Download A 36 year old man with quadriplegia has had an indwelling Foley

A 36 year old man with quadriplegia has had an indwelling Foley catheter since his spinal cord
injury several years ago. He has regained some control of his upper extremities since then. He
develops fever and cloudy urine. Blood and urine cultures are obtained. Blood cultures are
negative, and urine cultures grow E. coli. Which of the following is the most appropriate
management?
Student response: Percent Correct Student
Answer Choices
Value Response Response
0.0%
a. fourteen days of oral
antibiotics such as a
quinolone
Score:
Question 2
0.0%
b. replace the Foley catheter
with a suprapubic catheter
after 14 days of antibiotics
100.0%
c. change the Foley catheter at
the time of diagnosis, and
give 14 days of antibiotics
0.0%
d. replace the indwelling
catheter with intermittent
catheterization, and 14 days
of antibiotics
0.0%
e. 14 days of antibiotics,
followed by long term low
dose antibiotic suppression
20 / 20
(20 points)
A 29 year old woman seeks advice because of recurrent urinary tract infections. Over the past
year, she has been treated with antibiotics seven times by different physicians. Each time, she
was given a prescription for either ciprofloxacin or trimethoprim-sulfamethoxazole for three
days. She is sexually active with multiple partners, and uses barrier contraception methods. Her
past medical history is unremarkable. Which of the following is the next step in management?
Student response: Percent Correct Student
Value Response Response
Answer Choices
0.0%
a. recommend urogenital
evaluation including
urodynamics and CT scan
of the pelvis
0.0%
b. prescribe fourteen days of
antibiotics at the next
episode
0.0%
c. prescribe abstinence for a
trial period to assess
recurrence rate
100.0%
0.0%
Score:
Question 3
d. recommend discontinuation
of spermicidal agents while
continuing barrier
contraception
e. prescribe intravaginal
probiotic suppositories
0 / 20
(20 points)
A 39 year old man presents with suprapubic pain, dysuria and pyuria. He is monogamous and
uses barrier protection during intercourse. This is his first such episode. Which of the following
is true?
Student response: Percent Correct Student
Answer Choices
Value Response Response
0.0%
a. this is uncomplicated
cystitis, and should be with
antibiotics treated for three
days
Score:
Question 4
100.0%
b. this is complicated cystitis,
and should be treated with
antibiotics for at least seven
days
0.0%
c. until proven otherwise, it
should be assumed that this
represents non-gonococcal
urethritis, and the patient
should be treated
accordingly
0.0%
d. this represents chronic
prostatitis, and the patient
will need several weeks of
antibiotic therapy
0.0%
e. this patient likely has an
underlying urogenital
anatomic abnormality
20 / 20
(20 points)
A 20 year old woman presents with onset of dysuria, suprapubic pain and cloudy urine two days
ago. She has no vaginal discharge or irritation. Urine dipstick is positive for leucocyte esterase
and nitrites. She had a urinary tract infection about one year ago. She recently became sexually
active. Which of the following is true of her management?
Student response: Percent Correct Student
Answer Choices
Value Response Response
0.0%
a. it is never appropriate to
prescribe antibiotics in this
setting without a urine
culture
100.0%
Score:
Question 5
b. it is reasonable to treat with
three days of oral
antibiotics
0.0%
c. ampicillin, ciprofloxacin
and trimethoprimsulfamethoxazole are
equivalent treatment
options
0.0%
d. she should be screened for
sexually transmitted
infections
0.0%
e. she is at risk for
pyelonephritis if she has
further recurrences
20 / 20
(20 points)
A 35 year old woman presented five days ago with fever, flank pain and nausea and vomiting.
Urine dipstick demonstrated leucocyte esterase and nitrites. The patient was hospitalized, and has
been treated with intravenous quinalone antibiotics since then. She has had improvement but not
resolution of pain, and she continues to have low grade fever. Which of the following is the most
appropriate management decision?
Student response: Percent Correct Student
Value Response Response
Answer Choices
0.0%
a. transition to oral antibiotics
and continue therapy for ten
to fourteen days
0.0%
b. continue intravenous
antibiotics for fourteen days
0.0%
c. empirically change from a
quinolone to ceftriaxone or
trimethoprim-
sulfamethoxazole.
Score:
100.0%
d. evaluate with imaging for
perinephric abscess
0.0%
e. this patient should have a
prolonged course of oral
antibiotics
0 / 20
60 / 100 = 60.0%
A 62 years old female pt with type 2 diabetes comes for a follow up visit.On
exam her BP is 142/80 mm Hg , her heart rate is 80/min . The HBA1C is 9.4.
She is on Metformin 100mg po bid , Pioglitazone 45 mg po qd, Lantus 30
units per day.
Patients glucose profile:
Fasting: mean 105
Pre lunch :mean 138
Pre dinner : mean 140
2 hour post prandial:232-295
Which of the following medication adjustments is most likely to improve this
patient's blood glucose profile?
Total score:
Student response: Percent Correct Student
Value Response Response
Score:
Question 2
Answer
Choices
0.0%
a. Add
Acarbose
0.0%
b. Add NPH
in AM
0.0%
c. Add NPH
at bedtime
100.0%
d. Add short
acting
insulin with
meals
0.0%
e. Increase
lantus dose.
20 / 20
(20 points)
a 65 years old women with type 2 diabetes dignosed few months ago comes
for a follow up. The pt has been trying to control her diabetes with diet and
exercise only.her fasting glucose are in the range of 130-144 mg/dl. She has a
h/o hypertension, hyperlipidemia, renal insufficiency( creatinine of 2
mg/dl).Her Hba1c is 7.2 %, which of the following would be the most
appropriate next step?
Student response: Percent Correct Student
Answer
Value Response Response
Choices
100.0%
a. Add
Glyburide
Score:
Question 3
0.0%
b. Add
Metformin
0.0%
c. Start Insulin
0.0%
d. Add
Pioglitazone
0.0%
e. Continue
diet and
exercise.
0 / 20
(20 points)
19 years old male pt with Type 1 Diabetes comes for a follow up. His BP is
130/80 mm Hg. His Hba1c is 7 percent.
The urine albumin/ creatinine ratio is elevated at 133 mg /g . Which of the
following is the most appropriate next step in the management of the pt?
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. Begin a
calcium
channel
blocker
0.0%
b. Increase the
pts insulin
0.0%
c. Continue to
observe
0.0%
d. Begin
Calcium
channel
blocker
100.0%
e. Begin ACE
inhibitor
Score:
Question 4
20 / 20
(20 points)
A 65 years old female pt with h/o type 2 diabetes comes for a follow up. She
is on Glimepiride 4 mg, her fasting
Glucose is ranging between 160-200 mg/dl. She is overweight and her BP is
132/84 mm Hg .Her Hba1c is 8.6 % and her creatinine is 1 mg/dl
What should be the next step of action?
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. Increase
glimepride
to 6 mg per
day.
Score:
Question 5
0.0%
b. No change
100.0%
c. Continue
Glimepiride
, add
metformin
0.0%
d. Stop
Glimepiride,
start
pioglitazone
0.0%
e. Start Insulin
70/30 bid.
20 / 20
(20 points)
A 20 years old male pt with h/o type 1 diabetes comes to the ER with c/o
having abdominal pain , vomiting for 24
Hours. Pt skipped his last insulin dose as he was not feeling well.His BP is
100/60 mm Hg.He denies drinking alcohol in the past week. His abdomen is
tender , no guarding or rigidity. Rectal exam is negative for occult blood.
