Pocket Medicine High-Yield Board Review (Sep 15, 2020)_(1975142438)_(LWW)

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Title Page
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Contributors
Preface
Contents
1 Cardiology
	1.
		(ECG)
		What is the most likely diagnosis?
	2.
		ECG
		What is the most likely diagnosis?
	3.
		ECG
		What is the correct interpretation?
		3. The correct answer is:
	4.
		ECG
		What is the most likely etiology of the ECG changes?
		4. The correct answer is:
	5.
		ECG
		Which of the following would increase his risk of lifethreateningarrhythmia?
		5. The correct answer is:
	6.
		ECG
		What is the most likely diagnosis?
		6. The correct answer is:
	7.
		Physical examination reveals
		ECGis checked and shows
		What is the next best step?
	8.
		Initial vital signs arenotable for
		His ECG is shown below:
		What is the next best step?
	9.
		For the past week, he has had
		Vital signs are notable for
		His ECG is shown below:
		Which of the following is most consistent with the clinicalpresentation and ECG?
	10.
		At angiography, she is
		echocardiogram that shows
		What should be considered the next appropriate step in herworkup?
	11.
		Which test should you recommend?
	12.
		Vitalsigns are
		His ECG has
		His serum troponin is
		Which of the following choices would be the most reasonablefirst test to order?
	13.
		with a remote history of
		presentswith
		coronary angiography and was foundto have
		What is the purpose of the cardiac MRI?
	14.
		with a history of
		The ECG obtained 7 minutes intorecovery is shown below:
		What is the next best diagnostic test?
	15.
		His home medications included
		His ECG exhibited
		Perfusion imagingdemonstrated
		Which of the following would be the next most appropriatestep?
	16.
		Which of the following is the most appropriate first step in hismanagement?
	17.
		Which of the following would you recommend?
	18.
		Which of the following is the next appropriate step in hismanagement?
	19.
		His jugular venous pressure (JVP) is
		12-lead ECG demonstrates
		At this stage, which of the following medications should beavoided?
	20.
		On day 3 in the hospital
		Which of the following is the next best diagnostic step?
	21.
		A 12-lead ECG reveals
2 Pulmonary
	Dyspnea
		Dyspnea on exertion
			Dyspnea on exertion to the emergencydepartment (ED). He notes black-colored stools for the past 2 weeks.His initial examination is notable for conjunctival pallor, clear lungfields without rales, wheezing, or rhonchi, as well as tachycardia. hemoglobin of 5.5.
				1.
			a 50-pack-year history of cigarette smoking. progressive dyspnea on exertion. She notes episodic wheezing andexperiences a “chest cold” about two times per year. Herexamination reveals distant breath sounds to auscultation and hyperresonantchest to percussion. forced expiratory volume (FEV1) of 50% predicted, forced vitalcapacity (FVC) of 70% predicted, and FEV1/FVC of 0.50.
				2.
					A CXR demonstrates
					What pattern best describes her PFT results?
			scattered reticular opacities at thebilateral lung bases. PFTs reveal an FEV1 of 50% predicted, FVC of45% predicted, and FEV1/FVC of 0.95.
				3.
			reduced diffusioncapacity of 45% predicted. Her spirometry and total lung capacityare within normal limits.
				4.
			progressive dyspnea
			14.
			cough andshortness of breath. She denies joint pain or swelling, rashes, fevers,or night sweats. She does recall a tender red rash on her R shin about2 months prior, which self-resolved. The patient works as a secretaryand does not have any pets. She has never smoked. Examination isnotable for fine crackles throughout the lung fields, but no skin orjoint findings. CT scan is performed, which shows enlarged hilarlymph nodes and fibrotic changes. PFTs are notable for a mixedobstructive and restrictive pattern.
				The most likely diagnosis?
				the most appropriate diagnostic step?
					20.
			23.
			colon cancer is admitted for surgical resection. On his fifth day at rehab, he develops shortness ofbreath and tachycardia. His SpO2 is 89% on room air. CXR isunremarkable and labs are pending.
				27.
			mean pulmonary arterypressure >25 mmHg, which is elevated, the pulmonary capillarywedge pressure is normal, and the transpulmonary gradient (meanpulmonary artery pressure-pulmonary capillary wedge pressure) is22 mmHg (normal <12-15 mmHg). no evidence of COPD on PFTs or interstitial lung disease on CT.
				31.
		Acute dyspnea
			man with non-Hodgkin lymphoma experienceswheezing, dyspnea, and hypotension several minutes after theinitiation of his second infusion of rituximab treatment. He is noted to be in acute distress with diffuse wheezing and urticaria on his abdomen and chest.
		The most likely diagnosis a 35-year-old woman with cough and shortness of breath. a tender red rash on her R shin about 2 months prior, which self-resolved. fine crackles throughout the lung fields. CT scan is performed, which shows enlarged hilarlymph nodes and fibrotic changes. PFTs are notable for a mixedobstructive and restrictive pattern.
		the most appropriate diagnostic step in a 35-year-old woman with cough and shortness of breath. a tender red rash on her R shin about 2 months prior, which self-resolved. fine crackles throughout the lung fields. CT scan is performed, which shows enlarged hilarlymph nodes and fibrotic changes. PFTs are notable for a mixedobstructive and restrictive pattern.
		A 77-year-old man with a history of diabetes, hypertension, andcolon cancer is admitted for surgical resection with a complicated postoperative courseand a prolonged hospitalization. He is eventually discharged to arehab facility. On his fifth day at rehab, he develops shortness ofbreath and tachycardia. His SpO2 is 89% on room air. CXR isunremarkable
	Cough
		Chronic cough
			The etiology in a patient with frequent pulmonary infections for the past 5 years presents to her PCP’s officewith chronic cough, shortness of breath, and copious sputumproduction. inspiratory squeaks. tram-tracking on CXR
		20.
		23.
	a history of diabetes, ischemiccardiomyopathy (ejection fraction [EF] 45%), and current smokingpresents to the ED with shortness of breath and productive cough.
	Sputum
		copious sputum
			14.
	Hemoptysis
		severe hemoptysis. She has expectorated approximately 600 mL ofblood in the past 24 hours and she continues to have episodes ofhemoptysis. CXR shows a patchyopacification in the right mid-lung field.
		blood-tinged cough and pleuritic chest pain. The CT scanshows bilateral nodular opacities and masses in the peripheral lungfields with some areas of cavitation. Pulmonary emboli are not present. New hearing loss and intermittent epistaxis. many red blood cells present on urine microscopy.
	Wheezing
		2.
		man with non-Hodgkin lymphoma experienceswheezing, dyspnea, and hypotension several minutes after theinitiation of his second infusion of rituximab treatment. He is noted to be in acute distress with diffuse wheezing and urticaria on his abdomen and chest.
			9.
	hearing loss
		22.
	epistaxis
		22.
	urticaria
		9.
	tender red rash
		Allergic reactions
			man with non-Hodgkin lymphoma experienceswheezing, dyspnea, and hypotension several minutes after theinitiation of his second infusion of rituximab treatment. He is noted to be in acute distress with diffuse wheezing and urticaria on his abdomen and chest.
			a history of allergic reaction to peanutspresents to the ED with urticaria after an accidental exposure topeanuts at a restaurant. urticaria on the chest and upper back. He reports ahistory of similar reaction and denies any associated symptoms suchas dyspnea, facial swelling, or throat tightness at this time.
		19.
		20.
	examination
		3.
