پرسش [ سوالات تستي براي دانشجويان پزشكي ]

[Himmler 22,171]

11

 

A previously healthy 25-year-old music teacher develops fever and a rash over her face and chest. The rash is itchy and on exam involves multiple papules and vesicles in varying stages of development. One week later she complains of cough and is found to have an

infiltrate on x-ray. The most likely etiology of the infection is

 

A)Streptococcus pneumoniae

B)Mycoplasma pneumoniae

C)Pneumocystis carinii

D)Varicella virus

[Himmler 22,171]

12

A 25-year-old male from East Tennessee had been ill for 5 days with fever, chills, and headache when he noted a rash that developed on his palms and soles. In addition to macular lesions, petechiae are noted on the wrists and ankles. The patient has spent the summer camping. The most important fact to be determined in the history is

 

A)Exposure to contaminated springwater

B)Exposure to raw pork

C)Exposure to ticks

D)Exposure to prostitutes

[Himmler 22,171]

13

A 19-year-old male has a history of athlete's foot but is otherwise healthy when he develops the sudden onset of fever and pain in the right foot and leg. On physical exam, the foot and leg are fiery red with a well-defined indurated margin that appears to be rapidly advancing. There is tender inguinal lymphadenopathy. The most likely organism to cause this infection is

A)Staphylococcus epidermidis

B)Tinea pedis

C)Streptococcus pyogenes

D)Mixed anaerobic infection

[Himmler 22,171]

14

An 18-year-old male has been seen in clinic for urethral discharge. He is treated with ceftriaxone, but the discharge has not resolved and the culture has returned as no growth. The most likely etiologic agent to cause this infection is

 

A)Ceftriaxone-resistant gonococci

B)Chlamydia psittaci

C)Chlamydia trachomatis

D)Herpes simplex

[Himmler 22,171]

kidney and urinary tract

 

Quiz

 

 

 

 

1

A 68-year-old female with stable coronary artery disease undergoes angiography of the right lower extremity for peripheral vascular disease. The patient is on warfarin for recurrent deep vein thrombosis, aspirin, lisinopril, metoprolol, and atorvastatin. Preangiography, she received a course of dicloxacillin for cellulitis 1 week ago. Three weeks after angiography the patient is evaluated for general malaise. Physical examination reveals a petechial rash and livedo reticularis on both lower extremities. Laboratory evaluation reveals that her creatinine has risen from 1.5 to 3.7 mg/dL. Other laboratory abnormalities include an ESR of 96 mm/h, leukocytosis, eosinophiluria, and a reduced third component of complement (C3). Urine sodium is 40 meq/L. Urinalysis reveals 1+ protein, 10 to 20 WBC/HPF, and 5 to 10 RBC/HPF with no casts. What is the most likely diagnosis

?

 

A)

Prerenal azotemia

B)

Radiocontrast-induced acute renal failure

C)

Drug-induced acute interstitial nephritis

D)

Atheroembolic renal failure

[Himmler 22,171]

2

A 46-year-old male with HIV and severe penicillin allergy receiving zidovudine, indinavir, and stavudine presents with fever, nonproductive cough, and severe hypoxia. Chest x-ray reveals diffuse increased interstitial markings and a possible lobar consolidation in the left lower lobe. After appropriate evaluation, the patient receives levofloxacin, trimethoprim-sulfamethoxazole, and acyclovir. Initial serum creatinine is 1.6 mg/dL. On day 4, it has risen to 3.8 mg/dL and a normal serum potassium has risen to 7.1 mg/dL. Urinalysis reveals no casts, 10 to 20 WBC/HPF, and rare RBCs. Which drug is the most likely cause of renal failure

?

A)Levofloxacin

B)Trimethoprim-sulfamethoxazole

C)Acyclovir

D)Indinavir

[Himmler 22,171]

3

A 43-year-old female presents with hypertension, edema, hyperlipidemia, and a deep venous thrombosis in her left leg. Which of the following is not necessary to diagnose the nephrotic syndrome

?

A)

Edema

B)

Hypertension

C)

24h urine albumin e3 g

D)

Hyperlipidemia

[Himmler 22,171]

4

A patient with a serum sodium of 110 meq/L suffers grand mal seizures. CT scan of the head and lumbar puncture are normal. What is the immediate treatment of the hyponatremia

?

A)Normal saline at 250 mL/h

B)750 mL oral fluid restriction

C)3% saline at 30 to 40 mL/h plus furosemide

D)Demeclocycline

[Himmler 22,171]

5

You are designing a dialysis unit with dietitians, nurses, and pharmacologists to provide the best possible care. Patients suffering from which of the following conditions will make up your largest population

?

A)Chronic glomerulonephritis

B)Hypertension

C)Diabetes mellitus

D)Obstructive uropathy

[Himmler 22,171]

infectious dis.

clinical case1

 

 

1

A 10-year-old boy presents with his mother, complaining of intense itching, worse at night, since the first week of school. He has numerous excoriations in the interdigital web spaces, wrists, and anterior axillary folds. A course of treatment for eczema with topical corticosteroids has provided little relief. His infant sister has recently developed intensely pruritic linear burrow-like lesions on her palms, soles, face, and scalp. Their mother works in a nursing home and has developed pruritus and reddish-brown nodular lesions in her axillae and perineum that have persisted several months after she treated herself with a lotion that was provided at her place of work. The most likely ectoparasite affecting this family is:

A)Head lice (pediculosis).

