Chemo Secrets From a Breast Cancer Survivor

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Creatinine Amylase

102 nm/cell ll,100/|lL 90,U00/pL 140 mEtj/L 4.2 mFq/L 108 niEq/L 24 mEq/L 26 mg/dL 1.4 mg/dL 764 U/L (normal = 53-123 u/L)

What is the best way to manage this patient'?

(A) Send patient home after making a follow up ap-poirlmeit with her physician and prescribing a nonsteroidal analgesic for pain.

(B) Admit to the hospital for a blood transfusion.

(C) Ad mi I to the hospital for medical management.

(D) Admit to the hospital for surgery.

(E) Perform a CT scan of the abdomen.

Question 3(13

Which of the following patients would be least likely to develop anemia?

(A) A pregnant lS-year-old female vegetarian

(B) A premature infant

(C) A 32-vear-old woman with peptic ulcer disease (D> A 59-year-old male smoker with long-standing emphysema

(E) A 21 -year-old black man with cholelithiasis consisting of pigment stones

A 24-year-tild woman with lupus who is taking high-tlose indomethacin presents with shortness of breath and weakness. Looking at the electrocardiogram, what is the most likely diagnosis?

(A) Hypokalemia tB) Hyperkalemia

(C) Hypocalcemia

(D) Hypercalcemia

(H) Wolff-Parkinson-While syndrome

Question 305

Looking at the electrocardiogram, which antihypertensive is this 54-year-old male patient most likely taking, assuming the electrocardiogram was normal before drug therapy was started?

(A) Atenolol

(B) Nifedipine

(C) Captopril

(D) Terazosin (H) Irbcsartan

A 53-year-old disheveled woman presents with abdominal pain and tenderness without peritoneal signs on examination. She claims to have had similar bouts of pain in the past that usually "go away in a few days, but sometimes I have to come into the hospital." An abdominal radiograph is obtained:

Which of the following is true regarding the most likely cause of this patient's pain?

(A) The cause is likely to be adhesions from prior surgery,

(B> She is likely to be an alcoholic.

(C) The 5-year survival is less than 5%.

(D) Surgical resection is the treatment of choice.

(E) None of the above

Question 307

Flight of ideas is seen mosi commonly in which of (he following disorders?

(B l Schizoid personality disorder

(C) Borderline personality disorder

(D) Depression

(E) Obsessive-compulsive disorder

A 29-year-old gravida 3, pars 2. woman with a 13-week intrauterine pregnancy develops a deep venous thrombosis of the left lower extremity. What is the most appropriate treatment?

(A) Heparin

(B i Heparin acutely, then switching the patient to warfarin for the second half of the pregnancy (O Warfarin

(D) Aspirin

(E) No treatment is advised. Question 309

Which of the following is least correct regarding Huntington's disease?

(A) It can cause dementia.

(B) It can cause psychosis.

(C) It is inherited in an autosomal dominant fashion.

(D) Early diagnosis is crucial for prognosis.

(E) CT scan or MRI often reveals changes in the basal ganglia.

Question 310

Which of the following treatments is least appropriate as maintenance therapy for bipolar disorder?

(A) Doxepin tB> Lithium

(C) Valproic acid

(D) Carbamazepine

(E) Lamotrigine

Question 311

Which of the following is not an expected finding in patients with untreated systemic lupus erythematosus?

(A) Malar rash

(B) Hirsutism

(C) Serositis

(D) Arthritis

(E) Oral ulcers

Which of the following is an expected part of Felty's syndrome?

(A) Hepatomegaly

(B) Glossitis

(C) Neutropenia

(D) Diffuse lymphadenopathy

(E) Skeletal dysplasia

Question 313

Assuming detection occurs only after a patient presents with symptoms from cancer, which of the following cancers is most likely to be curablc?

(A) Esophageal carcinoma

(B) Pancreatic carcinoma

(C) Ovarian carcinoma

(D) Choriocarcinoma

<E) Hepatocellular carcinoma

Question 314

A child is born with a large right-sided facial port-wine stain in the distribution of the first and second branches of the trigeminal nerve. What is the child at the highest risk for developing?

(A) Seizures

(B| Bilateral acoustic neuromas

(C) Bilateral retinoblastomas

(D) Thymic aplasia and profound immunodeficiency fE) Diabetes insipidus and diffuse osteopenia

Question 315

In which type of bacterial infection would aztreonam most likely be an effective monotherapy?

(A) Urinary tract infection

(B) Community-acquired typical pneumonia

(C) Community-acquired atypical pneumonia (D> Pharyngitis

(E) Osteomyelitis

Which of the following is the best agent to treat confirmed Chlamydia pneumonia?

