IM Rosh Qbank UPDATED ACTUAL CORRECT Answers
1. 75-year-old woman presents to the emergency de- Permanent pacemaker
partment after collapsing at work. She reports this
is her third syncopal episode in the past month. The Sick sinus syndrome EKG
electrocardiogram above is obtained during the initial = bradycardia alternating
workup. What definitive clinical intervention is indicat- with tachycardia as well as
ed for this patient? extended periods of sinus
Amiodarone inactivity
Flecainide
Observation
Permanent pacemaker
2. 65-year-old woman who is a former smoker with a Adenocarcinoma
past medical history of hypertension, hyperlipidemia, MC form of bronchogenic
and arthritis presents to her primary care clinic for carcinoma
three months of cough with hemoptysis, generalized seen in *periphery* of
chest discomfort, and weight loss. Vitals show a heart lungs
rate of 68 bpm, blood pressure of 132/81 mm Hg,
O2 saturation of 96% on room air, respiratory rate of
16 breaths per minute, and temperature of 98.1°F.
Vaccines are up to date, and there has been no travel
or sick contacts. Chest X-ray and CT scan of the chest
show multiple irregularly shaped nodules in the pe-
riphery of the lungs bilaterally. Which of the following
is the most likely diagnosis?
Adenocarcinoma
Large cell carcinoma
Small cell lung cancer
Squamous cell carcinoma
3. 68-year-old woman presents with progressively wors- Ulcerative Colitis
ening diarrhea over the past 3 weeks. She describes
the bowel movements as frequent and small in vol- *absence of peri oral
, ume with bright red blood often present. She aver- involvment (prevalent in
ages five episodes per day. She experiences a fre- crohns)
quent, and sometimes sudden, urge to evacuate her read explanation
bowels. She reports she sometimes does not make it
to the bathroom in time. She reports fatigue. She is
afebrile. Abdominal exam reveals mild abdominal ten-
derness without palpable mass. A gastroenterology
referral is prepared. What is the most likely diagnosis
given the patient's history and physical exam?
Celiac sprue
Crohn disease
Diverticulitis
Ulcerative colitis
4. 72-year-old man presents with acute pain, stiffness, Positively birefringent cal-
and swelling of his left knee. His medical history is cium pyrophosphate crys-
significant for hypothyroidism and osteoarthritis. On tals
physical exam, the knee is erythematous, warm, and
tender to touch. Cartilage calcification is seen on plain pseudo gout - MC in knee
film radiography. Which of the following findings of
synovial fluid analysis is best to diagnose the suspect-
ed condition?
Negatively birefringent monosodium urate crystals
Nonpathogenetic crystals of cholesterol artifact
Positive Gram stain with positive culture
Positively birefringent calcium pyrophosphate crys-
tals
5. A 35-year-old woman presents to her primary care Cyclophosphamide
provider for a one-week history of dark urine. She
has a past medical history of systemic lupus erythe- Lupus nephritis tx = corti-
matosus but is not currently on medication due to costeroids (prednisone) +
, a lapse in insurance. Her blood pressure is 165/105 immunosuppressant (cy-
mm Hg. Urine dipstick reveals 2+ protein and hema- clophosphamide)
turia. Lab tests reveal low complement protein and
azotemia. The patient is started on prednisone. What *hydroxychloroquine for
other medication is indicated for the treatment of this indicated in all SLE for skin
complication of systemic lupus erythematosus? lesions and joint pain >>
Cyclophosphamide used after kidney function
Furosemide stabilizes*
Hydroxychloroquine
Ibuprofen
6. 25-year-old man presents to urgent care with general Reactive arthritis
fatigue, slight fever, and pain, warmth, and swelling
to his left knee for the past two weeks. He reports asymmetric, following GI
an occurrence of gastroenteritis nearly one month or GU symptoms
before these symptoms presented. On exam of the
left knee, there is erythema, swelling, warmth, and
extreme tenderness at locations of tendon insertion.
Which of the following is the most likely diagnosis?
