1.-A 48-year-old agricultural worker is brought to the clinic because of cough productive of yellow sputum. It began several weeks ago. Initially his fellow workers and the foreman thought it was a bad cold. In the interval, the worker has been getting worse, however. He smokes occasionally and is known to drink alcohol on the weekends. In the clinic he is evaluated. He appears to be in no distress except for coughing spells. The temperature is 99.8 deg F at the time. His chest sounds are shallow without rales. He sis given instructions in the collection of a sputum sample. A PPD skin test is placed and the patient is asked to come back in 48 hours for another examination and examination of the sputum. At the second clinic visit his PPD is read  against a control skin test for candida. The candida antigen reaction is 10 mm. The PPD is 20 mm. Which of the following statements is true?

a.-PPD is essentially negative because the patient has a good response to the candida skin test revealing an adequate cell mediated immunity.

b.-PPD test cannot be used in agricultural workers because they often come from the Caribbean and Central America where they have received BCG vaccination against TB.

c.-PPD test is positive and the patient must be considered to have active tuberculosis until proven otherwise by chest radiograph and sputum acid-fast smear study.

d.-Patient has no history of HIV risks, immunosuppression or steroid use; therefore, he is  at low risk of active tuberculosis.

   

2.- Which of the following statements regarding venous thrombosis is NOT true?

a.-Homan's sign (resistance to dorsiflexion in the affected leg) does not reliably predict the presence or absence of deep vein phlebitis

b.-Classical symptoms of phlebitis (unilateral leg swelling, tenderness at the level of calf, and warmth) are present in more than 75% of patients with phlebitis

c.-Calf deep vein phlebitis seldom causes pulmonary embolization.

d.-Saphenous and pelvic veins phlebitis are frequently accompanied by pulmonary embolization.

 

3.- 21 -year-old woman presents to the emergency department because of weakness and nausea. She has no significant past medical history except for urinary tract infection treated three weeks ago by her primary care physician. She has no history of renal disease or diarrhea. Examination in the ER reveals a dehydrated patient with a blood pressure of 90/50 and a pulse rate of 120 regular and Kussmaul respirations. Which of the following sets of electrolytes fits best the clinical picture?

		Na	K	Cl	Bicarb	BUN	Glucose	Arterial pH
	a.-	140	3.5	110	23	35	200	7.43
	b.-	155	5.0	115	30	15	900	7.35
	c.-	130	3.2	100	25	10	130	7.48
	d.-	140	5.0	100	5	8	540	7.10

4.- A 17 -year-old adolescent presents to the clinic brought in by his parents because of fever. He has been out in the woods in summer camp in Arkansas. Three days after returning home in South Florida he experienced the sudden onset of fever and headaches. The family gave him acetaminophen and mild relieve. One day later he appeared confused and complained of muscle aches. There was no history of changes in the color or quantify of his urinary output. On examination in the outpatient service he appeared to be acutely ill and febrile. The examination of the skin revealed generalized erythematous macules. Which of the following diagnoses seems most likely at this point in time?

a.-Ehrlichiosis

b.-Babesosis

c.-Rochy Mountain Spotted Fever

d.-Q fever

 

5.- Which of the following is associated with a restrictive type of problem in pulmonary physiology?

a.-Asthma

b.-Chronic bronchitis

c.-Sarcoidosis

d.-Bronchiectasis

 

6.- Which of the following statements is true regarding hypothyroidism?

a.-Hypothyroidism rarely results from treatment of hyperthyroidism with radioactive I-131.

b.-Hashimoto's  thyroiditis is a common cause of hypothyroidism in patients with thyroid enlargement.

c.-A low TSH level in serum in a hallmark of primary hypothyroidism.

d.-TSH level should be followed biweekly in the management of hypothyroidism patients.

