Pediatrics
Internal Medicine
Pulmonology
Cardiology
Potpourri
100
Which of the following methods is most useful in diagnosing respiratory syncytial virus? 1. Antibody titers 2. Viral cultures 3. Nasal wash for antigen detection 4. Sputum for antigen detection
(3) Nasal wash for antigen detection Nasal wash can be used for respiratory syncytial virus antigen detection. Immunofluorescence is also used.
100
What is the most frequent neurologic complication in patients with chronic renal failure? 1. Seizures 2. Peripheral neuropathy 3. Parkinsonism 4. Dementia
(2) Peripheral neuropathy -Patients with chronic renal failure can develop peripheral neuropathy that is most often distal, symmetric, and mixed sensorimotor. -It affects males more than females. -There is often axon degeneration. -Dialysis may improve the condition.
100
In a patient with new onset clubbing, what is the study of choice? 1. Pulmonary function tests 2. Liver function tests 3. Cardiac enzymes 4. Chest x-ray
(4) Chest x-ray -Clubbing of both hands is an asymptomatic pulmonary process that requires chest x-ray for further evaluation.
100
A 34-year-old non-obese man with a strong family history of cardiovascular disease (first-degree relatives with heart attack and stroke) asks about the best diet to follow. Which of the following diets has been shown in randomized clinical trial to reduce the risk of cardiovascular events? 1. High protein diet 2. Low-fat diet 3. Mediterranean diet 4. Very low-calorie diet
(3) The Mediterranean diet has been show to reduce the risk of cardiovascular events. Characteristics of the Mediterranean diet include high intake of fruits, vegetables, whole grains, nuts, beans, and seeds; olive oil as the main source of unsaturated fat; moderate wine intake; and low red meat consumption.
100
Hepatitis A is spread via the: 1. Blood borne route 2. Fecal-oral route 3. Respiratory droplet route 4. None of the above
(2) Fecal-oral route Hepatitis A is spread via the fecal-oral route; Vaccination and passive immunization have decreased the incidence of the disease; Advances in sanitation have also decreased the incidence of the disease; Hepatitis B, C and D are blood borne
200
In a child less than 12 months of age with a fever, seizure and clouded sensorium, which of the following tests must be a priority in the ER? 1. BMP 2. Nasal swab for H1N1 3. EEG 4. Lumbar puncture
(4) Lumbar puncture Any child less than 12 months of age who presents with a febrile seizure and postictal state needs to be evaluated for meningitis and/or encephalitis. -An EEG following a first febrile seizure may not be necessary if a source of infection is found. -A BMP may be drawn to monitor electrolytes but will not determine a cause for the febrile seizure. A nasal swab for swine flu is not indicated for patients presenting with febrile seizures as their primary symptom.
200
A 54-year-old man comes to the physician for follow-up. He had a recent screening colonoscopy that showed 4 small polyps of 4-6 mm in the rectum. All were removed by cold biopsy. Histopathologic examination showed hyperplastic polyps with no dysplasia. Which of the following studies is the most appropriate follow-up for this patient? 1. Colonoscopy in 1-2 years 2. Colonoscopy in 3 years 3. Colonoscopy in 5 years 4. Colonoscopy in 10 years 5. Genetic testing for familial polyposis syndrome
(4) Colonoscopy in 10 years. Patients with small, distal hyperplastic polyps should be considered to have a normal colonoscopy and are at average risk for colorectal cancer.
200
What is a normal FEV1 to FVC ratio percentage? 1. 30 percent 2. 55 percent 3. 75 percent 4. 90 percent
(3) 75 percent -Normal FEV1 to FVC is 75 percent
200
Which of the following chest pain descriptions by a patient is most consistent with myocardial ischemia (angina pain)? 1. Bursting 2. Fleeting 3. Heartburn 4. Knife-like 5. Pins and needles
(3) Ischemic chest pain is usually described as chest tightness, heaviness, squeezing, crushing, burning, heartburn, achiness, band-like, or pressure sensation. In contrast, chest pain describes as sharp, stabbing, positional, and/or pleuritic is generally non-cardiac in etiology.