His Labs show:
Hb 17 g/dl
Sodium 120 meq /L
Potassium 5.6 meq/L
Chloride 96 meq/L
Bicarbonate 12 meq/L
Bun 32 mg/dl
Creatinine 1.2 mg/dl
Glucose 575 mg/dl
Normal Serum amylase and lipase, with urine ketones of 3 plus.
What would be your diagnosis?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Alcoholic
Ketoacidosis.
0.0%
b. Acute
Pancreatitis
100.0%
c. Diabetic
Ketoacidosis
0.0%
d. Hyperglycemic
coma
0.0%
e. Alcoholic
Hepatitis.
Score:
20 / 20
Total score:
80 / 100 = 80.0%
A 19yo male presents to the ER after his parents say “they couldn’t deal with
his abnormal behavior anymore.” For the past week, he has not been
sleeping much, has been extremely talkative, and has spent more than 1,000
dollars buying useless items on Ebay. He has not bathed nor gone to school
since this began. He had a similar episode, but much less drastic,
approximately 6 months ago, and that lasted for 2 days only. He denies any
visual or auditory hallucinations, and feels he deserves the items he bought
because he is “extra-special.” He has been hospitalized twice in the past for
major depressive episodes, but currently denies and depression and states he
has never been happier. Based on his history and current presentation, what
is his most likely diagnosis?
Student response: Percent Correct Student
Value Response Response
Answer
Choices
0.0%
a. Schizophrenia
0.0%
b. Cyclothymia
0.0%
c. Bipolar Type
I disorder
100.0%
d. Bipolar Type
II disorder
0.0%
Score:
Question 2
e. Major
Depression
20 / 20
(20 points)
A 67yo patient presents to you for a second opinion. He states his previous
doctor told him he had schizophrenia, however, he does not trust that doctor,
and in fact, wants to sue him. He also wants to sue his dermatologist for
leaving what he says is a huge scar on his back (you look and note that it is
barely visible), and sue his cardiologist because he only spent 5 minutes with
him. He states he often hears his lawyer whispering in his ear to “sue sue
sue!”. He also feels that President Barack wants to make him suffer because
he did not go and “shoot up people in Iraq” like his lawyer also told him to
do. The patient is very disorganized in his thinking and goes from one
thought to another. He is wearing one white and one black sock, and his shirt
is inside out and buttoned wrong. What type of schizophrenia does he have?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Paranoid type
0.0%
b. Disorganized
type
0.0%
c. Residual type
100.0%
0.0%
Score:
Question 3
d. Undifferentiated
type
e. Schizophreniform
disorder
0 / 20
(20 points)
A 25yo female patient presents to you for a physical exam. She has been
well-controlled on olanzapine for the last 5 years for mild schizophrenia. She
comes in for a Depo-Provera shot every 3 months for prevention of
pregnancy and has never missed an appointment. What laboratory test would
you like to get and why?
Student response: Percent Correct Student Answer Choices
Value Response Response
a. Fasting plasma
100.0%
glucose, as up
to 1/3rd of new
cases of
diabetes can be
attributed to the
use of atypical
antipsychotics
Score:
Question 4
0.0%
b. Urinalysis, as
atypical
antipsychotics
can cause
proteinuria
0.0%
c. RPR, as her
medication
may cause her
to have
unprotected sex
0.0%
d. Pregnancy test,
as even DepoProvera is not
100% effective
for pregnancy
prevention
0.0%
e. TSH, as
antipsychotics
can cause
hypothyroidism
20 / 20
(20 points)
A 35yo female presents to you with complaints of feeling sad all the time,
tired, and loss of interest in hobbies that used to make her happy. She is
irritable and yells at her children often. You feel that she is depressed, and
she agrees to start taking antidepressant medication. She is started on a
SSRI, sertraline 50mg daily and is referred for psychotherapy. She comes
back 2 weeks later and states there has been no changes in her mood and
symptoms. What is your next step?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Change to a
SNRI
0.0%
b. Increase the dose
of sertraline
0.0%
c. Refer her for
electroconvulsive
therapy (ECT)
0.0%
100.0%
Score:
Question 5
d. Add
arirpriprazole
(Abilify)
e. Reassure her that
antidepressants
can take up to 8
weeks to start
working and she
should continue
seeing her
therapist
20 / 20
(20 points)
A medical students presents to you with the following symptoms, present for
at least 5 out of 7 days for the last 10 months: he has uncontrollable worry
about his grades (even though he is in the 95th percentile of his class) and
about how he is afraid he will kill his first patient. His worry is so excessive
that he has major bouts of diarrhea every time he is asked to see a patient. He
is fatigued even though he gets 7 hours of sleep every night. He also worries
that his cat will die of starvation if he leaves him alone for more than 8
hours. Finally, he worries that he will never be able to pay back his student
loans and that he will have to go on food stamps once he becomes a
physician. He worries so much that he often forgets where he puts his keys,
groceries, etc. What is his most likely diagnosis and how would you treat it?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Obsessive
Compulsive
Disorder; start
an SSRI or
SNRI
0.0%
b. He is a
medical
student – it is
normal to
worry that
much; advise
that this too
shall pass
Score:
0.0%
c. Major
Depression;
start an SSRI
or SNRI
0.0%
d. Paranoid
Schizophrenia:
start an
atypical
antipsychotic
100.0%
e. Generalized
Anxiety
Disorder; start
an SSRI or
buspirone
20 / 20
80 / 100 = 80.0%
Total score:
A 32 year old woman gave birth to her second child three months ago. She
had hypertension since week 12 of pregnancy, and was diagnosed with
preeclampsia when proteinuria was discovered in the third trimester. The
proteinuria has resolved, but the patient still requires antihypertensive therapy
to maintain a blood pressure below 140/90. Which is the correct diagnosis?
Student response:
Percent Correct Student
Answer Choices
Value Response Response
0.0%
a. persistent preeclampsia
0.0%
b. chronic hypertension
100.0%
c. preeclampsia superimposed
on chronic hypertension
0.0%
d. gestational hypertension
0.0%
e. severe pre-eclampsia
Score:0 / 20 Question 2 (20 points) A 36 year old woman presents in her
first trimester of pregnancy. She has two healthy children, the youngest of
whom is seven years old. She had gestational hypertension with her second
pregnancy, which persisted and became chronic. Blood pressure is currently
well controlled on hydrochlorthiazide and valsartan. Which is the appropriate
next step in this patient’s management?
Student response:
Percent Correct Student
Answer Choices
Value Response Response
0.0%
a. assess for proteinuria with
twenty four hour urine
0.0%
b. fetal ultrasound to assess
for anomalous limb buds
0.0%
c. discontinuation of valsartan
and substitution with an
ACE inhibitor
100.0%
d. discontinuation of valsartan
and substitution with a beta
blocker
0.0%
e. discontinuation of
hydrochlorthiazide and
substitution with loop
blocker
Score:20 / 20 Question 3 (20 points) A 22 year old primigravida woman
late in her second trimester of pregnancy presents to the emergency
department with severe headache. She had no peripheral edema until the last
week, but now has pitting edema to the knees. She has no papilledema. Blood
pressure is 190/115. Which of the following is the best therapy at this time?
