Request edit access
INTERNAL MEDICINE MCQ TRIAL 1
Please take your time and read the scenarios well, then attempt to answer.
Sign in to Google to save your progress. Learn more
Email *
1. A 60-year-old man is evaluated for a 3-month history of persistent left lower facial pain in the mandibular region that has worsened and been unresponsive to treatment with acetaminophen, 4 g four times daily, over the past 3 weeks. He describes the pain as “electrical” in nature, often triggered by dental manipulation or extreme temperature exposure. His dentist found no oral or dental cause for the pain but treated him with a 14-day course of amoxicillin for presumptive sinusitis without improvement. The physical examination, including a complete neurologic evaluation, is normal. Laboratory studies and CT of the sinuses are normal. Which of the following is the most cost-effective and efficacious treatment for this patient? *
1 point
2. A 35-year-old woman is evaluated for a red right eye that is also tearing; her symptoms have developed over the past 24 hours. Her vision is not altered, and she denies eye pain, trauma to the eye, changes in visual acuity, or pruritus. On physical examination, the right conjunctiva is diffusely red, and the eye is tearing with clear discharge. The left eye appears normal. The vision is 20/20 in both eyes. Which of the following is the most appropriate next step in the management of this patient  *
1 point
3. An 18-year-old woman is evaluated for acne. She has had intermittent outbreaks of acne over the past 5 years. She is currently a college student who experiences stress associated with her studies. Because of her busy schedule, she often eats fast food and snacks on chocolate bars. She has tried over-the-counter topical salicylic acid and antibiotic medications to treat her acne without benefit. She is sexually active and uses barrier contraception. On physical examination, she has comedonal acne with open (blackheads) and closed (whiteheads) comedones on her face. There are no nodular lesions. Which of the following is the most appropriate management strategy for this patient's acne? *
1 point
4. A 72-year-old man is evaluated for decreased central vision, poor night vision, and floaters. The patient has a 20-year history of type 2 diabetes mellitus controlled with oral medications, a 20-pack-year smoking history, and hypertension. The patient has not had an eye examination in over 5 years but was told at that time that he had some early changes in his eyes due to diabetes. On physical examination, the blood pressure is 135/89 mm Hg. The ophthalmoscopic examination shows microaneurysms, cotton-wool spots, dilated retinal vessels, and new formation of retinal vessels. Neurologic evaluation is remarkable for decreased sensation in the lower extremities. Laboratory studies include a hemoglobin A1C of 7.9% and a fasting plasma glucose level of 160 mg/dL (8.88 mmol/L). Which of the following is the most appropriate next step in the treatment of this patient's vision? *
1 point
5. A 25-year-old woman is evaluated for a 3-day history of malodorous vaginal discharge. She denies any itching or irritation. She has been sexually active with the same partner for 6 months, using condoms to avoid pregnancy. Her medical history is unremarkable. On physical examination, external genitalia are normal. Internal vaginal examination reveals a homogenous, white, malodorous discharge that does not adhere to the vaginal walls, without the presence of vaginal erythema. Bimanual examination reveals no cervical motion tenderness. Mixing the vaginal discharge with a normal saline preparation reveals the presence of clue cells. Which of the following is the most likely diagnosis? *
1 point
6. A 22-year-old woman is evaluated during a routine evaluation. She has no medical problems except for feeling tired all the time, which she attributes to working part-time while attending classes full-time and her many social activities. She denies depression, anhedonia, or constipation, and, although she has not gained weight, she has not lost any weight despite being on a diet for years. She has occasional heartburn, particularly after alcohol consumption, which she successfully self-treats two to three times per week with calcium carbonate, 500 mg. She admits to occasional binge drinking, once or twice yearly, but her CAGE score is 0/4. She smokes because it helps her to control her weight. On physical examination, she is slightly overweight, with a BMI of 27. Her heart rate is 68/min and her blood pressure is 188/62 mm Hg. The oropharynx is remarkable for an excoriation at the back of the throat and mild bilateral parotid gland swelling. The remainder of the physical examination is normal. Complete blood count and serum thyroid-stimulating hormone level are unremarkable. Serum electrolytes are notable for mildly decreased serum potassium, slightly elevated serum bicarbonate, and mildly decreased serum chloride levels. The serum creatinine/blood urea nitrogen levels, liver chemistry tests, and urinalysis are unremarkable. Which of the following is the most likely diagnosis? *
1 point
7. A 22-year-old woman is evaluated for acne on her face that has worsened over the past few weeks and includes inflammatory and small nodular lesions. The patient has a history of moderate-to-severe acne outbreaks occurring since she was age 14 years. Her parents and siblings also had serious acne. She has been taking topical retinoid and antibiotic preparations with no improvement. She is otherwise healthy. She takes combined oral contraceptives for birth control and has regular menses. On physical examination, she has several papulonodular lesions on the face. The lesions are tender, and some have pustules. Which of the following is the most appropriate next step in the management of this patient? *