Pseudogout
Reactive arthritis
Rheumatoid arthritis
Septic arthritis
7. 60-year-old man presents to the ER for acute abdom- Mottled, lace-like purple
inal pain. The patient has a significant past medical discoloration (livedo retic-
history of hepatitis B. The patient reports a history of ularis)
recent malaise, 10 lb weight loss, and fevers leading
up to this episode of abdominal pain. Physical exam Polyarteritis nodosa: mi-
reveals elevated blood pressure, diffusely tender ab- croaneurysms, Hep B/C,
domen, and a rash on the patient's legs. Computed mesenteric ischemia
tomography with IV contrast of the abdomen reveals
, microaneurysms with sudden cutoffs and evidence
of mesenteric ischemia. What description of the rash
would be consistent with the suspected diagnosis?
Diffuse maculopapular
Mottled, lace-like purple discoloration
Palpable purpura
Violaceous, raised discoloration
8. A 53-year-old man presents to his primary care Stage 1 hypertension
provider for his annual physical. His blood pressure
reading is 131/83 mm Hg at this visit. He returns to elevated BP: 120-129/<
the clinic 2 weeks later for a second blood pressure 80 mm Hg
measurement, and his BP at this time is 135/80 mm stage 1: 130-139/80-89
Hg. Which of the following is the most appropriate mm Hg
diagnosis according to ACC/AHA guidelines? stage 2: e140/e90 mm Hg.
Elevated blood pressure
Normal blood pressure
Stage 1 hypertension
Stage 2 hypertension
9. 26-year-old man who uses intravenous drugs pre- Echocardiography
sents with an acute onset of fever, chills, malaise,
and anorexia. On physical exam, his temperature is Acute bacterial endocardi-
101.4°F, BP 98/50 mm Hg, HR 120 beats per minute, tis
and RR 22 breaths per minute. Splinter hemorrhage
osler nodes (painful, vi-
and Osler nodes are present. Which of the following
olaceous raised lesions
diagnostic tests would confirm the suspected diagno-
sis? of the fingers, toes, and
feet),
Chest radiography
Computed tomography
Echocardiography
Electrocardiogram
1. 75-year-old woman presents to the emergency de- Permanent pacemaker
partment after collapsing at work. She reports this
is her third syncopal episode in the past month. The Sick sinus syndrome EKG
electrocardiogram above is obtained during the initial = bradycardia alternating
workup. What definitive clinical intervention is indicat- with tachycardia as well as
ed for this patient? extended periods of sinus
Amiodarone inactivity
Flecainide
Observation
Permanent pacemaker
2. 65-year-old woman who is a former smoker with a Adenocarcinoma
past medical history of hypertension, hyperlipidemia, MC form of bronchogenic
and arthritis presents to her primary care clinic for carcinoma
three months of cough with hemoptysis, generalized seen in *periphery* of
chest discomfort, and weight loss. Vitals show a heart lungs
rate of 68 bpm, blood pressure of 132/81 mm Hg,
O2 saturation of 96% on room air, respiratory rate of
16 breaths per minute, and temperature of 98.1°F.
Vaccines are up to date, and there has been no travel
or sick contacts. Chest X-ray and CT scan of the chest
show multiple irregularly shaped nodules in the pe-
riphery of the lungs bilaterally. Which of the following
is the most likely diagnosis?
Adenocarcinoma
Large cell carcinoma
Small cell lung cancer
Squamous cell carcinoma
3. 68-year-old woman presents with progressively wors- Ulcerative Colitis
ening diarrhea over the past 3 weeks. She describes
the bowel movements as frequent and small in vol- *absence of peri oral
, ume with bright red blood often present. She aver- involvment (prevalent in
ages five episodes per day. She experiences a fre- crohns)
quent, and sometimes sudden, urge to evacuate her read explanation
bowels. She reports she sometimes does not make it
to the bathroom in time. She reports fatigue. She is
afebrile. Abdominal exam reveals mild abdominal ten-
derness without palpable mass. A gastroenterology
referral is prepared. What is the most likely diagnosis
given the patient's history and physical exam?