Student response:
Percent Correct Student
Answer Choices
Value Response Response
0.0%
a. immediate delivery of the
fetus
0.0%
b. intravenous nicardipine
0.0%
c. intravenous hydralazine
0.0%
d. intravenous nitroprusside
100.0%
e. intravenous labetolol
Score:20 / 20 Question 4 (20 points) A 30 year old woman presents in the
first trimester of her first pregnancy. She has chronic hypertension, and is
currently well controlled on metoprolol. She has no proteinuria, and not preexisting renal disease. Her mother never had preeclampsia. In counseling her
about the risks of pregnancy, which of the following is the complication she is
most likely to experience?
Student response:
Percent Correct Student
Answer Choices
Value Response Response
0.0%
a. abruption placenta
100.0%
b. preeclampsia
0.0%
c. preterm birth
0.0%
d. fetal growth retardation
0.0%
e. gestational diabetes
Score:0 / 20 Question 5 (20 points) A 28 year old woman presents at the
start of the third trimester of her second pregnancy. She has received no
prenatal care with this pregnancy so far. Her first pregnancy was
uncomplicated, with full term vaginal delivery. The interpartum interval was
unremarkable. She now has blood pressure of 160/110 but no proteinuria and
no pedal edema. Which of the following is most likely true?
Student response:
Percent Correct Student
Answer Choices
Value Response Response
0.0%
a. she does not have
preeclampsia
0.0%
b. she probably has chronic
hypertension
100.0%
c. she might have
preeclampsia or gestational
hypertension
0.0%
d. preeclampsia can be
distinguished by uterine
artery Doppler
0.0%
e. her blood pressure does not
require treatment in absence
of proteinuria or end organ
damage
An isolated elevation of GGT out of proportion to that of other liver enzymes
such as Transaminases and Alkaline Phosphatase is usually an indication of :
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. Viral
Hepatitis
0.0%
b. Autoimmune
Hepatitis
0.0%
c. Ulcerative
Colitis
100.0%
0.0%
d. Alcoholic
liver disease.
e. Liver
fibrosis.
Score:
Question 2
0 / 25
(25 points)
You have a patient with normal GGT levels and abnormally raised Alkaline
Phosphatase , what test should you order next ?
Student response: Percent Correct Student
Value Response Response
Score:
Question 3
0.0%
Answer
Choices
a. Antismooth
muscle Ab
0.0%
b. ANA titers
100.0%
c. Fractiorated
Alkaline
Phosphatase
0.0%
d. Hepatitis
Profile
0.0%
e. PT/INR
0 / 25
(25 points)
A 45 years old female patient presents to you with complaint of having
increased pruritis, hyperpigmentation of the skin. On exam you find mild
hepatomegaly . You order Liver function tests and find elevated Alkaline
phosphatase , which serological test would you now order while you suspect
Primary Biliary Cirrhosis?
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. ANA
100.0%
Score:
Question 4
b. Anti
mitochondrial
Ab
0.0%
c. Anti smooth
muscle Ab
0.0%
d. Anti- ANCA
0.0%
e. Anti Ro/La
25 / 25
(25 points)
A 50 years old female patient with H/o ulcerative colitis presenting to you
with c/o having fatigue and pruritis. A comprehensive Metabolic panel shows
elevated serum alkaline phosphatase with mildly raised transaminases. You
order a P-ANCA , which comes back positive.
Now the next step to confirm the diagnosis of PSC would be:
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. Liver Biopsy
0.0%
100.0%
Score:
b. Liver
Ultrasound
c. ERCP/MRCP
0.0%
d. Ig M levels
0.0%
e. HIDA scan.
0 / 25
25 / 100 = 25.0%
Total score:
A newly diagnosed HIV patient comes to you for consultation. His CD4
count is 550 and his viral load is 67,000. He has not had any opportunistic
infections and the remainder of his labs are within normal limits. When
would you start antiretroviral therapy on him?
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. Now
Score:
Question 2
0.0%
b. When his
CD4 count
is < 200
0.0%
c. When his
CD4 count
is < 50
100.0%
d. When his
CD4 count
is < 350
0.0%
e. When is
viral load is
>75,000
20 / 20
(20 points)
Questions 2&3 pertain to the following case:
An HIV patient who you follow at your primary care clinic comes in with the
following lipid profile: Total Cholesterol 308, Triglycerides 187, LDL 189,
HDL 30. His lipid profile 6 months ago, prior to starting antiretroviral
medication, was within normal limits.
What class of drugs is likely causing this abnormality?
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. Integrase
inhibitors
0.0%
b. Nucleoside
Reverse
Transcriptase
inhibitors
0.0%
c. Nonnucleoside
Reverse
Transcriptase
inbitors
100.0%
d. Protease
inhibitors**
0.0%
Score:
Question 3
e. Fusion
inhibitors
20 / 20
(20 points)
His HIV specialist does not want to change his antiretroviral regimen because
of certain mutations the patient has, causing drug resistance. In addition to
diet and exercise, how would you manage his lipid profile?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Start
simvastatin
40mg
100.0%
b. Start
rosuvastatin
40mg
0.0%
c. Start lovastatin
40mg
0.0%
d. Start
atorvastatin
40mg
0.0%
e. Start
cholestyramine
Questions 4
and 5 refer to
the following
case:
Score:
Question 4
20 / 20
(20 points)
Your HIV positive patient, who is currently on Atripla, has a declining CD4
count, the most recent one being 147. Her viral load, which was once
undetectable, is now 45,194 copies/ml. She states she takes her medications
every night, and practices safe sex. She has never had any opportunistic
infections, and has a sulfa allergy. Physical exam reveals a cachectic female
with white oropharyngeal exudates. Remainder of exam is normal.
What specific laboratory test would you like to order now; one that would
help you the most?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. HIV-2 screen
100.0%
0.0%
Score:
Question 5
b. HIV genotype
c. Urinalysis
0.0%
d. Cytomegalovirus
IgG
0.0%
e. Toxoplasma IgG
20 / 20
(20 points)
In addition to treating her oral thrush with antifungals, would other
medication would you like to start and why?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Trimethoprimsulfamethoxazole
for PCP
prophylaxis
100.0%
b. Dapsone for PCP
prophylaxis
0.0%
c. Amoxicillin for
PCP prophylaxis
0.0%
d. Azithromycin for
MAC
prophylaxis
0.0%
e. Azithromycin for
PCP prophylaxis
Score:
20 / 20
Total score:
100 / 100 = 100.0%
A 40 years old male pt presents to the ER with c/o having chest pains for 1
day. Pt has a h/o esophageal reflux disease and pt describes the chest pain as
burning in nature which has been persisting for 24 hours, with no radiation of
pain. Pt states that the pain started after eating a heavy meal. Pts EKG done at
the ER is normal and 3 sets of cardiac enzymes are negative.Pt feels better
after taking nitroglycerin , the next best step would be:
Student response: Percent Correct Student
Value Response Response
100.0%
Answer
Choices
a. Give
empiric PPI
as the pain
is most
likely
secondary
to reflux
esophagitis
or
esophageal
spasm.
0.0%
b. Schedule
the pt for a
Stress test
0.0%
c. Get a
nuclear
scan.
0.0%
d. send the pt
for an echo
0.0%
e. start the pt
on
NSAIDS.
