[MCQs] The Quizzes about Acute Complaints - Part 10 (20 test)

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Acute Complaints-10

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Question 1

A new mother brings her infant to see you to discuss his He is 4 weeks old, and is exclusively breast-fed. He vomits with every meal. On examination, his abdomen is distended with normal bowel sounds, and he appears dehydrated. He has lost 4 oz since his visit with you 2 weeks ago. What is the most likely diagnosis?

A	Allergy to breast milk
B	Normal gastroesophageal reflux
C	Pyloric stenosis
D	Intussesception
E	Small bowel obstruction

Question 1 Explanation:

Children with pyloric stenosis usually present with weight loss, dehydration, and occasionally a palpable “olive” mass in the epigastric area. It usually is identified before 7 weeks of age. Breast milk allergies are uncomomon. Reflux may be possible, but is less likely to be associated with weight loss and dehydration. Intussesception is associated with significant abdominal pain, and hemoccult positive stools. Small bowel obstructions are less likely, and are associated with high-pitched bowel sounds.

Question 2

You are evaluating a 31 year-old man with the acute onset of nausea and It is associated with significant epigastric pain that radiates to the back and occurs after eating any type of food. It is somewhat better if he does not eat at all. Which of the following tests is most likely to be abnormal in this case?

A	Complete blood count
B	Amylase and lipase
C	Hemoccult testing of the stool
D	Abdominal x-rays
E	Upper endoscopy

Question 2 Explanation:

Pancreatitis is associated with the acute onset of significant nausea, vomiting, and epigastric pain. The symptoms occur after eating, and are improved when the patient does not eat. Amylase and lipase are likely to be abnormal, but the CBC is likely normal. Hemoccult testing, abdominal x-rays, and upper endoscopy are likely to be normal.

Question 3

You are evaluating a 44-year-old woman with the acute onset of nau- sea and It is associated with pain, and occurs after eating a fatty meal. Which of the following tests is most likely to be abnormal in this case?

A	Amylase and lipase
B	Hemoccult testing of the stool
C	Abdominal x-rays
D	Ultrasound
E	Upper endoscopy

Question 3 Explanation:

The patient described likely has cholelithiasis. Nausea, vomiting, and pain occur after eating fatty meals. The diagnostic test of choice would be a right upper quadrant ultrasound to identify stones in the gallbladder. Amylase and lipase may be positive if the patient develops secondary pancreatitis, but are unlikely to be elevated until that point. Hemoccult testing, abdominal x-rays, and upper endoscopy are all likely to be normal.

Question 4

You are treating a 26-year-old woman for Which of the following antiemetics is most likely to cause extrapyramidal reactions in the patient?

A	Trimethobenzamide (Tigan)
B	Prochlorperazine (Compazine)
C	Promethazine (Phenergan
D	Metoclopramide (Reglan)
E	Ondansetron (Zofran)

Question 4 Explanation:

Antiemetics can cause a variety of side effects. The phenothiazines (Compazine and Phenergan) generally cause drowsiness, dry mouth, and dizziness. Tigan causes similar side effects. Zofran is a serotonin receptor antagonist, and may cause dizziness and headache. Reglan is a prokinetic agent, and can cause diarrhea and extrapyramidal reactions.

Question 5

You are evaluating a 33-year-old woman complaining of Which of the following characteristics, if present, increase the likelihood that the symptoms are cardiac in etiology?

A	The fact that the patient is female
B	The fact that the patient has a sister with similar symptoms
C	Her description of the symptoms as an “irregular heartbeat”
D	The fact that her father has a history of heart disease
E	The fact that the episodes last less than 1 minute

Question 5 Explanation:

There are several characteristics of palpitations that can help the physician determine whether or not the symptoms are from a cardiac cause. These include male sex, the description of the symptom as an “irregular heartbeat,” a personal history of heart disease, and event duration greater than 5 minutes. Family history of similar symptoms would not be a risk factor for cardiac disease.

Question 6

You are seeing a hypertensive 56-year-old woman who is complaining of a “fluttering in her ” She describes a rapid heart rate, and to her it seems irregular. She is otherwise well, and denies shortness of breath, lighthead- edness pedal edema or other acute symptoms. On examination, her pulse rate is rapid and irregular. Which of the following is her most likely diagnosis?

