Test Prep Test Prep Certifications MCQS Questions & Answers

• Question 131:

  12 years old girl with malaise, fatigue, sore throat and fever. On examination there were petechial rash on palate, large tonsils with follicles, cervical lymphadenopathy and hepatosplenomegaly.

  All are complications except:

  A. Chronic active hepatitis

  B. Splenic rupture

  C. Transverse myelitis

  D. Encephalitis

  E. Aplastic anemia

  Correct Answer: A

• Question 132:

  Ophthalmoplegic migraine is best characterised as?

  A. Headache associated with irreversible palsy of 3rd nerve

  B. Headache with optic neuritis

  C. Recurrent headache with transient palsy of 3, 4 and / or 6th cranial nerves

  Correct Answer: C

  Recurrent headache with transient palsy of 3, 4 and / or 6th cranial nerves OPHTHALMOPLEGIC MIGRAINE It is a rare condition which was previously considered as a type of migraine. Recent studies suggest that is it likely to be an inflammatory cranial neuropathy. The International Headache Classification has reclassified ophthalmoplegic migraine as a type of neur earlier classification as a type of migraine.It is characterised by transient migraine like headache asso paresis of oculomotor, trochlear and/or abducens nerves.To arrive at a diagnosis of ophthalmoplegic m causes should be ruled out by appropriate investigations (like digital subtraction angiography / magne angiography of the brain).

• Question 133:

  An infant boy is born at 39 weeks' gestation by way of spontaneous vaginal delivery to a healthy, 32-yearold primigravid women. Prenatal care was appropriate and there were no problems at the time of delivery. Physical examination by the staff pediatrician is normal, with the exception of the genital examination. She observes that the urethral meatus is located on the ventral aspect of the penile shaft.

  Which of the following is the most correct statement about this condition?

  A. The infant may have a circumcision now

  B. Voiding cystourethrogram should be ordered

  C. A-Circumcision should be delayed D. The infant may never have a circumcision

  Correct Answer: C

  This infant has hypospadias. This condition occurs when there is incomplete invagination of ectoderm that is located at the glans penis where the normally located urethral meatus should be. When this occurs, the urethral opening is located on the ventral side of the penis, somewhere between the tip and the base of the shaft. Circumcision should never be performed directly after an infant is born with this condition (choice B). Rather, it should be delayed until approximately 6 months of age when the infant can better tolerate anesthesia. The reason to delay circumcision is because the prepuce will be needed for the plastic reconstruction that will need to be done. At the time of reconstruction, the infant will also undergo a circumcision (choice C). These patients do not have an increased risk for urinary tract infections. Therefore, a urine culture is not necessary (choice D). A voiding cystourethrogram (VCUG) allows for evaluation of the bladder, urinary reflux, and the presence or absence of posterior urethral valves. None of these conditions are associated with hypospadias

• Question 134:

  A 70-year-old man comes to the emergency department having had chest pain for the last hour. His initial EKG shows ST segment elevation in leads V2璙4. Aspirin has been given.

  Which of the following will most likely benefit this patient?

  A. Diltiazem

  B. Angioplasty

  C. Thrombolytics

  D. Metoprolol

  Correct Answer: B

  Angioplasty will lower the risk of mortality most for this patient. If it can be obtained within 90 minutes, angioplasty is the best therapy. Metoprolol lowers mortality but is not dependent on how soon you give it, as long as the patient receives it before going home.

• Question 135:

  Which of the following lowers mortality in COPD?

  A. Home oxygen therapy (continuous)

  B. Smoking cessation

  C. Both of above

  Correct Answer: C

• Question 136:

  Highest source/cause of increased ACTH in Cushing syndrome:

  A. Increase ACTH from adrenal

  B. Ectopic source

  C. Increase ACTH from pituitary adenoma

  D. Unknown

  Correct Answer: C

• Question 137:

  A 36-year-old woman presents with pains in both hands for the last few months and stiffness that improves as the day goes on. Multiple joints are swollen on exam. X-rays of the hands show some erosion.

  What is the single most accurate test?

  A. ANA

  B. Rheumatoid factor

  C. Sedimentation rate

  D. Anti-cyclic citrullinated peptide (anti-CCP)

  Correct Answer: D

  Rheumatoid factor (RF) is present in only 75?5 percent of patients with rheumatoid arthritis (RA).It can also be present in a number of other diseases; hence, the RF is rather nonspecific. Anti-cyclic citrullinated peptide (anti-CCP) is the single most accurate test for RA. It is > 95 percent specific for RA, and it appears earlier in the course of the disease than the RF. There is nothing specific on joint aspiration to determine a diagnosis of RA.

• Question 138:

  60 years old patient has only HTN best drug to start with:

  A. Diuretics

  B. ACEI

  C. ARB

  D. Beta blocker E-Alpha blocker

  Correct Answer: A

  Antihypertensive therapy has been shown to reduce morbidity and mortality in older patients with elevated systolic or diastolic blood pressures. This benefit appears to persist in patients older than 80 years, but less than one third of older patients have adequate blood pressure control. Systolic blood pressure is the most important predictor of cardiovascular disease. Blood pressure measurement in older persons should include an evaluation for orthostatic hypotension. Low- dose thiazide diuretics remain first-line therapy for older patients. Beta blockers, angiotensin-converting enzyme inhibitors, angiotensin-receptor blockers, and calcium channel blockers are second-line medications that should be selected based on comorbidities and risk factors.

  Reference: http://www.aafp.org/afp/2005/0201/p469.html

• Question 139:

  A 76-year-old woman is brought in for respiratory distress and altered mental status. Her medical history records right-sided hemiplegia from a stroke several years ago. She has blood pressure 86/52; heart rate 123 BPM, breathing rate 33 Br PM, temperature 102.3癋, and O2 sat 84%. Exam reveals rhonchi bilaterally with "E to Ah" changes and warm extremities with faint pulses. Chest x-ray shows bilateral infiltrates.

  What is the likely etiology of this patient's hypotension?

  A. Neurogenic shock

  B. Cardiogenic shock

  C. Septic shock

  D. Hypovolemic shock

  Correct Answer: C

  This patient is presenting with 3 SIRS criteria: hypotension, altered mental status, and a source of infection (pneumonia). The physical exam is also consistent with septic shock: Massive vasodilation has yielded warm extremities and faint pulses. Both hypovolemic shock and cardiogenic shock would have pale and cool extremities. There is no mention of bleeding, ruling out hemorrhagic shock.

• Question 140:

  A 31-year-old woman presents to the ED with a sudden onset of left-sided chest pain and difficulty breathing. She states her only medication is birth control pills. She has smoked 1 pack of cigarettes per day for 10 years. She is tachypneic (24 BrPM) and her heart rate is 120 beats per minute. Physical examination reveals diminished breath sounds on the left and the trachea deviated to the right.

  What is the most likely diagnosis?

  A. Tension pneumothorax

  B. Pulmonary embolus

  C. Pericardial tamponade

  Correct Answer: A

  Tension pneumothorax presents with decreased breath sound on one side and tracheal deviation PE does not give tracheal deviation, although it does have chest pain and tachycardia. Muffled heart sounds are seen typically in pericardial tamponade. This patient's risk for pneumothorax is that she is a smoker. It is likely she has a pleural bleb that burst due to her smoking history.