			His examination reveals
			What pattern best describes his PFT results?
		inspiratory squeaks
			14.
		fine crackles
			19.
			20.
	Asthma
		occasional shortness of breath and wheezing despiteher current asthma treatment. She currently takes a low-dose inhaledcorticosteroid
			5.
				5. The correct answer is:
		Management
			a history of asthma presents to her PCPcomplaining of occasional shortness of breath and wheezing despiteher current asthma treatment. She currently takes a low-dose inhaledcorticosteroid and is requiring her albuterol rescue inhaler daily.
				5.
			a history of asthma, prescribedfluticasone/salmeterol twice daily and albuterol, as needed, presentsto the ED with wheezing and severe shortness of breath for the past day. decreased air movement throughout alllung fields with scattered wheezing. A CXR is unremarkable.
			long-standing asthma that has been difficultto control with standard therapies. He requires rescue albuteroltreatment multiple times daily despite treatment with a high-doseinhaled corticosteroid, a long-acting β-agonist, a leukotriene receptorantagonist, and oral corticosteroids.
		Test
			A 20-year history of asthma is referred to apulmonary clinic for recent worsening of her symptoms withfrequent intermittent wheezing. which had been well-controlled with albuterol and a low-dose inhaled corticosteroid. has recently been renovating her basement. absolute eosinophil count of 2000 cells/μL. PFTs reveal a worsening obstructive pattern.
		which had been well-controlled with albuterol and a low-doseinhaled corticosteroid.
		6.
			What is the next best step in his management?
			6. The correct answer is:
		6.
		previously controlled asthma that hassuddenly worsened
			7.
				Basic laboratory evaluation is notable for
				Which of the following is the next most appropriate test?
		difficultto control with standard therapies. He requires rescue albuteroltreatment multiple times daily despite treatment
			poorlycontrolled asthma despite escalation of inhaled therapy andadjunctive treatments. failed to benefit from allergy testing
				8.
	Chronic obstructive pulmonarydisease (COPD)
		Management
			a COPD flare with steroids about 5 months ago. worsening shortness of breath and increased sputumproduction recently. His PFTs are notable for an FEV1 of 71%. on albuterol four times a day as needed.
				11.
			a history of severe COPD presents toher PCP’s office for increased dyspnea over the past 9 months. PFTsdemonstrate a progressive worsening in her obstructive deficit overthe past 5 years—currently, her FEV1 is 18% of predicted. She takesa combination of a long-acting β-agonist, a long-acting muscarinicantagonist, and an inhaled corticosteroid daily. oxygen saturation is noted to be 87% at rest.
		Oxygen therapy in COPD
			13.
		presents to the ED withshortness of breath and wheezing in the setting of a recent viral URI.He is found to be hypoxemic to 86% on room air. He is started onnasal cannula oxygen and his SpO2 improves to 99%. He is laterfound to be somnolent by his nurse.
			12.
		oxygen therapy
			13.
	Cystic fibrosis
		Maintaining lung function and avoiding future exacerbation in a man with cystic fibrosis with acute exacerbation. He completes 4 weeks ofantibiotic treatment targeting Pseudomonas aeruginosa from hissputum culture. He continues to take lumacaftor as prescribed.
	Pulmonary infections
		Recurrent pulmonary infection
			The etiology in a patient with frequent pulmonary infections for the past 5 years presents to her PCP’s officewith chronic cough, shortness of breath, and copious sputumproduction. inspiratory squeaks. tram-tracking on CXR
	ILD
		Idiopathic pulmonary fibrosis
			the following is NOT a CT feature of idiopathicpulmonary fibrosis?
				21.
	Pleural effusion
		Fluid studies are notable forlactate dehydrogenase (LDH) of 202 units/L, protein 4.1 g/dL,cholesterol 52 mg/dL,glucose 49 mg/dL, and pH 7.1. Serum proteinis 6.8 g/dL and serum LDH is 243 units/L. There is a predominanceof polymorphonuclear neutrophils (PMNs) on cell count.
			is most likely due to which of the followingunderlying conditions?
			the next best therapeutic step
		Bilateral effusion in a patient with decompensated congestive heart failure treated with diuretics with persistence of the bilateral effusions but improved interstitial edema in .Pleural fluid studies arenotable for LDH 77 units/L, protein 4.1 g/dL, cholesterol 35 mg/dL,glucose 100 mg/dL, and pH 7.4. There are no WBCs or red bloodcells present. Cytology examination is unremarkable. Serum studiesare notable for LDH 187 units/L, protein 7.2 g/dL, and glucose 110mg/dL.
	Thromboembolism
		thromboprophylaxis
			A 77-year-old man with a history of diabetes, hypertension, andcolon cancer is admitted for surgical resection.
		77-year-old man with a history of diabetes, hypertension, andcolon cancer is admitted for surgical resection with a complicated postoperative courseand a prolonged hospitalization. He is eventually discharged to arehab facility. On his fifth day at rehab, he develops shortness ofbreath and tachycardia. His SpO2 is 89% on room air. CXR isunremarkable
			the best diagnostic test to use in this patient?
			agent should be used in this patient to treat hispulmonary embolus on discharge?
		The patient in Questions 26 and 27 is found to have a pulmonaryembolus in the right pulmonary artery. He is started on a heparindrip.
		The patient in Question 29 is worried about developing a pulmonaryembolus and asks if there is anything she can do to prevent this.
	Pulmonary pressure
		Dyspnea on exertion. CXR and CT scan are within normal limits. PFTs show mild restriction and noobstruction. Transthoracic echocardiogram shows an EF of 54%,normal valves, and right ventricular systolic pressure of 55 mmHg. Pulmonary capillarywedge pressure is 13 mmHg and mean pulmonary artery pressure is35 mmHg.
		the first-line treatment for this patient?
		Episode of presyncope while walking. HR 118 beats/min, BP 78/41 mmHg, RR 22 breaths/min, and SpO2 82% on room air (that improves to 88% on 6 L via nasal cannula). elevated jugular venous pressure and coolextremities. Lactic acid is elevated to 4.0 mmol/L. Bedsideultrasound shows a dilated and diffusely hypokinetic right ventricle.
	solitary pulmonary nodule
		statements is INCORRECT regardingsolitary pulmonary nodules in general
			17.
		The next best step in management of a 70-year-old non-smoker man with a 5-mm solid nodule with smoothborders in the right upper lobe, without other associatedabnormalities noted.
			18.
	MV
		multifocal pneumonia and intubated for hypoxemia.Following intubation, his SpO2 is 87% on volume control with thefollowing settings: VT 500 mL, RR 15 breaths/min, positive endexpiratorypressure 5 cm H2O, and FiO2 70%.
		the peakinspiratory pressure is elevated, but the plateau is unchanged
		would suggest that the patient is notready for extubation
		acute respiratory distress syndrome
			The ventilator for hypoxemic to 79% despite high-flow nasal cannula at maximalsettings. He is subsequently intubated. Postintubation CXR isnotable for diffuse bilateral infiltrates. Postintubation ABG is7.3/30/80 on 100% FiO2.
			interventions has been found to havea mortality benefit in acute respiratory distress syndrome
	Shock
		A patient with CKD on HD was confused and unable to get off of the couch the evening after a dialysis session. BP 78/33 mmHg. Vital signs in the ED: T 35.6°C, BP 92/52 mmHg, RR 28 breaths/min, and SpO2 88%on room air. On examination he is somnolent. Lungs are clear andabdomen is soft. Labs are notable for WBC count of 11 × 109/L ,creatinine 4.9 mg/dL, and lactate 3.7 mmol/L. Blood cultures arepending.
		antibiotic regimen is most appropriate in the patient on HD with septic shock.
