Potent Potables
A 68-year-old female with diabetes mellitus, coronary artery disease, fibromyalgia, and dyspepsia presents for follow-up. She has been taking omeprazole (Prilosec) for 10 years. It was started during a hospitalization, and her symptoms have returned with previous trials of discontinuation.
Which one of the following adverse events is this patient at risk for as a result of her omeprazole use?
A. Hypermagnesemia
B. Urinary tract infections
C. Nephrolithiasis
D. Hip fractures
B. Hip Fractures
A 38-year-old female who recently underwent a laparoscopic sleeve gastrectomy for weight loss presents to your office for a follow-up visit. She has had no complications with her recent postoperative course. Her medical history includes diabetes mellitus, hypertension, and hyperlipidemia. She has also had problems with bilateral knee pain from osteoarthritis. Patient education should include advising the patient to
A) drink extra fluids with meals
B) increase her intake of fibrous vegetables
C) avoid pregnancy for 3 years
D) take ibuprofen as needed for pain
E) have a bone density test in 2 years
E) have a bone density test in 2 years
A 35-year-old male amateur rugby player presents with right anterolateral hip pain of several months’ duration that has progressed to the point of interfering with his athletic performance. The pain is accentuated when he transitions from a seated to a standing position, and especially when he pivots on the hip while running, but he cannot recall any significant trauma to the area. Over-the-counter analgesics do not relieve the pain. On examination his gait is stable. The affected hip appears normal and is neither tender to palpation nor excessively warm to touch. Although he has a full range of passive motion, obvious discomfort is evident with internal rotation of the flexed and adducted right hip. Which one of the following is most strongly suggested by this clinical picture?
A) Osteoarthritis
B) Avascular necrosis
C) Bursitis
D) Impingement
E) Pathologic fracture
D) Impingement
A 46-year-old male with a prosthetic heart valve requests your advice regarding antibiotic prophylaxis for an upcoming dental procedure. The patient is allergic to penicillin. Which one of the following would be most appropriate? A) Ciprofloxacin (Cipro) B) Clindamycin (Cleocin) C) Doxycycline D) Rifampin (Rifadin) E) Trimethoprim/sulfamethoxazole (Bactrim)
B) Clindamycin (Cleocin)
A 76-year-old female presents with a 3-month history of watery diarrhea with up to 12 episodes per day. She has no hematochezia and no travel history. You suspect microscopic colitis. Which one of the following is the test of choice to confirm the diagnosis?
A) A barium enema
B) A stool test for calprotectin
C) A celiac panel
D) A biopsy of the colon
E) A jejunal biopsy
D) A biopsy of the colon
A 14-year-old female bumped heads with another player in a soccer game. She was knocked down, appeared briefly dazed, and now has a headache and mild dizziness while seated on the sidelines.
Which one of the following would be most appropriate at this point?
A. Return to play after symptoms have resolved for at least 30 minutes
B. Immediate neuroimaging to rule out intracranial injury
C. Complete cognitive and physical rest for 24 hours before returning to normal activities
D. Initial complete cognitive and physical rest followed by an individualized graded return to activity
D. Initial complete cognitive and physical rest followed by an individualized graded return to activity
An 82-year-old white male consults you following several syncopal episodes that are clearly orthostatic in nature. During the course of your evaluation you find that he has a large tongue, mild cardiomegaly, and findings that suggest bilateral carpal tunnel syndrome. The most likely diagnosis at this time is A) pernicious anemia
B) cervical spondylosis
C) amyloidosis
D) polymyalgia rheumatica
C) amyloidosis
A 16-year-old male is hit on his shoulder while playing football. A radiograph subsequently reveals a midclavicular fracture that is minimally displaced. Appropriate management would be
A) a weekly radiograph to monitor for displacement
B) a sling for 2–6 weeks
C) a shoulder immobilizer for 6 weeks
D) a figure-of-eight bandage for 8 weeks
E) immediate referral to an orthopedist
B) a sling for 2–6 weeks
A 62-year-old male with diabetes mellitus recently underwent angioplasty with placement of a drug-eluting stent for the treatment of left main coronary artery disease and acute coronary syndrome. The patient is not considered at high risk for bleeding and you initiate dual antiplatelet therapy with aspirin and clopidogrel (Plavix). For how long should this patient continue dual antiplatelet therapy?
