MEDICINE Dally Test Day 01

Which of the following tests for the diagnosis of Graves disease is the LEAST useful?

Which of the following statements about fecal occult blood testing is correct?

Which of the following statements concerning hepatitis markers is FALSE?

Earliest Indicator of sodium loss is –

A 9 – year – old boy fell from a slide and hit the ground with his arm in full extension. There is swelling of his elbow and the palm of his hand. He will not extend his arm at the elbow because of pain. Radiographs of his arm were obtained. Which of the following statements is False?

The probability that the disease is present when the test result is positive is the test’s:

Nitrate tolerance, which is associated with long – term use of nitrates in angina, may be avoided by :

A 29 – year – old woman presents with bilateral galactorrhea. A blood test for human chorionic gonadotropin is negative. Her serum prolactin level is very high. The test of choice is a:

Which of the following pairs of drugs or substances and their antidotes is INCORRECT? For:

All of the following woman are undergoing mammography. In which of these cases is screening mammography being performed?

A patient presents with an elevated osmolal gap, oxaluria, and metabolic acidosis. The MOST LIKELY diagnosis is:

A 3 ½ year – old boy presents with a sore throat and high fever. He is drooling and refuses to lie down for abdominal exam. His mother says he has had an upper respiratory infection that has suddenly gotten worse. The next step should be to obtain:

MM isoforms of creatine kinase are clinically useful for determining:

A 59 – year – old woman with a history of breast cancer, metastatic to the lungs and bones, has now developed confusion, lethargy, nausea, and vomiting. Further questioning indicates that she also appears to have polyuria and constipation. She completed chemotherapy 6 weeks ago and since then has been on hormonal therapy. She was started on sustained – release morphine sulfate and a nonsteroidal anti – inflammatory agent 1 month ago because of worsening bone and back pain. Based on this history, you decide to admit her to the hospital. Our initial workup and treatment are based on a suspected diagnosis of:

Respiratory arrest due to respiratory alkalosis is rectified by –

Which of the following is the feature of Y chromosome?

A 26 – year – old woman presents with nausea, vomiting and epigastric pain of 3 days duration. She denies alcohol intake. Laboratory tests reveal elevated alkaline phosphatase and liver enzyme levels, with mildly increased bilirubin. You should request:

A 47 – year – old white male comes to you for a routine physical examination. He is physically fit and has been a sun worshipper all his life. He is blond and has blue eyes, but states that he tans easily and does not burn, although he did suffer a bad sunburn during his early childhood. Examination reveals an nonpruritic, non painful, hyperpigmented lesion with red and brown coloration and irregular borders on his upper back. There are no palpable lymph nodes. He states that he was not aware of this lesion. What is the MOST APPROPRIATE next step?

A patient has a normal bleeding time but a prolonged partial thromboplastin time and defective clotting in the test tube. Which of the following would most likely make corrective blood component therapy successful?

Which of the following antihypertensive agents causes the highest incidence of constipation?

A 21 – year – old asthmatic female who takes birth control pills presents with pleuritic chest pain, mild hemoptysis decreased O2, and an increased A – a (alveolar – arterial) gradient. Her chest radiograph findings are negative. Her right lower extremity is tender and has been swollen for 1 week. Findings of a V/Q scan are reported as low probability of pulmonary embolism. She has an iodine allergy. You should:

A severely anemic patient has a low serum vitamin B12 level. A Schilling test is performed after oral ingestion of radiolabeled vitamin B12. The measured urinary excretion is 2% of the total dose (normal > 7%). Following the ingestion of radiolabeled vitamin B12 and intrinsic factor, the urinary excretion remains at 2%. These findings indicate:

The BEST predictor that a staging radionuclide bone scan will be negative when assessing newly diagnosed, untreated prostate cancer is/are:

The cytology report on a routine cervical smear (Papanicolaou’s) of a 27 – year – old sexually active woman is positive for squamous cell carcinoma in situ, with evidence of viral infection. The MOST APPROPRIATE next step is to:

Which of the following drug groups is associated with an increased risk of osteoporosis?

A 53 – year – old woman who is postmenopausal and on hormone replacement therapy is seen for a yearly checkup. On physical examination, you palpate a 1 – cm rounded, nontender mass in the upper inner quadrant of her right breast. You send the patient to have a mammogram, which is negative. You should tell her the results are negative and:

All of the following are indicators of hemolytic anemia EXCEPT increased:

Use of whole blood for transfusion is justified in which of the following clinical situations?

