Chronic Alcoholic with memory loss...

 A chronic alcoholic develops severe memory loss with marked confabulation. Deficiency of which of the following vitamins would be most likely to contribute to the neurologic damage underlying these symptoms?

A. Folic acid
B. Niacin
C. Riboflavin
D. Thiamine
E. Vitamin B12

A 74 year old man after angiography...

8. A 74-year-old man is noted to have purplish-discolored right third and fourth toes 4 days after coronary angiography and a creatinine level of 2.4 mg/dL (creatinine level was normal on admission). He has a history of adult-onset diabetes mellitus, hypertension, and 50 pack-years of smoking. Cholesterol crystal atheromatous embolization is suspected. Which of the following may be present?

A. Livedo reticularis
B. Elevated erythrocyte sedimentation rate and/or leukocytosis and/or eosinophilia
C. Prominent gastrocnemius pain or claudication
D. Source(s) of the cholesterol emboli are usually the abdominal aorta or iliofemoral arteries rather than the more distal arteries.
E. All of the above

A 43-year-old, diabetic patient with hypertension...

A 43-year-old, insulin-dependent diabetic patient is diagnosed with hypertension and begins therapy with an antihypertensive agent. Three days later, he measures his blood glucose at home and finds that it is 53 mg/dL. He recalibrates his glucose testing apparatus and repeats the test, only to find that the first reading was accurate. He is concerned that his hypoglycemia did not produce the normal premonitory signs and symptoms. Which of the following medications was most likely prescribed to treat his hypertension?

A. Captopril
B. Diltiazem
C. Methyldopa
D. Prazosin
E. Propranolol

26 year old man with Heroin abuse

 A 26-year-old man is admitted through the emergency department to the hospital for a heroin overdose. His heart rate is 45 beats/min, and his blood pressure is 75/40 mm Hg. Which of the following best depicts the results from an arterial blood sample ?

pH PaCO2 (mm Hg) HCO3- (mEq/L)
A. 7.22 66 26
B. 7.34 29 15
C. 7.40 40 24
D. 7.47 20 14
E. 7.49 48 35

A Woman after a Road Traffic Accident

A healthy, 37-year-old, recently divorced woman loses her job at the auto factory. She picks up her three young children from the factory day care center and gets into an automobile accident on the
way home. Her 5-year-old son, who was not wearing a seat belt, sustains a severe head injury. The woman was not hurt in the accident, but is hyperventilating as she sits in the waiting room at the
hospital. She complains of feeling faint and has blurred vision. Which of the following is decreased in this woman?

A. Arterial oxygen content
B. Arterial oxygen tension (PO2)
C. Arterial pH
D. Cerebral blood flow
E. Cerebrovascular resistance

Woman with Fever

A 37-year-old female presents to the emergency room with a fever. Chest x-ray shows multiple patchy infiltrates in both lungs. Echocardiography and blood cultures suggest a diagnosis of acute bacterial endocarditis limited to the tricuspid valve. Which of the following is the most probable etiology?

A. Congenital heart disease
B. Illicit drug use
C. Rheumatic fever
D. Rheumatoid arthritis
E. Systemic lupus erythematosus

40 year old man with productive cough

A 40-year-old, moderately obese man presents with a persistent productive cough. The cough has been present for several weeks, but recently the man noted that his sputum has assumed a greenish color. Further questioning elicits a history of productive cough , usually in the winter months, over the past several years. He has smoked two packs of cigarettes per day since he was 16 years old. On examination, the man is febrile (100° F), and coarse rhonchi and wheezes can be appreciated bilaterally. Which of the following is the most likely diagnosis?

A. Bronchogenic carcinoma
B. Chronic bronchitis with superimposed infection
C. Cystic fibrosis
D. Emphysema
E. Pulmonary tuberculosis