Which of the following is the appropriate treatment for acute Clostridium tetani infection?
A
tetanus immune globulin, tetanus toxoid, and metronidazole
A 64-year-old man has been experiencing signs and symptoms compatible with diverticular disease for the past 3 weeks. He now presents to the emergency department malnourished with severe left-sided lower abdominal pain. After appropriate workup and hydrat
B
Hartmann procedure
What is the most serious complication of the influenza B virus?
C
Reye's syndrome
The Centers for Disease Control and Prevention recommend the first lead screening for children living in high risk areas in the United States at which age?
B
9 months
A 54 year-old female returns for pathology results after being diagnosed with ovarian cancer. Which of the following is the most likely cause of ovarian epithelial malignancy?
Serous tumors
A 23-year-old man presents to the outpatient clinic for follow-up from a recent urgent care visit. He complains of sore throat, fever, fatigue, myalgias, and a rash that started 5 days ago, and have worsened since he was seen in the urgent care 3 days ago
A
Abstain from sexual activity
First-time parents present to the clinic with their 2-week old infant for a well-child visit. Which of the following strategies should be recommended to parents to help prevent sudden infant death syndrome (SIDS)?
B
Encourage tummy time while awake
Which of the following drugs can cause syndrome of inappropriate antidiuretic hormone (SIADH)?
A
carbamazepine
A 48-year-old woman presents with new-onset headache that she describes as nonspecific, worse on awakening, intermittent throughout the day but can worsen with bending over or coughing. Her husband reports that she has not been herself since the headaches
C
contrast-enhanced brain MRI
A 24-year-old male has an eight-month history of loose thought associations, social withdrawal, auditory hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted to have a flat affect, perceptual distortions,
Ziprasidone (Geodon)
A 33-year-old female presents to the emergency department for the complaint of abdominal pain that has been present for the last month. During her workup, she has an ECG completed. She denies any shortness of breath, palpitations, orthopnea, dyspnea on ex
No therapy
A 55-year-old woman with a history of hypertension and 2 vessel CABG presents to the emergency department with increasing dyspnea while walking up one flight of stairs. She denies chest pain and discomfort, but states that for the last 24 hours she has al
B
IV ibutilide alone
A 47-year-old male presents to the hospital with complaints of palpitations. He has a history of hypertension, for which he takes diltiazem. On exam he is alert, awake, and oriented. His blood pressure is 144/76, his pulse rate is 52, and his respiratory
Stop diltiazem
Which of the following medications is NOT recommended by the American Neurological Association based upon Level I evidence to treat severe and unrelenting neuropathic pain because of significant side effect potential?
A
amitryptyline
A six-month-old infant presents to the primary care provider with complaints of a spreading rash. The physical exam shows multiple yellow-brown macules and plaques that urticate when stroked. What would an appropriate treatment regimen include?
patient education to avoid NSAIDS and extremes of temperature
A 33-year-old woman presents with a 3-year history of a persistent, unfluctuating depressed mood. She also notes persistent insomnia, poor concentration, and very little appetite. She denies previous similar symptoms, substance abuse, current prescriptive
A
dysthymic disorder
A 37-year-old woman, G3P2 at 30 weeks gestation, complains of lower extremity swelling and her weight is up 5 pounds this week. Her PMH is insignificant, and her other pregnancy was uncomplicated. Her BP baseline is now 142/92. On exam her BP is unchanged
A
Glomeruloendotheliosis
25-year-old gravida 1 woman who is HIV positive arrives at the hospital in early labor. Membranes are intact and the cervix is 50% effaced and 3 to 4 cm dilated. Fetal heart rate is 150 beats/min. Which of the following procedures is contraindicated durin
use of fetal scalp electrodes
What range of time does it take for a PPD test to become positive as an immune response?
A
2 to 10 weeks
A 17-year-old female presents to the emergency department complaining of watery vaginal discharge for 6 hours. She is found to be at 35 weeks gestation. An external fetal monitor reveals fetal heart tones in the 130s, good variability, and no contractions
Preterm and premature rupture of membranes
You are evaluating a 67-year-old male with known cirrhosis of the liver secondary to alcoholic liver disease, although he has been sober for the past year. He is brought in to the emergency department by his daughter, who notes that for the past few days
lactulose
A disk herniation that is putting pressure on the L5 nerve root may present with weakness of what muscle(s)?
B
Extensor hallucis longus
Which of the following is one standard of care to treat a first-time deep vein thrombosis (DVT) without pulmonary embolism (PE)?
Begin the patient on enoxaparin 2 mg/kg SQ QD while also starting warfarin 5 mg PO once daily and check INR in five days and adjust to therapeutic levels continuing warfarin for six months and enoxaparin until therapeutic on the warfarin.
Radiculopathy due to nerve root compression occurs most commonly at which nerve root within the brachial plexus?