In what percentage of patients with anorexia nervosa amenorrhoea is a presentation –

A 33 – year – old woman with moderately severe rheumatoid arthritis was started on therapy with acetylsalicylic acid, 625 mg q.i.d. subsequently, 200 mg of ibuprofen t.i.d and weekly injections of gold were bugen. After 3 months she developed a pruritic eruption on her wrists, forearms, and lower legs. Examination reveals 2 to 3 mm violaceous, shiny, polyangular, flat – topped papules in the affected areas. The scalp, oral cavity, palms, and nails are all normal. There are some healed lesions that exhibit only marked hyperpigmentation. What is the MOST LIKELY diagnosis?

Three days after arriving from Varanasi , a 34 – year – old male develops cramping abdominal pain associated with the passage of 10 bloody stools per 24 hours. He is mildly dehydrated but afebrile and has nonspecific abdominal tenderness. Which of the following is the MOST APPROPRIATE management option for this patient?

A 32 – year – old woman comes to your office complaining of severe right knee pain that was present upon awakening this morning. She said that she had bumped her knee on a table leg 24 hours ago. She cannot recall having any similar episdoes previously, and she has no history of sexually transmitted diseases. On exam, her right knee is swollen and warm with moderate – to – severe pain on range of motion, which is significantly limited. The MOST APPROPRIATE initial management is :

Which of the following statements about ulcers from venous stasis following a previous episode of thrombophlebitis is NOT TRUE?

A 45-year-old man has a history of progressive weakness for 5 weeks. He had particular difficulty getting out of the bath. On examination there was severe truncal and proximal limb weakness, without wasting or fasciculation. Tendon reflexes, plantar and sensation were all normal. The vital capacity was 1.8L. What is the most likely diagnosis?

The second-generation antihistamines (e.g., astemizole and terfenadine):

Which of the following correctly defines a sunscreen with an Sun protection factor -SPF of 20? The skin:

All of the following statements regarding Helicobacter pylori (HP) infection are true EXPECT:

A 49-year-old man presents with several large, purulent, painful ulcers on the legs. He believes these began after trauma. He says that recently he has had canker sores in his mouth. Physical examination confirms necrotic ulcers with purulent drainage on both legs; the borders are undermined. The results of a complete review of systems are negative. Which of the following diagnoses is the MOST UNLIKELY?

Three clinical features are listed below. For each, select the MOST LIKELY diagnosis. Each diagnosis may be used once, more than once, or not at all. Clinical features: Serum antimitochondrial antibody

Pyridoxine deficiency can cause all except –

Main treatment for hypoventilation with obesity is –

A 58-year-old man with a history of heartburn develops progressive dysphagia for solid foods over a 4-month period. He has insulin-dependent diabetes and is taking a diuretic and digitalis for mild congestive heart failure. Although he has gained 15 pounds over the past year, he believes that there has been some recent loss of weight. A barium swallow and upper gastrointestinal radiographic series demonstrate an area of esophageal narrowing immediately upstream of a hiatus hernia. What is the MOST APPROPRIATE management?

A woman with long-standing rheumatoid arthritis is being treated with methotrexate. She sees her rheumatologist twice yearly and has monthly follow-up visits with you for routine monitoring. You should counsel the patient or perform appropriate laboratory testing for each of the following conditions EXCEPT:

A 30-year-old woman consults you because of a flesh-colored papule on her chin. She believes it has been there for a while, but recently it bled after trauma. Physical examination shows a 4 mm, flesh-colored lesion with a central crust from recent trauma. The patient is blue-eyed and freckled and exhibits other stigmata of frequent sun exposure. Which of the following is correct?

All of the following statements regarding fecal occult blood testing are true EXCEPT:

A 58-year-old man comes to your office for treatment of “jock rash”. He says that for the last year he has had a spreading rah on the perineum, scrotum, and inner thighs. Use of antifungal powders and creams and wearing boxer shorts have not improved the problem. He has minimal pruritus but is embarrassed by the appearance. He has eight individual, erythematous lesions that are somewhat moist on the perineum,scrotum, and thighs. No other lesions are noted. His feet are normal. Which of the following statements is most correct? The patient:

Select the BEST RESPONSE regarding flexible sigmoidoscopy and screening for colorectal carcinoma.