Score:
Question 2
25 / 25
(25 points)
In the above patient , the Gastroenterologist performs esophageal manometry
and finds that the pt has esophageal dysmotility . The next step in the
management would be :
Student response: Percent Correct Student
Value Response Response
100.0%
Score:
Question 3
Answer
Choices
a. Trial of
Calcium
Channel
Blockers:
Diltiazem
240 mg 360 mg
once per
day.
0.0%
b. PPI
0.0%
c. NSAIDS.
0.0%
d. Aspirin
0.0%
e. Tums
25 / 25
(25 points)
You have a 45 years old male pt who is presenting to your office with c/o
having chest pains for 2 days. Patient states that he noticed the chest pains
after lifting heavy weights at the gym. No radiation of the pain and he denies
symptoms of GERD. The next step in the management would be :
Student response: Percent Correct Student
Answer Choices
Value Response Response
0.0%
a. Send the pt for a
stress test
100.0%
0.0%
b. Provide a
thorough physical
exam and look for
chest wall
tenderness/muscle
tenderness.
c. Send the pt for
ECHO
Score:
Question 4
0.0%
d. Start the pt on
PPI
0.0%
e. Start the pt on
Aspirin and
Nitrogycerin.
25 / 25
(25 points)
When the patient places his/ her fist on the center of the chest , what is the
sign known as ?
Student response: Percent Correct Student
Value Response Response
0.0%
100.0%
Answer
Choices
a. Kernings
sign
b. Levine sign
0.0%
c. Turner's
sign
0.0%
d. Phallens
sign
0.0%
e. Rosvings
sign
Score:
25 / 25
Total score:
100 / 100 = 100.0%
A 65 years old man with h/o COPD comes to your office for a follow up. Pt
has a complaint of having increased cough and shortness of breath on
exertion On exam you find that the pt has decreased breath sounds, and a
pulse ox of 87 percent on room air. PFT show FEV1 of 39 percent of
predictive value and FVC is 78 percent of predictive value. Which of the
following may prolong life in the pt?
Student response: Percent Correct Student
Value Response Response
0.0%
Answer
Choices
a. Albuterol
100.0%
b. Supplemental
Oxygen
0.0%
c. Theophylline
0.0%
d. Spiriva.
Score:
Question 2
20 / 20
(20 points)
The indication for supplemental oxygen in a patient with COPD is:
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. Dyspnea
0.0%
Score:
Question 3
b. Increased
wheezing
100.0%
c. Cor
Pulmonale
and Pao2
between 55
and 60
mmHg
0.0%
d. Pao2 less
than or
equal to 65
mmHg.
20 / 20
(20 points)
A 71 years old man who was admitted in the hospital for COPD exacerbation
Is ready for discharge. He received a pneumococcal vaccine 3 years ago and
a Flu vaccine 2 years ago, recently received H1N1 shot. What vaccination
strategy is best for this patient?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
100.0%
Score:
Question 4
a. Pneumococcal
vaccine
b. Flu vaccine
0.0%
c. Pneumococcal
and flu
vaccine
0.0%
d. H1N1
vaccine.
20 / 20
(20 points)
The most common cause of upper lobe bronchiectasis is:
Student response: Percent Correct Student
Value Response Response
0.0%
a. COPD
0.0%
b. Bronchogenic
carcinoma
100.0%
0.0%
Score:
Question 5
Answer
Choices
c. Cystic
Fibrosis
d. Tuberculosis.
20 / 20
(20 points)
The best radiological modality for diagnosing Emphysema is :
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. Chest X ray
100.0%
0.0%
0.0%
Score:
20 / 20
Total score:
100 / 100 = 100.0%
b. HRCT chest
c. MRI chest
d. Plain CT
chest.
A 42 years old female pt with h/o GERD and asthma presents to you. She has
a history of using rescue inhalers three times per week lately. What would be
the next best step in the management?
Student response: Percent Correct Student
Value Response Response
Answer
Choices
100.0%
a. Add a PPI
to better
control
asthma
symptoms
0.0%
b. Start the pt
on
Singulair
0.0%
c. Start the pt
on oral
steroids
Score:
Question 2
0.0%
d. Start the pt
on long
acting beta
agonist.
0.0%
e. Start the pt
on a
combination
of inhaled
steroids and
inhaled long
acting beta
agonist.
25 / 25
(25 points)
What would be the advantage of using Symbicort( budesonide / formoterol)
over advair ( (fluticosone/salmeterol)?
Student response: Percent Correct Student
Value Response Response
Answer
Choices
0.0%
a. Symbicort
has a rapid
onset of
inspite of
being a long
acting beta
agonist and
could also
be used as a
rescue
inhaler.
0.0%
b. Symbicort
has a
delayed
onset of
action.
0.0%
c. Symbicort
dose not
increase
cardiac
related
serious
adverse
events.
Score:
Question 3
0.0%
d. Both a and c
are true
100.0%
e. No
advantage
of
symbicort
over advair.
0 / 25
(25 points)
We have a 24 years old female presenting with c/o experiencing Shortness of
Breath and mild wheezing which she notices after playing tennis or recently
after having sex with her boyfriend. The most likely diagnosis would be:
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. Chronic
Bronchitis
100.0%
Score:
Question 4
b. Exercise
induced
asthma
0.0%
c. Pneumonia
0.0%
d. COPD
0.0%
e. Seasonal
Allergies
25 / 25
(25 points)
A 24 years patient with h/o mild intermittent asthma presents to you with
shortness of breath and wheezing, on exam patients pulse ox is 99 percent
and pt .has scattered rhonchi on the chest exam. What would you expect the
pts. Chest x ray to show?
Student response: Percent Correct Student Answer Choices
Value Response Response
a. Normal Chest
100.0%
x ray.
0.0%
b. Bronchiectatic
changes in the
upper lobes
Score:
0.0%
c. Bronchiectatic
changes in
the lower lobe
0.0%
d. Pleural
Effusion
0.0%
e. Increased
interstitial
lung
markings.
25 / 25
75 / 100 = 75.0%
Total score:
A 33 year old female presents with accelerated hypertension and decreasing
urine output. She has a faint rash on her trunk and extremities, and complains
of painful hot joints in her hands and wrists. Laboratory evaluation reveals
BUN=37 mg/dl, creatinine=4.1 mg/dl, and potassium is 5.6 meq/l. Urine is
dark. Microscopic examination of the sediment shows erythrocyte casts.
Which of the following is the likely diagnosis?
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. ischemic
acute
tubular
necrosis
Score:
Question 2
100.0%
0.0%
b. vasculitis
0.0%
d. pre-renal
azotemia
0.0%
e. toxic acute
tubular
necrosis
c. allergic
interstitial
nephritis
20 / 20
(20 points)
A 44 year male in the intensive care unit has acute kidney injury after
experiencing multiple trauma in a motorcycle accident. He is currently nonoliguric, potassium is 5.6 meq/l, and azotemia is increasing daily. At what
point should renal replacement therapy be initiated?
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. when the
patient
becomes
oliguric and
diuretic
resistant
Score:
Question 3
0.0%
b. when
hyperkalemia
results in
prolonged
PR intervals
0.0%
c. when a
pericardial
friction rub is
present
0.0%
d. when
metabolic
acidosis is
intractable to
intravenous
infusions of
bicarbonate
100.0%
e. no consensus
exists on
timing of
initiation of
renal
replacement
therapy
20 / 20
(20 points)
A 70 year old female has multi-organ failure after bowel resection,
complicating surgical exploration for ovarian cancer. She has severe sepsis,
and has developed oliguric acute tubular necrosis. She is severely fluid
overloaded, and requires pressor support with catecholamines. Despite this,
she becomes dangerously hypotensive on acute intermittent daily
hemodialysis. Which of the following is an option to remedy this problem?