C
C7
A patient is undergoing induction treatment for acute myelogenous leukemia. They received daunorubicin and cytarabine seven days ago. They present in the emergency department with a temperature of 38.4�C, HR: 90, RR: 20. They are complaining of cough, fat
A
Obtain blood cultures and start cefepime
A 1-day-old infant being examined in the newborn nursery is noted to have a central, 4 mm cataract affecting his right eye. Which of the following diagnostic studies should be performed as a result of this finding?
Rapid plasma reagin (RPR)
According to the Centers for Disease Control and Prevention (CDC), which of the following cannot be treated with a course of doxycycline 100 mg PO BID for 10 to 14 days?
A
babesiosis
A 78-year-old woman with a medical history of diabetes and hypertension presents to the emergency department complaining of left hand weakness and slurred speech. Which of the following tests is most likely to determine the source of an arterial thrombus?
A
carotid ultrasound
What is the definitive treatment of choice for elderly patients diagnosed with Graves' disease?
Radioactive iodine
A patient presents with clinical features of thrombotic thrombocytopenic purpura. They also have an associated diarrhea positive hemolytic uremic syndrome. Which is the best treatment option for this patient?
Supportive therapy and dialysis
61-year-old male presents with acute onset dyspnea, cough with thick, blood tinged sputum, and fever. He is a known, longstanding alcoholic and has Type II Diabetes, for which he takes no medication. A chest x-ray reveals a right upper lobe infiltrate wit
Fluoroquinolone
Klebsiella pneumoniae, a gram negative bacteria, is associated with pneumonia in immunocompromised patients, especially alcoholics. Community-acquired pneumonia due to Klebsiellae is associated with a broad range of presentations. This may
A 28-year-old man presents with a complaint of new-onset headache. The pain awakens him early in the morning and is described as a sharp, lancinating pain around his right eye, which is 9 out of 10. When he looks in the mirror he notices tearing of his ri
oral corticosteroids
68-year-old male patient presents to your office complaining of difficulty urinating, nocturia that is interfering with his sleep to the point where he is fatigued, along with lower back pain. On physical examination, his prostate is enlarged, irregular,
prostate cancer
An 8-year-old male with hair loss, pruritus, and posterior cervical lymphadenopathy has a + culture on dermatophyte test medium (DTM). Which of the following is the most appropriate treatment?
The positive DTM confirms the diagnosis of tinea capitis. The only approved treatment for tinea capitis is griseofulvin
Which of the following laboratory findings will be observed in a patient with noninflammatory nonbacterial prostatitis?
negative bacterial culture with normal leukocytes
A patient that was diagnosed with severe hemophilia B in 1974 and requiring regular factor IX replacement therapy will have a 1:2 chance of also having which of the following?
HIV
Approximately 50% of older and severely affected patients with either hemophilia A or hemophilia B are now HIV positive, due to the pooled nature of therapeutic products prior to 1985. These patients are also at increased risk for Hepatitis B and C, b
A 28-year-old male has Hemophilia A. He is in for genetic counseling on the risk of his children developing the disease. What is the likelihood that a son of his will develop Hemophilia A?
0%
A 54-year-old man presents to the emergency department with crampy abdominal pain, nausea, and vomiting. The patient has not passed gas or had a bowel movement for at least 10 hours. On examination, the abdomen is distended and there are high-pitched bowe
Surgical exploration
An otherwise healthy 20-year-old man has been given the accurate diagnosis of migraine. His frequency of attack is about one per month. He has never experienced adequate relief with any over-the-counter analgesics. Which of the following would be appropri
rizatriptan 10 mg at onset, may repeat once in 2 hours
A 37-year-old man with a history of Paget disease presents with a deviation of the tongue to the right side upon sticking it out. The right side of the tongue is also observed to have slight atrophy. These symptoms most likely point to a lesion of which o
right hypoglossal nerve
A 6-year-old female presents to the emergency department with left wrist pain after falling off the monkey bars at the school playground. Imaging of the left upper extremity shows the following fracture pattern:
Which type of Salter-Harris Classification
type 1
Which of the following is the drug of choice for acute hypertensive encephalopathy?
A
Labetolol
Which of the following is the initial treatment step in an adolescent who presents to the emergency department with status epilepticus?
B
stabilize airway
A 43-year-old woman presents to the outpatient clinic complaining of right eye redness, photophobia, and pain. She notes some blurred vision and denies the presence of discharge. On physical exam her visual acuity is 20/20 left eye, and 20/60 right eye. H
B
Acute anterior uveitis
A 55-year-old woman with a history of mitral stenosis (secondary to rheumatic heart disease) presents to the emergency department with increasing dyspnea while walking up one flight of stairs. She denies chest pain and discomfort, but states that for last
Warfarin, dosed to INRs between 2.0 and 3.0
A 26-year-old male has a history of schizophrenia that has been characterized by marked incoherence and a silly affect. Which classification of schizophrenia does this most closely resemble?
