial index. Which of the following statements is most accurate?

AA falsely high index may indicate severely hardened, non-compressible leg vessels

BA low ankle-brachial index indicates peripheral venous insufficiency

CAn ankle-brachial index of 1.2 indicates severe disease

DIt is the ratio of ankle to arm diastolic blood pressure

A falsely high index may indicate severely hardened, non-compressible leg vessels

A 23-year-old man presents to the emergency department after being stabbed in the flank during a bar fight. He received 2 liters of normal saline by EMS. On arrival, his vital signs are T 37.2°C, HR 130, BP 75/50, RR 30. He appears anxious and diaphoretic. On examination, he has a stab wound to the right flank, abdominal distention, no sensation below the level of T10, weakness of bilateral lower extremities, poor peripheral pulses and cool extremities. Which of the following is the most likely cause of this patient's hemodynamic instability?

AHypovolemic shock

BNeurogenic shock

CObstructive shock

DSpinal shock

A hypovolemic shock

A 23-year-old man presents for evaluation of a painless right-sided scrotal mass that he noted for the first time while showering one week ago. On physical examination, the mass is located on the anterior surface of the testicle. It is soft on palpation and transilluminates. Which of the following is the most likely diagnosis?

AHydrocele

BSpermatocele

CTesticular cancer

DVaricocele

A hydrocele

A 56-year-old man you saw recently has returned for a follow-up. Suspecting the patient had heart failure, you had previously ordered a B-type natriuretic peptide level, which was elevated. Upon further discussion today, the patient tells you he has difficulty breathing when walking around the house, but does not have any issues when he is relaxing or resting. Which of the following New York Heart Association (NYHA) classification categories does this patient fall into?

ANYHA class I

BNYHA class II

CNYHA class III

DNYHA class IV

C NYHA class III

A 56-year-old woman presents to the office with complaints of double vision, drooping eyelids, and speech that becomes slurred late in the day. Patient reports symptoms have been ongoing for weeks. Physical exam reveals ptosis and speech that is "nasal" in quality. The patient underwent a positive tensilon test. Blood work was positive for acetylcholine receptor binding antibodies. Which of the following is first line in the treatment of this patient's neuromuscular disease?

ACarbidopa/levodopa

BEdrophonium

CPlasmapheresis

DPyridostigmine

D pyridostigmine

Major manifestations in the modified Jones' criteria for the diagnosis of acute rheumatic fever include which of the following?

AArthritis and fever

BCarditis and arthritis

CCarditis and prolonged PR interval

DErythema marginatum and elevated ESR

B carditis and arthritis

The serum creatine kinase-MB peaks after an acute myocardial infarction in which of the following time frames?

A16-24 hours

B48-72 hours

C4-6 hours

D8-12 hours

A 16 - 24 hours

A 24-year-old woman is admitted to the intensive care unit after developing thyroid storm status post appendectomy and is being treated with propylthiouracil. What is the mechanism of action of this drug?

ADecreases adrenergic tone

BDecreases vasomotor instability

CInhibits conversion of thyroxine to triiodothyronine

DInhibits release of thyroid hormone

C inhibits conversion of thyroxine to triiodothyronine

A 48-year-old man with a history of hypertension presents to the emergency department with a headache and blurring of vision. He reports poor compliance with his blood pressure medications due to lack of access to a primary care provider. On presentation, his vital signs are 36.9°C, HR 87, BP 190/120, RR 16. He denies chest pain or shortness of breath. Physical examination is unremarkable. His laboratory studies are notable for a creatinine of 2.5 U/L. Which of the following is contraindicated in the control of this patient's blood pressure?

AEsmolol

BLabetalol

CNicardipine

DNitroprusside

D nitroprusside

A 65-year-old man with a 30 pack-year smoking history presents for an annual physical exam. He is a current smoker. He asks about lung cancer screening. Which of the following screening methods would you recommend?

AChest radiography

BLow-dose chest computed tomography

CPositron emission tomography

DSputum cytology

B low dose chest CT

A medical student from India is preparing for a clinical rotation at a hospital in New York. Before starting his rotation, he is required to take a Mantoux tuberculin skin test. Two days later, a reading of the test reveals an induration of 13 mm on his forearm. The patient does not feel sick and is asymptomatic. Which of the following monotherapies is appropriate?

AEthambutol

BIsoniazid

CPyrazinamide

DStreptomycin

B isoniazide

A patient was recently diagnosed with histoplasmosis. Where would you suspect this patient recently traveled?

