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1 | |
A 55-year-old male is being evaluated for constipation. There is no history of prior gastrectomy or of upper GI symptoms. Hemoglobin is 10 g/dL, mean corpuscular volume (MCV) is 72 fL, serum iron is 4 mg/dL (normal is 50 to 150 mg/dL), iron-binding capacity is 450 mg/dL (normal is 250 to 370 mg/dL), saturation is 1% (normal is 20 to 45%), and ferritin is 10 mg/L (normal is 15 to 400 mg/L). The next step in the evaluation of this patient's anemia is |
| | A) | Red blood cell folate |
| | B) | Iron absorption studies |
| | C) | Colonoscopy |
| | D) | Bone marrow examinaton |
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2 | |
A 50-year-old woman complains of pain and swelling in her proximal interphalangeal joints, both wrists, and both knees. She complains of morning stiffness. She had a hysterectomy 10 years ago. Physical exam shows swelling and thickening of the PIP joints. Hemoglobin is 10.3 g/dL, MCV is 80 fL, serum iron is 8 mmol/L, iron-binding capacity is 200 mg/dL (normal is 250 to 370 mg/dL), and saturation is 10%. The most likely explanation for this woman's anemia is |
| | A) | Occult blood loss |
| | B) | Vitamin deficiency |
| | C) | Anemia of chronic disease |
| | D) | Sideroblastic anemia |
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3 | |
A 35-year-old female who is recovering from Mycoplasma pneumonia develops increasing weakness. Her Hgb is 9.0 g/dL and her MCV is 110. The best test to determine whether the patient has a hemolytic anemia is |
| | A) | Serum bilirubin |
| | B) | Reticulocyte count and blood smear |
| | C) | Mycoplasma antigen |
| | D) | Serum LDH |
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4 | |
fter undergoing surgical resection for carcinoma of the stomach, a 60-year-old male develops numbness in his feet. On exam, he has lost proprioception in the lower extremities and has a wide-based gait and positive Romberg sign. A peripheral blood smear shows macrocytosis and hypersegmented polymorphonuclear leukocytes. The neurologic dysfunction is secondary to a deficiency of which vitamin? |
| | A) | Folic acid |
| | B) | Thiamine |
| | C) | Vitamin K |
| | D) | Vitamin B12 |
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5 | |
A 67-year-old male presents with hemoptysis 1 week in duration. He has smoked 11/2 packs of cigarettes per day for 50 years and has been unable to quit smoking despite nicotine replacement therapy and bupropion. He has mild COPD for which he uses an ipratropium inhaler. Chest x-ray reveals a 3-cm perihilar mass. The most likely cause of this patient's hemoptysis is |
| | A) | Adenocarcinoma of the lung |
| | B) | Squamous cell carcinoma of the lung |
| | C) | Bronchoalveolar cell carcinoma |
| | D) | Bronchial adenoma |
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6 | |
A 38-year-old female presents with recurrent sore throats. She is on no medications, does not use ethanol, and has no history of renal disease. Physical exam is normal. A CBC shows Hgb of 9.0 g/dL, MCV is 85 fL (normal), white blood cell count is 2,000/mL, and platelet count is 30,000/mL. The best approach to diagnosis is |
| | A) | Erythropoietin level |
| | B) | Serum B12 |
| | C) | Bone marrow biopsy |
| | D) | Liver spleen scan |
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7 | |
A 20-year-old male finds a mass in his scrotum. The first step in evaluating this mass is |
| | A) | Palpation and transillumination |
| | B) | HCG and a-fetoprotein |
| | C) | Scrotal ultrasonography |
| | D) | Evaluation for inguinal adenopathy |
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8 | |
A 65-year-old man presents with painless hematuria. He has a 45-year history of tobacco use. He denies fever, chills, and dysuria. General physical exam is unremarkable. On rectal exam, the prostate is small, nonnodular, and nontender. A urinalysis shows 100 red blood cells per high-power field. No white cells or protein are present. Three months previously, the patient had an abdominal ultrasound for right upper quadrant pain; on review, both kidneys were normal. The most useful diagnostic test at this time is |
| | A) | Urine culture and sensitivity |
| | B) | PSA |
| | C) | Renal biopsy |
| | D) | Cystoscopy |
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9 | |
