Question no. 373

  

A one year old child is brought in for a regular "well baby" check up. The child appears to have strabismus. The reflection of a bright light from the ceiling of the examination room comes from a different place in each eye. The family explains that the child has always looked that way, and there has been no recent change in the appearance his eyes. Which of the following is the most effective management? 

Question no.372

A previously healthy male postal worker complains of fever, headache, myalgia and cough for the past 3 days.He reports that several of his coworkers have also been ill with similar complaints. His leukocyt count is normal with a relative lymphopenia. A chest X-ray shows only enlarged hilar shadows.

Question no.369

        A 19 year old high school senior complains of feeling "fat & ugly" despite being extremely thin. She takes small amounts of food at meals and occasionally gags herself to induce vomiting after meals.

Which of the following is commonly associated with this disorder?

a) Menorrhagia.

b) Metrorrhagia.

c) Loss of body hair.

d) Bradycardia.

e) Thrombocytopenia.

Question no.362

        You make the diagnosis of Marfan syndrome in a very tall 22 year old man with long, thin extremities.

1) What other finding is associated with this disease?

        A) Family history in 100%of the patients.

        B) Upward sublaxation of the lenses.

        C) Mental retardation.

        D) Malar rash.

        E) Increased length of trunk compared with the limbs.

USMLE 33

A 35 year old morbidly obese woman with newly diagnosed  type 2 DM is interested in gastric bypass to help her lose weight.

Which one of these factors would preclude her from being considered a good candidate for surgery?

A) BMI of 38.

B) HTN.

C) Age.

D) DM.

E) Inability to follow a diet.

USMLE 32

     A 2 year old child was recently adopted from India.She appears to be healthy,and there are no abnormal symptoms.Her weight and height are at 25th percentile for age.Her examination is normal .On screening,you find a positive TB skin test using  PPD with 20mm induration.She has a history of receiving a BCG vaccination at birth.

Your management plan is to do which of the following?

A) Obtain a chest x-ray and treat only of this is abnormal.

B) Repeat the test in 3-6 months.

C) Attribute the +ve PPD to the BCG vaccination & do serial yearly x-rays.

D) Obtain sputum cultures.

E) Obtain a CXR and initiate prophylactic ttt with INH.

USMLE 31

   A 60 year-old patient with long standing diabetes has a creatinine of 3.6, which has been stable for several years.

Which of the following antibiotics requires the most dosage modification in chronic renal failure?

A) Gentamycin.

B) Tetracycline.

c) Erythromycin.

D) Nafcillin.

E) Chloramphenicol.

USMLE 30

     

    A 54 year old man presents to ER complaining of epigastric discomfort, which began while he was walking after dinner about one hour earlier.He hasn't received medical care for several years.On examination he is moderately obese and  his Bp 160/98. His ECG reveals inferior wall myocardial infarction.

Which of the following is the most appropriate next step in management?

A) Trial of antacid immediately.

B) Reassurance and arrange outpatient follow up.

C) Arrange for cardiac ICU bed.

D) Begin thrombolytic therapy in the ER.

E) Arrange for urgent echocardiogram.

USMLE 29

A mother of a 4 year old girl brings her daughter to see you because the girl developed breasts 6 months ago. The girl has had no vaginal bleeding, and there is no pubic hair. She takes no medication.

1-Which of the following is the most appropriate next diagnostic step?

A) Ultrasound of the pelvic.

B) pelvic examination under anaesthesia.

C) CT scan of her head.

D) serum estradiol concentration.

E) serum FSH concentration.

2- The tests you ordered are normal for a prepubertal girl.

Which of the following is the most likely diagnosis?

A) Ingestion of mother's COCs.

B) A granulosa cell tumor.

C) 21 hydroxylase deficiency.

D) Polycyctic ovary syndrome.

E) Premature thelarche.

USMLE 28

A 30 year-old woman has used COCs for 5 years with no problem.However, she just read an article about complications of COCs and asks you about the risks and hazards of taking COCs.

You will tell her :

A) The risk of developing endometrial carcinoma is decreased.

B) The risk of developing ovarian cancer is increased.

C) The risk of developing PID in increased.

D) The risk of ectopic pregnancy is increased.

E) The risk of bearing a child with major congenital anomalies is increased if taken while pregnancy.

USMLE 27

A 46 year old male living in a homeless shelter is exposed to TB from a fellow resident. He is found to have a 15 m of induration on the mantoux skin test.

Which of the following risk factors will increase the man's likelihood of developing active TB subsequent to his infection?

a) History of cough variant asthma.

b) Scliosis.

c) Chronic obstructive pulmonary disease (COPD).

d) Bronchitis.

e) Siderosis.

USMLE 26

A 56 year old retired policeman has had hypertension for about 15 years for which he takes hydralazine.He has a 35 pack -year tobacco history and continues to smoke one pack a day. On his visit, he complains about the appearance of his nose (nasal erythema) and asks is some thing can be done to decrease the redness.

Which of the following is correct?

A) Hydralazine doesn't play a role in his nasal erythema.

B) Smoking probably aggrevates the dilatation of the blood vessels on his nose.

C) He should avoid alcohol and spicy foods.

D) There is no effective topical therapy.

E) Laser therapy will worsen the erythema.

USMLE 25

57 year old woman had a left modified radical mastectomy for intraductal carcinoma 2 year previously. She presents with lethergy, confusion and thigh pain.X rays reveal a lytic lesion in the shaft of the femur.

Which of the following blood abnormalities is most likely?

a) High magnesium.

b) Low calcium.

c) High glucose.

d) High calcium.

e) High potassium.

Which of the following is the most appropriate initial therapy?

a) Tamoxifen.

b) Vigorous saline infusion.

c) Radiotherapy to the femur.

d) Chemotherapy.

e) Glucocorticoids.

USMLE 24

A 19 year old high school senior complains of feeling (fat & ugly) despite being extremely thin.She takes small amounts of food at meals and occasionally gags herself to induce vomiting after meals.

Which of the following is commonly associated with this disorder?

a)Metrorrhagia.

b)Menorrhagia.

c)Loss of body hair.

d)Bradycardia.

e)Thrombocytopenia.

USMLE 23

   A 23 year old woman presents with skipped heartbeats and on cardiac examination is found to have a mid-systolic click followed by a late systolic murmur.

Echo shows prolapse of the mitral valve.

Which of the following is true about this condition?

a) Mitral valve prolapse is present in up to 10 % of the population.

b) Prophylaxis against bacterial endocarditis is never recommended.

c) Mitral valve prolapse is more common in men.

d) Risk of pulmonary embolism is high.

e) Ventricular arrhythmias don't occur.

USMLE 22

A 4 year old previously healthy girl presents to the E.R. with a 24-hour history of rectal bleeding & dizziness. She has no other GIT symptoms.

On examination she appears pale. Her heart rate is 140 beats/min, she has a 20 mmHg postural drop in systolic blood pressure. her abdomen is not distended and not tender, and fresh blood and clots are in the rectal vault on rectal examination.

What is your clinical diagnosis?

a)  juvenile rectal polyp.

b) Anal fissure.

c) Bleeding Meckel's diverticulum.

d) Hemorrhoids.

e) Intussusception.

What is the appropriate diagnostic study for her condition?

a) Colonoscopy.

b) Laparoscopy.

c) Technetium scan.

d) UGI contrast study with small bowel follow through.

e) Barium enema.

USMLE 21

A 17 year old girl presents with a 2 day history of lower abdominal discomfort, burn in micturition & increased frequency of urination. She had her first sexual intercourse last week. Her vital signs are stable.

Examination shows supra-pubic tenderness. Urinalysis shows +ve esterase, 50+ WBC and many bacteria.

Which of the following is the most likely mechanism responsible for her clinical condition?

A- Hematogenous spread of infection.

B- Lymphatic spread of infection.

C- Sexual transmission.

D- Poor genital hygiene.

E- Ascending infection.

Medical Case 32

A 60 year old woman is very worried because she recently had a close family member and friend die, One after the other, First her 85 year old mother died of an ovarian cancer that was diagnosed 4 years ago.

Last week, she lost her best friend to lung cancer that metastasized to brain & liver.

Today, her 53 year old sister learned that she has breast cancer. 

She has regular pap smears and breast examinations. She has read that there are a few ways that have proved to prevent breast cancer.

Which of the following measures has the best evidence of preventing breast CA in high risk woman?

a) BRCA screening.

b) Prophylactic oophorectomy.

c) Tamoxifen.

d) Mammograms every month.

e) Low fat diet.

USMLE 20

A 70 year old man presents to urgent care complaining of a painful, swollen left knee. He previously has had no problems with this knee.

3 days prior to onset, he went out dancing for 3 hours but recalls no specific injury.

**Examination of the knee reveals a moderate sized effusion and mild pain with any range of motion. Plain x-ray shows no fracture.

Which of the following is the best next management?

a) MRI of Knee.

b) Aspiration of effusion fluid.

c) Physical therapy referral.

d) Arthroscopy.

e) Rest, ice and leg elevation.

USMLE 19

A 32 year old woman is visiting you in your primary care office as a new patient.Overall, she is healthy.On taking a a family history , you learn that her mother was diagnosed with colorectal cancer at the age of 52.

When should this patient start being screened for colorectal cancer?

a) There is no proven benefit for colorectal cancer screening.

b) at age of 40

c) at age of 30

d) at age of 60

e) at age of 50