(A) Clarithromycin

(B) Piperacillin

(C) Amikacin

(D) Clindamycin

(E) Imipenem

Question 317

Which of the following is not one of the potential or regular functions of the spleen?

(A) To remove senescent red blood cells I B) To store red blood cells

(C) To produce red blood cells

(D) To act as a lymphoid organ (E> None of the above

Question 318

Which of the following is the most common form of cancer affecting the skin?

(A) Basal cell cancer I B ) Squamou s eel I can cer

(C) Malignant melanoma

(D) Cutaneous T cell lymphoma

(E) Metastatic lung cancer

Question 319

A city being studied has a population of 100,00(1. Using culture as the gold standard test, 5000 people in Lhe city are found to have chlamydial infection. A new DNA probe chlamydial test is positive in 4000 people in the city, of whom only 3000 tested positive by culture. What is the sensitivity of the new DNA probe test?

What is the most likely cause of death in a 17-year-old black male?

(A) Homicide

(B) An accident

(C) Suicide

(D) Cancer

Question 321

What is the most likely cause of death in a 17-year-old white male?

(C) Suicide

(D) Cancer

Question 322

When is a fetus most susceptible to teratogenic agents?

( A) The first 3 weeks after conception

(B) The 4th through the 9th weeks after conception

(C) The 10th through 15th weeks after conception

(D) The 16th through 21st weeks after conception

(E) The 22nd through 27th weeks after conception

Question 323

A 64-year-old woman presents with a large, ulcerating breast mass that is highly suspicious for cancer. She tells you that she is not interested in knowing the diagnosis. What is the best approach to this patient?

(A) Ask her why she does not want to know the diagnosis.

(B) Tell her that you think it is best that she know the diagnosis,

(C) Respect the patient's wishes and do not tell her the diagnosis.

(D) Call the patient's relatives and discuss the option with them.

(E) Refuse to withhold the diagnosis from the patient and urge her to consider immediate treatment.

Question 324

Which of the following agents acts by direct binding to the luminal aspect of the gastric mucosa?

(A) Sucralfate

(Bj Magnesium hydroxide

(Cj Omeprazole

(D) Ranitidine

(E> Metoclopramide

Question 325

What is the treatment of choice for a severe p-blocker overdose?

(A) Isoproterenol (B> Epinephrine <C) Glucagon

(D) Growth hormone

(E) Cortisol

Question 326

Which of the following statements regarding gestational trophoblastic disease is incorrect?

(A) A human chorionic gonadotropin level that fails to return to zero after an abortion or delivery often is helpful in making the diagnosis.

(B) An ultrasound can help establish the diagnosis and may reveal a "snowstorm" pattern.

(C) A choriocarcinoma can be excluded if the symptoms occur after a term delivery.

(D) A dilation and curettage is adequate treatment for most cases.

( E) If metastases occur, the disease often still responds to chemotherapy.

Question 327

A 33-year-old sexually active woman presents with a complaint of vaginal lesions. On examination, the woman has exophytic, pedunculated, soft, moist, discrete lesions on the external genitalia, The lesions are nontender and do not appear ulcerated. What is the most likely diagnosis'/

(A) Condyloma acuminatum ( B ) Condyloma latum

(C) Vaginal squamous cell cancer

(D) Chancroid

(E) Herpes genitalis

In which of the following conditions would a pulmonary artery wedge pressure of 26 mniHg (normal = 8-12 mmHg) be unexpected?

(A) Severe mitral regurgitation

(B> Cardiogenic shock

(C) Untreated renal failure

(D) Septic shock

(E) Severe mitral stenosis

Question 329

Which of the following is unlikely in severe hypovolemia?

(A) Lower than normal skin temperature

(B) Low pulmonary capillary wedge prcssure

(C) Low systemic vascular resistance

(D) Low urine output

(E) 1j>w blnod pressure

Question 330

Which of the following would be unlikely to result purely from cor pulmonale?

(A) Distended neck veins

(B) Pulsusalternans

(C) Hepatomegaly

(D) Nocturia

(E) Lower extremity edema Question 331

A 64-year-old woman with a family history of breast cancer presents with a self-detected breast mass in her right breast. On physical examination, the mass is hard and slightly mobile, and it is difficult to feel distinct margins of the lesion, which seems to measure approximately 3x4 cm. The left breast is unremarkable on examination, and no axillary lymph nodes are palpable. What is the most appropriate management of the mass?

(A) Mammography

(B) Ultrasound

(C) CT scan of the chest to look for metastatic disease tDj Stereotactic needle biopsy

(E) Excisional biopsy

Which of the following complications is unlikely in a person wiih bulimia nervusa, assuming that no other psychiatric disturbances are present?

