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A 28-year-old student is seen in the school health clinic with complaints of a hacking
cough that is productive of small amounts of sputum and a runny nose. He does not
take any medications, denies any allergies, and has no significant medical history.
Physical examination reveals a low-grade temperature of 99.9 degrees Fahrenheit,
respirations of 16/min, a pulse of 90 beats per minute, and diffuse fine crackles in the
base of the lungs. A chest radiograph (x-ray) shows diffuse infiltrates on the lower lobe
of the right lung. The total white blood cell count is 10,500/uL. What is the most likely
diagnosis?
A) Streptococcal pneumonia
B) Mycoplasma pneumonia
C) Acute bronchitis
D) Legionnaires disease - correct answer...✔✔B) Mycoplasma pneumonia
Mycoplasma pneumonia is the organism most commonly seen in children and young
adults. It is easily spread from droplets, from sneezing and coughing, in close proximity.
Diagnosis is based on symptoms and x-ray results of infiltrates in lower lobes.
Which of the following antihypertensive medications has beneficial effects for an elderly
White female with osteoporosis?
A) Calcium channel blocker
B) Angiotensin-converting enzyme (ACE) inhibitor
C) Beta-blocker
D) Diuretic - correct answer...✔✔A) Calcium channel blocker
Calcium channel blockers act by blocking the cal- cium channels in the heart muscle
and the blood vessels, thereby keeping more calcium in the bones.
All of the following are false statements regarding acute gastritis except:
A) Chronic intake of nonsteroidal anti-inflammatory drugs (NSAIDs) can cause the
disorder
B) Chronic lack of dietary fiber is the main cause of the disorder
C) The screening test for the disorder is the barium swallow test
D) The gold standard to evaluate the disorder is a colonoscopy - correct answer...✔✔
C) The screening test for the disorder is the barium swallow test
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,The gold standard for diagnosing gastric disease is biopsy of gastric and/or duodenal
tissue by upper endoscopy. Chronic use of NSAIDs disrupts the production of
prostaglandins, which decreases blood supply and then breaks down the protective
layer of the mucosa, which leads to gastric disease.
Epidemiologic studies show that Hashimoto's disease occurs most commonly in:
A) Middle-aged to older women
B) Smokers
C) Obese individuals
D) Older men - correct answer...✔✔A) Middle-aged to older women
Hashimoto's disease commonly occurs in middle-aged to older women.
A 63-year-old patient with a 10-year history of poorly controlled hypertension presents
with a cluster of physical exam findings. Which of the following indicate target organ
damage commonly seen in hypertensive patients?
A) Pedal edema, hepatomegaly, and enlarged kidneys
B) Hepatomegaly, AV nicking, bibasilar crackles
C) Renal infection, S3, neuromuscular abnormalities
D) Glaucoma, jugular vein atrophy, heart failure - correct answer...✔✔B)
Hepatomegaly, AV nicking, bibasilar crackles
With long-term, uncontrolled hypertension, organ damage may occur. Organs
commonly affected include: brain (stroke), eyes (retinopathy, AV nicking, bleeding,
blindness), heart (heart dis- ease, left ventricular hypertrophy, MI, and/or CHF), and
kidneys (renal failure, proteinuria).
While performing a Pap smear on a postmenopausal patient, several areas of flat white
skin lesions that are irregularly shaped are found on the patient's labia. The patient
reports that the lesions are extremely itchy and have been present for several years
without much change. Which condition is best described?
A) Chronic scabies infection
B) Lichen sclerosus
C) Chronic candidal vaginitis
D) A physiologic variant found in some older women - correct answer...✔✔B) Lichen
sclerosus
Lichen sclerosus is a disease of the skin, in which white spots appear on the skin and
change over time. It is most commonly seen in the genital and rectal areas, but can
appear in other areas. The spots are usually shiny and smooth and can eventually
spread into patches. The skin appears thin and crinkled. Then the skin tears easily, and
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,bright red or purple bruises are common. Sometimes, the skin becomes scarred. If the
disease is a mild case, there may be no symptoms
The heart sound S2 is caused by:
A) Closure of the atrioventricular valves
B) Closure of the semilunar valves
C) Opening of the atrioventricular valves
D) Opening of the semilunar valves - correct answer...✔✔B) Closure of the semilunar
valves
The heart sound S2 is caused by closure of the semilunar valves.