		The initial pressor of choice in this patient with fall in BP to 75/40 mmHg despite 2 L lactated Ringer (LR) fluid resuscitation.
	Lung transplant
		Fever, cough, and shortness of breath, and hypoxemia 88% on room air 2 months after bilateral lung transplantation for CF. normal CXR.
		the next best diagnostic step for the patient
		the treatment
	CT scan
		The most likely diagnosis a 35-year-old woman with cough and shortness of breath. a tender red rash on her R shin about 2 months prior, which self-resolved. fine crackles throughout the lung fields. CT scan is performed, which shows enlarged hilarlymph nodes and fibrotic changes. PFTs are notable for a mixedobstructive and restrictive pattern.
		the most appropriate diagnostic step in a 35-year-old woman with cough and shortness of breath. a tender red rash on her R shin about 2 months prior, which self-resolved. fine crackles throughout the lung fields. CT scan is performed, which shows enlarged hilarlymph nodes and fibrotic changes. PFTs are notable for a mixedobstructive and restrictive pattern.
		the following is NOT a CT feature of idiopathicpulmonary fibrosis?
		blood-tinged cough and pleuritic chest pain. The CT scanshows bilateral nodular opacities and masses in the peripheral lungfields with some areas of cavitation. Pulmonary emboli are not present. New hearing loss and intermittent epistaxis. many red blood cells present on urine microscopy.
	PFTs
		The most likely diagnosis a 35-year-old woman with cough and shortness of breath. a tender red rash on her R shin about 2 months prior, which self-resolved. fine crackles throughout the lung fields. CT scan is performed, which shows enlarged hilarlymph nodes and fibrotic changes. PFTs are notable for a mixedobstructive and restrictive pattern.
		the most appropriate diagnostic step in a 35-year-old woman with cough and shortness of breath. a tender red rash on her R shin about 2 months prior, which self-resolved. fine crackles throughout the lung fields. CT scan is performed, which shows enlarged hilarlymph nodes and fibrotic changes. PFTs are notable for a mixedobstructive and restrictive pattern.
	pleural effusion
		23.
		24.
		25.
	thromboprophylaxis
		admitted for surgical resection
			26.
	postoperative
		27.
	deepvein thrombosis (DVT)
		29.
		30.
	pulmonaryembolus
		28.
	Pulmonary function tests (PFTs)
		2.
		3.
		diffusioncapacity of 45% predicted. Her spirometry and total lung capacityare within normal limits.
			4.
				Which of the following diseases could the PFT findings NOTsupport?
				4. The correct answer is:
		mixedobstructive and restrictive pattern
			19.
		31.
	acute respiratory distress syndrome
		37.
		38.
	ventilation
		34.
		35.
	sepsis/septicshock
		39.
		40.
		41.
	lung transplantation
		44.
		45.
		46.
	ABG
		37.
	Electrocardiogram (ECG)
		42.
			43.
		43. What is the next best step in the management of the patient fromQuestion 42?
	CXR
		14.
		15.
		diffuse bilateral infiltrates
			37.
		37.
	CT scan
		enlarged hilarlymph nodes and fibrotic changes
			19.
		bilateral nodular opacities and masses in the peripheral lungfields with some areas of cavitation
			22.
		31.
		33.
	8.
		8. The correct answer is:
	9.
		What is the immediate first-line management?
		9. The correct answer is:
	10.
		Which of the following statements about management ofallergic reactions is FALSE?
		10. The correct answer is:
	11.
		What medication should be added to his medication regimen?
		11. The correct answer is:
	14.
3 Gastroenterology
	trouble swallowing
		1.
		The correct answer is:
		GERD
			2.
			2. The correct answer is:
	vomiting
		episodeslike this in the past, lasting days at a time, and notes that hot showershave improved his symptoms during prior episodes
			11.
			11. The correct answer is:
	pain
		epigastric pain
			has been taking ibuprofen “around theclock” for pain control
				3.
				3. The correct answer is:
		Salmonella infection
			10.
		focal diverticulitis of the sigmoid colon
			14.
			14. The correct answer is:
			15.
			15. The correct answer is:
	Anemia
		The next best step in management of a new, symptomatic microcytic anemia, with elevated red cell distribution width, normal abdominal examination & digital rectal examination, positive fecal occult blood test, with unrevealing colonoscopy and esophagogastroduodenoscopy?
			7. The correct answer is:
		Several-years of intermittent cramping, abdominal pain, and bloating, and 4 to 6 months of worsening foul-smelling diarrhea that float in the toilet water & is relieved by fasting with elevated fecal fat, as well as iron deficiency anemia.
	Diarrhea
		Several-years of intermittent cramping, abdominal pain, and bloating, and 4 to 6 months of worsening foul-smelling diarrhea that float in the toilet water & is relieved by fasting with elevated fecal fat, as well as iron deficiency anemia.
			8. The correct answer is:
		The next most appropriate step in management of four to six loose stools without fever or leukocytosis on postoperative day 1 after receiving cephalexin preoperatively & MiraLAX to prevent constipation postoperatively with positive stool Clostridioides difficile polymerase chain reaction (PCR), and negative stool C. difficile enzyme-linked immunoassay (EIA; toxin A/B test).
			9. The correct answer is:
		For which of the following groups should antibiotics beconsidered in the treatment of Salmonella infection?
			10. The correct answer is:
		Salmonella infection
	Hematemesis
		The next most appropriate step in management of a patient with alcoholic cirrhosis & ascites and splenomegaly presents with an upper GI bleeding & is hemodynamically resuscitated with 2 L of normal saline, with normalization of BP, and started on IV pantoprazole, IV ceftriaxone, and an octreotide bolus followed by a continuous octreotide infusion.
			5. The correct answer is:
	hematochezia
		The most appropriate immediate next step for gnawing epigastric pain that worsened with meals yesterday followed by passing large amounts of bright red blood per rectum this morning five days after starting taking prednisone and ibuprofen for a gout flare. Shock with low BP 89/50 mmHg, & tachycardia 120/min?
			4. The correct answer is:
		Hematochezia with bright red blood loss of approximately 700 mL at home per rectum in a 75-year-old man several hours ago, but the bleeding had stopped by the time he arrived at the ED. Normal vital signs are normal with no dizziness, light-headedness, or abdominal pain.
		6. The correct answer is:
	absent flatus
		severe pancreatitisrequiring vasopressors. She is given IV fluids and IV morphine forpain control
			12.
				12. The correct answer is:
	ulcerative colitis
		You suspect that the patient may have ulcerative colitis. If so, which of the following would you expect a colonoscopy to show?
		Which of the following would you tell a patient with ulcerative colitis?
		18. The correct answer is:
	colorectal cancer
		16.
	pancreatitis
		13.
4 Nephrology
	Acid-base disturbance?
		Metabolic acidosis
			type 1 diabetes mellitus, HCO3 14mEq/L, glucose 560 mg/dL, serum osmolality 303 mmol/kg, andserum lactate 3.5 mmol/L. Arterial blood gas (ABG) shows a pH of7.20, PaCO2 of 23 mmHg, and PaO2 of 88 mmHg. Urinalysis ispositive for ketones and glucose and a urine toxicology screen ispositive for ethanol and cannabinoids.
				1.
