EMERGENCY MED PACKRAT TEST 1 Q
AND A
Abu52buyear-
oldbufemalebucomesbutobuthebuofficebubecausebuofbublackbustoolsbuforbuthebupastbu3budays.bu
Shebuisbuafebrilebuandbushebuhasbunobupertinentbuphysicalbuexaminationbuabnormalities.bu
Whichbuofbuthebufollowingbuisbuthebumostbuappropriatebuinitialbudiagnosticbustudy?
A.buStoolbuforbuoccultbubloodbu
B.buStoolbucultures
C.buSigmoidoscopy
D.buAbdominalbuCTbuscanbu-buanswer--
(c)buA.buOccultbubleeding,buasbuevidencedbubybuthebupatient'sbuhistorybuofbublackbustools,bui
sbuinitiallybuverifiedbubybuabupositivebufecalbuoccultbubloodbutest.
(u)buB.buStoolbuculturesbuarebuindicatedbuinbuthebuevaluationbuofbuacutebudiarrheabuandbunot
buforbuthebuevaluationbuofbuacutebuGIbubleeding.bu
(u)buC.buMelenabusuggestsbuabusourcebuofbubleedingbuthatbuisbuproximalbutobuthebuligamentb
uofbuTreitz,bunotbuabulowerbuGIbubleed.
SigmoidoscopybuisbuusedbutobuevaluatebuonlybulowerbuGIbubleedingbusources.
(u)buD.buAbdominalbuCTbuscanbuisbuindicatedbuforbuevaluationbuofbuobscurebubleedingbuinbuo
rderbutobuexcludebuabupancreaticbuorbuhepatic
sourcebuofbubleedingbuifbuendoscopybufailsbutobuidentifybuthebusource.
Abu65buyear-oldbupatientbuwithbusteroid-
dependentbuchronicbuobstructivebulungbudiseasebupresentsbuwithbuabuheadachebuthatbuhas
bubeenbuincreasingbuinbuseveritybuoverbuthebupastbuweek,buaccompaniedbubybunauseabuand
buvomiting.buHebudeniesbufever,bubutbuhasbuhadbuphotophobiabuandbuabustiffbuneck.buWhichb
uofbuthebufollowingbuisbuthebumostbulikelybudiagnosis?
A.buTransientbuischemicbuattackbu
B.buBacterialbumeningitis
C.buMigrainebuheadache
D.buCryptococcosisbu-buanswer--
(u)buA.buTransientbuischemicbuattacksbupresentbuwithbufocalbuneurologicalbufindingsburathe
rbuthanbuheadaches.
(a)buB.buBacterialbumeningitisbuisbutypicallybuacutebuinbuonsetbuandbucausesbufever,bubutbuim
munocompromisedbupatientsbumaybuhavebua
slowerbuonsetbuandbunobufever.
(u)buC.buMigrainesbugenerallybudobunotbubeginbuinbuthisbuagebugroup,buandbuarebunotbuacco
mpaniedbubybunuchalburigidity.
(c)buD.Cryptococcusbuisbuanbuopportunisticbufungalbuinfectionbuthatbuaffectsbuimmunocom
promisedbupatients,buincludingbuthosebuwith
HIV,buchronicbusteroidbuuse,buorganbutransplants,budiabetesbumellitus,buandbuchronicburen
albuorbuliverbudisease.buThebumostbucommonbuclinicalbupresentationbuisbuthatbuofbumeningiti
s;bufeverbuisbupresentbuinbuonlybuaboutbuhalfbuofbupatients.
Whichbuofbuthebufollowingbuisbuabucommonbusymptombuassociatedbuwithbularyngotracheob
ronchitisbu(viralbucroup)?
,A.buDrooling
B.buHighbufever
C.bu"Hotbupotato"buvoicebu
D.buBarkingbucoughbu-buanswer--
(u)buA.buDroolingbuandbuabu"hotbupotato"buvoicebuarebuseenbuwithbuepiglottitis,bunotbuviralbucr
oup.
(u)buB.buFeverbuisbuusuallybuabsentbuorbulow-gradebuinbupatientsbuwithbuviralbucroup.
