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Bugs and Drugs
Beauty is only skin deep
What's the evidence?
Respiratory
Electrolytes and Beyond
100
Which one of the following is effective for single-dose prophylaxis against Lyme disease after next Ixodes scapularis tick bite? A. azithromycin B. amoxicillin C. cefuroxime D. trimethoprim/sulfamethoxazole E. doxycycline
What is E. doxycycline?
100
A 40-year-old male presents with a new rash. On examination you note multiple erythematous-to-yellow dome-shaped papules on the extensor surfaces of his extremities, on his buttocks, and on his hands. The papules are tender and pruritic. A biopsy reveals foamy macrophages and dermal extracellular lipids. This patient’s rash is associated with A. endocarditis B. systemic vasculitis C. a viral infection of the skin D. hypertriglyceridemia E. urticaria
What is D. hypertriglyceridemia?
100
Which one of the following reflects the percentage of patients with a disease who have a positive test for the disease in question? A. likelihood ratio B. sensitivity C. specificity D. positive predictive value E. negative predictive value
What is B. sensitivity?
100
55-year-old obese male with hypertension and daytime somnolence is found to have severe obstructive sleep apnea, with an apnea-hypopnea index of 32 on an overnight polysomnogram. Which one of the following is considered to be first-line therapy for this patient’s condition? A. CPAP B. An oral dental appliance C. Uvulopalatopharyngoplasty D. Sleep positioning therapy E. Tracheostomy
What is A. CPAP?
100
Which one of the following is true concerning people in the United States who do not have health insurance? A. Most uninsured people are members of a family with at least one working adult B. Most uninsured people who are employed full-time work for large companies C. Most uninsured people who work part time and have incomes below the poverty line are eligible for Medicaid D. On average uninsured people have as much access to routine healthcare as those with insurance
What is A. Most uninsured people are members of a family with at least one working adult?
200
40-year-old male respiratory therapist presents for a health examination pray the hospital pointed. His history indicates that as a child Helidac farm in Iowa, and his examination is unremarkable, but a chest radiograph shows the both minefields have BB-sized calcifications in a miliary pattern. No other findings are notes. A PPD skin test is negative. The findings in this patient are most likely a result of A. HIV infection B. histoplasmosis C. coccidiomycosis D. tuberculosis E. cryptococcosis
What is B. histoplasmosis?
200
A 54 yo female presents with 2 months of intense vulvar itching that has not improved with topical antifungal treatment. On exam, you note areas of white, thickened, excoriated skin. Concerned about malignancy, you perform punch biopsies which reveal lichen sclerosus. The treatment of choice for this condition is the topical application of:? A. Conjugated estrogens B. Fluorinated corticosteroids C. Petrolatum D. 2% testosterone E. Fluorouracil (Efudex)
What is B. Fluorinated corticosteroids?
200
You were treating a 53-year-old female for deep vein thrombosis in her left leg. The use of compression stockings for this problem has been shown to A. increase the risk of pulmonary embolism B. increase the level of pain C. increase complications if used prior to completion of the course of anticoagulation therapy D. decrease the risk of post-thrombotic syndrome
What is D. decrease the risk of post-thrombotic syndrome?
200
A three-year-old male was treated for acute otitis media last month. His mother brings him in for follow up because she believes his hearing has not been normal since then. He attends day care and has had several upper respiratory infections. On examination the tympanic membranes are not inflamed, but the membrane is retracted on the right side. Tympanography produces a normal peak (type a) on the left side, but a flat tracing (type b) on the right side. Which one of the following would be the most appropriate recommendation? A. Audiometry B. observation with close follow-up C. Antihistamine/decongestant combination D. intranasal corticosteroids E. systemic corticosteroids
What is B. observation with close follow-up?
