05-14-2009, 03:11 PM
1.A 34-year-old mother of 2 who is now 8 weeks pregnant and works in a pre-school complains of an erythematous rash on her face and limbs with fever. She remembers a child in her class had a similar rash 2 weeks ago. She also complains of joint pains in her hands and some fatigue.
On physical exam she appears non-toxic with a faint salmon colored rash on her forearms, with a temperature of 38° C. She has symmetrically swollen metacarpophalangeal and interphalangeal joints. She is up to date on her polio and measles-mumps and rubella vaccines as a child.
The MOST likely cause of her illness is:
A) Parvovirus B-19
B) Enterovirus infection
C) Coxsackie virus
D) Rubella
E) Atypical measles
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2.A 28-year-old man with history of Mitral Valve Prolapse comes to your office complaining of chest pain that began 1 day prior to presentation. He states he has had similar episodes recently. He describes it as searing pain at the center of his chest that now radiates to his neck. He denies an exertional component, diaphoresis, nausea, emesis, abdominal pain or dyspnea.
Your nurse has recorded two blood pressures in the right and left arm that are markedly different however she tells you she thinks this is because his arms are too long.
Physical exam reveals a diastolic murmur, no S3, marked scoliosis, clear lung fields and no edema.
The MOST likely diagnosis in this patient is?
A) Marfan™s Syndrome
B) Costochondritis
C) Mitral Valve Prolapse with Mitral Regurgitation
D) C5-6 herniated disc
E) Acute Coronary Syndrome
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3.A 34-year-old woman presents to your clinic with a variety of complaints that have been worsening over the past year or so. She notes fatigue, amenorrhea, and weight gain. She states that her primary physician diagnosed her with hypothyroidism several months ago, and she has been faithfully taking thyroid hormone replacement. Her thyroid-stimulating hormone (TSH) has been in the normal range over the last two laboratory checks. When her symptoms did not improve on synthroid, she was sent to your clinic for further evaluation. A diagnosis of pan-hypopituitarism is considered. All of the following are consistent with normal pituitary function except
A. basal elevation of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in a postmenopausal woman
B. elevation of aldosterone after infusion of cosyntropin
C. elevation of growth hormone after ingestion of a glucose load
D. elevation of cortisol after injection of regular insulin
E. elevation of TSH after infusion of thyrotropin-releasing hormone (TRH)
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4.A 54-year-old woman is referred to endocrinology for evaluation of osteoporosis after a recent evaluation of back pain revealed a compression fracture of the T4 vertebral body. She is perimenopausal with irregular menstrual periods and frequent hot flashes. She does not smoke. She otherwise is well and healthy. Her weight is 70 kg, and height is 168 cm. A bone mineral density scan shows a T-score of “3.5 SD and a Z-score of “2.5 SD. All of the following tests are indicated for the evaluation of osteoporosis in this patient except
A. 24-h urine calcium
B. follicle-stimulating hormone and luteinizing hormone levels
C. serum calcium
D. renal function panel
E. vitamin D levels (25-hydroxyvitamin D)
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5.The Diabetes Control and Complications Trial (DCCT) provided definitive proof that reduction in chronic hyperglycemia
A. improves microvascular complications in type 1 diabetes mellitus
B. improves macrovascular complications in type 1 diabetes mellitus
C. improves microvascular complications in type 2 diabetes mellitus
D. improves macrovascular complications in type 2 diabetes mellitus
E. improves both microvascular and macrovascular complications in type 2 diabetes mellitus
On physical exam she appears non-toxic with a faint salmon colored rash on her forearms, with a temperature of 38° C. She has symmetrically swollen metacarpophalangeal and interphalangeal joints. She is up to date on her polio and measles-mumps and rubella vaccines as a child.
The MOST likely cause of her illness is:
A) Parvovirus B-19
B) Enterovirus infection
C) Coxsackie virus
D) Rubella
E) Atypical measles
=====================================================
2.A 28-year-old man with history of Mitral Valve Prolapse comes to your office complaining of chest pain that began 1 day prior to presentation. He states he has had similar episodes recently. He describes it as searing pain at the center of his chest that now radiates to his neck. He denies an exertional component, diaphoresis, nausea, emesis, abdominal pain or dyspnea.
Your nurse has recorded two blood pressures in the right and left arm that are markedly different however she tells you she thinks this is because his arms are too long.
Physical exam reveals a diastolic murmur, no S3, marked scoliosis, clear lung fields and no edema.
The MOST likely diagnosis in this patient is?
A) Marfan™s Syndrome
B) Costochondritis
C) Mitral Valve Prolapse with Mitral Regurgitation
D) C5-6 herniated disc
E) Acute Coronary Syndrome
=====================================================
3.A 34-year-old woman presents to your clinic with a variety of complaints that have been worsening over the past year or so. She notes fatigue, amenorrhea, and weight gain. She states that her primary physician diagnosed her with hypothyroidism several months ago, and she has been faithfully taking thyroid hormone replacement. Her thyroid-stimulating hormone (TSH) has been in the normal range over the last two laboratory checks. When her symptoms did not improve on synthroid, she was sent to your clinic for further evaluation. A diagnosis of pan-hypopituitarism is considered. All of the following are consistent with normal pituitary function except
A. basal elevation of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in a postmenopausal woman
B. elevation of aldosterone after infusion of cosyntropin
C. elevation of growth hormone after ingestion of a glucose load
D. elevation of cortisol after injection of regular insulin
E. elevation of TSH after infusion of thyrotropin-releasing hormone (TRH)
===============================================
4.A 54-year-old woman is referred to endocrinology for evaluation of osteoporosis after a recent evaluation of back pain revealed a compression fracture of the T4 vertebral body. She is perimenopausal with irregular menstrual periods and frequent hot flashes. She does not smoke. She otherwise is well and healthy. Her weight is 70 kg, and height is 168 cm. A bone mineral density scan shows a T-score of “3.5 SD and a Z-score of “2.5 SD. All of the following tests are indicated for the evaluation of osteoporosis in this patient except
A. 24-h urine calcium
B. follicle-stimulating hormone and luteinizing hormone levels
C. serum calcium
D. renal function panel
E. vitamin D levels (25-hydroxyvitamin D)
=================================================
5.The Diabetes Control and Complications Trial (DCCT) provided definitive proof that reduction in chronic hyperglycemia
A. improves microvascular complications in type 1 diabetes mellitus
B. improves macrovascular complications in type 1 diabetes mellitus
C. improves microvascular complications in type 2 diabetes mellitus
D. improves macrovascular complications in type 2 diabetes mellitus
E. improves both microvascular and macrovascular complications in type 2 diabetes mellitus
eople with type 2 diabetes (then known as non-insulin-dependent diabetes mellitus or NIDDM in the medical community and "sugar diabetes" or "adult-onset diabetes" in the general population) were excluded from the study, as were patients