(u)buC.buSeebuAbuforbuexplanation.
(c)buD.buViralbucroupbuisbucharacterizedbubybuabuhistorybuofbuupperburespiratorybutractbusym
ptomsbufollowedbubybuonsetbuofbuabubarking
coughbuandbustridor.
Abu23buyear-
oldbufemalebuwithbuhistorybuofbuasthmabuforbuthebupastbu5buyearsbupresentsbuwithbucomplain
tsbuofbuincreasingbushortnessbuofbubreathbuforbu2budays.buHerbuasthmabuhasbubeenbuwell-
controlledbuuntilbu2budaysbuago.buSincebuyesterday,bushebuhasbubeenbuusingbuherbualbutero
lbuinhalerbueverybu4butobu6buhours.buShebuisbunormallybuverybuactive,buhoweverbuyesterdaybu
shebudidbunotbucompletebuherbu30buminutebuexerciseburoutinebuduebutobuincreasingbudyspn
ea.buShebudeniesbuanybucough,bufever,burecentbusurgeries,buorbuusebuofbuoralbucontraceptiv
es.buOnbuexamination,buyoubunotebuthebupresencebuofbuprolongedbuexpirationbuandbudiffus
ebuwheezing.buTheburemainderbuofbuthebuexambuisbuunremarkable.buWhichbuofbuthebufollowi
ngbuisbuthebumostbuappropriatebuinitialbudiagnosticbuevaluationbupriorbutobuinitiationbuofbutrea
tment?
A.buChestbux-ray
B.buSputumbugrambustain
C.buPeakbuflow
D.buVentilation-perfusionbuscanbu-buanswer--(u)buA.buAbuchestbux-
raybushouldbubebuorderedbuinbuanbuasthmaticbupatientbuonlybuifbuyoubuarebuconcernedbuabou
tbuthebupresencebuofbupneumoniabuorbupneumothorax,buneitherbuofbuwhichbuisbusupportedbu
bybuthebuH&Pbufindingsbunotedbuabove.
(u)buB.buAbusputumbugrambustainbuisbuperformedbuinbupatientsbuwhobuyoubususpectbuhavebua
nbuinfectiousbuprocess,busuchbuasbupneumonia.bu
(c)buC.buAbupeakbuflowbureadingbuwillbuhelpbuyoubutobugaugebuherbucurrentbuextentbuofbuairflo
wbuobstructionbuandbuisbuhelpfulbuinbumonitoring
thebueffectivenessbuofbuanybutreatmentbuinterventions.
(u)buD.buAbuventilation-
perfusionbuscanbu(V/
Qbuscan)buisbuindicatedbuinbucasesbuofbususpectedbupulmonarybuembolism.buThebupatient
abovebudoesbunotbuhavebuanyburiskbufactorsbuthatbuwouldbuleadbuyoubutobususpectbusuchbuab
udiagnosis.
Abu53buyear-
oldbufemalebustatusbupostbuabdominalbuhysterectomybu3budaysbuagobusuddenlybudevelops
bupleuriticbuchestbupainbuandbudyspnea.buOnbuexam,bushebuisbutachycardicbuandbutachypnei
cbuwithburalesbuinbuthebuleftbulowerbulobe.buAbuchestbux-
raybuisbuunremarkablebuandbuanbuEKGburevealsbusinusbutachycardia.buWhichbuofbuthebufollo
wingbuisbuthebumostbulikelybudiagnosis?
A.buAtelectasis
B.buPneumothorax
C.buPulmonarybuembolismbu
,D.buMyocardialbuinfarctionbu-buanswer--
(u)buA.buSmallbuatelectasisbuisbucommonlybuasymptomatic,buwhilebulargebuatelectasisbuma
ybuproducebusignsbuofbudyspneabuandbucough.buExamburevealsbuabsencebuofbubreathbusou
ndsbuinbuthebuareabuinvolvedbuandbudullnessbutobupercussion.buAbuchestbux-
raybuwouldburevealbuvariousbufindingsbudependentbuonbuthebulocationbuofbuthebuatelectasis,
bubutbuwouldbunotbubebunormal.
