Multiple Choice Questions (MCQ)

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Category: Medicine--->General Medicine and Prevention
Page: 6

Question 26# Print Question

A 40-year-old obese man presents with intense pain in his left first metatarsophalangeal (MTP) joint for the past few hours. He has no history of trauma, fever, sweats, chills, and no previous similar episode. He has no history of renal disease or diabetes though he has been told he is “prediabetic.” He does not recall any recent skin infections and no family member has had any reported staphylococcal infection. On examination he has a swollen, red, warm, tender first MTP joint on the left. Uric acid level is 9 mg/dL; serum creatinine is normal.

What is the best treatment approach for this patient? 

A. Start allopurinol immediately and titrate for a uric acid level below 6. Use colchicine if this is not effective within the first 24 hours
B. Begin prednisone 50 mg daily until symptoms subside
C. Begin indomethacin 50 mg po tid. As the patient improves, reduce the dose to minimize gastrointestinal side effects
D. Prescribe hydrocodone-acetaminophen 7.5 mg/325 mg qid until pain is under control
E. Refer the patient to a rheumatologist

Question 27# Print Question

A 38-year-old obese woman with history of chronic venous insufficiency and peripheral edema was admitted to the hospital the previous night for cellulitis involving both lower legs. She has had recurrent such episodes, treated successfully in the past with various antibiotics, including cefazolin, nafcillin, ampicillin/sulbactam, and levofloxacin. Intravenous levofloxacin was again chosen due to the perceived ease in transitioning to a once-daily oral outpatient dose. Normal saline at 50 mL/h is administered. Past history is otherwise significant only for hypertension, which is being treated at home with HCTZ 25 mg, lisinopril 40 mg, and atenolol 100 mg, all once each morning. Admission BP was 144/92 and the orders were written to continue each of these antihypertensives at one tablet po daily. The only other in-hospital medication is daily prophylactic enoxaparin. As you round at 6 PM on the day following admission, the nurse contacts you emergently stating that she has just finished giving evening medicines and the patient’s BP is unexpectedly 90/50. Pulse rate is 92. There is no chest pain, dyspnea, or tachypnea.

What is most likely cause of her hypertension? 

A. An allergic reaction either to the antibiotic or to one of the antihypertensives
B. A vasovagal reaction secondary to pain
C. Hypovolemia due to the cellulitis
D. Acute pulmonary embolism
E. Medication error

Question 28# Print Question

A 44-year-old Hispanic woman comes to clinic for a general checkup due to concern about a family history of diabetes and high blood pressure. Her height is 62 in, weight 50 kg (110 lb), waist circumference 33 in (85 cm), and blood pressure 138/88. Laboratory evaluation reveals fasting glucose of 120 mg/dL. Lipid profile shows total cholesterol 240 mg/dL, HDL 38 mg/dL, and triglycerides 420 mg/dL; LDL cannot be calculated. She does not smoke, use alcohol, or take any medications.

Which of the following is correct regarding the identification of the metabolic syndrome in this patient? 

A. Metabolic syndrome is not present in this case due to the absence of abdominal obesity
B. Metabolic syndrome is not present because the blood pressure is not sufficiently elevated to be a risk factor
C. Metabolic syndrome is not present because the glucose is not sufficiently elevated to be a risk factor
D. Metabolic syndrome is present based on the risk factors given
E. Metabolic syndrome cannot be identified until the LDL is determined

Category: Medicine--->General Medicine and Prevention
Page: 6 of 6