Student response: Percent Correct
Student
Answer
Value Response Response
Score:
Question 4
Choices
0.0%
a. switch to
acute
peritoneal
dialysis
0.0%
b. switch to
continuous
venovenous
hemodialysis,
using
replacement
solution
warmed to
body
temperature
100.0%
c. switch to
continuous
venovenous
hemodialysis,
using cool
replacement
solution
0.0%
d. continue
intermittent
daily
hemodialysis
with reduced
goals for fluid
removal
0.0%
e. continue
intermittent
daily
hemodialysis
using a more
biocompatible
membrane
20 / 20
(20 points)
A 69 year old man had cardiac catheterization with iodine based contrast
about two weeks ago. It revealed severe multivessel coronary artery disease.
He had coronary artery bypass grafting 48 hours ago. His surgery was
complicated by an intraoperative myocardial infarction and prolonged time
on cardiopulmonary bypass. In the intensive care unit, he has required
pressor support and large doses of loop blocking diuretics to maintain a
nonoliguric state. Nonetheless, his azotemia is climbing rapidly. Which of the
following is the most likely renal diagnosis?
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. toxic acute
tubular
necrosis
Score:
Question 5
0.0%
b. prerenal
azotemia
0.0%
c. allergic
interstitial
nephritis
0.0%
d. atheroembolic
renal disease
100.0%
e. ischemic
acute tubular
necrosis
20 / 20
(20 points)
A 70 year old man had percutaneous coronary intervention 5 days ago. Three
coronary arteries were dilated in an extensive procedure. On the third day, he
was noted to have rising BUN and creatinine, but was not oliguric. There
were no eosinophils seen in his urine but he did have mild eosinophilia in his
CBC. He has developed painful lesions which look like splinter hemorrhages
in several of his toes. He has visual field deficits and unusual lesions in his
optic fundi. Which of the following is the likely cause of his renal disease?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. acute tubular
necrosis
caused by
iodine based
contrast
100.0%
0.0%
b. atheroembolic
renal disease
c. allergic
interstitial
nephritis
cause by
contrast
Score:
0.0%
d. ischemic
acute tubular
necrosis
caused by
hypotension
during cardiac
catheterization
0.0%
e. acute
vasculitis
20 / 20
100 / 100 = 100.0%
Total score:
A 60 year old man is evaluated in the emergency department after being
found wandering on the street. He is a known alcoholic. He is confused and
actively hallucinating, but able to say that his last drink was two or three days
ago. He is tremulous. His pulse is 120 beats per minute, respiratory rate is 28
breaths per minute, temperature is 38.5º C, and blood pressure is 160/96.
Which of the following is the most appropriate statement regarding his care?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. lumbar puncture
should be
performed to
rule out
meningitis
0.0%
b. this represents
alcoholic
hallucinosis and
is self-limited
0.0%
c. symptoms can
be managed
with beta
adrenergic
blockers or
centrally acting
alpha-2 agonists
0.0%
d. the patient has
alcoholic
encephalopathy
and should be
started on
lactulose
100.0%
Score:
Question 2
e. the patient is in
delirium
tremens and
should be
started on
benzodiazepines
20 / 20
(20 points)
A 45 year old male presents with a history of recurrent admissions for
complications of alcoholic cirrhosis, including ascites and episodes of hepatic
encephalopathy. He has had numerous attempts at detoxification and
rehabilitation. Which of the following is most likely to improve his prognosis
in reference to progressive hepatic impairment?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. colchicine
0.0%
b. propylthiouracil
100.0%
0.0%
0.0%
Score:
Question 3
c. abstinence
d. silymarin
e. liver
transplantation
20 / 20
(20 points)
A 54 year old male with chronic alcoholism presents with altered mental
status. He has had numerous episodes of hepatic encephalopathy in the past,
as well as other symptoms of acute and chronic alcohol abuse. At this time,
he appears demented, with symmetric spasticity in his appendiceal muscles,
dysrthria, and inability to walk. He is treated with thiamine, glucose,
intravenous fluids and dextrose and vitamins. His condition deteriorates
gradually over several days. This course is most characteristic of which of the
following?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. recurrent
hepatic
encephalopathy
Score:
Question 4
0.0%
b. Wernicke's
encephalopathy
0.0%
c. Korsakoff's
syndrome
100.0%
d. MarchiafavaBignami
disease
0.0%
e. Alcoholic
cerebellar
degeneration
0 / 20
(20 points)
A 48 year old woman requires emergency surgery after a motor vehicle
accident. Her blood alcohol level was elevated, and history given by family
reveals that she drinks a bottle of wine daily. Which of the following is a
controversial measure in perioperative care?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. intravenous
thiamine,
dextrose and
multivitamins
0.0%
b. prompt
initiation of
benzodiazepines
to prevent
alcohol
withdrawal
syndrome
100.0%
c. intravenous
ethanol to
prevent alcohol
withdrawal
syndrome
0.0%
d. need for higher
than usual doses
of propafol and
fentanyl for
intraoperative
sedation and
analgesia
0.0%
Score:
Question 5
e. post-operative
cardiac
monitoring for
"holiday heart
syndrome"
20 / 20
(20 points)
A 42 year old male presents with elevated transaminase levels for the last six
months. He admits to drinking 3 to 4 six-packs of beer daily, but he functions
well at a responsible position in his company. He does not believe the
abnormal blood tests could be related to alcohol intake. He has chronic
Hepatitis C, diagnosed recently, attributed to drug use when he was in
college. He has telangectasias on his abdomen, and his gums bleed when he
brushes his teeth. Which of the following is a reason for this patient NOT to
have a liver biopsy?
Student response: Percent Correct Student
Value Response Response
Score:
Answer Choices
0.0%
a. coexistence of
Hepatitis C
establishes that as
the cause of
transaminosis
0.0%
b. presence of
coagulopathy
clinically, or by
prolonged
prothrombin time
0.0%
c. likelihood that
transaminosis
will resolve
spontaneously
0.0%
d. hypoalbuminemia
100.0%
e. gastroenterologist
does not know
how to proceed at
this point without
biopsy
20 / 20
80 / 100 = 80.0%
Total score:
A 64 year old female present to your office to establish care. She has not
received regular medical care and does not take any prescription or over the
counter medication. She complains of progressive dyspnea over the last 3
months that is worse at night when she lays flat. She is a nonsmoker and does
not get regular exercise. Her physical exam is remarkable for a blood
pressure of 160/100 mmHg, an S3 on cardiac examination, bibasilar rales,
and 2+ pretibial edema of bilateral lower extremities. Early treatment of
which of the following is most likely to have prevented the patient's
condition?
Student response: Percent Correct Student
Value Response Response
100.0%
0.0%
Score:
Question 2
Answer Choices
a. Hypertension
b. Asthma
0.0%
c. Gastroesophageal
reflux disease
0.0%
d. Allergic Rhinitis
0.0%
e. Obstructive
Sleep Apnea
20 / 20
(20 points)
Which of the following is most appropriate next step in establishing a
diagnosis?