A	Atrial fibrillation
B	Paroxysmal supraventricular tachycardia (PSVT)
C	Stable ventricular tachycardia
D	Stimulant abuse
E	Hyperthyroidism

Question 6 Explanation:

When a patient describes her heartbeat as rapid and irregular, it suggests either atrial fibrillation or atrial flutter. Ectopy and atrial fibrillation can both cause an irregular pulse. PSVT is usually rapid and regular, as is stable ventricular tachycardia (VT). Stimulant abuse will generally cause a sinus tachycardia. While hyperthyroidism may cause atrial fibrillation, the patient would likely have other additional symptoms.

Question 7

You are seeing a 32-year-old otherwise healthy woman who is com- plaining of She describes the sensation as a “flip flop” in her chest. They only last an instant, and are not associated with lightheaded- ness or other symptoms. She denies other symptoms. Which of the follow- ing is the most likely etiology of her complaint?

A	Atrial fibrillation
B	PSVT
C	Ventricular premature beats
D	Stimulant abuse
E	Hyperthyroidism

Question 7 Explanation:

Ventricular premature beats are often random, episodic, and instantaneous beats, often described as a “flip-flopping” sensation. Atrial fibrillation is described more as a rapid and182 Family Medicine irregular heart rate or a “fluttering” in the chest. PSVT is generally rapid and regular, and lasting a longer time. Stimulant abuse would likely cause sinus tachycardia, and while hyperthyroidism can cause premature beats, the patient would likely experience other symptoms.

Question 8

You are seeing a 22-year-old African American man who is com- plaining of an irregular He says that when he is exercising, he can feel his heartbeat, and it is more than what he would expect with exer- tion. It is associated with some lightheadedness and shortness of breath. On examination, his heart has a regular rate and rhythm, but you note a harsh holosystolic murmur along the left sternal border. It seems to increase with Valsalva’s maneuver. Which of the following is the most likely cause of his symptoms?

A	Mitral valve prolapse
B	Hypertrophic obstructive cardiomyopathy
C	Dilated cardiomyopathy
D	Atrial fibrillation
E	CHF

Question 8 Explanation:

Hypertrophic cardiomyopathy can be associated with atrial fibrillation or ventricular tachycardia. The characteristic heart murmur associated with it is a systolic ejection murmur (like aortic stenosis) worsening with Valsalva’s maneuver. Mitral valve prolapse would have a different characteristic murmur. Dilated cardiomyopathy and CHF would likely be associated with other symptoms. Atrial fibrillation would not be associated with a regular rhythm.

Question 9

You are seeing a 26-year-old woman who is complaining of “skipping heartbeats.” She uses caffeine daily, but denies other The rest of her history is completely normal, as is her physical examination. In the office, her 12-lead ECG is also normal. Her electrolytes and CBC comes back normal, as does her thyroid stimulating hormone. Which of the fol- lowing is the next step in her workup?

A	Reassure her and continue observation
B	Perform ambulatory ECG monitoring (a 24-Holter monitor, or a continuous loop event recorder)
C	Electrophysiology consultation
D	Stress testing
E	Echocardiography

Question 9 Explanation:

When the history, physical examination, 12-lead ECG and limited laboratory evaluation are negative, it is appropriate to reassure the patient with palpitations and continue observation. The likely etiology is benign supraventricular or ventricular ectopy. Other tests and consultation would only be indicated if the patient’s symptoms are incapacitating or worrisome.

Question 10

You are evaluating a 23-year-old African American swimmer who is complaining of episodes of symptomatic rapid heart Twice during swim practice, he develops a sensation that his heart is racing. When he measures his heart rate, he finds it to be between 140–160 beats per minute. The first episode lasted approximately 4 minutes, and the second lasted more than 10 minutes. He denies lightheadedness or other symptoms dur- ing the events. Limited laboratory evaluation and ECG are normal. Which of the following is the next step in the evaluation?

