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Chemo Secrets From a Breast Cancer Survivor

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50 Questions

Time Allowed: 60 Minutes

(Question 501

A 34-year-old nurse with abdominal pain receives a plain abdominal radiograph:

Which of the following is most likely to be true?

(A) The woman has hypercalcemia secondary to malignancy.

(B) The woman has hypocalcemia.

(C) The woman has had recurrent Proteus urinary tract infections.

(D) The woman has hyperuricemia and a history of arthritis.

(E) The woman has factitious disorder.

Question 502

A 62-year-old woman with heart disease and a long smoking history presents with the following lesion on her ankle:

What is the most likely cause of this appearance?

(A) Arterial insufficiency

(B) Venous insufficiency (CI Peripheral neuropathy

(D) Cardiac embolus traveling into the lower extremity

(E) Fungal infection

A 59-year-old woman presents with concern over an area of skin on her right leg. She says the lesion has been on her leg for years, but recently has gotten bigger and started to itch.

Which of the following is true regarding the most likely diagnosis?

(A) Prognosis often is closely related to the depth of invasion,

(B) The fact that the lesion itches makes it more likely to be benign.

(C) Surgical excision is contraindicated.

(D) Intravenous antibiolic therapy is needed.

(E) Local intra! esional steroid injection is the treatment of choice.

Question 5<M

Which of the following medications generally should be avoided in an asthmatic?

CA) Acetaminophen

(B) Penicillin

(C) Captopril ([)) Propranolol iE) Ranitidine

A 56-year-old man presents for an annual physical examination. His chest is wider in the anteroposterior direction than across, and he breathes with pursed lips. On a routine chest radiograph, (he patient is noted to have hyperinflation of ihe lungs. Which of the following is most likely to he the cause of these findings?

(A) The patient had polio as a child

(B) The patient is a smoket.

<C) The patient has cystic fibrosis.

ID) The patient has Klinefelter^ syndrome.

(E) The patient uses illicit drugs.

Question 506

What congenital heart defect is associated with upper extremity hypertension in the presence of a normal or low blood pressure in the lower extremities'?

(A) Patent ductus arteriosus

1B) Ventricular septal de feet

(C) Atrial septal defect

(D) Coarctation of the aorta

(E) Telralogy of Fallot

A 42-year-old intravenous drug abuser presents to the emergency department w ith low back pain, requesting narcotics. Laboratory tests reveal the following:

Hepatitis A IgM antibody Negative

Hepatitis B surface IgG Positive antibody

Hepatitis B surface antigen Negative

Hepatitis B core IgG Positive antibody

Hepatitis C antibody Positive

Which of the following is most likely to he true?

(A) The patient has chronic hepatitis B.

(B) The patient has chronic hepatitis C.

(C) The pattern of liver enzyme elevation indicates alcoholic hepatitis.

(D) The patient's hepatitis B serology is due to vaccination.

(E) The liver enzyme elevation is a laboratory error caused by dehydration.

Question 507

Which of the following would be expected to improve a symptomatic supraventricular bradycardia'.'

(A) Metoprolol tB) Verapamil

(C) Procainamide

(D) Atropine

(E) Lidocaine

Question 508

A 31-year-old previously healthy woman with no medical history presents wilh anxiety, insomnia, heat intolerance, and new-onset atrial fibrillation. Which of the following is most likely to be (rue?

(A) The thyroid-stimulating hormone level is abnormally low,

(B) The patienl has constipation.

(C) The patient has unexplained weight gain.

(D) The patient's symptoms are due to anxiety and possibly panic attacks.

iE) The patient's symptoms are due to a type IV hypersensitivity reaction.

Question 510

Which of the following is true regarding inflammatory bowel disease?

(A) Crohn's disease usually involves only the colon.

(B) Ulcerative colitis is less likely to cause colon cancer than Crohn's disease.

(C) Transmural involvement is characteristic of ulcerative colitis,

{D} The presence of skip lesions is more characteristic of Crohn 's disease.

(E) Fistulas and abscess are more common with ulcerative colitis.

Question 511

A 24-year-old Mediterranean wimn is referred to vour office because asymptomatic anemia is discovered on a routine complete blood count before elective plastic surgery- Laboratory values are as follows:

Hemoglobin ]0 gAiL

Mea n corpuscu Isr 7S pir^ee! I volume

White blood cell count 7200/nL

Platelets 324,<KKl/|tL Hemoglobin A2 (normal - 1.5-3,5)

Haptoglobin 140 mg/dL (normal = 40-336)

Coombs' test Negative

What is the best way to treat this anemia?