ANortheastern United States

BOhio River Valley

CPacific Northwest

DSouthwestern United States

B ohio river valley

A 55-year-old woman with a history of HIV presents to the clinic complaining of a productive cough and dyspnea for two weeks. Her oxygen saturation is 92%, temperature is 101.5°F, pulse is 95/minute, respirations are 17/minute, and blood pressure is 130/85. She has a 10-year history of rheumatoid arthritis and is currently being treated with infliximab. Chest X-ray shows diffuse, bilateral, interstitial infiltrates. The diagnosis is confirmed by examination of respiratory secretions. Which of the following is the most appropriate therapy?

AAzithromycin

BLevofloxacin

CPrednisone

DTrimethoprim-sulfamethoxazole

D TMP SMX

A 62-year-old man presents reporting urinary hesitancy, dribbling, and feeling of incomplete voiding. He states his symptoms have been progressively worsening for the last six months. He denies hematuria, pain with urination, or scrotal swelling. Which of the following physical exam findings is most consistent with the diagnosis of benign prostatic hypertrophy?

AAsymmetry of the prostate

BBoggy consistency of the prostate

CDecreased anal sphincter tone

DRubbery consistency of the prostate

D rubbery consistency of the prostate

A 68-year-old man presents to the clinic with a medical history of hepatitis B infection and hepatic cirrhosis. Which of the following is the best choice of surveillance for the development of hepatocellular carcinoma in this patient?

AAbdominal CT scan every 12 months

BAbdominal CT scan every 2 years

CLiver ultrasound every 12 months

DLiver ultrasound every 6 months

D liver ultrasound every 6 months

A 57-year-old woman presents to the clinic complaining of difficulty getting out of bed in the morning and difficulty climbing the stairs into the house. She also reports a weight loss of 20 pounds over the past six months. You suspect a diagnosis of polymyositis. Which of the following physical exam findings is most consistent with the diagnosis of polymyositis?

APainful proximal muscles without weakness

BPositive Homan's sign

CSeveral positive tender points

DWeakness of the proximal muscles without pain

D weakness of the proximal muscles without pain

A 35-year-old man presents to the emergency department with low-grade fever, flu-like symptoms, petechiae, and a new onset murmur. Which of the following diagnostic tests is most sensitive to diagnose this condition?

AChest computed tomography

BElectrocardiogram

CTransesophageal echocardiogram

DTransthoracic echocardiogram

C transesophageal echocardiogram

A 28-year-old woman with no known drug allergies presents to the clinic after discharge from the hospital for acute rheumatic fever with carditis. Echocardiographic records reveal subsequent mitral valve disease. Which of the following is the most appropriate choice for secondary prophylaxis of rheumatic fever in this patient?

AIntramuscular injection of penicillin G benzathine every 21-28 days for 10 years

BIntramuscular injection of penicillin G benzathine every 21-28 days until age 40

COral azithromycin 250 mg once daily for 10 years

DOral penicillin V 250 mg twice daily for 10 years

B IM injection of pen G benzathine every 21 - 28 days until age 40

A 60-year-old man presents to the clinic for his annual wellness visit. He is a nonsmoker and has no remarkable past medical history. He denies any history of intravenous drug use. Which of the following preventative services is recommended for this patient?

AHepatitis C antibody screen

BLive attenuated zoster vaccine

CPneumococcal polysaccharide vaccine 23-valent

DUltrasound of the abdominal aorta

A hepatitis C antibody screen

A 56-year-old man presents to clinic complaining of bright red blood he noticed on the toilet paper while wiping. He has a history of constipation and often strains to get stool out. He denies experiencing pain during defecation. Visual inspection of the anal verge and perianal area is unrevealing. On digital rectal exam, no abnormalities are palpated and the examiner's finger returns with bright red blood. Which of the following is the most likely cause of this patient's symptoms?

AAnal fissure

BExternal hemorrhoid

CInternal hemorrhoid

DPerianal abscess

C internal hemorrhoid

Which of the following scenarios is most likely to result in a metabolic acidosis?

ABacterial pneumonia with underlying chronic obstructive lung disease

BHyperventilation due to anxiety

CPersistent diarrhea

DVomiting

C persistent diarrhea

A 34-year-old man presents to the emergency department complaining of anorexia, chills, fever, and night sweats that started three days ago. He has a history of intravenous drug use and alcohol use disorder. Auscultation reveals a holosystolic murmur heard throughout the precordium. Blood cultures are sent off. He is started on empiric antibiotic therapy. Which of the following heart structures is most likely involved?

AAortic valve

BMitral valve

CPulmonic valve

DTricuspid valve

D tricuspid valve