A	Reassure and continue observation
B	Ambulatory ECG monitoring
C	Consultation with an electrophysiologist
D	Stress testing
E	Echocardiography

Question 10 Explanation:

Since this patient’s arrhythmia only seems to occur with exercise, stress testing would be useful. Ambulatory ECG monitoring and echocardiography would not be useful. Consultation with an electrophysiologist may be appropriate, depending on the results of the testing

Question 11

You are caring for a 23-year-old woman complaining of pelvic She reports one-sided pain that is diffuse and dull, but occasionally sharp. Menses have been normal. She denies fever. Her pelvic examination is normal with the exception of a smooth mobile adnexal mass on the right side. What is the most likely cause of the pain?

A	Pelvic inflammatory disease
B	Ectopic pregnancy
C	Ovarian cyst
D	Uterine leiomyoma
E	Appendicitis

Question 11 Explanation:

Classically, ovarian cysts present with a unilateral dull pain that can become diffuse and severe if the cyst ruptures. On physical examination, the examiner feels a smooth mobile adnexal mass with peritoneal signs if the cyst ruptures. PID is associated with fever and vaginal discharge. Ectopic pregnancy may present with similar symptoms, but menses would not be normal. Uterine leiomyoma would be associated with an enlarged uterus, and appendicitis would be associated with nausea and anorexia.

Question 12

You are caring for a 21-year-old woman complaining of pelvic She reports a gradual onset of bilateral pain associated with fever, vaginal discharge, and mild dysuria. Her pelvic examination demonstrates uterine, adnexal, and cervical motion tenderness. What is the most likely cause of the pain?

A	Pelvic inflammatory disease
B	Ectopic pregnancy
C	Ovarian cyst
D	Uterine leiomyoma
E	Appendicitis

Question 12 Explanation:

Pelvic inflammatory disease is classically described as lower abdominal pain that is gradual in onset and bilateral. Fever, vaginal discharge, dysuria, and occasionally abnormal vaginal bleeding may be associated symptoms. The minimal diagnostic criteria include uterine, adnexal, or cervical motion tenderness. Treatment should provide coverage for likely etiologic agents (N. gonorrhoeae, C. trachomatis, anaerobes, and enteric gram-negative rods).

Question 13

You are caring for a 27-year-old woman complaining of pelvic She reports localized pain on the left side that has increased in severity over the last 2 days. She also reports amenorrhea and nausea. On examination, you note a tender adnexal mass on the left. What is the likely cause?

A	Pelvic inflammatory disease
B	Ectopic pregnancy
C	Ovarian cyst
D	Uterine leiomyoma
E	Appendicitis

Question 13 Explanation:

The pain associated with ectopic pregnancy is often described as colicky, and may radiate to the shoulder if there is a significant hemoperitoneum. Amenorrhea and symptoms of pregnancy are diagnostic clues.

Question 14

You are evaluating a 33-year-old woman with chronic pelvic She reports cyclic pain, generally during the premenstrual period and dur- ing her menses. She has been trying to conceive for 15 months without success. Her pelvic examination is normal. Which of the following tests would be most helpful in determining the cause of her pain?

A	Complete blood cell count
B	Erythrocyte sedimentation rate
C	CA-125 levels
D	Transvaginal pelvic ultrasound
E	Magnetic resonance imaging

Question 14 Explanation:

The patient described has symptoms and signs suggestive of endometriosis. A complete blood cell count would be helpful if the signs are suggestive of an infectious process (appendicitis or PID). An erythrocyte sedimentation rate is elevated in 75% of patients with pelvic inflammatory disease, but is nonspecific. CA-125 levels may be helpful if the physician is concerned about an ovarian mass. Transvaginal ultrasound may be helpful, but MRI is more sensitive for localization of endometriosis.

Question 15

You are evaluating a 13-year-old girl with pelvic She is not sex- ually active, and you do not have suspicion of abuse. On pelvic examina- tion, you confirm that she has never been sexually active, but feel an ovarian mass on the right side. Which of the following approaches is most appropriate in this case?

A	Reassurance and use of NSAIDs for pain control
B	Reassurance and repeat pelvic examination in 6–8 weeks
C	Transvaginal pelvic ultrasound
D	CT scanning of the abdomen and pelvis
E	MRI evaluation of the pelvis

Question 15 Explanation:

Eighty percent of ovarian masses in girls younger than 15 years are malignant. Because of the high potential for malignancy, any adnexal mass should be evaluated by transvaginal ultrasound and referral for surgical removal. In many women of child-bearing years, adnexal masses are commonly cysts. If the pain is not acute or recurrent, palpable cysts less than 6 cm in size may be monitored with repeat pelvic examination. Ultrasound is reserved for those masses that do not resolve, or those that increase in size. CT and MRI may be useful in some cases, but the ultrasound is the best first test

Question 16

You are evaluating a 18-year-old male with a sore It has been present for 3 days, and is associated with fever, aches, and fatigue. On examination, he has an exudative pharyngitis, soft palate petechiae, and posterior cervical adenopathy. Which of the following is the most likely diagnosis?

A	Group A streptococcal infection
B	Group A streptococcal colonization
C	Corynebacterium diphtheriae infection
D	Gonorrhea infection of the throat
E	Epstein-Barr virus infection

Question 16 Explanation:

Any of the conditions listed as answers in this question can cause an exudative pharyngitis. Palatal petechiae suggest either a group A streptococcal infection of Epstein–Barr virus (EBV) pharyngitis. However, posterior cervical adenopathy should point to EBV as the correct diagnosis.

Question 17

A 7-year-old boy comes to see you for a sore throat. He reports fevers, chills, myalgias, and pain on On examination, you note anterior adenopathy, erythematous tonsils, and uveal edema. He has no drug allergies. Which of the following would be the best treatment for his condition?

A	Symptomatic care
B	Antiviral therapy
C	Doxycycline (Vibramycin)
D	Amoxicillin (Amoxil)
E	Erythromycin (Emycin)

Question 17 Explanation:

Fever, chills, myalgias, and pain with swallowing are nonspecific signs, and are associated with pharyngitis from any cause. Anterior adenopathy is also associated with viral or bacterial pharyngitis. However, uveal edema is suggestive of group A hemolytic streptococcal infection. First line treatment should be amoxicillin, as up to 15% of group A streptococcal infections are resistant to penicillin. Doxycycline can be a good second-line agent. Macrolides are not generally effective, as they have poor penetration and may induce resistance.

Question 18

You are treating a 16-year-old girl with a sore She denies runny nose or cough, but does report fevers and myalgia. On examination, she has an exudative pharyngitis, and posterior cervical adenopathy. Her rapid streptococcal antigen is positive. You treat her with penicillin, and she develops a diffuse maculopapular rash. What is the most likely diagnosis?

A	Scarlet fever
B	Infectious mononucleosis
C	Viral exanthem
D	Pityriasis rosea
E	Tinea versicolor

Question 18 Explanation:

Approximately 30% of patients with infectious mononucleosis are colonized with group A streptococcal organisms. Therefore, their rapid streptococcal antigen and throat cultures may be positive. When patients with mononucleosis are treated with penicillin or amoxicillin, they often develop a maculopapular skin rash that may be confused with scarlet fever. The distinguishing feature in this case is posterior chain adenopathy, consistent with an infectious mononucleosis.

Question 19

An 8-year-old patient has a positive group A streptococcal throat cul- ture whether symptomatic or You have determined that he is a strep- tococcal carrier. Assuming that the patient has no allergies, what is the best therapeutic option in this patient?

A	Penicillin (PenVK)
B	Amoxicillin (Amoxil), using the usual dose
C	Amoxicillin (Amoxil), using high dosages
D	Erythromycin (Emycin)
E	Clindamycin (Cleocin)

Question 19 Explanation:

The best antibiotics to eliminate group A streptococcal carriage from oropharyngeal secretions are an oral respiratory quinolone or oral clindamycin. The other therapies would be less likely to eliminate colonization.

Question 20

You are treating a 16-year-old patient with a sore She has had 3 days of symptoms, and does not have nasal congestion or cough. She also reports laryngitis. On examination, she has an erythematous pharynx with- out exudate. Which of the following is the most appropriate therapy based on the symptoms described?

A	Supportive care
B	Penicillin (PenVK)
C	Amoxicillin (Amoxil)
D	Erythromycin (Emycin)
E	Clindamycin (Cleocin)

Question 20 Explanation:

Laryngitis with pharyngitis is generally associated with a viral infection, and only supportive care is needed. Antibiotic therapy is not indicated in this case.

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II. Preview all questions below

1.A new mother brings her infant to see you to discuss his He is 4 weeks old, and is exclusively breast-fed. He vomits with every meal. On examination, his abdomen is distended with normal bowel sounds, and he appears dehydrated. He has lost 4 oz since his visit with you 2 weeks ago. What is the most likely diagnosis?

Allergy to breast milk
Normal gastroesophageal reflux
Pyloric stenosis
Intussesception
Small bowel obstruction

2. You are evaluating a 31 year-old man with the acute onset of nausea and It is associated with significant epigastric pain that radiates to the back and occurs after eating any type of food. It is somewhat better if he does not eat at all. Which of the following tests is most likely to be abnormal in this case?

Complete blood count
Amylase and lipase
Hemoccult testing of the stool
Abdominal x-rays
Upper endoscopy

3. You are evaluating a 44-year-old woman with the acute onset of nau- sea and It is associated with pain, and occurs after eating a fatty meal. Which of the following tests is most likely to be abnormal in this case?

Amylase and lipase
Hemoccult testing of the stool
Abdominal x-rays
Ultrasound
Upper endoscopy

4. You are treating a 26-year-old woman for Which of the following antiemetics is most likely to cause extrapyramidal reactions in the patient?

Trimethobenzamide (Tigan)
Prochlorperazine (Compazine)
Promethazine (Phenergan)
Metoclopramide (Reglan)
Ondansetron (Zofran)

5. You are evaluating a 33-year-old woman complaining of Which of the following characteristics, if present, increase the likelihood that the symptoms are cardiac in etiology?

The fact that the patient is female
The fact that the patient has a sister with similar symptoms
Her description of the symptoms as an “irregular heartbeat”
The fact that her father has a history of heart disease
The fact that the episodes last less than 1 minute

6. You are seeing a hypertensive 56-year-old woman who is complaining of a “fluttering in her ” She describes a rapid heart rate, and to her it seems irregular. She is otherwise well, and denies shortness of breath, lighthead- edness pedal edema or other acute symptoms. On examination, her pulse rate is rapid and irregular. Which of the following is her most likely diagnosis?

Atrial fibrillation
Paroxysmal supraventricular tachycardia (PSVT)
Stable ventricular tachycardia
Stimulant abuse
Hyperthyroidism

7. You are seeing a 32-year-old otherwise healthy woman who is com- plaining of She describes the sensation as a “flip flop” in her chest. They only last an instant, and are not associated with lightheaded- ness or other symptoms. She denies other symptoms. Which of the follow- ing is the most likely etiology of her complaint?

Atrial fibrillation
PSVT
Ventricular premature beats
Stimulant abuse
Hyperthyroidism

8. You are seeing a 22-year-old African American man who is com- plaining of an irregular He says that when he is exercising, he can feel his heartbeat, and it is more than what he would expect with exer- tion. It is associated with some lightheadedness and shortness of breath. On examination, his heart has a regular rate and rhythm, but you note a harsh holosystolic murmur along the left sternal border. It seems to increase with Valsalva’s maneuver. Which of the following is the most likely cause of his symptoms?

Mitral valve prolapse
Hypertrophic obstructive cardiomyopathy
Dilated cardiomyopathy
Atrial fibrillation
CHF

9. You are seeing a 26-year-old woman who is complaining of “skipping heartbeats.” She uses caffeine daily, but denies other The rest of her history is completely normal, as is her physical examination. In the office, her 12-lead ECG is also normal. Her electrolytes and CBC comes back normal, as does her thyroid stimulating hormone. Which of the fol- lowing is the next step in her workup?

Reassure her and continue observation
Perform ambulatory ECG monitoring (a 24-Holter monitor, or a continuous loop event recorder)
Electrophysiology consultation
Stress testing
Echocardiography

10. You are evaluating a 23-year-old African American swimmer who is complaining of episodes of symptomatic rapid heart Twice during swim practice, he develops a sensation that his heart is racing. When he measures his heart rate, he finds it to be between 140–160 beats per minute. The first episode lasted approximately 4 minutes, and the second lasted more than 10 minutes. He denies lightheadedness or other symptoms dur- ing the events. Limited laboratory evaluation and ECG are normal. Which of the following is the next step in the evaluation?

