IM_Midterm_April_2010 - 1. A 69-year-old man is evaluated...

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Unformatted text preview: 1. A 69-year-old man is evaluated for chronic leg heaviness and aching. His medical history is notable for hypertension treated with hydrochlorothiazide. On physical examination, pulse rate is 72/min, and blood pressure is 112/66 mmHg. The BMI is 30. Examination of the lower extremities is notable for tortuous large (> 4mm), dilated veins over the thighs and calves. There is no warmth, erythema, ulceration, or hyperpigmentation over his legs, but there is symmetric trace pitting edema of the ankles. Which of the following is the most appropriate initial management for this patient's symptoms? A) Laser therapy B) Furosemide C) Vein stripping D) Injection sclerotherapy E) Compression stocking 2. A 66-year-old man presents with malaise, fever and lower abdominal pain and diarrhea. Six weeks ago he was hospitalized for pneumonia and subsequently diarrhea. His stool study revealed the presence of C.difficile toxins. The was treated with metronidazole and his symptoms resolved in two weeks. He now returns with fever, diarrhea and lower abdominal pain again. His stool once again shows presence of C.difficile toxins A and B. In addition to rehydration, which of the following is the most appropriate action? A) Stool culture with sensitivity test B) Restart metronidazole C) Vancomycin intravenously D) Colonoscopy E) Sigmoidoscopy 3. A 30-year-old man is referred for evaluation of hematuria which is found during a pre-employement health evaluation. He has a remote history of kidney stone. The patient is a chronic smoker but he denies taking any illicit drugs. His past medical history is unremarkable although he had symptoms of upper respiratory infection a week ago. Laboratory studies: Hemoglobin 14 g/dL Leukocyte count 6000/ u L Platelet 200,000/ u L Serum creatinine 1.1 mg/dL Blood urea nitrogen 15 mg/dL Electrolytes normal Serum calcium 9.8 mg/dL Urinalysis 2 + protein, microscopic findings as shown above. Which of the following is the most likely cause of his hematuria? A) Prostatitis B) Renal cell carcinoma C) Bladder cancer D) Glomerulonephritis E) Pyelonephritis 4. A 26-year-old woman who is 30 weeks' pregnant is referred to you because of a murmur that was noted during her current pregnancy as well as intermittently in the past. The patient is asymptomatic. Physical examination shows slight elevation of the jugular venous pressure, with an A wave. A parasternal lift is also noted. S1 is normal, and S2 is somewhat prominent, fixed, and split. A grade 2 mid-peaking ejection systolic murmur is noted at the left sternal border. Which of the following is the most likely diagnosis?...
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IM_Midterm_April_2010 - 1. A 69-year-old man is evaluated...

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