03.2010 internal

You are investigating the cause for a patient’s anemia. He is a 50-year-old man who was found to have a hematocrit of 25% on routine evaluation. His hematocrit was 47% 1 year ago. Mean corpuscular volume is 80, mean corpuscular hemoglobin concentration is 25, mean corpuscular hemoglobin is 25. Reticulocyte count is 5%. Review of the peripheral blood smear shows marked numbers of polychromatophilic macrocytes. Ferritin is 340 µg/L. What is the cause of this patient’s anemia?

A patient presents to the clinic complaining of nausea, vomiting, crampy abdominal pain, and markedly increased flatus. The patient has not experienced any diarrhea or vomiting but notes that he has been belching more than usual and he describes a “sulfur-like” odor when he does so. He returned from a 3-week trip to Peru and Ecuador several days ago and notes that his symptoms began about a week ago. Giardiasis is considered in the differential. Which of the following is true regarding Giardia?

Which of the following statements about diabetic retinopathy is true?

Which of the following conditions is often the first sign of amyloidosis?

A 73-year-old man is admitted to the hospital with 3 weeks of malaise and fevers. His past medical history is notable only for hypertension controlled with a thiazide diuretic. He smokes one pack of cigarettes per day and works as an attorney. His physical examination is notable only for a new systolic heart murmur heard best in the mitral region. His laboratory examination is notable for mild anemia, an elevated white blood cell count, and occasional red blood cells on clean catch urine. Blood cultures grow Streptococcus bovis and echocardiogram shows a <1-cm vegetation on the mitral valve. What additional evaluation is indicated for this patient?

In a patient with bacterial endocarditis , which of the following echocardiographic lesions is most to lead to embolization ?

Which of the following signs and symptoms are associated with Sjogren’s syndrome?

A healthy 62-year-old woman returns to your clinic after undergoing routine colonoscopy. Findings included two 1.3-cm sessile (flat-based), villous adenomas in her ascending colon that were removed during the procedure. What is the next step in management?

Several family members present to a local emergency room 2 days after a large family summer picnic where deli meats and salads were severed . They all complain of profuse diarrhea ,headaches ,fevers ,and myalgias .Their symptoms began ~24 h after the picnic . It appears that everyone who ate Aunt Emma’s bologna surprise was afflicted .Routine cultures of blood and stool are negative to date . Which of the following is true regarding Listeria gastroenteritis ?

Which of the following laboratory results best support the diagnosis of subclinical hypothyroidism?

Which of the following statements about cardiac toxicity from cancer treatments is true?

A 19-year-old woman comes to your office after being bitten by a bat on the ear while camping in a primitive shelter. She is unable to produce a vaccination record. On physical examination, she is afebrile and appears well. There are two small puncture marks on the pinna of her left ear. What is an appropriate vaccination strategy in this context?

A high urinary sodium concentration in the presence of a low plasma osmolality is most closely associated with:

The triad of portal vein thrombosis, hemolysis, and pancytopenia suggests which of the following diagnoses?

In a patient who has undergone a traumatic splenectomy, what test can be ordered to establish lack of splenic function?

Side effects of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors include:

Which of the following best describes the mechanism of action of clopidogrel?

A person with liver disease caused by Schistosoma mansoni would be most likely to have what condition?

A 24-year-old poorly controlled diabetic patient presents to your emergency room with ketoacidosis, fever, pain, and purulent drainage of the sinuses with black eschar formation affecting the nasal septum. The most likely diagnosis is:

Which of the following symptoms is most suggestive of an esophageal mass?

Which of the following represents an emergent (same day) indication for cardiac surgery in a patient with infective endocarditis?

A 62-year-old business executive with a history of migraines is noted to have hypertension; otherwise, he is healthy. Which of the following is the best medication for the treatment of his mhypertension?

Which of the following carries the best disease prognosis with appropriate treatment?

A 30-year-old female is seen in the clinic before undergoing an esophageal dilation for a stricture. Her past medical history is notable for mitral valve prolapse with mild regurgitation. She takes no medications and is allergic to penicillin. Her physician should recommend which of the following?

Which of the following is an effect of niacin use?