B)Chiggers (mites).

C)Ticks.

D)Fleas.

E)Scabies

[Himmler 22,171]

2

What is the next best step in this case

?

 

A)Removal of the individual organisms

B)Tetracycline 10 mg/kg divided TID for all affected family members

C)Oral ivermectin 200 mcg/kg in 1 oral dose, repeated in 2 weeks for all affected family members

D)Symptomatic treatment with topical steroids and oral antihistamines

E)One application of 5% permethrin cream for all family members for 8-14 hours, followed by showering and single-dose oral ivermectin 200 mcg/kg; repeated in 2 weeks for the mother

[Himmler 22,171]

3

 

You successfully treated the whole family. They are now comfortable, happy, and totally confident in your abilities. The mother returns with her girl, who is now 3 years old, with a new complaint. Apparently, the patient has complained of her "bottom" hurting, a symptom that her mother has interpreted to mean perineal pain. The pain is worse at night and the child has awoken several nights complaining of vaginal pain. The mother thinks that she may have a bladder infection, but there are no urinary symptoms. The patient complains only of "itchy butt." The exam is normal. What is the next best step in diagnosis of this

problem

?

A)Urinalysis, microscopic exam, and urine culture.

B)Speculum vaginal exam with cultures.

C)"Scotch tape" test.

D)Stool collection for ova and parasites.

E)Referral to a pediatric behavioral disorders specialist

[Himmler 22,171]

4

 

Your "Scotch tape" test is a success, proving your clinical suspicions. The best intervention is to

:

A)Treat the patient with mebendazole 100 mg PO once, repeat in 2 weeks, and encourage good hand washing for the whole family

B)Treat the patient and the entire family with mebendazole 100 mg PO daily for 14 days

C)Treat the patient and the entire family with mebendazole 100 mg PO once, and repeat in 2 weeks

D)Treat the patient with metronidazole 500 mg PO once, and repeat in 2 weeks

[Himmler 22,171]

Quiz for Students

Neurology

 

 

1

A 30-year-old male complains of unilateral headaches with rhinorrhea and tearing of the eye on the side of the headache. Episodes are precipitated by alcohol. Headaches may become a problem for weeks to months, after which a headache-free period occurs. The most likely diagnosis is

 

 

A)

Migraine

B)

Cluster headache

C)

Sinusitis

D)

Tension headache

[Himmler 22,171]

2

A 35-year-old previously healthy woman complains of a severe, excruciating headache and then has a transient loss of consciousness. There are no focal neurologic findings. The next step in evaluation is

A)

CT scan without contrast

B)

CT scan with contrast

C)

Carotid angiogram

D)

Holter monitor

[Himmler 22,171]

3

A 70-year-old male complains of the sudden onset of syncope. It occurs without warning and with no sweating, dizziness, or light-headedness. He believes episodes tend to occur when he turns his head too quickly or sometimes when he is shaving.The best way to make a definitive diagnosis in this patient is

A)ECG

B)Carotid massage with ECG monitoring

C)Holter monitor

D)Electrophysiologic studies to evaluate the AV node

[Himmler 22,171]

4

Which of the following is correct with respect to treatment of this patient

?

A)Riluzole arrests the underlying pathologic process in ALS

B)Riluzole was FDA approved for ALS because it improves survival rate

C)Riluzole has no significant side effects

D)Insulin-like growth factor is another alternative for the treatment of ALS

[Himmler 22,171]

5

A 20-year-old woman complains of weakness that is worse in the afternoon, worse during repetitive activity, and improved by rest. When fatigued, the patient is unable to hold her head up, speak, or chew her food. On physical exam, there is no loss of reflexes, sensation, or coordination. The underlying pathogenesis of this disease is

A)Serum antiacetylcholine receptor antibodies causing neuromuscular transmission failure

B)Destruction of anterior horn cells by virus

C)Progressive muscular atrophy

D)Demyelinating disease

[Himmler 22,171]

6

The diagnosis of myasthenia gravis is made by a positive edrophonium test, repetitive nerve stimulation test of a weak muscle, and antiacetylcholine receptor antibody assay

MRI of the mediastinum is now indicated to

 

A)

Rule out tuberculosis before starting prednisone

B)Rule out thymoma

C)Look for small cell carcinoma and Lambert-Eaton syndrome

D)Rule out sarcoidosis

[Himmler 22,171]

7

A 45-year-old woman presents to her physician with an 8-month history of gradually increasing limb weakness. She first noticed difficulty climbing stairs, then problems rising from chairs, walking more than half a block, and, finally, lifting her arms above shoulder level. Aside from some difficulty swallowing, she has no ocular, bulbar, or sphincter problems and no sensory complaints. Family history is negative for neurological disease. Examination reveals significant proximal limb and neck muscle weakness with minimal atrophy, normal sensory findings, and intact deep tendon reflexes. The most likely diagnosis in this patient is

 

A)

Polymyositis

B)

Cervical myelopathy

C)

Myasthenia gravis

D)

Mononeuropathy multiplex

E)

Limb-girdle muscular dystrophy