ROSH POWER PACK- EXAM 1
67-year-old woman presents with shortness of breath, cough, and weight loss. On clinical exam, she is
noted to have a blood pressure of 156/102 mm Hg, facial flushing, mild hirsutism, truncal obesity,
marked proximal muscle weakness of both the upper and lower extremity, and hyperpigmentation over
the palms and back of the neck. Laboratory exam reveals hypercortisolism and increased ACTH. Which of
the following would be the most likely primary diagnosis in this patient?
Lymphoma
Ovarian cancer
Renal cell carcinoma
Small cell lung carcinoma - Small cell lung carcinoma
You wish to start a patient diagnosed with major depression on a pharmacologic therapy, but the patient
is concern regarding sexual side effects. Which of the following depression medications is an option that
will reduce the risk of sexual dysfunction?
Bupropion
Citalopram
Fluoxetine
Paroxetine - Bupropion
16-year-old has just moved schools. He is quiet, moody and not like himself at all. Within six months he
seems to have completely changed back to his previous personality. What diagnosis should you be
thinking of?
Adjustment disorder
Borderline personality disorder
Major depression disorder
Schizoaffective disorder - AAdjustment disorder
,24-year-old man has an eight-month history of loose thought associations, social withdrawal, auditory
hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted
to have a flat affect and perceptual distortions, and he behaves like he is detached from his own actions.
He is started on a neuroleptic medication, and a few weeks later he is noted to pace frequently and
seems to be unable to sit or stand still. What is the extrapyramidal symptom this patient is exhibiting
called?
Acute dystonia
Akathisia
Drug-induced parkinsonism
Dyskinesia - BAkathisia
48-year-old woman is seen by her health care provider because she is feeling poorly. She has a history of
chronic gastritis. Physical examination demonstrates pallor of skin and mucosal membranes. Hematocrit
is 33% (normal 36-44%). Blood smear shows enlarged erythrocytes that have enlarged central pale areas.
Some of the neutrophils have hypersegmented nuclei. Which of the following is the most likely
diagnosis?
Beta thalassemia trait
Folate-deficiency anemia
Sickle cell anemia
Vitamin B12 deficiency anemia - Vitamin B12 deficiency anemia
67-year-old woman presents with shortness of breath, cough, and weight loss. On clinical exam, she is
noted to have a blood pressure of 156/102 mm Hg, facial flushing, mild hirsutism, truncal obesity,
marked proximal muscle weakness of both the upper and lower extremity, and hyperpigmentation over
the palms and back of the neck. Laboratory exam reveals hypercortisolism and increased ACTH. Which of
the following would be the most likely primary diagnosis in this patient?
Lymphoma
Ovarian cancer
Renal cell carcinoma
Small cell lung carcinoma - Small cell lung carcinoma
,A 14-year-old field hockey player presents with prominent adenopathy, white purple exudates in the
throat and a palpable spleen. What is the most likely diagnosis?
Acute pharyngitis
Epiglottitis
Mononucleosis
Peritonsillar abscess - Mononucleosis
A 15-month-old infant should be able to which of the following?
Build tower of seven cubes
Feed self well with spoon
Put four words together
Walk alone - Walk alone
A 17-year-old man is brought to your Emergency Department by his girlfriend. She states that he has
been behaving strangely for the last three days, with rapidly fluctuating moods ranging from euphoric to
irritable and paranoid. The patient states that he is fine, just a little nervous about an upcoming test in
school. His pulse is 126 BPM, BP 182/106, pupils are widely dilated, and he is diaphoretic. What is his
most likely diagnosis?
Anxiety
Bipolar disorder
Cocaine intoxication
Heroin intoxication - Cocaine intoxication
A 20-year-old sexually active woman complains of a profuse, whitish gray vaginal discharge with a fishy
odor. Microscopic evaluation of the discharge reveals granular-appearing epithelial cells. Which of the
following is the BEST therapy?
, Ciprofloxacin
Doxycycline
Fluconazole
Metronidazole - Metronidazole
A 23-month-old boy presents to the office with his father who reports the patient has had an acute
onset of severe pharyngitis, fever of 103.5ºF and what sounds like harsh, high-pitched breath sounds. His
dad states the child has started drooling and seems to be worsening. The child is not presently crying but
has muffled voice sounds. The child has not been immunized due to religious reasons. What is the most
appropriate next step?
Administer Ceftriaxone
Administer racemic epinephrine
Endotracheal intubation to maintain the airway performed in the operating room
Obtain intravenous access - Endotracheal intubation to maintain the airway performed in the
operating room
A 28-year-old man presents with a rash. On physical exam you notice periocular violaceous erythema
and edema. He also exhibits significant proximal muscle weakness. What is the most likely diagnosis?
Dermatomyositis
Psoriasis
Seborrheic dermatitis
Systemic lupus erythematosus - Dermatomyositis
A 32-year-old patient presents with grouped vesicles that are intensely pruritic noted on the elbows,
knees, sacral area, and buttocks. The patient also notes a history of chronic diarrhea.
Immunofluorescence of a skin biopsy shows IgA deposits. Which of the following is the treatment of
choice for this patient?
