Board Review 7/3

A 41-year-old male presents with a complaint of headaches for the past 6 weeks. He has severe, sharp, right-sided periorbital pain 3–4 days each week. When these headaches occur his right eye gets watery, his right nostril feels clogged, and his forehead feels sweaty. When he gets the headaches he takes four 200-mg ibuprofen tablets and goes into a dark, quiet room. The headaches usually resolve in about 90 minutes. Currently he is feeling well and his examination is completely normal.

What type of headache does he most likely have?

• Medication overuse headache

• Migraine

• Paroxysmal hemicrania

• Temporal arteritis

• Cluster headache

An 82-year-old white male has a cardiopulmonary arrest while mowing his lawn and his heart rhythm is restored after 8 minutes of CPR by a neighbor. He is now your patient in the coronary care unit. He is on a ventilator and has severe hypoxic encephalopathy. Echocardiography shows an ejection fraction of 12% as a result of the massive anterior myocardial infarction he sustained. Your neurology consultant confirms that the patient will never again be able to meaningfully communicate, and will be ventilator-dependent.

Prior to this, the patient had been living independently and had no health problems. He has no living relatives, and his attorney confirms that he has no written advance directives. The neighbor, who is a close friend, tells you that on several occasions recently he and the patient had discussed such a scenario, and that the patient had said that if he had little chance of a meaningful recovery he would not want to remain on life support.

In consultation with the hospital ethics committee, which one of the following would be most appropriate in this case?

• Transfer care of the patient to another physician

• Ask a court to appoint a guardian to make medical decisions

• Withdraw life support

• Defer the decision regarding life support to the hospital attorney

• Ask the patient’s attorney to decide whether to terminate life support

According to national and international guidelines, which one of the following is the next step for adults with asthma who require therapy with inhaled β-agonists more than three times a week?

• Inhaled glucocorticoids

• Inhaled salmetero (Serevent)

• Sustained-release oral β-agonists

• Sustained-release oral theophylline

A 30-year-old male presents to your office with a 3-week history of nausea, weight loss, diarrhea, and hematochezia. He states that he has had similar episodes twice in the past and was treated at the local urgent care clinic for infectious diarrhea, with resolution of his symptoms. Your initial laboratory workup is negative for enteric pathogens and you refer the patient for colonoscopy and esophagogastroduodenoscopy with small bowel follow-through. The patient is found to have multiple noncontiguous transmural ulcerations throughout both the small and large intestines.

Which one of the following initial management strategies is most likely to induce remission in this patient?

• Laparotomy with colectomy

• Metronidazole (Flagyl)

• Prednisone

• Infliximab (Remicade)

A 7-year-old male presents with a 3-day history of sore throat, hoarseness, fever to 100.4°F (38°C), and cough. Your examination reveals injection of his tonsils, no exudates, shotty lymphadenopathy, and normal breath sounds.
Which one of the following would be most appropriate?

• Symptomatic treatment only

• Empiric treatment for streptococcal pharyngitis

• A rapid antigen test for streptococcal pharyngitis

• A throat culture for streptococcal pharyngitis

• An office test for mononucleosis

Which one of the following is more common in non-Hispanic whites than in the Hispanic population?

• Obesity

• Osteoporosis

• Diabetes Mellitus

• Hypertension

• Neurocysticercosis

A 60-year-old male smoker has lung cancer, and a life expectancy of 4–6 months. His wife is concerned about his state of mind and requests medication for him. His cancer-related pain is generally controlled.

When evaluating the patient, which one of the following features would be more characteristic of depression as opposed to a grief reaction?

• Insomnia

• Loss of interest or pleasure in all activities

• Feelings of guilt

• Thoughts of wanting to die

• Psychomotor agitation

A 63-year-old male with a history of alcoholism and compensated hepatic cirrhosis asks if there are pain medications he can use to treat his chronic low back pain and knee and hand osteoarthritis. He also has occasional headaches. He has not used alcohol for several years.

Which one of the following medications is CONTRAINDICATED in this patient?

• Acetaminophen

• Gabapentin (Neurontin)

• Naproxen

• Pregabalin (Lyrica)

• Tramadol (Ultram)

A 64-year-old male comes to your office for evaluation of a persistent rash affecting his groin. It is itchy but not painful and does not affect his daily activities. He has tried over-the-counter antifungal creams without relief. On examination you find well-demarcated, dark red patches in the inguinal region bilaterally. When examined with a Wood’s light the area fluoresces coral-red.

The most effective treatment for this condition is topical?

• Ketoconazole (Nizoral)

• Erythromycin

• Hydrocortisone

• Mupirocin (Bactroban)

• Terbinafine (Lamisil)

A 44-year-old female is brought to your office by her mother. The patient was in a severe car
accident 2 weeks ago. Her husband was killed instantly and she was extracted by emergency
responders almost an hour later. She received a full examination at a local emergency
department and was discharged home with only minor contusions and abrasions and no evidence
of a closed head injury.
The patient has been panicked and unable to sleep. She has recurrent flashbacks of the event and
dreams repeatedly about her husband’s death. She says that sometimes, even while awake, she
can almost sense her husband’s lifeless body near her. She has refused to get into a car since the
accident, which is the reason she has not sought care sooner. She has not been able to focus on
daily tasks but has been able to eat and drink adequate amounts.

Which one of the following diagnoses best describes her condition?

• Acute stress disorder

• Major depressive disorder

• Obsessive-compulsive disorder

• Panic disorder

• Generalized anxiety disorder