[MCQs] The Quizzes about Acute Complaints - Part 3 (20 test)

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Acute Complaints-3

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Question 1

You are evaluating a 22-year-old male patient who has recently devel- oped a red He just returned from a 4-day skiing trip, where he and his friends used the hot tub at the ski lodge daily. On examination, you note red dome-shaped pustules involving the hair follicles. What is the likely cause of his rash?

A	Streptococcal infection of the hair follicles
B	Staphylococcal infection of the hair follicles
C	Pseudomonal infection of the hair follicles
D	Tinea infection of the hair follicles
E	Candidal infection of the hair follicles

Question 1 Explanation:

Hot tub folliculitis is commonly seen in the setting described in this question. Often, the infection is self-limited, but occasionally antibiotics with pseudomonal coverage are necessary. While streptococcal and staphylococcal species are common causes of folliculitis, in the case of recent hot tub use, Pseudomonas is more likely. Tinea and candida do not generally cause folliculitis.

Question 2

You are seeing a 7-month-old boy whose mother is concerned about lesions under his nose and on his upper He has had a runny nose for the last 7 days, but his mother thought that was just a cold. Over the last 2 days, he has developed well-demarcated areas of erythema that seem to have ruptured. The crusts over the lesions are golden yellow. What is the likely cause of this child’s lesions?

A	Rhinoviral superficial skin infection
B	Streptococcal superficial skin infection
C	Pseudomonal superficial skin infection
D	Haemophilus superficial skin infection
E	Pneumococcal superficial skin infection

Question 2 Explanation:

The child in this case has the classic presentation of impetigo. Most cases of impetigo are caused byAcute Complaints Answers 151 either streptococcal or staphylococcal skin infections. When staphyloccus is the infecting organism, the lesions are generally bullous with minimal erythema. When streptococcus is the infecting organism, there is erythema with a typical golden crust that occurs after the lesion ruptures. While impetigo often occurs in the setting of an acute viral infection, the skin infection is not a result of the virus itself. Pneumococcus and haemophilus may cause skin infections, but typically not impetigo.

Question 3

You are seeing a 15-year-old Caucasian male for acne Examination of his face reveals multiple closed and open comedones with- out surrounding erythema or pustules. There is no evidence of scarring. Of the following, what treatment is likely to be most effective for him?

A	Topical antibiotic therapy
B	Oral antibiotic therapy
C	Topical retinoids
D	Prescription strength benzoyl peroxide
E	Oral isotretinoin (Accutane

Question 3 Explanation:

Acne is a potentially chronic skin condition that can have severe physical and social consequences. Classification of acne is the prime determinant of management and is based on the severity and type of lesions present. Comedonal acne involves impaction of the pilosebaceous follicle. Open comoedones (blackheads) and closed comedones (whiteheads) generally respond best to topical retinoids. These agents are comedolytic. Inflammatory acne is characterized by pustules and surrounding erythema, and generally responds best to antibiotic therapy (topical if more mild, oral if more severe) either alone or in combination with topical retinoids or benzoyl peroxide. Severe nodular or cystic acne may require oral isoretinoin.

Question 4

You are seeing a 14-year-old high school wrestler for a skin About a week ago, he noted a patch of erythematous skin on his right thigh. The patch has enlarged since he first noted it, and the central part of the lesion seems to be crusting and flaking. He reports that it is mildly pruritic. You scrape the lesion and evaluate the shavings under the microscope using potassium hydroxide. You visualize the following:

(Reproduced, with permission, from Wolff K, Johnson RA, Suurmond D. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology, 5th ed. NewYork: McGraw-Hill, 2005: 689.)

What is the most likely diagnosis?

A	Tinea corpris
B	Tinea cruris
C	Pityriasis rosea
D	Numular eczema
E	Impetigo

Question 4 Explanation:

Tinea infections are common, and may be spread by close person-to-person contact (as in school wrestling). The classic tinea lesion is pruritic, erythematous, with raised borders, and central scaling. This can often be confused with eczema or a bacterial skin infection, but by scraping the lesion and visualizing hyphae with microscopic examination, the diagnosis of tinea can be confirmed. Tinea cruris occurs in the groin, not on the thigh, Pityriasis rosea has a different classic appearance.

