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Sports Medicine
100
A 30-year-old white gravida 2 para 1 who has had no prenatal care presents for urgent care at 33 weeks gestation. Her symptoms include vaginal bleeding, uterine tenderness, uterine pain between contractions, and fetal distress. Her first pregnancy was uncomplicated, with a vaginal delivery at term. Which one of the following is the most likely diagnosis? A) Uterine rupture B) Vasa previa C) Placenta previa D) Placental abruption E) Cervical cancer
What is Placental abruption
100
A 30 yo M comes to your office with a 1-year history of frequent abdominal pain, nonbloody diarrhea, and a 20-lb weight loss. He has no history of travel outside the United States, antibiotic use, or consumption of well water. His review of systems is notable for a chronic, intensely pruritic rash that is vesicular in nature. His review of systems is otherwise negative and he is on no medications. A) lactose intolerance B) irritable bowel syndrome C) collagenous colitis D) celiac sprue E) Crohn’s disease
celiac sprue 1.
100
For normal term infants, current practice is to introduce solid foods into the diet at what age? A) 2–4 weeks B) 2–3 months C) 4–6 months D) 7–9 months E) 1 year
What is 4-6 months 5.
100
A 24-year-old female with a 2-year history of dyspnea on exertion has been diagnosed with exercise-induced asthma by another physician. Which one of the following findings on pulmonary function testing would raise concerns that she actually has vocal cord dysfunction? A) A good response to an inhaled ?-agonist B) Flattening of the inspiratory portion of the flow-volume loop, but a normal expiratory phase C) Flattening of the expiratory portion of the flow-volume loop, but a normal inspiratory phase D) Flattening of both the inspiratory and expiratory portion of the flow-volume loop 1 E) A decreased FEV and a normal FVC
What is Flattening of the inspiratory portion of the flow-volume loop, but a normal expiratory phase
100
A 35-year-old male amateur rugby player seeks your advice because right hip pain of several months’ duration 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 and finds no relief with over-the-counter analgesics. 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
What is Impingement
200
A 39-year-old African-American multigravida at 36 weeks gestation presents with a temperature of 40.0°C (104.0°F), chills, backache, and vomiting. On physical examination, the uterus is noted to be nontender, but there is slight bilateral costovertebral angle tenderness. A urinalysis reveals many leukocytes, some in clumps, as well as numerous bacteria. Of the following, the most appropriate therapy at this time would be A) oral trimethoprim/sulfamethoxazole (Bactrim, Septra) B) oral nitrofurantoin (Macrodantin) C) oral levofloxacin (Levaquin) D) intravenous doxycycline E) intravenous ceftriaxone (Rocephin)
What is intravenous ceftriaxone (Rocephin)
200
A 25-year-old female sees you in the office for follow-up after a visit to the emergency department for respiratory distress. She complains of several episodes of an acute onset of shortness of breath, wheezing, coughing, and a choking sensation, without any obvious precipitant. She has been on inhaled corticosteroids for 2 months without any improvement in her symptoms. Albuterol (Proventil, Ventolin) does not consistently relieve her symptoms. She is asymptomatic today. 1 1 Spirometry shows a normal FEV , a normal FVC and FEV /FVC ratio, and a flattened inspiratory loop. The most likely diagnosis is A) globus hystericus B) vocal cord dysfunction C) asthma D) anaphylaxis E) COPD
Vocal cord dysfunction 104.
200
During rounds, you notice a new rash on a full-term 2-day-old white female. It consists of 1-mm pustules surrounded by a flat area of erythema, and is located on the face, trunk, and upper arms. An examination is otherwise normal, and she does not appear ill.
What is Erythema toxicum neonatorum
200
Which one of the following is diagnostic for type 2 diabetes mellitus? A) A fasting plasma glucose level ?126 mg/dL on two separate occasions B) An oral glucose tolerance test (75-g load) with a 2-hour glucose level ?160 mg/dL C) A random blood glucose level ?200 mg/dL on two occasions in an asymptomatic person 1c D) A hemoglobin A ?6.0% on two separate occasions
What is A fasting plasma glucose level ?126 mg/dL on two separate occasions
200
A 40-year-old female comes to your office with a 1-month history of right heel pain that she describes as sharp, searing, and severe. The pain is worst when she first bears weight on the foot after prolonged sitting and when she gets out of bed in the morning. It gets better with continued walking, but worsens at the end of the day. She does not exercise except for being on her feet all day in the hospital where she works as a floor nurse. She denies any history of trauma. An examination reveals point tenderness to palpation on the plantar surface of the heel at the medial calcaneal tuberosity. Which one of the following should you recommend as first-line treatment? A) Taping/strapping B) Over-the-counter heel inserts C) Extracorporeal shock wave therapy D) A corticosteroid injection E) A fiberglass walking cast
What is Over-the-counter heel inserts
300
A 27-year-old white female at 12 weeks gestation comes to your office complaining of a vaginal discharge. On speculum examination you note a purulent cervical discharge with a friable cervix. A gonorrhea culture is negative. You make a diagnosis of Chlamydia trachomatis cervicitis. Which one of the following is the appropriate treatment? A) Metronidazole (Flagyl) B) Tetracycline C) Azithromycin (Zithromax) D) Miconazole (Monistat) cream
