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Đề Thi Ngày Tháng 25/11/2010
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1. Which clinical signs would you expect in a 53-yearold man with gait ataxia and these MRI findings (see Figure XI-12)?
A. Gait instability, urinary incontinence, dementia
B. Hypertension, tachycardia, diaphoresis
C. Migraine headache, limb weakness, breathing difficulties
D. Scanning speech, oscillatory tremor of the head, Nystagmus
2. On the neurologic consultation service, you are asked to evaluate a patient with mesial temporal lobe epilepsy syndrome. The patient has a history of intractable complex partial seizures that rarely generalize. Her seizures often begin with an aura and commonly manifest as behavioral arrests, complex automatisms, and unilateral posturing. MRI findings include small temporal lobes and a small hippocampus with increased signal on T2- weighted sequences. Which of these additional historic factors are also likely to be present in this patient?
A. History of febrile seizures
B. Hypothyroidism
C. Neurofibromas
D. Recurring genital ulcers
E. Type 2 diabetes mellitus
3. A 54-year-old man has been hospitalized following a myocardial infarction. He has a history of hypertension, hypertriglyceridemia, obesity, mild renal insufficiency and diet-controlled diabetes. His condition is improving, and on the third day of admission his serum urate is elevated at 8.8 mg/dL. He denies any joint complaints and cannot recall ever having symptoms compatible with gout. His serum creatinine is 1.5 mg/dL, which is close to his baseline over the past 3 years. In regard to this patient’s hyperuricemia, which of the following is true?
A. >70% of hospitalized patients will have increased serum urate levels.
B. His hyperuricemia is unrelated to his heart disease.
C. His renal disease is likely caused by his increased serum urate levels.
D. No treatment is needed.
E. This patient should be discharged on low-dose allopurinol
4. All of the following statements regarding hypoglycemia in diabetes mellitus are true except
A. Individuals with type 2 diabetes mellitus experience less hypoglycemia than those with type 1 diabetes mellitus.
B. Recurrent episodes of hypoglycemia predispose to the development of autonomic failure with defective glucose counterregulation and hypoglycemia unawareness.
C. The average person with type 1 diabetes mellitus has two episodes of symptomatic hypoglycemia weekly.
D. Thiazolidinediones and metformin cause hypoglycemia more frequently than sulfonylureas.
E. From 2–4% of deaths in type 1 diabetes mellitus are directly attributable to hypoglycemia.
5. A 27-year-old female with SLE is in remission; current treatment consists of azathioprine 75 mg/d and prednisone 5 mg/d. Last year she had a life-threatening exacerbation of her disease. She now strongly desires to become pregnant. Which of the following is the least appropriate action to take?
A. Advise her that the risk of spontaneous abortion is high.
B. Warn her that exacerbations can occur in the first trimester and in the postpartum period.
C. Tell her it is unlikely that a newborn will have lupus.
D. Advise her that fetal loss rates are higher if anticardiolipin antibodies are detected in her serum.
E. Stop the prednisone just before she attempts to become pregnant.
6. In the case vignette presented above, which of the following factors at presentation predicts a poor outcome and increased risk of death in acute pancreatitis?
A. Body mass index (BMI) >25 kg/m2
B. Hematocrit ≥40%
C. Lipase >1000 IU/L
D. PaO2 <60 mmHg
E. WBC count >10,000/μL
7. All of the following necessitate sending bacterial stool cultures in patients with diarrhea for 2 days severe enough to keep them home from work except
A. age >75
B. bloody stools
C. dehydration
D. recent lung transplantation
E. temperature >38.5°C
8. The patient in the preceding scenario is found to have a serum calcium of 12.1 mg/dL. Of the following interventions, what therapy is most appropriate in this patient?
A. Glucocorticoids
B. Intravenous loop diuretic
C. Intravenous phosphate
D. Oral calcitriol
E. Zoledronic acid
9. A 23-year-old hospital worker is evaluated for a known contact with a patient with active tuberculosis. One year ago his intermediate-strength PPD had 3 mm of induration; now it has 13 mm of induration at 48h. He has no significant past medical history and is on no medications. Subsequent management should include
A. chest radiography
B. isoniazid 300 mg/d for 3 months
C. measurement of baseline liver function tests
D. measurement of liver function tests every 3 months
E. repeated intermediate-strength PPD testing in 2 weeks
10. In the intensive care unit, you are caring for a 36-yearold man with a cocaine overdose. He has pyrexia, tachycardia, and hypertensive urgency. He begins to have brief episodes of ventricular tachycardia but is awake but disoriented. Over the next hour, his ventricular tachycardia becomes more frequent and lasts longer each time. What is the appropriate management strategy for his arrhythmia?
A. Intravenous diazepam
B. Intravenous hydralazine
C. Intravenous norepinephrine
D. Intravenous propranolol
11. All the following disorders may be associated with thoracic aortic aneurysm except
A. osteogenesis imperfecta
B. Takayasu’s arteritis
C. Ehlers-Danlos syndrome
D. ankylosing spondylitis
E. Klinefelter’s syndrome
12. Which of the following disorders is not associated with ventricular tachycardia as a cause of syncope?
A. Hypertrophic obstructive cardiomyopathy
B. Prior myocardial infarction
C. Atrial myxoma
D. Aortic valvular stenosis
E. Congenital long QT syndrome
13. Fall risks in the elderly include all of the following except
A. creatinine clearance <65 mL/min
B. diabetes mellitus
C. fear of falling
D. history of falls
E. hypertension
F. psychotropic medications
14. Which cardiac valvular disorder is the most likely to cause death during pregnancy?
A. Aortic regurgitation
B. Aortic stenosis
C. Mitral regurgitation
D. Mitral stenosis
E. Tricuspid regurgitation
15. A 43-year-old man with alcoholic liver disease complains of dyspnea upon sitting up. Physical examination is notable for chest spider angiomas and palmar erythema. His arterial oxygen saturations fall from 96% to 88% upon transition from lying to sitting. His lung fields are clear and heart sounds are crisp. Abdominal examination is notable for a palpable nodular liver edge but no fluid wave or shifting dullness. He has 1+ lower extremity edema. What is the most likely cause of his dyspnea?
A. Chronic thromboembolic disease
B. Congestive heart failure
C. Pulmonary arteriovenous fistula
D. Portal hypertension
E. Ventricular septal defect
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