6. A 55 -year-old woman with history of severe COPD requiring treatment with glucocorticoids for pulmonary management. Which of the following sets of clinical data describes best this woman’s clinical syndrome?

		Na	K	Cl	Bicarb	BUN	Creatinine
	a.	145	6.0	100	15	45	2.3
	b.	125	5.7	100	26	18	0.7
	c	122	3.0	105	30	20	1.5
	d.	137	3.1	105	27	12	1.0

7.Propanolol is useful in the acute management of which of the following clinical entities?

a. Cushing syndrome
b. Addison's disease
c. Thyroid storm
d. Syndrome of Inappropriate ADH

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8. Which of the following is considered the best method to diagnose hyperthyroidism?

a. Hyghly sensitive TSH
b. TSH
c. Free T4 index
d. T3 Resin Uptake
 

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10. Which of the following presents clinically associated with microcytic anemia?

a. Beta-thallassemia
b. Hypothyroidism
c. Alcoholism
d. Atrophic gastritis
 

11. Which of the following statements is true regarding Sickle Cell Anemia (SCA)?

a. The incidence of SCA in African-Americans is of the order of 2-3%
b. SCA is due to SS disease, an autosomal dominant genetic disorder
c. Acute chest syndrome occurs infrequently in SCA patients and it is NOT associated with mortality in adults
d. Bacterial infections may be implicated in eliciting a sickle crisis and splenic sequestration but not viruses
 

12. A 67 -year-old woman comes into the clinic for a general check up.
She is submitted to a chemical profile. The serum calcium level is 10.5 mg/dl, her albumin level is 5.0gm/dl, her phosphorus is 3.5mEq/L, and the magnesium is 1.95 mg/dl. Which of the following is the "corrected calcium level"?

a. 9.5
b. 10.1
c. 11.9
d. 5.5
 

13. A 55 -year-old college professor presents for discussion of recently diagnosed type diabetes mellitus. He has a strong family history of coronary artery disease. (His father expired from a myocardial infarction at age 48). His physical examination is normal and his blood pressure is 140/90 mm HG. Laboratory studies reveal:
 

BUN	15 mg/Dl
Creatinine	0.9 mg/dL

Which one the following statements most accurately represents current recommendations regarding urine screening for proteinuria for this patient?

a. Not indicated unless renal insufficient develops
b. Yearly testing with standard urine dipstick beginning 5 years after diagnosis
c. Yearly testing with standard urine dipstick beginning at the time of diagnosis
d. Yearly testing for microalbuminuria beginning at the time of diagnosis
e. Yearly testing for microalbuminuria beginning 5 years after diagnosis

14. A 37-year-old male presents via ambulance to the emergency department after being found unresponsive. He has had no prior medical problems. The triage nurse reports a fruity smell to the patient's  breath. Vital signs are:

Temperature	98.2
Respiratory rate	28
Blood pressure	120/80 mm Hg
Apical pulse	120 beats/min

Initial lab results are as follows:

Sodium	140 mEq/L
Potassium	5.2  mEq/L
Chloride	111 mEq/L
CO2	15   mEq/L
Glucose	476 mg/dL

Which of the following is correct?

a. No potassium should be added to the intravenous fluids.
b. Hypernatremia necessitates replacement with hypotonic intravenous fluids
c. Bicarbonate should be added to the intravenous fluid to correct the acidosis
d. Intravenous replacements of potassium should accompany onset of treatment
e. Aggressive fluid resuscitation with lactated Ringer's solution is indicated

 

15. A 50 -year-old female presents to the emergency department with new onset seizures. The following laboratory values are notes.

NA+	115  mEq/L
K+	3.5   mEq/L
CL_	115  mEq/L
CO2	25    mEq/L
BUN	18    mg/dL
Creatinine	1.0   mg/dL
Serum Osmolality	Low
Urine Osmolality	High

What is the most likely explanation for these laboratory abnormalities?

a. diuretic overuse
b. syndrome of inappropriate antidiuretic hormone (SIADH)
c. uncompensated metabolic acidosis
d. renal tubular acidosis, type II
e. water intoxication from psychogenic polydipsia

 

16. A 28 -year-old female complains of fatigue over the past 6 months.
History and physical examination are otherwise normal. Laboratory testing reveals the following:

hemoglobin	10.0 mg/dl
hematocrit	28.0 %
MCV	76 fl
Serum iron	decreased
TIBC	increased
% saturation	decreased
ferritin	decreased

What is the most likely for this patient's anemia?

a. iron deficiency
b.aplastic anemia
c. folate deficiency
d. anemia of chronic disease
e. beta-thalassemia trait

 

17. Which of the following is TRUE  regarding insulin pumps for management of diabetes mellitus?

a. indicated only for treatment of type 1 diabetes mellitus
b. measures serum electrolytes and automatically administers an appropriate bolus of insulin
c. delivers an appropriate insulin bolus at a predetermined serum bicarbonate level
d. automatically delivers programmed basal and bolus doses of insulin.
e. prohibits the use of additional injectable insulin

18. A 44 -year-old black female presents for recheck on hr type 2 diabetes mellitus. Her BP is 129/78 mm Hg and her physical examination is unremarkable. Her sugars have been well controlled at home, and her Hgb  A1C is 6.7. Her only medication is metformin (Glucophage) 500 mg BID. Her urine albumin/creatine ratio is 320. Which of the following is the most appropriate next step for this patient?