200
A 19-year-old college student comes to the office with her mother. The mother reports that her daughter has frequently been observed engaging in binge eating followed by induced vomiting. She has also admitted to using laxatives to prevent weight gain. Which one of the following laboratory abnormalities is most likely to be found in this patient? A. hypokalemia B. hypoglycemia C. hyponatremia D. hypercalcemia E. hypermagnesemia
What is A. hypokalemia?
300
Which one of the following drugs would be the most appropriate empiric therapy for nursing home acquired pneumonia in a patient with no other underlying disease? A. Cefazolin B. Erythromycin C. Ampicillin D. Tobramycin E. Levofloxacin
What is E. Levofloxacin?
300
Which one of the following Mantoux tuberculin skin test results should be read as NEGATIVE for latent tuberculosis infection? A. 7 mm induration on an individual having recent household contact with a tuberculosis patient B. 8 mm induration on an HIV-positive individual who has no documented previous test result C. 10 mm induration on a nursing-home resident D. 12 mm induration on a homeless individual E. 9 mm induration on a hospital-based nurse who had a test with 2 mm induration 1 year ago
What is E. 9 mm induration on a hospital-based nurse who had a test with 2 mm induration 1 year ago?
300
Regular breast self-examinations to screen for breast cancer A. are performed by most American woman B. reduce mortality due to breast cancer C. reduce all cause mortality in women D. are recommended by the U.S. Preventative Services Task Force E. increase the number breast biopsies performed
What is E. increase the number breast biopsies performed?
300
A 30-year-old female presents to your office for an initial visit. She reports a long history of asthma that currently awakens her three times per month, necessitating the use of an albuterol inhaler. According to the current guidelines, which one of the following would be optimal treatment? A. Continued use of a short acting beta agonist only as needed B. Adding a long acting beta agonist C. Adding a leukotriene receptor antagonist D. Adding a low dose inhaled corticosteroid E. Adding theophylline
What is D. Adding a low dose inhaled corticosteroid?
300
An 88 yo male has been hospitalized for the past three days after being found in the four of us home by a neighbor and transported to the hospital by ambulance. He was cachectic and dehydrated at the time of admission, with his serum albumin level of 1.9. He has received intravenous fluids and is now euvolemic. He began nasogastric tube feeding two days ago and has now developed nausea vomiting hypotension and delirium. Which one of the fine is the most classic electrolyte abnormality with this condition? A. hypocalcemia B. hypercalcemia C. hyperkalemia D. hypophosphatemia E. hyperphosphatemia
What is D. hypophosphatemia?
400
A 20-year-old female presents with painful and frequent urination that has had a gradual onset over the past week. She has never had a urinary tract infection. There is no associated hematuria, flank pain, suprapubic pain, or fever. She says she has not noted any itching or vaginal discharge. A midstream urine specimen taken earlier in the week showed significant pyuria but a culture was reported as no growth. She is taking an anabatic for two days without relief. Only other medication is an oral contraceptive agent. Which one of the following is the most likely infectious agent? A. Escherichia coli B. Chlamydia trachomatis C. Candida albicans D. Staphylococcus saprophyticus
What is B. Chlamydia trachomatis?
400
62 yo female presents with painful lesions at both corners of her mouth characterized by redness, scaling, and deep cracks. The cracks sometimes bleed when she opens her mouth. She has treated them with bacitracin/neomycin/polymyxin B ointment (Neosporin) but says it has not helped. Which one of the following would be most appropriate at this point? A. A biopsy of the lesions B. An anticandidal medicine C. Bacitracin D. vitamin B 12
What is B. An anticandidal medicine?
400
One of your patients is planning to fly from Nebraska to Israel and asked about measures to prevent or reduce jet lag. Which one of the following is supported by the best evidence? A. Melatonin should be started on the morning of departure and taken every morning for one week B. Melatonin should be taken nightly for 2 to 5 nights, beginning on the first night at the destination C. Melatonin will help only on the return flight D. A dose of caffeine equivalent to 3 cups of coffee should be taken every morning, beginning in the morning of the departure
What is B. Melatonin should be taken nightly for 2 to 5 nights, beginning on the first night at the destination?