Question 5

You are evaluating a 40-year-old male patient in the office who is complaining of chest His father had a myocardial infarction at age 42, and the patient is quite concerned. Which characteristic, if included in the history, decreases the likelihood that his chest pain is cardiac in origin?

A	The pain is worse with inspiration
B	The pain radiates to his right arm
C	The pain radiates to his left arm
D	The pain is associated with nausea
E	The pain is associated with sweatiness

Question 5 Explanation:

When someone presents to the office complaining of chest pain, the history is invaluable in helping determine if the pain is due to a life-threatening cause (myocardial infarction, pulmonary embolism, aortic dissection or tension pneumothorax, to name a few). Studies have shown that the likelihood of myocardial infarction with a chest pain history increases when pain is said to: • Radiate to the right, left, or both arms/shoulders • Be exertional • Be associated with diaphoresis • Be associated with nausea or vomiting Be described as a “pressure” • Be described as worse than previous cases of angina, or similar to past MI The likelihood decreases when the pain is described as pleuritic.

Question 6

You are evaluating a 26-year-old female smoker who developed chest pain several hours Her past history is unremarkable, and she takes no medications regularly. She reports the abrupt onset of nonexertional chest pain, associated with shortness of breath and cough. It seems to be worse when she is lying down. It was not brought on by trauma. Which of the fol- lowing is the most likely origin of her pain?

A	Costochondritis
B	Asthma
C	Pulmonary embolus (PE)
D	Myocardial ischemia
E	Bronchitis

Question 6 Explanation:

Historical features are important when determining likely causes of chest pain. In the case described, several of the symptoms are nonspecific, and may be related to any of several etiologies. Shortness of breath is possible in asthma, PE, ischemia, or bronchitis. Cough is also possible in asthma, PE, and bronchitis. Pain that is worse with lying down is more commonly associated with a PE, but the key feature here is the abrupt onset. In general, musculoskeletal pain not associated with trauma has a vague onset. Pain from asthma and bronchitis is usually not abrupt. Pain from myocardial ischemia is usually gradual as well, and associated with activity.

Question 7

You are evaluating a 61-year-old man in the office who is complain- ing of chest Given his history and risk factors, you are concerned about myocardial ischemia. Which of the following features, if present, would most reliably establish cardiac ischemia as a cause?

A	Relief of pain with nitroglycerine administration
B	Relief of pain with a “gastrointestinal (GI) cocktail” (viscous lidocaine and an antacid)
C	Relief of pain with cessation of activity
D	Relief of pain with eating
E	Relief of pain with sitting up and leaning forward

Question 7 Explanation:

Nitroglycerine may relieve the pain of myocardial ischemia, but is not reliable enough to distinguish between ischemia and other noncardiac causes of chest pain. Relief of pain with a GI cocktail is similarly unreliable. If pain is relieved with eating, it is likely GI in origin, and if it is relieved with sitting up and leaning forward, pericarditis is likely. Relief with activity cessation is strongly suggestive of ischemic pain

Question 8

You are evaluating a 20-year-old man presenting to your office with the abrupt onset of chest He has an unremarkable past medical his- tory, but his father had his first myocardial infarction in his late 30s. On examination, he is thin and anxious-appearing. Other than tachycardia, his cardiac examination is normal. His lung examination reveals decreased breath sounds on the right, with hyperresonance to percussion. What is the best treatment for his condition?

A	Insertion of a chest tube
B	Antibiotic therapy
C	Bronchodilator therapy
D	Long-term anticoagulation
E	325 mg of aspirin immediately, and transfer to an emergency room

Question 8 Explanation:

Given his history and physical examination findings, the patient is likely to have a spontaneous pneumothorax. Of the options listed, chest tube insertion may be the most appropriate therapeutic intervention. Antibiotics, bronchodilators, anticoagulation, and aspirin may be appropriate with other diagnoses,

Question 9

A nurse asks you to emergently see a patient who came to the office in distress without an He is 22 years old and is presenting with chest pain. He has never experienced this in the past, and is clearly agi- tated and upset. He reports a history of slightly elevated blood pressure, “heartburn,” and says he is recovering from a recent viral upper respiratory infection. He admits to smoking one pack of cigarettes a day, and has used ille- gal drugs in the past. His blood pressure is 138/90, and physical examination is significant for tachycardia and diaphoresis. Which of his historical features are most suggestive of myocardial ischemia as a cause of his symptoms?

