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Acute Complaints- 4
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1.A 25-year-old woman returned from her honeymoon in Mexico She spent the last day of her trip with frequent loose bowel movements that have persisted over this 3-day period. She has not had fevers or blood in her stool. Her examination is unremarkable. What is most likely cause of her diarrhea?
- Norwalk virus
- Enterotoxigenic E. coli
2. You have diagnosed travelers’ diarrhea in a 30-year-old otherwise healthy man who has recently returned from an African Which of the following is the best empiric treatment option?
3. A 28-year-old mother of two young children is seeing you to discuss her chronic She reports that symptoms began in her early 20s. She doesn’t have symptoms daily, but does report at least 1 day a week with more frequent bowel movements with a less firm consistency. She reports crampy abdominal pain that is relieved with bowel movements, passage of some mucus with bowel movements, a sensation of incomplete evacuation and abdominal distention. She denies nighttime symptoms, does not note symptoms with certain foods or liquids, has not lost weight, and has never passed blood with her stools. What is the most likely cause of her diarrhea?
- Entamoeba histolytica
- Irritable bowel syndrome (IBS)
- Inflammatory bowel disease
- Lactose intolerance
4. You have diagnosed an otherwise healthy adult with acute viral diar- Which of the following dietary measures should you recommend?
- The patient should fast until the diarrhea resolves
- The patient should not eat solids, but should drink an oral rehydrating solution
- The patient should drink milk
- The patient should avoid wheat, barley, and rye.
- The patient should avoid caffeine
5. A 33-year-old woman is seeing you with a chief complaint of “dizzi- ” Upon further characterization, she describes “unsteadiness” and a feeling that “her balance is off.” Based on this description, which of the fol- lowing terms should be used to characterize her complaint?
6. A 42-year-old woman is seeing you to follow up with a new com- plaint of “dizziness.” She reports that symptoms first began several months At that time, she reported a subjective hearing loss and a ringing in her left ear only. Symptoms were mild, and her physical examination was nor- mal, so you elected to follow her. Since that time, her symptoms have pro- gressed to include dizziness and some facial numbness. What is her most likely diagnosis?
- Vestibular neuronitis
- Benign positional vertigo
- Acoustic neuroma
- Meniere’s disease
- Cerebellar tumor
7. In the evaluation of a 55-year-old man complaining of dizziness, you perform the Dix-Hallpike (Nylen-Barany) maneuver several You had the patient sit on the edge of the examining table and lie down suddenly with the head hanging 45° backward and turned to either side. With this maneu- ver, the vertigo was reproduced immediately, and symptoms did not lessen regardless of repetition. The direction of the nystagmus changed with chang- ing the direction that the head is turned, and the symptoms were of mild intensity. Which of the following is the most likely cause of the vertigo?
- Vestibular neuronitis
- Benign positional vertigo
- Meinere’s disease
- Acoustic neuroma
8. You are caring for a 26-year-old man with You have diagnosed him with a peripheral vestibular disorder, and are considering treatment options. Which of the following would be the first-line therapy?
9. You are evaluating a patient complaining of “dizziness,” but your his- tory and examination cannot distinguish whether his symptoms are sug- gestive of a central or peripheral Which of the following tests is the best option for clarification?
- MRI of the brain
- CT scan of the brain
- Brainstem evoked audiometry
10. You are evaluating a 56-year-old farmer who is complaining of dysp- nea. His history includes being hospitalized for bronchiolitis as a young child leading to childhood asthma, and a history of pneumonia 2 years ago, for which he was also He has a 20-pack year history of smok- ing. Which of the following increase his risk for having restrictive lung dis- ease as the cause of his dyspnea?
