4. . Which of the following is most likely to enhance the healing of this patient’s ulcer?

5. A patient is started on furosemide. Two weeks later, she presents to the emergency department complaining of feeling weak and dizzy with changes in position. The history reveals she had experienced several days of diarrhea during the past week associated with a quick weekend trip to Mexico. Which of the following EKG changes would be most consistent with this history?

6. A 63-year-old man comes into the emergency department brought in by his family because of increasing weakness. He has been complaining of weakness and easy fatigability for the past several days.  He has a history of hypertension and has had in the past years several “mini-strokes.” He has been particularly worried about leg weakness and palpitations.  There is no history of alcohol abuse or tobacco smoking. He has been on enalapril 5 mg per day, dipyridamole 50 mg bid and aspirin 325 mg po qd for 6 months. On examination his temperature is 97.3 deg F ( 36.3 deg C) and the blood pressure is 120/80. The laboratory studies reveal a serum sodium of 137 mEq/L and a potassium level of 4.2 mEq/L. His thyroid functions are normal. His EKG is shown in the next page. Which of the following is most CORRECT?

7. A 48-year-old black male presents for a preventive health examination after he was discovered to have elevated blood pressure at his place of employment. His log reveals average daily readings of 144/90 mm Hg over the past several weeks. Family history is negative for coronary artery disease, cancer or diabetes. His physical examination is normal. His blood pressure is 142/90 mm Hg. Which of the following statements is TRUE regarding the diagnosis and treatment of blood pressure in this patient?

8. What is the most appropriate long-term therapy for post-myocardial infarction medication regimen for a patient with type 2 diabetes and hypertension who has had an uncomplicated myocardial infarction?

9. Warfarin (Coumadin) therapy is indicated at the time of hospital discharge for patient after acute myocardial infarction with:

10. A 45-year-old male presents for a physical examination prior to initiating an exercise program. He is 5 feet 10 inches tall, weighs 209 pounds (96 Kg), with a waist measurement of 44 inches and a chest circumference of 40 inches. His physical examination is otherwise normal. His fasting laboratory values are:

This patient should be considered at risk for which of the following conditions?

11. A 65-year-old black male presents with a complaint of pain in his right foot. Two days ago he suffered a mechanical fall and bruised his right shin. He reports no other injury. Prior medical history is positive for MI, CHF, hypertension, and atrial fibrillation. His mediations are: nadolol (Corgard), digoxin (Lanoxin), lovastatin (Mevacor), flurosemide (Lasix), and warfain (Coumadin). On examination he has extensive ecchymosis on his right lower leg. His right foot is cool to touch and no pulses can be palpated. The least appropriate immediate approach is:

12. An 80 year old man is admitted to the hospital through the Emergency Department because of syncope. He suffers from chronic anemia with a hemoglobin of 9.0 gm/dl and heart failure. The patient felt somewhat short of breath prior to admission and suddenly was observed to loose consciousness. On arrival at the ER a 12-lead Ekg is done. This is shown in the next page. Which of the following is TRUE?

13. Which of the following classes of medications have been shown to prolong life and reduce the risk of disease progression in patients with chronic heart failure?

14. Which of the following findings is usually most common in pulmonary embolism?

15. Which of the following is associated with a restrictive type of problem in pulmonary physiology?

16. A 68-year-old former smoker man with a history of COPD (non-supplemental oxygen dependent) presents with a 2-day history of worsening dyspnea and increased quantity and purulence of sputum. Physical exam reveals scattered rhonchi in all lung fields and utilization of the accessory muscles of respiration at rest . Blood pressure is 140/90 mm Hg, apical pulse is100 and regular, respiratory rate is 24 and the temperature is 101°F (38.3). ABG on room air and laboratory studies reveal the following:

What is the appropriate diagnosis for the acid-base status of this  patient?

17. Acanthosis (acantho meaning thorn) nigricans (black) may be a benign condition but its presence may also be associated with certain diseases. Which of the following diseases IS NOT ASSOCIATED with acanthosis nigricans?

18. A 30-year-old African American female presents to your office complaining of fatigue, dyspnea, and a dry cough. Physical exam reveals uveitis and parotid enlargement. Chest x-ray reveals bilateral hilar adenopathy. Which of the following lab results would you expect to find in this patient?