(A) One-week course of oral iron therapy

(B) Three-month course of oral iron therapy

(C) Correction of the underlying inflammatory disorder

(D) Administration of folate

(E) None of the above

Question 512

A 32-year-old woman with a history of gastrointestinal problems has a macrocytic anemia with several hyper-segmented neutrophils on peripheral smear. Aktiough otherwise healthy, she has fatigue secondary to the anemia. Physical examination reveals decreased position sense in the lower extremities, mild ataxia, and mild hyperreflexia. Which of the following tests is likely to reveal the patient's pioblem?

(A) Tolal colonoscopy

(B) MK1 of the brain <C) Schilling lest

(D) Cerebral angiogram

(E) Red blood cell folate level

Question 513

Which of the following is not likely to be seen in a nephritic syndrome, such as poststreptococcal glomerulonephritis?

(A) Oliguria

(B) Azotemia

(C) 6 g of proteinuria per day

(D) Red blood cell casts seen in the urine

(F) Hypertension

Which of the following is most likely to he found in thecal stages of a nephrotic syndrome, such as minimal change disease?

(A) Lipiduria

(B) Severe hypertension

(C) Red blood cell casts

(D) Uremia

(E) Encephalopathy

Question 515

What is the preferred method of anesthesia in obstetric patients who require iL?

(A) General anesthesia

(B) Epidural anesthesia

(C) .Spinal anesthesia

(D) Caudal anesthesia

(E) Paracervical block

Question 516

Which of the following is nut a sign of placental separation?

(A; A fresh show of blood from the vagina

(B) Visualization of the utenis at the introitus

(C) lengthening of the umbilical cord

(D) The fundus rising up

(E) The fundus becoming firm and globular

Question 517

Which of the following is indicated for a cervical chlamydial infection detected during pregnancy?

(A) Delay of treatment until after delivery

(B) Treatment with tel racy dine

(C) Treatment with erythromycin

(D) Reconfirmation of the culture in the postpartum period because of a high false-positive rate during pregnancy

(E) CotrcalmenL lor presumed gonorrhea infection

A 21-year-old gravida 0, pssia 0. woman presents to your office because she thinks she has breast cancer. She notes humps in both breasts that become tender around [he time of menstruation. On examination, multiple cystic, lender lesions can be fell in both breasts without a dominant mass. What is the best course of action"?

(A) Reassurance and scheduling of a follow-up appointment

(B) Ultrasound of the breasts

(CJ Fine-needle biopsy of both breasts

(D) Open breast biopsy of the largest lesion

(E) Mammography

Question 519

A thin 32-year-old woman with recently diagnosed schizophrenia and no other medical problems presents to [he office complaining of amenorrhea, bilateral clear breast discharge, and decreased libido. She has been taking haloperidul for the last 3 months and seems coherent and appropriate. What is the most likely diagnosis?

f A) Delusional symptoms secondary to schizophrenia

(B) Malingering

(C) Hyperprolactinemia from haloperidol

(D) Breast cancer

(El Polycystic ovary syndrome

Question 52U

Which person would be least likely to develop a gram-negative pneumonia?

(A) A child with cystic fibrosis

(B) A homeless alcoholic

(C) A man with hypertension tD) A hospitalized patient in the ICI J

(E) A woman with several episodes of vomiting while unconscious

Question 521

Which of the following patients does not have an indication for the Streptococcus pneumoniae vaccine?

(A) A 38-year-old male with HIV

fB) A 56-year-old woman with hypertension, diabetes, and renal insufficiency (Ç) A 25-year-old woman with sickle cell disease fD> A healthy 6i>-year-old woman (E) None of the above

Which of the following conditions is the most potent risk factor for testicular cancer?

(A) Family history of neoplasm (B > Hi story ofahydrocele

(C) History ill' corrected cryptorchidism

(D) History of a varicocele

(E) History of chemotherapy for an un re la led malignancy

Question 523

A 64-year-old male alcoholic presents wiih a chief complainl of 40-lb weight loss over ihe last 3 months and food "sticking"' in his chest. He has smoked cigarettes for 50 years but has no olher medical history. What is the most likely diagnosis?

(A) Barren's esophagus fB) Adenocarcinoma of (he esophagus

(C) Squamous cell carcinoma of the esophagus

(D) Colon cancer (El Achalasia

Question 524

What is Ihe mosi common location of primary bTain tumors in children?

(A) Cerebral hemispheres

(B) Hypothalamus

(C) Raihkc's pouch

(D) Posterior fossa

(E) Thalamus

Question 525

Which of the following is true concerning electromyography and nerve conduction studies1'

(A) A demyelinating disorder causes increased conduction velocity and amplitude.