Jason, an 8-year-old with type 1 diabetes, is being seen for a 3-day history of fre-
quency and nocturia. He denies flank pain and is afebrile. The urinalysis result is
negative for blood and nitrites but is positive for a large amount of leukocytes and
ketones. He has a trace amount of protein. Which of the following is the best test to
order initially?
A) Urine for culture and sensitivity
B) 24-hour urine for protein and creatinine clearance
C) 24-hour urine for microalbumin
D) An intravenous pyelogram - correct answer...✔✔A) Urine for culture and sensitivity
An 8-year-old male patient with the diagnosis of diabetes has a high risk of urinary tract
infections. A large amount of leukocytes in the urinalysis is abnormal and he has been
having symptoms of frequency and nocturia for the past 3 days. The urine culture would
be ordered because he has a high risk of infection. The urine culture and sensitivity
(C&S) is the best evaluation for diagnosing a urinary tract infection.
The best test for diagnosing congenital glaucoma is which of the following?
A) Fluorescein staining
B) Tonometry
C) Snellen vision exam
D) The refractive index - correct answer...✔✔B) Tonometry
A tonometer is used to measure the intraocular pressure (IOP) of the eye to screen for
glaucoma. Normal range IOP is 10-22 mm Hg.
All of the following are false statements about atopic dermatitis except:
A) Contact with cold objects may exacerbate the condition
B) It does not have a linear distribution
C) It is associated with bullae
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, D) The lesions have vesicles that are full of serous exudate - correct answer...✔✔B) It
does not have a linear distribution
Atopic dermatitis is a skin condition in which the lesions occur in a linear fashion. They
may have many different stages, including erythematous papules and vesicles, with
weeping, drainage, and/or crusting. Lesions are commonly found on the scalp, face,
forearms, wrists, elbows, and backs of the knees. Commonly pruritic. Also known as
eczema.
All of the following are possible causes for secondary hypertension except:
A) Acute pyelonephritis
B) Pheochromocytoma
C) Renovascular stenosis
D) Coarctation of the aorta - correct answer...✔✔A) Acute pyelonephritis
Pheochromocytoma is an adrenal gland tumor in which there is increased production of
the hormones adrenaline and noradrena- line, which may cause long-term elevation in
blood pressure. Renovascular steno- sis is a narrowing of one or both arteries leading
to the kidneys. It can cause severe hypertension and irreversible kidney damage.
Coarctation of the aorta is a con- genital heart defect of the aorta; it is a narrowing of the
aorta that causes the heart to work harder to get blood to flow through the narrow aortic
passageway to other organs, which in turn causes an increase in blood pressure.
A patient with a history of mitral valve prolapse (MVP) is requesting prophylaxis before
her dental surgery. Which of the following would you prescribe this patient?
A) Amoxicillin a half hour before and 2 hours after the procedure
B) Amoxicillin 1 hour before the procedure
C) Amoxicillin 1 hour before and 3 hours after the procedure
D) Prophylaxis is not recommended for this patient - correct answer...✔✔D)
Prophylaxis is not recommended for this patient
The American Heart Association does not recommend routine antibiotic prophylaxis
prior to dental procedures except for patients who are at high risk for bacterial
endocarditis (a prosthetic cardiac valve, previous history of bacterial endocarditis,
congenital heart defects, etc.).
An elderly woman has been on digoxin (Lanoxin) for 10 years. Her electrocardio- graph
(EKG) is showing a new onset of atrial fibrillation. Her pulse is 64/min. She denies
syncope and dizziness. Which of the following interventions is most appropriate?
A) Order an electrolyte panel and a digoxin level
B) Order a serum thyroid-stimulating hormone (TSH), digoxin level, and an electrolyte
panel
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