(u)buB.buWhilebuabupneumothoraxbucommonlybupresentsbuwithbupleuriticbuchestbupainbuandb
udyspnea,buexambuwouldburevealbuthebupresencebuofbudiminishedbubreathbusoundsbuandbu
hyperresonancebuonbuthebuinvolvedbuside.buAbuchestbux-
raybuwouldburevealbupresencebuofbuabupleuralbulinebuonbuthebuexpiratorybuchestbux-ray.
(c)buC.buThisbupatient'sburiskbufactorsbuforbupulmonarybuembolismbuincludebuadvancedbuag
e,busurgery,buandbuprolongedbubedrest.buWhilebuthebudiagnosisbuofbupulmonarybuembolis
mbuisbudifficultbutobumakebuduebutobunonspecificbuclinicalbufindings,buthebumostbucommonbus
ymptomsbuincludebupleuriticbuchestbupainbuandbudyspneabuassociatedbuwithbutachypnea.bu
Chestbux-raybuandbuEKGbuarebuusuallybunormal.
(u)buD.buWhilebuabumyocardialbuinfarctionbuusuallybupresentsbuwithbudyspnea,buthebuchestbu
painbuisbunotbuusuallybupleuriticbuinbunature.buAnbuEKGbuwouldbucommonlyburevealbuSTbuse
gmentbuchangesbuwhichbuwouldbubebuconsistentbuwithbuischemiabuorbuinfarct.
Abu34buyear-
oldbufemalebuwithbuabuhistorybuofbuasthmabupresentsbuwithbucomplaintsbuofbuincreasingbuast
hmabuattacks.buThebupatientbustatesbushebuhasbubeenbuwell-
controlledbuonbualbuterolbuinhalerbuuntilbuonebumonthbuago.buSincebuthatbutimebushebunotice
sbuthatbushebuhasbuhadbutobuusebuherbuinhalerbu3-
4butimesbuabuweekbuandbualsobuhasbuhadbuincreasingbunighttimebuusebuaveragingbuaboutbut
hreebuepisodesbuinbuthebupastbumonth.buSpirometryburevealsbugreaterbuthanbu85%bupredict
edbuvalue.buWhichbuofbuthebufollowingbuisbuthebumostbuappropriatebuinterventionbuatbuthisbuti
me?
A.buOralbuprednisone
B.buOralbutheophyllinebu(Theo-Dur)bu
C.buSalmeterolbu(Serevent)buinhalerbu
D.buBeclomethasonebu(Qvar)inhalerbu-buanswer--
(u)buA.buOralbucorticosteroids,busuchbuasbuprednisone,buarebuaddedbutobutherapybuinbusever
ebupersistentbuasthma.buWhilebuabucoursebuofbuoralbucorticosteroidsbumaybubebuneededbufo
rbumildbuexacerbationsbuofbuasthma,butheybuarebunotbuaddedbuuntilbuinhaledbucorticosteroid
sbuhavebufailedbutobucontrolbuthebusymptoms.
(u)buB.buDuebutobuitsbusafetybuprofile,buoralbutheophyllinebuisbunowbuconsideredbuabuthirdbuorb
ufourthbulinebutreatmentbuoptionbuforbuasthma.bu
(u)buC.buLongbuactingbuinhaledbubeta2-
agonists,busuchbuasbusalmeterol,buarebunotbuaddedbutobuthebutreatmentburegimenbuuntilbuth
e
symptomsbuindicatebuabumoderatebupersistentbuasthma.buLongbuactingbuinhaledbubeta2-
agonistsbushouldbualsobunotbubebuused
inbuplacebuofbuinhaledbusteroids.
(c)buD.buThisbupatientbuhasbuprogressedbutobumildbupersistentbuasthma.buInbuadditionbutobuh
erbuinhaledbubeta2-agonistbu(albuterol),bushe
shouldbubebustartedbuonbuanbuanti-
inflammatorybuagent.buInhaledbucorticosteroids,busuchbuasbubeclomethasone,buarebuprefe
rredbuforbulong-termbucontrol.
