Question about bluebottle jelly fish management
a) wash with seawater
b) wash with warm water
68yo woman, slurring speech. history of hypertension, type 2 diabetesmellitus, and bipolar disorder. Medications include amlodipine, metformin, and lithium. Frequent bradycardia and sinus pauses. Next step?
a) Serum lithium level test
b) Echocardiography
c) Serum lithium level test
29yo woman, gravida 3 para 2, vaginal bleeding. inconsistent prenatal. had a low transverse cesarean delivery. smokes daily. Irregular contractions every 10-15 minutes. diagnosis?
a) Placenta previa
b) Placental abruption
22yo, car collision. anterior chest wall pain and painful respirations. Anterior chest wall bruising. pain improves with medication. next step?
a) Administer a beta blocker
b) Admit the patient and monitor serial cardiac enzymes
c) Obtain an electrocardiogram
62yo woman, dizzy while sitting. stand up and felt like falling to the side. dizziness is intensified by any movement of the head, and she has a mild posterior headache. Medical history is significant for hypertension. Gait is ataxic. next step?
a) Administer intravenous alteplase
b) Administer oral meclizine and refer to physical therapy
18 month-old boy, cough and fever. oropharynx shows enlarged tonsils. Auscultation demonstrates rales and rhonchi, and the point of maximal impulse is displaced into right side. diagnosis?
a) Common variable immunodeficiency
b) Cystic fibrosis
c) Kartagener syndrome
17 yo boy, unusual behavior. Good grades started slipping and became argumentative. Sclerae are anicteric. mouth slightly open. neck is supple. chest is clear to auscultation. dysarthria and hyperactive deep tendon reflexes. next step?
a) Electroencephalography
b) Lumbar puncture
c) Serum ceruloplasmin level
23yo man, injured right shoulder . right arm is held in slight abduction and external rotation. Distal pulses are full. If left untreated, complication of this patient’s injury?
a) Inability to extend fingers
b) Loss of the biceps reflex
c) Shoulder abduction weakness
28yo man, white lesions tongue, not painful or itchy. smokes a pack of cigarettes daily and does not drink alcohol. multiple enlarged cervical lymph nodes. next step?
a) Obtain HIV testing
b) Obtain lymph node biopsy
67 yo man, sore on right face. bleeds and oozes. Skin examination reveals a 1.5-cm lesion. Biopsy shows basal cell carcinoma. next step?
a) CT scan of the head and neck
b) Curettage and electrodesiccation
c) Mohs micrographic surgery
29yo man, broke into store and yelling “the end of world is here. Covid will consume us all” history of depression treated with antidepressants and a hospitalization 2 years ago, and suicide attempt. initial step?
a) Carbamazepine
b) Clozapine
c) Lorazepam
17 yo girl, heavy menses. 1 unit of packed red blood cell transfusion. anxious and short of breath. pale. pain at the IV insertion site. urine dark. next step?
a) Epinephrine injection
b) Intravenous furosemide
c) Intravenous normal saline
32yo woman, gravida 4 para 3. has type 1 diabetes mellitus. daily exercise routine of weight lifting and running on a treadmill. contraindication to exercise in pregnancy?
a) History of cervical insufficiency
b) Maternal BMI
16yo boy, persistent epistaxis. no personal history of excessive bleeding. history of chronic glomerulonephritis and is on the waiting list for transplantation. next step?
a) Antiplatelet antibody measurement
b) Bone marrow biopsy
c) No additional testing
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5yo boy, fever. throat pain and not eaten well. gray, shallow ulcers are seen on soft palate and uvula. most likely pathogen?
a) Adenovirus
b) Coxsackie virus
42yo man, mood changes. restless from a work trip. keep waking up from nightmares, appears withdrawn. initial step?
a) Encourage the patient to take a temporary leave from work
b) Provide reassurance that his symptoms will likely resolve without intervention
c) Review common physical and emotional responses to trauma
32yo woman, gravida 2 para O aborta 1. no vaginal bleeding or contractions. Fundal height is 35 cm. Fetal heart tones are 155/min. underlying cause of uterine size-dates discrepancy?
a) Gestational diabetes mellitus
b) Incorrect pregnancy dating
19yo woman, feeling cold all the time. wears sweaters despite the warm weather and sleeps with multiple blankets at night. difficulty losing weight. last menstrual period was 2 months ago. next step?
a) Administer fluoxetine
b) Administer low-dose olanzapine
c) Admit to hospital
21yo man, fall, hit head on a rock. headache and vomited twice. Swelling and tenderness over the left frontoparietal region. CT scan of the head will most likely reveal?
a) Diffuse axonal injury
b) Epidural hematoma
43yo woman, congestive heart failure. dullness to percussion at the right lung base. moderate-size right pleural effusion. low pleural fluid glucose concentration?
a) High amylase content of the pleural fluid
b) High white blood cell content of the pleural fluid
45yo man, pain left foot. history type 1 diabetes mellitus. deformed left ankle and left foot. Peripheral pulses are full and symmetric. cause?
a) Age-related degenerative osteoarthritis
b) Atherosclerosis of the tibial arteries
c) Impaired sensation and joint proprioception
73yo man, increasing confusion. history type 2 diabetes mellitus, neuropathy, and coronary artery. diabetic ulcer over the right heel; no purulence or surrounding erythema. Blood ix shows bicarbonate of 16. Serum glucose 9.8. next step?
