1. A 62 yr old diabetic man comes to the physician for followup. He recently had diabetic screening tests, including urine microalbumin check, foot exam, and Hb A1c. Having failed oral therapy, diabetes is now well controlled with insulin. Lab values and foot exam are within normal range. During the man's annual eye exam three months ago, fundoscopy revealed diffuse, opaque white spots throughout the fundus, a few scattered hard exudates, and multiple small microaneurysms. Visual exam is 20/20 OS and 20/25 OD. He denies floaters, diplopia, or blurred vision. Which of the following is the most likely cause of these findings?
2.. A one and Half year old boy is diagnosed with a degenerative disease involving the basal ganglia. Further studies show less than 1 % normal activity of the enzyme hypoxanthine guanine phosphoribosyl transferase (HGPRT). Which of the following enzymes is most likely to show increased activity in this patient?
A. Arginase
B. Xanthine oxidase
C. 3,4 dihydroxy phenylalanine (dopa) decarboxylase
D. Mitochondrial carbamoyl phosphate synthetase
Answer: B. Xanthine oxidase
3. A 68 yr old man is diagnosed with colon cancer during a routine screening. He gets an abdominal CT scan to check for metastasis. No metastatic lesions are found but the gallbladder has significant intramural calcification. The calcified walls are thickened though there is no pericholecystitic fluid present. There's no history of abdominal pain and the man report feeling healthy. In addition to surgical resection of colon cancer, which is the most appropriate treatment for the calcified gallbladder?
A. Prophylactic open cholecystectomy
B. Medical treatment with ursodeoxycholic acid
C. Repeat CT scans at 6 months and 1 yr
D. Reassurance that the finding is inconsequential
Answer: A. Prophylactic open cholecystectomy
4. A 47 year old woman comes to the physician because of poor sleep, general weakness, fatigue, mood disturbances, headache, musculoskeletal pain, and joint tenderness for the last seven months. Her recent lab report of CBC, ESR, basic metabolic panel, TFTs, muscle enzymes, urinalysis, ECG, chest xray were within normal limits. Physical exam was significant for multiple areas of joint tenderness. What is the most appropriate initial management in this patient?
A. Cognitive behavioral therapy
B. Prednisone
C. Fluoxetine
D. Amitriptyline
Answer: D. Amitriptyline
5. A 3 yr old caucasian girl is brought to the ER because of severe cough with sputum, fever, and rapid breathing. The cough started 1 month ago with sputum and has become persistent. Her past medical history is significant for prolonged neonatal jaundice and 2-3 episodes of bronchiolitis at the age of six and twelve months. Temp is 101.8. Exam reveals tachypnea, nasal polyps and coarse breath sounds on auscultation. Pulse oximetry shows O2 saturation of 87%. Chest X-ray shows hyperinflation with patchy consolidations. She is below the 5th percentile for height and weight. Which of the following is the most appropriate next step in management?
A. IV ceftazidime with tobramycin
B. Histopathologic analysis of nasal polyps
C.Pilocarpine iontophoresis test
D. IV levofloxacin
Answer: A. IV ceftazidime with tobramycin
A. Proliferative diabetic retinopathy
B. Macular edema
C. Non proliferative diabetic retinopathy
D. Age related ocular changes
C. Non proliferative diabetic retinopathy
D. Age related ocular changes
Answer: C. Non proliferative diabetic retinopathy
A. Arginase
B. Xanthine oxidase
C. 3,4 dihydroxy phenylalanine (dopa) decarboxylase
D. Mitochondrial carbamoyl phosphate synthetase
Answer: B. Xanthine oxidase
3. A 68 yr old man is diagnosed with colon cancer during a routine screening. He gets an abdominal CT scan to check for metastasis. No metastatic lesions are found but the gallbladder has significant intramural calcification. The calcified walls are thickened though there is no pericholecystitic fluid present. There's no history of abdominal pain and the man report feeling healthy. In addition to surgical resection of colon cancer, which is the most appropriate treatment for the calcified gallbladder?
A. Prophylactic open cholecystectomy
B. Medical treatment with ursodeoxycholic acid
C. Repeat CT scans at 6 months and 1 yr
D. Reassurance that the finding is inconsequential
Answer: A. Prophylactic open cholecystectomy
4. A 47 year old woman comes to the physician because of poor sleep, general weakness, fatigue, mood disturbances, headache, musculoskeletal pain, and joint tenderness for the last seven months. Her recent lab report of CBC, ESR, basic metabolic panel, TFTs, muscle enzymes, urinalysis, ECG, chest xray were within normal limits. Physical exam was significant for multiple areas of joint tenderness. What is the most appropriate initial management in this patient?
A. Cognitive behavioral therapy
B. Prednisone
C. Fluoxetine
D. Amitriptyline
Answer: D. Amitriptyline
5. A 3 yr old caucasian girl is brought to the ER because of severe cough with sputum, fever, and rapid breathing. The cough started 1 month ago with sputum and has become persistent. Her past medical history is significant for prolonged neonatal jaundice and 2-3 episodes of bronchiolitis at the age of six and twelve months. Temp is 101.8. Exam reveals tachypnea, nasal polyps and coarse breath sounds on auscultation. Pulse oximetry shows O2 saturation of 87%. Chest X-ray shows hyperinflation with patchy consolidations. She is below the 5th percentile for height and weight. Which of the following is the most appropriate next step in management?
A. IV ceftazidime with tobramycin
B. Histopathologic analysis of nasal polyps
C.Pilocarpine iontophoresis test
D. IV levofloxacin
Answer: A. IV ceftazidime with tobramycin
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