B
Disorganized
Which of the following indicates a poor prognosis for someone diagnosed with schizophrenia?
D
younger age at diagnosis
A 12 year old female found a tick on her leg after a camping trip. The tick was removed without incident. According to CDC recommendations, what is the appropriate testing for Lyme disease?
A
ELISA, if + or equivocal, follow up with Western Blot
A 63 year-old woman presents to the clinic seeking counseling and medication to help quit smoking. Which of the following tobacco cessation agents binds with high affinity and selectivity at a4?2 neuronal nicotinic acetylcholine receptors?
varenicline
The American Academy of Pediatrics (AAP) recommends which of the following treatments for a two-year-old child with an acute otitis media who has a fever of 103.7�F, had an ear infection two months ago, and in whom you suspect penicillin-resistant strep b
C
Amoxicillin-clavulanate 45 to 90 mg/kg, divided into BID dosing and administered for 10 day
A 25-year-old male has a history of schizophrenia, and was brought to the emergency department by ambulance after he was found wandering along the highway. Which of the following is considered a positive symptom of schizophrenia?
C
Hallucinations
A 66-year-old female is admitted to the hospital with a new onset of atrial fibrillation. Her past medical history has hypertension, diabetes mellitus type II, hypercholesterolemia, and rheumatoid arthritis. Her vital signs show a blood pressure of 136/78
C
Transesophageal echocardiography
Your 24-year-old female patient has a longstanding history of hypercoaguability disorders and is on lifelong anticoagulation due to prior pulmonary emboli. She advises you that she is attempting to get pregnant. Which of the following medications should b
B
enoxaparen
A 19-year-old female patient presents to her family practice office for her annual Pap test and her first dose of the quadravalent human papillomavirus (HPV) vaccine. As her physician assistant, when would you schedule her to come in for her second dose o
B
two months
A 45-year-old male presents to your office complaining of severe unilateral eye pain with some photophobia for one day. He denies any history of trauma. On examination and with staining, you notice a dendritic lesion to the cornea, and an otherwise normal
prednisolone ophthalmic drops
A 62-year-old man presents to the office concerned about an abdominal aortic aneurysm (AAA). He has had no symptoms but states that his father died from an aortic dissection at the age of 50 and his brother was diagnosed last week with an AAA. What is the
D
Ultrasound
A 45-year-old patient presents 2 days postoperatively with a partial thyroidectomy. She has been experiencing vomiting with diarrhea. On physical exam, her temperature is 101�F and jaundice is noted. Her heart rate is irregularly irregular with a rate of
C
PTU 600 mg
A patient who is suspected of having pneumonia produces a sputum sample that grows gram-positive diplococci in chains (see image). What is the best choice of antibiotics for this type of patient?
Penicillins
A 30-year-old male presents to your office complaining of sinus and facial pain, congestion, and purulent nasal discharge for one month. He has been treated with two courses of different antibiotics by another provider, and does not feel any improvement i
D
CT scan
A patient presents with a cerumen impaction. Which of the following is true when performing the Rinne- Weber test?
A
Weber lateralizes to the affected ear
A
Weber lateralizes to the affected ear
A 4-year-old girl is brought to urgent care complaining of left ear fullness and difficulty hearing. The parents express concern that she put an elbow macaroni noodle into her ear. This concern is confirmed on otoscopic evaluation of the ear. Which of the
Remove the noodle with a loop
A 29-year-old woman comes in for evaluation of "panic attacks." She has no history of anxiety or depression. She says that during these episodes, which have been getting more frequent and more severe over the past month, she perspires heavily, feels highl
A
plasma fractionated free metanephrines
Which of the following tests should an HIV-positive pregnant woman undergo in each trimester of pregnancy?
A
CD4+ lymphocyte count
A
CD4+ lymphocyte count
A 12-year-old female presents with a complaint of dry flaking skin that becomes fissured and painful. Her skin has always had dark plate-like scales. What is the most likely finding in the patient's history?
C
There was a membrane present at birth
A 5-year-old girl presents to the office with her mother, who states the child is experiencing excessive tearing, itching, and redness of her eyes. On physical exam you note marked injection with chemosis without discharge. The patient lacks adenopathy. W
Olopatadine 0.1% ophthalmic solution twice daily
A mother presents with a four-month-old male infant complaining of a dry, itchy rash that never seems to completely resolve. There are days when it appears to improve. She currently uses baby wash and baby lotion to care for his skin. She recently discont
frequent bathing and soap based cleansers
A 22-year-old recent immigrant from Vietnam, who is 28 weeks pregnant with her first child, presents to the emergency department with complaints of worsening dyspnea and lower extremity edema. She is unable to answer definitively whether or not she has a
A
Beta blockade and support stockings
25-year-old female presents to your office complaining of intermittent episodes of shortness of breath, especially at night and when she gets a cold. She has smoked one pack per day for 11 years and is asymptomatic on physical examination, with clear brea
Perform spirometry, administer a nebulizer treatment, and after waiting 20 minutes repeat the spirometry; after interpretation to differentiate between asthma and chronic obstructive pulmonary disease, treat accordingly.