					Urinalysis ispositive for
					What is the cause of metabolic acidosis in this patient?
			a history of alcohol use disorder, pH 7.20, pCO2 32 mmHg (ABG) with Na 125 mEq/L, Cl90 mEq/L, HCO3 15 mEq/L, and albumin of 3.0 g/dL with a lactateelevated at 6 mmol/L. The ED orders 2 L lactated Ringer’s, withrepeat labs showing pH 7.18 with Cl 89 mEq/L, HCO3 20 mEq/L,and repeat lactate 7 mmol/L.
			altered mental status and blurry vision, pupillary dilation, poordentition, and mild diffuse abdominal pain. Labs reveal Na 132mEq/L, Cl 92 mEq/L, HCO3 22 mEq/L, blood urea nitrogen (BUN)30 mg/dL, Cr 1.2 mg/dL, Ca 7.4 mg/dL, glucose 160 mg/dL, andalbumin 3 g/dL. Liver enzymes are normal. The serum alcohol levelis 160 mg/dL and the measured serum osmolality is 350 mOsm/kg.
			confusion and respiratory failure.Medications at this time include high-dose IV diazepam drip, IVthiamine, Cl of101 mEq/L, and HCO3 of 20 mEq/L. Serum osmolality is 390mOsm/kg, glucose 130 mg/dL, creatinine 1.6 mg/dL, and lactate 5mmol/L. ABG shows a pH of 7.30, PaCO2 of 42 mmHg, and PaO2 of88 mmHg. Urinalysis is mildly positive for ketones. Ethanol level is2 mg/dL.
			pH of 7.18 with a pCO2 of 28 mmHg onan ABG with Na 130 mEq/L, Cl 108 mEq/L, HCO3 12 mEq/L, K 3.0mEq/L, and albumin 4.0 g/dL in the setting of severe diarrhea.
			K 3.2mEq/L, Cl 118 mEq/L, HCO3 8 mEq/L, and albumin 4 g/dL with aserum pH of 7.28 and a pCO2 of 24 mmHg. Urine studies are notablefor Na 40 mEq/L, K 20 mEq/L, and Cl 30 mEq/L with urinalysisnotable for trace blood, no protein, and a pH of 6.0.
			a recent history of bladder cancer and underwent acystoprostatectomy and ileal neobladder creation 2 months ago. Cl of 110 mEq/L, and HCO3 of 14mEq/L. ABG shows a pH of 7.28, pCO2 of 30 mmHg, and pO2 of 78mmHg. Urinalysis shows 20 to 50 red blood cells (RBCs) and 20 to50 white blood cells (WBCs) per high-power field (hpf).
			pH 7.15, pCO2 20 mmHg, pO2 80 mmHg, and HCO312 mEq/L and a chemistry panel shows an anion gap of 16 mEq/dL(normal 10-12 mEq/L).
			pH of 7.25 and a pO2 of 140 mmHgon 30% FiO2 and a positive end-expiratory pressure of 5 mmHg. Achest x-ray reveals mild pulmonary edema. Her BUN and Cr are 63mg/dL and 4.2 mg/dL, respectively. Her urine output is 25 mL/h.
			Nausea and vomitingafter eating sushi the night prior. Na 126 mEq/L, K 3.2 mEq/L, Cl 87 mEq/L, and HCO3 20mEq/L with albumin 2 g/dL. An ABG shows a pH of 7.38 and apCO2 of 36 mmHg.
		metabolic alkalosis
			3 days of emesis withinability to tolerate PO intake. dry mucousmembranes with no lower extremity edema. pH7.50, PaCO2 48 mmHg with Na 130 mEq/L, Cl 88 mEq/L, HCO3 30mEq/L, and K 2.8 mEq/L.
			diuretic-induced metabolic alkalosis. HCO3 on the chemistry panel is noticed to be 45 mEq/L and an ABGdrawn shows pH of 7.51 and PaCO2 of 52 mmHg. In a team meeting,it is decided that IV diuresis needs to be continued.
	Gross hematuria
		change in the color of his urine for a week. He describes his urine aslooking “tea colored.” He denies any recent trauma, kidney stones, orFoley catheter insertion.
	sodium
		Hyponatremia
			a subarachnoid hemorrhage. absence of axillary sweat and dry mucous membranes.
				Na 126 mEq/L, K 3.6 mEq/L, and Cr0.9 mg/dL. Serum osmolality is 262 mOsm/kg, urine sodium is 49mEq/L, and urine osmolality is 360 mOsm/kg. AM serum cortisol is8 μg/dL (normal 5-25 μg/dL) and thyroid-stimulating hormone(TSH) is 8 μU/mL (normal 0.5-5 μU/mL). Free triiodothyronine (T3)and thyroxine (T4) levels are normal. After administration of 1 L ofIV saline, serum Na is 127 mEq/L while urine Na is 60 mEq/L andurine osmolality is 260 mOsm/kg.
			Disoriented and unableto answer questions. has been at home for the last week drinking 3 to 4 sixpacksof beer per day. moist mucous membraneswith normal capillary refill and skin turgor. Serum sodium is foundto be 126 mEq/L with a glucose level of 120 mg/dL. Urine studiesare sent. Urine osmolality is 75 mOsm/kg.
			a history of lung cancer. patient’s hyponatremia worsened from 120 to116 mEq/L, resulting in a seizure after normal saline resuscitation
			Hypothyroidism, moist mucous membranes, nausea and headache but is arousable. In the ED, shehas an episode of vomiting. Examination is notable for moist mucousmembranes. Labs are notable for Na 118 mEq/L, BUN 18 mg/dL,and glucose 87 mg/dL with a serum osmolality of 250 mOsm/kg.UNa is 35 mEq/L and urine osmolality 450 mOsm/kg.
		she is somnolent but easily arousable, with dry mucous membranes.Serum sodium is 156 mEq/L with glucose 140 mg/dL. Urineosmolality is found to be 225 mOsm/kg with a serum osmolality of335 mOsm/kg. A Foley catheter is placed and IV normal saline isstarted. Over the next 12 hours, she voids 1.5 L and repeat serum Nais 154 mEq/L and urine osmolality is 255 mOsm/kg. Desmopressin(DDAVP) is administered and urine osmolality increases from 285 to310 mOsm/kg.
	polyuria
		polyuria persistsdespite fluid restriction, a desmopressin challenge is administered.Baseline 6 hours of fluid restriction 2 hours after desmopressin challengeSodium 138 mEq/L 143 mEq/L 141 mEq/LSerum osmolality 287 mOsm/kg 295 mOsm/kg 290 mOsm/kgUrine osmolality 90 mOsm/kg 95 mOsm/kg 310 mOsm/kgUrine volume 8 L/24 hours 3 L/6 h 300 mL/2 h
	K
		hypokalemia
			Na 142 mEq/L, Cl 102 mEq/L, HCO3 18mEq/L, K 2.8 mEq/L, WBC 9 × 109/L, urine Na 10 mg/dL, K 40mg/dL, Cl 60 mg/dL, and Cr 2 mg/dL. hypokalemia with urine K/Cr ratio >13 and high BP in thesetting of large ingestion on black licorice.
			started on a therapeutic hypothermiaprotocol. Her temperature is 32.5°C after 12 hours. She is intubated,sedated, and receiving vasopressin and norepinephrine infusions. Theresident on call notices that the patient’s potassium has fallen from3.9 mEq/L at admission to 2.8 mEq/L. The urine output recordedover the last 24 hours is about 3.5 L and the serum creatinine isnormal. Stool output is 200 mL.
		hyperkalemia
			a history of chronic lymphocytic leukemia, severe hyperkalemia on a serum chemistrypanel without ECG changes, unchanged serum potassium despite hyperkalemia treatment and anormal ECG.
			a COPDexacerbation. He is on day 3 of his hospitalization and is beingtreated for COPD with short-acting bronchodilators and oralprednisone. Today, his labs are notable for pH 7.32 with Na 130mEq/L, K 5.5 mEq/L, HCO3 28 mEq/L, BUN 30 mg/dL, Cr 1.7mg/dL, and glucose 450 mg/dL.
			a contraindication to SPS administration?
			potassium 6.5 mEq/Lwith peaked T waves. A Foley is placed and there is no urine output.He receives Ca gluconate, insulin, dextrose, and IV furosemide.After 1 hour, urine output is 5 mL. Repeat labs show a potassium of6.6 mEq/L.