A gluten-free diet
Acyclovir
67-year-old woman presents with shortness of breath, cough, and weight loss. On clinical exam, she is
noted to have a blood pressure of 156/102 mm Hg, facial flushing, mild hirsutism, truncal obesity,
marked proximal muscle weakness of both the upper and lower extremity, and hyperpigmentation over
the palms and back of the neck. Laboratory exam reveals hypercortisolism and increased ACTH. Which of
the following would be the most likely primary diagnosis in this patient?
Lymphoma
Ovarian cancer
Renal cell carcinoma
Small cell lung carcinoma - Small cell lung carcinoma
You wish to start a patient diagnosed with major depression on a pharmacologic therapy, but the patient
is concern regarding sexual side effects. Which of the following depression medications is an option that
will reduce the risk of sexual dysfunction?
Bupropion
Citalopram
Fluoxetine
Paroxetine - Bupropion
16-year-old has just moved schools. He is quiet, moody and not like himself at all. Within six months he
seems to have completely changed back to his previous personality. What diagnosis should you be
thinking of?
Adjustment disorder
Borderline personality disorder
Major depression disorder
Schizoaffective disorder - AAdjustment disorder
,24-year-old man has an eight-month history of loose thought associations, social withdrawal, auditory
hallucinations, and deterioration in his personal appearance and hygiene. Upon examination, he is noted
to have a flat affect and perceptual distortions, and he behaves like he is detached from his own actions.
He is started on a neuroleptic medication, and a few weeks later he is noted to pace frequently and
seems to be unable to sit or stand still. What is the extrapyramidal symptom this patient is exhibiting
called?
Acute dystonia
Akathisia
Drug-induced parkinsonism
Dyskinesia - BAkathisia
48-year-old woman is seen by her health care provider because she is feeling poorly. She has a history of
chronic gastritis. Physical examination demonstrates pallor of skin and mucosal membranes. Hematocrit
is 33% (normal 36-44%). Blood smear shows enlarged erythrocytes that have enlarged central pale areas.
Some of the neutrophils have hypersegmented nuclei. Which of the following is the most likely
diagnosis?
Beta thalassemia trait
Folate-deficiency anemia
Sickle cell anemia
Vitamin B12 deficiency anemia - Vitamin B12 deficiency anemia
67-year-old woman presents with shortness of breath, cough, and weight loss. On clinical exam, she is
noted to have a blood pressure of 156/102 mm Hg, facial flushing, mild hirsutism, truncal obesity,
marked proximal muscle weakness of both the upper and lower extremity, and hyperpigmentation over
the palms and back of the neck. Laboratory exam reveals hypercortisolism and increased ACTH. Which of
the following would be the most likely primary diagnosis in this patient?
Lymphoma
Ovarian cancer
Renal cell carcinoma
Small cell lung carcinoma - Small cell lung carcinoma
,A 14-year-old field hockey player presents with prominent adenopathy, white purple exudates in the
throat and a palpable spleen. What is the most likely diagnosis?
Acute pharyngitis
Epiglottitis
Mononucleosis
Peritonsillar abscess - Mononucleosis
A 15-month-old infant should be able to which of the following?
Build tower of seven cubes
Feed self well with spoon
Put four words together
Walk alone - Walk alone
A 17-year-old man is brought to your Emergency Department by his girlfriend. She states that he has
been behaving strangely for the last three days, with rapidly fluctuating moods ranging from euphoric to
irritable and paranoid. The patient states that he is fine, just a little nervous about an upcoming test in
school. His pulse is 126 BPM, BP 182/106, pupils are widely dilated, and he is diaphoretic. What is his
most likely diagnosis?
Anxiety
Bipolar disorder
Cocaine intoxication
Heroin intoxication - Cocaine intoxication
A 20-year-old sexually active woman complains of a profuse, whitish gray vaginal discharge with a fishy
odor. Microscopic evaluation of the discharge reveals granular-appearing epithelial cells. Which of the
following is the BEST therapy?
, Ciprofloxacin
Doxycycline
Fluconazole
Metronidazole - Metronidazole
A 23-month-old boy presents to the office with his father who reports the patient has had an acute
onset of severe pharyngitis, fever of 103.5ºF and what sounds like harsh, high-pitched breath sounds. His
dad states the child has started drooling and seems to be worsening. The child is not presently crying but
has muffled voice sounds. The child has not been immunized due to religious reasons. What is the most
appropriate next step?
Administer Ceftriaxone
Administer racemic epinephrine
Endotracheal intubation to maintain the airway performed in the operating room
Obtain intravenous access - Endotracheal intubation to maintain the airway performed in the
operating room
A 28-year-old man presents with a rash. On physical exam you notice periocular violaceous erythema
and edema. He also exhibits significant proximal muscle weakness. What is the most likely diagnosis?
Dermatomyositis
Psoriasis
Seborrheic dermatitis
Systemic lupus erythematosus - Dermatomyositis
A 32-year-old patient presents with grouped vesicles that are intensely pruritic noted on the elbows,
knees, sacral area, and buttocks. The patient also notes a history of chronic diarrhea.
Immunofluorescence of a skin biopsy shows IgA deposits. Which of the following is the treatment of
choice for this patient?
A gluten-free diet
Acyclovir