(B) A lower motor neuron lesion produces a lack of electric activity when the musele is at rest.

CC> Repetitive stimulation of nerves often improves muscle contraction amplitude in myasthenia gravis.

(D> Primary muscle disorders usually result in a decreased contraction amplitude. (E) A normal muscle has a large amount of random electric activity at rest.

Question 526

A 32-year-old woman presents with symmetric weakness in her legs 10 days alter having an upper respiratory infection. The weakness came on in both feet and gradually aseendcd to involve the leg muscles below the knee over the next 24 hours. She denies any sensory changes. Physical examination reveals symmetric, bilateral muscle weakness below the knee with decreased reflexes and intact sensation. Which of the following is true concerning the most likely diagnosis?

(A) The patient needs immediate high-dose corticosteroids,

(B) Plasmapheresis may shorten the duration of symptoms.

(C) Cerebrospinal fluid is likely to show large numbers of lymphocytes and markedly increased pressure.

(D) CT scan or MKI of the brain is likely to show widespread demyelination.

(E) Nerve conduction velocity is likely to be normal

Question 527

A 42-year-old man on no medications presents with an "itchy" skin rash on his back. He is otherwise in good health and appears to have good hygiene. He has multiple erythematous, oval, scaly patches on the back that appear parallel to the skin cleavage lines. There also are a few patches on the chest. He mentions that it started with one lesion 10 days ago on his left arm and that 1 week later, his whole back broke out. Which of the following is the treatment of choice for the most likely condition?

(A) Reassurance and supportive measures

(B) Excisional biopsy of the lesions

(C) Permethrin cream

(D) Intravenous corticosteroids as an inpatient for 10 days

(E) Oral fluconazole for 10 days

A city being studied has a population of 100,000, Using culture as the gold standard test, 3000 people in the city are found to have chlamydial infection. A new DNA probe chlamydial test is positive on 4000 people in the city, of whom only 3000 tested positive by culture. Wrhat is the incidence of Chlamydia in this city?

(E) Cannot be calculated from the information given Question 529

A scientist decides to examine the risk of smoking in developing pancreatic cancer. He finds 1<K) cases of smokers who died and 200 cases of nonsmokers who died. By reviewing the hospital charts and autopsy records, the scientist determines the number of people in each group who died of pancreatic cancer. The cases are matched carefully so that there are no inequalities in terms of age, sex, or other demographics or habits. The scientist finds that four people in the smoking group died of pancreatic cancer versus two people in the nonsmoking group. Using the scientist's data, what is the relative risk of pancreatic cancer in smokers compared with nonsmokers?

(E) Cannot be calculated from the information given Question 530

A teacher contacts you because she is worried about a student in her seventh-grade class. The child often comes into class after lunch seeming euphoric and unsteady on his feet, and seems to have a heightened sense of power and mildly slurred speech. She says the child is normal in the mornings and usually is back to normal within an hour after lunch. She does not note any symptoms of withdrawal (e.g., irritability, excessive fatigue) by the end of the day. Which of the following is the child likely to be abusing?

(B) Cocaine

(C) Heroin

(D) Marijuana

(E) Inhalants

A woman comes to I he office because she is concerned about her 32-yeai-Old husband, who occasionally wears her underwear under his normal male clothing. He docs this only occasionally and in private, and she claims they have a normal sex life. She claims he does it because it makes him "feel sexy." It does not bother her husband, w ho is a successful stockbroker, but the woman is disturbed by it. Which of the following best describes the man's behavior?

(A) Homosexuality iB> Fetishism (Q Transsexual (Dj Transvestite (E) Normal variant

Question 532

A 34-year-old woman comes to the office with a complaint of feeling anxious She says she feels overwhelmed by life and constantly worries about how things will turn out. What is ihe best question to ask the woman?

tA) "Does this condition run in your family?" (BJ "Could you tell me more about it?" (C) "Do you have difficulty sleeping?" tD) "What medications are you currently taking?" (L) "Are you experiencing depression?"

Questkm 533

Which of the following substances is not a confirmed teratogen?

(A) Isotretinoin

(B) Alcohol

(E) Trimcthadionc

Which of the following is false concerning group B Streptococcus in relation to pregnancy?

(A) It is a common cause of neonatal sepsis,

(B) It is a common cause of chorioamnionitis.

(C) It is a gram-positive cocci.

(D) Mothers with a positive culture for the organism should be treated during labor with amoxicillin.

(El Its presence in the female genital tract indicates a maternal infection.

Question 535

Which of the following is true concerning pregnant HIV-positive mothers?

(A) It is okay for them to breast-feed.