	Acute kidney injury
		A normal urinalysis in acute kidney injury helps exclude
		a congestive heart failure exacerbation with acute kidney injury, hypervolemia, Na of 122 mEq/L and Cr 2.2 mg/dL with normal baseline of 0.9mg/dL. Urinalysis is without protein or blood.
		creatinine of 3.2 mg/dL (baseline 1.0 mg/dL) after cycle 3 ofpembrolizumab. recent diarrhea and poor oral intake., Na 134 mEq/L, K 3.4mEq/L, HCO3 19 mEq/L, and Cl 90 mEq/L. Liver function testswere normal. Urinalysis 5 to 10 WBCs/hpf and urine sediment wasbland. He is given 2 L of IV saline and a day later, his Cr was 2.9mg/dL. His urine output has been 1.3 L over the last 24 hours. Hisrenal ultrasound shows normal sized kidneys with nohydronephrosis.
		On pembrolizumab. Acute kidney injury with symptoms (diarrhea, poor oral intake)and examination (hypotension). creatinine has notsignificantly improved with IV hydration. WBCs in urine
		creatine kinase (CK) comes back at 62 000 IU/L andhis creatinine, serum potassium, and serum calcium are 1.7 mg/dL,6.0 mEq/L, and 6.7 mg/dL
		association between acute kidney injury and therisk of the following adverse outcomes?
		the best intervention to reduce the risk of contrastassociatedacute kidney injury in this patient?
		pH of 7.25 and a pO2 of 140 mmHgon 30% FiO2 and a positive end-expiratory pressure of 5 mmHg. Achest x-ray reveals mild pulmonary edema. Her BUN and Cr are 63mg/dL and 4.2 mg/dL, respectively. Her urine output is 25 mL/h.
		decide when to stop or interrupt dialysis in patientswith an underlying chronic kidney disease and an acute insult.
			received three dialysis sessions and her infection hasresolved. Her urine output has progressively increased and she nowmakes around 2.1 L of urine a day. Her BUN is 65 mg/dL, creatinineis 4.1 mg/dL, and potassium is 4.3 mEq/L. Her last dialysis sessionwas 48 hours ago. Her postdialysis BUN was 55 mg/dL and hercreatinine was 3.3 mg/dL.
		cirrhotic patients requiring renal replacement therapy, most favorable prognostic factor if she were to beinitiated on dialysis?
	chronic kidney disease
		presented to the dialysis unit with these symptoms and hencecould not be started on dialysis.
		Dialysis, severe pain and a nonpalpable pulse, The fistula isexamined, is deemed to have matured well, and is used forhemodialysis that day with full blood flow rates (400 mL/min).Immediately on return to the inpatient unit, the patient complains ofnumbness and severe pain in her left hand. The radial pulse isnonpalpable and the fingers are cold to the touch.
		Crohn’s disease, a kidneystone 3 years ago. His creatinine on admission was 4.5 mg/dL anddecreased to 3.8 mg/dL after fluid resuscitation. You notice that hiscreatinine was 0.5 mg/dL 5 years ago and 1.3 mg/dL 8 months agowhen he was seen by his primary care physician. His urine proteincreatinine ratio is 0.2 g/dL. His renal ultrasound is normal.
	kidney transplant
		the possibility of being listed for a deceased donorkidney transplant.
	glomerulonephritis
		crescentic glomerulonephritis
			the least likely diagnosis in this patient?
		hepatitis C, worsening joint pain and swellingaround her ankles. Vitals are notable for a BP of 164/98 mmHg.Examination is notable for moist mucous membranes, bibasilarcrackles, no ascites, 1+ ankle edema, and purpura along herextremities. Labs are notable for a Cr 2.4 (baseline 1.2), decreasedC3 and C4.
	nephrotic syndrome
		an allogenic hematopoieticstem cell transplantation 15 months ago. His cyclosporine wastapered and discontinued 3 months before admission. He nowpresents with a rash on his face and forearms for 2 weeks along withlower extremity swelling. He is found to have nephrotic syndromewith 4.2 g of proteinuria and a serum albumin of 2.3 mg/dL. Hiscreatinine was elevated at 1.4 mg/dL from 0.9 mg/dL a month ago.
	monoclonal gammopathy of renalsignificance
		the best way to detect the monoclonal protein inthe circulation?
	dialysis
		the following statements is false?
	Stones
		the following statements is not true?
		serum calcium is 9 mg/dL (normal 8.5-10 mg/dL) and her vitamin Dlevel is 53 ng/mL (normal 30-60 ng/mL). She reports childhoodasthma but no other medical conditions. She works a desk job andkeeps herself well hydrated. She extensively researches health issuesonline and takes medications that she feels improve her health,including cholecalciferol 500 units daily; multivitamins, includingvitamin B complex and vitamin C (2 g daily); aspirin 81 mg daily;and fish oil 1000 mg daily.
	systemic lupus disease. A spot urine sample from aweek ago showed 800 mg/g of proteinuria. There is no hematuria onthe urinalysis and her renal panel is normal with a creatinine of 0.7mg/dL. Her complement levels are mildly low.
	immunoglobulin A (IgA) nephropathy
		BP is 135/90 mmHg. Aurinalysis shows hematuria and he is found to have a urinemicroalbumin/creatinine ratio of 0.6 g/g. His serum creatinine is 0.9mg/dL. Renal ultrasound is normal. A renal biopsy reveals findingsconsistent with immunoglobulin A (IgA) nephropathy.
	Hypertension
		Resistant hypertension, on lisinopril 40mg daily, amlodipine 10 mg daily, and chlorthalidone 12.5 mg daily.
		antihypertensive should NOT be used in pregnancy?
5 Hematology-Oncology
	1.
		What is the most likely etiology of her anemia?
	2.
		Examinationreveals
		Labs are notable for
		After confirmatory diagnostic tests, what is the mostappropriate treatment?
	3.
		What will his iron studies likely show (normal iron 60-170μg/dL, normal total iron binding capacity [TIBC] 240-450 μg/dL,normal ferritin 12-250 ng/mL)?
	4.
		What is the most appropriate management?
	5.
		What is the most likely diagnosis?
	6.
		What is the most likely diagnosis?
	7.
		Her laboratory workup is shown below:
		Which of the following is the most likely diagnosis?
	8.
		basic laboratorystudies
		medical records from the time of her firstpregnancy at age 29
		Which of the following is the correct diagnosis?
	9.
		Physical examination reveals
		Labs show
		What is the most important next treatment step for thispatient?
	10.
		Labsshow
		Peripheral smear shows
		How should this be managed?
	11.
	12.
		noncontrast head computed tomography (CT)
		Laboratory studies
	13.
