Internal Medicine

Q: A 23-year-old type 1 diabetic is brought to the emergency department after being found in a coma. The scent of acetone is present on the patient's breath. Urinary catheterization with subsequent dipstick analysis demonstrates marked positivity for glucose and ketones. Stat blood chemistries would most likely show which of the following values for the anion gap?

(a) :  6 mEq/L
(b) :  11 mEq/L
(c) :  13 mEq/L
(d) :  15 mEq/L
(e) :  20 mEq/L
Answer:  20 mEq/L

Q: A 50-year-old man consults a physician because he has been having transient periods of rapid heart beat accompanied by sweating, flushing, and a sense of impending doom. Physical examination is unrevealing, with no evidence of arrhythmia at the time of the exam. However, the man's wife is a nurse, so the physician asks that she take vital signs the next time one of the episodes occurs. She does, and demonstrates a blood pressure of 195/140 mm Hg with heart rate 160/min during the episode. She promptly takes her husband to the emergency room, but the spell is over by the time that he is seen. Urinary measurement of which of the following would most likely be diagnostic in this case?

(a) :  Dehydroepiandrosterone (DHEA)
(b) :  Human chorionic gonadotropin (hCG)
(c) :  17-ketosteroids
(d) :  Vanillylmandelic acid VMA
(e) :  Zinc protoporphyrin
Answer:  Vanillylmandelic acid VMA

Q: A 37-year-old woman presents with complaints of severe heartburn with or without meals. She has a history of hypertension, which has been treated with captopril. She also has a history of Raynaud disease, multiple facial telangiectasias, and very taut skin on the dorsum of both hands. She has failed to obtain relief for her heartburn with large doses of antacids, ranitidine, or omeprazole. Esophageal manometry is ordered. Which of the following would be the most likely results of this test?

(a) :  Decreased esophageal peristalsis and decreased LES pressure
(b) :  Decreased esophageal peristalsis and increased LES pressure
(c) :  Increased esophageal peristalsis and decreased LES pressure
(d) :  Increased esophageal peristalsis and increased LES pressure
(e) :  Normal esophageal peristalsis and normal LES pressure
Answer:  Decreased esophageal peristalsis and decreased LES pressure

Q: .A 74-year-old woman presents to her physician for a postoperative medical visit. Three days ago, she underwent a left total knee replacement for severe osteoarthritis. She has a past medical history significant for type 1 diabetes mellitus and glaucoma. Her hospital course was uneventful. She continues to take daily NPH insulin and has good control of her blood glucose. She also takes oxycodone, which was given to her in the hospital for pain. She is involved in a physical therapy rehabilitation program at the local hospital. On review of her medications, which of the following is most acutely indicated at this time?

(a) :  An ACE inhibitor
(b) :  A nonsteroidal anti-inflammatory agent
(c) :  Oral aspirin
(d) :  Oral Coumadin
(e) :  Subcutaneous unfractionated heparin
Answer:  Oral Coumadin

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