Multiple Choice Questions (MCQ)

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Category: Q&A Medicine--->Practice Examination
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Question 1# Print Question

A 49-year-old man presents to the physician with fever, confusion, and abdominal pain. His wife explains that for the past few days he has had fevers, night chills, and fatigue, but suddenly developed confusion this morning. His medical history is significant for hypertension and diabetes, for which he takes losartan, amlodipine, and metformin. He denies any tobacco, ethanol, or drug use. His vitals show a temperature of 38.4°C, a blood pressure of 142/90 mmHg, a heart rate of 96 beats per minute, and a respiratory rate of 16 breaths per minute. He has poor dentition, no jugular venous distention, and a normal pulmonary examination. There is a 3/6 holosystolic murmur heard over the apex. Blood cultures are drawn, and the patient is started on empiric antibiotics. A transthoracic echocardiogram shows a normal ejection fraction with no valvular lesions.

What is the most appropriate next step in management of this patient?

A. Transesophageal echocardiogram
B. Immediate surgery
C. CT scan of the chest and abdomen
D. Serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
E. Intravenous corticosteroids

Question 2# Print Question

A 62-year-old man with a history of GERD and peptic ulcer disease presents with severe upper abdominal pain. The patient reports that the pain abruptly started 6 hours ago while he was eating breakfast. He reports diffuse pain that radiates to his back. He has a blood pressure of 100/60 mmHg, pulse of 118/min, temperature of 37.9°C, and a respiratory rate of 24 breaths per minute. On physical examination, there is exquisite tenderness to superficial palpation over the entire abdomen. The patient is unable to tolerate the rest of the abdominal examination.

Which of the following is the best next step in management?

A. Ultrasound of the abdomen
B. Lipase levels and liver function tests
C. CT scan of the abdomen
D. Chest x-ray

Question 3# Print Question

A 17-year-old girl presents with 2 weeks of weight loss, intractable nausea and vomiting, and a decreased level of consciousness. She is found to have glucose of 439 mg/dL. She is started on IV fluids and insulin. Four hours later, her laboratory tests demonstrate the following.

  • Sodium 143 mEq/L
  • Potassium 4.2 mEq/L
  • Chloride 102 mEq/L
  • Bicarbonate 22 mEq/L
  • Blood urea nitrogen 14 mg/dL
  • Creatinine 0.9 mg/dL
  • Glucose 204 mg/dL

What is the most appropriate next step in management?

A. Switch to subcutaneous insulin glargine
B. Continue current management
C. Add glucose to the IV fluids
D. Switch to oral metformin
E. Obtain ECG

Question 4# Print Question

A middle-aged man comes to the Emergency Department complaining of 2 days of shaking chills, as well as a cough with foul-smelling sputum and small amounts of blood. He admits to drinking a pint of vodka and smoking 3 packs of cigarettes each day. He has been to prison twice in the last year. A chest x-ray shows right upper lobe infiltrates. His laboratory tests are shown below.

  • Hemoglobin 13.6 g/dL
  • Leukocyte count 16,400/mm3
  • Sodium 135 mEq/L
  • Potassium 4.2 mEq/L
  • Creatinine 0.9 mg/dL
  • Glucose 110 mg/dL

An HIV and tuberculin skin test are both negative. What is the best next step in management?

A. Begin ceftriaxone and clindamycin
B. Obtain a CT scan of the chest with contrast
C. Begin vancomycin and ceftriaxone
D. Begin trimethoprim–sulfamethoxazole and prednisone
E. Begin rifampin, isoniazid, pyrazinamide, and ethambutol

Question 5# Print Question

A 33-year-old African American woman complains of fevers, night sweats, and shortness of breath over the past few weeks. Her vital signs are normal, and her lungs are clear to auscultation. She has some waxy skin plaques on her face and erythematous nodules on the anterior portion of her legs. A chest x-ray is performed, which is shown in Figure below.

Which of the following is the likely diagnosis?

A. Tuberculosis
B. Hodgkin lymphoma
C. Pulmonary hypertension
D. Sarcoidosis

Category: Q&A Medicine--->Practice Examination
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