1 point
8 A 32-year-old nurse presents with episodes of anxiety, headache and sweating. During one attack her blood pressure is measured at 190/140. Which of the following is true? *
1 point
9. A 43-year-old woman is evaluated during an initial visit. She has brought with her a written list of health problems, including headaches, muscle pain and weakness, abdominal pain, diarrhea, sinusitis, and frequent urinary tract infection. She also reports problems with sexual intimacy. For the past 4 years, her health problems have interfered with her ability to work. Previous treatments for headache have included venlafaxine, verapamil, propranolol, and gabapentin. For each of these, she reports no relief or an intolerance to the medication. Previous evaluation by a neurologist, gastroenterologist, and rheumatologist yielded no diagnosis of her medical problems. Previous laboratory studies, including complete blood count; erythrocyte sedimentation rate; serum B-12/folate, electrolyte, creatinine, blood urea nitrogen, and thyroid-stimulating hormone levels; liver chemistry tests; serum lipid panel; serum rheumatoid factor and antinuclear antibody assays; heterophile antibody testing; and urinalysis, were normal. Results of MRI of the head, colonoscopy, and CT of the abdomen were negative. She has not had any tick exposures or bites nor any memory of experiencing an expanding red rash. The patient describes health problems in response to each portion of the general review of systems. When she is asked if she feels depressed, she becomes visibly angry. The physical examination, including vital signs, is normal. Which of the following is the most appropriate management option for this patient? *
1 point
10. A 30-year-old man was evaluated for a 4-day history of acute unilateral eye pain with a foreign-body sensation in the eye. He reported no antecedent trauma, and the pain was worse in the morning on awakening. The medical history was noncontributory. On physical examination, there was conjunctival erythema of the affected eye, with no evidence of a foreign body. Results of fluorescein staining indicated a corneal ulcer. The patient was prescribed pain medication and was counseled to call the next day if there was no resolution or worsening of symptoms. The patient calls the next day, stating that his pain has gotten progressively worse and there is a mucopurulent discharge from his eye. Which of the following possible patient factors is likely to be helpful in establishing a diagnosis? *
1 point
11. A 67-year-old woman is evaluated because she is worried that her memory is not what it used to be. She has trouble remembering where she places her keys and purse and sometimes has difficulty remembering where she parked her car on shopping trips. She is otherwise well and is fully independent in performing her activities of daily living. She denies depression or anhedonia and plays a round of golf each week. Her medical history includes hypertension and hypothyroidism well controlled with hydrochlorothiazide, lisinopril, and levothyroxine. She takes no herbal supplements, and her only other medications are low-dose enteric-coated aspirin, calcium, and vitamin D. On physical examination, her Mini–Mental State Examination score is 28/30. The remainder of her examination is unremarkable. Her most recent laboratory studies of 4 months ago, including complete blood count, mean corpuscular volume, liver chemistry tests, and serum creatinine, electrolyte, blood urea nitrogen, calcium, and thyroid-stimulating hormone levels, were normal. Which of the following is the most appropriate management option for this patient? *
1 point
12. A 54-year-old woman undergoes urgent preoperative evaluation before resection of a partially obstructing mass in the descending colon. She has lost 9 kg (20 lb) over the past 6 months. Her history includes moderately severe chronic obstructive pulmonary disease (COPD) but no known coronary artery disease. She smokes 1 pack of cigarettes daily. Her only medication is a combined ipratropium–albuterol oral inhaler. On physical examination, she appears ill. The blood pressure is normal. Weight is 48.9 kg (108 lb). Oxygen saturation is 88% on room air. On cardiopulmonary examination, the lungs are clear, with distant breath sounds and a prolonged expiratory phase, and the heart has a regular rhythm without murmur or gallop. On abdominal examination, high-pitched bowel sounds are heard, and a 6-cm mass, tender to palpation, is detected in the left lower quadrant of the abdomen. Laboratory tests are normal except for a hemoglobin of 10.0 g/dL (100 g/L) and a serum albumin level of 2.9 g/dL (29 g/L). The chest radiograph shows only changes consistent with COPD, and the electrocardiogram is normal. In addition to routine use of scheduled bronchodilator treatments and supplemental oxygen, which of the following strategies is most appropriate in preventing postoperative pneumonia in this patient? *
1 point
13.  A 37-year-old man is evaluated during a routine visit and reports feeling depressed. He meets the criteria for major depression and generalized anxiety disorder. The medical history is otherwise noncontributory. The physical examination, including vital signs, is normal. Laboratory studies are unremarkable. Which of the following is the most appropriate treatment option for this patient? *
1 point
