1. A 30-year-old male patient complains of fever and sore throat for several
days. The patient presents to you today with additional complaints of hoarse-
ness, difficulty breathing, and drooling. On examination, the patient is febrile
and has inspiratory stridor. Which of the following is the best course of action?
a. Begin outpatient treatment with ampicillin.
b. Culture throat for β-hemolytic streptococci.
c. Admit to intensive care unit and obtain otolaryngology consultation.
d. Schedule for chest x-ray.
e. Obtain Epstein-Barr serology.
2. A 40-year-old woman complains of 7 weeks of pain and swelling in both
wrists and knees. She has several months of fatigue. After a period of rest,
resistance to movement is more striking. On examination, the metacarpopha-
langeal joints and wrists are warm and tender. There are no other joint abnor-
malities. There is no alopecia, photosensitivity, kidney disease, or rash. Which
of the following is correct?
a. The clinical picture suggests early rheumatoid arthritis, and a rheumatoid factor
should be obtained.
b. The prodrome of lethargy suggests chronic fatigue syndrome.
c. Lack of systemic symptoms suggests osteoarthritis.
d. X-rays of the hand are likely to show joint space narrowing and erosion.
e. An aggressive search for occult malignancy is indicated.
3. A 60-year-old male has had a chronic cough with clear sputum pro-
duction for over 5 years. He has smoked one pack of cigarettes per day for
20 years and continues to do so. X-ray of the chest shows hyperinflation
without infiltrates. Arterial blood gases show a pH of 7.38, PCO2 of 40 mm Hg,
and PO2 of 65 mm Hg. Spirometry shows an FEV1/FVC of 45% without
bronchodilator response. Which of the following is the most important
treatment modality for this patient?
a. Oral corticosteroids
b. Home oxygen
c. Broad-spectrum antibiotics
d. Smoking cessation program
e. Oral theophylline
4. A 60-year-old male patient is receiving aspirin, an angiotensin-converting
enzyme inhibitor, nitrates, and a beta-blocker for chronic stable angina. He
presents to the ER with an episode of more severe and long-lasting anginal
chest pain each day over the past 3 days. His ECG and cardiac enzymes are
normal. Which of the following is the best course of action?
a. Admit the patient and add intravenous digoxin.
b. Admit the patient and begin low-molecular-weight heparin.
c. Admit the patient for thrombolytic therapy.
d. Admit the patient for observation with no change in medication.
e. Increase the doses of current medications and follow closely as an outpatient.
5. A 20-year-old woman complains of skin problems and is noted to have
erythematous papules on her face with blackheads (open comedones) and
whiteheads (closed comedones). She has also had cystic lesions. She is pre-
scribed topical tretinoin, but without a totally acceptable result. You are con-
sidering oral antibiotics, but the patient requests oral isotretinoin, which
several of her college classmates have used with benefit. Which of the fol-
lowing statements is correct?
a. Intralesional triamcinolone should be avoided due to its systemic effects.
b. Systemically administered isotretinoin therapy cannot be considered unless
concomitant contraceptive therapy is provided.
c. Antimicrobial therapy is of no value since bacteria are not part of the patho-
genesis of the process.
d. The teratogenic effects of isotretinoin are its only clinically important side effects.
e. The patient will not benefit from topical antibiotics since she did not respond
to topical retinoids.
answers; 1-c, 2-a, 3-d, 4-b, 5-b
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