Internal Medicine

Q: A 70-year-old man presents to the emergency department with a 3-day history of right temporal headache, fever, and profound malaise. He appears acutely ill. His temperature is 39.5 C (103.1 F), blood pressure is 130/80 mm Hg, pulse is 98/min, and respirations are 24/min. Tenderness over the right temporal region is appreciated on palpation. The right temporal artery is tender and slightly nodular. Neurologic examination is normal, including funduscopic examination. However, visual acuity is reduced. Laboratory studies show:

(a) :  Measurement of intraocular pressure
(b) :  Visual field assessment
(c) :  Low-dose (10 mg/day) prednisone treatment
(d) :  High-dose (60 mg/day) prednisone treatment
(e) :  Temporal artery biopsy
Answer:  High-dose (60 mg/day) prednisone treatment
Explanation:  

Q: A 5 year old patient is scheduled for tonsillectomy. On the day of surgery he had running nose, temperature 37.5°C and dry cough. Which of the following should be the most appropriate decision for surgery?

(a) :  Surgery should be cancelled
(b) :  Can proceed for surgery if chest is clear and there is no history of asthma
(c) :  Should get Xray chest before proceeding for surgery
(d) :  Cancel surgery for 3 weeks and patient to be put on antibiotics
(e) :  None of the above
Answer:  Cancel surgery for 3 weeks and patient to be put on antibiotics
Explanation:  

Q: A 34-year-old woman who is healthy without underlying medical problems presents to clinic with complaints of temperature up to 101 F and cough with greenish sputum production for 2 days without any dyspnea. Her heart rate is 88/min, and her respiratory rate is 18/min. There is no accessory muscle use or conversational dyspnea, nor are there wheezes, bronchial breath sounds, rales, or egophony over the right lower lung fields. Chest x-ray film reveals a right lower lobe consolidation. A CBC shows a leukocyte count of 13,000/mm3. Which of the following is the most appropriate pharmacotherapy?

(a) :  Amoxicillin
(b) :  Ampicillin-sulbactam
(c) :  Ceftriaxone
(d) :  Erythromycin
(e) :  Erythromycin plus ceftriaxone
Answer:  Erythromycin
Explanation:  

Q: A 60-year-old woman consults a physician because of weakness, headaches, dizziness, and tingling in her hands and feet. Physical examination demonstrates multiple areas of bruising on the back of her forearms and shins. On specific questioning, she reports having had five nosebleeds in the past two months, which she had attributed to "dry air". Blood studies are drawn which show a platelet count of 1.2 × 106/µL, a red cell count of 5.1 ×106/µL, and a white count of 10,500/µL with a normal differential count. Review of the peripheral smear demonstrates many abnormally large platelets, platelet aggregates, and megakaryocyte fragments. No abnormal red or white blood cells are seen. Philadelphia chromosome studies are negative. Which of the following is the most likely diagnosis?

(a) :  Chronic myelogenous leukemia
(b) :  )Myelofibrosis
(c) :  Polycythemia vera
(d) :  Primary thrombocythemia
(e) :  Secondary thrombocythemia
Answer:  Primary thrombocythemia
Explanation:  

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