A	History of hypertension
B	History of “heartburn”
C	Recent viral upper respiratory infection
D	Smoking history
E	Drug use

Question 9 Explanation:

Hypertension is a risk factor for coronary artery disease and aortic dissection. “Heartburn” is not a feature suggestive of myocardial ischemia. A recent viral infection may precede an episode of pericarditis or myocarditis. His smoking history is certainly significant, but not as important as his history of drug use. His physical examination findings (diaphoresis and agitation) are more consistent with a stimulant use, likely cocaine. The risk of myocardial infarction increases 24 times that of baseline in the 60 minutes after cocaine use.

Question 10

A 45-year-old man with no significant past medical history presents to your office complaining of midsternal chest pain for 5 The pain is described as “sharp.” On examination, the patient has normal breath sounds, but the pain increases with palpation. Which of the following is the most appropriate next step?

A	Obtain a chest x-ray
B	Obtain a CBC and blood cultures
C	Obtain an electrocardiogram (ECG)
D	Treat with NSAIDs
E	Treat with a proton pump inhibitor

Question 10 Explanation:

Pain that is increased with palpation is most often associated with a musculoskeletal etiology. In this case, treatment with NSAIDs is most appropriate. A chest x-ray and bloodworkAcute Complaints Answers 153 is not necessary at this time. An ECG might be indicated if there were risk factors for coronary artery disease, but based on this patient’s symptoms and lack of concerning historical features, it would not be necessary. A proton pump inhibitor would not be indicated for pain that is worsened with palpation.

Question 11

A 43-year-old woman with a history of well-controlled hypertension and diabetes presents to your office complaining of intermittent chest pain for the last 3 The last episode was 1 week ago, after climbing four flights of stairs at work. The pain was relieved with rest. An ECG in your office is shown below:

(Reproduced, with permission, from Ferry D. Basic Electrocardiography in Ten Days, 1st ed. New York: McGraw-Hill, 2001: 35.) She is currently asymptomatic. Which of the following is the most appro- priate next step?

A	Reassure the patient and have her return if symptoms continue
B	Reassure the patient, but increase her medication to ensure tight control of her blood pressure and glucose levels
C	Admit to the hospital for serial enzymes
D	Obtain a treadmill stress ECG
E	Obtain a treadmill stress echocardiogram

Question 11 Explanation:

The ECG shown has no acute changes, but is suggestive of left ventricular hypertrophy. Her symptoms are quite suggestive of angina. Since she is currently asymptomatic and her ECG shows nothing acute, transfer to the hospital is unwarranted. The best approach would include patient education for warning signs, and some sort of stress testing. For women in her age group, stress ECGs are often falsely positive, so a stress test with imaging is most appropriate.

Question 12

You are evaluating a 75-year-old woman with diabetes and hyper- lipidemia complaining of chest She reports having occasional chest pain with exertion for years, but yesterday she reported syncope with the pain. On examination, she is afebrile with mildly elevated blood pressure. Cardiac auscultation demonstrates a harsh, rasping crescendo-decrescendo systolic murmur heard best at the second intercostal space at the right upper sternal border. Her carotid pulse is small and rises slowly. Which of the following is the most likely diagnosis?

A	PE
B	Aortic dissection
C	Left ventricular hypertrophy
D	Aortic stenosis
E	Mitral valve prolapse

Question 12 Explanation:

Syncope associated with chest pain may be seen with aortic dissection. Hemodynamic instability may be associated with a PE, a ruptured aortic aneurysm or critical aortic stenosis. The physical examination findings described, including the murmur and carotid pulse findings (pulsus parvus et tardus), are very suggestive of aortic stenosis.

Question 13

You are evaluating a generally healthy 45-year-old man who is com- plaining of chest pain. His symptoms are typical for angina, and are relieved with rest. He is a nonsmoker, has no family history of heart disease, but has high His physical examination and ECG are normal. What is the most appropriate next step?

A	Exercise ECG testing
B	Exercise echocardiography
C	Pharmacologic myocardial perfusion imaging
D	Cardiac catheterization
E	Electron beam computed tomography

Question 13 Explanation:

Exercise ECG testing is simple and inexpensive. It is not useful in the face of an abnormal resting ECG (ST segment changes, left ventricular hypertrophy, Wolff Parkinson White syndrome or paced rhythm). Chemical stress tests or tests with imaging are reserved for those who cannot exercise or those who have baseline ECG abnormalities. Catheterization would not be indicated, and Electron beam CT scanning is not clinically useful in this setting.

