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FREE MCCEE QUESTIONS www.mcceereview.com General Medicine Questions 1) A family physician cares for a family consisting of a 45-year old husband, 43-year-old wife and a 12-year-old daughter. The family reports that recently the 77-year-old maternal grandmother who lived with them died after a prolonged respiratory infection. Autopsy subsequently confirms that she had active pulmonary tuberculosis at the time of death. The organism tested sensitive to all anti-tuberculosis drugs. In responding to the grandmother's illness, which of the following is the most appropriate step in management? A. Obtain leukocyte counts on all family members B. Obtain sputum cultures for acid fast bacilli C. Obtain chest computerized tomograms on all members D. Place protein purified derivative (PPD) test on all members E. Schedule bronchoscopy lavage for the adults Explanation: The correct answer is D. The immediate step is to screen the family for TB exposure. The most effective manner in which to accomplish this is by placing PPDs on all members and working up those with a positive test. The white cell count may be elevated for a variety of reasons and would not necessarily help in diagnosis or management (choice A). Sputum cultures will take 6 months to grow and may be too cumbersome to obtain (choice B). Chest CT scans may show the tuberculosis lesion but a more effective method would be to place the PPD and perhaps then scan those with a positive test (choice C). A bronchoscopy would be too invasive an option at this point (choice E). 2) A 57-year-old man comes to the emergency department because of excruciating pain in his right big toe. He describes the pain as so severe that it woke him from a deep sleep. He has no chronic medical conditions, does not take any medications, and denies any similar episodes in the past. He admits to a few "drinking binges" over the past 2 weeks. His temperature is 38.1 C (100.5 F), blood pressure is 130/90 mm Hg, and pulse is 80/min. Examination shows an erythematous, warm, swollen, and exquisitely tender right great toe. The skin overlying the first metatarsophalangeal joint is dark red, tense, and shiny. Synovial fluid analysis reveals negatively birefringent, needle-shaped crystals within polymorphonuclear leukocytes (PMNs). Laboratory studies show: Serum Leukocytes........16,000/mm3 Uric acid...........15 mg/dL Calcium.............9 mg/dL Which of the following is the most appropriate pharmacotherapy? A. Allopurinol B. Ceftriaxone C. Indomethacin D. Probenecid E. Sulfinpyrazone Explanation: The correct answer is C. This patient has the classic presentation of a patient with acute gouty arthritis with the sudden onset of severe pain (typically in the middle of the night), swelling, erythema and warmth of a single joint. Low-grade fever and leukocytosis may be seen. It is more common in men and it is associated with hyperuricemia, usually due to decreased renal excretion of uric acid. Common causes are thiazides and alcohol. Diagnosis is made by examination of of uric acid.... View Full Document

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