		On examination
		Laboratory studies
		Which of the following best describes the etiology of thepatient’s abnormal hemostasis and the appropriate intervention?
	14.
		On examination
		Laboratory studies
		Which of the following is the most appropriate diagnostic testto perform next?
	15.
		On physical examination
		Laboratory studies
		Which of the following is the most likely diagnosis?
	16.
		On examination
		Laboratory studies
		Which of the following is the most appropriate next step?
	17.
		Laboratory studies
		What is the diagnosis in this case?
	18. How would you treat the patientin Question 17 in the acute setting?
	19.
		Her labs show
		What blood products does this patient need prior toproceeding with surgery?
	20.
	21.
		What is NOT a possible etiology of his thrombocytopenia?
	22.
		Labsare notable for
		Peripheral smear shows
		Which of the following agents is most appropriate toadminister?
	23.
	23. The correct answer is:
	24.
	24. The correct answer is:
	25.
		Physical examination reveals
		Labs show
		What diagnostic test will reveal the most likely underlyingdisorder?
	26.
		Physical examination reveals
		Labs are notable for
		A head CT shows
		brain magnetic resonanceimaging (MRI) shows
		Which long-term anticoagulation option is most appropriatefor this patient?
	27.
	28.
		What treatment is indicated at this time?
	29.
		What is the most likely cause of this eosinophilia?
	30.
		Examination of her blood under the microscope identifies
		What is the most likely diagnosis?
	31.
		Which of the following types of RBCs is the most appropriateto administer?
	32.
		Labs are notable for
		What is the most appropriate next step?
	33.
		Baseline Hgb was
		CXR showed
		What is the most likely etiology of her respiratory distress?
	34.
		Physical examination reveals
		Labs are notable for
		Peripheral smear reveals
		Bone marrow biopsy demonstrates
		Cytogenetics shows
		Which of the following is NOT an appropriate treatment forthis patient?
	35.
	36.
		Physical examination reveals
		Labs are notable for
		Peripheral smear reveals
		Cytogenetics shows
		Which of the following is an appropriate treatment for thispatient?
	37.
		Initialtesting was
		Physical examination is remarkable for
		Which of the following will NOT be indicated in the patient’ssubsequent therapy?
	38.
		Her labs are
		A bone marrow biopsy identifies
		What is the next indicated course of treatment?
	39.
		What is the most appropriate treatment for the patient’sessential thrombocytosis?
	40.
		CBC
		A bone marrow biopsy
		Which of the following sets of laboratory results from thepatient’s bone marrow would be consistent with a favorableprognosis in this patient?
	41.
		On examination
		A CXR shows
		Her laboratory workup is notable for
		A bone marrowbiopsy
		Which of the following is the most appropriate choice forinduction chemotherapy?
	42.
		A bone marrowbiopsy is performed and demonstrates
		On the eighth day of treatment
		CXR is performed and demonstrates
		What is the most likely diagnosis and most appropriate nextstep in management?
	43.
		How would you advise her at this point?
	44.
		Cerebrospinal fluid (CSF) studies were
		A repeat bone marrow biopsy shows
		How would you treat this patient with relapsed disease?
	45.
		His labs in the ED showed:
		What is the diagnosis?
	46.
	47.
		CT of his head identifies
		What is the patient’s CD4 count (cells/mm3) most likely tobe?
	48.
		What is the most appropriate therapy for this patient’s chroniclymphocytic leukemia ?
	49.
		Labs show
		What is the most likely diagnosis?
	50.
		A CT of the chestwith contrast demonstrates
		which of the following are required tocomplete staging and risk stratification?
	51.
		on her excisional rightsupraclavicular lymph node biopsy
		PET-CT demonstrates
		Which of the following would be the most appropriate initialstep in management?
	52.
		which of the followingwould be the most appropriate initial workup specific to thispatient’s risk factors?
	53.
		Which of the following is the most appropriate next step inmanagement?
	54.
		Laboratory studies
		Which of the following are the next steps in diagnosis?
	55.
		Urineprotein electrophoresis shows
		The creatinine is
		Which of the following most accurately represents thispatient’s risk of progression to multiple myeloma, Waldenstrommacroglobulinemia, or a malignant lymphoproliferative disease?
	56.
		Bone marrow biopsy shows
		Which of the following is the most likely explanation for thepatient’s symptoms of confusion, headache, dizziness, blurredvision, and shortness of breath?
	57.
		A bone marrow biopsy is performed and demonstrates
		Which of the following is the next best step in management?
	58.
6 Infectious Diseases
	1.
		What is the most likely diagnosis?
		1. The correct answer is:
	2.
	2. The correct answer is:
	3.
	3. The correct answer is:
	4.
	4. The correct answer is:
	5.
	5. The correct answer is:
	6.
	6. The correct answer is:
	7.
		Which of the following factors does not increase the risk forinvasive fungal infection?
		7. The correct answer is:
	8.
	8. The correct answer is:
	9.
	9. The correct answer is:
	10.
	10. The correct answer is:
	11.
	11. The correct answer is:
	12.
		What is the most likely diagnosis?
		12. The correct answer is:
	13.
		What is the most likely diagnosis?
	14.
	15.
	16.
		What is the most likely diagnosis?
		16. The correct answer is:
	17.
	17. The correct answer is:
	18.
	18. The correct answer is:
	19.
		On physical examination
		What is the most likely diagnosis?
		19. The correct answer is:
	20.
	20. The correct answer is:
	21.
	21. The correct answer is:
	22.
	22. The correct answer is:
	23.
	23. The correct answer is:
	24.
		What is the most likely diagnosis?
		24. The correct answer is:
	25.
7 Endocrinology
	1.
		The following labs are acquired:
		What is the next best step in her management?
		2.
			What is the expected result of the cosyntropin stimulation testthe morning following the surgery, assuming she received stress dosedexamethasone prior and after the surgery?
			2. The correct answer is:
	3.
		What would be the next best step in her management?
		4.
			What is the next best step in her management?
			4. The correct answer is:
	5.
		Which of the following would be the next best step in hisdiagnosis?
		5. The correct answer is:
		6.
		What is the next best step in his management?
		6. The correct answer is:
	7.
		What is the most likely source of her symptoms?
		8.
		What is the next best step in her management?
		8. The correct answer is:
	9.
		Laboratory evaluations include:
		A brain MRI is performed
		A thyroid ultrasound
		What is the most important screening test for this patient aftermanagement of her acute presentation?
		9. The correct answer is:
	10.
	10. The correct answer is:
	11.
		How should his hypothyroidism be managed?
		11. The correct answer is:
	12.
	12. The correct answer is:
	13.
		Laboratoryevaluation is notable for
		What is the most appropriate next best step in hermanagement?
		13. The correct answer is:
	14.
		One week into her hospitalization, thyroid functionstudies are checked and she is found to have
		What is the appropriate management?
		14. The correct answer is:
	15.
		Onexamination
		What is the next best diagnostic step?
		15. The correct answer is:
	16.
		Which of the following is the most likely diagnosis?
		16. The correct answer is:
	17.
		Which of the following would be the best treatment option?
		17. The correct answer is:
	18.
		All except for which of the following are recommended asinitial treatment?
		18. The correct answer is:
	19.
		What is the most appropriate management?
		19. The correct answer is:
	20.
		What is the next appropriate step?
		20. The correct answer is:
	21.
	21. The correct answer is:
	22.
		Evaluation for the most likely secondary cause would involvewhich of the following?
		22. The correct answer is:
		23.
		23. The correct answer is:
		24.
			What is the next best step in his management?