- A history of childhood bronchiolitis
- A history of asthma
- A smoking history
- A recent history of pneumonia
- His occupation as a farmer
11. You are seeing a 26-year-old female patient complaining of She reports having an upper respiratory infection 2–3 weeks ago, but that seemed to resolve. Since then, she has noted progressive weakness of the muscles in her legs, and yesterday began feeling short of breath. She is worse today. On examination, she has symmetric proximal leg muscle weakness with markedly depressed deep tendon reflexes. Her lung exami- nation is significant for decreased inspiratory volume without crackles or wheezes. What is her most likely diagnosis?
- Parkinson’s disease
- Gullain-Barre syndrome
- Amyotrophic lateral sclerosis
- Lyme disease
- Psychogenic weakness and dyspnea
12. You are evaluating a 36-year-old woman with She reports a cough and some pleuritic chest pain. On examination, her temperature is 101°F, and you note egophony in the left lower lobe. What is the likely cause of the dyspnea?
- Congestive heart failure (CHF)
13. You are evaluating a 71-year-old male patient with the complaint of shortness of It mainly occurs with exertion. He also complains of fatigue, and needing to sleep propped up on two pillows. On physical examination, you note a large apical impulse and jugular venous distension (JVD). He has fine crackles in the bases of both lungs with decreased breath sounds. What would be the most appropriate treatment?
14. You are seeing a young child whose mother says she is having trou- ble She is 3 years old, and this is her third episode of difficulty breathing. On examination, you note nasal flaring and sternal retractions with accessory muscle use. You auscultate expiratory wheezes bilaterally. Which of the following is the most likely diagnosis?
- Ventricular septal defect
- Valvular disease
15. You are seeing a 23-year-old woman with the complaint of shortness of She is otherwise healthy, taking only oral contraceptives regularly. The dyspnea began suddenly, and is associated with pleuritic chest pain. On physical examination, you note tachypnea, tachycardia, and some mild uni- lateral lower extremity edema. What would the best treatment option be for this patient?
16. You are evaluating a 69-year-old woman with a history of asthma and ischemic cardiomyopathy who is complaining of You are not sure if her symptoms are related to asthma or CHF, and you order a b-type natri- uretic peptide to help in her evaluation. The level is found to be 76 pg/mL (normal is 0–100 pg/mL). Which of the following is most correct regarding the interpretation of this laboratory value?
- The probability that her symptoms are related to CHF is near zero
- The probability that her symptoms are related to CHF is low
- The probability that her symptoms are related to CHF is moderate
- The probability that her symptoms are related to CHF is high
- The probability that her symptoms are related to CHF is indeterminate
17. You are seeing a sedentary, obese 41-year-old woman who presents to you with acute shortness of She has tachycardia, but no other abnormal examination findings. You order a d-dimer and it comes back low. Which of the following is the most appropriate option?
- Order a spiral CT of the chest
- Order a ventilation/perfusion (V/Q) scan
- Order Doppler flow studies of her lower extremities
- Order a pulmonary angiogram
- Reassure the patient
18. One of your patients is dying of end stage breast She is com- plaining of dyspnea. Which of the following treatment options would be most beneficial?
- A pulmonary rehabilitation program
19. A 23-year-old sexually active woman visits a free clinic, reporting a sudden onset of dysuria that began 2 days On further questioning, she also reports urinary frequency, some back pain, and a pink discoloration to her urine. She denies vaginal discharge or irritation, and has been afebrile. The clinic has no microscope or urine dip sticks available. Based on this history, what is her most likely diagnosis?
- Acute bacterial cystitis
- Interstitial cystitis
20. An 18-year-old woman is seeing you for back pain, frequency, and She has never had a urinary tract infection (UTI) in the past, and though she recently became sexually active, she denies vaginal discharge or risk for sexually transmitted infection. In this setting, when would a urine culture be necessary?
- If a urine dipstick were negative
- If a urine dipstick was positive for leukocyte esterase only
- If a urine dipstick was positive for leukocyte esterase and blood
- If a microscopic evaluation of her centrifuged urine revealed more than 5 white blood cells per high powered field
- If a microscopic evaluation of her centrifuged urine revealed significant bacteriuria