Student response: Percent Correct Student
Value Response Response
100.0%
Score:
Answer Choices
a. Electrocardiogram
and Chest
Radiograph
0.0%
b. Arterial Blood
Gas and Sleep
Study
0.0%
c. Upper endoscopy
0.0%
d. Plasma BNP
0.0%
e. No further
diagnostic workup
needed
20 / 20
Question 3
(20 points)
A 54 year old Caucasian male presents to the emergency room complaining
of fatigue and progressive dyspnea. He has a past medical history of
hypertension and diabetes. Physical Examination reveals a blood pressure of
150/92 mm Hg, bibasilar rales, and 2+ lower extremity edema. An
echocardiogram reveals a left ventricular ejection fraction of 30%. Which of
the following is appropriate pharmacotherapy for this patient?
Student response: Percent Correct Student
Value Response Response
100.0%
Score:
Question 4
Answer
Choices
a. Furosemide,
ACE
inhibitors
0.0%
b. Furosemide,
Beta
Blocker
0.0%
c. ACE
inhibitors,
Beta
Blocker
0.0%
d. Furosemide,
Hydralazine
0.0%
e. ACE
inhibitors,
Calcium
Channel
Blocker
20 / 20
(20 points)
A 66 year old African American male with Stage III heart failure is evaluated
in his primary care physicians office. His current medication regimen
includes lisinopril 40mg po daily, carvedilol 12.5 mg po twice daily,
furosemide 20mg po daily, and atorvastatin 40mg po daily. The addition of
which medication will result in a reduced mortality?
Student response: Percent Correct Student
Answer Choices
Value Response Response
0.0%
a. Digoxin
100.0%
0.0%
b. Hydralazine with
nitrates
c. Hydrochlorothiazide
Score:
Question 5
0.0%
d. Procardia with
nitrates
0.0%
e. Sildenafil
20 / 20
(20 points)
An 86-year-old man presents complaining of dyspnea on exertion and 2pillow orthopnea. His PA Chest radiograph reveals a cardiothoracic ratio of
0.6 and cephalization of the pulmonary vessels. Echocardiogram reveals a
dilated left ventricular and a LVEF of 40%. What is the most likely
diagnosis?
Student response: Percent Correct Student
Value Response Response
0.0%
Answer
Choices
a. Cardiac
Tamponade
100.0%
b. Systolic
Heart
Failure
0.0%
c. Diastolic
Heart
Failure
0.0%
d. Acute
pulmonary
embolism
0.0%
e. Bacterial
Pneumonia
Score:
20 / 20
Total score:
100 / 100 = 100.0%
A 57y.o. patient is found to have diverticulosis on a routine colonoscopy. He
is asymptomatic. What do you recommend to him to prevent future
complications?
Student response: Percent Correct Student
Value Response Response
Answer
Choices
0.0%
a. Colonoscopy
q2years
0.0%
b. Colon
cleansing
once a
month
Score:
Question 2
0.0%
c. Avoid
lactosecontaining
foods
100.0%
d. High fiber
diet
0.0%
e. Low fiber
diet
20 / 20
(20 points)
Questions 2 & 3 refer to the following case:
A 70y.o. female follows up at the clinic after a recent hospitalization 5 days
ago for acute diverticulitis. She was treated with antibiotics. She feels a little
weak and is still having some mild abdominal cramping and bloating. Stool
habits have returned to her baseline. She is afebrile and has a normal white
blood cell count.
What do you recommend at this point during her recovery?
Student response: Percent Correct Student
Value Response Response
Score:
Question 3
Answer
Choices
0.0%
a. Colonoscopy
immediately
0.0%
b. High fiber
diet
100.0%
c. Low fiber
diet
0.0%
d. Another 2
weeks of
antibiotics
0.0%
e. Readmit to
the hospital
for further
workup
0 / 20
(20 points)
What antibiotics was the above patient most likely on? She is not allergic to
any medications.
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Ciprofloxacin
Score:
Question 4
0.0%
b. Metronizadole
0.0%
c. Erythromycin
100.0%
d. Ciprofloxacin
and
metronizadole
0.0%
e. Ciprofloxacin,
metronizadole,
and
erythromycin
20 / 20
(20 points)
A 38yo male patient with a history of diverticulitis and diverticulosis comes
in complaining of bloating, cramping, irregular defection, and flatulence for
approximately 2 years. He maintains a high fiber diet and has tried various
food eradication diets (lactose, fat, gluten, etc.) as well as simethicone and
Beano, and still has no relief. He works as a telemarketer and has a sedentary
lifestyle because of some knee osteoarthritis. His physical exam reveals a
BMI of 34.5, and some mild left lower quadrant tenderness. He is Guiacnegative and a recent colonoscopy revealed mild sigmoid diverticula. What
would you advise this patient to help with his symptoms?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Increase red
meat intake
0.0%
b. Trial of
cholestyramine
100.0%
c. Increase
physical
activity and
lose weight
0.0%
d. Increase red
wine intake
0.0%
e. A trial of
antibiotics
Score:
Question 5
20 / 20
(20 points)
A 74y.o. female presents to the ER with a complaint of a single episode of
painless rectal bleeding. Upon history, she states she has been eating a lot of
sunflower seeds and cashew nuts lately to "increase the salt in her blood" (her
nephrologist said her "salt level" was low). She does admit to some foulsmelling stools and flatulence lately, and then recalls maybe "having a fever
off and on" for the last 2-3 days. When you press on her left lower quadrant,
she screams in pain and then recalls similar pain over the last few weeks but
attributed it to gas. Her temperature in the ER is 101.5 F. Based on her
history and physical, you suspect she has acute diverticulitis. Your attending
insists you do a confirmatory test (although you have read that history and
physical alone can often indicate the diagnosis). What is the best test to
confirm your diagnosis? Of note, her BUN/Cr is 10/0.7, and her sodium is
131.
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Rectal exam
with stool
occult blood
testing
100.0%
Score:
b. CT of
abdomen/pelvis
with IV and
oral contrast
0.0%
c. Immediate
colonoscopy
0.0%
d. Double
contrast barium
enema
0.0%
e. Abdominal
ultrasound
20 / 20
80 / 100 = 80.0%
Total score:
A32 year old female (Meg) presents to the emergency room after having a
witnessed seizure. The seizure was described by her sister as a loss of
consciousness followed by generalized shaking of her arms and legs. The
patient's sister states that when the shaking stopped she seemed confused.
She has not received regular medical care and does not take any prescription
or over the counter medication. She is a nonsmoker, nondrinker and does not
get regular exercise. Her vital signs are stable and neurologic examination is
non-focal. The most appropriate diagnosis?
Student response: Percent Correct Student
Value Response Response
100.0%
Score:
Question 2
Answer
Choices
a. Generalized
tonic-clonic
seizure
0.0%
b. Absence
seizure
0.0%
c. Todd's
paralysis
0.0%
d. Complex
partial
seizure
0.0%
e. Atonic
seizure
20 / 20
(20 points)
An Electroencephalography (EEG) reveals multiple spike-wave complex and
MRI of the brain was unremarkable. Which of the following is the most
appropriate therapy?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. No therapy
indicated
100.0%
b. Lamotrigine
125mg po
twice daily
0.0%
c. Topiramate
200mg po
twice daily
0.0%
d. Gabapentin
600mg po
three times
daily
0.0%
e. Carbamazepine
200mg po
twice daily
Score:
Question 3
20 / 20
(20 points)
A 24 year old female with primary epilepsy presents for follow up with her
primary care provider. She has been seizure free for the last 6 months on
lamotrigine 125mg po twice daily. She is currently using condoms as her
only form of birth control and would like to start oral contraception. What
effect could the initiation of birth control have on the patients current medical
condition?