(A) Weight less than 75% of ideal body weight lB| Laxative abuse

(C) Heavy, prolonged exercise

(D) Periods of binge eating during which the person feels no control

(E) Female sex

Question 333

An IK-rm>nth-old boy is brought in with a fever, and a urinalysis reveals that the infant is having a third urinary tract infection since birth. Physical examination is within normal limits, and the infant has no other notable history. Which of the following is most likely to be the underlying cause of the infections?

(A) Posterior urethral valves (Ft) Exstrophy of the bladder (C) Hypospadias

Ureterocolic fistula (E) Prune-belly syndrome (Eagle-Barrett syndrome)

Question 334

Which of the following is least likely to be a result of hemolytic-uremic syndrome?

(A) Acute renal failure requiring dialysis

{B) History of recent gastrocntcriLis

(C) Microangiopathic hemolytic anemia

(D) Thrombocytopenia

(E) Antiplatelet antibodies

Question 335

Which neoplasm is least likely in a 3-y ear-old child?

(A) Wilms" tumor (nephroblastoma)

(B) Neuroblastoma

(C) Leukemia f D> Posterior fossa brain tumor (E) Osteogenic sarcoma

Which neoplasm is least likely in a 12-year-old child?

(A) Neuroblastoma

(B t Primary malignant bore tumor

(C) Leukemia

(D) Lymphoma

(E) Soft tissue sarcoma

Question 337

Which of the following would describe best a 7-month-old infant with thrombocytopenia, eczema, and immunodeficiency?

(A) Glan/mann's thrombasthenia

(B) Bernard-Soulier syndrome

(C) Idiopathic thrombocytopenic purpura

(D) Wiskott-Aldrich syndrome

(E) Kasabach-Merritt syndrome

Question 33H

A 57-year-old man undergoes open cholecystectomy for gangrenous cholecystitis. On postoperative bays 1 and 2, the man appears increasingly anxious and tremulous but denies pain and simply says ''hospitals make bim nervous." On postoperative day 3, the man becomes disoriented and agitated, calling out that he is being attacked when no one else is in the room. Other than the mental status changes, the physical examination is unremarkable. Vital signs arc unremarkable other than a blood pressure of 168/88 nimHg, and the patient has been afebrile since surgery. Complete blood count and electrolytes arc within normal limits. Oxygen saturation measured by pulse oximetry is 97%, What is the most likely cause of the patient's symptoms?

(A) Delirium tremens

(B) Pulmonary embolus

(C) Sepsis

(D) Acute bypoadrenalism

(E) Occult hyponatremia

339-344 Matching

Decide the most likely cause of third-trimester bleeding for the following numbered items. Each answer may only be used once, if at all

(A) Placenta previa

(B) Abiuptio placentae

(Q Uterine rupture

(D) Vasa previa

(E) Cervical lesions (e.g., herpes, gonorrhea, Chlamydia, Candida)

(F) Bleeding disorder in the mother

(G) Cervical cancer

(H) Bloody show

339 A 36-year-old gravida 6, para 5, woman with two prior cesarean sections has sudden onset of severe abdominal pain and hypotension during oxytocin infusion.

340 A 26-year-old gravida I, para 0, woman with triplets has painless vaginal bleeding and stable vital signs, and one of the fetuses shows marked tachycardia and decreased spontaneous movements.

341 A 22-year-old gravida 1. para 0, woman has a blood-tinged, mucouslifce discharge that resolved immediately (before she got to the hospital) and subsequently went into labor. The woman is anxious, and the cervix is dilated to 4 cm. The fetus seems stable by external fetal monitoring.

342 A 34-year-old gravida 5, para 4, woman with multiple uterine fibroids presents with profuse, painless bleeding ai 40 weeks. She said the bleeding became bright red and more diffuse as she got nearer to the hospital-

343 A 19-year-old gravida 3, para 0, woman presents with bleeding, a tender uterus, and fetal distress. Urine toxicology screen is positive for cocaine.

344 A 37-year-old promiscuous gravida 4. para 3. woman with an extensive smoking history and no routine medical care over the last 10 years presents with vaginal bleeding and a friable, eroded cervix. Cerv ical cultures are negative.

345-35« Matching

Use each item only once or not at all.

(A) Somatization disorder (B> Conversion disorder

(C) Hypochondriasis

(D) Body dysmorphic disorder

(E) Factitious disorder

(F) Malingering

(G) Dissociative fugue

(H) Multiple personality disorder fl) Social phobia

345 Persons with this condition are most likely to have beer sexually abused as children,

346 Only secondary gain is to assume the sick role.

347 Focus on symptoms but no overt secondary gain

34N A woman has a fight with boyfriend, then soon after is unable to move Iter arm.

349 Patients with this condition often desire cosmetic plaslic surgery.

350 Focus on a disease hut no overt secondary gain

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