 

7.- You are caring for a patient with HIV whose Mantoux TB skin test shows 7 mm induration. The patient has a normal chest x-ray and she denies fever, cough, or night sweats. Which of the following is the most appropriate recommendation for this patient?

a.-Initiate INH treatment

b.-Sputum culture fro AFB

c.-Perform 2-step TB skin test

d.-Repeat the Mantoux test in one year

e.-Repeat the TB skin test with an anergy panel

 

8.- A 60 -year-old woman is admitted to the hospital because of dyspnea and pleuritic chest pain. In the emergency room she is submitted to a chest radiograph. The latter reveals blunting of the costophrenic angles. A diagnostic thoracentesis is performed. The fluid reveals the following data: Pleural fluid to serum protein ratio of 0.2, Pleural fluid to serum LDH is 0.1. Which of these diagnoses is favored?

a.-Cirrhosis of the liver

b.-Carcinoma of the lung

c.-Pulmonary tuberculosis

d.-Empyema

 

9.- Which of the following can be used to clearly differenttiate Type 1 versus type 2 diabetes mellitus?

a.-2 hours blood glucose level

b.-C-peptide level

c.-Epinephrine level

d.-Glycohemoglobin level
 

10.- Which of the following statements is TRUE regarding West Nile Virus (WNV) infection?

a.-The disease is transmitted by a tick bite

b.-A characteristic rash is required to meet diagnostic criteria.

c.-A majority of cases include neurological manifestations

d.-WNV encephalitis is treatable with intravenous acyclovir (Zovirax)

e.-Diagnosis is best made by detecting IgM antibody in serum or CSF.

 

11.- All of the following microorganisms are known to be associated with atypical pneumonia. Which one of the following is best described by the constellation of hemoconcentration, hypoxia, and thrombocytopenia responding to ribavirin treatment?

a.-Mycoplasma pneumonia

b.-Hanta virus

c.-Pneumocystis carinii

d.-Legionella pneumophila

 

12.-A 19 -year-old female found wandering the streets at 3 AM presents to the emergency room via EMS. She is agitated  and disoriented with the following vital signs:

Temperature	101.2
Pulse	regular at 162
Respiratory	22
Blood pressure	140/90 mm Hg.

a.-Propranolol, PTU, acetaminophen

b.-Propranolol, methimazole, aspirin

c.-Levothyroxine, propranolol, aspirin

d.-Levothyroxine, albuterol, acetaminophen

e.-Methotrexate, celecoxib, warfarin

 

13.-A 25 -year-old male steps on a rusty can while walking on the beach. He suffers a 3 inch jagged laceration. The wound is cleansed, irrigated, debried and sutured. He completed a full primary tetanus series as a child and received a Td booster 7 years ago. Which of the following is most appropriate for tetanus prophylaxys?

a.-Td

b.-Tetanus immune globulin

c.-No additional treatment

d.-Td and tetanus immunoglobulin

e.-Td and prophylactic cephalosporin

 

14.-You are evaluating a patient with suspected asthma. She reports coughing and wheezing that occurs a coupe of times each week. Similar symptoms occurs each year in the spring. Her symptoms resolve completely with the use of inhaled albulerol (Ventolin). She has not needed to change any of her normal activities. She denies any symptoms at night. Her lungs at this time are clear to auscultation and office PFT reveals normal FEV1. Which of the following is the most appropriate diagnosis for this patient?

a.-Mild intermitted asthma

b.-Mild persistent asthma

c.-Moderate intermittent asthma

d.-Moderate persistent asthma

e.-Chronic bronchitis

 

15.- During a routine work-up, a 59-year-old female has a TSH of 20.5 mU/L. An anti-thyroperoxidase titer is positive. You suspect the diagnosis of:

a.-Sheehan's syndrome

b.-Hashimoto's thyroiditis

c.-Grave's disease

d.-Toxic multinodular goiter

e.-Primary thyroid carcinoma
 

16.- A 22 year-old nursing student completed the 3 injection series for Hepatitis B six months ago. Which of the following tests should be utilized to determine her immunity?

a.-HBV-DNA

b.-Hepatitis B surface antigen

c.-Hepatitis B surface antibody

d.-Hepatitis B IgM core antibody

e.-Hepatitis B IgG core antibody

 

17.- A 19 -year-old college student athlete presents to the office with oral temperature of 102 deg F, sore throat, lymphadenopthy and fatigue. She denies any cough or congestions. Her rapid strep screen is negative. Heterophile and monospot are positive. What is the most appropriate recommendation for this patient?

a.-Avoid contact sports

b.-Amoxicillin

c.-Epstain-Barr viral titers

d.-Return to normal activity

e.-Absolute bed rest

 

