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Board review Jan 20 2020

Quiz by Jumana Antoun

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10 questions
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  • Q1
    14-year-old female sees you for follow-up after hypercalcemia is found on a chemistry profile obtained during a 5-day episode of vomiting and diarrhea. She is now asymptomatic, but her serum calcium level at this visit is 11.0 mg/dL (N 8.5–10.5). Her aunt underwent unsuccessful parathyroid surgery for hypercalcemia a few years ago. Which one of the following laboratory findings would suggest a diagnosis other than primary hyperparathyroidism?
    Decreased serum phosphate
    High-normal to increased serum chloride
    Low 24-hour urine calcium
    Elevated alkaline phosphatase
  • Q2
    A 70-year-old African-American male who has been hospitalized for 2½ weeks for heart failure develops severe, persistent diarrhea. For the past 3 days he has had abdominal cramps and profuse, semi-formed stools without mucus or blood. The patient’s current medications include captopril (Capoten), digoxin, furosemide (Lasix), subcutaneous heparin, spironolactone (Aldactone), and loperamide (Imodium). He has coronary artery disease, but has been relatively pain free since undergoing coronary artery bypass surgery 4 years ago. An appendectomy and cholecystectomy were performed in the past, and the patient has since been free of gastrointestinal disease. On physical examination his blood pressure is 100/80 mm Hg, pulse 100 beats/min and regular, and temperature 37.0°C (98.6°F). He has mild jugular venous distention and crackles at both lung bases. Examination of his heart is unremarkable, although there is 1+ dependent edema. His abdomen is diffusely tender without masses or organomegaly. Findings on a rectal examination are normal. The results of routine laboratory tests, including a CBC, chemistry profile, EKG, and urinalysis, are all normal. The stool examination shows numerous white blood cells. Of the following, the most likely diagnosis is:
    viral gastroenteritis
    ulcerative colitis
    digoxin toxicity
    Clostridium difficile colitis
  • Q3
    A 63-year-old female with type 2 diabetes mellitus presents to the emergency department with unstable angina. Her blood pressure is 150/90 mm Hg, her pulse rate is 70 beats/min, and her lungs are clear to auscultation. The patient expresses a preference for conservative (i.e., noninvasive) therapy. In addition to aspirin, which one of the following agents should be administered at this time?
    Nifedipine (Procardia) immediate-release, orally
    Indomethacin (Indocin) orally
    Clopidogrel (Plavix) orally
    Abciximab (ReoPro) intravenously
  • Q4
    Increasing patient copayments for prescription medications results in:
    improved efficiency in the utilization of outpatient medical services
    little demonstrable change in purchasing patterns
    increased hospitalizations for patients with chronic illnesses
    an increase in the number of prescriptions filled by low-income medical-assistance recipients
  • Q5
    A 25-year-old female has an annular rash on the dorsal surface of both hands. The rash does not respond to initial treatment with an antifungal medication, and a biopsy reveals granuloma annulare. Which one of the following would be the most appropriate advice for this patient?
    Cover the rash because it is contagious
    Allow the rash to resolve without further treatment
    Treat the rash with systemic corticosteroids
    Treat the rash with a stronger antifungal medication
  • Q6
    A 2-year-old child stumbles, but his mother keeps him from falling by pulling up on his right hand. An hour later the child refuses to use his right arm and cries when his mother tries to move it. The most likely diagnosis is
    anterior dislocation of the humeral head
    dislocation of the ulna
    subluxation of the head of the radius
    dislocation of the olecranon epiphysis
  • Q7
    The recommended time to screen for gestational diabetes in asymptomatic women with no risk factors for this condition is:
    at 24–28 weeks gestation
    in the first trimester
    at 16–20 weeks gestation
    at 35–37 weeks gestation
  • Q8
    The 1990 Patient Self-Determination Act requires that:
    hospitals ask patients about advance directives
    verbally expressed wishes be honored for individuals who do not have a written advance directive
    a living will be implemented for patients upon admission to the hospital
    the process for advance directives be standardized for all 50 states
  • Q9
    A 55-year-old male consults you because he wants to begin an exercise program. He is asymptomatic, but because of his family history you determine that he should undergo a stress test with echocardiography. Which one of the following would be considered a normal ejection fraction in this patient?
  • Q10
    A 42-year-old asymptomatic female presents for a routine evaluation. On examination her uterus is irregularly enlarged to the size seen at approximately 8 weeks gestation. Pelvic ultrasonography shows several uterine fibroid tumors measuring <5 cm. The patient does not desire future fertility. Which one of the following would be the most appropriate treatment option?
    Laparoscopic myomectomy
    An oral contraceptive

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