Student response: Percent Correct Student
Value Response Response
0.0%
Score:
Question 4
Answer
Choices
a. No effect
100.0%
b. Reduced
plasma
concentration
of
lamotrigine
0.0%
c. Increased
plasma
concentration
of
lamotrigine
0.0%
d. Increased
frequency of
seizure due
to estrogen
suppression
20 / 20
(20 points)
A 28 year old male presents via ambulance to the emergency room after
being found laying on the ground confused. He has a past medical history of
HIV and alcohol abuse. He has no history of seizure disorder and takes no
current medications. Physical Examination reveals a temperature of 101.2?F
and a positive babinski on the right. Which of the following is most
appropriate next step in caring for this patient?
Student response: Percent Correct Student
Value Response Response
0.0%
100.0%
0.0%
Answer Choices
a. Lumbar puncture
b. Brain CT
c. Electroencephalography
Score:
Question 5
0.0%
d. Lymphocyte profile
0.0%
e. HIV viral load
20 / 20
(20 points)
A 42-year-old man presents with his wife complaining of recurrent episodes
where he stares off in space and has repetitive lip-smacking. His physical
examination is normal and neurologic examination is non-focal. What is the
most likely diagnosis?
Student response: Percent Correct Student
Value Response Response
Answer
Choices
0.0%
a. Generalized
tonic-clonic
seizure
0.0%
b. Absence
seizure
0.0%
c. Todd's
paralysis
100.0%
d. Complex
partial
seizure
0.0%
Score:
20 / 20
Total score:
100 / 100 = 100.0%
e. Atonic
seizure
A 65-year-old male presents with coffee-ground emesis. The patient is felt
likely to have a stomach full of blood. Which of the following has been
proven to improve visibility, shorten endoscopy time, and reduce the need for
a second-look endoscopy in this patient?
Student response: Percent Correct Student
Value Response Response
100.0%
0.0%
Answer
Choices
a. Erythromycin
b. cisplatin
0.0%
c. doxycycline
0.0%
d. metronidazole
0.0%
e. verapamil
Score:
Question 2
20 / 20
(20 points)
A 55-year-old man with chronic back pain presents with coffee ground
emesis. He admits to using NSAID’s frequently at home.The drug of choice
for his condition is administered intravenously. Which of the following best
describes how this medication works?
Student response: Percent Correct Student
Answer
Value Response Response
Choices
0.0%
a. activation of
α1, α2, β1,
and β2
receptors
Score:
Question 3
0.0%
b. dopamine
D2
receptors
where it is a
receptor
antagonist
100.0%
c. inhibition
gastric acid
production
0.0%
d. histamine
receptor
antagonist
0.0%
e. inhibition of
bacterial
protein
synthesis
20 / 20
(20 points)
A 62-year-old man with cirrhosis presents with an upper gastrointestinal
bleed. Which of the following is most accurate?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. angiodysplasia
is most likely
the source of
bleeding
100.0%
b. prophylactic
antibiotics
should be
administered
Score:
Question 4
0.0%
c. endoscopy is
contraindicated
0.0%
d. nasogastric
tube insertion
is
contraindicated
0.0%
e. prophylactic
lactulose
should be
administered
20 / 20
(20 points)
Which of the following is associated with upper gastrointestinal bleeding?
Student response: Percent Correct Student Answer Choices
Value Response Response
100.0%
Score:
Question 5
a. history of an
abdominal
aortic aneurysm
graft
0.0%
b. coronary
angiography
0.0%
c. history of a
cholecystectomy
0.0%
d. Parkinson
disease
0.0%
e. Prader-Willi
syndrome
20 / 20
(20 points)
A 40-year-old female is found to have a gastric ulcer upon endoscopy. Which
of the following features of the ulcer would be most likely to predict
recurrence of bleeding?
Student response: Percent Correct Student
Value Response Response
Answer
Choices
Score:
0.0%
a. clean-based
ulcer
0.0%
b. visible
vessel in
ulcer
100.0%
c. active
bleeding
during
endoscopy
0.0%
d. adherent
clot to ulcer
bed after
saline
lavage
0.0%
e. presence of
intestinal
metaplasia
20 / 20
100 / 100 = 100.0%
Total score:
A 24 year old female presents to the emergency room for evaluation of an
episode of loss of consciousness. Upon awakening the patient felt completely
normal without any confusion. The episode occurred at work, where she was
standing for approximately 2 hours checking identifications at the door of a
club. The patient reports that prior to the episode that she had felt flushed and
diaphoretic. She denies a history of similar episodes and denies any medical
problems. Her vital signs are normal with a blood pressure of 120/76, and
physical examination and laboratory evaluation is unremarkable. What is the
most likely etiology of the patients presenting complaint?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Cardiac
syncope
0.0%
b. Pulmonary
embolism
100.0%
c. Vasovagal
syncope
0.0%
d. Orthostatic
syncope
0.0%
e. Hypoglycemia
Score:
Question 2
20 / 20
(20 points)
Which of the following is most appropriate initial treatment for this patient?
Student response: Percent Correct Student
Value Response Response
100.0%
Score:
Question 3
Answer
Choices
a. Reassurance
0.0%
b. Betablockers
0.0%
c. Alpha-1adrenergic
agonist
0.0%
d. Selective
serotonin
uptake
inhibitors
0.0%
e. Theophylline
20 / 20
(20 points)
A 67 year old male presents to the emergency room complaining of a
transient loss of consciousness. He has a past medical history of type 2
diabetes mellitus, hypertension and hyderlipidemia. Current medications
include lisinopril 20mg twice daily and metformin 1000mg twice daily.
Physical Examination reveals a blood pressure of 104/60 and a heart rate of
42. Evaluation reveals a cardiac examination remarkable for bradycardia with
normal S1/S2 and no murmurs. EKG reveals 3rd degree AV block. Which of
the following is most appropriate initial treatment for this patient?
Student response: Percent Correct Student
Value Response Response
100.0%
Answer
Choices
a. Pacemaker
0.0%
b. Volume
expansion
0.0%
c. Alpha-1adrenergic
agonist
0.0%
d. Reassurance
0.0%
e. Betablocker
therapy
Score:
Question 4
20 / 20
(20 points)
A 78 year old female presents to the emergency room for evaluation of an
episode of loss of consciousness. Upon awakening the patient felt completely
normal without any confusion. The episode occurred in the mid-afternoon,
when she had got up from a nap on the sofa to go answer the phone. She
denies a history of similar episodes and past medical history is remarkable for
type 2 diabetes mellitus. Her vital signs reveal a blood pressure of 124/66
laying and 98/54 after standing for 5 minutes. Physical examination,
laboratory evaluation, and EKG are unremarkable. What is the most likely
etiology of the patients presenting complaint?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Cardiac
syncope
0.0%
b. Pulmonary
embolism
0.0%
c. Vasovagal
syncope
100.0%
d. Orthostatic
syncope
0.0%
Score:
Question 5
e. Hypoglycemia
20 / 20
(20 points)
In addition to counseling the patient on maneuvers to trasition from the
laying to standing position, which of the following is the most appropriate
treatment?