14.  A 37-year-old man is evaluated for frontal headaches, nasal congestion, and mucopurulent nasal drainage that have persisted intermittently for several years. He also has fatigue, a nighttime cough, and decreased sense of smell. Over the past 4 months, he has received three successive courses of antibiotics for worsening symptoms—initially with weeklong courses of trimethoprim–sulfamethoxazole and doxycycline. Most recently, he completed a 3-week course of amoxicillin–clavulanate in combination with a nasal steroid inhaler, nasal saline irrigation, and an oral decongestant. This treatment regimen provided only partial relief. He has no history of allergic rhinitis, eczema, or drug allergy. On physical examination, he is afebrile. The turbinates are edematous, with yellowish mucus between the right middle turbinate and lateral nasal wall. The septum is deviated to the right but with no nasal polyps. Percussion of his right maxillary sinus elicits mild tenderness. Which of the following is the most appropriate management for this patient's condition? *
1 point
15. A 55-year-old woman is evaluated during a routine visit and seeks medication to help her lose weight. The patient had begun to put on weight after menopause at age 49 years. She has tried multiple diets but has failed to maintain the weight loss she initially achieves with each diet. She does not smoke or drink alcohol. Her medical history is significant for hypertension, for which she takes three medications. On physical examination, the pulse rate is 65/min, and the blood pressure is 142/90 mm Hg. The BMI is 33. The remainder of the physical examination is normal. Which of the following medications is the most appropriate treatment for this patient? *
1 point
16.  A 64-year-old man with end-stage metastatic prostate cancer is experiencing worsening skeletal pain throughout his back and bilateral lower extremities. He has already experienced disease progression with anti-hormonal therapy, has refused further chemotherapy, and has received the maximal dose of radiation to the spine and metastatic lesions. He had been controlling his pain with regular NSAID use but now requires short-acting narcotics almost every 4 to 6 hours. He is requesting a long-acting medication for his pain control, and his current health insurance does not include a pharmacy benefit. The remainder of the medical history is noncontributory. On physical examination, no focal neurologic findings are noted. Results of renal function and liver chemistry tests are normal. Which of the following is the most cost-effective choice for long-acting analgesic medication in this patient? *
1 point
17. A 24-year-old woman with Down's syndrome is evaluated for hair loss. Hair comes out in patches when she washes or brushes it. She feels well and has had no recent stressors or changes in her routine. She takes no medications. She is not fatigued and has had no recent change in weight. On examination, she has a well-demarcated bald patch in the occipital area. The area shows a small oval patch of smooth skin with no scale or redness. Wood's light examination is negative. Which of the following is the most likely diagnosis? *
1 point
18.  A 68-year-old man is evaluated in the emergency department with a 5-day history of shortness of breath. He describes being jarred in an elevator 5 days earlier and sustaining a large bruise on his right flank. That evening, he had trouble sleeping from the pain, but finally managed to rest while sitting in a recliner. Over the past 5 days he has had progressive shortness of breath; originally it was related to exertion, but it now occurs at rest. He continues to sleep in the recliner for comfort. He does not smoke. On physical examination, an ecchymosis is evident on his right flank. He is mildly dyspneic with conversation. BMI is 25.7. Temperature is 38.3 °C (100.9 °F), pulse rate is 112/min, respiration rate is 26/min, and blood pressure is 142/72 mm Hg bilaterally. Pulse oximetry is 93% on room air. The trachea is midline, and jugular venous pressure is 6 cm. Lungs are dull to percussion, and there are decreased breath sounds on the right side of the chest. Cardiovascular point of maximal impulse is at the fifth intercostal space, midclavicular line. He has tachycardia. No rubs, murmurs, or gallops are heard, and there is no evidence of edema. The electrocardiogram shows sinus tachycardia without acute ST- or T-wave changes. Which of the following is the most likely diagnosis? *
1 point
19. A 42-year-old woman is evaluated during a routine examination. She has been married and monogamous for 21 years. Her history includes celiac sprue, which was diagnosed at age 25 years and for which she maintains a gluten-free diet that limits her symptoms. She also has mild rosacea and frequent urinary tract infections. Her mother was recently diagnosed with hypothyroidism, but the patient reports no fatigue or hot or cold intolerance, and she has had no changes in weight, hair, skin, and nails. The patient exercises regularly. She reports no polyuria or polydipsia. On physical examination, the patient is fair-skinned. BMI is 18.9, and weight has been stable. The pulse rate is 68/min, and blood pressure is 102/66 mm Hg. The remainder of the physical examination is unremarkable. Which of the following is the most appropriate management for this patient *
1 point
20.  A 77-year-old man who wears glasses is evaluated for symptoms of increasing visual glare when he is out at night, but he reports no problems with bright sunlight, reading, or watching television. He no longer drives because he lives in a downtown condominium and prefers to walk and use public transportation. His history is negative for diabetes, corticosteroids, and cigarette smoking. His corrected visual acuity is 20/25 in each eye. Direct ophthalmoscopy reveals bilateral red reflexes with central opacities, but the optic disks and retinal vessels are normal. Which of the following is the most appropriate management for this patient's visual symptoms? *
1 point
Submit
Clear form
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms