[MCQs] The Quizzes about Acute Complaints – Part 12 (31 test)

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1.You are caring for a 3-year-old boy who goes to daycare while his parents are at His mother brought him to see you because the day- care will not take him back until he’s had a doctor evaluate his eye symp- toms. He developed an acute redness of the left eye, associated with runny nose, cough, and increased irritability. On examination, his eye is red and watery. The discharge is clear, and he has mild eyelid edema. Which of the following is the most common cause for his condition?

1. Coxsackie virus
2. Parainfluenza virus
3. Adenovirus
4. Rhinovirus
5. Herpes virus

2. You are seeing a 32-year-old contact lens wearer who has recently suffered from recurrent Which of the following treatments would be best in this situation?

1. Supportive care
2. Ciprofloxacin (Ciloxan) ointment
3. Ploymyxin-trimentoprim (Polytrim) ointment
4. Gentamicin (Garamycin) ointment
5. Immediate ophthalmologic referral

3. You are evaluating a 20-year-old college student who complains of an acute red He complains that his eye is irritated, with significant yel- lowish discharge. When he wipes his eye, it almost immediately reforms. You confirm this by wiping his eye with a cotton swab. When asked, he also reports dysuria and penile discharge. What is the most appropriate treatment?

1. Supportive care
2. Ciprofloxacin ointment
3. Tobramycin ointment
4. Ceftriaxone (Rocephin) intramuscularly
5. Immediate ophthalmologic referral

4. You have been treating a 43-year-old woman with rheumatoid arthri- tis for You and her rheumatologist have had her illness in relatively good control. She presents to you with a red eye and significant eye pain. She denies trauma. Upon further questioning, she complains of decreased vision and headache. She describes the pain as deep and boring. Her exam- ination reveals diffuse injection of the deeper vessels with minimal dis- charge. Her pupils react normally. What is her most likely diagnosis?

1. Scleritis
2. Episcleritis
3. Corneal abrasion
4. Acute glaucoma
5. Iritis

5. You are caring for a 32-year-old female smoker with upper respira- tory She reports congestion, facial pressure, nasal discharge, tooth pain, and headache. Her symptoms have been present for 14 days. Which portion of her history is most commonly used to define clinical rhi- nosinusitis?

1. Facial pressure
2. Nasal discharge
3. Tooth pain
4. Headache
5. 14-days of illness

6. A 35-year-old man has been struggling with recurrent He develops at least four sinus infections per year, and wonders what he can do to prevent these. You are discussing predisposing factors with him, in an effort to control any present. Which of the following is the most common predisposing condition leading to chronic or recurrent sinusitis?

1. Allergic rhinitis
2. Gastroesophageal reflux disease
3. Cigarette smoking
4. Environmental pollutants
5. Immunodeficiency

7. You are seeing a 21-year-old college student who complains of con- gestion, headache, sinus pressure and tooth pain for more than 2 She is otherwise healthy, but feels like she’s “having trouble shaking this cold.” She has used over the counter decongestants with limited relief. A CT scan of her sinuses demonstrates acute sinusitis. Of those listed, which is the most common organism causing her symptoms?

1. Moraxella Catarrhalis
2. aureus
3. Group A beta hemolytic streptococcal species
4. Streptococcus pneumoniae
5. A polymicrobial mixture of many organisms

8. You are caring for a 42-year-old woman with a persistent She first came to see you 3 months ago, was treated with amoxicillin, and improved. She returned 2 months ago, received another course of amoxi- cillin, and improved again. Last month, her symptoms reoccurred, and you prescribed trimethoprim/sulfamethoxazole. She returns today with contin- ued symptoms. What would be your treatment of choice?

1. A macrolide for 10 days
2. A macrolide for 14–21 days
3. A fluoroquinolone for 10 days
4. A fluoroquinolone for 14–21 days
5. A second or third generation cephalosporin for 10 days

9. You are treating a woman with chronic and recurrent Along with antibiotic therapy directed at the underlying bacterial cause, which of the following has been shown to help break the cycle of recurrent disease?

1. Phenylpropanolamine
2. Pseudoephedrine
3. Topical alpha agonists (Afrin)
4. Topical nasal steroids
5. Echinacea

10. You are seeing a 16-year-old high school football player to discuss a recent Last night, during football practice, he felt an acute numbness and tingling from his neck down to his right hand, “like an electric shock.” The inciting event occurred when he was tackled, compressing his head, while his head and neck were flexed toward the right side. The numbness resolved within a few minutes, but he did not continue play. He is seeing you for evaluation and treatment. He currently has normal range of motion, with no neurological deficit or pain. What is the most appropriate next step?

1. Return to play without restriction
2. Immobilization until radiographs can be obtained
3. Immobilization until magnetic resonance imaging can be obtained
4. Obtain an electromyelogram of the right arm before allowing return to play
5. Refer for physical therapy

11. You are working with the team physician at a local high One of the football players was hit with his arm extended, causing a left shoul- der injury. On examination, he has acromioclavicular (AC) joint swelling, bruising, and pain. X-rays show more than a 50% AC joint separation with a posterior displacement of the clavicle. Which of the following is the best management plan for this injury?

