AQUIFER INTERNAL MEDICINE END OF
CASE EXAM QUESTIONS AND ANSWERS
A 39-year-old male with no significant past medical history
presents to the hospital with lower abdominal pain for the past two
days. His initial vitals are notable where his temperature is 38.5 C
(101.3 F), pulse is 112 beats/minute, and blood pressure is
103/68 mmHg. He reports that his last bowel movement was two
days ago, and he recalls passing flatus earlier today. Your
physical exam reveals hypoactive bowel sounds, and a diffusely
tender abdomen, most tender in the right-lower quadrant. Hi -
ANSWER The ANSWER is B. From IM 12.
A 68-year-old male with a history of peptic ulcer disease,
diabetes mellitus, and hypertension is admitted to the hospital
with a 24-hour history of abdominal pain and three episodes of
loose stool. Initial vital signs reveal temperature is 38.9 C (102.02
F), pulse is 102 beats/minute, respiratory rate is 16
breaths/minute, blood pressure is 132/78 mmHg, and oxygen
saturation is 98% on room air. White blood count (WBC) is 13,100
cells/μl. He has tenderness to palpation of the left lower quadran -
ANSWER The ANSWER is A. From IM 12.
A 51-year-old male is admitted to the hospital for acute,
uncomplicated diverticulitis. Medical history is significant for
asthma, gastroesophageal reflux disease (GERD), and
hypertension. He is treated with intravenous ciprofloxacin and
metronidazole, intravenous fluids, and pain medication. After two
days, his pain is improved and he is tolerating food. Which of the
following discharge plans is most appropriate for him?
,A. Continue oral antibiotics for 21 days
B. Prescribe subcutaneous enoxap - ANSWER The ANSWER is
C. From IM 12.
A 63-year-old female with a past history of hypertension, chronic
obstructive pulmonary disease (COPD), type 2 diabetes mellitus,
and hyperlipidemia is admitted to the hospital with Clostridium
difficile (C. difficile) colitis. Of the following options, which is the
best choice for deep vein thrombosis (DVT) prophylaxis for her?
A. Ambulation
B. Aspirin, 81 mg by mouth (PO) daily
C. Enoxaparin, 40 mg subcutaneous daily
D. Heparin intravenous (IV) continuous infusion, titrated for a
goal-activat - ANSWER The ANSWER is C. From IM 12.
A 67-year-old male comes to the clinic for a health maintenance
visit. His past medical history is significant for chronic allergic
rhinitis, severe chronic obstructive pulmonary disease (COPD),
osteoporosis, psoriasis, atrial fibrillation, and benign prostatic
hypertrophy. Vital signs show his temperature is 36.8 C (98.2 F),
pulse is 76 beats/minute, respiratory rate is 12 breaths/minute,
and blood pressure is 118/70 mmHg. His weight is 129.2 kg (285
lbs) and his body mass index (BMI) is 41. Wh - ANSWER The
ANSWER is A. From IM 16.
A 52-year-old female comes to the clinic to discuss weight loss.
Her medical history is significant for obesity; her body mass index
(BMI) is 41; hypertension; hyperlipidemia; and obstructive sleep
apnea. She knows that losing weight will help her hypertension
and hyperlipidemia, but she doesn't feel like these things bother
her. Her only other concern is fatigue; she doesn't use her
continuous positive airway pressure (CPAP) machine, because
,she doesn't like the mask. What additional informatio - ANSWER
The ANSWER is A. From IM 16.
Ms. Tsvetanova is a 42-year-old female with no significant past
medical history presenting to establish care with her primary care
physician. On review, she notes a weight gain of 14 kg (30 lbs)
over the last three years. She attributes this mostly to her
sedentary lifestyle, snacking, and difficulty with portion control.
She works as a receptionist for a local physician's office and
spends most of her day sitting. She denies constipation, low
energy, cold intolerance, muscle weakness, depressed -
ANSWER The ANSWER is D. From IM 16.
Mr. York is a 44-year-old male presenting for evaluation of an
eyelid lesion. He noticed the lesion about one year ago. There is
no associated itching, discharge, or other bothersome symptoms.
Which of the following is the next best step in the management of
the eyelid lesion?
A. Low potency topical corticosteroid
B. Measurement of serum cholesterol levels
C. Measurement of serum uric acid levels
D. No further management
E. Skin biopsy - ANSWER The ANSWER is B. From IM
!6.