			24. The correct answer is:
	25.
		Laboratory values show
		dexamethasone suppression test (DST)
		What is the next best step in her management?
		25. The correct answer is:
		26.
			What is the next best step in her management?
			26. The correct answer is:
	27.
		In the course of hisworkup, he has a CT of his abdomen and pelvis that is notable for
		What is the next best step in management of this finding?
		27. The correct answer is:
		28.
		28. The correct answer is:
	29.
		Laboratory findings show
		What is the next best step in her management?
		29. The correct answer is:
		30.
			What is the next best step in her management?
			30. The correct answer is:
			31.
				What is the next best step in her management?
				31. The correct answer is:
				32.
					What is the recommended follow-up?
					32. The correct answer is:
	33.
		On examination
		What is the next best step in her management?
		The correct answer is:
		34.
			What is the next appropriate step in her management?
			The correct answer is:
			35.
				What is the appropriate treatment for her Addison disease?
				35. The correct answer is:
	36.
	36. The correct answer is:
	37.
		Which of the following diagnoses is highest in thedifferential?
		37. The correct answer is:
		38.
		What is the most likely etiology of the hypercalcemia?
		38. The correct answer is:
		39.
		39. The correct answer is:
	40.
		What is the most likely diagnosis?
		40. The correct answer is:
	41.
		What tests would you order?
		41. The correct answer is:
	42.
		What is the next best diagnostic test?
		42. The correct answer is:
	43.
		What is the next best step?
		43. The correct answer is:
	44.
		What is the next best step?
		44. The correct answer is:
	45.
		His past medical history is notable for
		What would be the next best drug to add?
		45. The correct answer is:
	46.
		In order to improve glycemic control, you make which of thefollowing changes to his current therapy?
		46. The correct answer is:
	47.
		with
		What changes would you recommend?
		47. The correct answer is:
	48.
		What parameters, in addition to blood glucose <200 mg/dL,do the American Diabetes Association (ADA) recommend be metwhen tapering IV insulin and overlapping with SC insulin?
		48. The correct answer is:
	49.
		Which of the following labs drawn during hypoglycemia aremost consistent with endogenous hyperinsulinemia?
		49. The correct answer is:
	50.
		Initial management of hyperosmolar hyperglycemic stateinvolves all BUT which of the following?
		50. The correct answer is:
	51.
		All of the following are true regarding diabetic nephropathyand sodium-glucose cotransporter 2 (SGLT2) inhibitors EXCEPT?
		51. The correct answer is:
	52.
		What are the appropriate instructions for starting insulin?
		52. The correct answer is:
	53.
		What changes would be appropriate to make toantihyperglycemic agents today?
		53. The correct answer is:
	54.
	54. The correct answer is:
	55.
	55. The correct answer is:
	56.
	56. The correct answer is:
	57.
		His pretreatment low-densitylipoprotein (LDL) was
		What is the next best step in his management?
		57. The correct answer is:
	58.
		On examination
		A lipid panel is performed, which shows
		What would be recommended treatment at this time?
		58. The correct answer is:
	59.
		Laboratory work shows
		A lipid panel isperformed, which shows
		Other than aggressive hydration and NPO status, what is thenext best step in management for this patient’s triglycerides?
		59. The correct answer is:
8 Rheumatology
	Pain
		wrist
			1.
				Physical examination reveals
				Pain is reproducedwith
				Which of the following is the most likely diagnosis?
				The correct answer is:
		hand pain
			2.
				Medications include
				Examination isnotable for
				Labs show
				X-rays of hands
				Which of the following is the most likely diagnosis?
				The correct answer is:
				3.
				The correct answer is:
		shoulder pain
		low back pain
			16.
				Hisexamination is notable for
				What is the most likely diagnosis?
					17.
					18.
						Laboratory evaluations show
						Which of the following testing is necessary prior to startingadalimumab in this patient?
			bilateral eye redness at the time of diagnosis with gonococcalurethritis that has since resolved, a rash on the glans penis, and lowback pain, right knee and left ankle synovitis
				19.
		lower extremity pain
			49.
		acute intermittent inflammatory asymmetric oligoarthritis
			8.
			9.
		polyarticular pain
			daily fevers, night sweats, unintentional weight loss,and lymphadenopathy
				7.
			Raynaud phenomenon, hand edema, puffy fingers
				31.
			fevers, arthralgia, rash, and chest pain upon inspiration, positive antinuclearantibody, positive anti-dsDNA, and a positive anti-histone antibody.
				33.
					34.
	synovitis
		monoarthritis
			acute monoarthritis
				a history of hypertension, stage 4 chronickidney disease, diabetes mellitus, and atrial fibrillation on Coumadin
					12.
						On examination
						X-ray demonstrates
						His CBC is
						Basic metabolic panel is notable for
						Which of the following is NOT a likely cause of hispresentation?
						13.
						14.
						15.
					13.
					15.
				man with T2DM, rheumatoid arthritis, and crystalprovengouty arthritis. GFR of 35 mL/min. X-rayof his knee shows evidence of chondrocalcinosis.
					23.
					24.
					25.
		Polyarthritis
			bilateral second to fourth metacarpal phalangeal (MCP)synovitis and proximal interphalangeal synovitis.
				2.
			the wrists, elbows, knees, ankles, andmetatarsal phalangeals.
				with PMH of hypertension, hyperlipidemia, type1 diabetes mellitus (T1DM) (on insulin pump), peptic ulcer disease,stage 3 chronic kidney disease, ischemic cardiomyopathy, and gout
					10.
						PMH of
						On the third day ofhospitalization
						On examination
						Arthrocentesis of the right knee isperformed, with preliminary studies showing
						Crystal examination and Gram stain are
						ACBC shows
						glomerular filtration rate (GFR) is
						His uric acid level is
						A recentHbA1c was
						Which of the following is the best treatment for his arthritis?
				10.
			11.
				PMH of
				Which antihypertensive medication adjustment would yourecommend?
			bilateral second through fifth metacarpal phalangeals(MCPs), proximal interphalangeals, and both wrists.
				26.
			33.
		Oligoarthritis
			acute intermittent inflammatory asymmetric oligoarthritis
				8.
			bilateral eye redness at the time of diagnosis with gonococcalurethritis that has since resolved, a rash on the glans penis, and lowback pain, right knee and left ankle synovitis
				19.
				20.
			Left ankle and right hand pain, A few pustular papules, Synovial fluid analysis shows a WBC count of 35000 cells/μL, 84% neutrophil predominant. UA shows 20 to 50 WBCs.
				21.
					22.
	Ophthalmo
		Fundusexamination
			bilateral parafoveal retinal pigmentatrophy, and further ophthalmologic testing confirms these findingsconsistent with “bull’s eye maculopathy.”
				37.
				38.
	Neuro
		“tingling, electricity-likesensation” affecting both feet and both ankles.
			49.
		sensation to light touch
			decreased sensation to light touch of the feet and ankles
			49.
		carpaltunnel syndrome
			49.
	rash
		7.
		nodules
			8.
		bilateral eye redness at the time of diagnosis with gonococcalurethritis that has since resolved, a rash on the glans penis, and lowback pain, right knee and left ankle synovitis
			19.
		Left ankle and right hand pain, A few pustular papules, Synovial fluid analysis shows a WBC count of 35000 cells/μL, 84% neutrophil predominant. UA shows 20 to 50 WBCs.
			21.
				22.
		Raynaud phenomenon
			27.
			Raynaud phenomenon, hand edema, puffy fingers
				31.
		easy bruising
			49.