a) CT scan of the head
b) Debridement of the foot eschar
c) Intravenous antibiotics
25yo torres strait woman, heavy menstrual cycles for 3 months. gums bleed when brush teeth. pain and stiffness in hands and wrists. nonpainful oral ulcer is present. petechiae on upper arms and shins. cause?
a) Aberrant splenic sequestration
b) Bone marrow invasion by malignancy
c) Peripheral destruction
43yo woman, high blood pressure. exercises regularly and low-salt diet. history asthma. no smoke or alcohol. BMI is 27. peripheral pulses are 2+ and symmetrical. additional studies?
a) 24-hour urine cortisol excretion
b) Lipid panel and urinalysis
52yo man, decreased libido. Married, one child. drinks alcohol but no tobacco or drugs. decreased levels of total triiodothyronine (T3) and thyroxine (T4). Physical examination shows bilateral gynecomastia and firm and small testes. diagnosis?
a) Adrenal insufficiency
b) Chronic liver disease
25yo woman, gravida 2 para 2. vaginal delivery at 36 weeks gestation. daily iron supplementation due to menstrual bleeding. no chronic medical conditions. Vital signs are normal. contraceptive option?
a) Combined estrogen/progestin oral contraceptive pills
b) Copper-containing intrauterine device
c) Subdermal progestin-releasing implant
74yo woman, sudden vision loss in right eye. malaise and fatigue. history cataract surgeries. pupils are 4 mm bilaterally. swollen pale disc with blurred margins. therapy?
a) High-dose systemic glucocorticoid
b) Intravenous acetazolamide
15 month-old girl, unresponsive. crying incessantly, stopped breathing until unresponsive. takes no medications, and vaccinations are up to date. Vital signs are good. diagnosis?
a) Arrhythmias
b) Epilepsy
c) Normal development
37 yo woman, gravida 2 para 1, last menstrual period was 10 weeks ago. brown vaginal discharge. mild nausea. failed in vitro fertilization cycles. enlarged uterus. next step?
a) Diagnostic laparoscopy
b) Observation and serial 3-hCG levels
c) Suction curettage
42yo woman, abdominal pain. burning pain with nausea. awakened at night, and bloating after meals. no dysphagia, regurgitation, weight loss, or change in bowel habits. no family history of gastrointestinal cancer. cause?
a) Gastrin-secreting pancreatic tumor
b) Immune-mediated bile duct injury
c) Urease-producing bacterial infection
25yo woman, gravida 1 para 1, fatigue, palpitation, excessive sweating. delivered a male child at 39 weeks. no chronic medical conditions. Blood pressure is 140/70 and pulse is 110. Bilateral lid lag is noted. tremor hands. therapy?
a) Add prednisone
b) Add propylthiouracil
c) No additional therapy
31yo woman, shortness of breath and anxiety. no chest pain or palpitations. No smoke and alcohol. history anxiety and sleep problems. no extremity edema and no skin rashes. next step?
a) Compression ultrasound of legs
b) CT pulmonary angiogram
c) Reassurance and follow-up
25yo woman, suicidal. quick to anger and insecure. sadness lasting 1-2 days history of 3 prior suicide attempts. takes no medications. diagnosis?
a) Bipolar I disorder
b) Bipolar II disorder
c) Borderline personality disorder
12 hour-old girl, bilious emesis. born at 35 weeks gestation by vaginal delivery. urinated but no bowel movement. vomit green fluid since the third feed. diagnosis?
a) Cocaine withdrawal
b) Duodenal atresia
c) Hirschsprung disease
62yo man, coronary artery bypass graft surgery. have 3-vessel coronary artery disease. medical conditions includ0e hypertension, type 2 diabetes mellitus, and hyperlipidemia. history of severe penicillin allergy. antibiotic?
a) Azithromycin
b) Ciprofloxacin
c) Vancomycin
65yo woman, lethargy. No tobacco or illicit drugs but drinks a glass of red wine nightly. yoga 3 times weekly. thin but well nourished. Large lymph nodes in bilateral cervical. diagnosis?
a) Chronic lymphocytic leukemia
b) Chronic myeloid leukemia
30 month-old, parents are divorced. They disagree about car safety and ask for advice about his car seat. mother says the boy’s height and weight are acceptable to remain in this position. father says that the boy’s legs are bent against the back seat while he is rear-facing. advice?
a) “A belt-positioning booster seat is recommended for kids his age.”
b) “A forward-facing car seat should be used based on his height.”
c) “Until he outgrows his car seat’s height or weight limit, he should be rear-facing.”
62yo woman, malaise and fever. decreased appetite and unintentional weight loss. history type 2 diabetes mellitus and hypertension. smoked a pack of cigarettes daily for 30 years. thin and pale. diagnosis?
a) Acute diverticulitis
b) Appendiceal abscess
c) Renal cell carcinoma
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29yo woman, seizure. at a party consumed alcohol. blood alcohol level is 0.06%. no further seizure activity but remains unresponsive an hour after treatment. next step?
a) Activated charcoal
b) Electroencephalography
74yo woman, gravida 5 para 5, vaginal spotting and discharge. mass coming out of vagina. difficulty defecating; increased straining. History hypertension, type 2 diabetes mellitus. Blood pressure is 150/90, pulse is 84. BMI is 41. next step?
a) Endometrial biopsy
b) Hormone replacement therapy
c) Pessary fitting
13yo girl, cystic fibrosis, nausea. bumped heads with another person but did not lose consciousness. is alert and oriented but is sweating profusely. develops abdominal cramps and nausea and then vomits. diagnosis?
a) Cystic fibrosis exacerbation
b) Exertional heat stroke
c) Heat exhaustion