200
Folic acid deficiency is thought to be the cause for one of the following birth defects: 1. Cardiac defects 2. Neural tube defects 3. Arthrogryposis 4. Trachea esophageal fistula
(2) Neural tube defects - Folate deficiency in pregnancy can cause neural tube defects. -Neural tube defects occur due to failure of fusion of neural tubes during early fetal life -Folate supplementation is advised for all pregnant mothers before pregnancy -Rubella infection can result in congenital cardiac defects
300
A 2-year-old boy is brought to the physician for evaluation of a rash. For the past 3 days, the child has been febrile to 40C (104F). The fever subsided today, but he developed a rash on his neck and back. The parents gave him acetaminophen and ibuprofen for the fever. His current temperature is 37.5 C (99.5F) and pulse if 112/min. A blanching, erythematous, maculopapular rash is present on his neck, abdomen, and extremities. Which of the following is the most likely cause of this child's condition? 1. Coxsackie virus 2. Human herpes virus 3. Measles virus 4. Parvovirus B19 E. Rubella virus
(2) Human herpes virus. Roseola is caused by human herpes virus 6 and classically presents 3-5 days of high fever that resolves abruptly. It is followed by erythematous maculopapular rash that begins on the neck and trunk and spreads to the face and extremities.
300
Oral vancomycin is most appropriate for treatment of which of these organisms? 1. MRSA 2. Enterovirus 3. Closridium difficile 4. Escherichia coli
(3) Clostridium difficile. Oral vancomycin is typically used for severe infections, and metronidazole is used for mild-to-moderate infections.
300
Which of these is the principal imaging test for the diagnosis of pulmonary embolism? 1. CT angiography 2. Venous ultrasonography 3. ECG 4. Lung scanning
(1) CT angiography scan of the chest with IV contrast is the principal imaging test for the diagnosis of primary embolism. The CT scan results in excellent images of the RV and LV, and can be used for risk stratification as well as diagnosis.
300
In which of the following conditions should a beta blocker be used as first-line therapy for hypertension? 1. Age greater than 60 2. Depression 3. Isolated systolic hypertension 4. Renovascular hypertension 5. Systolic heart failure
(5) Systolic heart failure Beta blockers are not typically considered first-line therapy for hypertension as they are associated with less protection against stroke and a possible increase in mortality, particularly in patient age greater than 60. They should be considered in patients with either a compelling indication or other condition responsive to beta blocker therapy (eg, systolic heart failure).
300
What muscle grade is characterized by full range of motion against full resistance? (1.) 2 muscle grade (2.) 3 muscle grade (3.) 4 muscle grade (4.) 5 muscle grade
(4) 5 muscle grade -Muscle grade 5 is characterized by full normal range of motion against resistance and gravity. -Muscle grade 4 is characterized by full normal range of motion against gravity and minimal resistance. -Muscle grade 3 is characterized by full normal range of motion against only gravity. -Muscle grade 2 is characterized by full range of motion without gravity.
400
A 3-year-old boy is brought to the physician with 2 days of watery diarrhea, abdominal pain, and a fever of 38 C (100.4F). He has not eaten much in the past day but is drinking small amounts of fluids without vomiting. He has no underlying health problems and has no other complications. He takes no medications and has no allergies. During the examination, the parents ask if the child is dehydrated. A change in which of the following is the most accurate method of assessing the degree of dehydration? 1. Capillary refill 2. Pulse 3. Respiratory rate 4. Skin elasticity 5. Weight
(5) Weight. Decrease oral intake, diarrhea, and fever are risk factors for dehydration. Percent weight loss is the gold standard in determining degree of dehydration. Familiarity with other clinical signs of dehydration is essential to guide appropriate rehydration therapy and prevent severe dehydration.
400
A 67-year-old man comes to the physician for a preventative visit. He has a history of hypertension controlled with amlodipine. He does not recall any previous pneumonia vaccines. Which of the following is the most appropriate vaccination advice for this patient? 1. 13-valent pneumococcal conjugate (PCV13) vaccine only 2. 13-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal polysaccharide vaccine 3. 23-valent pneumococcal polysaccharide vaccine only 4. No pneumococcal vaccination
(2) 13-valent pneumococcal conjugate vaccine is recommended for all adults age 65 years or greater followed by the 23-valent pneumococcal polysaccharide vaccine at least 6-12 months later.