Question 14

One of your patients is undergoing stress testing for episodic chest He is hypertensive and takes hydrochlorothiazide and metoprolol. Which of the following is the most appropriate advice to give this patient prior to undergoing the stress test?

A	Continue all medications as directed
B	Do not take either antihypertensive medication on the day of the test
C	Continue the metoprolol, but do not take hydrochlorozide at least 2 days before the test
D	Continue hydrocholothiazide, but withdraw the metoprolol at least 2 days before the test
E	Continue hydrochlorothiazide, but withdraw the metoprolol at least 6 days before the test

Question 14 Explanation:

According to the 2002 ACA/AHA guidelines, beta blockers should be discontinued for four to five half-lives (typically around 48 hours) prior to stress testing if possible. The drug should be withdrawn gradually. Hydrochlorothiazide does not interfere with stress testing

Question 15

You are seeing a 44-year-old nonsmoker for an acute The cough has been present for 4 days. He had a low-grade fever for the first 2 days, but that has resolved. He reports that the cough is worse at night, has become productive of yellow sputum, but there is no hemoptysis or shortness of breath. What is the most likely cause of the cough?

A	Pneumonia
B	Sinusitis with postnasal drip
C	Pertussis
D	Viral upper respiratory infection
E	Tuberculosis

Question 15 Explanation:

The differential diagnosis for an acute cough includes asthma exacerbation, acute bronchitis, aspiration, exposure to irritants (cigarette smoke, pollutants), allergic rhinitis, uncomplicated pneumonia, sinusitis with postnasal drip, and viral upper respiratory infection. Of these usual causes, viral upper respiratory infection is by far the most common cause. Viral URIs is the most frequent illness in humans with a prevalence of up to 35%.

Question 16

A 33-year-old nonsmoking man presents to you for evaluation of his chronic He says the cough has been present for about 8 weeks. Ini- tially, he went to an urgent care where he received antitussives and a bron- chodilator. Those did not help, and he returned 1 week later and was given a course of azithromycin. His cough has continued to persist. His symp- toms are worse when he lies down for sleep, and are associated with a sore throat and a “sour” taste in the back of his mouth. He has also noticed that when he drinks caffeine or alcohol, the cough seems to worsen. What is the most likely diagnosis?

A	Gastroesophageal reflux
B	Asthma
C	Side effect from a medicaiton
D	Chronic bronchitis
E	Pertussis

Question 16 Explanation:

The most common causes of a chronic cough are asthma, postnasal drainage, smoking, and gastroesophageal reflux disease. Given that he did not respond to a bronchodilator, asthma is an unlikely diagnosis. Pertussis would have likely responded to azithromycin, and is therefore not likely to be the correct answer in this case. His associated symptoms of sore throat and sour taste in his mouth, combined with symptoms that are worse when lying down make GERD the most likely diagnosis. Medication side effects should be considered, with the ACE inhibitors most likely to cause a cough.

Question 17

You are treating a 52-year-old woman with a 40-pack/year history of She reports a productive cough that has been present for the last 3–4 months, beginning in the fall. She remembers having the same symp- toms last year in the fall, and attributed it to a “cold that she just couldn’t kick.” She does not have fevers, reports mild dyspnea when walking up stairs, and denies hempotysis. What is the most likely diagnosis?

A	Irritation of airways from cigarette smoke
B	Chronic bronchitis
C	Postnasal drainage due to seasonal allergies
D	Lung cancer
E	Asthma

Question 17 Explanation:

Because the patient reports a productive cough for at least 3 months of the year for at least 2 consecutive years, she meets the criteria for chronic bronchitis. This is the most common cause of chronic cough in smokers. While it is true that her smoking may cause irritation of her airways, it wouldn’t explain why the cough isn’t present year-round (since she continues to smoke throughout the year). The most common cause of chronic cough in nonsmokers is postnasal drainage, but since this patient has a significant smoking history, chronic bronchitis is more likely. Lung cancers rarely present solely with cough. Associated signs and symptoms include weight loss and hemoptysis. Asthma is less likely to present with a productive cough.