, Abu43buyear-
oldbuasymptomaticbudiabeticbufemalebuisbufoundbutobuhavebuanbuelevatedbutotalbucalciumbul
evelbuofbu12.4bumg/
dL.buWhichbuofbuthebufollowingbutestsbumustbubebuassessedbuinbuorderbutobuevaluatebuthisbul
aboratorybuabnormality?
A.buIntactbuparathyroidbuhormone
B.buSerumbualbumin
C.bu24buhourbuurinebucalciumbulevelbu
D.buCompletebubloodbucountbu-buanswer--
(u)buA.buIntactbuparathyroidbuhormonebulevelsbuarebuonlybuobtainedbuforbupatientsbuwithbutru
ebuhypercalcemiabuwithbuanbuunknownbuetiology.
(c)buB.buSincebuapproximatelybu50%buofbucalciumbuisbuproteinbubound,butotalbucalciumbulev
elsbushouldbubebuinterpretedburelativebutobualbuminbulevels.
(u)buC.buDemonstrationbuofbuexcessivebucalciumbuinbuthebuurinebudoesbunotbuprovidebuanybu
additionalbuinformationburegardingbuthebuincreasedbuserumbucalcium.
(u)buD.buCompletebubloodbucountbuhasbunoburelationshipbutobuthebuserumbucalciumbulevels.
WhichbuofbuthebufollowingbuconditionsbuwouldbucausebuabupositivebuKussmaul'sbusignbuonbu
physicalbuexamination?
A.buLeftbuventricularbufailurebu
B.buPulmonarybuedema
C.buCoarctationbuofbuthebuaortabu
D.buConstrictivebupericarditisbu-buanswer--
(u)buA.buLeftbuventricularbufailureburesultsbuinbuthebuback-
upbuofbubloodbuintobuthebuleftbuatriumbuandbuthenbuthebupulmonarybusystembusobuitbuwouldbun
otbubebuassociatedbuwithbuKussmaul'sbusign.
(u)buB.buPulmonarybuedemabuprimarilyburesultsbuinbuincreasedbupulmonarybupressuresbura
therbuthanbuhavingbueffectsbuonbuthebuvenousbuinflowbuintobuthebuheart.
(u)buC.buCoarctationbuofbuthebuaortabuprimarilybuaffectsbuoutflowbufrombuthebuheartbuduebutob
uthebustenosisburesultingbuinbudelayedbuandbudecreasedbufemoralbupulses;buitbuhasbunobueff
ectbuonbucausingbuKussmaul'sbusign.
(c)buD.buKussmaul'sbusignbuisbuanbuincreaseburatherbuthanbuthebunormalbudecreasebuinbutheb
uCVPbuduringbuinspiration.buItbuisbumostbuoftenbucausedbubybusevereburight-
sidedbuheartbufailure;buitbuisbuabufrequentbufindingbuinbupatientsbuwithbuconstrictivebupericard
itisbuorburightbuventricularbuinfarction.
Duringbuabubaseballbugame,buabu22buyear-
oldbucollegebustudentbuisbuhitbuinbutheburightbueyebubybuabubaseball.buHebucomplainsbuofbublur
rybuvisionbuinbuthatbueye.buOnbuphysicalbuexam,buthebuphysicianbuassistantbunotesbuproptosi
sbuofbutheburightbueye,buandbulimitationbuofbumovementbuinbuallbudirections.buOnbuCTbuscan,bu
whichbuofbuthebufollowingbuisbumostbulikelybutobubebuseen?
A.buFracturebuofbuthebumedialbuorbitalbuwallbu
B.buProlapsebuofbuorbitalbusoftbutissue
C.buHematomabuofbuthebuorbit
D.buOrbitalbuemphysemabu-buanswer--
(u)buA.buFracturebuofbuthebumedialbuorbitalbuwallbuisbuassociatedbuwithbudiplopiabufrombumed
ialburectusbuimpingement,buorbitalbuemphysemabuandbuepistaxis.