400
Oxygen should be administered to maintain an O2 saturation of at least which of these percentages in all patients with moderate-to-severe asthma? 1. 90% 2. 94% 3. 96% 4. 98%
(2) 94%. An oxygen saturation of less than 92%-94% 1 hour after beginning standard treatment is a strong predictor of the need for hospitalization. Oxygen should be administered as soon as possible in the office setting or during transport by emergency medical services before reaching the hospital. At the hospital, it is recommended to maintain an oxygen saturation greater than 94%.
400
A 31-year-old woman recently diagnosed with mitral valve prolapse asks about complications of her disease. Which of the following is the most important determinant of adverse events in this patient? 1. Anxiety disorder 2. Degree of mitral regurgitation 3. Nonexertional chest pain 4. Resting bradycardia 5. Ventricular premature beats 4.
(2) Degree of mitral regurgitation. Moderate to severe mitral regurgitation and a reduced ejection fraction less than 50% are associated with increased risk of adverse cardiovascular event in patient with mitral valve prolapse.
400
What is the feared complication of retropharyngeal abscess? 1. Sepsis 2. Airway compromise 3. Mediastinitis 4. Aspiration pneumonia
(2) Airway compromise -Airway compromise can occur in a rapidly filling retropharyngeal abscess. -Usually patients present with strider and hyper extended neck -Aspiration pneumonia, sepsis, and mediastinitis are other complications
500
A newborn boy is in the nursery after a spontaneous vagina delivery. Yesterday, his mother was febrile and developed a vesicular rash covering most of her body. She was diagnosed with varicella zoster infection, and acyclovir treatment was initiated. The infant has normal Apgar scores, vital signs, and physical examination. Which of the following is the best approach to the management of the newborn? 1. Administer acyclovir 2. Administer varicella zoster vaccine 3. Feed the infant formula instead of breast milk 4. Isolate the infant from the mother 5. Measure the anti-varicella antibody level
(4) Isolate the infant from the mother. Newborns exposed to varicella are at a high risk of developing life-threatening neonatal varicella infection. Infants should be followed closely for signs of infection and isolated from the infected contact until all lesions have crusted. Varicella zoster immune globulin should be administered to infants whose mothers became symptomatic 5 days before or 2 days after delivery.
500
Which of these is the minimal percentage of body weight loss that has been shown to decrease triglycerides, glucose and hemoglobin A1C? (1.) 1%-2% (2.) 3%-5% (3.) 6%-8% (4.) 9%-10%
(2) 3%-5%. Sustained weight loss of 3% -5% can decrease multiple clinical markers and decrease the risk of developing type 2 diabetes mellitus. Greater weight loss results in greater decrease in clinical markers.
500
Which of these is the gold-standard investigation for the diagnosis of bronchiectasis? 1. Chest radiography 2. High-resolution CT (HRCT) scan of the chest 3. Spirometry 4. Culture of sputum
(2) High resolution CT (HRCT) scan of the chest. Bronchial wall dilation and thickening is seen on HRCT. A chest radiograph can neither exclude nor establish the diagnosis of bronchiectasis. FEV1 as determined by spirometry is an easily recorded marker of disease progression. Sputum cultures are collected at different time points to determine the type of antibiotic therapy.
500
Your 57-year-old African-American male patient is undergoing routine physical examination. He states he has not seen a physician in 8 years. He has a family history of premature cardiovascular disease, and smokes 10 t0 12 cigarettes daily. He has a sedentary lifestyle and reports heavy alcohol consumption. Currently, BMI is 41 kg/m2. Systolic blood pressure is 185 mm Hg and diastolic blood pressure is 112 mm Hg. No obvious signs of renovascular disease are noted. Which of these is the most likely diagnosis? 1. Prehypertension 2. Primary hypertension 3. Secondary hypertension 4. Stage 1 hypertension
(2) Primary hypertension is defined as high BP for which no obvious secondary cause (eg, renovascular disease, aldosteronism, pheochromocytoma, or gene mutations) can be determined.
500
What is the best conformational test for tinea versicolor? 1. Clinical 2. KOH 3. Wood lamp 4. Antibody
(2) KOH -Tinea veriscolor can be confirmed with KOH microscopic examination. -Wood lamp will often show fluorescence
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