Celiac sprue
Crohn disease
Diverticulitis
Ulcerative colitis
4. 72-year-old man presents with acute pain, stiffness, Positively birefringent cal-
and swelling of his left knee. His medical history is cium pyrophosphate crys-
significant for hypothyroidism and osteoarthritis. On tals
physical exam, the knee is erythematous, warm, and
tender to touch. Cartilage calcification is seen on plain pseudo gout - MC in knee
film radiography. Which of the following findings of
synovial fluid analysis is best to diagnose the suspect-
ed condition?
Negatively birefringent monosodium urate crystals
Nonpathogenetic crystals of cholesterol artifact
Positive Gram stain with positive culture
Positively birefringent calcium pyrophosphate crys-
tals
5. A 35-year-old woman presents to her primary care Cyclophosphamide
provider for a one-week history of dark urine. She
has a past medical history of systemic lupus erythe- Lupus nephritis tx = corti-
matosus but is not currently on medication due to costeroids (prednisone) +
, a lapse in insurance. Her blood pressure is 165/105 immunosuppressant (cy-
mm Hg. Urine dipstick reveals 2+ protein and hema- clophosphamide)
turia. Lab tests reveal low complement protein and
azotemia. The patient is started on prednisone. What *hydroxychloroquine for
other medication is indicated for the treatment of this indicated in all SLE for skin
complication of systemic lupus erythematosus? lesions and joint pain >>
Cyclophosphamide used after kidney function
Furosemide stabilizes*
Hydroxychloroquine
Ibuprofen
6. 25-year-old man presents to urgent care with general Reactive arthritis
fatigue, slight fever, and pain, warmth, and swelling
to his left knee for the past two weeks. He reports asymmetric, following GI
an occurrence of gastroenteritis nearly one month or GU symptoms
before these symptoms presented. On exam of the
left knee, there is erythema, swelling, warmth, and
extreme tenderness at locations of tendon insertion.
Which of the following is the most likely diagnosis?
Pseudogout
Reactive arthritis
Rheumatoid arthritis
Septic arthritis
7. 60-year-old man presents to the ER for acute abdom- Mottled, lace-like purple
inal pain. The patient has a significant past medical discoloration (livedo retic-
history of hepatitis B. The patient reports a history of ularis)
recent malaise, 10 lb weight loss, and fevers leading
up to this episode of abdominal pain. Physical exam Polyarteritis nodosa: mi-
reveals elevated blood pressure, diffusely tender ab- croaneurysms, Hep B/C,
domen, and a rash on the patient's legs. Computed mesenteric ischemia
tomography with IV contrast of the abdomen reveals
, microaneurysms with sudden cutoffs and evidence
of mesenteric ischemia. What description of the rash
would be consistent with the suspected diagnosis?
Diffuse maculopapular
Mottled, lace-like purple discoloration
Palpable purpura
Violaceous, raised discoloration
8. A 53-year-old man presents to his primary care Stage 1 hypertension
provider for his annual physical. His blood pressure
reading is 131/83 mm Hg at this visit. He returns to elevated BP: 120-129/<
the clinic 2 weeks later for a second blood pressure 80 mm Hg
measurement, and his BP at this time is 135/80 mm stage 1: 130-139/80-89
Hg. Which of the following is the most appropriate mm Hg
diagnosis according to ACC/AHA guidelines? stage 2: e140/e90 mm Hg.
Elevated blood pressure
Normal blood pressure
Stage 1 hypertension
Stage 2 hypertension
9. 26-year-old man who uses intravenous drugs pre- Echocardiography
sents with an acute onset of fever, chills, malaise,
and anorexia. On physical exam, his temperature is Acute bacterial endocardi-
101.4°F, BP 98/50 mm Hg, HR 120 beats per minute, tis
and RR 22 breaths per minute. Splinter hemorrhage
osler nodes (painful, vi-
and Osler nodes are present. Which of the following
olaceous raised lesions
diagnostic tests would confirm the suspected diagno-
sis? of the fingers, toes, and
feet),
Chest radiography
Computed tomography
Echocardiography
Electrocardiogram
