1.- 31-year-old man presented with a history of
multiple erythematous papules, pustules, nodules, and purulent discharging
cysts on the face. The patient dnies bites, fever, diaphoresis, scaling, or
unusual stress recently. A photograph of the lesion is available for your
examination.
Which of the following is the most likely diagnosis:
PHOTO
a.-Gram-negative folliculitis
b.-Seborrheic dermatitis
c.-Acne vulgaris
d.-Psoriasis
2.- What is the most
appropriate post-myocardial infraction medication regimen for a patient with
a type 2 diabetes and hypertension who has had an uncomplicated myocardial
infarction ?
a.-ACE inhibitor, nitrate, statin
b.-Beta-blocker, statin, ACE inhibitor
c.-ARB, ACE inhibitor, statin, nitrate
d.-Beta-blocker, ACE inhibitor, nitrate
3.- Which of the following is associated with
the most serious or worse prognosis in mitral valve prolapse?
a.-evidence for a mid-systolic click
b.-History of palpitations
c.-mitral regurgitation with myxomatous
degeneration of mitral leaflets.
4.- A 40 -year-old female is evaluated with a
one-month history of a pruritic rash. She has multiple, purple, popular
lesions on the flexor surfaces of he arms and legs. The lesions have a fine
white scale. She also has a white lacy pattern on the buccal mucosa. Which
of the following is the most likely diagnosis?
a.-lichen planus
b.-pityriasis rosea
c.-psoriasis
d.-seborrheic dermatitis
e.-vitiligo
5.- Which of the following does not appreciably affect conduction through
the AV node ?
a.-Diltiazen
b.-Verapamil
c.-Nifedipine
6.- A 22-year old female presents with a
hypopigmented maculae rash, present for the last 2 months. The borders of
the lesion show slight scalling. KOH preparation reveals "spaghetti and
meatballs" appearance. Which of the following is an appropriate treatment
for this patient?
a.-1% hydrocortisone cream
b.-topical selenium shampoo
c.-Oral tetracycline
d.-PUVA
e.-Oral prednisone
7.- Which of the following
statements is TRUE regarding basal cell carcinoma?
a.-very likely to metastasize
b.-always requires elliptical excision with 5 mm margins
c.-may be treated with curettage and electrodesiccation
d.-unrelated to sun exposure
e.-never has telangiectasia
8.- A 25 -year-old male with T4 paraplegia
presents with recurrence of a wound over the left lateral malleolus. On
examination, the feet are warm and pink with normal pulses. The wound is
oval and approximately 5 cm in diameter with full thickness depth and
greenish drainage. He states that this area had healed but then he noticed
signs of recurrent breakdown one week ago that quickly progressed to the
present state. The most likely explanation is:
a.-dermal infarction
b.-new-onset diabetes mellitus
c.-osteomyelitis
d.-peripheralneuropathy
e.-pyoderma gangrenosum
9.- A resting ECG is obtained as shown on the
facing page. The most appropriate interpretation of this ECG is:
a.-complete left bundle branch block
b.-early repolarization
c.-interventricular re-entry pathway
d.-myocardial infarction
e.-normal
10.- A 57-year- old male
presents to the office complaining of progressive calf pain when walking
more than four blocks. He is a smoker and has a total cholesterol of 256 mg/dL
with an LDL cholesterol of 168 mg/DL. He has a history of glucose
intolerance. The next appropriate diagnostic test is :
a.-angiography
b.-electromyelogram/nerve
conduction velocity examination
c.-ankle brachial index
d.-MRI scan of the lumbar spine
e.-bone scan
11.- Which of the following is the initial test
choice in evaluation a 68-year-old patient with a history of
claudication and angina?
a.-pulmonary function testing
b.-exercise stress testing
c.-exercise stress testing with radioisotope scanning
d.-pharmacologic stress testing
e.-exercise stress testing with two-dimensional echocardiography
12.-Which of the following classes of mediations
have been shown to prolong life and reduce the risk of disease progression
in patients with chronic heart failure?
a.-nitrates
b.-beta-blockers
c.-loop diuretics
d.-positive inotropes
e.-calcium channel blockers
13.-A 66-year- old male presents stating that
his heat is "skipping beats". He denies chest pain dyspnea and neurological
symptoms. His past medical history is positive for osteoarthritis. He
currently takes no medication. His examination is unremarkable. An ECG is
obtained as shown on the facing page. What is the most appropriate
interpretation for this ECG?
a.-atrial fibrillation
b.-sinus tachycardia
c.-normal sinus rhythm
d.-third-degree heart block
e.-multifocal atrial tachycardia
14.-Which of the following is the correct
regarding the initial treatment of hypertension?
a.-a-blockers are the treatment of choice for
young Caucasian males
b.-African-American should always receive
a B-blocker plus an ARB (angiotension-receptor blocker )
c.-ARBs (angiotension receptor blockers) are most effetive than ACE
(angiotension-converting enzyme) inhibitors
d.-calcium channel blockers are preferred for
Hispanics
e.-hydrochlorothiazide, ACE (angiotension-converting
enzyme ) inhibitors or b-blockers are preferred
15.- Which of the following statements is TRUE
regarding the use of B-type natriuretic peptide (BNP) in the evaluation of a
patient with dyspnea?
a.-alow BNP (<100 helps to rule out heart
fairlure.
b.-an elevated BNP (>500) helps to rule out
systolic heart failure
c.-an elevated BNP (>500) helps to rule out
diastolic heart failture
d.-an elevated BNP (>1000) suggests the patient
has a pulmonary embolism
e.-a low BNP (<100) should repeated after
treatment with nesiritide (Natrecor)
16.- A 31 year-old female suddenly becomes
apneic and pulseless. You initiate cardiopulmonary resuscitation while a
monitor becomes available. After no response to three incremental
defibrillation attempts at 200, 300 and 360 joules for ventricular
fibrillation, which of the following medications should be at first
administered?
a.-amiodarone
b.-bretylium
c.-epinephrine
d.-lidocaine
e.-procainamide
17.- 76-year-old female presents to the office.
On three separate occasions you have noted blood pressure readings averaging
160/82 mm Hg. She has never been on medication for hypertension and she has
no other comorbidities. Which of the following of the most appropriate for
this patient?
a.-angiotensin receptor blocker
b.-B-blocker
c.-Calcium Channel blocker
d.-observation only
e.-thiazide diurectic
18.-The most appropriate next step for this
patient is:
a.-electrophysiologic study
b.-reassurance and check in six months
c.-referral for coronary angiogram
d.-stress echocardiogram
e.-transesophageal echocardiogram
19.-A 39-year-old woman is presented with a
scaly papular skin eruption of unknown characterized by mild exanthematous
inflammatory skin changes and the presence of salmon-colored maculopapular
lesions. The patient denies malaise, fever, or mucosal lesions. On
examination, you note that the arrangement of the lesions is such that the
long axis is parallel to the lines of cleavage. A photograph of the lesion
is available for your examination.
Which of the following is the most likely diagnosis:
PHOTO
a.-Viral exanthema
b.-Contact dermatitis
c.-Guttate psoriasis
d.-Pitiryasis rosea
20.- A 46 -year-old male requests evaluation for
abnormal nails. These changes have been presents for several years. Can you
draw a diagram of each of these and describe them?
a.-psoriasis
b.-paronychia
c.-onychomycosis
d.-onychogryphosis
e.-basal cell carcinoma
Index Albarran