In evaluating the allergic patient, skin testing is:

An 83-year-old man comes for a routine examination. He says he is well but has noted that his feet and ankles have been swelling more than usual. Otherwise, he has no complaints. He has no evidence of herart disease, liver enlargement, of jaundice. A few spider telangiectasia are seen on his legs; he has no obvious varicosities. On both ankles and feet are several brown macules, some of which feel firm to palpation. A consultant suggests he has Kaposi’s sarcoma and recommends a biopsy. Which of the following statements is correct ? The lesions:

An 82 – year – old woman complains of abdominal fullness and mild dyspnea 3 days following hip replacement surgery. She is afebrile and has a normal blood pressure and pulse. Her abdomen is distended, tympanic to percussion, and a few scanty high –pityched bowel sounds are present. Although the abdomen is tender, there is no peritonitis. The chest radiograph is normal, but the abdominal films demonstrate dilatation of the colon with mild distension of the distal ileum. The cecum is 9.5 cm in diameter. The blood count is normal. Which of the following is the MOST APPROPRIATE immediate management?

Which of the following conditions is currently under investigation for an association with silicone breast implants?

A 28-year-old homosexual male known to have the acquired immunodeficiency syndrome is admitted to the hospital because of complaints of not feeling well, chills, fever, nausea, and anorexia of 48 hours duration. He has been on prophylactic treatment for Pneumocystis carinii. On physical examination he looks ill. Hairy leukoplakia and thrush are seen. His lungs are clear, and a chest radiograph is reported as unremarkable. Scattered over his arms, legs, and trunks are small, 2 to 5 mm erythematous papules that are asympromatic. The patient thinks these developed in the previous few days, but is not certain. You request a routine complete blood cell count, liver enzymes, renal function studies, urinalysis, and cultures of the blood and urine. Which of the following skin biopsy tests is/are also indicated ?

Interferon is useful treatment for decompensated cirrhosis in–

A 32 – year – old woman consults you for evaluation of several lesions on both tibial surfaces. The lesions started as madly tender, red – to violaceous papules and plaques. They slowly enlarged, and several on the left tibia coalesced into a large 4x6 cm plaque. With time the lesions became depressed, with atrophy of the central epidermis and dermis. The base of the lesions had clearly visible capillaries and a yellowish color. The edges of the lesions were a yellowish – pink color. The lesions ulcerated following trauma and healed slowly. Which of the following statements is correct? The patient should be:

Acne vulgaris is characterized by the presence of pustules on the face, chest, and back. Which of the following statements is MOST correct?

A 50 – year – old woman describes a 1 – year history of gradually increasing pain and swelling of her hands and wrists bilaterally. Over the last 3 months, she has also had pain and swelling of her ankles, knees, and elbows. Examination reveals bilateral synovitis of the wrists, metacarpophalangeal and proximal interphalangeal joints, knees, and ankles. A rheumatoid factor test is negative. In order to meet the 1987 American College of Rheumatology revised criteria for a diagnosis of rheumatoid arthritis, which of the following tests would you order?

An 18 – year – old male comes to you for a routine examination. He is covered by innumerable dark, irregularly shaped, almost macular spots. Some are present on the lips and the palms. He says he has been in good health. He does spend long hours sunbathing, and he thought the spots were related to sun exposure. Possibly, they began appearing during his early childhood. On physical examination, a systolic murmur is noted over the pulmonary artery. He is rather short. He states that he reached puberty at the age of 15. He has a pectus excavatum and a high – arched palate. Which is the MOST LIKELY diagnosis?

An 8 – year – old child, who is in for a routine physical examination, is noted to have about 10 hyperpigmented macules that are approximately 2 to 3 cm in diameter scattered over his integument. These have gradually developed since infancy. His father and other family members have similar spots=select one +which are asymptomatic. A few freckles are noted in the axillary vault. Which is the MOST LIKELY diagnosis?

A 32 – year – old woman presents with abdominal pain and diarrhea. Five years previously she underwent a right hemicolectomy with removal of 25 cm of distal ileum because of Crohn’s disease. She has subsequently experienced a number of simiarl episodes and has received numerous courses of high – dose corticosteroids over several years, with partial relief. She has cushingoid features and appears pale. She has early lenticular cataracts. Her abdomen is mildly distended and bowel sounds are very active. Edematous perianal skin tags are present but there are no sinuses or suggestion of a perianal abscess. Stools are negative for ova and parasites. The abdominal radiograph demonstrates small bowel air – fluid levels. Initial treatment consistes of nasogastric suction, intravenous fluids, and intravenous corticosteroids and the obstructive features settle after a few days. She is able to tolerate a soft diet without any problems and the stool frequency and consistency improve. A small bowel follow – through radiographic series demonstrates a long, narrowed area immediately upstream of the anastomosis, which is consistent with active Crohn’s disease. A colonoscopy reveals diffuse, patchy colonic ulceration with granulomas on histological evaluation. Which is the MOST APPROPRIATE management option?

