Internal Medicine End of Rotation Questions

Chest x-ray findings in CHF include all of the following, EXCEPT:  Cardiomegaly  Interstitial edema  Pleural effusion  Lobar consolidation A 65-year-old retired steel worker who has never had any sexual dysfunction experiences difficulty in obtaining and maintaining an erection shortly after he starts taking a medication prescribed by his primary care physician. What medication is most likely to cause such a side effect?  Propanolol  Amoxicillin  Lorazepam  Bupropion  Thyroid hormones With vitamin B12 deficiency, which of the following accumulates in the blood?  Cysteine  Methymalonic acid  Methionine  Succinic acid  Propionic acid Treatment of angina pectoris includes all of the following, EXCEPT:  Calcium channel blockers  Nitrates  Beta Blockers  Theophyllines Omeprazole has been added to the H2 antagonists as a therapeutic approach to the management of acute gastric and duodenal ulcers. It acts by:  Blocking breakdown of mucosal-damaging metabolites of NSAIDs  Providng adirect cytoprotective effect  Buffering gastric acids  Inhibiting parietal cell hydrogen-potassium-ATPase  Inhibiting gastrin release and parietal cell acid production A 73-year-old man with a history of hypertension complains of a 10-minute episode of left-sided weakness and slurred speech. On further questioning, he relates three brief episodes in the last month of sudden impairment of vision affecting the right eye. His examination now is normal. Which of the following would be the most appropriate next diagnostic test?  Creatinine phosphokinase (CPK)  Holter monitor  Visual evoked response  Carotid artery Doppler ultrasound  Conventional cerebral angiography Conditions that can mimic angina pectoris include all of the following, EXCEPT: (the internet said all of them can?? Lame :P probably divertic.)  Esophageal spasm  Cholecystitis  Cervical or thoracic spine disease  Diverticulosis Which of the following is used in the prophylactic treatment of migraines?  Amitriptyline  Propanolol  Verapamil  Valproic acid  All of the above The most common manifestation of muscle weakness with myasthenia gravis is:  Diaphragmatic weakness  Wrist-drop  Foot-drop  Ocular muscle weakness  Dysphagia Which statement is true regarding HDL cholesterol?  Removes cholesterol from peripheral tissues and transports to the liver  Aerobic exercise increases HDL  Low HDL is a risk factor for coronary artery disease  All of the above Which of the following organisms is recognized as a major cause of peptic ulcer disease (PUD)?  Campylobacter jejuni

 Helicobacter pylori  Clostirdium dificile  Pseudomonas aeruginosa  Enterotosigenic echechia coli Sebhorrhea and sebhorrheic dermatitis occurs in the following areas, EXCEPT:  Nasolabial region  Scalp  Mid to upper back  Presternal region All of the following statements are true regarding herpes zoster, EXCEPT:  Is a reactivation of varicella virus  Causes vesicles  Can cause post herpetic neuralgia  The lesions are usually distributed along the entire trunk An acute increase in intracranial pressure is characterized by which of the following clinical findings?  Respiratory irregularities  Decreased blood pressure  Tachycardia  Papilledema  Compression of the fifth cranial nerve Inverted T waves are caused by all of the following, EXCEPT:  Myocardial ischemia  Subendocardial infection  High calcium intake Work up for the newly diagnosed patient with hypertension should include:  CBC  Renal function test  Electrolytes  EKG  All of the above Which of the following is TRUE about hepatitis B?  It is the most common form of acute viral hepatitis  Even without treatment, it seldom progresses to chronic disease  It is a vaccine-preventable liver disease  Its prevalence is related to the quality of the water supply  Food-borne hepatitis B is a common mode of transmission A 55-year-old woman with breast cancer is waiting for the results of her bone scan. She promises God that she will stop smoking and attend Mass every Sunday if the scan does not show signs of metastases. According to Elisabeth Kubler-Ross, who extensively studied the psychological processes of dying patients, which behavior is typical of the stage of:  Anger  Denial  Sublimation  Bargaining  Acceptance Woman’s risk of breast cancer may be reduced by all of the following, EXCEPT:  Oral contraceptives  Prophylactic mastectomy  Tamoxifen  Smoking cessation  Oophorectomy Lab findings in acute MI include all of the following, EXCEPT:  Leukocytosis  Elevated GGTP  Elevated CK  Elevated troponin I Which of the following can precipitate a typical angina attack?  Physical exertion  Vomiting  Warm weather Which of the following is NOT a risk factor for the independent development of deep vein thrombosis?  Stroke  CHF