(u)buB.buProlapsebuofbuorbitalbusoftbutissue,buincludingbuinferiorburectusbumuscle,buinferiorbu
obliquebumuscle,buorbitalbufat,buandbuconnectivebutissueburesultsbuinbuenophthalmos,buptos
AND A
Abu52buyear-
oldbufemalebucomesbutobuthebuofficebubecausebuofbublackbustoolsbuforbuthebupastbu3budays.bu
Shebuisbuafebrilebuandbushebuhasbunobupertinentbuphysicalbuexaminationbuabnormalities.bu
Whichbuofbuthebufollowingbuisbuthebumostbuappropriatebuinitialbudiagnosticbustudy?
A.buStoolbuforbuoccultbubloodbu
B.buStoolbucultures
C.buSigmoidoscopy
D.buAbdominalbuCTbuscanbu-buanswer--
(c)buA.buOccultbubleeding,buasbuevidencedbubybuthebupatient'sbuhistorybuofbublackbustools,bui
sbuinitiallybuverifiedbubybuabupositivebufecalbuoccultbubloodbutest.
(u)buB.buStoolbuculturesbuarebuindicatedbuinbuthebuevaluationbuofbuacutebudiarrheabuandbunot
buforbuthebuevaluationbuofbuacutebuGIbubleeding.bu
(u)buC.buMelenabusuggestsbuabusourcebuofbubleedingbuthatbuisbuproximalbutobuthebuligamentb
uofbuTreitz,bunotbuabulowerbuGIbubleed.
SigmoidoscopybuisbuusedbutobuevaluatebuonlybulowerbuGIbubleedingbusources.
(u)buD.buAbdominalbuCTbuscanbuisbuindicatedbuforbuevaluationbuofbuobscurebubleedingbuinbuo
rderbutobuexcludebuabupancreaticbuorbuhepatic
sourcebuofbubleedingbuifbuendoscopybufailsbutobuidentifybuthebusource.
Abu65buyear-oldbupatientbuwithbusteroid-
dependentbuchronicbuobstructivebulungbudiseasebupresentsbuwithbuabuheadachebuthatbuhas
bubeenbuincreasingbuinbuseveritybuoverbuthebupastbuweek,buaccompaniedbubybunauseabuand
buvomiting.buHebudeniesbufever,bubutbuhasbuhadbuphotophobiabuandbuabustiffbuneck.buWhichb
uofbuthebufollowingbuisbuthebumostbulikelybudiagnosis?
A.buTransientbuischemicbuattackbu
B.buBacterialbumeningitis
C.buMigrainebuheadache
D.buCryptococcosisbu-buanswer--
(u)buA.buTransientbuischemicbuattacksbupresentbuwithbufocalbuneurologicalbufindingsburathe
rbuthanbuheadaches.
(a)buB.buBacterialbumeningitisbuisbutypicallybuacutebuinbuonsetbuandbucausesbufever,bubutbuim
munocompromisedbupatientsbumaybuhavebua
slowerbuonsetbuandbunobufever.
(u)buC.buMigrainesbugenerallybudobunotbubeginbuinbuthisbuagebugroup,buandbuarebunotbuacco
mpaniedbubybunuchalburigidity.
(c)buD.Cryptococcusbuisbuanbuopportunisticbufungalbuinfectionbuthatbuaffectsbuimmunocom
promisedbupatients,buincludingbuthosebuwith
HIV,buchronicbusteroidbuuse,buorganbutransplants,budiabetesbumellitus,buandbuchronicburen
albuorbuliverbudisease.buThebumostbucommonbuclinicalbupresentationbuisbuthatbuofbumeningiti
s;bufeverbuisbupresentbuinbuonlybuaboutbuhalfbuofbupatients.
Whichbuofbuthebufollowingbuisbuabucommonbusymptombuassociatedbuwithbularyngotracheob
ronchitisbu(viralbucroup)?
,A.buDrooling
B.buHighbufever
C.bu"Hotbupotato"buvoicebu
D.buBarkingbucoughbu-buanswer--
(u)buA.buDroolingbuandbuabu"hotbupotato"buvoicebuarebuseenbuwithbuepiglottitis,bunotbuviralbucr
oup.
(u)buB.buFeverbuisbuusuallybuabsentbuorbulow-gradebuinbupatientsbuwithbuviralbucroup.
