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1. You are evaluating a 16-year-old who has not menstruated She appears short in stature. Which of the following is the most likely genetic diagnosis?
- Turner’s syndrome
- Fragile X syndrome
- Down syndrome
- Testicular feminization syndrome
- Factor V Leiden deficiency
2. You are evaluating a 32-year-old woman complaining of She has mild hypertension, hypothyroidism, gastroesophageal reflux disease, and depression. On evaluation, her prolactin level was found to be 89 ng/mL (H). Which of the following medications would be most likely to cause the elevated prolactin level?
- Proton pump inhibitors
- Selective serotonin reuptake inhibitors
- Thiazide diuretics
- ACE inhibitors
- Thyroid hormone replacement
3. You are evaluating 32-year-old woman who has not menstruated in 4 She has a long history of irregular menstrual periods, but has never gone this long without a period in the past. She is not pregnant, her laboratory evaluation is normal, and you decide to perform a progestin challenge test. The week after she takes 10 mg of medroxyprogesterone acetate (Provera) for 7 days, she reports having a period. Which of the following is the most likely cause of her amenorrhea?
- Premature ovarian failure
- Ovarian neoplasm
- Turner’s syndrome
- Asherman’s syndrome
- Polycystic ovarian syndrome
4. During the workup of amenorrhea in a 44-year-old woman, you dis- cover her testosterone levels are elevated (322 ng/dL) and her DHEA-S levels are also elevated (9 mg/dL). Which of the following would be appropriate in this setting?
- CT scanning of the adrenal glands
- MRI of the brain
5. You are evaluating a 16-year-old girl who has never She has normal secondary sexual characteristics, and her laboratory evaluation is negative. She has no withdrawal bleeding after a progestin challenge, and you choose to perform an estrogen-progestin challenge. She has no with- drawal bleeding after that challenge as well. Which of the following is the most likely reason for her amenorrhea?
- An outflow tract obstruction
- Hypergonadotropic amenorrhea
- Hypogonadotropic amenorrhea
- Polycystic ovarian syndrome
- Pituitary adenoma
6. You are seeing a 24-year-old woman complaining of She has always had painful periods, but lately they seem to be worsening. Her physical examination, including pelvic examination, is normal. She is not currently sexually active. Which of the following is the most appropri- ate next step in the workup?
- No further workup is needed
- Gonorrhea and Chlamydia cultures
- Pelvic ultrasound
7. You are evaluating an 18-year-old college student complaining of painful menstrual She reports that she began menstruating at age 14. Since that time, her periods have always been associated with pain. The pain begins just prior to her period starting, and lasts for up to 3 days. She has associated nausea, fatigue, and headache. Which of the following is the most likely diagnosis?
- Primary dysmenorrhea
- Ovarian cysts
8. You are evaluating a 20-year-old with Her history and physical examination are normal, and you choose to treat her with a trial of oral contraceptives. How do oral contraceptives work to treat dysmenorrhea?
- Suppressing of prostaglandin synthesis
- Suppressing of prostaglandin release
- Causing endometrial hyperplasia
- Increasing vasoconstriction in the uterus
- Directly decreasing uterine resting tone
9. You are caring for a 70-year-old hospitalized male who is currently 1 day out from a carotid You are called to the floor at 3:00 a.m. because the patient removed his peripheral IV and is demanding to go home. Reviewing his chart, you see he has a history of hypertension and hyperlipi- demia, both of which are well controlled with medication. He is working part- time as an auto mechanic, and lives at home with his wife. On evaluation, he is agitated but responds to questions, oriented to person only, and denies chest pain, palpitations, shortness of breath, dizziness, or other problems. Of the fol- lowing, which characteristic points to delirium instead of dementia in this case?
- The acute onset of his symptoms
- The fact that he is disoriented to time and place
- His history of hypertension
- The fact that he is responsive to questions
- The fact that this happened in the early morning hours
10. You are in the emergency room caring for a 47-year-old man who was brought in by his wife who states that he had an acute onset of confu- sion. His past medical history is unremarkable, without evidence of drug or alcohol On examination, you find his blood pressure to be 210/130, his pulse to be 97, and his respirations to be 20 per minute. His tempera- ture is 98.4°F. Strength, sensation, and gait are normal. He has no tremor. What would you expect to find on ophthalmologic examination?
- Pinpoint pupils
- Dilated pupils
- 6th cranial nerve palsy
- Anisocoria of 1 mm
11. You are evaluating a homeless person in the emergency department who is displaying a hyperalert Withdrawal of which of the fol- lowing substances is most likely to cause this state?