Question 18

Four weeks ago, you treated a 22-year-old woman for acute bronchi- Although she feels much better, the cough has persisted. She has used bronchodilators, antihistamines, and antitussives. What is the best course of treatment at this time?

A	A 10-day course of amoxicillin
B	A 5-day course of azithromycin
C	Steroid nasal spray
D	NSAIDs
E	An oral steroid taper

Question 18 Explanation:

The Centers for Disease Control published guidelines for treating acute bronchitis. The guidelines state the antibiotics are not indicated for uncomplicated acute bronchitis, regardless of the duration of the cough. Antibiotics should be reserved for patients with significant chronic obstructive pulmonary disease (COPD), CHF, those who are very ill appearing or the elderly. This patient likely has hyper-responsive airways, sometimes called a postbronchitic cough. In this case, the best treatment would be an inhaled steroid or oral steroid taper. Anti-inflammatory medications and nasal steroids are not effective.

Question 19

You are seeing an 18-year-old man who has had a cough for 2 It started like a typical “cold,” but has persisted. Over the last 3 days, the cough has come in “spasms” and he barely has time to catch his breath dur- ing the coughing episodes. Nasopharyngeal swab confirms the diagnosis of pertussis. Which of the following treatments is recommended?

A	A 10-day course of amoxicillin
B	A 10-day course of amoxicillin/clavulanate
C	A 10-day course of erythromycin
D	A 5-day course of azithromycin
E	Supportive therapy without antibiotics, but in isolation

Question 19 Explanation:

Antibiotics do not alter the course of pertussis unless initiated early in the illness. However, antibiotics do prevent transmission and decrease the need for respiratory isolation from 4 weeks to 1 week, and are therefore recommended. The first-line antibiotic choice is either erythromycin for 14 days, or azithromycin for 5 days. Amoxicillin and amoxicillin/clavulanate are not effective.

Question 20

You are seeing a 6-month-old boy whose mother reports that he has had diarrhea for almost 2 He has had 4–6 bowel movements a day, with a loose to liquid consistency. His mother stays at home with him and the child is not in daycare. His symptoms began after his young cousins visited for Christmas. What would be the most likely cause of his diarrhea?

A	Rotavirus
B	Norwalk virus
C	Giardiasis
D	Salmonella
E	Enterotoxigenic E. coli

Question 20 Explanation:

Acute diarrhea is defined as an increased number or decreased consistency of stool lasting 14 days or less. Most acute diarrhea is due to infection and usually occurs after the ingestion of contaminated food or water, or direct person-to-person contact. Viral infections account for 70–80% of acute infectious diarrhea, with Rotavirus being the most frequent cause. Enteric adenoviruses are the second most common type. Rotavirus occurs in the winter months, and most cases occur between the ages of 3 months and 2 years. Contaminated water, salads, or shellfish may transmit Norwalk virus. Giardiasis is less common in the general population, but may be more prevalent in children in daycare centers. Salmonella is generally due to raw or undercooked meat, and enterotoxigenic E. coli is the most common cause of traveler’s diarrhea.

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II. Preview all questions below

1. You are evaluating a 22-year-old male patient who has recently devel- oped a red He just returned from a 4-day skiing trip, where he and his friends used the hot tub at the ski lodge daily. On examination, you note red dome-shaped pustules involving the hair follicles. What is the likely cause of his rash?

Streptococcal infection of the hair follicles
Staphylococcal infection of the hair follicles
Pseudomonal infection of the hair follicles
Tinea infection of the hair follicles
Candidal infection of the hair follicles

2. You are seeing a 7-month-old boy whose mother is concerned about lesions under his nose and on his upper He has had a runny nose for the last 7 days, but his mother thought that was just a cold. Over the last 2 days, he has developed well-demarcated areas of erythema that seem to have ruptured. The crusts over the lesions are golden yellow. What is the likely cause of this child’s lesions?

Rhinoviral superficial skin infection
Streptococcal superficial skin infection
Pseudomonal superficial skin infection
Haemophilus superficial skin infection
Pneumococcal superficial skin infection

3. You are seeing a 15-year-old Caucasian male for acne Examination of his face reveals multiple closed and open comedones with- out surrounding erythema or pustules. There is no evidence of scarring. Of the following, what treatment is likely to be most effective for him?

