Shock
Microbiology
Pharmacology
Pathology
Random (Press Your Luck)
100
Cardiogenic
RA Pressure?
RV pressure?
PCWP (Left side preload) ?
Cardiac output?
SVR (afterload)?
High
High
High
Low
High
100
A 20-year-old female presents to student health with one week of a non-productive cough. On physical exam, there are intermittent diffuse crackles in all lung fields. CXR shows diffuse interstitial infiltrates and a cold agglutination test is positive. Which of the following is a characteristic of the most likely causative microorganism?
Anaerobic
Not seen on Gram stain
Induces production of auto-IgG antibodies
Seen on silver stain
Zoonotic
Not seen on Gram stain
100
A 74-year-old male with a PMH of congestive heart failure presents with increasing shortness of breath over the past two days. On physical exam, temp-37.2, BP-142/95, HR-89, RR-19, SpO2-90% RA. His extremities are warm and his lungs are dull to auscultation at the bases. He is diagnosed with acute decompensated heart failure and started on 100mg IV furosemide. Which of the following lab findings can be expected in this patient?
↑Na ↓K ↓Mg ↓Ca
↓Na ↓K ↓Mg ↑Ca
↑Na ↓K ↑Mg ↑Ca
↑Na ↑K ↑Mg ↓Ca
1. ↑Na ↓K ↓Mg ↓Ca
100
A 65-year-old male with a 48 pack-year history presents with abdominal pain, fatigue, intermittent nausea, and persistent cough. His physical exam is unremarkable. Labs are drawn and reveal an elevated calcium level. A workup for hypercalcemia is performed, showing a low PTH and an elevated PTHrP. The patient then gets a CXR, which shows a new hilar opacity on the left. Which of the following is the likely diagnosis?
Carcinoid tumor
Large cell carcinoma
Adenocarcinoma
Small cell carcinoma
Squamous cell carcinoma
Squamous cell carcinoma
100
A 9-month-old girl is transferred to the PICU and intubated following worsening respiratory status during her hospital admission for bronchiolitis. Her ABG the following morning shows pH-7.33, pO2-89, pCO2-49, HCO3-25. Which of the following ventilator changes should be made to correct the disturbance?
Increase FiO2
Decrease FiO2
Increase positive end-expiratory pressure (PEEP)
Decrease PEEP
Increase RR
Decreased RR
Decrease tidal volume
5. Increase RR
200
Septic/Distributive
RA Pressure
RV pressure
PCWP (Left side preload)
Cardiac output
SVR (afterload)
low/ normal
low/ normal
low/ normal
High
Low
200
An 11-year-old boy with cystic fibrosis is diagnosed with bacterial pneumonia. Which of the following is the most likely causative organism?
H. influenza
P. aeruginosa
S. aureus
S. pneumoniae
Klebsiella
S. aureus
200
A patient with stable angina is prescribed isosorbide mononitrate for episodes of chest pain. What is the major mechanism of action of this drug?
Decreased SA node activity leading to decreased HR
Decreased AV node activity leading to decreased HR
Systemic arterial dilation leading to decreased afterload
Coronary artery dilation leading to increased perfusion
Venous dilation leading to decreased preload
Venous dilation leading to decreased preload
200
A 68-year-old female with a PMH of ovarian cancer treated with salpingo-oophorectomy and bleomycin presents with six months of progressive dyspnea. On physical exam, diffuse crackles are heard on auscultation of the lungs. Which of the following PFT findings would be consistent with the diagnosis of a restrictive lung disease?
↑FVC; ↑TLC; ↑FEV1
↑FVC; ↑TLC; ↓FEV1
↑FVC; ↓TLC; ↓FEV1
↓FVC; ↓TLC; ↓FEV1
↓FVC; ↑TLC; ↓FEV1
↓FVC; ↓TLC; ↓FEV1
200
A 35 year old woman comes to the physician because of fever and sharp chest pain for 3 days. Her temperature is 38.5 C (101.3 F). A friction rub is heard on auscultation of the chest. After a thorough exam, all secondary causes of pericarditis are ruled out. Which of the following is the most likely cause of primary pericarditis in this patient?
A. Bacterium
B. Fungus
C. Parasite
D. Tumor
E. Virus
Virus
300
Hypovolemic Shock
RA Pressure
RV pressure
PCWP (Left side preload)
Cardiac output
SVR (afterload)
Low
Low
Low
Low
High
300
A 20-year-old man comes to the emergency department because of fever and altered mental status. Physical examination reveals a petechial rash on his trunk and arms and a positive Kernig sign. Two hours later he becomes hypotensive, and fluid resuscitation does not restore his blood pressure. A comprehensive metabolic panel is obtained and shows a sodium level of 119 mEq/L and potassium level of 6.0 mEq/L. A repeat physical examination shows generalized abdominal tenderness elicited upon deep palpation.
1) What clinical picture is this suggestive of?
2) Which of the following is the most likely additional finding?
A) Decreased activation of the sympathetic nervous system
B) Elevated cortisol
C) Elevated fibrinogen
D) Elevated renin levels
E) Metabolic alkalosis
D) Elevated renin levels
300
A 62-year-old man is brought to the ED with chest pain that began one hour earlier. While waiting in the ED, he develops palpitations. An EKG shows ventricular tachycardia, and he is given an unknown drug, which resolves the patient’s symptom. A repeat EKG shows that the patient is now in normal sinus rhythm but now reveals a new onset of QT prolongation. Which of the following drugs was most likely given to the patient?
