Test Prep Test Prep Certifications MCQS Questions & Answers

• Question 61:

  Greatest benefit of thrombolysis is when given in Acute MI?

  A. less than 12 hours from onset of pain

  B. Same benefit in A and B

  C. less than 24 hours from onset of pain

  Correct Answer: A

  The greatest benefit is less than 12 hours. Very rarely patient gets thrombolytic in 30-60 minutes of chest pain especially in developing country, no resources to transport, and no good medical care nearby, literature shows advantage of thrombolytic after onset of chest pain is greatest by before 12 hours ...for practical purpose earlier is better may be in 30-60 mins, but you gets mortality reduction advantage if thrombolytic taken within 12 hours of chest pain.

• Question 62:

  Which of the following is most sensitive for detecting diabetic nephropathy?

  A. Urine albumin

  B. Glucose tolerance test E-Ultrasonography

  C. Serum creatinine level

  D. Creatinine clearance

  Correct Answer: A

  Nephropathy is a leading cause of death in diabetic patients. Diabetes may be functionally silent for 10 to 15 years. Clinically detectable diabetic nephropathy begins w development of microalbuminuria (30 to 300 mg of albumin per 24 h). The glomerular filtration may be elevated at this stage. Only after the passage of additional time will the proteinuria be (0.5 g/L) to be detectable on standard urine dipsticks.

  Microalbuminuria precedes nephropathy with both non-insulin- dependent and insulin-dependent diabetes. An increase in kidney size al the initial hyper filtration stage. Once the proteinuria becomes significant enough to be detected a steady decline in renal function occurs, with the glomerular filtration rate falling an average of minute per month. Therefore, azotemia begins about 12 years after the diagnosis of diabetes.

• Question 63:

  A patient's wife comes to take her husband home after a Myocardial Infarction and asks how long they should wait before they have sex.

  What do you tell her?

  A. No waiting necessary

  B. After echocardiography

  C. 2-6 weeks

  D. They should wait for a normal angiography

  Correct Answer: C

  Some waiting is necessary to have sex after an infarction. Sex minimally increases the risk of infarction. The duration and the intensity of exertion are sufficient to provoke ischemia in some cases

• Question 64:

  Which of the following will have the lowest glucose level on pleural effusion?

  A. Cancer

  B. Pulmonary tuberculosis

  C. Rheumatoid arthritis

  D. Pneumonia

  Correct Answer: C

  Rheumatoid arthritis has the lowest glucose level of all the causes of pleural effusion described here.

• Question 65:

  A 58-year-old man comes to the office a few days after an episode of chest pain. This was his first episode of pain, and he has no risk factors. In the emergency department, he had a normal EKG and normal CKMB and was released the next day.

  Which of the following is most appropriate in his further management?

  A. LDL level

  B. Repeat CK-MB

  C. Stress (exercise tolerance) testing

  D. Statin

  Correct Answer: C

  Stress test when the case is equivocal or uncertain for the presence of CAD. Do not do an angiography unless the stress test is abnormal. Exercise tolerance, or "stress," testing detects coronary artery disease when the heart rate is raised and ST segment depression is detected. This case is asking you to know that a stress test is a way of increasing the sensitivity of detection of CAD beyond an EKG and enzymes.

• Question 66:

  A 43-years-old man is brought to the emergency department after a motor vehicle accident involving ahead He mentioned that he is having headache and dizziness. During his overnight admission for observation, his serum sodium level rises to 151 meq/L.

  All of the following tests are indicated EXCEPT:

  A. Measurement of morning cortisol level E-Measurement of plasma and urine osmolality

  B. Measurement of response to desmopressin

  C. MRI scan of the head

  D. Overnight dehydration test

  Correct Answer: A

• Question 67:

  A 67-year-old homeless woman presents to the ED with substernal chest pain that began shortly after vomiting. The patient has a history of alcoholism and has just finished a 3-day binge of vodka. Physical examination reveals a "snap, crackle, and pop" upon palpation around the clavicles.

  What is the most likely diagnosis?

  A. Volvulus

  B. Boerhaave syndrome

  C. Mycocardial infarction

  D. Pancreatitis

  E. Biliary colic

  Correct Answer: B

  Boerhaave syndrome is a full-thickness tear of the esophagus secondary to retching. The patient will have a history of severe incessant vomiting, often due to alcoholism. MI is unlikely in this patient given the subcutaneous emphysema. The other choices do not have substernal chest pain. Pancreatitis presents with abdominal pain that radiates to the back upon alcohol intake, not air in the subcutaneous space. Biliary colic has postprandial RUQ pain. Volvulus is malrotation of the colon.

• Question 68:

  An old man undergoing planned brain surgery. He is on aspirin. What is most appropriate recommendation for him prior to surgery?

  A. Vitamin K Parenterally

  B. Delay surgery for 2 weeks

  C. Delay surgery for 2 days

  Correct Answer: B

• Question 69:

  A 32-year-old woman comes to the emergency department with lower abdominal pain and tenderness, fever leukocytosis, and cervical motion tenderness.

  What is the next best step in the management of this patient?

  A. Ceftriaxone and doxycycline

  B. Laparoscopy

  C. Pelvic sonogram

  D. Urine pregnancy test

  Correct Answer: D

  The most important thing to do in a woman with lower abdominal pain or tenderness is to exclude an ectopic pregnancy. Perform a urine pregnancy test first and then get a cervical culture and start therapy.

• Question 70:

  A patient who has recently undergone hip fracture repair develops the sudden onset of shortness of breath. His pulse is 110 per minute. The chest is clear to auscultation. Chest x-ray is normal, and the EKG shows sinus tachycardia. ABG shows pH 7.48, pCO2 28, pO2 75.

  What is the next best step in management?

  A. Spiral CT scan

  B. dimers

  C. Heparin

  D. Angiography

  E. Lower extremity Doppler

  Correct Answer: C

  When the case so clearly suggests a pulmonary embolus with sudden onset of shortness of breath and clear lungs in a patient with a risk factor, the first thing to do after the chest x-ray.