(u)buC.buSeebuAbuforbuexplanation.
(c)buD.buViralbucroupbuisbucharacterizedbubybuabuhistorybuofbuupperburespiratorybutractbusym
ptomsbufollowedbubybuonsetbuofbuabubarking
coughbuandbustridor.
Abu23buyear-
oldbufemalebuwithbuhistorybuofbuasthmabuforbuthebupastbu5buyearsbupresentsbuwithbucomplain
tsbuofbuincreasingbushortnessbuofbubreathbuforbu2budays.buHerbuasthmabuhasbubeenbuwell-
controlledbuuntilbu2budaysbuago.buSincebuyesterday,bushebuhasbubeenbuusingbuherbualbutero
lbuinhalerbueverybu4butobu6buhours.buShebuisbunormallybuverybuactive,buhoweverbuyesterdaybu
shebudidbunotbucompletebuherbu30buminutebuexerciseburoutinebuduebutobuincreasingbudyspn
ea.buShebudeniesbuanybucough,bufever,burecentbusurgeries,buorbuusebuofbuoralbucontraceptiv
es.buOnbuexamination,buyoubunotebuthebupresencebuofbuprolongedbuexpirationbuandbudiffus
ebuwheezing.buTheburemainderbuofbuthebuexambuisbuunremarkable.buWhichbuofbuthebufollowi
ngbuisbuthebumostbuappropriatebuinitialbudiagnosticbuevaluationbupriorbutobuinitiationbuofbutrea
tment?
A.buChestbux-ray
B.buSputumbugrambustain
C.buPeakbuflow
D.buVentilation-perfusionbuscanbu-buanswer--(u)buA.buAbuchestbux-
raybushouldbubebuorderedbuinbuanbuasthmaticbupatientbuonlybuifbuyoubuarebuconcernedbuabou
tbuthebupresencebuofbupneumoniabuorbupneumothorax,buneitherbuofbuwhichbuisbusupportedbu
bybuthebuH&Pbufindingsbunotedbuabove.
(u)buB.buAbusputumbugrambustainbuisbuperformedbuinbupatientsbuwhobuyoubususpectbuhavebua
nbuinfectiousbuprocess,busuchbuasbupneumonia.bu
(c)buC.buAbupeakbuflowbureadingbuwillbuhelpbuyoubutobugaugebuherbucurrentbuextentbuofbuairflo
wbuobstructionbuandbuisbuhelpfulbuinbumonitoring
thebueffectivenessbuofbuanybutreatmentbuinterventions.
(u)buD.buAbuventilation-
perfusionbuscanbu(V/
Qbuscan)buisbuindicatedbuinbucasesbuofbususpectedbupulmonarybuembolism.buThebupatient
abovebudoesbunotbuhavebuanyburiskbufactorsbuthatbuwouldbuleadbuyoubutobususpectbusuchbuab
udiagnosis.
Abu53buyear-
oldbufemalebustatusbupostbuabdominalbuhysterectomybu3budaysbuagobusuddenlybudevelops
bupleuriticbuchestbupainbuandbudyspnea.buOnbuexam,bushebuisbutachycardicbuandbutachypnei
cbuwithburalesbuinbuthebuleftbulowerbulobe.buAbuchestbux-
raybuisbuunremarkablebuandbuanbuEKGburevealsbusinusbutachycardia.buWhichbuofbuthebufollo
wingbuisbuthebumostbulikelybudiagnosis?
A.buAtelectasis
B.buPneumothorax
C.buPulmonarybuembolismbu
,D.buMyocardialbuinfarctionbu-buanswer--
(u)buA.buSmallbuatelectasisbuisbucommonlybuasymptomatic,buwhilebulargebuatelectasisbuma
ybuproducebusignsbuofbudyspneabuandbucough.buExamburevealsbuabsencebuofbubreathbusou
ndsbuinbuthebuareabuinvolvedbuandbudullnessbutobupercussion.buAbuchestbux-
raybuwouldburevealbuvariousbufindingsbudependentbuonbuthebulocationbuofbuthebuatelectasis,
bubutbuwouldbunotbubebunormal.