		33.
		poikiloderma of the upper chest and back, and fissured scaly plaques
			29.
			30.
		petechial rash
			Allergic rhinitis, asthma, andthe peripheral eosinophilia seen on his WBC differential, fevers,unintentional weight loss, hemoptysis, petechial rash, andmononeuritis multiplex,
				39.
				40.
			fever, malaise, weight loss, abdominal pain,hematochezia, and myalgias and is found to have purpura andmononeuritis multiplex on examination. The patient is also noted tobe hypertensive with elevated inflammatory markers and an acutekidney injury on laboratory testing.
				41.
					42.
			petechial rash, lower extremity arthritis, and abdominal pain 3 weeksafter a streptococcal pharyngitis infection. Skin biopsy showsleukocytoclastic vasculitis with positive IgA staining
				43.
					44.
			47.
		jaundice
			45.
		nails
			27.
			28.
	Labs
		CBC
			daily fevers, night sweats, unintentional weight loss,and lymphadenopathy
				7.
			Allergic rhinitis, asthma, andthe peripheral eosinophilia seen on his WBC differential, fevers,unintentional weight loss, hemoptysis, petechial rash, andmononeuritis multiplex,
				39.
				40.
		creatinine
			27.
			28.
			fever, malaise, weight loss, abdominal pain,hematochezia, and myalgias and is found to have purpura andmononeuritis multiplex on examination. The patient is also noted tobe hypertensive with elevated inflammatory markers and an acutekidney injury on laboratory testing.
				41.
					42.
			42. Which of the following infections is most closely associated with thepatient in Question 41’s condition?
			49.
		IgG4
			45.
		rheumatoid factor
			47.
				48.
		C4
			47.
		LFTs
			4.
			7.
		UA:
			27.
			28.
			fever, malaise, weight loss, abdominal pain,hematochezia, and myalgias and is found to have purpura andmononeuritis multiplex on examination. The patient is also noted tobe hypertensive with elevated inflammatory markers and an acutekidney injury on laboratory testing.
				41.
					42.
	Rheumatoid arthritis
		started on sulfasalazine (SSZ)500 mg BID and hydroxychloroquine 400 mg QD. fever, cough, fever, rash, myalgias, and transaminitis.
			4.
				Labs are notable for
				Achest radiograph (CXR) is
				Which of the following is the next most appropriate step inthe management of this patient?
				The correct answer is:
		intolerance
			5.
				Her PMH isnotable for
				Which of the following is the next aopriate agent?
				5. The correct answer is:
		biologic disease-modifyingantirheumatic drug (DMARD)
			6.
				6. The correct answer is:
	Systemic lupus erythematosus
		34.
		patient with aknown history of lupus presents with fatigue, low-grade fevers, rash,and synovitis.
			35.
		36.
		37.
	gout
		PMH of hypertension, hyperlipidemia, andtophaceous gout
			11.
	X-ray
		12.
		chondrocalcinosis
			man with T2DM, rheumatoid arthritis, and crystalprovengouty arthritis. GFR of 35 mL/min. X-rayof his knee shows evidence of chondrocalcinosis.
				23.
				24.
				man with T2DM, rheumatoid arthritis, and crystalprovengouty arthritis. GFR of 35 mL/min. X-rayof his knee shows evidence of chondrocalcinosis.
					23.
	Arthrocentesis
		rhomboid-shaped crystals with weaklypositively birefringence
			14.
		bilateral eye redness at the time of diagnosis with gonococcalurethritis that has since resolved, a rash on the glans penis, and lowback pain, right knee and left ankle synovitis
			19.
		Left ankle and right hand pain, A few pustular papules, Synovial fluid analysis shows a WBC count of 35000 cells/μL, 84% neutrophil predominant. UA shows 20 to 50 WBCs.
			21.
				22.
		WBC count of 49 000 cells/μL with98% neutrophils. Crystal examination is positive for extracellularnegatively birefringent, needle-shaped crystals. Gram stain isnegative
			25.
	Treatment
		18.
	7.
		On examination
		A CBC shows
		His AST andALT are
		Rheumatoid factor, cyclic citrullinated peptide (CCP), andantinuclear antibody (ANA) are
		X-rays of the wrists are
		Blood cultures show
		Which of the following is NOT an appropriate step inevaluation and management?
	8.
		PMH of
		On examination
		Examination is notable for
		Left knee examination is also notable for
		Labsin the ED show
		He denies any history of
		Which of the following is the most likely diagnosis?
		9.
9 Neurology
	1.
		On examination
		What is the next best step in her management?
		1. The correct answer is:
	2.
		Which of the following is NOT true about the cause of hermental status change?
		2. The correct answer is:
	3.
		brain imaging, whichis depicted below:
		What is the most likely diagnosis?
		3. The correct answer is:
	4.
	4. The correct answer is:
	5.
	5. The correct answer is:
	6.
		Which of the following statements is FALSE?
		6. The correct answer is:
	7.
		Laboratory studies reveal
		Electrocardiogram (ECG) reveals
		EEG shows
		Which of the following is a contraindication to startinglevetiracetam in this patient?
		7. The correct answer is:
	8.
		8. The correct answer is:
	9.
		The correct answer is:
	10.
		10. The correct answer is:
	11.
		On examination
		What is the most likely diagnosis?
		11. The correct answer is:
	12.
		What is the most likely diagnosis?
		12. The correct answer is:
	13.
		All of the following findings would be concerning for aposterior circulation stroke EXCEPT:
		13. The correct answer is:
	14.
		14. The correct answer is:
	15.
		15. The correct answer is:
	16.
		The correct answer is:
	17.
		Her NIHSS(National Institutes of Health Stroke Scale) score is
		CT withangiography of the head and neck is ordered.This test does all of the following EXCEPT:
		The correct answer is:
	18.
		Which of the following is the most likely etiology?
		18. The correct answer is:
	19.
		Neurologic examination wasnotable for
		The correct answer is:
		Lumbar puncture was performed and showed
		What is the next best step in her management?
	20.
		On examination
		Labs show
		Which of the following is not an effective option for treatingneuropathic pain?
		The correct answer is:
	21.
		He had
		The neurologicexamination showed
		Deep tendon reflexes (DTRs) were
		Nerveconduction studies showed
		What treatment would be most effective in reducingsymptoms in this condition?
		The correct answer is:
	22.
		Motor examination was notable for
		His creatine kinase(CK) level was
		Nerve conduction studies were
		EMG showed
		Which of the following findings on muscle biopsy would bemost consistent with his diagnosis?
		The correct answer is:
	23.
		This patient’s symptoms are most consistent with which ofthe following?
		The correct answer is:
	24.
		Herneurologic examination is
		MRI of thebrain with a venogram
		What is the best initial treatment?
		The correct answer is:
	25.
		Her personal medical history is notable for
		family history is remarkablefor
		Brain MRI is shown below:
		Genetic testing is most likely to show abnormalities in whichof the following genes?
		The correct answer is:
	26.
		Examination shows evidence of
		Cranial imaging is obtained and shown below:
		What would be the next best step in her management?
		The correct answer is:
	27.
		His symptoms came on
		On physicalexamination
		sensation to pinprick
		Reflexes are
		What is the localization of his symptoms?
		The correct answer is:
	28.
		The correct answer is:
	29.
		On examination
			Her toes were
			sensation to pinprick
		Imaging ofthe spine was obtained and is shown below:
		What is the most appropriate next step in her management?
		The correct answer is:
Abbreviations