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* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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