Dermatology
Heme/Onc
GI
Neurology
Cardiology
100
A 4-year-old girl was diagnosed with chicken pox 15 days ago with her parents, who are concerned that their daughter continues to develop new lesions. They describe that she "seems to keep getting new groups of itchy bumps". On exam, her most recent lesions appear as 2-4 mm rounded, reddish-brown macules and papules. older lesions, some of which are beginning to crust, are both vesicular and necrotic in nature. Lesions are most prominent on the trunk and are symmetrically distributed over the proximal thighs and flexor surfaces of the arms. Which of the following is the most appropriate treatment?
A. Topical steroids
B. Systemic steroids
C. Oral Erythromycin
D. Antihistamines
E. IVIG
1
C. Oral erythromycin
100
A 16 year old teen male presents to your office with a large, firm 2 cm testicular mass. A subsequent U/s confirms the presence of a solid mass. which of the following is the most appropriate next step?
A. Orchiectomy with trans scrotal approach
B. BM biopsy for mets
C. Measurement of serum beta hcg and alpha fetoprotein
D. Referral to fertility clinic to discuss sperm banking
E. Needle biopsy of mass for pathologic evaluation.
C. Measurement of serum beta hcg and alpha fetoprotein
100
A 16 yo girl presents with a 2-3 week history of nausea, bilious vomiting, and intercurrent abdominal pain. she reports relief of pain when lying on her left side in a knee-chest positioning. her BMI is in the 5th % and she reports trying to lose weight. Evaluation includes an UGI series, which showed a mechanical obstruction in the 3rd portion of the duodenum and a dilated stomach. Which of the following disorders is most commonly associated with her likely diagnosis?
A. T2DM
B. IBS
C. Anorexia
D. Small bowel lymphoma
E. Wilson syndrome
C. Anorexia
100
A 8-year-old girl presents with a hx of intermittent headaches. They are described as pounding, moderate in intensity, and located in the b/l frontal area. She has no aura and frequently experiences nausea and vomiting. there is associated photo and phonophobia. Which of the patient's symptoms is seen more frequently in kids who have migraines compared to adults with migraines?
A. Presence of aura
B. Osmophobia
C. Photophobia
D. Bilateral pain
E. Phonophobia
D. Bilateral pain
100
A 16 year old girl presents to office for a new complaint of recurrent syncope over the past several months. She is on no meds and has a normal neuro exam. Lytes are normal. EKG is below. Based on this tracing, you should initiate therapy with which of the following?
A. High dose ASA
B. Nadolol
C. Glucose insulin drip
D. Fludrocortisone
E. Amiodarone
B. Nadolol
200
A 40 yo male who returned from Belize 4 days ago is evaluated for fever, retro orbital pain myalgia and severe lumbosacral pain. the skin changes shown occurred following insufflation of the BP cuff. Which of the following is the most likely diagnosis?
A. Dengue
B. Hep A
C. Leptospirosis
D. Malaria
Dengue
200
A 78 yo male undergoes pre op eval for left knee arthroplasty. besides knee pain, he has no other symptoms. PMHx is unremarkable. His only med is Ibuprofen, which is d/c. On exam, VSS. Diffuse adenopathy w nodes 1.5-2 cm are present in the cervical, axillary, and inguinal areas. Spleen is enlarged 2 cm below left costal margin. Results of the labs show leukocyte count of 62K and 90% lymphocytes, Hb 12.8, Platelets 152K. Flow cytometry shows a predominance of CD5, CD19, and CD 20 cells expressing only K light changes consistent with CLL.
Which of the following is the most appropriate management?
A. BM biopsy
B. Begin ibrutinib
C. Begin rituximab and bendamustine
D. Proceed with surgery
Proceed with elective surgery
200
A 44 yo woman is evaluated for a 6-month hx of non-bloody liquid stools 5-6 x a day. She has a good appetite and no weight loss. she underwent cholecystectomy for acute cholecystitis 5 years ago. On exam, VSS. Abd is soft, non-tender, and non-distended with hyperactive bowel sounds. Labs reveal stool sodium level of 85 and stool potassium 4.5. CBC and TSH are normal.
Which of the following conditions are most consistent with this patient stool studies?
