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1) A 36 year old woman with presents to her primary care doctor for medical clearance. She is planning on a elective hernial repair. She was recently diagnosed with sarcoidosis several months ago and placed on prednisone. Upon inspection, her physician notices a well nourished woman with telangiectasias and purple red marks on her extremeties. She also has some signs of hirsutism that he did not notice on her previous visit several months ago.

Which of the following would correctly describe her primary acid-base disturbance?

A) Low pH, Low HCO3, High Base Deficit, Low pCO2.

B) Low pH, High HCO3, High Base Excess, High pCO2.

C) Neutal pH, Low HCO3, High Base Deficit, Low pCO2.

D) High pH, High HCO3, High Base Excess, High pCO2.

E) High pH, Low HCO3, High Base Excess, Low pCO2.

Explanation will be posted soon....

2) A 23-year-old man with rheumatic mitral regurgitation presents to your clinic with frequent palpitations and exercise intolerance. He is currently in no distress and other wise appears healthy. He is a current smoker and has a 10 pack-year smoking history. He has no history of diabetes and has never been hospitalized since he had rheumatic fever as a child.

Which one of the following is not an indicator of the severity of his mitral regurgitation?

A) Third heart sound

B) The loudness of the murmur.

C) Signs of heart failure.

D) Presence of thrill.

E) S4

Explanation will be posted soon....

3) A 60-year-old man complains of left eye pain and photophobia. On examination there is an erythematous rash of the periorbital skin and forehead on the left side. You also note erythema and a small vesicle on the tip of the patient?s nose. His ipsilateral conjunctiva is injected and after staining the affected eye with fluorescein, Wood?s lamp examination reveals corneal uptake in a fine branching pattern.

What is the most appropriate therapy for this patient?

A) Oral acyclovir 800mg three times a day for 7-10 days

B) Oral valacyclovir 500 mg three times a day for 7 days

C) Oral famciclovir 500mg three times a day for 7 days

D) Oral prednisolone, 40mg daily for 7 days

E) Topical acyclovir, 5 times a day until resolution of ocular symptoms

Explanation will be posted soon....

4) Match the most likely micro-organism with the clinical scenario:

A 35-year-old woman, recently returned from a hiking trip in Arizona, presents with low-grade fever, cough with minimum clear sputum production, and rash. She is otherwise healthy with no significant past medical history. She has been on treatment with ventolin for intermittent asthma and she does have seasonal allergies.

A) Coccidioides immitis

B) Measles virus (rubeola)

C) Mycobacterium tuberculosis

D) Mycoplasma pneumoniae

E) Histoplasmosis

5) A 15-year-old high school student and several of her friends ate lunch at a local Chinese restaurant. They all were served the daily luncheon special, which consisted of sweet and sour pork with vegetables and fried rice. All the girls developed nausea, vomiting, abdominal pain, and diarrhea within 6 hours of eating lunch. The were all sent to the local emergency department for work-up of their suspected food poisoning. The children are all otherwise healthy and none are on any medication and have no known allergies.

Which of the following is the most likely cause of these symptoms?

A) Bacillus cereus

B) Staphylococcus aureus

C) Clostridium botulinum

D) Clostridium perfringens

E) EHEC (Enterohemorrhagic Escherichia coli)

6) A 57-year-old man is brought to the emergency room with a 2 hour history of central crushing chest pain radiating to the left arm. Clinical examination revealed a sweaty distressed gentleman with a pulse rate of 130, blood pressure of 140/95, but no other signs of cardiac or respiratory disease.

An electrocardiogram showed a wide-complex ventricular tachycardia at a rate of 126 beats per minute. The physician prescribed a drug to decrease Sino atrial (SA) node automaticity, increase Atrio Ventricular (AV) node refractoriness, and decrease AV node conduction velocity.

Which of the following agents was most likely prescribed?

A) Amiodarone

B) Disopyramide

C) Lidocaine

D) Propranolol

E) Verapamil

7) A 65- year- old retired truck driver who smokes a pack of cigarettes daily is diagnosed with essential hypertension. He has no previous history of cardiovascular disease or sexual dysfunction. In the primary care physician?s office, his blood pressure is 170/95 mmHg. He is prescribed a single therapeutic agent. Shortly after the beginning of the treatment, he experiences difficulties in obtaining and maintaining an erection.

What medication is most likely to have caused this adverse effect?

A) Hydrochlorothiazide

B) Enalapril

C) Losartan

D) Prazosin

E) Verapamil

8) A 34-year-old California man in otherwise good health presents with coughing spasms followed by post-tussive emesis for three weeks. A nasopharyngeal swab was collected and the culture came back positive for a gram negative aerobic extracellular coccobacillis.

According to the Centers for Disease Control and Prevention, which one of the following is the best next step?

A) Prescribe inhaled albuterol

B) Do not prescribe antibiotics for the patient until culture results are available

C) Administer whole-cell pertussis vaccine

D) Treat close household contacts with antibiotics

E) Strict isolation of patient

9) A 10 year-old male is brought to the urgent care clinic by his grandmother. She tells you that her cat bit the boy on the hand approximately 8 hours ago while he was teasing the animal. He just told his grandmother a few minutes ago because his hand started to hurt. The cat is up to date on all immunizations, as is the patient with his as their immunization records showed.

The child is otherwise healthy except for recurrent otitis media and mild season allergies. He is allergic to penicillins as he developed a rash the last time he took the antibiotic. On examination, vital signs are: BP 106/68 mmHg, Temp 99 F, Resp 17/min, Pulse 92/min. The physical exam is remarkable only for a deep pair of puncture wounds to the right thenar eminence, mild surrounding erethema, and localized tenderness to palpation.

After appropriate wound care in the urgent care clinic, what is the best antibiotic regimen for this patient?

A) cephalexin and trimethoprim-sulfamethoxazole

B) clindamycin and trimethoprim-sulfamethoxazole

C) azithromycin and cephalexin

D) azithromycin and trimethoprim-sulfamethoxazole

E) ciprofloxacin and clindamycin

10) You are working in a local TB health center and you are about to interpret the result of a Mantoux tuberculin skin test on one of your patients who has had a history of fever and cough.

Which of the following is NOT true about tuberculin skin testing (TST) for tuberculosis?

A) Patients who have received BCG vaccine should not have TST.

B) An initially negative test does not exclude the possibility of active infection.

C) A subsequent (2nd) negative test, several weeks after the first, does not exclude the possibility of active infection.

D) A previously TST-positive patient can become TST-negative later in life.

E) For TST to reflect recent infection it should be done > 3 weeks after exposure