1. Return to play when the pain subsides
2. Immobilization with a sling, and return to play when the pain subsides
3. Immobilization with a sling, and early range of motion exercises with return to play when the pain subsides
4. Reduction under conscious sedation, then immobilization, early range of motion exercises, and return to play when the pain subsides
5. Surgical fixation

12. A 20-year-old college basketball player comes to your office com- plaining of knee Her symptoms started several weeks ago, but she was able to play through the pain. She reports anterior knee pain, some mild swelling after activity, and significant stiffness and pain after she’s been sitting for a long period of time. Examination reveals a positive patellar grind test. Based on her history and examination, which of the following exercises would be most likely to help her symptoms?

1. Patellar tendon stretching
2. Quadriceps stretching
3. Vastus lateralis strengthening
4. Vastus medialis strengthening
5. Hamstring strengthening

13. A patient comes to see you after a skiing accident 6 days He reports twisting his knee during a fall, feeling a “pop,” and noting significant immedi- ate swelling. He was able to bear weight immediately, but did not ski for the rest of the trip. His pain is now improved, and he is ambulating, but he says the knee feels unstable. What is the most likely cause of his symptoms?

1. Patellofemoral pain syndrome
2. Anterior cruciate ligament (ACL) tear
3. Posterior cruciate ligament (PCL) tear
4. Meniscal injury
5. Collateral ligament tear

14. One of your patients injured his knee playing In trying to determine the extent of his injury, you palpate the joint line with one hand and internally/externally rotate while flexing and extending the knee. This maneuver elicits a catch with pain at the joint line. Which of the following knee injuries is most likely?

1. Patellar tendon rupture
2. Patellar fracture
3. ACL tear
4. Meniscal tear
5. Collateral ligament tear

15. You are seeing a 14-year-old girl who hurt her ankle while dancing She reports that her ankle “twisted in” causing immediate pain and the inability to bear weight. In the office, she has bruising and tender- ness over the anterior talofibular ligament (ATFL) with acute swelling. She is unable to bear weight due to the pain. Which of the following is the most appropriate next step?

1. Obtain x-rays of her ankle
2. Encourage early mobilization
3. Prescribe rest, ice, compression, and elevation
4. Use a NSAID to help with the pain and inflammation
5. Begin physical therapy

16. A 65-year-old male patient comes to your office after a syncopal Which of the following etiologies of syncope has the highest mor- tality rate associated with it?

1. Vasovagal syncope
2. Situational syncope
3. Cardiac syncope
4. Vertebrobasilar artery insufficiency
5. Subclavian steal syndrome

17. You are seeing a 55-year-old man who presents with Regard- less of the cause, which of the following tests is always indicated in the workup?

1. Complete blood count
2. Thyroid stimulating hormone
3. ECG
4. Holter monitoring
5. Ambulatory loop ECG

18. A 21-year-old generally healthy college student is seeing you in your office after having “passed out” playing This has never hap- pened before. He has no significant past medical history and takes no med- ications. On examination, you note a harsh crescendo-decrescendo systolic murmur, heard best at the apex and radiating to the axilla. Which of the following tests is most likely to reveal the etiology of his syncopal episode?

1. An echocardiogram
2. A Holter monitor
3. A long-term ambulatory loop ECG
4. Stress testing
5. Tilt table testing

19. You are caring for a 49-year-old type 2 diabetic woman who presents to you after passing The event occurred 1 day ago, while she was walk- ing up steps to her seat at a movie theatre. She reports that she felt breath- less, became hot and sweaty, and the next thing she remembers, she was waking up on the floor. Her diabetes has been fairly well controlled with metformin, and her last glycosolated hemoglobin 1 month ago was 7.9%. Her examination is benign, as is her ECG. Which of the following tests would be most likely to reveal the cause of her syncope?

1. Serum glucose
2. Hemoglobin A1C
3. Echocardiogram
4. Stress testing
5. A 24-hour Holter monitor

20. You are evaluating a 28-year-old woman who has had several episodes of passing In general, the events are unpredictable, and are not preceded by any prodrome. Her examination has been consistently normal. Initial workup, including a pregnancy test, hematocrit, serum glu- cose, orthostatic blood pressures, and ECG were normal. She underwent 24-hour Holter monitoring and long-term ambulatory loop ECG evalua- tion, both of which were negative. Which of the following is the most appropriate next test?

1. Psychiatric evaluation
2. Carotid Dopplers
3. MRI of the brain
4. Stress testing
5. Tilt-table testing

21. You are evaluating a woman who is complaining of vaginal She reports clear discharge and some vaginal irritation. She has recently become sexually active for the first time again after a divorce 2 years ago. She and her partner use condoms. On examination, she has a reddened, swollen vulva and a clear exudate. She does not douche. Based on this his- tory, which of the following is the most likely cause of her discharge?

