Q: December 12, 2012

A 73-year old man with a 40 pack-year smoking history, hypertension, and hyperlipidemia, and asthma presents to the office with dyspnea on exertion.  He claims it had started a few months ago, and has ever so gradually become worse.   His exercise/activity tolerance have decreased, and now he is developing chest pain after walking up 2 stairs to his apartment.  His pain diminishes after resting for ~30-60 minutes.  His hypertension and hyperlipidemia are poorly controlled; he has been prescribed hydrochlorothiazide and Rosuvastatin to respectively treat them, but frequently misses doses.  His asthma, however, is well-controlled with inhaled fluticasone/albuterol.  Which of the following drugs can normally be used in the treatment of ischemic chest pain,  but is contraindicated in this patient?

(A) Propanolol

(B) Nitroprusside

(C) Aspirin

(D) Ranolazine

(E) Isosorbide dinitrate

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Q: December 7, 2012

A 22-year old female is brought to the ER by her fiance.  Her HR is 127 bpm and she is diaphoretic.  She has extreme dyspnea and is having trouble responding to verbal commands.  Her fiance claims that they had an altercation that morning before he left for work, and when he found her this evening, she was laying on the ground unresponsive.  There was an empty bottle of aspirin next to her as well as a suicide note.  Which of the following blood gas values would you expect to see in this patient when she first showed serious symptoms?

(A) pH = 7.3, PaCO2 = 52

(B) pH = 7.4, PaCO2 = 45

(C) pH = 7.5, PaCO2 = 22

(D) pH = 7.3, PaCO2 = 25

(E) pH = 7.5, PaCO2 = 60

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Q: November 30, 2012

A toddler presents to the emergency department in respiratory distress, unable to speak.  His parents have brought him in because of a very loud inspiratory stridor.  The child was in the parent’s care all day and had not ingested anything for 3 hours.  ENT is paged to perform a laryngoscopy, and they note an extremely swollen epiglottis and oropharynx.  CBC shows elevated PMNs.  Which of the following situations has caused the number of cases such as this to either increase or decrease in recent years?

(A) Increased, due to new guidelines in diagnosis

(B) Increased, due to virulent mutations

(C) Increased, due to antibiotic resistance

(D) Decreased, due to vaccine development

(E) Decreased, due to antibiotic development

Q: November 29, 2012

A clinical trial is being run for a new asthma medication. The medication’s method of action works through the downregulation of a product of the arachadonic acid metabolism pathway.  Which of the following compounds could be downregulated to most specifically alleviate asthmatic symptoms?

(A) LTC4

(B) PGE2

(C) PGI2

(D) APC

(E) PGH2

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Q: November 28, 2012

A 44-year old woman presents to her primary care office complaining of fever, crampy abdominal pain, and diarrhea for 3 days.  Her physician remembers she had just come into the office 2 weeks prior for a pharyngeal bacterial infection which was successfully treated.  The patient denies eating any suspect food, travel, and sick contacts.  Which of the following drug therapies should be administered to treat her condition?

(A) Albendazole

(B) Penicillin G

(C) Vancomycin, intravenously

(D) Metronidazole

(E) Amoxicillin, Clarithromycin, and Omeprazole

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Q: November 27, 2012

You are a medical student beginning your first day of hospital rotations.  On your way up to the hospital floor you pass by your microbiology professor.  He wishes you good luck and asks you what would be the best laboratory tests to differentiate between the 3 most common typical organisms found in community acquired pneumonia. Which tests would BEST differentiate between these 3 commonly found organisms?

 

A) Gram stain, Oxidase test, Quellung reaction, Growth on chocolate agar with bacitracin

B) Gram stain, Quellung reaction, Hemolysis test, Coagulase test

C) Oxidase test, Growth on chocolate agar with bacitracin, Hemolysis test

D) Oxidase test, Hemolysis test, Coagulase test, Quellung reaction.

 

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Q: November 25, 2012

A 72-year old man with a 50-year pack history presents to the clinic complaining of a persistent dry cough and fatigue.  Despite recent weight loss, he has found his pants to be tighter around his waist.  Physical exam shows decreased muscle strength in all limbs as well as purple striae on the abdomen.  A diagnosis of primary lung cancer is made.  Which of the following statements is consistent with this man’s type of cancer?

(A) Surgery is usually not indicated

(B) The tumor is composed of large, anaplastic cells

(C) It is the most common lung cancer diagnosed in non-smokers

(D) The tumor is usually located in the periphery of the lungs

(E) Imaging studies would show dense pleuritic masses

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Q: November 22, 2012

A man presents to his family’s house for Thanksgiving dinner.  He complains of poor company, lackluster conversation, and mediocre side dishes.  He is involved in multiple arguments, and his blood pressure is 150/97.  He denies drinking too much, and refuses to make a toast.  While ferociously eating (in an upright position), he aspirates a small piece of turkey bone.  What is its most likely site of deposition in his lungs?

(A) Right middle lobe

(B) Right inferior lobe

(C) Left lingula

(D) Left superior lobe

(E) Left inferior lobe

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Q: November 21, 2012

A 35-year old male is experiencing strange sensations in his feet.  Two weeks ago, he had recovered from a few days of diarrhea accompanied by a fever.  When he woke up yesterday morning, he felt a tingling sensation in both feet that he described as “almost numbness, but still tingly.”  Today, the paresthesia has spread to his lower shins.  Neurological examination shows full ranges of motion and full strength in the knee, leg, ankle, and foot.  Which of the following is most likely the cause of his current changes in sensation?

 

(A) Charcot-Marie-Tooth Disease

(B) Li-Fraumeni Syndrome

(C) Wiskott-Aldrich Syndrome

(D) Lambert-Eaton Syndrome

(E) Guillain-Barre Syndrome

 

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Q: November 20, 2012

A 32-year old African American female presents to her primary care physician with a progressively worsening dyspnea and overall fatigue.  She has diffuse red patches on the skin of her legs, and a month-long persistent cough that hasn’t responded to over the counter treatment.  The patient denies fever, recent travel, and says her weight has remained fairly constant.  Below is a biopsy of her lung tissue.  Which of the following cell types are responsible for this formation?

Image

(A) Macrophages, Natural Killer Cells

(B) Plasma Cells, Neutrophils

(C) Fibroblasts, Chondrocytes

(D) Th1 CD4+ Helper T-Cells, Macrophages

(E) CD8+ Cytotoxic T Lymphocytes, Neutrophils

 

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