400
The 40-year-old female with chronic asthma presents for a six-month follow-up visit. For the past year she has done very well on fluticasone/salmeterol 350/50 ug, except for when she had to use albuterol inhaler for two days because of cold symptoms five months ago. Most reasonable change to this patient’s medication regimen would be to A. Add montelukast B. Replace fluticasone/salmeterol with fluticasone C. Replace fluticasone/salmeterol with budesonide/formoterol D. Replace fluticasone/salmeterol with tiotropium
What is B. Replace fluticasone/salmeterol with fluticasone?
400
Treatment with which one of the following antihypertensive medications may mimic the effects of primary hyperparathyroidism? A. amlodipine B. doxazosin C. hydrochlorothiazide D. lisinopril E. metoprolol
What is C. hydrochlorothiazide?
500
74-year-old male presents with a four day history of diarrhea and he initially thought was a “24 – hour virus.” He states of the onset of his illness included nausea, one episode of vomiting, and profuse diarrhea. He has felt feverish and has been having abdominal cramps. He does not recall eating anything unusual and has not traveled recently. On examination he appears uncomfortable, but in no real distress. His temperature is 98.8°, blood pressure 134/82, and pulse rate 100. He has lost 4 kg (9 lb) since his last visit two months earlier. His abdomen is soft, with hyperactive bowel sounds and mild diffuse tenderness on palpation. A CBC and basic metabolic profile are normal. Which one of the following is the most likely cause of this patient’s illness? A. Norwalk like virus (Norovirsu) B. Shigella C. Campylobacter D. E. coli O157:H7 E. Staphylococcus aureus
What is C. Campylobacter?
500
A 50 yo male presents with erythroderma and fever. He has not had a sore throat, rhinorrhea, cough, or urinary tract symptoms. His current medicatios include lisinopril, atenolol, and allopurination. On examination he has a BP of 110/90, HR 90, Temp 101.5. The skin is remarkable for marked erythema over 90% of the body with tenderness to touch. His mental status is clera nd his neck is supple. Mildly tender adenopathy is noted in the neck, axillae, and groin. He has no oral ulcerations or ocular symptoms. A CBC shows a WBC of 15,000 with 20% eosinophils. A metabolic profile shows an AST of 100 and an ALT of 110, but is otherwise normal. Which one of the following is the most likely diagnosis? A. Stevens-Johnson syndrome B. Erisipelas C. Red man syndrome D. Toxic shock syndrome E. Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome)
What is E. Drug reaction with eosinophilia and systemic symptoms (DRESS syndrome)?
500
A 45 yo male asks you to evaluate his cardiovascular health status. He is currently asymptomatic, but wants to do everything he can to prevent heart disease and to understand his potential CV risk. His Framingham score indicates that he is at low risk (10 yr risk <6%) and his physical examination is normal. He asks which laboratory and imaging tests he should have and you recommend a lipid profile. According to the American College of Cariology Foundation and the American Heart Association, which one of the following should also be recommended for this patient at this time? A. Lipoprotein and apolipoprotein B. C-reactive protein level C. Measure of cardiac calcium D. An ankle-brachial index E. No further testing
What is E. No further testing?
500
A 50-year-old female presents for evaluation of dyspnea that tends to occur with exercise. She has a 40 pack year history of smoking and has been diagnosed with exercise-induced asthma. She denies any other medical problems. You perform spirometry and find that the expiratory loop is normal and that she has a flattened inventory loop what is the most likely diagnosis? A. Vocal cord dysfunction B. COPD C. asthma D. restrictive lung disease
What is A. Vocal cord dysfunction?
500
Which one of the fine is the most common cause of death for African-American males in the United States? A. Heart disease B. Stroke C. Cancer D. Accidental injuries E. Homicide
What is A. Heart disease?