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1. A 42-year-old man presents for a follow-up visit for mild hypertension. His blood pressure has been consistently elevated over the last 2 visits. In discussion with the patient, you decide to initiate antihypertensives. He had previously been on ramipril and stopped when he developed tongue swelling. His past medical history consists of asthma and hyperlipidemia. Which one of the following is the most appropriate treatment at this time?
A) Enalapril.
B) Metoprolol.
C) Clonidine.
D) Hydrochlorothiazide.
E) Hydralazine.
2. A mother brings her 1-month-old infant for routine health examination. The infant was born at term with no complications. He is exclusively breastfed every 3-4 hours and growth parameters are normal. His mother tells you that feedings are difficult (the baby cries any time she tries to put him down) and that she is exhausted. Her husband has been on a military mission since the infant was 2-weeks-old. Which one of the following is the most appropriate next step in management?
A) Refer to a lactation consultant.
B) Inquire about symptoms of depression.
C) Reassure that this is a normal phase.
D) Increase the frequency of the feeds.
E) Suggest a switch to hypoallergenic infant formula.
3. An 87-year-old man presents with a 2-week history of stiffness in both shoulders and both hips. On further questioning, he tells you that he has experienced a 2 kg unintentional weight loss over the last month. His past medical history is otherwise unremarkable and he is on no medications. On examination, he has limited range of motion due to pain in his shoulders and hips. The remainder of his examination, including muscle strength and joint exam, is normal. Which one of the following will you specifically ask about regarding his history?
A) Night sweats
B) Unilateral headache
C) Recent diarrheal illness
D) Tremor
E) Anhedonia
4. A 32-year-old man presents to the clinic for assessment of a dog bite sustained 3 days ago while traveling in another country. He recalls having seen the dog eat where he was staying, and the animal did not appear well.
On examination, the patient has 2 distinct deep puncture wounds on his left leg. There is an erythematous border but no exudate. He is unsure of his immunization status. Which one of the following is the most appropriate management?
A) Order serum creatine kinase
B) Start antibiotic treatment with ciprofloxacin
C) Give rabies immunoglobulin and vaccine
D) Arrange for wound debridement
E) Irrigate the wounds with hydrogen peroxide
5. A 39-year-old man presents to a psychiatrist. He says, " It often seems to me that I am not part of this world.
My voice sounds strange to me, and other people seem like figures in a dream. " He has had these feelings intermittently for about 2 years. There is no history of hallucinations, and there are no current indications of disorganized thinking. Which one of the following is the most likely diagnosis?
A) Schizophrenia.
B) Delusional disorder.
C) Depersonalization/derealization disorder.
D) Conversion disorder.
E) Persistent depressive disorder.
Solutions:
| Question # 1 Answer: D | Question # 2 Answer: B | Question # 3 Answer: B | Question # 4 Answer: C | Question # 5 Answer: C |
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