08-20-2015, 05:30 AM
1.An 18-year-old man is brought to the emergency department by friends 1 hour after they found him on the couch at a party unable to move. Earlier that evening, he had been using synthetic heroin. On arrival, his pulse is 85/min, respirations are 18/min, and blood pressure is 130/80 mm Hg. Examination shows stiffness in all extremities, drooling, and slow response to questions. Which of the following brain regions is most likely affected?
A) Cerebellar vermis
B) Globus pallidus
C) Locus ceruleus
D) Mammillary bodies
E) Nucleus accumbens
F) Substantia nigra
2.A 32-year-old woman comes to the physician because of increasingly severe pain that originates in her left shoulder and radiates to her elbow. She describes the pain as constant and burning, rating her current pain as a 7 on a 10-point scale. Eighteen months ago, she sustained a nerve injury of the left upper extremity in a motor vehicle collision. Since that time, she has been unable to return to work. Current medications include oxycodone and gabapentin. Physical examination shows atrophy of the left thenar eminence. Muscle strength in the left forearm and finger flexors is 3/5. On sensory examination, there is severe pain with light stroking of the anterolateral aspect of the left arm. Further sensory testing is deferred. During the examination she tells her physician, "I'm tired of all this. My medication is not strong enough. It only takes the edge off my pain, which is only getting worse. I'm realizing I'll be like this forever." Which of the following is the most appropriate response by the physician?
A) "Are you worried about more nerve damage developing?"
B) "Do you ever use more pain medication than is prescribed?"
C) "Have you been feeling like just giving up?"
D) "Is the pain caused by touch socially limiting?"
E) "Let's review your medical concerns."
3.A 27-year-old woman comes to the physician for an examination prior to starting a new job. She has a 10-year history of binge-eating and self-induced vomiting. She takes no medications. She does not drink alcohol or use illicit drugs. She is 178 cm (5 ft 10 in) tall and weighs 72 kg (160 lb); BMI is 23 kg/m2. Her temperature is 37°C (98.6°F), pulse is 70/min, respirations are 10/min, and blood pressure is 120/70 mm Hg. Physical examination shows yellow dental enamel and abdominal striae. Serum studies are most likely to show which of the following abnormalities?
A) Decreased bicarbonate concentration
B) Increased amylase activity
C) Increased magnesium concentration
D) Increased potassium concentration
E) Increased sodium concentration
4.A 57-year-old woman comes to the physician because of difficulty sleeping, tearfulness, and restlessness since her daughter was diagnosed with metastatic breast cancer 3 days ago. She reports that when she goes to bed at night, she is unable to fall asleep for several hours and lays in bed worrying about her daughter's situation. The patient underwent a mastectomy for breast cancer 7 years ago. She takes acetaminophen/butalbital for occasional migraines. Her vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she is tearful and tense but calms during the conversation. There is no evidence of suicidal ideation. Which of the following is the most appropriate next step in management?
A) Biofeedback
B) Carbamazepine therapy
C) Clonazepam therapy
D) Clonidine therapy
E) Imipramine therapy
F) Olanzapine therapy
G) Pentobarbital therapy
H) Sertraline therapy
5.A 47-year-old woman is brought to the emergency department by her husband because of increasing confusion during the past 2 days. On arrival, she has a generalized tonic-clonic seizure lasting 4 minutes. She has bipolar disorder treated with several medications, but her husband is unsure of their names. He knows that she sometimes takes ibuprofen for mild arthritis pain caused by exercise. He says that she has been active and exercising more lately, but he cannot think of other changes in her routine. She has no history of seizure disorder. She is oriented to person but not to place and time. Her pulse is 90/min, and blood pressure is 140/90 mm Hg. On physical examination, she is tremulous and somnolent. There is bilateral nystagmus. An ECG shows a second-degree atrioventricular block. The most likely cause of this patient's symptoms is an adverse effect of which of the following medications?
A) Bupropion
B) Haloperidol
C) Lithium
D) Risperidone
E) Valproic acid
A) Cerebellar vermis
B) Globus pallidus
C) Locus ceruleus
D) Mammillary bodies
E) Nucleus accumbens
F) Substantia nigra
2.A 32-year-old woman comes to the physician because of increasingly severe pain that originates in her left shoulder and radiates to her elbow. She describes the pain as constant and burning, rating her current pain as a 7 on a 10-point scale. Eighteen months ago, she sustained a nerve injury of the left upper extremity in a motor vehicle collision. Since that time, she has been unable to return to work. Current medications include oxycodone and gabapentin. Physical examination shows atrophy of the left thenar eminence. Muscle strength in the left forearm and finger flexors is 3/5. On sensory examination, there is severe pain with light stroking of the anterolateral aspect of the left arm. Further sensory testing is deferred. During the examination she tells her physician, "I'm tired of all this. My medication is not strong enough. It only takes the edge off my pain, which is only getting worse. I'm realizing I'll be like this forever." Which of the following is the most appropriate response by the physician?
A) "Are you worried about more nerve damage developing?"
B) "Do you ever use more pain medication than is prescribed?"
C) "Have you been feeling like just giving up?"
D) "Is the pain caused by touch socially limiting?"
E) "Let's review your medical concerns."
3.A 27-year-old woman comes to the physician for an examination prior to starting a new job. She has a 10-year history of binge-eating and self-induced vomiting. She takes no medications. She does not drink alcohol or use illicit drugs. She is 178 cm (5 ft 10 in) tall and weighs 72 kg (160 lb); BMI is 23 kg/m2. Her temperature is 37°C (98.6°F), pulse is 70/min, respirations are 10/min, and blood pressure is 120/70 mm Hg. Physical examination shows yellow dental enamel and abdominal striae. Serum studies are most likely to show which of the following abnormalities?
A) Decreased bicarbonate concentration
B) Increased amylase activity
C) Increased magnesium concentration
D) Increased potassium concentration
E) Increased sodium concentration
4.A 57-year-old woman comes to the physician because of difficulty sleeping, tearfulness, and restlessness since her daughter was diagnosed with metastatic breast cancer 3 days ago. She reports that when she goes to bed at night, she is unable to fall asleep for several hours and lays in bed worrying about her daughter's situation. The patient underwent a mastectomy for breast cancer 7 years ago. She takes acetaminophen/butalbital for occasional migraines. Her vital signs are within normal limits. Physical examination shows no abnormalities. On mental status examination, she is tearful and tense but calms during the conversation. There is no evidence of suicidal ideation. Which of the following is the most appropriate next step in management?
A) Biofeedback
B) Carbamazepine therapy
C) Clonazepam therapy
D) Clonidine therapy
E) Imipramine therapy
F) Olanzapine therapy
G) Pentobarbital therapy
H) Sertraline therapy
5.A 47-year-old woman is brought to the emergency department by her husband because of increasing confusion during the past 2 days. On arrival, she has a generalized tonic-clonic seizure lasting 4 minutes. She has bipolar disorder treated with several medications, but her husband is unsure of their names. He knows that she sometimes takes ibuprofen for mild arthritis pain caused by exercise. He says that she has been active and exercising more lately, but he cannot think of other changes in her routine. She has no history of seizure disorder. She is oriented to person but not to place and time. Her pulse is 90/min, and blood pressure is 140/90 mm Hg. On physical examination, she is tremulous and somnolent. There is bilateral nystagmus. An ECG shows a second-degree atrioventricular block. The most likely cause of this patient's symptoms is an adverse effect of which of the following medications?
A) Bupropion
B) Haloperidol
C) Lithium
D) Risperidone
E) Valproic acid