End of Rotation Exam
January 2008
 

Each of the following items has only one correct answer. Read all statements and choices and select the correct answer by clearly marking the letter in front of your choice.

The following clinical vignette refers to items 1 and 2.

An 86-year-old man with long standing history of Parkinson’s Disease was brought to the hospital because of the onset of gross hematuria on the day of admission. He has a Glasgow Coma Scale of 8/15. He appears rigid. His vital signs were as follows:
BP 78/56 mm Hg, Pulse 100 /min regular, Resp. 22 / min. T 96.8 0F (36.0 0C).

His urine analysis reveals the following data
 
Spec. gr. 1.025
pH 5.5.
RBC > 100/hpf
WBC 5-10 / hpf
Crystals None
Blood Large
Protein 30 mg/dl
Glucose 0
Nitrite 0
Leukocyte esterase trace
Acetone 0

1. Which of the following clinical assessments seems most appropriate?

1.-

 

a.The patient has signs of chronic renal failure with hematuria
b.The patient is able to concentrate urine and there is gross hematuria.
c.The patient has reasonable renal function and has signs of pyelonephritis
d.The patient has been fasting for a prolonged period of time and is volume depleted.

2. The serum electrolytes are reported as follows:
 
Na 133 mEq/L
K  4.1 mEq/L
Cl 98 mEq/L
HCO3  14 mEq/L
BUN 26 mg/dl
Creatinine 2.2 mg/dl
Glucose 138 mg/dl

Which of the following clinical assessments is most appropriate?

2.-

a. The patient does not have an acid base disturbance.
b.The patient is sodium depleted.
c.The patient has intrinsic renal disease
d. The patient has mostly pre-renal azotemia

3. The diagnosis of otitis media requires the presence of certain clinical findings. All of the following findings – except for one – are needed to make a diagnosis of otitis media. Which one is not?

3.

 

a. Fever (subjective or measured at more than 100°F [37.8°C]).
b. Signs and symptoms of effusion.
c. Signs and symptoms of middle ear inflammation.
d. Rapid onset of symptoms.

4. Serum trypsinogen is used to assess clinically which of the following?

4.

a. Pancreatic exocrine function.
b. Pancreatic endocrine function
c. Protein nutritional status
d. Integrity of the bowel mucosa

 

5. A 12-year-old boy presents with back pain that has awakened him over the previous three weeks. Which one of the following causes is most commonly associated with the patient's presentation?

5.

 

a. Spinal infection or tumor.
b. Inflammatory joint disorder.
c. Psychological problem.
d. Scheuermann's kyphosis

6. An 89-year-old woman is brought to the emergency department with a history of syncope. A 12-lead EKG is obtained and it is available for you in the next page. Which of the following statements is true?

6.

a. There are signs of right bundle branch block.
b. The rhythm is sinus rhythm with premature atrial complexes.
c. The rhythm is atrial fibrillation with a controlled ventricular response.
d. There are signs of right atrial enlargement.
 

The following clinical vignette refers to items 7 and 8.
A 45-year-old man is admitted to the hospital complaining of progressive rectal pain and constipation for 6-8 weeks. The onset apparently occurred insidiously but 3 weeks prior to admission he felt fullness in the rectum associated with a painful sensation. He denies weight loss, nausea, vomiting, diarrhea. He has no history of bowel problems, colitis, travel or antibiotic use.

7. On admission, his blood pressure was 137/85 mm hg, the pulse 87 regular, and the temperature 98.2 0F (36.8 0C). The respirations were slightly labored. The abdominal exam revealed slight fullness in the left lower quadrant. No rebound. A CT of the abdomen and pelvis is obtained and the films are available for your review. Which of the following clinical assessments is most appropriate?

7.

a. Pancreatitis
b. Appendicitis
c. Colitis
d. Perforated viscus with free air under the diaphragm

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8.Laboratory data are reported as follows:
 
WBC 20,600 per mm2
Hgb 10.9 gm/dl
Serum iron 10 mcg/dl
Ferritin 2207 mug/L
ESR 135 mm
Albumin 2.3 gm/dl

Which of the following assessments is most appropriate

8.

 

 

a.The patient has a colonic lesion or inflammatory process, rectal bleeding and classical iron deficiency anemia.
b.The patient has a colonic inflammatory process and protein loosing enteropathy
c.The patient has left colon pathology and anemia of chronic disease.
d.The patient should be transfused to hemoglobin greater than 11 gm/dl before any other investigation is performed.

The following clinical vignette refers to items 9 and 10.

A 57-year-old man is admitted to the hospital because of a one-week history of cough and yellow sputum production. He has a history of COPD and hypertension and was in his usual state of health until these symptoms were noticed. Associated symptoms include dyspnea and generalized weakness. He has used tobacco for about 30 years. He denies alcohol, travel, tuberculosis or hemoptysis.

 
9. On admission, his blood pressure was 151/87 mm Hg, the pulse 107 /min regular, the respirations 22 /min slightly labored at rest, and the temperature 97.8 0F (96.6 0C). Chest exam revealed decreased breath sounds. A chest film is obtained and is available for your review.
Which of the following is the most appropriate clinical assessment?

9.

 

 

a.There is evident marked cardiomegaly.
b.There are no signs of atherosclerosis.
c.There is a right base pulmonary infiltrate.
d.There are bilateral pleural effusions.

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10. A 12-lead EKG is obtained. The tracing is reproduced in the next page. Which of the following assessments is correct?

 

10.

 

 

a. There are signs of atrial flutter
b. There are signs of right atrial pathology
c. R wave progression is normal.
d. There are signs of an old anterolateral myocardial infarction.

 

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