(u)buB.buWhilebuabupneumothoraxbucommonlybupresentsbuwithbupleuriticbuchestbupainbuandb
udyspnea,buexambuwouldburevealbuthebupresencebuofbudiminishedbubreathbusoundsbuandbu
hyperresonancebuonbuthebuinvolvedbuside.buAbuchestbux-
raybuwouldburevealbupresencebuofbuabupleuralbulinebuonbuthebuexpiratorybuchestbux-ray.
(c)buC.buThisbupatient'sburiskbufactorsbuforbupulmonarybuembolismbuincludebuadvancedbuag
e,busurgery,buandbuprolongedbubedrest.buWhilebuthebudiagnosisbuofbupulmonarybuembolis
mbuisbudifficultbutobumakebuduebutobunonspecificbuclinicalbufindings,buthebumostbucommonbus
ymptomsbuincludebupleuriticbuchestbupainbuandbudyspneabuassociatedbuwithbutachypnea.bu
Chestbux-raybuandbuEKGbuarebuusuallybunormal.
(u)buD.buWhilebuabumyocardialbuinfarctionbuusuallybupresentsbuwithbudyspnea,buthebuchestbu
painbuisbunotbuusuallybupleuriticbuinbunature.buAnbuEKGbuwouldbucommonlyburevealbuSTbuse
gmentbuchangesbuwhichbuwouldbubebuconsistentbuwithbuischemiabuorbuinfarct.
Abu34buyear-
oldbufemalebuwithbuabuhistorybuofbuasthmabupresentsbuwithbucomplaintsbuofbuincreasingbuast
hmabuattacks.buThebupatientbustatesbushebuhasbubeenbuwell-
controlledbuonbualbuterolbuinhalerbuuntilbuonebumonthbuago.buSincebuthatbutimebushebunotice
sbuthatbushebuhasbuhadbutobuusebuherbuinhalerbu3-
4butimesbuabuweekbuandbualsobuhasbuhadbuincreasingbunighttimebuusebuaveragingbuaboutbut
hreebuepisodesbuinbuthebupastbumonth.buSpirometryburevealsbugreaterbuthanbu85%bupredict
edbuvalue.buWhichbuofbuthebufollowingbuisbuthebumostbuappropriatebuinterventionbuatbuthisbuti
me?
A.buOralbuprednisone
B.buOralbutheophyllinebu(Theo-Dur)bu
C.buSalmeterolbu(Serevent)buinhalerbu
D.buBeclomethasonebu(Qvar)inhalerbu-buanswer--
(u)buA.buOralbucorticosteroids,busuchbuasbuprednisone,buarebuaddedbutobutherapybuinbusever
ebupersistentbuasthma.buWhilebuabucoursebuofbuoralbucorticosteroidsbumaybubebuneededbufo
rbumildbuexacerbationsbuofbuasthma,butheybuarebunotbuaddedbuuntilbuinhaledbucorticosteroid
sbuhavebufailedbutobucontrolbuthebusymptoms.
(u)buB.buDuebutobuitsbusafetybuprofile,buoralbutheophyllinebuisbunowbuconsideredbuabuthirdbuorb
ufourthbulinebutreatmentbuoptionbuforbuasthma.bu
(u)buC.buLongbuactingbuinhaledbubeta2-
agonists,busuchbuasbusalmeterol,buarebunotbuaddedbutobuthebutreatmentburegimenbuuntilbuth
e
symptomsbuindicatebuabumoderatebupersistentbuasthma.buLongbuactingbuinhaledbubeta2-
agonistsbushouldbualsobunotbubebuused
inbuplacebuofbuinhaledbusteroids.
(c)buD.buThisbupatientbuhasbuprogressedbutobumildbupersistentbuasthma.buInbuadditionbutobuh
erbuinhaledbubeta2-agonistbu(albuterol),bushe
shouldbubebustartedbuonbuanbuanti-
inflammatorybuagent.buInhaledbucorticosteroids,busuchbuasbubeclomethasone,buarebuprefe
rredbuforbulong-termbucontrol.