A patient with bacterial endocarditis develops thrombophlebitis while hospitalized. His course in the hospital is uncomplicated. On discharge he is treated with penicillin, rifampin, and warfarin. Therapeutic prothrombin levels are obtained on 15 mg/d of warfarin. After 2 weeks, the penicillin and rifampin are discontinued. You should now |
| | A) | Cautiously increase warfarin dosage |
| | B) | Continue warfarin at 15 mg/d for about 6 months |
| | C) | Reduce warfarin dosage |
| | D) | Stop warfarin therapy |
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10 | |
A 65-year-old male with diabetes mellitus, bronzed skin, and cirrhosis of the liver is being treated for hemochromatosis previously confirmed by liver biopsy. The patient experiences increasing right upper quadrant pain, and his serum alkaline phosphatase is now elevated. There is a 15-lb weight loss. The next step in management is |
| | A) | Increase frequency of phlebotomy for worsening hemochromatosis |
| | B) | Obtain CT scan to rule out hepatoma |
| | C) | Obtain hepatitis B serology |
| | D) | Obtain antimitochondrial antibody to rule out primary biliary cirrhosis |
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11 | |
A 40-year-old cigarette smoker is found on routine physical exam to have a 1-cm white patch on his oral mucosa that does not rub off. There are no other lesions in the mouth. The patient has no risk factors for HIV infection. The lesion is nontender. The next step in management is |
| | A) | Culture for Candida albicans |
| | B) | Follow lesion with annual physical exam |
| | C) | Refer to oral surgeon for biopsy of lesion |
| | D) | Reassure patient that this is a normal variant |
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12 | |
A 20-year-old black male with sickle cell anemia (SS homozygote) has had several episodes of painful crises. The least likely physical finding in this patient is |
| | A) | Scleral icterus |
| | B) | Systolic murmur |
| | C) | Splenomegaly |
| | D) | Ankle ulcers |
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13 | |
A 30-year-old black man plans a trip to India and is advised to take prophylaxis for malaria. Three days after beginning treatment, he develops dark urine, pallor, fatigue, and jaundice. Hematocrit is 30% (it had been 43%) and reticulocyte count is 7%. He stops taking the medication. Treatment should consist of |
| | A) | Splenectomy |
| | B) | Administration of methylene blue |
| | C) | Administration of vitamin E |
| | D) | Exchange transfusions |
| | E) | No additional treatment is required |
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14 | |
A 70-year-old intensive care unit patient complains of fever and shaking chills. The patient develops hypotension, and blood cultures are positive for gram-negative bacilli. The patient begins bleeding from venipuncture sites and around his Foley catheter. Laboratory studies are as follows:
Hct: 38%
WBC: 15,000/mL
Platelet count: 40,000/mL (normal 130,000 to 400,000)
Peripheral blood smear: fragmented RBCs
PT: elevated
PTT: elevated
Plasma fibrinogen: 70 mg/dL (normal 200 to 400)
The best course of therapy in this patient is |
| | A) | Begin heparin |
| | B) | Treat underlying disease |
| | C) | Begin plasmapheresis |
| | D) | Give vitamin K |
| | E) | Begin red blood cell transfusion |
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15 | |
A 30-year-old female with Graves' disease has been started on propylthiouracil. She complains of low-grade fever, chills, and sore throat. The most important initial step in evaluating this patient's fever is |
| | A) | Serum TSH |
| | B) | Serum T3 |
| | C) | CBC |
| | D) | Chest x-ray |
| | E) | Blood cultures |
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16 | |
A 64-year-old African American man presents for evaluation of a painless "lump" in the left thigh. He first noticed the abnormality about 1 month previously and thinks it has increased in size; there is no prior history of trauma. On exam, you find a 5-cm soft tissue mass, firm to hard in consistency, in the soft tissue above the knee. There is no tenderness or erythema; the mass is deep to the subcutaneous tissue and appears fixed to the underlying musculature. Inguinal lymph nodes are normal. You should |
| | A) | Reexamine the lesion in 3 months, as it is probably a lipoma |
| | B) | Obtain a bone scan |
| | C) | Treat with cephalexin 500 mg po qid for presumed abscess |
| | D) | Refer the patient for surgical biopsy |
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