A Bile salt induced diarrhea
B. Enterotoxigenic E. coli
C. Fructose malabsorption
D. VIPoma
Bile salt induced diarrhea
Fecal osmotic gap= 290 - (sx stool sodium + stool potassium)
if stool osmotic gap is > 100 mOsm/kg suggests osmotic diarrhea
200
A 31 yo man is evaluated for a 5 mm saccular aneurysm in the ACA found incidentally on MRA of head, ordered to investigate new onset trigeminal neuralgia. The pt is otherwise asymptomaic and has no additional medical problems. He is on Carbamazepine. On Exam, VSS and exam are normal. Which of the following is the most appropriate management?
A. Aneurysm clipping
B. Aneurysm coiling
C. Catheter based angiography
D. CT angiography
E. Serial MRA
Serial MRA
200
A 63 yo male is evaluated during a follow up exam for rheumatic aortic valve disease. He is asymptomatic and has not exercise limitations. He has no other medical problems. On exam, BP is 134/32. Grade 3/6 holo diastolic murmur is heard best at LSB. Peripheral pulses are bounding. No evidence of heart failure. TTE showed L EF of > 55% and tricuspid aortic valve with severe aortic regurgitation. the left ventricular end systolic dimension is elevated 45 mm.
Which of the following is the most appropriate Management?
A. Repeat eval in 6 months
B. Surgical aortic valve replacement
C. Transcatheter Aortic valve implantation
D. TTE
Repeat eval in 6 months
300
A 19 year old male with Crohn's disease presents with c/o "painful ulcer that won't get better" on his left shin. He was kicked in the shin while playing soccer. It has only worsened since, despite use of a topical antibiotic ointment. On exam, there is a 4 cm ulcer with overhanging, gray border of skin on the left lower leg. Which of the following is the most appropriate treatment for this patient?
A. Steroids
B. TMP/SMX
C. Cephalexin
D. Ketoconazole
E. Valacyclovir
A. Steroids
300
A 4-year-old boy presents to the ED after awakening in the morning " covered with bruises". His parents state that he appeared well throughout the previous day and denies trauma, daily meds, or allergies. Generalized petechiae and purpura are noted on the exam, which is otherwise normal. Which of the following would most likely be identified on peripheral smear if this patient's clinical findings were due to ITP?
A. Normal sized or large platelets
B. Micro thrombocytes
C. White blood cell inclusions
D. Schistocytes
E. Toxic granulations
A. Normal sized or large platelets
300
A 7-week-old infant returns in follow up for continued vomiting of feeds. weight is decreased by 3oz since last visit 6 days prior. On U/s, both the pyloric muscle thickness and length are greater than expected. These findings are known to occur with increased frequency among which of the following?
A. Female
B. Asian decent
C. Offspring of an affected parent
D. Post term births
E. Advanced maternal age
C. Offspring of an affected parent
300
A 16-year-old boy who is being treated for new onset focal epilepsy is admitted for SI. During routine labs, his AED level is within normal range. However, he is noted to be hyponatremic with Na level of 129. Which of the following medications is most often associated with this finding?
A. Oxcarbazepine
B. Phenytoin
C. Levetiracetam
D. Gabapentin
E. Valproate
A. Oxcarbazepine
300
An infant with severe cyanosis presents. For which of the following conditions would a balloon atrial septostomy be helpful?
A. A large VSD
B. TGA
C. Anomalous pulmonary venous return without obstruction
D. Truncus arteriosis
E. Tetralogy of Fallot
B. TGA
400
A 38 yo woman has acute fever, headache and sore throat that began 5 days ago. 2 days ago, a rash developed on her face and then spread to her proximal extremities. The rash is noted on the leg.
Which of the following is the most likely diagnosis?
A. Guttate psoriasis
B. Primary varicella zoster
C. Secondary syphilis
D. Smallpox 
Smallpox
400
A 62 yo woman is hospitalized for an abd wall hematoma at a recent surgical site and large eccymoses on her back and chest. She underwent an elective cholecystectomy 7 days ago; eccymoses appeared 2 days ago. she has no history of bleeding, and no family members have bleeding disorders. She is otehrwise well and takes no med. On exam, HR is 110 and other VSS. She has a 10 cm hematoma in the RUQ abd wall and ecchymoses on her chest and upper back.
labs: PTT: 89 s (77s after mixing study); Hb 10g/dl; Platelets 190K, PT 11s, fibrinogen 200 and F8activity 2%.
Which is the most appropriate treatment?