Topical antibiotic therapy
Oral antibiotic therapy
Topical retinoids
Prescription strength benzoyl peroxide
Oral isotretinoin (Accutane)

4. You are seeing a 14-year-old high school wrestler for a skin About a week ago, he noted a patch of erythematous skin on his right thigh. The patch has enlarged since he first noted it, and the central part of the lesion seems to be crusting and flaking. He reports that it is mildly pruritic. You scrape the lesion and evaluate the shavings under the microscope using potassium hydroxide. You visualize the following:

What is the most likely diagnosis?

Tinea corpris
Tinea cruris
Pityriasis rosea
Numular eczema
Impetigo

5. You are evaluating a 40-year-old male patient in the office who is complaining of chest His father had a myocardial infarction at age 42, and the patient is quite concerned. Which characteristic, if included in the history, decreases the likelihood that his chest pain is cardiac in origin?

The pain is worse with inspiration
The pain radiates to his right arm
The pain radiates to his left arm
The pain is associated with nausea
The pain is associated with sweatiness

6. You are evaluating a 26-year-old female smoker who developed chest pain several hours Her past history is unremarkable, and she takes no medications regularly. She reports the abrupt onset of nonexertional chest pain, associated with shortness of breath and cough. It seems to be worse when she is lying down. It was not brought on by trauma. Which of the fol- lowing is the most likely origin of her pain?

Costochondritis
Asthma
Pulmonary embolus (PE)
Myocardial ischemia
Bronchitis

7. You are evaluating a 61-year-old man in the office who is complain- ing of chest Given his history and risk factors, you are concerned about myocardial ischemia. Which of the following features, if present, would most reliably establish cardiac ischemia as a cause?

Relief of pain with nitroglycerine administration
Relief of pain with a “gastrointestinal (GI) cocktail” (viscous lidocaine and an antacid)
Relief of pain with cessation of activity
Relief of pain with eating
Relief of pain with sitting up and leaning forward

8. You are evaluating a 20-year-old man presenting to your office with the abrupt onset of chest He has an unremarkable past medical his- tory, but his father had his first myocardial infarction in his late 30s. On examination, he is thin and anxious-appearing. Other than tachycardia, his cardiac examination is normal. His lung examination reveals decreased breath sounds on the right, with hyperresonance to percussion. What is the best treatment for his condition?

Insertion of a chest tube
Antibiotic therapy
Bronchodilator therapy
Long-term anticoagulation
325 mg of aspirin immediately, and transfer to an emergency room

9. A nurse asks you to emergently see a patient who came to the office in distress without an He is 22 years old and is presenting with chest pain. He has never experienced this in the past, and is clearly agi- tated and upset. He reports a history of slightly elevated blood pressure, “heartburn,” and says he is recovering from a recent viral upper respiratory infection. He admits to smoking one pack of cigarettes a day, and has used ille- gal drugs in the past. His blood pressure is 138/90, and physical examination is significant for tachycardia and diaphoresis. Which of his historical features are most suggestive of myocardial ischemia as a cause of his symptoms?

History of hypertension
History of “heartburn”
Recent viral upper respiratory infection
Smoking history
Drug use

10. A 45-year-old man with no significant past medical history presents to your office complaining of midsternal chest pain for 5 The pain is described as “sharp.” On examination, the patient has normal breath sounds, but the pain increases with palpation. Which of the following is the most appropriate next step?

Obtain a chest x-ray
Obtain a CBC and blood cultures
Obtain an electrocardiogram (ECG)
Treat with NSAIDs
Treat with a proton pump inhibitor

11. A 43-year-old woman with a history of well-controlled hypertension and diabetes presents to your office complaining of intermittent chest pain for the last 3 The last episode was 1 week ago, after climbing four flights of stairs at work. The pain was relieved with rest. An ECG in your office is shown below:

She is currently asymptomatic. Which of the following is the most appro- priate next step?

Reassure the patient and have her return if symptoms continue
Reassure the patient, but increase her medication to ensure tight control of her blood pressure and glucose levels
Admit to the hospital for serial enzymes
Obtain a treadmill stress ECG
Obtain a treadmill stress echocardiogram

12. You are evaluating a 75-year-old woman with diabetes and hyper- lipidemia complaining of chest She reports having occasional chest pain with exertion for years, but yesterday she reported syncope with the pain. On examination, she is afebrile with mildly elevated blood pressure. Cardiac auscultation demonstrates a harsh, rasping crescendo-decrescendo systolic murmur heard best at the second intercostal space at the right upper sternal border. Her carotid pulse is small and rises slowly. Which of the following is the most likely diagnosis?

