You Should Have Completed Approximately 25 Questions and Have 30 Minutes Remaining

5-26. A young mother is involved in a car accident that claims the life of her two sons. When she is told that her two children have died from the injuries they suffered in the crash, she becomes agitated and combative. Her speech is disorganized and incoherent, but observers understand that she hears the voices of her children screaming to her to help them and that she believes that the hospital nurses are prison guards. These symptoms remit spontaneously in 1 wk. What is the most likely diagnosis?

a. Delirium secondary to brain injury b. Schizophreniform disorder c. Major depression with psychotic features d. Brief psychotic disorder e. Posttraumatic stress disorder

5-27. On routine physical exam, a young woman is found to have a thyroid nodule. There is no pain, hoarseness, hemoptysis, or local symptoms. TSH is normal. The next step in evaluation is a. Ultrasonography b. Thyroid scan c. Surgical resection d. Fine-needle aspiration of the thyroid

5-28. A 7-year-old girl suddenly develops acute separation anxiety, oppositional behavior, nighttime fears, and a variety of compulsive behaviors (lining up her toys, ritualistic counting, excessive washing). Two weeks earlier the girl a. Was diagnosed with Group A ^-hemolytic streptococcal pharyngitis b. Was scratched by the family cat c. Went camping in a tick-infested area d. Ate a poorly cooked pork sausage e. Suffered several mosquito bites

5-29. A 30-year-old woman with a history of diabetes mellitus presents with a 3-wk history of hand numbness that often awakens her from sleep. The symptoms resolve after she shakes her hands for a few minutes. On physical examination, there is no sensory or motor deficit of her hands, but the patient has a positive Tinel sign. Which of the following is the most likely diagnosis?

a. Thoracic outlet syndrome b. Carpal tunnel syndrome c. Dupuytren's contracture d. Mallet finger e. Ganglion f. Trigger finger

5-30. A 7-year-old girl is seen by her pediatrician for left lower quadrant pain. You are consulted because an ovarian neoplasm is identified by ultrasound. Of the following, the most likely ovarian tumor in this patient is a. Germ cell b. Papillary serous epithelial c. Fibrosarcoma d. Brenner e. Sarcoma botryoides

5-31. A 19-year-old woman presents with severe right-sided flank pain accompanied by fever, shaking chills, dysuria, and frequency. She is sexually active with one partner and always uses condoms. Her last menstrual period was 5 days ago. On physical examination, her temperature is 103.8°F and her heart rate is 120 beats/min. Blood pressure and respirations are normal. Abdominal examination reveals suprapubic tenderness with palpation. The patient complains of pain when percussion is performed with the ulnar surface of the fist over the right costovertebral angle (CVA). Pelvic examination is normal. Which of the following is the most likely diagnosis?

a. Diverticulitis b. Acute cystitis c. Renal calculi d. Pyelonephritis e. Appendicitis

5-32. Which of the following primary treatments is most appropriate for this patient with extensive vulvar lesions shown below?

a. Application of podophyllum b. 5-Fluorouracil c. Morcellation d. Simple vulvectomy e. Local excision

Reprinted, with permission, from Evans MI, Ginsburg KA: Obstetrics and Gynecol-ogy: PreTest Self-Assessment and Review, 9th ed. New York, McGraw-Hill, 2001.

5-33. A 70-year-old intensive care unit patient complains of fever and shaking chills. The patient develops hypotension, and blood cultures are positive for gram-negative bacilli. The patient begins bleeding from venipuncture sites and around his Foley catheter.

Platelets: 40,000/^L (normal: 130,000 to 400,000/|lL) Peripheral blood smear: fragmented RBCs PT: elevated PTT: elevated

Plasma fibrinogen: 70 mg/dL (normal: 200 to 400 mg/dL)

The best course of therapy in this patient is to a. Begin heparin b. Treat underlying disease c. Begin plasmapheresis d. Give vitamin K

e. Begin red blood cell transfusion

5-34. A 59-year-old woman presents complaining of a cough productive of sputum for nearly 10 years. Her cough occurs during the day and she produces sputum daily. The woman states that as a child she had several episodes of pneumonia requiring hospital admissions and antibiotics. Several times a year, her sputum becomes purulent and she requires antibiotic therapy. She denies smoking cigarettes and has worked as a seamstress all of her life. On physical examination, the lungs are clear without wheezes, rhonchi, or crackles. A chest radiograph reveals "tram-track" markings at the bases. Which of the following is the most likely diagnosis?

a. Asthma b. Cystic fibrosis c. Chronic bronchitis d. Emphysema e. Bronchiectasis

5-35. A 75-year-old man presents to the emergency room after a sudden syncopal episode. He is alert and in retrospect describes occasional substernal chest pressure and shortness of breath on exertion. His lungs have a few bibasilar rales and his blood pressure is 110/80. On cardiac auscultation, the classic finding you expect to hear is a. A harsh systolic crescendo-decrescendo murmur heard best at the upper right sternal border b. A diastolic decrescendo murmur heard at the mid-left sternal border c. A holosystolic murmur heard best at the apex d. A midsystolic click

5-36. A 23-year-old woman (gravida 2, para 2) calls her physician 7 days postpartum because she is concerned that she is still bleeding from the vagina. It would be appropriate to tell this woman that it is normal for bloody lochia to last up to a. 2 days b. 5 days c. 8 days d. 11 days e. 14 days

5-37. A 19-year-old woman with a lifelong history of easy bruisability presents with menorrhagia. She also admits to occasional nosebleeds. She has no family history of bleeding disorders and takes no medications. Physical examination is normal. Laboratory investigation reveals a normal platelet count but a prolonged bleeding time. Which of the following is the most likely diagnosis?

a. Hemophilia A

b. Hemophilia B

c. Type III von Willebrand disease d. Type I von Willebrand disease e. Christmas disease f. Bernard-Soulier syndrome

5-38. A 10-mo-old infant has poor weight gain, a persistent cough, and a history of several bouts of pneumonitis. The mother describes the child as having had very large, foul-smelling stools for months. Which of the following diagnostic maneuvers is likely to result in the diagnosis of this child?

a. CT of the chest b. Serum immunoglobulin test c. TB skin test d. Inspiratory and expiratory chest x-ray e. Sweat chloride test

5-39. A 42-year-old welder presents to his employee health service complaining of tearing eye pain and photophobia. A photo-keratoconjunctivitis is diagnosed. The most likely cause of this condition is a. Infrared radiation b. Visible radiation c. Ultraviolet radiation A

d. Magnetic radiation e. Ultraviolet radiation B

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