What is Azithromycin (Zithromax)
300
Which one of the following would be most appropriate for stroke prevention in a patient with hypertension, diabetes mellitus, and atrial fibrillation? A) Clopidogrel (Plavix) B) Aspirin C) Dipyridamole (Persantine) D) Warfarin (Coumadin) E) Enoxaparin (Lovenox)
What is Warfarin (Coumadin)
300
A 4-year-old white male is brought to your office because he has had a low-grade fever and decreased oral intake over the past few days. On examination you note shallow oral ulcerations confined to the posterior pharynx. Which one of the following is the most likely diagnosis? A) Herpangina B) Herpes C) Mononucleosis D) Roseola infantum E) Rubella
What is Herpangina
300
In a patient with hyperuricemia who has experienced an attack of gout, which one of the following is LEAST likely to precipitate another gout attack? A) Red meat B) Milk C) Seafood D) Nuts E) Beans
What is Milk
300
A 5-year-old female is seen for a kindergarten physical and is noted to be below the 3rd percentile for height. A review of her chart shows that her height curve has progressively fallen further below the 3rd percentile over the past year. She was previously at the 50th percentile for height. The physical examination is otherwise normal, but your workup shows that her bone age is delayed. Of the following conditions, which one is the most likely cause of her short stature? A) Constitutional growth delay B) Growth hormone deficiency C) Genetic short stature D) Turner syndrome E) Skeletal dysplasia
What is Growth hormone deficiency
400
A 29-year-old gravida 2 para 1 presents for pregnancy confirmation. Her last menstrual period began 6 weeks ago. Her medical history is significant for hypothyroidism, which has been well-controlled on levothyroxine (Synthroid), 150 ?g daily, for the past 2 years. Which one of the following would be the most appropriate next step in the treatment of this patient’s hypothyroidism during her pregnancy? A) Add liothyronine (Cytomel) to her current regimen B) Decrease the levothyroxine dosage C) Increase the levothyroxine dosage D) Continue her current regimen
What is Increase the levothyroxine dosage
400
A 61-year-old female is found to have a serum calcium level of 11.6 mg/dL (N 8.6–10.2) on routine laboratory screening. To confirm the hypercalcemia you order an ionized calcium level, which is 1.49 mmol/L (N 1.14–1.32). Additional testing reveals an intact parathyroid hormone level of 126 pg/mL (N 15–75) and a urine calcium excretion of 386 mg/24 hr (N 100–300). Which one of the following is the most likely cause of the patient’s hypercalcemia? A) Primary hyperparathyroidism B) Malignancy C) Familial hypocalciuric hypercalcemia D) Hypoparathyroidism E) Hyperthyroidism
What is Primary hyperparathyroidism
400
Which one of the following is the most common cause of recurrent and persistent acute otitis media in children? A) Haemophilus influenzae B) Moraxella catarrhalis C) Penicillin-resistant Streptococcus pneumoniae D) Pseudomonas aeruginosa E) Staphylococcus aureus
What is Penicillin-resistant Streptococcus pneumoniae
400
Hantavirus pulmonary syndrome results from exposure to the excreta of A) migratory fowl B) bats C) parrots D) mice E) turtles
What is mice
400
While playing basketball, a 29-year-old male falls on his outstretched hand with his wrist fully extended. He sees you the following day because of diffuse wrist pain and decreased range of motion. The point of maximal tenderness is on the dorsal aspect of the wrist between the extensor pollicis brevis and extensor pollicis longus tendons. There is no visible deformity. Radiographs show no fracture. Which one of the following is the most appropriate initial treatment of this patient? A) A wrist extension splint B) An ulnar gutter splint C) A thumb spica splint D) A short arm cast E) Physical therapy
What is a thumb spica splint
500
A 26-year-old gravida 3 para 2 was diagnosed with gestational diabetes mellitus at 24 weeks gestation. She was prescribed appropriate nutritional therapy and an exercise program. After 4 weeks, her fasting plasma glucose levels remain in the range of 105–110 mg/dL. Which one of the following would be the most appropriate treatment for this patient at this time? A) Continuation of the current regimen B) Long-acting insulin glargine (Lantus) once daily C) Pioglitazone (Actos) once daily D) A combination of intermediate-acting insulin (e.g., NPH) and a short-acting insulin (e.g., lispro) twice daily E) Sliding-scale insulin 4 times daily using ultra-short-acting insulin
What is A combination of intermediate-acting insulin (e.g., NPH) and a short-acting insulin (e.g., lispro) twice daily
500
Patients with which rheumatologic condition have the highest relative risk of internal malignancy compared to the general population? A) Systemic scleroderma B) Systemic lupus erythematosus C) Sjögren’s syndrome D) Rheumatoid arthritis E) Dermatomyositis
What is Dermatomyositis
500
The FDA recommends that over-the-counter cough and cold products not be used in children below the age of A) 1 year B) 2 years C) 3 years D) 4 years E) 5 years
What is 2 years
500
Which one of the following is a frequent cause of cross-reactive food-allergy symptoms in latex-allergic individuals? A) Avocadoes B) Goat’s milk C) Pecans D) Pastrami E) Peppermint
What is Avocadoes
500
A 16-year-old female cross-country runner has pain around both ankles. On examination, pain is elicited on foot inversion and there is decreased motion of the hind foot and peroneal tightness. A rigid flat foot also is observed.
What is Tarsal coalition