MCQ Questions

69 96. A 38-year-old woman who is a single mother of two small children comes to the office saying that she feels "halfway tired all the time." Her physical examination is normal. Toward the end of the visit she says anxiously, "My children just don't listen. They make me so angry that I feel out of control sometimes." She pauses. "Yesterday my 7-year-old daughter talked back to me and I slapped her in the face." Her eyes fill with tears. Which of the following is the most accurate statement concerning this patient? (A) She should be reported to child abuse authorities (B) She was clearly a victim of child abuse herself (C) She would benefit from antidepressant medication (D) She would benefit from family counseling (E) She would exhibit better self-control if she were married NOTE: THIS IS THE END OF THE OFFICE/HEALTH CENTER BLOCK. ANY REMAINING TIME MAY BE USED TO CHECK ITEMS IN THIS BLOCK. 70 Block 3: Inpatient Facilities Items 97-120; Time - 30 minutes You have general admitting privileges to the hospital, including to the children's and women's services. On occasion you follow your own patients in the critical care unit. Postoperative patients are usually seen on the regular surgical ward unless the recovery room is specified. You may also be called to see patients in the psychiatric unit. There is a short-stay unit where you may see patients undergoing same-day operations or being held for observation. Also, you may visit patients in the adjacent nursing home/extended care facility and the detoxification unit. ALL ITEMS REQUIRE SELECTION OF ONE BEST CHOICE. 97. A 67-year-old man is admitted to the hospital because of fever, malaise and weight loss for the past 6 weeks. Night sweats began 4 weeks ago. His medical records show that he has had a tonsillectomy, adenoidectomy, mitral valve commissurotomy and sigmoid colon resection for diverticulitis. His temperature has been as high as 38.3°C daily. Today, vital signs are: temperature is 38.8°C , pulse 100/min and respirations 14/min. The patient appears chronically ill but is in no acute distress. Other physical findings include a cotton-wool exudate in the right eye, crackling rales at the lung bases and a moderate blowing grade 2/6 pansystolic murmur. There is moderate left lower quadrant abdominal tenderness. Leukocyte count is 11,500/mm3 with normal differential and hematocrit is 35%. Urinalysis shows 4 WBC/hpf and 10 RBC/hpf. Chest and abdominal x-ray films are normal except for slight left ventricular enlargement. At this which of the following is the most likely diagnosis? (A) Bacterial endocarditis (B) Diverticulitis (C) Hodgkin disease (D) Pyelonephritis (E) Vivax malaria 98. A 60-year-old man is admitted to the hospital because of acute pancreatitis. Laboratory studies show: Serum Blood Amylase 1,000 U/L Hematocrit 42% Calcium 8.4 mg/dL WBC 14,000/mm3 Urea nitrogen 5 mg/dL Results of serum liver chemistry profile are normal. After 48 hours of fluid therapy and observation, a poor prognosis would be indicated by which of the following laboratory studies? (A) Serum alanine aminotransferase (ALT) of 106 U/L (B) Serum amylase of 2,000 U/L (C) Serum bilirubin of 4.2 mg/dL (D) Serum calcium of 6.6 mg/dL (E) Serum glucose of 200 mg/dL 71 Items 99-100 A 25-year-old man has been on life support systems for the past 48 hours following blunt head trauma. 99. Which of the following is the most important criterion to declare the patient brain dead and to permit removal of life support systems? (A) Bedside EEG showing no electrical activity (B) Decorticate and decerebrate posturing (C) Failure to respond to electroconvulsive stimuli (D) Glasgow coma score of 3 or less (E) Unenhanced MRI of the brain showing dilated ventricles 100. Brain death cannot be established in this patient if there is the presence of which of the following? (A) Carotid blood flow (B) Cremasteric reflexes (C) Elevated serum aminoglycoside concentrations (D) Hypothermia (E) Marked cerebral edema END OF SET Items 101-102