- 1 Ten MCQs

2010-09-18T17:14:00.000-07:00

----(1)----

A 23-year-old woman comes to the physician for a health maintenance examination. She enjoys good health and exercises regularly. Her height is 172 cm (68 in) and weight is 66 kg (145 lb). Her blood pressure is 120/80 mm Hg, pulse is 74/min, and respirations are 12/min. Physical examination is unremarkable except for heart auscultation, which reveals an isolated midsystolic click. Which of the following is the most common cause of this auscultatory finding?

(A) Bicuspidaorticvalve

(B) Congenital pulmonary stenosis

(D) Ruptured papillary muscle

(E) Tricuspid regurgitation

-----(2)-----

A 50-year-old man comes to the physician because of gingival bleeding, epistaxis, and fever for 2 days. He appears acutely ill. His temperature is 39 C (102 F), blood pressure is 120/70 mm Hg, pulse is 120/min, and respirations are 22/min. Bilateral rhonchi are heard on chest examination. He is admitted for further evaluation. Chest x-ray shows bibasilar infiltrates consistent with bronchopneumonia. Blood tests show 12,000 leukocytes/mm3 with numerous myeloid blasts. Platelet count is 15,000/mm3. A bone marrow biopsy demonstrates hypercellular marrow, with 35% blasts. Elongated cytoplasmic inclusions consistent with Auer rods are appreciated in peripheral and marrow blasts. Which of the following is the most likely diagnosis?

(A) Acute lymphocytic leukemia (ALL)

(B) Acute myelogenous leukemia (AML)

(D) Leukemoid reaction

(E) Myelodysplastic

-------(3)-------

A 48-year-old man comes to the physician because of a 2-day history of severe low back pain. He states that he has had periodic low back pain for years, but this is more severe than usual and radiates to the buttock and down the right leg. His temperature is 36.8 C (98.2 F). Examination shows some rigidity of the lumbar spine. The pain is exacerbated by applying pressure on the paravertebral region in the lower lumbar spine and by passively raising the leg at 45 degrees while the patient lies supine. A reduced Achilles tendon reflex is noted. Which of the following is the most appropriate next step in management?

(A) MRI examination of vertebral column

(B) Nonsteroidal anti-inflammatory drugs (NSAIDs) and 2 days of bed rest

(D) Radionuclide bone scanning

(E) Surgical consultation

------(4)-------

A previously healthy 30-year-old man is injured in an automobile accident. He is taken to the emergency department, where he is noted to have multiple lacerations of his extremities, some of which are bleeding profusely. His blood pressure is 70/palpable mm Hg. The decision is made to transfuse 2 units of blood after rapid cross-matching. No reactions are detected in the blood bank. Ten minutes after the transfusion, the patient develops a severe case of hives. The development of hives in this setting would be most likely to be seen in a patient with which of the following syndromes?

(A) Adenosine deaminase deficiency

(B) Ataxia telangiectasia

(D) Selective IgA deficiency

(E) Wiskott-Aldrich syndrome

-------(5)-------

A 71-year-old man presents with a complaint of dyspnea for the past week. The patient has a history of diabetes and hypertension and was recently diagnosed with cancer. He is currently on multiple drug therapy. On examination, temperature is 37.2 C (99.0 F), his blood pressure is 140/90 mm Hg, pulse is 90/min, and respirations are 22/min. His lungs have a few crackles at the bases with no wheezing. A chest x-ray film shows bilateral diffuse interstitial markings. Which of the following medications is likely responsible for the patient's dyspnea?

(A) Bleomycin

(B) Cisplatin

(D) Verapamil

(E) Vincristine

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A 30-year-old woman complains of fatigue and dysp- nea for the past 2 months. She reports that she has also lost 15 pounds during this time. She has been previously healthy and is not taking any medications. She is pale and thin and has a flow murmur on her cardiac examination. She also has mildly enlarged supraclavicular lymph nodes. Laboratory results are notable for a hematocrit of 30%, mean corpuscular volume (MCV) of 78 um3, decreased transferrin iron binding capacity (TIBC), and increased ferritin. A screening erythrocyte protoporphyrin level is <35 ug/dL, and a blood smear shows microcytic red cells. Which of the following is the most likely diagnosis?

(A) Anemia of chronic disease

(B) Aplasticanemia

(D) Pyridoxine deficiency

(E) Spherocytosis

(F) Thiamine deficiency

------(7)-------

A 50-year-old man comes to the physician because of an unusual appearing mole on his upper back. He says that his wife has noted a recent change in its color and shape. The lesion measures 0.7 cm and has ill-defined margins and irregular pigmentation. The patient is otherwise healthy and takes no medication. Which of the following is the most appropriate next step in manage- ment?

(A) Follow-up examination in 6 months

(B) Topical application of Podophyllum resin

(D) Shave biopsy

(E) Incisional biopsy

(F) Excisional biopsy

-------(8)--------

A 52-year-old man with a history of chronic low back pain complains of 3 days of a cough productive of purulent sputum, fever, and left-sided subcostal pain worsened by breathing. A single episode of shaking chills accompanied the onset of the illness. He has no gastrointestinal complaints. His temperature is 40 C (104 F), blood pressure is 160/80 mm Hg, pulse is 100/min, and respirations are 38/min with nasal flaring and splinting. The cardiac and abdominal examinations are within normal limits. There are moist crackles and egophony at the left lung base. A chest x-ray film shows a left lower lobe infiltrate. Gram stain of the sputum shows multiple polymorphonuclear leukocytes and occasional epithelial cells. Which of the following is the most likely pathogen?

(A) Gram-negative diplococci

(B) Gram-negative rods

(D) Gram-positive diplococci in chains

(E) Gram-positive rods

-------(9)---------

A 38-year-old man who works as a reporter for a travel magazine comes to his physician because of the acute onset of jaundice, malaise, and temperatures to 38.5 C (101 F). He had returned from Burma 2 weeks ago, where he spent 4 weeks. He says that he abstains from alcohol beverages and does not take any medications. Laboratory studies show elevated serum aminotransferases, high bilirubin (both total and direct), and negative serology for hepatitis A virus (HAV) and C virus (HCV) infection. He was vaccinated for hepatitis B virus (HBV) 3 years ago and is now positive for anti- HBsAg antibodies. Which of the following serologic markers should be tested as the most appropriate next step in diagnosis?

(A) Anti-HCV IgG antibodies by RIBA

(B) Anti-HDVIgGantibodies

(D) Anti-HGV IgG antibodies

(E) HBsAg

-------(10)--------

A 50-year-old man returns to his home in Minnesota after a diving trip to Belize (Central America). The day after his return, he comes to the physician because of diarrhea, abdominal cramps, and nausea. His temperature is 37 C (98.6 F). His stools do not contain mucus or blood. Microscopic examination of a stool sample reveals no leukocytes. Which of the following is the most likely pathogen?

(A) Bacillus cereus

(B) Clostridium perfringens

(D) Rotavirus

(E) Staphylococcus aureu

How to answer ?

First comment answer first mcq and Second comment answer the second mcq if he accept that the first answer is right if not he re answer the first mcq.... Easy :)

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- 1 Ten MCQs