A) 1 month
B) 3 months
C) 6 months
D) 9 months
E) At least 12 months
E) At least 12 months
A 33-year-old female comes to your office for follow-up of irritable bowel syndrome. You ruled out other causes of her abdominal bloating, abdominal pain, and diarrhea at earlier visits. She has no change in symptoms, such as constipation or blood in her stool. She has resisted treatment in the past, but her symptoms are becoming more frequent and she would now like to consider treatment. Evidence shows that which one of the following would most likely be beneficial for this patient?
A) Acupuncture
B) Increased insoluble fiber in her diet
C) Fluoxetine (Prozac), 20 mg daily
D) Neomycin, 1000 mg every 6 hours for 7 days
E) Polyethylene glycol (MiraLAX), 17 g daily
C) Fluoxetine (Prozac), 20 mg daily
A 62-year-old male comes to your office as a new patient. He has a past history of a myocardial infarction and is currently in stage C heart failure according to the American Heart Association classification. His ejection fraction is 30%. Which one of the following medications that the patient is currently taking is potentially harmful and should be discontinued if possible?
A. Diltiazem (Cardizem)
B. Lisinopril (Prinivil, Zestril)
C. Carvedilol (Coreg)
D. Atorvastatin (Lipitor)
A. Diltiazem (Cardizem)
A 32-year-old obese female from Saudi Arabia presents with muscle aches. Her clothing limits sun exposure and you decide to test her for vitamin D deficiency. Which one of the following is the most appropriate test for this condition?
A) Calcium
B) Alkaline phosphatase
C) 25-hydroxyvitamin D
D) 1,25-dihydroxyvitamin D
E) Parathyroid hormone
C) 25-hydroxyvitamin D
An 18-year-old female presents with a painful right ankle after twisting it during a basketball game. On examination she has no tenderness over the lateral malleolus or posterior distal fibula, which she has identified as the location of the pain. According to the Ottawa ankle rules, which one of the following would indicate that an ankle radiograph should be performed?
A) Moderate ankle swelling
B) The inability to bear weight on the right foot with the left foot elevated for 5 seconds
C) The inability to stand for 5 seconds with weight evenly distributed on both feet, at the time of injury and during the evaluation
D) The inability to take 4 steps at the time of the injury and during the evaluation
E) The inability to walk 6 feet during the evaluation
D) The inability to take 4 steps at the time of the injury and during the evaluation
You are called to a rapid response on the inpatient medical ward at your local hospital. A 66-year-old male who was admitted for pneumonia complains of the sudden onset of lightheadedness. Evaluation of his mental status shows that he is coherent. His heart rate is 175 beats/min and his blood pressure is 120/62 mm Hg. A cardiac rhythm strip reveals a widened, regular, monomorphic QRS. Which one of the following would be the best initial management of this patient?
A) Chest compressions
B) An isotonic fluid bolus
C) Adenosine (Adenocard)
D) Defibrillation
C) Adenosine (Adenocard)
Which one of the following patients should be tested for Helicobacter pylori infection and, if positive, treated with eradication therapy without endoscopy?
A) A 45-year-old male with a 2-month history of epigastric burning after eating
B) A 45-year-old male who has progressive epigastric pain with associated anorexia and weight loss
C) A 53-year-old female with a 6-week history of burning in the chest after eating
D) A 60-year-old female with a 2-month history of constant epigastric burning
E) A 60-year-old male who takes daily aspirin and has developed epigastric burning and associated vomiting over the past month
A) A 45-year-old male with a 2-month history of epigastric burning after eating
You evaluate an 18-month-old male with fecal impaction and determine that disimpaction is indicated. Which one of the following would be most appropriate initially?
A. An oral stimulant such as sennosides (Senokot)
B. An oral osmotic agent such as polyethylene glycol 3350 (MiraLax)
C. An enema using saline, mineral oil, or phosphate soda
D. A bisacodyl (Dulcolax) rectal suppository
E. Manual disimpaction
B. An oral osmotic agent such as polyethylene glycol 3350 (MiraLax)
A 55-year-old male sees you for follow-up. His medical problems include morbid obesity, type 2 diabetes mellitus, hypertension, hyperlipidemia, and major depressive disorder. His medications include metformin (Glucophage), glipizide (Glucotrol XL), lisinopril (Prinivil, Zestril), aspirin, simvastatin (Zocor), and fluoxetine (Prozac). His BMI is 52.4 kg/m2 and he is struggling to lose weight. Which one of the following medication replacements could help promote weight loss?