The most acceptable treatment for chronic sinusitis includes :

A 64 – year – old man complaining of palpitations was evaluated by a 24 – hour Holter monitor. The recording showed premature ventricular contractions with couplets, for which quinidine was prescribed. He presented to the emergency department with weakness and asyncope, and the electrocardiogram showed polymorphic ventricular tachycardia. Initial management should consist of:

Which of the following study results would confirm a diagnosis of sarcoidosis?

A 46 – year old man presents with a history of prolonged substernal chest pain radiating to the jaw that began 6 hours earlier. The most useful and reliable enzyme test for acute myocardial infarction is:

Which group of the following organism consists of common causes of community – acquired pneumonia?

The most reliable evidence of right ventricular infarction is:

Which of the following pathogens is the LEAST LIKELY cause of community acquired pneumonia in a 64-year-old man with a long history of smoking?

A 36 – year old woman sustained insect bites in a wooded area. On week later, a rash developed at the site of one of the bites. The rash was flat, erythematous, and measured about 12 cm in diameter; it persisted for 2 weeks and then cleared. The patient was well for another 3 weeks, and then she experienced a syncopal attack. A second degree heart block was found on EKG. Which of the following diagnoses is the most likely?

Cardiogenic shock in acute myocardial infarction is caused by all of the following EXCEPT :

A 62 – year – old man is admitted to the hospital for surgical resection of a colonic carcinoma. Two days postoperatively he complains of the onset of shortness of breath. He arterial PO2 is 59. His chest radiograph shows only bibasilar areas of plate like atelectasis. His radioisotope ventilation – perfusion lung scan shows low probability of pulmonary embolism on interpretation. The appropriate next step in the diagnosis or treatment should be:

A 65 – year old man develops an Escherichia coli urinary tract infection. The organism is sensitive to all antibiotics tested, including ampicillin. The patient is treated for 10 to 14 days with amoxicillin, but the infection relapses within 3 days of cessation of therapy. The organism remains sensitive to all antibiotics. A second course of tetracycline is given for 7 more days, but again, relapse occurs. The most likely diagnosis is:

A 65 – year – old woman presents with hoarseness, cough and weight loss. Findings of examination are remarkable only for a hoarse voice and slightly decreased breath sounds on the left. Her chest radiograph shows a left hilar mass and adenopathy in the aortico – pulmonary window on the left. Bronchoscopy reveals paralysis of the left true vocal cord and an endobronchial lesion in the left upper lobe bronchus. Further investigation, including computed tomography of the chest, upper abdomen, and brain, reveals no evidence of metastatic disease. Bronchial biopsy reveals small – cell carcinoma. The MOST APPROPRIATE treatment would be:

Treatment proven to lower mortality rates inpatients with with acute Q wave myocardial infarction includes:

A previously well 16 – year – old boy develops a fever and sore throat. His sore thraot has become so severe that he feels he is going to choke, and he is having trouble breathing. His tonsils approximate in the midline and an exudate is seen. His peripheral white blood cell count is 6,000 per mm3 with 60% lymphocytes, 30% of which are atypical. Which of the following is the MOST APPRORIATE therapy?

Drug(s) NOT useful for the long – term treatment of congestive heart failure is/are:

A35 – year – old woman presents with dyspnea on exertion, with insidious onset over several months. She has no prior history of dyspnea and takes only oral contraceptives. Her chest radiograph shows an enlarged cardiopericardial silhouette and enlargement of the hilar pulmonary vascular shadows, but no interstitial changes. An echocardiogram shows normal left atrial and ventricular size and function, but dilated right – sided chambers. Which of the following diagnoses should be considered?

A previously healthy 65 – year – old man has a history of multiple traumas, repeated surgeries, prolonged hospitalization, and major blood loss in 1938. He enters the hospital because of a progressive cough with little sputum production, but some shortness of breath. Roentgnography reveals bilateral interstitial infiltrates. His pulse oximeter demonstrates hypoxemia. What is the most likely diagnosis?

Which of the following factors does NOT predict an increased risk for recurrent febrile seizures?

Complication associated with treatment with procainamide, a class type IA antiarrhythmic medication, include:

Clinical descriptions:Painful lytic lesion of the femur in a patient with known squamous cell carcinoma of the lung : Treatment –

A 7 – year – old child develops severe pharyngitis. On physical examination he is febrile was a temperature of 1030F, has purulent tonsillites and has anterior cervical adenopathy. Which of the following is the LEAST LIKELY causes of his condition?

