Section 6 Part-I (O1-A man e admitted with Ecol Gacteremia Which of the following Is the most appropiate therapy? ‘Aancomyein| ELinerota (C-Ouinolones, aminoglycasiées, carbepenum, ppersciin, D-Doxvoyeln| E-Ciindamycin (02-4 man comes to emergency room with complain of fever, severe head ache, neck sins and photophobia. (On examination he has weakness in le am and log.what isthe mest appropriate next step in management ofthis patent? ‘A-Cofiaxone, vancomycin, ster Ertiead CT sean Ceftriaxone ‘D-Neuralogy consut steroids (3-what ls the most accurate test for herpes encephalls? ‘Aran biopey B-PCR for O3F‘Beira etre of CSF ‘ E-rzonek prep Serology for herpes fa, lM) (24-4 womans scmitted for herpes encephattls, corfiemd by PCR.ahtr 4 day of aoyelovr her eretinine level begin to ie. Wht is the most appropriate net step in management? KeStop soyelowe ‘cReauce cose of ayclovir and Hydrate {Suit to os familar or valoiiove Surin efoscarnet ‘O5.which ofthe fotowing is most senstive physica! nding of Otc medio? ences Buimmebty CBugm Dibeoresse ight refine Evgosase nearne (5-5 years women presents with tec pain, isolore nasal scharge, bed ts n her mouth snd ever es (On physical examination she has facia! tendemess, Which ofthe following i tho most aocurat test in dignoste? ‘sinus biopsy or apirate ‘Creean xray Scute of stscharge E-Tranellomination test 07-94 yoars woman preconts with facial pain zoloure nasal discharged teste inher mouth and ‘over on physiesl examination she fe focal encores. ‘Wins ete mast appropriate nak slap oF ection or management? BLinesotd xray Amoxil ais ane ¢ decongestant EvEnthromyein and decongestant (co-Which af the folowing comeates best wth an increase Helyhood ef martlty in acute hoptis betiont? Reoliabio B-Prothombine tne CALT Bast Akane phosphatase {2p- which of the folowing wil Bocomesbnormat Blinn Surtees antigen Ce antgen Dicer pt antedy Ear Ft hepet B tbody (ote: Which ofthe flowing indicts tat «person isn longer re for tarsmiting Infection ‘se another person (Aetve infection hes resolved? in Acute hepatitis? ebirbin normalize ‘So aurfoce arian found (G-No Eantigen found ile sore ft antibody found E-ALT normalizes Fras nepatte tibody (011-Which of he ftowing the best indcation of need fr treatment with antiviral melestion ‘ron hepatitis? Bestar Brsurace angen CE antigen ~ - ore iM antbody Ear - Fart hepatitis Be antibody22. Whlch of the folowing ete best inicator tht pregnant woman wil ensmit hepetits inflection foher ene? Sinan Becuraco antigen -E atiaen Decors test antmoay Ft hepatite 8 e antibody Cts-A woman comes to ctnc with multiple painful genial vesces. Wt ithe next slap in manageman!? Beneyeow oaly BAepelot toplcay Creanck stan Eel cts F-Serlouy (14-490 yore oe ganealy hathy woman comes to opd with compin of unary requasney an burning ‘The urinalysis showed more tan 50 WBC po igh power fa hati the appropriate next step in management? Betirotramtain or 3 cape Aerofrantis for? ess ‘tessoune of unary system Ect scan of unary ystem. ‘a16-A man comesin emergency depariment with fever and mur. Blood culture showed streptococcus bows ‘Wansthoracc echocarsiography shows vegetaons. ‘wate the eppropeate next step managoment ofthis patient? ‘Colonoscopy Tren esophogea echecariography (C-Ropeat Blood eure DCT soan af abaomen Surge! vale eptacement (018-4 5 years woman comes tothe ofce with chest pein that has been oecuring since lst cover! ‘asia. The pln snot relay related fo excerton se fs comfortable now The locaton of pln ie retrosteralinepoin is cometime seeotieted wih nausea. Theres no shortness of breath and psin ‘oes nat asta beyond the chet. She has na past modal history. Wate the most aly dagnosie? 