19. Which of the following is the gold standard for the diagnosis of  Celiac sprue?

20. Which of the following statements BEST represents current colon Cancer screening guidelines endorsed by both gastroenterologists, and the United States Preventive Services Task Force (USPSTF) for low risk patients between the ages of 50-60?

21. Coronary heart disease is the leading cause of mortality in the United States, with 84 percent of persons 65 years or older dying from this disease. All of the following preventive measures have been recommended by various governmental and professional organizations EXCEPT?

22. More than 40% of tourists visiting Latin America and the Caribbean develop the syndrome of “Traveler’s Diarrhea.” Which is the most common etiology of diarrhea in these patients?

23. A 34-year-old postal worker develops cough, fever and dyspnea. He has a uneventful past medical history except for gonorrheal urethritis diagnosed while he was in the US Army in Germany and treated properly with Ceftriaxone. Chest x-ray at this time shows bilateral mild infiltrates. A set of  blood cultures is done and it is found to be positive (two out of two  samples) for anthrax. Which of the following is most appropriate for initial treatment?

24. A 76-year-old man is brought to the emergency department because of dizziness and weakness. He has a history of myocardial infarction two years ago and diabetes mellitus. Patient denies palpitations or shortness of breath.

On examination his blood pressure is 110/70, the respirations are unlabored and the temperature is 97.6 deg F. ( 36.4 deg C). His blood glucose is 123 mg/dl and the hemoglobin is 15.7 gm/dl. An EKG is obtained. The tracing is available for your review in the next page. Which of the following is CORRECT?

The following clinical vignette refers to items 25 and 26 below.

A 54-year-old woman with a history of mental illness is brought to a psychiatric facility for evaluation. She has no history of fever, organomegaly or travel abroad. She denies sexual encounters in the past 15 years. She denies drug abuse or history of hepatitis. She does admit to alcohol use to the point of six bears per day for several years. On examination she appears to be free of any distress. She does have signs of hepato-splenomegaly. There are no signs of shifting dullness. There are no petechiae. Her laboratory work up reveals a WBC of 1,700 with 67% segs, 24 % lymphs, 13% monos, and 1 % basos. The hemoglobin is 12 gm/dl and the platelets are 13,000 per cubic mm.

25. Which of the following courses of actions seems most appropriate?

26. The electrolytes are as follows: Na 136 mEq/L, K 3.9 mEq/L, Cl 98 mEq/L, Bicarb 32 mEq/L, BUN 7 mg/dl, creatinine 0.8 mg/dl, serum glucose 120 mg/dl. An arterial blood gas is obtained: pH 7.515, pCO2 27, PO2 92, Bicarb (calc) 21 mEq/L. Which of the following is most CORRECT?

27. A 56 year old woman presents to the emergency department because of chest pain. She has a history of hypercholesterolemia, migraine headaches, obesity and hypertension. The chest discomfort does not radiate to the arms or back but seems to move in the direction of the epigastric area. On arrival at the ER an EKG is done and the results are available in the next page.

Which of the following is CORRECT?

28. Which of the following statements is INCORRECT regarding our clinical knowledge about hyperthermia.

29. Rocky Mountain spotted fever, a disease caused by Rickettsia rickettsii,  must be recognized on clinical grounds and through a high index of suspicion in certain clinical settings. Which of the following statements IS NOT TRUE?

30. A 57-year-old man with hypertension, high cholesterol levels, and stable angina pectoris awoke one morning and could not see to his left. During the preceding weeks, he had had several brief attacks of dizziness accompanied by difficulty focusing his eyes. During one spell, his body veered to the right. He decided to go to the nearest Emergency Department. On examination he was found to have a left homonymous hemianopia. The review of systems revealed: Dizziness, vertigo, headache, vomiting, double vision, numbness, and weakness involving structures on both sides of the body. The patient has not had numbness or difficulty walking ever prior to this event. He denies trauma to his head recently or in the past few months, strokes, or fever. There is no history of speech disorder. A CT of the brain without contrast is read as negative. Which of the following statements is TRUE?

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