, Abu43buyear-
oldbuasymptomaticbudiabeticbufemalebuisbufoundbutobuhavebuanbuelevatedbutotalbucalciumbul
evelbuofbu12.4bumg/
dL.buWhichbuofbuthebufollowingbutestsbumustbubebuassessedbuinbuorderbutobuevaluatebuthisbul
aboratorybuabnormality?
A.buIntactbuparathyroidbuhormone
B.buSerumbualbumin
C.bu24buhourbuurinebucalciumbulevelbu
D.buCompletebubloodbucountbu-buanswer--
(u)buA.buIntactbuparathyroidbuhormonebulevelsbuarebuonlybuobtainedbuforbupatientsbuwithbutru
ebuhypercalcemiabuwithbuanbuunknownbuetiology.
(c)buB.buSincebuapproximatelybu50%buofbucalciumbuisbuproteinbubound,butotalbucalciumbulev
elsbushouldbubebuinterpretedburelativebutobualbuminbulevels.
(u)buC.buDemonstrationbuofbuexcessivebucalciumbuinbuthebuurinebudoesbunotbuprovidebuanybu
additionalbuinformationburegardingbuthebuincreasedbuserumbucalcium.
(u)buD.buCompletebubloodbucountbuhasbunoburelationshipbutobuthebuserumbucalciumbulevels.
WhichbuofbuthebufollowingbuconditionsbuwouldbucausebuabupositivebuKussmaul'sbusignbuonbu
physicalbuexamination?
A.buLeftbuventricularbufailurebu
B.buPulmonarybuedema
C.buCoarctationbuofbuthebuaortabu
D.buConstrictivebupericarditisbu-buanswer--
(u)buA.buLeftbuventricularbufailureburesultsbuinbuthebuback-
upbuofbubloodbuintobuthebuleftbuatriumbuandbuthenbuthebupulmonarybusystembusobuitbuwouldbun
otbubebuassociatedbuwithbuKussmaul'sbusign.
(u)buB.buPulmonarybuedemabuprimarilyburesultsbuinbuincreasedbupulmonarybupressuresbura
therbuthanbuhavingbueffectsbuonbuthebuvenousbuinflowbuintobuthebuheart.
(u)buC.buCoarctationbuofbuthebuaortabuprimarilybuaffectsbuoutflowbufrombuthebuheartbuduebutob
uthebustenosisburesultingbuinbudelayedbuandbudecreasedbufemoralbupulses;buitbuhasbunobueff
ectbuonbucausingbuKussmaul'sbusign.
(c)buD.buKussmaul'sbusignbuisbuanbuincreaseburatherbuthanbuthebunormalbudecreasebuinbutheb
uCVPbuduringbuinspiration.buItbuisbumostbuoftenbucausedbubybusevereburight-
sidedbuheartbufailure;buitbuisbuabufrequentbufindingbuinbupatientsbuwithbuconstrictivebupericard
itisbuorburightbuventricularbuinfarction.
Duringbuabubaseballbugame,buabu22buyear-
oldbucollegebustudentbuisbuhitbuinbutheburightbueyebubybuabubaseball.buHebucomplainsbuofbublur
rybuvisionbuinbuthatbueye.buOnbuphysicalbuexam,buthebuphysicianbuassistantbunotesbuproptosi
sbuofbutheburightbueye,buandbulimitationbuofbumovementbuinbuallbudirections.buOnbuCTbuscan,bu
whichbuofbuthebufollowingbuisbumostbulikelybutobubebuseen?
A.buFracturebuofbuthebumedialbuorbitalbuwallbu
B.buProlapsebuofbuorbitalbusoftbutissue
C.buHematomabuofbuthebuorbit
D.buOrbitalbuemphysemabu-buanswer--
(u)buA.buFracturebuofbuthebumedialbuorbitalbuwallbuisbuassociatedbuwithbudiplopiabufrombumed
ialburectusbuimpingement,buorbitalbuemphysemabuandbuepistaxis.
(u)buB.buProlapsebuofbuorbitalbusoftbutissue,buincludingbuinferiorburectusbumuscle,buinferiorbu
obliquebumuscle,buorbitalbufat,buandbuconnectivebutissueburesultsbuinbuenophthalmos,buptos