Which of the following medications for type 2 diabetes mellitus is thought to best preserve beta cell function in the pancreas?
pioglitazone
What is the most common embolic source of acute arterial occlusion in the lower extremities?
A
Atrial fibrillation
Which peripheral nerve is involved in the most common compression neuropathy in the upper extremity?
Median
A patient is recovering from having a total thyroidectomy two days ago for medullary thyroid cancer. An extensive neck dissection was required during the surgery. Post-operative lab testing reveals a low serum calcium level. Which of the following clinica
E
Paresthesias
Which drug can potentially lead to oropharyngeal candidiasis, and which agent can be used to treat this type of infection?
B
triamcinolone; fluconazole
A 30-year-old woman presents to the office complaining of an inability to achieve pregnancy after over a year of trying. What is the couple's least likely cause for infertility?
Pituitary disease
A 67-year-old female presents to the emergency department with abdominal pain, bloating, inability to pass gas or stool, and vomiting. Which of the following, if present, would be a contraindication to placing a nasogastric tube?
B
Esophageal strictures
A patient is undergoing induction treatment for acute myelogenous leukemia. They received daunorubicin and cytarabine seven days ago. They present in the emergency department with a temperature of 38.4�C, HR: 90, RR: 20. They are complaining of cough, fat
A
Obtain blood cultures and start cefepime
Administration of a drug that inhibits acetylcholinesterase would most likely lead to which of the following?
increased gastric juice secretion
Which of the following medications is NOT recommended by the American Neurological Association based upon Level I evidence to treat severe and unrelenting neuropathic pain because of significant side effect potential?
A
amitryptyline
A 61-year-old male presents with acute onset dyspnea, cough with thick, blood tinged sputum, and fever. He is a known, longstanding alcoholic and has Type II Diabetes, for which he takes no medication. A chest x-ray reveals a right upper lobe infiltrate w
Fluoroquinolone
You are monitoring a 30-year-old G2P1 at 40 weeks gestation, who is in an active stage of labor and is 6-cm dilated. The fetal heart tracing has a baseline heart rate of 140, with 7 to 10 beats of variability. With the last five contractions you have note
B
Assessment of dilatation
A 28-year-old man presents with a complaint of new-onset headache. The pain awakens him early in the morning and is described as a sharp, lancinating pain around his right eye, which is 9 out of 10. When he looks in the mirror he notices tearing of his ri
D
oral corticosteroids
A 63 -year-old male returns to the office for follow-up complaining of increasing abdominal girth and weight gain of 10 pounds in the past month, despite his usual caloric intake. His vital signs are normal. He continues to drink at least a six-pack of be
B
spironolactone
A 37-year-old woman, G3P2 at 30 weeks gestation, complains of lower extremity swelling and her weight is up 5 pounds this week. Her PMH is insignificant, and her other pregnancy was uncomplicated. Her BP baseline is now 142/92. On exam her BP is unchanged
A
Glomeruloendotheliosis
Which of the following etiologies is the most common cause of nontraumatic subarachnoid hemorrhage (SAH)?
A
Cerebral aneurysm
A 12-year-old male exhibits prominent brown scaling on his neck, trunk, and extremities with involvement of flexural regions. The palms and soles are spared. What is the most likely diagnosis?
X-linked ichthyosis
A 72-year-old man is transported via ambulance to the emergency department with severe chest pain and shortness of breath. Electrocardiogram (ECG) reveals ST-segment elevation in leads II, III, and aVF. While in the emergency department, he loses consciou
B
>1
The Centers for Disease Control and Prevention recommend the first lead screening for children living in high risk areas in the United States at which age?
B
9 months
Which of the following best describes the mechanism of action of angiotensin-converting enzyme (ACE) inhibitors in controlling blood pressure and preventing or slowing kidney damage?
C
They result in dilation of the efferent arteriole, reducing glomerular pressure.
A 6-week-old male with sickle cell disease presents to the pediatric office for his well-child visit. When should this child begin taking daily prophylactic penicillin?
B
2 months
Which of the following antineoplastic medications is most likely to cause cardiac toxicity and precipitate heart failure?
A
doxorubicin
Which of the following is the appropriate treatment for acute Clostridium tetani infection?
A
tetanus immune globulin, tetanus toxoid, and metronidazole