18.-A 14-year-old asthmatic presents with a 5-day history of a cold. He has a cough productive of clear sputum. He is non-smoker. He has been experienced increasing tightness in his chest. His peak flow is 50% of predicted. Prior to the cold, he was using his albuterol inhaler twice a week. Which of the following is the most appropriate step?

a.-Initiate treatment with a macrolide antibiotic

b.-Change the albuterol to salbutamol

c.-Add inhaled cromolyn to his treatment regimen

d.-Add on oral corticosteroid to his treatment regimen

e.-Add a leukotriene antagonist to his treatment regimen

 

19.-You are evaluating a patient for fatigue and weight loss. The physical examination is normal. Laboratory results are:

Test	Value
Calcium	14 mg/dL
Ionized calcium	10 mg/dL
Intact PTH	5 pg/ml
Protein	5g/dL
BUN	18 mg/dL
Creatinine	0.9 mg/dL

These results are most consistent with which of the following conditions?

a.-Hipercalcemia secondary to hypoproteinemia

b.-Hypothyroidism

c.-Malignancy

d.-Primary hiperparathyroidism

e.-Vitamin D deficiency

 

20.- Which of the following medications increases a woman's risk of osteoporosis?

a.-Depakote

b.-Veramil

c.-Allopurinol

d.-Progesterone

e.-Hydrochlorothiazide

 

21- A 30-year-old African American female presents to your office complaining of fatigue, dyspnea, and a dry cough. Physical exam reveals uveitis and paroid enlargement. Chest x-ray reveals bilateral hilar adenopathy. Which of the following lab results would you expect to find in this patient?

a.-Increased lymphocytes on the peripheral smear

b.-Increased rheumatoid factor

c.-Increased angiotensin-converting enzyme level

d.-Thrombocytosis

e.-Hypocalcemia

 

22- A 68 -year-old former smoker with a history of chronic obstructive pulmonary disease (non-oxygen-dependent) presents with a two-day history of worsening dyspnea and increased quantity and purulence of sputum. Physical examination reveals scattered rhonchi in all lung fileds and utilization of the accessoty muscles of respiration. Temperature is 38.3 C (101. F), blood pressure is 140/90 mm Hg, apical heart rate is 100/min, and respiratory rate is 24/min. Arterial blood gas analysis on room air and laboratory studies reveal the following:

pH	7.30
PCO	60 mm Hg
PO2	55 mm Hg
HCO3	22 mEq/L
Pulse oximetry:	80%
White blood cell count;	8,000/mm3
Na	140 mEq/L
K	4.0  mEq/L
Cl	115 mmoI/L
CO2	22 mEq/L
BUN	25 mg/dL
Creatinine	1.5 mg/dL

The acid-base status of this patient is:

a.-Acute respiratory acidosis

b.-Compensated metabolic acidosis

c.-Compensated metabolic alkalosis

d.-Mixed acidosis

e.-Respiratory alkalosis

23- Which of the following treatments regimens is most appropriate for this patient?

a.-Inpatient treatment with bronchodilators and antibiotics

b.-Inpatient treatment with bronchodilators and steroids; antibiotics only id sputum culture is positive

c.-Inpatient treatment with bronchodilators, systemic steroids and antibiotics

d.-Outpatient treatment with bronchodilators and oral steroids, antibiotics only if sputum culture is positive

e.-Outpatient treatment with bronchodilators, inhaled steroids and antibiotics

 

24- Which of the following sets of O2 orders is most appropriate for this patient?

a.-Avoid supplemental oxygen due to CO2 retention

b.-O2 as need for dyspnea

c.-O2 via non-rebreather mask

d.-Titrate O2 to a pulse oximetry > 92%

e.-Titrate O2 to a pulse oximetry > 98%

 

25.- Meningococcal vaccine is recommended for which of the following groups?

a.-All high school freshmen

b.-Anyone over 65 years of age

c.-The military and college freshmen

d.-All osteopathic medical students

e.-All teachers

 