Ms. H is a 68-year-old female with a medical history significant
for obesity, type II diabetes, hypothyroidism, hypertension, and
recently diagnosed hyperlipidemia. Her most-recent lipoprotein
(LDL), three months ago, was 197 mg/dL. At that time,
atorvastatin was initiated. Other medications include metformin,
insulin glargine, amlodipine, hydrochlorthiazide, and
, levothyroxine. Which of the following may be contributing to her
elevated LDL?
A. Amlodipine
B. Hydrochlorthiazide
C. Insulin glargine - ANSWER The ANSWER is B. From IM 16.
A 66-year-old female is evaluated in the emergency department
with a two-day history of right-sided pleuritic chest pain and
intermittent shortness of breath. Past medical history is significant
for hypertension, chronic kidney disease, and depression.
Medications include lisinopril, baby aspirin, and oral hormone
replacement therapy. Physical examination shows her
temperature is 37.8 C (100.1 F), pulse is 112 beats/minute,
respiratory rate is 22 breaths/minute, blood pressure is 158/76
mmHg, bo - ANSWER The ANSWER is E. From IM 22.
A 56-year-old male presents to the emergency department with
shortness of breath with minimal activity for two days. He
endorses orthopnea and paroxysmal nocturnal dyspnea. Past
medical history is significant for hypertension, hyperlipidemia, and
peripheral vascular disease for which he takes aspirin,
amlodipine, and atorvastatin. He has a 20-pack-per-year history
of smoking. Vital signs are as follows: temperature is 37.1 C (98.7
F), pulse is 102 beats/minute, blood pressure is 180/100 mmHg,
bo - ANSWER The ANSWER is D. From IM 22.
A 45-year-old human immunodeficiency virus (HIV)-infected male
presents to the emergency department with nonproductive cough,
fever, and progressive exertional dyspnea for one week. His CD4
count was 150/microliter one month ago. He has not been
adherent to his antiretroviral regimen. On arrival, his temperature
is 38.3 C (100.9 F), heart rate is 98 beats/minute, blood pressure
is 110/70 mmHg, and oxygen saturation is 89% on room air.
CASE EXAM QUESTIONS AND ANSWERS
A 39-year-old male with no significant past medical history
presents to the hospital with lower abdominal pain for the past two
days. His initial vitals are notable where his temperature is 38.5 C
(101.3 F), pulse is 112 beats/minute, and blood pressure is
103/68 mmHg. He reports that his last bowel movement was two
days ago, and he recalls passing flatus earlier today. Your
physical exam reveals hypoactive bowel sounds, and a diffusely
tender abdomen, most tender in the right-lower quadrant. Hi -
ANSWER The ANSWER is B. From IM 12.
A 68-year-old male with a history of peptic ulcer disease,
diabetes mellitus, and hypertension is admitted to the hospital
with a 24-hour history of abdominal pain and three episodes of
loose stool. Initial vital signs reveal temperature is 38.9 C (102.02
F), pulse is 102 beats/minute, respiratory rate is 16
breaths/minute, blood pressure is 132/78 mmHg, and oxygen
saturation is 98% on room air. White blood count (WBC) is 13,100
cells/μl. He has tenderness to palpation of the left lower quadran -
ANSWER The ANSWER is A. From IM 12.
A 51-year-old male is admitted to the hospital for acute,
uncomplicated diverticulitis. Medical history is significant for
asthma, gastroesophageal reflux disease (GERD), and
hypertension. He is treated with intravenous ciprofloxacin and
metronidazole, intravenous fluids, and pain medication. After two
days, his pain is improved and he is tolerating food. Which of the
following discharge plans is most appropriate for him?
,A. Continue oral antibiotics for 21 days
B. Prescribe subcutaneous enoxap - ANSWER The ANSWER is
C. From IM 12.
A 63-year-old female with a past history of hypertension, chronic
obstructive pulmonary disease (COPD), type 2 diabetes mellitus,
and hyperlipidemia is admitted to the hospital with Clostridium
difficile (C. difficile) colitis. Of the following options, which is the
best choice for deep vein thrombosis (DVT) prophylaxis for her?