IB) Transmission of Ihe virus to the infant is unlikely.

(C) Ami retroviral medications should rol be used in pregnant women.

(D) They should be screened for other sexually transmitted diseases even if asymptomatic.

(E) Positive HIV tesl in a neonate confirms the transmission of HIV,

Question 53<i

A normally healthy 50-year-old woman presents to the office complaining of irregular menstrual periods, hoi flashes, and unpredictable mood swings. Which of the following is likely to be true?

(A) She has uterine cancer.

(B) Her irregular menstrual periods are pathologic.

(C) Her follicle-stimulating hormone level is elevated.

(D) She has major depression.

(E) She has cervical cancer.

Question 537

A 14-year-old girl comes to the office complaining of amenorrhea. She says her first period was at the age of 11 and that they are normally regular. Whai should you do next to work up ihe amenorrhea?

(A) Order a urine human chorionic gonadotropin test. (BI Administer progesterone.

(C) Order scrum follicle-stimulating hormone and luteinizing hormone levels.

(D) Order a serum prolactin level.

(E| Order a serum thyroid stimulating hormone.

Question 53K

What is the preferred treatment for proliferative diabetic retinopathy?

(A) Laser burns applied to the entire periphery of the retina

(B) Focal laser burns to the involved area

(C) Intraocular methotrexate

(D) Reduction of insulin dose

(E) Vitrectomy

Question 539

Which of the following is the most likely cause of acquired legal blindness in an African-American adult?

(A) Glaucoma

(B) Type I diabetes

(C) Exudative ("wet") macular degeneration

(D) Trauma

(E) Retinal detachment

Question 54(1

Which of the following is least likely to causc death in the acute setting if treatment is delayed?

(A) Cardiac tamponade

(B) Pneumothorax

(C) Airway obstruction

(D) Epidural hematoma

(E) Aortic rupture

Which of the following is true concerning abdominal trauma?

(A) With any gunshot wound to the abdomen, proceed directly to abdominal MR1

(B) With any knife wound to the abdomen, proceed directly to abdominal MR1.

(C) With blunt abdominal trauma, if the patient is stable, abdominal angiography is preferred before surgery.

(D) If the patient is stable after blunt abdominal trauma with a normal abdominal examination, careful observation may be indicated.

(E) After blunt trauma, the combination of abdominal pain, hypotension, and left shoulder pain usually means a ruptured gallbladder.

Question 542

Which of die following is more consistent with a diagnosis of omphalocele than with gastroschisis in a newborn?

(A) The defect is in the midline.

(B) There is no true hernia sac.

(C) The umbilical ring is present.

(D) The presence of no other physical anomalies is more consistent.

(E) Only small bowel is exposed

Question 543

A male newborn has respiratory distress after delivery, and when you listen to the chest, you hear what sounds like bowel sounds in the left thorax. Which of the following is true of the most likely condition?

(A) Pulmonary hypoplasia is likely.

(B) The lesion is caused by birth trauma. tC) The defect is more common on the right,

(D) The condition normally resolves on its own.

(E) Surfactant is the treatment of choice.

A previously healthy 11 -month-old infant presents with bilious vomiting, maroon stools mixed with mucus, and a palpable sausage-shaped mass in the abdomen. What is the likely diagnosis?

(A) Intussusceplioii

(Hi Pyloric stenosis

(C) Intestinal atresia |D} Meconium ileus

(E) Necrotizing entcrtx:oliLis

Question 545

Pain in the anatomist's snuiT box after a fall on an Outstretched hand likely represents fracture of which of the following carpal bones?

(A) Hamate bone

(B) Triquetral bone fC) Scaphoid bone

(D) Pisiform bone

(E) Lunate bone

Select the correct vitamin or mineral responsible for each of the following items. Each choice car be used as many times as needed to answer the items correctly.

CA)

Vitamin A

(B)

Vitamin B|

(C)

Vitamin

ID)

Vitamin B,,

iE)

Vitamin B^

(F)

Vitamin C

rt;>

Vitamin L>

(H)

Vitamin F

(1)

Vitamin K

(I)

Iron

<K)

Calcium

<L)

Magnesium

(M)

Folate

(N)

Phosphate

fo)

Niacin

54G it has been shown lo be teratogenic in high doses.

547 A 57-year-old man presents with dementia, dermatitis. diarrhea, and stomatitis.

548 A 42-year-old thin man presents with new-onset diabetes, bronze-colored skin, and cardiomegaly on chest radiograph.

549 A 47-year-old woman presents with difficulty seeing at night and scaly, dry skin.

550 Acute elevation in pregnant women is often iatrogenic and may cause respiratory depression.

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