Flecainide
Amiodarone
Lidocaine
Diltiazem
Esmolol
2. Amiodarone
300
The following EKG strip shows which type of arrythmia?
Atrial fibrillation
Sinus tachycardia
First degree heart block
Second degree heart block, type 1
Second degree heart block, type 2
Second degree heart block, type 1
300
A 6-year-old girl is brought to her pediatrician by her father with a sore throat and conjunctivitis. The father states that several of her classmates have been out of school with similar symptoms. On physical exam, that patient has conjunctival injection with watery discharge bilaterally and pharyngeal erythema with no tonsillar enlargement or discharge. Which of the following are characteristics of the most likely causative virus?
Double-stranded DNA, non-enveloped
Single-stranded DNA, enveloped
Single-stranded DNA, non-enveloped
Single-stranded RNA, enveloped
Double-stranded DNA, non-enveloped
400
Obstructive
RA Pressure
RV pressure
PCWP (Left side preload)
Cardiac output
SVR (afterload)
High
high
Low
(except tamponade - fluid pushing on heart so high)
Low
High
400
A 37-year-old male presents to the ED with three days of sinus congestion and one day of left-sided facial swelling. He also reports a headache but denies and nasal discharge, fever, cough, sore throat, and dyspnea. He has a past medical history of poorly-controlled T1DM with several admissions for diabetic ketoacidosis and was most recently discharged one week prior to this current presentation. On physical exam, the patient is noted to have a large necrotic lesion in his left nasal cavity. Culture of the lesion would most likely reveal an organism with which of the follow characteristics?
Encapsulated yeast
Septate hyphae branching at acute angles
Budding yeast
Non-septate hyphae branching at right angles
Pseudohyphae
Non-septate hyphae branching at right angles
400
A 76-year-old man presents to his PCP for a two-week follow-up appointment after starting a new medication for his systolic heart failure at his last visit. The patient reports no changes in his symptoms, but repeat labs show an elevation of his BNP from a baseline of 154pg/mL to a current level of 205pg/mL. Which of the following medications was the patient most likely started on?
Sacubitril/Valsartan
Enalapril
Losartan
Furosemide
Cavedilol
Sacubitril/Valsartan
400
A 56-year-old women presents to her PCP due to several weeks of intermittent loose stools. She says that these episodes are associated with facial flushing. On physical exam, temp-36.9, BP-122/79, HR-75, RR-14, SpO2-99% RA. The rest of the exam is unremarkable aside from wheezing heard on auscultation of the right middle lung field. A CXR is performed, which reveals a new right peri-hilar opacity. Following evaluation with a chest CT, the patient undergoes a biopsy, which reveals a diagnosis of carcinoid tumor. Which of the following is characteristic of this type of lung cancer?
Chromogranin A positive
Keratin pearls
Intercellular bridges
Association with smoking
Production of PTHrP
1. Chromogranin A positive
400
A 2-year-old boy is brought to his pediatrician by his mother because she has noticed that her son turns blue when he is running around or cries and that it improves if he squats. The boy was born full term at home and has no past medical history according to the mother. On physical exam, a 3/6 systolic murmur is heard at the second intercostal space at the left sternal border. Which of the following features is associated with this child’s most likely congenital defect?
Aortic stenosis
Left ventricular hypertrophy
Patent ductus arteriosus
Ventricular septal defect
Single vessel arising from both ventricles
4. Ventricular septal defect
500
Daily Double!!!!!
Who is your favorite TA????
I accept all answers except Sam
500
A 37-year-old woman presents to her PCP with patches of skin discoloration she first noticed three days ago. She states that the patches are non-pruritic and non-tender. She has never travelled outside of the country, but she did recently return from a trip to Texas to visit family. On exam, the patient has several scattered patches of hypopigmented skin that have decreased sensation. Which of the following organism is the most likely cause of these findings?
Mycobacterium leprae
HHV-3
Tinea versicolor
Candida albicans
Malassezia furfur
Mycobacterium leprae
500
An 8-year-old girl with asthma is prescribed montelukast to control her symptoms. What is the mechanism of this drug?
Muscarinic receptor antagonist
Mast cell degranulation inhibitor
5-lipoxygenase inhibitor
Leukotriene receptors antagonist
IgE receptor antagonist
Leukotriene receptors antagonist
500
A 47-year-old man presents to his PCP with a progressive cough over the past three weeks that is intermittently productive of blood-tinged sputum. His past medical history is significant for well-controlled hypertension and several episodes of sinusitis over the past year. He also reports mild dyspnea and an episode of hematuria a couple of days ago but denies any fever, chills and weight loss. He works as a farmer and has never smoked. Which of the following findings is most likely?
Septate hyphae branching at acute angles
Non-septate hyphae branching at right angles
Positive for anti-proteinase 3 antibodies
Positive for anti-myeloperoxidase antibodies
Positive for IgA immune complex depositions
Positive for anti-proteinase 3 antibodies
500
A 59-year-old man with hypercholesterolemia presents to his PCP for his annual physical. On routine lab work, the patient is found to have persistently elevated triglycerides despite being on 80mg atorvastatin. His PCP recommends starting an additional medication. Which of the following medications should be avoided due to its increased risk of myositis in combination with statins?
Niacin
Cholestyramine
Ezetimibe
Alirocumab
Gemfibrozil - Fibrate
Gemfibrozil - Fibrate