26.- A 33 -year-old male from Somalia presents with sore throat and low grade fever. On physical examination you observe adherent, bluish-white pharyngeal exudates. Bleeding occurs when you attempt o remove the exudates. You suspect the causative organism to be:

a.-Streptococcus pyogenes

b.-Corynebacterium diphtheria

c.-Coxsackie virus

d.-Hemophilus influenza

e.-Epstein-Barr virus

 

27.- Of the following, which vaccines contain live organism?

a.-DtaP

b.-MMR

c.-Hep B

d.-IPV

e.-HIB

 

28.- An obese 14-year-old female presents with hyperpigmented areas around her neck and axilla. She has a strong family history of hyperlipidemia. Next step include nutrition counseling and the lab work including:

a.-FBS

b.-Liver function tests

c.-RPR

d.-HIV

e.-KOH skin scraping

 

29.- A 52-year-old female with type 2 diabetes mellitus is evaluated for peripheral Neuropathy during a routine diabetic visit. She denies foot pain or numbness. Her only medication is glyburide (Diabeta) 20 mg daily. Her blood pressure is 120/78 mm Hg and her glycosylated hemoglobin is 7.8%. Monofilament testing of ifve istes o each foot reveals that se lacks sensation at one site each foot. The most appropriate treatment plan for this patient is to

  a.-Consult a neurologist

b.-Obtain a serum sample for somatostanin

c.-Obtain an MRI of the lumbar spine

d.-Perform a full foot examination at each visit

e.-Repeat filament testing at each quarterly visit

30.-Which of the following treatment additions is most likely to retard progression of the neuropathy?

  a.-Clopidrogrel (Plavix)

b.-Enalapril (Vasotec)

c.-Gabapentin (Neurontin)

d.-Losartan (Cozaar)

e.-Metformin (Glucophage)

 

31.-A 55-year-old diabetic female with a history of recurrent urinary tract infections now complains of multiple episodes of loose, watery diarrhea. The single best laboratory test to order is

  a.-Clostridium difficile culture

b.-Clostridium difficile cytotoxin assay

c.-Stool for culture and sensitivity

d.-Stool for occult blood

e.-Stool for ova and parasites

32.-The most appropriate treatment for prophylaxis of Pneumocystis carinii pneumonia in HIV-positive patients with a CD4 count less than 200/mm3 is

  a.-Aerosolized pentamidine (Nebupent)

b.-Atovaquone (Mepron)

c.-Clindamycin/primaquine

d.-Dapsone

e.-Trimethprim-sulfamethoxazole (bacterium, Septra)

 

33.-A 67-year-old male presents with persistent pain in the area of a prior herpes zoster infection, which healed four months ago. The pain has a burning quality and occasionally shoots through the affected area. It is accompanied by pruritus. No neurological deficits are noted on physical examination. Which of the following is the most cost-effective and appropriate pharmacologic intervention in the initial treatment of the current condition?

  a.-Amitriptyline (Elavil)

b.-Corticosteroids

c.-Famciclovir (Famvir)

d.-Fentanyl (Duragestic) patch

e.-Sertraline (Zoloff)

 

34.-Two hours after returning from a picnic, a patient develops intense abdominal cramping followed by explosive diarrhea and vomiting. The most likely cause of these symptoms is

  a.-Campylobacter

b.-Clostridium

c.-Salmonella

d.-Shigella

e.-Staphylococcus

 

35.-A mother brings in her 12-months-old son for the evaluation of diarrhea. He is having 10 to 12 stools per day. Physical examination reveals a lethargic child who is whining softly an clinging to his mother. He has had a 0.5-kg (1-lb) weight loss since a well-child visit one week ago. His temperature is 37.6C (99.6F), his heart rate is 90/min, and his respiratory rate is 24/min. Mucous membranes are dry. The most likely cause of this child's diarrhea is

  a.-Clostridium difficile

b.-Cytomegalovirus

c.-Poor diet

d.-Rotavirus

e.-Vibrio cholerae

36.-The most appropriate initial fluid management for this child is

  a.-A 20mL/kg bolus of normal saline followed by maintenance fluids

b.-A potassium rider with 40 mEq KCL of normal saline

c.-An interosseous bolus of 500 mL of lactated ringer solution

d.-Intravenous hydration with a maintenance rate of D5 in normal saline

e.-Oral rehydration with water

 

 

Index Albarran