A) Atorvastatin (Lipitor) instead of simvastatin
B) Canagliflozin (Invokana) instead of glipizide
C) Carvedilol (Coreg) instead of lisinopril
D) Paroxetine (Paxil) instead of fluoxetine
E) Pioglitazone (Actos) instead of glipizide
B) Canagliflozin (Invokana) instead of glipizide
A 34-year-old male presents with a painful great toe after his foot was stepped on during a soccer game. He has significant bruising and tenderness over the first distal phalanx and has no rotational deformity. You obtain a radiograph and see a nondisplaced fracture of the distal first phalanx that involves 40% of the joint space. Which one of the following would be the preferred treatment for this fracture?
A) Buddy taping
B) A rigid-sole shoe
C) A short leg walking cast with a toe plate
D) Surgical fixation
D) Surgical fixation
A 63-year-old male hospitalized for treatment of metastatic lung cancer develops a proximal deep vein thrombosis of the leg. Which one of the following anticoagulants should be prescribed when he is discharged from the hospital?
A) Apixaban (Eliquis)
B) Dabigatran (Pradaxa)
C) Enoxaparin (Lovenox)
D) Rivaroxaban (Xarelto)
E) Warfarin (Coumadin)
C) Enoxaparin (Lovenox)
A 7-month-old infant is hospitalized for the third time with lower-lobe bronchopneumonia. Findings include a weight and height below the 10th percentile. A sibling died of sudden infant death syndrome. Laboratory testing reveals a hemoglobin level of 9.0 g/dL (N 10.5–14.0), a mean corpuscular volume of 85 m 3 (N 72–88), and a serum calcium level of 9.0 mg/dL (N 9.0–10.5). A sweat chloride level is 20 mEq/L (N < 60)
A) Cystic fibrosis
B) DiGeorge’s syndrome
C) Battered child syndrome
D) Gastroesophageal reflux
E) -Thalassemia
D) Gastroesophageal reflux
A 30-year-old female is referred to you by a local optometrist after she was treated several times for anterior uveitis. You are concerned about an associated systemic disease. She feels well otherwise, and denies back or joint pain, rash, cough, or fever. A chest radiograph reveals enlarged mediastinal lymph nodes.
Which one of the following is most likely to be associated with her recurrent uveitis? (check one)
A. Cat-scratch disease
B. Lyme disease
C. Sarcoidosis
D. Syphilis
C. Sarcoidosis
A 4-year-old male is brought to your office by his maternal aunt, who is his new guardian. She is concerned that he is exhibiting problems with behavior and attention. On examination you note long, wide, protruding ears, an elongated face, and frontal bossing. Which one of the following is the most likely cause of these dysmorphic features?
A) Angelman syndrome
B) Fragile X syndrome
C) Klinefelter syndrome
D) Marfan syndrome
E) Prader-Willi syndrome
B) Fragile X syndrome
An 11-year-old female who plays in a local youth soccer league presents with right heel pain that has persisted for several months. She does not recall a specific injury that could have caused the pain. On examination the skin is intact and she is tender over the right posterior heel. Examination of the ankle and forefoot is unremarkable and a neurovascular examination is normal. You decide that rest and physical therapy would be the best initial management. Which one of the following is CONTRAINDICATED for this patient?
A) Ice packs
B) Moist heat
C) Whirlpool therapy
D) An exercise prescription
E) Therapeutic ultrasound
E) Therapeutic ultrasound
One of your patients recently went into atrial fibrillation and you order an echocardiogram. The diameter of which one of the following structures best predicts the likelihood that sinus rhythm will be maintained after successful cardioversion?
A) The left atrium
B) The right atrium
C) The left ventricle
D) The right ventricle
E) The aortic root
A) The left atrium
A patient is admitted to the hospital with severe acute pancreatitis, based on diagnostic criteria for severity. After appropriate intravenous hydration, which one of the following is associated with shorter hospital stays and lower mortality?
A) Parenteral nutrition
B) Nothing by mouth until the pain has resolved
C) Clear liquids by mouth after 48 hours
D) Bolus nasogastric enteral nutrition
E) Continuous nasogastric enteral nutrition
E) Continuous nasogastric enteral nutrition