A. Ambulation
B. Aspirin, 81 mg by mouth (PO) daily
C. Enoxaparin, 40 mg subcutaneous daily
D. Heparin intravenous (IV) continuous infusion, titrated for a
goal-activat - ANSWER The ANSWER is C. From IM 12.
A 67-year-old male comes to the clinic for a health maintenance
visit. His past medical history is significant for chronic allergic
rhinitis, severe chronic obstructive pulmonary disease (COPD),
osteoporosis, psoriasis, atrial fibrillation, and benign prostatic
hypertrophy. Vital signs show his temperature is 36.8 C (98.2 F),
pulse is 76 beats/minute, respiratory rate is 12 breaths/minute,
and blood pressure is 118/70 mmHg. His weight is 129.2 kg (285
lbs) and his body mass index (BMI) is 41. Wh - ANSWER The
ANSWER is A. From IM 16.
A 52-year-old female comes to the clinic to discuss weight loss.
Her medical history is significant for obesity; her body mass index
(BMI) is 41; hypertension; hyperlipidemia; and obstructive sleep
apnea. She knows that losing weight will help her hypertension
and hyperlipidemia, but she doesn't feel like these things bother
her. Her only other concern is fatigue; she doesn't use her
continuous positive airway pressure (CPAP) machine, because
,she doesn't like the mask. What additional informatio - ANSWER
The ANSWER is A. From IM 16.
Ms. Tsvetanova is a 42-year-old female with no significant past
medical history presenting to establish care with her primary care
physician. On review, she notes a weight gain of 14 kg (30 lbs)
over the last three years. She attributes this mostly to her
sedentary lifestyle, snacking, and difficulty with portion control.
She works as a receptionist for a local physician's office and
spends most of her day sitting. She denies constipation, low
energy, cold intolerance, muscle weakness, depressed -
ANSWER The ANSWER is D. From IM 16.
Mr. York is a 44-year-old male presenting for evaluation of an
eyelid lesion. He noticed the lesion about one year ago. There is
no associated itching, discharge, or other bothersome symptoms.
Which of the following is the next best step in the management of
the eyelid lesion?
A. Low potency topical corticosteroid
B. Measurement of serum cholesterol levels
C. Measurement of serum uric acid levels
D. No further management
E. Skin biopsy - ANSWER The ANSWER is B. From IM
!6.
Ms. H is a 68-year-old female with a medical history significant
for obesity, type II diabetes, hypothyroidism, hypertension, and
recently diagnosed hyperlipidemia. Her most-recent lipoprotein
(LDL), three months ago, was 197 mg/dL. At that time,
atorvastatin was initiated. Other medications include metformin,
insulin glargine, amlodipine, hydrochlorthiazide, and
, levothyroxine. Which of the following may be contributing to her
elevated LDL?
A. Amlodipine
B. Hydrochlorthiazide
C. Insulin glargine - ANSWER The ANSWER is B. From IM 16.
A 66-year-old female is evaluated in the emergency department
with a two-day history of right-sided pleuritic chest pain and
intermittent shortness of breath. Past medical history is significant
for hypertension, chronic kidney disease, and depression.
Medications include lisinopril, baby aspirin, and oral hormone
replacement therapy. Physical examination shows her
temperature is 37.8 C (100.1 F), pulse is 112 beats/minute,
respiratory rate is 22 breaths/minute, blood pressure is 158/76
mmHg, bo - ANSWER The ANSWER is E. From IM 22.
A 56-year-old male presents to the emergency department with
shortness of breath with minimal activity for two days. He
endorses orthopnea and paroxysmal nocturnal dyspnea. Past
medical history is significant for hypertension, hyperlipidemia, and
peripheral vascular disease for which he takes aspirin,
amlodipine, and atorvastatin. He has a 20-pack-per-year history
of smoking. Vital signs are as follows: temperature is 37.1 C (98.7
F), pulse is 102 beats/minute, blood pressure is 180/100 mmHg,
bo - ANSWER The ANSWER is D. From IM 22.
A 45-year-old human immunodeficiency virus (HIV)-infected male
presents to the emergency department with nonproductive cough,
fever, and progressive exertional dyspnea for one week. His CD4
count was 150/microliter one month ago. He has not been
adherent to his antiretroviral regimen. On arrival, his temperature
is 38.3 C (100.9 F), heart rate is 98 beats/minute, blood pressure
is 110/70 mmHg, and oxygen saturation is 89% on room air.