a. refer to a nephrologist
b. initiate dietary protein restriction
c. increase metformin (Glucophage) to 1000 mg BID
d. obtain 24-hour urine specimen
e. add rosiglitazone (Avandia) 4 mg daily

 

19. Hemoglobin A10 assays are inaccurate in patients with

a. iron deficiency anemia
b. anemia of chronic disease
c. cor pulmonale
d. sickle cell disease
e. hypothyroidism

 

20. You are evaluating a 68 -year-old female for fatigue. Her past medical history is positive for rheumatoid arthritis that is well controlled on methotexate. Her evaluation has demonstrated anemia. Her laboratory values are as follows:

hemoglobin	10.0 mg/dl
hematocrit	28.0%
MCV	82 fL
Serum iron	decreased
TIBNC	normal
%saturation	normal
ferritin	normal

What is the most likely diagnosis for this patient's anemia?

a. gastrointestinal blood loss
b. anemia of chronic disease
c. iron deficiency anemia
d. hemolytic anemia
e. hemochromatosis

21. A 51 year-old female presents with palpitations and persistent soreness in her neck. She was well until approximately 20 days ago when she had a URI complicate by maxillary sinusitis. Physical exam revealed her to be uncomfortable and irritable. Her pulse rate was 110/min and regular with a blood pressure of 136/74 mm Hg. She demonstrated no lid lag or stare. There was also anterior cervical adenopathy and non-exudative tonsillitis. There was also diffuse tenderness of the thyroid gland.

Laboratory Studies
TSH	0.01 mU/L
Total T4	15.5 mug/dL

Which of the following is the most appropriate next step for this patient?

a. fine needle aspiration and biopsy of the thyroid
b. measurement of serum thyroid-stimulating immunoglobulin
c. radioactive iodine (I123) uptake and scan
d. thyroid ultrasound
e. measurement of serum thyroglobulin

 

22. The treatment of choice for the patient in question 21 would include which of the following:

a. propylthiouracil (PTU)
b. thyroidectomy
c. thyroid replacement therapy with levothyroxine (Levoxyl)
d. radioactive iodine
e. no treatment at this time

 

23. A 44-year-old female has the following values on thyroid testing: TSH: 0.01 mU/L with T4 and T3 in the normal ranges. The patient denies any symptoms and the physical examination is normal. What is the diagnosis?

a. euthyroid sick
b. subclinical hyperthyroidism
c. thyroiditis
d. subclinical hypothyroidism
e. Grave's disease

 

24. A 55 -year-old males presents complaining of a funny looking tongue. Your examination reveals a fissured tongue. You also note a loss of vibratory sensation during his exam. His hemoglobin 9.0 grams/dL and his MCV is 125 m/mm3. His hemoccult is negative. What is the most likely diagnosis?

a. anemia of chronic disease
b. hypothyroidism
c. pernicious anemia
d. hyperthyroidism
e. beta-thalassemnia

 

25. An 18 -year-old male with known diabetes mellitus is being evaluated in the emergency room for diabetic ketoacidosis (DKA). He has elevated blood glucose and positive serum ketones. Which other lab abnormality would be most consistent with a diagnosis of DKA?

a. decreased serum magnesium level
b. decreased serum osmolality
c. elevated liver enzymes
d. elevated serum bicarbonate
e. elevated anion gap

 

26. Which of the following is associated with an increased risk of breast cancer?

a. aspirin use
b. multiparity
c. raloxifene (Evista)
d. early menopause
e. alcohol consumption

 

27. Which of the following increases a female's risk for breast carcinoma?

a. First pregnancy before the age of 18
b. Late menarche
c. Late menopause
d. Low body mass index
e. Multiparity

 

28. A 26-year-old female complains of a one-month history of tremor. She is three Months post-uncomplicated vaginal delivery. Her only medications is norgestimate/ethinyl estradiol (Ortho Tri-Cyclen). The remainder of her history is normal. Her physical examination reveals a mild intention tremor of her hands bilaterally. Her thyroid is neither enlarged nor tender, and the remainder of her ENT, neurological and mental status examination is normal. Laboratory studies reveal normal complete blood count, blood glucose, calcium and electrolytes. The thyroid-stimulating hormone is 0.25 u U/mL, the RIA-T3 is 300ng/dL, and the radioactive iodine uptake is low.

The most likely diagnosis is:

a. Euthyroid sick syndrome
b. Graves disease
c. Postpartum thyroiditis
d. Secondary hypothyroidism
e. Subclinical hyperthyroidism

 

29. The most appropriate treatment is:

a. Radioactive iodine ablation of the thyroid
b. Levothyroxine (Synthroid)
c. Levothyroxine (Synthroid) combined with liothyronine (Cytomel)
d. L-triiodothyronine (Cytomel)
e. Observation with reassurance

 

30. A 58-year-old woman is diagnosed with bilateral pulmonary emboli and metastatic adenocarcinoma to the liver. Two year prior she had a right lower extremity deep venous thrombosis at the time of her diagnosis of stage II uterine cancer. She underwent anticoagulation therapy with warfarin for 6 months following surgery.

After an initial seven day course of low molecular weight heparin, which of the following is the most appropriate for preventing recurrent venous thromboembolism in this patient?

a. Transition to warfarin with a target INR of 2.0 to 3.0
b. Transition to warfarin with a target INR of 3.0 to 4.0
c. Continue low molecular weight heparin
d. Place an inferior vena cava filter.

 

 

 

 

Index Albarran