A 40 – year – old man presents to you for a routine physical exam. He is healthy and has no significant complaints, but his family history includes polycystic kidney disease and a grandparent who died of hemorrhagic stroke at the age of 52. Ultrasound of the patient’s kidneys confirms the presence of=select one +polycystic kidney disease. Since central nervous system (CNS) problems can be associated with polycystic kidney disease your BEST course of action is to :

A 34 –year woman was participating in aerobic exercises when she experienced acute onset of shortness of breath and palpitations followed by hemoptysis. She was taken to the emergency department and a chest radiograph and showed interstitial edema. An echocardiogram was also obtained. The most likely diagnosis is:

All of the following are expected clinical findings associated with obstructive sleep apnea EXCEPT –

A 16 – year – old female is evaluated because of fever and headache. Her 2 – year –0 old brother had a rashlike illness 3 weeks previously. The patient has a fever (380C) and a moderately stiff neck. Lumbar puncture is performed and the spinal fluid contains 8 white cells/mm3, with 70% lymphocytes. The glucose level is 70 mg%, with a concurrent blood glucose level of 90 mg%. Gram’s stain is negative. Peripheral white blood cell count is 5,000 cells/mm3. Spinal fluid samples are sent for cultures. Which of the following is the MOST APPROPRIATE therapy?

A psychiatrist colleague asks you to evaluate his patient, a 32 – year – old woman who has a fever and an elevated leukocyte count. On examination, she is alert, frightened, diaphoretic, and exhibits “led pipe rigidity” throughout. What course of action would you suggest your colleague pursue with regard to this patient?

Management of unstable angina pectoris should include all of the following mediations EXCEPT :

5 – mm induration on purified protein derivative (PPD) skin testing in a patient positive for the human immunodeficiency virus with a negative chest radiography –What is next step in management

A 63 – year – old woman with congestive heart failure has developed spreading edema and pain in her right lower leg. The edema worsens and she becomes febrile. On physical examination, she has bilateral brawny edema from the ankle to the knee on both legs that is significantly worse on the right. There is severe erythema and warmth of the right leg. Her temperature is 390C; the peripheral white blood cell count is 17,000 cells/mm3. The MOST APPROPRIATE treatment for her cellulitis is –

A 36 – year – old man comes to you because of a 10 – year – history of daily headaches. The headaches are constant and nonpounding although occasionally he has a pounding headache accompained by nausea and vomiting. There is a family history of migraines. He has used actaminophen, barbiturates, and codeine combinations with varying success, but acetaminophen and nonsteroidal anti inflammatory drugs give no relief. He takes an analgesic every 4 hours while awake although he says this is ineffective. Of the following pharmacologic modalities, what is the MOST APPROPRIATE therapeutic approach for this patient?

Which of the following treatments has NOT been proven effective in secondary prevention of acute myocardial infarction?

A 54 – year – old man, a nonsmoker, complains of a nonproductive cough of 8 months duration. Findings on physical examination of the chest, chest radiographs, and spirometry are within the limits of normal. All of the following evaluations would be indicated EXCEPT –

A patient with a congenital abnormality of the aortic valve is about to undergo a dental procedure. Although she has a murmur, her condition has been stable enough to avoid valve replacement surgery. She has not had endocarditis, and has no known allergies. The MOST APPROPRIATE prophylaxis would include:

The patient presents with difficulty walking. On neurologic exam, there is spasticity in both legs, decreased vibratory sensation, and ataxia. Visual acuity is decreased. Which of the following conditions is/are the MOST LIKELY cause of the patient’s symptoms? 1.Vitamin B12 deficiency 2.Friedreich ataxia 3.Human immunodeficiency virus infection 4.Cervical myelopathy from spinal stenosis

Thrombolysis in acute myocardial infarction is –

Which of the following immunizations should be routinely considered for adults over the age of 65 years?

Which of the following agents has NOT been found useful in the treatment of cluster headaches?

A 32 – year old man presents for a routine physical examination. On examination, there is a right ventricular impulse, a fixed split second heart sound best heard in the pulmonic area, and a low rumbling middliastolic murmur at the lower left sternal border. Examination and subsequent workup show that he has an atrial septal defect. In your discussion yo tell him:

Presence of serum M2 antimitochondrial antibody is a classic sign of

Condition that Predisposes to development of hepatocellular carcinoma

Solitary 1 – cm peripheral pulmonary nodule, Treatment –