Reassure and continue observation
Ambulatory ECG monitoring
Consultation with an electrophysiologist
Stress testing
Echocardiography

11. You are caring for a 23-year-old woman complaining of pelvic She reports one-sided pain that is diffuse and dull, but occasionally sharp. Menses have been normal. She denies fever. Her pelvic examination is normal with the exception of a smooth mobile adnexal mass on the right side. What is the most likely cause of the pain?

Pelvic inflammatory disease
Ectopic pregnancy
Ovarian cyst
Uterine leiomyoma
Appendicitis

12. You are caring for a 21-year-old woman complaining of pelvic She reports a gradual onset of bilateral pain associated with fever, vaginal discharge, and mild dysuria. Her pelvic examination demonstrates uterine, adnexal, and cervical motion tenderness. What is the most likely cause of the pain?

Pelvic inflammatory disease
Ectopic pregnancy
Ovarian cyst
Uterine leiomyoma
Appendicitis

13. You are caring for a 27-year-old woman complaining of pelvic She reports localized pain on the left side that has increased in severity over the last 2 days. She also reports amenorrhea and nausea. On examination, you note a tender adnexal mass on the left. What is the likely cause?

Pelvic inflammatory disease
Ectopic pregnancy
Ovarian cyst
Uterine leiomyoma
Appendicitis

14. You are evaluating a 33-year-old woman with chronic pelvic She reports cyclic pain, generally during the premenstrual period and dur- ing her menses. She has been trying to conceive for 15 months without success. Her pelvic examination is normal. Which of the following tests would be most helpful in determining the cause of her pain?

Complete blood cell count
Erythrocyte sedimentation rate
CA-125 levels
Transvaginal pelvic ultrasound
Magnetic resonance imaging

15. You are evaluating a 13-year-old girl with pelvic She is not sex- ually active, and you do not have suspicion of abuse. On pelvic examina- tion, you confirm that she has never been sexually active, but feel an ovarian mass on the right side. Which of the following approaches is most appropriate in this case?

Reassurance and use of NSAIDs for pain control
Reassurance and repeat pelvic examination in 6–8 weeks
Transvaginal pelvic ultrasound
CT scanning of the abdomen and pelvis
MRI evaluation of the pelvis

16. You are evaluating a 18-year-old male with a sore It has been present for 3 days, and is associated with fever, aches, and fatigue. On examination, he has an exudative pharyngitis, soft palate petechiae, and posterior cervical adenopathy. Which of the following is the most likely diagnosis?

Group A streptococcal infection
Group A streptococcal colonization
Corynebacterium diphtheriae infection
Gonorrhea infection of the throat
Epstein-Barr virus infection

17. A 7-year-old boy comes to see you for a sore throat. He reports fevers, chills, myalgias, and pain on On examination, you note anterior adenopathy, erythematous tonsils, and uveal edema. He has no drug allergies. Which of the following would be the best treatment for his condition?

Symptomatic care
Antiviral therapy
Doxycycline (Vibramycin)
Amoxicillin (Amoxil)
Erythromycin (Emycin)

18. You are treating a 16-year-old girl with a sore She denies runny nose or cough, but does report fevers and myalgia. On examination, she has an exudative pharyngitis, and posterior cervical adenopathy. Her rapid streptococcal antigen is positive. You treat her with penicillin, and she develops a diffuse maculopapular rash. What is the most likely diagnosis?

Scarlet fever
Infectious mononucleosis
Viral exanthem
Pityriasis rosea
Tinea versicolor

19. An 8-year-old patient has a positive group A streptococcal throat cul- ture whether symptomatic or You have determined that he is a strep- tococcal carrier. Assuming that the patient has no allergies, what is the best therapeutic option in this patient?

Penicillin (PenVK)
Amoxicillin (Amoxil), using the usual dose
Amoxicillin (Amoxil), using high dosages
Erythromycin (Emycin)
Clindamycin (Cleocin)

20. You are treating a 16-year-old patient with a sore She has had 3 days of symptoms, and does not have nasal congestion or cough. She also reports laryngitis. On examination, she has an erythematous pharynx with- out exudate. Which of the following is the most appropriate therapy based on the symptoms described?

Supportive care
Penicillin (PenVK)
Amoxicillin (Amoxil)
Erythromycin (Emycin)
Clindamycin (Cleocin)

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[MCQs] The Quizzes about Acute Complaints – Part 10 (20 test)

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Acute Complaints-10

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