2-casio esophageal fix iseose (OERD) unstable angina ericarde| -Prevmethorax [EPrinameta anging| ‘Gr7-which ofthe following le the most kay to benefit patient’ sk of coronary heart isease? ‘hamanietraton of eetrogen atte te of menopause B-Stopping tamaxfon €-stopaing sremtase inhibitors DeRogular exercise E:Rolneation methos euch ae medtation (Ot8-whieh ofthe fotowing a most cengorous to patent In terms tris of coronary ator disease (CAD) ‘Bevatoc Cholesterl BeEloveted Pgloeriae (C-Low HDL igh Density Lipoprotein) D-Siovated LDL (Low Dent Lipoprotein) Eobesiy ‘o18-postmenopavea women develope ches! psn lnmasatly on the hearing nawe of oath of her son in wat. ‘he develops sto chest pai, dyspres ena ST sognent clovation in oae V2 te Vs on ECG.lovsed evel, ‘troponin confirms the myocsrdal ifaraton.Corenary angiogram is normal ncloing absence of ‘on provecting test Echocardiography showing apical left entice ballooning.‘ne tho prosumed mechanism othe elorder? Fekinsance at extagen -tassive catecholamine renee C-Piaquerptre D-Platoloe aggregation : E-embol to coronary ries (220-corecting which ofthe following tek factor for Coronary Artery eiseese{CAD) result in most Inmeclete bonoft to the patent? Aetiyporension Ebabetee (©Dyalipaderis ‘D-Tobaece smoking (2 A 4syyoare woman comes othe ofc with chet paln that hae been occurring since last sverah ‘weeks, The pain eno reniy relate te exertion Sho comfortable now. the looation of pain ‘etrortemaLhe has ne hypertension and ECO fe normal What the most appropiate next step in management? KORE troponin (G-Echo casiogra [-Seorice tolerance tet (ETT) Eangiograpty ct anglosraphy Stott montor (222-4 4 years ol man ie placed onLiinepl as apart of managing GAD In astocston of election ‘facion 25% and symptoms of besthlesenoas. Although e has rles some times in the lung examination. Pelion is aeympiomatie now physic! examination showed minimal pedal esems. Ms Potassium vel an ‘ehh le high on repestexaminstion. His ECG is normal. How would you best manage tis patient? Doha knyeaini Patassam Binding Fei) Benen glucoes SSeotsnert E-Switch Lisinopril te Hyrsazine and nitrates ‘GzE-whieh of te folowing is most common adverse efecto statin medication? 2: habcomyaiyie Bitver ayatuncion (C-Renal dysfunction Encephalopathy Eyportloomia (226-70 year's ol woman comes to the emergancy room with crushing eubsternal chest pain for te lst how ‘The pain racine ff sim and sesasated with anzaty, laphorals and neuse. She deacrbes pain ae "Sore" and cul and cnches her fit non of er chest Sho ha e history of hypertension. What ls most tks tobe found in thie patente? ‘A-Ommot hg decrease blood pressure on inspiration inerase jvgusir venous pressure on inhalation (CTnphasio seratahy sound on ausutstion ‘D-Confinuows machinery murmurs E-S4 galops (025-70 yoo’ od woman comes te the emergency room wit crushing substenal chest pain forthe last hou. Which ofthe folowing EC finding ls assist with wore prognosis? BeST elevation nod AVE ER Intarvs more than 200m (C-ST sievtion nleac V2ve D-Frequont promature ventricular eontractions(PVEs) ELST dopresion in lead VI snd V2 (220-70 yor’ ld woman comes tothe emergency oom with eushingsubsternal ches pan forthe ast hou. ‘What isthe most spproprict nat ctp in management ofthis patient? ‘K-CKME ove E-Morptine (C-osygen therapytitra cubsingul Esspirin F-angioplasy EcTromboiice (227-70 you's ot woman comes tothe emergency room with crushing substorna chest pain forte lest hour ‘An ECG showing ST segment eovaion i Segment V2te V4Aspin has given the patient to chew. Now ‘whet isthe most appropiate next sep In management of this patent? [RCKME ove Becopicogre ‘C-Oxygen therapy D-naretee-eubingual EThromboltcs Foaoglopiasty (o2b-hich ofthe fotowing is most important in desreasng Heo restanose star coronary artery PC! Deitetage procedure.e dome | vosea tome wlth multiple procecures Use ot heparin fr SS manthe afer proces (C-tarterin we after provedure [teoement of Bare meta ett [Placement of drug sing son Pacltaxe selene) (228-4 patient comer tos rural hospital without cardiac catheterization teclty. He has chest pin end [ST Segment elevation. What isthe appropiate axt stop in manaporment ofthis pation? (Refer to carioloay {280-A man comes othe emergency depsrtment with chest pln that efor last 90 minutes and ershing Innature. An does not change wit respiration ar poston of he bony. An ECG showed ST segment Sepression In V2 to V4 eaes.an Aspirn is ven ta the pation. ‘Wit ls the nox most appropiate stp in mansgement ofthis patient? ‘ow molecular weight heparin -Thromboiios (C-GPUnIE biore Dentestes Etorpine Frangloniesty Caat-hlch of he folowing isthe most common cause of death rom CHF (congestive Heart Fall} Pumonary edema iatyocarial intron Careynnia Sudden death Eyocerdeleupture (022-74 year Arcan American man wih itary of listed cerdlomyopsthy deconadary to Ml inthe pasts ‘seen inthe ofice for routine evclstono le asymptomatic ond maintained en Lisnope, ‘retoprall, [Reprenfurosomige and digoxin la tet persistent showed elevated potessium lovel ECS is unchanged. ‘watts the most epproprate next stop n management ofthis patient? ‘Sultch Lisinopril to Gandisarian B-Stop Lisinopel Caer to Hemocsie Star Koyertate. Sich Lino te Hyralzine and rsiycaie. (020-74 your's ald woman comes to emergency deparimont with acuo shortness of breath Respiratory te. Biminute, 8 gallop, rales in ngs and jugulovenous tension. ‘wnat tho bestinta step n management of tis patient? ‘Peso oximeter BLEchocarcography Cirravenoue furozomice D.Ramipr E-Metoprotel Fenesrie(224-4.85 year of od man comes tothe emergency known case of lng cancer with ineressing sudden shonnese St brevis trom tat several dayne basame somawht lghthended today. that whet has brought fim tothe opal fosay.on examination his puso rote 12min, SP-de/Sammet hg on inspiron, Sosr Jugulovencus isension ‘ich of the most appropriate to conf the diagnosis? B-ECGIEKGChect xray E-Eenocarcogram Cerne ethotereston Dicer Ma Choe Xray (205-4. years old man comes to the emereency doparmont wih acute chest panne sls has pain between tie ecepulae he he letory of hypotension and tobacco smoking. His loos pressure ls 170/00rmot hs. ‘ina isthe bet ina eet? Bchost Xray Sctrapecnaphapes!exhocuriogram CaEKe ° ‘Transthoracic echocardiogram Edagiogam -cT angiogram (86-465 years oc man comes to the emergency deperment wth acuie chest psn. He also hes pain beweer Fe aepuloe. He hes histor of hypertanion and tobscoo smoking. His blood pressures 170/100mmot hy. Wich fe the most accurste tect? ‘Chest Xray ‘Srabeceaphagee!echocariogram CaKG E-Transthoroco echocardiogram FCT angiogram G27-which ofthe folowing s most sppropitesoreering for aortic aneurysm (AAI? ‘Everyone above 5 with CT angiogram. Btn who ver smokoe ond ove 65 with Ultrasound Everyone above 8 with ulrasound DiBveryonesbove 50 with uleasouned Mon above 65 wih ufeasound (208-which ofthe folowing is the most dangerous to a pregnant women? Biel stenosis -Perpartum cariomyopathies (C-Esanmengerphanomenon | ita! vive prosepoce Arial spt defect (038-4 5 years symptomatic woman comes othe ofc for small mass she found on tyrlé by palpation. there ena tenderness and she le mot on any rreceation. ‘wnat the next most appropiate sto in management ofthis patient? Fine noodle Aspen Tee ana Tove (Coutrasoune tyro D-Redlonusice Iodine uptake scan E-Surgloal removal Excision blopes) ‘ot0-A 48 year's woman wih thyroid nada found to have normal thro function testng.tne needle Sepcation report comes 9 ingetorminant for flier adenoma" What is the most sparoprate next stp in management ofthe patient? Nook oT Surgical removal excision biopsy) CUlresound Doaltonn vel (06-78 years old man with story of malignancy smite wit complain of letnaey.confusion ang abdominal pate found to have msrked sieves calcu tvelie hes gan @ rs of Nermal saline and sndamidronet hie caleure ove ell markedly elaveted on folowing dy. ‘what isthe most eppropeat next step in management ofthis patient? E-Zolecrone acid Plcamyain Dita Froinseaioet . ‘2:2-patiente brought te the emergency department afer motor vehicle in which he sustined seve soma! raumon the socons any patios became mares hypotensive woul evidence o Bleeeng ore [5 feverhigh ectnipl count hyperkalams hypagiyoemnia and hypanatric, Wht is the most nest appropriate step inthe management? ACT en of aonal Draw corso level ane scminatrhysrosortione ‘C-Doxematnasone suppression tot BiACTH level E-Cosytvopn stimulation esting (048-60 year's old man admited to emergency department with altered mental status, hypervntiation land marked slveted bloos glucose love Wich ofthe folowing fe mest accurate measure of severity of his concion? JShusese love! Serum boarbonate E-Biood ges level (244-18 year old boy comes to the oti because of seesional shorines of breath every fow wooks. ‘Carer he fools wo houses no macionon ana denies anyother mesial problema ne vale stable ‘and chest extmination i norma. ich ofthe totowing le single mest agnostic ost at his time? ‘eoak expeatry ove cncreags in FEV! with albstorol -Difusion capacty of earbon monoxide 1Dis20%s decrne in FEV! wth ue of methschalne nerease seca arte oxygen diference (a grado) Finoressed AVC with tutor! (Gow volume loop on spromaty chest G1 scone (048-4 7 years male with story of asthma came to emergency room with increasing acute shortness ‘of bre, cough ané sputum prodtlon for several ays, hs roxpitatry ate le Sa/minate; Gite ‘expiratory wheeze and prolonged expiratory phase. “inch of te fllowing wou use as the best ineaor of sever ef hs asthma? ‘AeRespistoy rate Paice rate Palas onymetor ese of accessory muscle Puronery hneton teat, (046-65 yore old wornan sited o hospi with CAP\commurity scared poeumonlaeputum gram stain ‘howe gram postive cplocnosio bt eure does not show any organism. (Ghost xray showed lobar infitates an iargeefuslon. [Shee placa on eefviarone and saktworyeth “Thorecocerels vests marked eivated LDH and protein and white ces 17000 micro te. Blood ‘ute grows streptococcus proumone with MIC (minimal initory concentration to poniiinis ess ‘han 0. Miororam/mi Her Tomperstare 1027, Pusle 14/minute,SP-1107Tommet hy and Spo2 ls 86% at room ai ‘nati the mest appropiate nat step in management ofthis patent? Sofepetedthorecoventesis (C-adlampciin to treatment Piece pationt in irtensve care unit E-Consut pulmonologist(267-h patents admites to the hosp for head tums end suburathomatomsthe pation is intubsiad {for nyparventiaton anc subsequent craniotomy several dey aftr pation: acmssion patient stars blood invomiinghe was evalusted an found to have eteceloarlenoopeszol wae sara {hon developed VAP\venistor aesociste pretmons)ne put on imipenuminezoid ans gentamycin. phenytoin rtd prophyactioal three dye lear he creatinine is ising and patient starts having sere. repeat GT cen showe no changes compared to earlier sean. \What i the most appropriate net stop in management ofthis patient ‘Sich Phenyoln to carbamazepine stop Lansoprarsle (Stop Lineaots Stop mipenur Perform E50 (240-An HIV postive Arcan American man adeitod with history of depnea,éry cough and high LDH and ‘02 of eaminet ghee sertad on Sulphometnoxacle ane timethoprin'SWX/TMP) an pregncone.oh the {hire day of hospi he developed severe rh and nevtronenin.ne hax anemia ang thre ere bts oale on peripheral emear. What the most appropriste next stp in management ofthis patent? beStop TMPrSHO C-Switch TMP/SMX te intrevencus pentamidine ‘Salish TMP/SME te aoroslthorapy Soh TMP/SMX to cincamyoin and primaquin. (2¢8-an IV postive woman with CO 6 cel court 22cllamiorolter ls amted with POP and treated ‘Seccesful with TMPYSH propiylacto TMP/SHO and arkivomyjcin are startd.she ls then Started on [Snvetroval drug and her Ga all count le to 420celleroter for lest 6 month. what isthe next most apprepricte management for his patent? BeSiop THEN Stop TMP/SHOX ae stromycin Stop all drugs and monitor Stop all medications I PER-RNA le undetectable. E-Continus at meclestion F'Step aatromyein (050-4 65.yearols woman who recently underwent hip replacament comes to theemergency deparkment with the novte onset of shortens of breath and aciyoara. Te chest xray ie normal with hypoxia on ABG, ‘mr iereesed da racientand an EKG with sinus tchysores. \wnatis the most appropriate next stop in management? ‘elntravenovs urrectioneted heparin B-Trombohtios (Cnr wna cava ter Ditmboisctony Spiral CT sean entiation pertusion (V0) scan G-Lomerextremty Bopper sudies Hdcdimor ‘051-A man with a history of prostate cancer comes tothe emergoncy dapartment wit severe back pain Snd leg wesknen, He has tenderness of he spine, hypartfli, end decoasod sensation below his umbllous. “Wats the most appropiate nex step in the management ofthis patient? -Dexsrnathasone MAL ox-ay Dinadaton Eunice Fornasterise (082-Apatent with lng-stending Rhumatold arth iso have coronary bypase surgery Which ofthe felon wimostinpran lr ae? BeConeal sine ray Rheumatol factor (C-Entre dose of methotrexate E-Pneumocoscal vaccination (50-4 t-yeor-ok women with history at SLE is amie with pneumonia and confusion. As you ae \wreating withthe docsin ovr bolus of high-coue steroids a pereon with an infotion, you needto determine this tare of nus, oF spy ar infoction with sepsis causing confusion Wich of te allowing wil help you the most? Astaae in an-See Bisel ANA = Decrease i complament D-Deerease in compement and ie ln an-DS DNA EMR ofthe ran Response te steroids . (254-4 75-year-old man comes tothe ofce with fatigue thet hes become progressively worse ove the Inet sever monthe He alse enor of beeth when he walks up one fight of tis. He rinks 4 vodka ‘marine day. He compaine of rumnese and tinging in hie fet. On physical examination he ae ‘eorsasee ‘Senention of lft His hematocrit s 28% ana his MCVie 194 (elovste}, ‘What i the most appropriate next stp in management? seiomin B12 vel Boratto level Peripheral blocs smasr DiSohiing test E-Mothyimsonic ace love (55-4 75-year-o woman comer with decreased poston and vibratory sensslon ofthe lower extromte hemstoot of 25%, MCV of $14 f, and Mypersegmented nvtrophis. Her B12 lvelis decrease, but ‘ear the borderline of norma. Whats the most approprist next cto inthe management of ths patlent? ‘AMetiyimatonc aot lovel rantintnscfetorantbodion (CA paviota el nioocior Desehiings test Feiomacysteine eve 086. Which ofthe folowing a complication of B12 or flat replacement? AeSeisuree Bxemateis Ctypokaiemis Detyperaemia E-Dianmes {057-which ofthe fotowing canbe found on smear in sche cel disease? A Bacopaiiespoing SsHowstrdoly Boaee Coste cele Disenistooyne EMonioo (58-4 46-yeor-oc man with sickle coll csssse Is admitiod with en acute pain oss Hit ont routine Irodibation fo ck, His hematoat on adeson is 4%, On the thie hopital ay, he hamstocet Grops 022%. Wat i the best nt tat? ‘eReticuloeyt court [Parishral sear rola evel [D-Parvoviras 8-18 [aM vel Bone marow (050-4 5. yesrolé man comes tothe emergency department for shortness of beth, blury vision, confusion, ‘and paper His WBC bount Ie found tobe 28,000.The cal are predominant neutrophil wit ‘Shout 4% blasts. What the most appropriate net step inthe management of this cose? AeLovkapheresle EBOR-ABL testing (C-B0ne marrow Boney 1D-Bone marrow waneplant -Consut nomctlogy/oncoloay F-Few ovtomaty Gyros ‘060-Which oth folowing isthe most use to determine dosing of chemetherapy in Hodgki's cseace? ‘Actohocardogram Wy