 Use of oral contraceptives in women over 30 who smoke cigarettes  Hyperparathyroidism  Adenocarcinoma Which of the following statements regarding pancreatic carcinoma is TRUE?  The majority of cases present with jaundice alone  CT scan, angiography, and laparoscopy have been unsuccessful in predicting respectability  If a patient is jaundiced, the respectability rate is less than 5%  99% of patients with pancreatic cancer have metastatic disease at the time of diagnosis  The 5-year survival rate after a Whipple procedure (prancreaticdudodenectomy) performed for cure is 30-40% Which group is at highest risk of developing melanoma of the palms, soles, and mucous membrane?  African Americans  Caucasians  Light-skinned individuals  Those with poor tanning ability True statements regarding Cushing’s disease and Cushing’s syndrome include which of the following:  Adrenocortical hyperplasia is the most common cause of Cushing’s disease  Overproduction of ACTH is pathognomonic of Cushing syndrome  Clinical manifestations of Cushing’s disease and Cushing syndrome are identical  Cushing syndrome is caused by neoplasms of either the pituitary or adrenal glands  Cushing’s disease is incurable Causes of congestive heart failure include all of the following, EXCEPT:  Coronary artery disease  Cardiomyopathy  Viral mycocarditis  Hepatitis Which of the following is NOT a feature of left sided heart failure?  Pedal edema  Elevated pulmonary venous pressure  Dyspnea  Low cardiac output Which of the following is TRUE regarding genetic and lifestyle risk factors for ischemic stroke?  A rise in diastolic blood pressure is the most significant parameter of hypertensive risk  Smoking doubles (at least) risk, but quitting smoking returns the patient to normal levels within months  Binge drinking of alcohol increases the risk of both ischemic and hemorrhagic stroke  Carotid stenosis without a bruit (ie- asymptomatic) has very low risk of stroke since blood flow is still present  Diabetes Mellitus, when not associated with other risk factors, has a low independent risk factor (this is this what it said, cut off) Both trigeminal neuralgia and atypical facial pain involve pain that may be:  Lancinating  Paroxysmal  Associated with anesthetic patches  Abolished with resection of the gasserian ganglion  Unilateral The most common source of metastatic tumors to the brain is the:  Breast  Lung  Kidney  Skin  Uterus A correct statement concerning bronchial carcinoid tumor is that:  They frequently metastasize  They most commonly arise in peripheral terminal bronchioles  They rarely produce the carcinoid syndrome  They are radiosensitive  Five-year survival is less than 50% Which of the following drugs is a loop diuretic?  Hydrochlorthiazide  Triamterene  Furosemide  Chlorothiazide Among the following causes of hepatitis, which will most likely lead to chronic infection, is the most frequent reason for liver transplantation, and is a leading cause of liver cancer?  Hepatitis A

 Hepatitis B  Hepatitis C  Hepatitis D  Hepatitis E The seizure type that most commonly occurs in adults is:  Complex partial  Generalized tonic-clonic  Generalized absence  Simple partial  Jacksonian What antihypertensive drugs are associated with cough?  ACE inhibitors  Beta blockers  Calcium channel blockers  Diuretics Acoustic trauma from explosions, loud music, or industrial activities most commonly produce:  High-tone sensorineural loss  Low-tone sensorineural loss  High-tone conductive loss  Low-tone conductive loss  Central deafness In the dementia associated with Alzheimer’s disease, the EEG will usually show:  Spike-and-wave discharges  Periodic frontal lobe discharges  Focal slowing  Generalized background slowing  An isoelectric record Even though the physiologic deficiency in Parkinson’s disease is dopamine, L-dopa rather than dopamine is given to patients because:  L-dopa induces less nausea and vomiting than dopamine  Dopamine is readily metabolized in the gastrointestinal tract to ineffective compounds  L-dopa is more readily absorbed in the gastrointestinal tract than is dopamine  Dopamine cannot cross the blood-brain barrier and therefore has no therapeutic effect in the CNS  L-dopa is more effective at dopamine receptors than is dopamine itself A 40-year-old woman is found to have a 1 to 2 cm, slightly tender cystic mass in her breast; she has no perceptible axillary adenopathy. What course would you follow?  Reassurance and reexamination in the immediate postmenstrual period  Immediate excisional biopsy  Aspiration of the mass with cytologic analysis  Fluoroscopically guided needle localization biopsy  Mammography and reevaluation of options with new information An 80-year-old man is admitted to the hospital complaining of nausea, abdominal pain, distention, and diarrhea. A cautiously performed transanal contrast study reveal an “apple core” configuration in the rectosigmoid. Appropriate management at this time would be:  Colonscopic decompression and rectal tube placement  Saline enemas and digital disimpaction of fecal matter from the rectum  Colon resection and proximal colostomy  Oral administration of metronidazole and checking a Clostridium difficile titer  Evaluation of an electrocardiogram and obtaining an angiogram to evaluate for colonic mesenteric ischemia