Internal Medicine

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
Explanation:  

Q: A 65-year-old West Texas farmer of Swedish ancestry has an indolent, pale, raised, waxy, 1.2-cm skin mass over the bridge of the nose. The mass has been slowly growing over the past 3 years. There are no enlarged lymph nodes in the neck. Other than a "weather-beaten" appearance for the rest of his exposed skin, the remainder of the physical examination is unremarkable. Which of the following is the most likely diagnosis?

(a) :  Basal cell carcinoma
(b) :  Invasive melanoma
(c) :  Keratoacanthoma
(d) :  Pyogenic granuloma
(e) :  Squamous cell carcinoma
Answer:  Basal cell carcinoma
Explanation:  

Q: A 23-year old-dancer presents with a chief complaint of weakness. She denies any other symptoms, including nausea or vomiting. She denies diarrhea. Her blood pressure is 80/40 mm Hg. There is no edema and the lungs are clear. Laboratory analysis of serum shows:

(a) :  Bicarbonate
(b) :  Calcium
(c) :  Magnesium
(d) :  potassium
(e) :  sodium
Answer:  potassium
Explanation:  

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
Explanation:  

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