Student response: Percent Correct Student
Value Response Response
0.0%
100.0%
Score:
Answer Choices
a. Reassurance
b. Fludrocortisone
0.0%
c. Hydrochlorothiazide
0.0%
d. Beta-blocker
0.0%
e. Selective serotonin
uptake inhibitors
20 / 20
100 / 100 = 100.0%
Total score:
A 74 year old male with Stage 3 NYHA congestive heart failure has been
maintained on furosemide 40 mg every 12 hours for the past year. He has
normal renal function, and his other cardiac medications have been
optimized. He ran out of medication three days ago, and reported yesterday
an increase in shortness of breath and peripheral edema. His prescription was
refilled by telephone, and he resumed the same dose of furosemide yesterday
morning. Today he reports no improvement, and in fact thinks that he is
worse, but he is comfortable at home. Which of the following would be most
useful for this patient?
Student response: Percent Correct Student Answer Choices
Value Response Response
Score:
Question 2
0.0%
a. ultrafiltration
100.0%
b. addition of a
thiazide
diuretic
0.0%
c. doubling his
dose of
furosemide
0.0%
d. restricting
sodium in his
diet
0.0%
e. hospitalization
for
intravenous
furosemide
20 / 20
(20 points)
A 68 kg woman is having a colon resection for severe diverticulitis. She will
not be able to take anything by mouth for several days. Which of the
following is the most reasonable strategy for maintenance intravenous fluids?
Student response: Percent Correct Student
Value Response Response
Answer
Choices
0.0%
a. dextrose
and water at
105 ml/hr
0.0%
b. half normal
saline at
1500 ml/day
0.0%
100.0%
0.0%
Score:
Question 3
c. hypertonic
saline at
1500 ml/day
d. dextrose
and half
normal
saline at
105 ml/hr
e. normal
saline at 50
ml/hr
20 / 20
(20 points)
A 37 year old woman has been taking chlorthalidone 25 mg daily for several
years in treatment for hypertension. She is moderately obese, and has become
obsessed with body image and weight loss. On routine laboratory evaluation,
she is found to be hypokalemic, with serum potassium of 3.1 meq/dl. This is
a new finding for her. Blood pressure is 118/74. Which of the following is the
most appropriate statement?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. she has
become overly
sensitive to the
effects of
chlorthalidone,
which should
be
discontinued
0.0%
b. potassium
supplements
should be
initiated
100.0%
c. urine
electrolytes
should be
checked to
seek the
source of the
loss
0.0%
d. chlorthalidone
should be
changed to
amiloride or
triamterene
0.0%
Score:
Question 4
e. add ACE or
ARB to
enhance
potassium
retention
20 / 20
(20 points)
A 54 year old man has alcoholic cirrhosis. He has only a small amount of
peripheral edema, but complains of increasing abdominal girth and tenseness.
He is not compliant with sodium restriction. Which of the following is
appropriate for this patient?
Student response: Percent Correct Student Answer Choices
Value Response Response
Score:
Question 5
0.0%
a. furosemide 40
mg bid
0.0%
b. chlorthalidone
25 mg daily
100.0%
c. spironolactone
25 mg daily
0.0%
d. lactulose 30 ml
daily
0.0%
e. methazolamide
50 mg daily
20 / 20
(20 points)
A 73 year old man has ischemic cardiomyopathy with an ejection fraction of
20%. He has been managed without diuretics for the most part because of
concerns about his renal function. However, with worsening orthopnea, his
physician started furosemide 20 mg daily. The patient reports no
improvement in his symptoms of shortness of breath or edema, and he does
not think his urine output changed. What is the appropriate next step.
Student response: Percent Correct Student
Value Response Response
100.0%
Answer Choices
a. increase his
furosemide to 40
mg daily
Score:
0.0%
b. increase his
furosemide to 20
mg bid
0.0%
c. add metolazone to
his regimen
0.0%
d. change to a
different loop
blocking diuretic
0.0%
e. add
hydrochlorthiazide
to his regimen
20 / 20
100 / 100 = 100.0%
Total score:
A 50 year old female present to your office complaining of redness and pain
in her right shin. She has not received regular medical care and does not take
any prescription or over the counter medication. She complains of redness,
swelling and warmth of the area and fever/chills for the last 6 hours. She is a
nonsmoker and does not get regular exercise. Her physical exam is
remarkable for an area measuring 3cm x 4 cm of a raised erythematous lesion
with a clear line of demarcation between the involved and uninvolved tissue.
The most likely diagnosis of this patients condition is?
Student response: Percent Correct Student
Value Response Response
100.0%
0.0%
Score:
Question 2
Answer
Choices
a. Erysipelas
b. Cellulitis
0.0%
c. Contact
Dermatitis
0.0%
d. Herpes
Zoster
0.0%
e. Erythema
Migrans
20 / 20
(20 points)
What is the most likely organism responsible for erysipelas?
Student response: Percent Correct
Student Answer Choices
Value Response Response
Score:
Question 3
100.0%
a. Beta-hemolytic
streptococci
0.0%
b. Staphylococcus
aureus
0.0%
c. Pasteurella
multocida
0.0%
d. Vibrio
vulnificus
0.0%
e. Pseudomonas
aeruginosa
20 / 20
(20 points)
A 18 year old male presents to the emergency room complaining of a painful
red area on his right shoulder for the last 2 days. He has no past medical
history and is currently a college freshman. He reports that his roommate
recently was treated for a community acquired MRSA infection. Physical
Examination reveals an area of erythema and edema measuring 6cm by 5 cm,
no area of fluctulance is appreciated. In addition to updating the patients
tetanus vaccine, which of the following is appropriate pharmacotherapy for
this patient?
Student response: Percent Correct Student
Value Response Response
Answer Choices
0.0%
a. Cephalexin
500mg po every
6 hours
0.0%
b. Dicloxacillin
500mg po every
6 hours
100.0%
c. Penicillin 500mg
po every 6 hours
+ Trimethoprimsulfamethoxazole
DS po every 12
hours
0.0%
d. Cephalexin
500mg po every
6 hours +
dicloxacillin
500mg po every
6 hours
0.0%
Score:
Question 4
e. Clindamycin
300mg po every
6 hours +
linezolid 600mg
po every 12
hours
20 / 20
(20 points)
A 26 year old male presents to the emergency room 10 hours after receiving a
dog bite to his left hand. The injury involves the lateral aspect of his left hand
with multiple tear lacerations and puncture wounds. The most appropriate
choice of antibiotic is?
Student response: Percent Correct Student
Value Response Response
0.0%
a. Dicloxacillin
0.0%
b. azithromycin
0.0%
c. cephalexin
100.0%
d. amoxicillinclavulanate
potassium
0.0%
Score:
Question 5
Answer
Choices
e. Penicillin
20 / 20
(20 points)
What is the most likely organism responsible for an infection following a cat
bite?
Student response: Percent Correct Student Answer Choices
Value Response Response
0.0%
a. Beta-hemolytic
streptococci
0.0%
b. Staphylococcus
aureus
100.0%
c. Pasteurella
multocida
0.0%
d. Vibrio
vulnificus
0.0%
Score:
20 / 20
Total score:
100 / 100 = 100.0%
e. Pseudomonas
aeruginosa