PE
Aortic dissection
Left ventricular hypertrophy
Aortic stenosis
Mitral valve prolapse

13. You are evaluating a generally healthy 45-year-old man who is com- plaining of chest pain. His symptoms are typical for angina, and are relieved with rest. He is a nonsmoker, has no family history of heart disease, but has high His physical examination and ECG are normal. What is the most appropriate next step?

Exercise ECG testing
Exercise echocardiography
Pharmacologic myocardial perfusion imaging
Cardiac catheterization
Electron beam computed tomography

14. One of your patients is undergoing stress testing for episodic chest He is hypertensive and takes hydrochlorothiazide and metoprolol. Which of the following is the most appropriate advice to give this patient prior to undergoing the stress test?

Continue all medications as directed
Do not take either antihypertensive medication on the day of the test
Continue the metoprolol, but do not take hydrochlorozide at least 2 days before the test
Continue hydrocholothiazide, but withdraw the metoprolol at least 2 days before the test
Continue hydrochlorothiazide, but withdraw the metoprolol at least 6 days before the test

15. You are seeing a 44-year-old nonsmoker for an acute The cough has been present for 4 days. He had a low-grade fever for the first 2 days, but that has resolved. He reports that the cough is worse at night, has become productive of yellow sputum, but there is no hemoptysis or shortness of breath. What is the most likely cause of the cough?

Pneumonia
Sinusitis with postnasal drip
Pertussis
Viral upper respiratory infection
Tuberculosis

16. A 33-year-old nonsmoking man presents to you for evaluation of his chronic He says the cough has been present for about 8 weeks. Ini- tially, he went to an urgent care where he received antitussives and a bron- chodilator. Those did not help, and he returned 1 week later and was given a course of azithromycin. His cough has continued to persist. His symp- toms are worse when he lies down for sleep, and are associated with a sore throat and a “sour” taste in the back of his mouth. He has also noticed that when he drinks caffeine or alcohol, the cough seems to worsen. What is the most likely diagnosis?

Gastroesophageal reflux
Asthma
Side effect from a medicaiton
Chronic bronchitis
Pertussis

17. You are treating a 52-year-old woman with a 40-pack/year history of She reports a productive cough that has been present for the last 3–4 months, beginning in the fall. She remembers having the same symp- toms last year in the fall, and attributed it to a “cold that she just couldn’t kick.” She does not have fevers, reports mild dyspnea when walking up stairs, and denies hempotysis. What is the most likely diagnosis?

Irritation of airways from cigarette smoke
Chronic bronchitis
Postnasal drainage due to seasonal allergies
Lung cancer
Asthma

18. Four weeks ago, you treated a 22-year-old woman for acute bronchi- Although she feels much better, the cough has persisted. She has used bronchodilators, antihistamines, and antitussives. What is the best course of treatment at this time?

A 10-day course of amoxicillin
A 5-day course of azithromycin
Steroid nasal spray
NSAIDs
An oral steroid taper

19. You are seeing an 18-year-old man who has had a cough for 2 It started like a typical “cold,” but has persisted. Over the last 3 days, the cough has come in “spasms” and he barely has time to catch his breath dur- ing the coughing episodes. Nasopharyngeal swab confirms the diagnosis of pertussis. Which of the following treatments is recommended?

A 10-day course of amoxicillin
A 10-day course of amoxicillin/clavulanate
A 10-day course of erythromycin
A 5-day course of azithromycin
Supportive therapy without antibiotics, but in isolation

20. You are seeing a 6-month-old boy whose mother reports that he has had diarrhea for almost 2 He has had 4–6 bowel movements a day, with a loose to liquid consistency. His mother stays at home with him and the child is not in daycare. His symptoms began after his young cousins visited for Christmas. What would be the most likely cause of his diarrhea?

Rotavirus
Norwalk virus
Giardiasis
Salmonella
Enterotoxigenic E. coli

Acute Complaints mcq Acute Complaints quiz

[MCQs] The Quizzes about Acute Complaints – Part 3 (20 test)

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Acute Complaints-3

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