A. Activated factor 7
B. Desmopressin
C. FFP
D. Factor 8 concentrate
Activated Factor 7
400
A 60-year-old woman is evaluated for 6 months of progressive symptoms on dyspnea one exertion. She has cirrhosis due to metabolic dysfunction associated steatotic liver disease complicated by ascites and esophageal varices. Current meds are propranolol, furosemide and spironolactone. On exam, VSS. O2 sats are 99% on room air. Exam showed elevated CVP. The pulmonic component of S2 is increased in intensity. Lungs are clear. Liver is enlarged and tender and ascites are present. Posteroanterior and lateral radiographs of the chest are normal.
Which of the following is the most appropriate diagnostic test to perform next?
A. CT of chest
B. Echo
C. Echo with agitated saline
D. Ventilation - perfusion scanning
B. Echo
400
A 74 yo man is evaluated for fatigue and lack of energy. He had a pontine infarction 2 month ago. He has HTN, DM, and dyslipidemia. Current meds are ASA, HCTZ, Atorvastatin, and metformin. on exam, VSS. BMI 26. he has left facial weakness, slurred speech, left arm and leg weakness 4/5 with slower finger and toe tapping and a wide based gait using a cane. the remainder of the neuro and med exam is normal. Depression screening with PHQ 9 is normal.
which of the following is the most appropriate management?
A. Bupropion
B. Fluoxetine
C. Methylphenidate
D. MRI
D. Polysomnography
Polysomnography
400
A 38 yo male undergoes pre op eval before repair of torn ACL. His cardiac hx includes repaired Tet of fallot. He has no other symptoms. on exam, VSS. JVD and prominent a waves are noted. A RV heave is present. A single S2 is heard as is a grade 1/6 early systolic murmur localized to the left 2nd ICS and a grade 2/6 diastolic murmur best heard in the left 2nd and 3rd IC spaces. The diastolic murmur increases with inspiration.
Which of the following is the most likely diagnosis?
A. Aortic coarctation
B. Aortic regurgitation
C. Mitral stenosis
D. Pulmonary regurgitation
Pulmonary regurgitation
500
A 15-year-old Black male with albinism and decreased visual acuity presents for health maintenance examination. Exam show red hair, red/brown skin, multiple pigmented nevi and freckles. Which of the following is a common associated finding?
A. Nystagmus
B. Coloboma of iris
C. Ptosis and miosis
D. Macular degeneration
E. Conjunctival telangiectasia
A. Nystagmus
500
A 3-year-old boy presents with fussiness, diarrhea, widespread lymphadenopathy, and 3 "knots" on his skull. there has been no known trauma and no history of fever or URI symptoms. On exam, he is afebrile and alert but clingy. The skull lesions are non tender. The abdomen is distended, and a firm mass is noted in the left flank. Which metastatic disease is most likely associated with these findings?
A. Neuroblastoma
B. Hodgkin lymphoma
C. ALL
D. Wilms tumor
E. Osteosarcoma
A. Neuroblastoma
500
A 14-year-old girl recently diagnosed with celiac disease has been placed on a gluten free diet. She feels that this has bene preventing her from hanging out with friends and eating the same foods. therefore, she has had difficulty with the diet. In patients with celiac disease, compliance with dietary therapy is confirmed by:
A. Normal stools
B. Normal ttg and IgA levels
C. Normal serum albumin
D. Normal growth
E. Normal fecal calprotectin
Normal ttg and IgA levels
500
A 18-year-old college freshman presents for a preparticipation physical. She has a hx of seizures which is well controlled on AED. She also requests to be placed on OCP. which of the following AED could be used in conjunction with OCp without interfering with the action of the contraceptives?
A. Levetiracetam
B. Carbazepine
C. Phenytoin
D. Felbamate
E. Topiramate
A. Levetiracetam
500
Review this CXR in a workup for a kid with suspected CHD. It shows a "snowman sign". Which of the following best describes the anatomic anomaly typically associated with this radiographic sign?
a. Abnormal connection of the pulmonary veins
b. discordant AV and VA relationships "corrected transposition"
c. downward displacement of an abnormal tricuspid valve into the right ventricle
d. anterior deviation of the infundibular septum, resulting in vsd and subpulmonic stenosis.
e. a single arterial trunk rising from heart. 
a. Abnormal connection of the pulmonary vei