A 48-year-old woman is admitted to the hospital with anemia and thrombocytopenia after complaining of profound fatigue. Her initial hemoglobin is 8.5 g/dL, hematocrit 25.7%, and platelet count 42,000/µL. Her leukocyte count is 9540/µL, but 8% blast forms are noted on peripheral smear. A chromosomal analysis shows a reciprocal translocation of the long arms of chromosomes 15 and 17, t(15;17), and a diagnosis of acute promyelocytic leukemia is made. The induction regimen of this patient should include which of the following drugs:

A 78-years-old male presents to the clinic complaining that every time he shaves with a straight razor, he passes out. His symptoms have been occurring for the last 2 months. Occasionally, when he puts on a tight collar, he passes out as well. The loss of consciousness is brief, he has no associated prodrome, and he feels well afterward. His past medical history is notable for hypertension and hypercholesterolemia. His only medication is hydrochlorothiazide. On physical exam his vital signs are normal, and his cardiac exam is normal with the exception of a fourth heart sound. Which of the following is the most appropriate next diagnostic test?

A 60-year-old alcoholic man, currently being treated for gastritis, presents to the office with painful breasts that appear enlarged. The most likely cause is:

A 56-year-old patient inquires about screening for colon cancer. He has no risk factors for colon cancer, other than age. Which of the following statements is true regarding which screening test you recommend for this patient?

A 37-years-old male with Wolff-Parkinson-White syndrome develops a broad-complex irregular tachycardia at a rate of 200 beats per minute. He appears comfortable and has little hemodynamic impairment. Useful treatment at his point might include:

A 60-year-old man presents with pain, swelling, and redness of the first metatarsal phalangeal joint. His cardiologist recently prescribed hydrochlorothiazide for his hypertension. The most likely diagnosis is:

A 46-year-old woman presents with new onset ascites and severe abdominal pain: a hepatic Doppler examination reveals hepatic vein thrombosis. She also reports tea colored urine on occasion, particularly in the morning, as well as recurrent worsening abdominal pain. On further evaluation, she is found to have an undetectable serum haptoglobin, elevated serum lactase dehydrogenase, hemoglobinuria and an elevated reticulocyte count. A peripheral smear shows no schistocytes. What is the most likely diagnosis?

Which of the following patients meets criteria for the diagnosis of the metabolic syndrome?

Which of the following values is acceptable for a 65-year-old man who had a previous coronary artery bypass graft?

A 17-year-old woman presents to the clinic complaining of vaginal itchiness and malodorous discharge. She is sexually active with multiple partners, and she is interested in getting tested for sexually transmitted diseases. A wet-mount microscopic examination is performed, and trichomonal parasites are identified. Which of the following statements regarding trichomoniasis is true?

When treating a patient with a non -ST-segment elevation myocardial infarction (NSTEMI), risk stratification and timely administration of anti-ischemic and antithrombotic therapies are paramount. For a patient with unstable angina with negative biomarkers. which medication regimen is most appropriate an initial treatment?

A blood urea nitrogen (BUN): creatinine level greater than 20 is associated with:

A 32-year-old man presents with jaundice and malaise. He is found to have acute hepatitis B with positive hepatitis B virus (HBV) DNA and E antigen. Which of the following antiviral agents are approved as part of a therapeutic regimen for mono-infection with hepatitis B?

Which of the following associations correctly pairs clinical scenarios and community-acquired pneumonia (CAP) pathogens?

Which of the following is the most appropriate medication for the treatment of hypertension in a diabetic patient?

Which of the following is the most common cause of traveler’s diarrhea in Latin America?

Which of the following forms of hepatitis does NOT have a chronic state?

A 60-year-old woman presents with complaints of diffuse proximal muscle pain, low-grade fevers, and generalized fatigue. Laboratory findings include an elevated ESR and mild anemia. The most likely diagnosis is:

In the inpatient setting, extended-spectrum β-lactamase (ESBL)-producing gram-negative infections are most likely to occur after frequent use of which of the following classes of antibiotics?

Which of the following organisms is responsible for the development of pseudomembranous colitis?

Which of the following is associated with pseudogout?

Which of the following is true regarding influenza prophylaxis?

Which of the following medications is used for the treatment of pseudomembranous colitis?

A 65 year old man complains of gynecomastia and galactorhea with erectile dysfunction. the most likely diagnosis is: