Aquifer Internal Medicine End of Case Questions And Answers Latest Update 2023/2024 100% Correct

Aquifer Internal Medicine End of Case A 52-year-old female presents with one month of progressive dyspnea on exertion, a productive cough of clear sputum, bilateral leg swelling, and orthopnea. She has had no chest pain or fevers. She has a history of poorly controlled hypertension and 30-pack-years of smoking. Before beginning her physical exam, you determine that her pre-exam probability of heart failure is moderate. On exam, you find a jugular venous pulse and pressure (JVP) of 12 cm with positive hepatojugular reflux, regular heart rate, normal S1 and S2 with S3 gallop, 3/6 systolic crescendo-decrescendo murmur at the right upper sternal border, crackles at both lung bases. Which of the following physical examination findings most increases your post-exam probability of congestive heart failure? A. Bibasilar crackles B. Hepatojugular reflux C. Increased jugular venous pressure D. Systolic murmur in the aortic area E. Third heart sound - Answer The answer is E. From IM 04. A 68-year-old male with hypertension and non-ischemic cardiomyopathy is admitted to the hospital with an acute exacerbation of his congestive heart failure (CHF). An echocardiogram (ECG) one month ago showed left-ventricular hypertrophy and a left-ventricular ejection fracture (LVEF) of 60%. He takes ramipril and chlorthalidone at home, and these are continued. His pulse is 85 beats/minutes, blood pressure is 134/88 mmHg, and oxygen saturation is 95% on two liters of oxygen by nasal cannula. His exam is notable for jugular venous pulse and pressure (JVP) of 12, bilateral leg edema, and crackles at his lung bases. What will be the next step in management of this man? A. Add furosemide intravenously B. Add metoprolol orally C. Add valsartan D. Increase dose of chlorthalidone E. Increase dose of ramipril - Answer The answer is A. From IM 04. A 56-year-old female with non-ischemic cardiomyopathy and hypertension presents to the office for a routine followup. Her last hospitalization for a congestive heart failure (CHF) exacerbation was two years ago. Currently, she has no shortness of breath, orthopnea, leg edema, or chest pain. She has been following a low-salt diet and does not drink alcohol. Her medications are carvedilol and a baby aspirin. Her home blood pressure measurements have ranged from 140-150/80-90 mmHg. Her exam is notable for a blood pressure of 150/90 mmHg. Her pulse is 60 beats/minute with normal S1 and S2 with no murmurs or gallops, and she has a normal respiratory rate. Her jugular venous pulse and pressure (JVP) is normal and her lungs are clear. Her point of maximal impulse (PMI) is laterally displaced. What medication should you add that can also improve her mortality from heart failure? A. Amlodipine B. Digoxin C. Furosemide D. Hydrochlorothiazide E. Ramipril - Answer The answer is E. From IM 04. Which of the following physical examination findings is most consistent with right-sided heart failure? A. Abdominojugular reflux B. Bibasilar crackles C. Pitting pedal edema D. Sustained apical impulse E. Systolic murmur at right upper sternal border - Answer The answer is A. From IM 04. A 68-year-old female is admitted to the hospital because of increasing dyspnea and orthopnea over the past two weeks. Her medical history is significant for ischemic cardiomyopathy with an ejection fraction of 40% and low back pain for one month. She reports no chest pain, palpitations, fever, and cough. She has been adherent to a low-sodium diet. She does not use alcohol or tobacco. Daily medications are carvedilol, lisinopril, amlodipine, atorvastatin, aspirin, and ibuprofen. Which medication would most likely cause her worsening symptoms? A. Amlodipine B. Atorvastatin C. Carvedilol D. Ibuprofen E. Lisinopril - Answer The answer is D. From IM 04. A 24-year-old female presents to the emergency department with 18 hours of lower abdominal pain, nausea, vomiting, and diarrhea. She is afebrile and has normal vital signs except for tachycardia with a pulse at 105 beats/minute. Her abdomen is soft and non-distended with hypoactive bowel sounds. There is rebound tenderness in the left-lower quadrant. The abdominal exam finding of rebound tenderness has +LR = 2 and -LR = 0.4 for peritonitis. What is the best interpretation of this finding? A. Absence of rebound tenderness strongly argues against peritonitis B. Absence of rebound tenderness strongly argues against peritonitis, but presence of it does not affect the probability of peritonitis C. Neither the presence nor the absence of rebound tenderness is very helpful in diagnosing peritonitis D. Presence of rebound tenderness strongly suggests peritonitis E. Presence of rebound tenderness strongly suggests peritonitis, but absence of it does not affect the probability of peritonitis - Answer The answer is C. From IM 12. A 39-year-old male with no significant past medical history presents to the hospital with lower abdominal pain for the past two days. His initial vitals are notable where his temperature is 38.5 C (101.3 F), pulse is 112 beats/minute, and blood pressure is 103/68 mmHg. He reports that his last bowel movement was two days ago, and he recalls passing flatus earlier today. Your physical exam reveals hypoactive bowel sounds, and a diffusely tender abdomen, most tender in the right-lower quadrant. His abdominal muscles are tense, and do not relax with distraction techniques. A computed tomography (CT) scan of the abdomen and pelvis confirms your suspected diagnosis. You order broad-spectrum intravenous (IV) antibiotics. What is the best next step in management? A. Call a gastrointestinal (GI) consult for colonoscopy B. Call a surgical consult C. Order a bowel regimen D. Place a nasogastric tube for decompression E. Start IV steroids - Answer The answer is B. From IM 12. A 68-year-old male with a history of peptic ulcer disease, diabetes mellitus, and hypertension is admitted to the hospital with a 24-hour history of abdominal pain and three episodes of loose stool. Initial vital signs reveal temperature is 38.9 C (102.02 F), pulse is 102 beats/minute, respiratory rate is 16 breaths/minute, blood pressure is 132/78 mmHg, and oxygen saturation is 98% on room air. White blood count (WBC) is 13,100 cells/μl. He has tenderness to palpation of the left lower quadrant of his abdomen, with guarding but no rigidity. Renal function is normal. Computerized tomography (CT) scan of the abdomen and pelvis shows sigmoid diverticulitis without any sign of abscess or perforation. In addition to ordering intravenous (IV) antibiotics, IV fluid, and pain medication, what is the next best step in management? A. Blood cultures B. Colorectal surgery consult C. High-fiber diet D. Stool culture E. Stool test for occult blood - Answer The answer is A. From IM 12. A 51-year-old male is admitted to the hospital for acute, uncomplicated diverticulitis. Medical history is significant for asthma, gastroesophageal reflux disease (GERD), and hypertension. He is treated with intravenous ciprofloxacin and metronidazole, intravenous fluids, and pain medication. After two days, his pain is improved and he is tolerating food. Which of the following discharge plans is most appropriate for him? A. Continue oral antibiotics for 21 days B. Prescribe subcutaneous enoxaparin for 28 days C. Refer to gastroenterology for a colonoscopy D. Refer to a nutritionist to initiate a gluten-free diet E. Refer to surgery for resection of the affected bowel - Answer The answer is C. From IM 12. A 63-year-old female with a past history of hypertension, chronic obstructive pulmonary disease (COPD), type 2 diabetes mellitus, and hyperlipidemia is admitted to the hospital with Clostridium difficile (C. difficile) colitis. Of the following options, which is the best choice for deep vein thrombosis (DVT) prophylaxis for her? A. Ambulation B. Aspirin, 81 mg by mouth (PO) daily C. Enoxaparin, 40 mg subcutaneous daily D. Heparin intravenous (IV) continuous infusion, titrated for a goal-activated partial thromboplastin time (aPTT) of 50 to 70 seconds E. Intermittent pneumatic compression (IPC) device - Answer The answer is C. From IM 12. A 67-year-old male comes to the clinic for a health maintenance visit. His past medical history is significant for chronic allergic rhinitis, severe chronic obstructive pulmonary disease (COPD), osteoporosis, psoriasis, atrial fibrillation, and benign prostatic hypertrophy. Vital signs show his temperature is 36.8 C (98.2 F), pulse is 76 beats/minute, respiratory rate is 12 breaths/minute, and blood pressure is 118/70 mmHg. His weight is 129.2 kg (285 lbs) and his body mass index (BMI) is 41. Which of his co-morbidities is most likely to be associated with his BMI? A. Atrial fibrillation B. Benign prostatic hypertrophy C. Chronic allergic rhinitis D. Osteoporosis E. Psoriasis - Answer The answer is A. From IM 16. A 52-year-old female comes to the clinic to discuss weight loss. Her medical history is significant for obesity; her body mass index (BMI) is 41; hypertension; hyperlipidemia; and obstructive sleep apnea. She knows that losing weight will help her hypertension and hyperlipidemia, but she doesn't feel like these things bother her. Her only other concern is fatigue; she doesn't use her continuous positive airway pressure (CPAP) machine, because she doesn't like the mask. What additional information can you provide her to help motivate her weight loss? A. Her obstructive sleep apnea may improve with weight loss. B. Her risk of cardiovascular disease is similar to that of a female with a normal BMI. C. Obesity is mainly a cosmetic issue. D. Surgery should be considered before diet and exercise. - Answer The answer is A. From IM 16. Ms. Tsvetanova is a 42-year-old female with no significant past medical history presenting to establish care with her primary care physician. On review, she notes a weight gain of 14 kg (30 lbs) over the last three years. She attributes this mostly to her sedentary lifestyle, snacking, and difficulty with portion control. She works as a receptionist for a local physician's office and spends most of her day sitting. She denies constipation, low energy, cold intolerance, muscle weakness, depressed mood, easy bruisability, or other skin changes. On physical exam, vital signs reveal temperature is 36.8 C (98.2 F), pulse is 82 beats/minute, respiratory rate is 12 breaths/minute, blood pressure is 130/82 mmHg, weight is 81.6 kg (180 lbs), and height is 163 cm (64 in). The remainder of her physical exam is normal. Which of the following laboratory tests is most appropriate for the evaluation of this patient? A. 24-hour urine catecholamine levels B. 24-hour urine cortisol level C. Basic metabolic profile D. Lipid profile E. Thyroid stimulating hormone (TSH) - Answer The answer is D. From IM 16. Mr. York is a 44-year-old male presenting for evaluation of an eyelid lesion. He noticed the lesion about one year ago. There is no associated itching, discharge, or other bothersome symptoms. Which of the following is the next best step in the management of the eyelid lesion? A. Low potency topical corticosteroid B. Measurement of serum cholesterol levels C. Measurement of serum uric acid levels D. No further management E. Skin biopsy - Answer The answer is B. From IM !6. Ms. H is a 68-year-old female with a medical history significant for obesity, type II diabetes, hypothyroidism, hypertension, and recently diagnosed hyperlipidemia. Her most-recent lipoprotein (LDL), three months ago, was 197 mg/dL. At that time, atorvastatin was initiated. Other medications include metformin, insulin glargine, amlodipine, hydrochlorthiazide, and levothyroxine. Which of the following may be contributing to her elevated LDL? A. Amlodipine B. Hydrochlorthiazide C. Insulin glargine D. Levothyroxine E. Metformin - Answer The answer is B. From IM 16.