1. Contact dermatitis
2. Mycotic disease
3. Trichomoniasis
4. Bacterial vaginosis
5. Chlamydia infection

22. You are evaluating a 20-year-old woman complaining of vaginal dis- charge. She reports vaginal itch and white She has no history of vaginal infections in the past, and has never been sexually active. A KOH preparation of the discharge is shown below:

(Reproduced, with permission, from Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 5th ed. New York: McGraw-Hill, 2005: 717.)

Which of the following is the best treatment option for this condition?

1. Reassurance that this is a normal variation and that no treatment is necessary
2. Topical azole applications
3. Topical metronidazole
4. Oral clindamycin
5. Doxycycline

23. You are discussing recurrent vaginal discharge with a She has been evaluated three times in the last 6 months, and has had a vaginal can- didiasis each time. She has symptom-free intervals, but the infection seems to be recurrent. She is sexually active, takes birth control pills, and denies other complaints or known illnesses. Which of the following is most likely to improve this patient’s condition?

1. Test her for diabetes, and control her elevated glucose level
2. Ask her to discontinue her birth control pills
3. Treat her sexual partner
4. Test her for HIV, and begin therapy
5. Ask her to add fiber to her diet

24. You are evaluating a 16-year-old woman who complains of vaginal She has been sexually active with one partner for 4 months. She also reports urinary frequency. On examination, you note yellow-green bubbly discharge with bright red vaginal mucosa and cervical petechiae. What is the saline preparation of the discharge likely to show?

1. Sheets of epithelial cells “studded” with bacteria
2. “Moth-eaten” epithelial cells
3. Motile triangular cells with long tails
4. Many white blood cells
5. Hyphae

25. Your patient describes a recent vaginal She reports more discharge than usual, and an unusual odor after intercourse with her hus- band. A KOH preparation of the discharge produces a fishy odor, and a saline preparation is shown below:

(Reproduced, with permission, from Knoop K, Stack L, Storrow A. Atlas of Emergency Medicine, 2nd ed. New York: McGraw-Hill, 2002: 683.)

 Of the following, what is the treatment of choice for her condition?

1. Metronidazole
2. Doxycycline
3. Clotrimazole
4. Imiquimod
5. Acyclovir

26. You are caring for an 18-month-old infant, whose mother brings him in for “wheezing.” She reports that he has had a runny nose and a slight cough for 2 days, along with a low-grade On examination, he does not appear to be in respiratory distress, but his lung examination does reveal bilateral wheezing. What is the most likely diagnosis?

1. Acute viral respiratory tract infection
2. Pneumonia
3. Bronchiolitis
4. Aspiration
5. Asthma

27. A 61-year-old man comes to see you for shortness of He has a history of hypertension, type 2 diabetes and hyperlipidemia. He quit smoking 4 years ago after a more than 30-pack year history. On physical examination, he is not in respiratory distress, but he has diffuse wheezing in the bilateral lower lobes of his lungs. His cardiac examination demon- strates an S4, and he demonstrates JVD. Which of the following treatments would likely relieve his symptoms?

1. Antibiotic therapy
2. Epinephrine
3. Steroid therapy
4. Diuretics
5. Anticoagulation

28. You are seeing a 26-year-old woman who presents to your office complaining of “wheezing.” On further questioning, she reports acute shortness of breath that occurred while she was at work this morning, and her wheezing is associated with pleuritic pain. She is otherwise healthy, only taking oral On examination, she is tachypneic, but not in acute distress. Auscultation of her lungs is normal. What is the most likely cause of her symptoms?

1. Bronchitis
2. Gastroesophageal reflux
3. Pulmonary embolism
4. Asthma
5. Acute allergic reation

29. You are seeing a 23-year-old man for shortness of He has no history of asthma or wheezing, and is otherwise healthy. His lung examination does reveal significant wheezing bilaterally. Which of the following tests is necessary?

1. Observation and treatment
2. Chest x-ray
3. Peak flow testing
4. Pulmonary function tests
5. A complete blood count

30. You are evaluating a 9-month-old child with recurrent His mother also reports that he vomits after formula as well. What is the best test to determine the cause of his wheezing?

1. Pulmonary function testing
2. A chest x-ray
3. Upper GI barium swallow
4. Upper endoscopy
5. A 24-hour pH probe

31. You are evaluating a 35-year-old patient with known He comes to your office complaining of increased shortness of breath despite compliance with his usual asthma regimen. He reports cough, but denies fever or sputum production. His pulmonary examination reveals wheezing bilaterally without crackles or rhonchi. Which of the following is most use- ful in this setting?

1. Chest x-ray
2. Peak flow testing
3. Pulmonary function testing
4. A complete blood count
5. A nasopharyngral wash