12. You receive a telephone call from the roommate of an 18-year-old col- lege freshman who is your The roommate states the patient com- plained of a headache, aches, and a low-grade fever throughout the day. The patient went to take a nap 20 minutes ago, and is now difficult to arouse. Which of the following tests would be most likely to reveal the diagnosis?
- Complete blood count
- Toxicology screen
- Pregnancy test
- Lumbar puncture
13. You are seeing a 70-year-old woman who was brought to the office by her The daughter says she is worried, because her mother seems more forgetful lately. She has a 20-year history of type 2 diabetes, controlled with glu- cophage. On examination, she is mildly hypertensive with otherwise normal vital signs. She is oriented to time, place, and person. She is unable to complete “serial sevens” on the mini-mental status examination. Which of the following features would be more consistent with dementia as opposed to delirium?
- Her mild hypertension
- Her long history of diabetes
- Her current level of consciousness
- The inability to complete serial sevens
- The recent onset of her symptoms
14. You are discussing symptoms of nausea and vomiting with a 52-year- old female patient with longstanding type 2 diabetes She reports chronic symptoms that become worse after eating. She will occasionally vomit 1 or 2 hours after eating, and the food that comes up is undigested. On examination, she has not lost weight, and is not showing signs of clin- ical dehydration. What is the best treatment for her condition?
- An anticholinergic medication, like scopolamine (Transderm Scop)
- An antihistamine, like promethazine (Phenergan)
- A benzamide, like metoclopramide (Reglan)
- A cannabinoid, like dronabinol (Marinol)
- A phenothiazine, like chlorpromazine (Thorazine)
15. You are evaluating a 63-year-old man who complains of abdominal pain, distension, nausea, and It began rather suddenly this morn- ing, though he has had mild pain for several days. His past history is sig- nificant for a partial sigmoid resection for diverticulosis and an appendectomy at age 23. On examination, he is afebrile, his mucous mem- branes are dry, but he has no orthostatic symptoms. His abdomen is dis- tended and diffusely tender, and his bowel sounds are hyperactive. Which of the following is the most likely cause of his nausea and vomiting?
16. You are seeing a 12-year-old girl for nausea and She was diagnosed as having viral gastroenteritis in the emergency department more than 6 weeks ago, but since that time has had difficulty keeping food down. She states that whenever she eats, she gets nauseated and vomits within 10–30 minutes. She has been using antiemetics to control her symptoms, but they do not work consistently. She has always done well in school, and denies social stressors. Her medical history is unremarkable, but she was treated for depression last year. On examination, she is well- nourished, interactive and in no distress with no signs of dehydration. Her weight is 147 lb—5 lb less than at her well examination 6 months ago— and her height is 5 ft. What is the most likely cause of her symptoms?
- Chronic gastroenteritis
- Psychogenic vomiting
- Anorexia nervosa
- Bulimia nervosa
- Central nervous system malignancy
17. You are seeing a 6-year-old boy with nausea and His symp- toms began acutely last evening, starting with malaise, headache, low- grade fever, body aches, and diarrhea. On examination, he has dry mucous membranes, but no orthostatic symptoms. He has diffuse mild abdominal pain without rebound or involuntary guarding. What is the best treatment for his condition?
- Nothing by mouth until his symptoms improve
- Oral rehydration with clear liquids, advancing the diet as tolerated
- Intravenous rehydration, advancing to oral as tolerated
- Antiemetics, given intravenously or intramuscularly
- Trimethoprim/sulfamethoxazole therapy
18. You are seeing a 44-year-old woman with hypertension controlled with lisinopril, who presents with severe nausea and She reports having months of occasional right upper quadrant pain, usually after eat- ing out with her husband, that resolves within a couple of hours. Over the last 24 hours, her symptoms have been severe, and she is unable to eat or drink without vomiting. Her pain is significant, radiates to her back, and is better when she leans forward. On laboratory evaluation, her amylase is elevated, and her alanine aminotransferase (ALT) is elevated. Which of the following would be the best approach to avoid recurrent problems in her case?
- Discontinue lisinopril
- Avoid calcium in the diet
- Work with the patient to remain sober
- Remove the patient’s gallbladder
- Use medication to lower the patient’s triglyceride level
19. You are evaluating a 38-year-old man who is complaining of nausea and vomiting. He reports that he is nauseated before breakfast, and the vomiting is described as “projectile.” The symptoms improve throughout the It is also associated with some headache and subjective dizziness. Of the following, which is the most likely diagnosis?
- A vestibular disorder
- A brain tumor
20. You are evaluating a 45-year-old obese woman who is complaining of Occasionally, she vomits what appears to be undigested food. Her symptoms occur an hour or two after eating meals, and she denies any pain. What is the most likely diagnosis?
- A vestibular disorder
- A brain tumor