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POP QUIZ

So You Want to Be a Doctor?

Think you've got what it takes to be a physician? One of the first steps to getting a license is taking the United States Medical Licensing Examination. For the untrained, just skimming the dozens of practice questions on the USMLE website can lead to a migraine, but here are a few examples that you might be able to diagnose.

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December 16, 2007

1. A 38-year-old homemaker and mother of four children (ages 5 to 12 years) has been coming to you for management of tension headaches that have not improved with trials of several appropriate medications. She has been married to a policeman for the past six years. You ask if she has been under extra stress, and she begins to cry. You notice bruises on her arms. On further questioning, you learn that her husband hits her whenever he is drunk, which is at least two nights per week. She says, "He is nice . . . a good husband when he's sober. But when he drinks, oh he's awful! He accuses me of cheating on him. Last night he said he would kill me if I try to leave." Her husband is also a patient of yours. Which of the following is the most appropriate intervention?

a) Advise her to leave her home with her children and move in with her relatives
b) Contact her husband's supervisor to discuss recent stress levels on the job
c) Gather more information while remaining neutral, since both the husband and wife are your patients
d) Refer her to a domestic violence program
e) Seek a restraining order against her husband on her behalf

2. A 68-year-old man with documented alcohol abuse returns to the office because of abdominal pain and bloating. When you meet with him, he appears dejected and his eye contact is poor. Physical examination is normal. Since his last visit, he has moved from the neighborhood where he had lived for 40 years. In addition, he mentions that approximately six months ago breast cancer was diagnosed in his wife; she is currently receiving radiation therapy for bony metastases. The most important next step in management of his symptoms is evaluation for which of the following?

a) Delirium tremens
b) Gastrointestinal bleeding
c) Pancreatic carcinoma
d) Situational anxiety disorder
e) Suicidal ideation

3. An 8-year-old boy needs to be coaxed to go to school and, while there, often complains of severe headaches or stomach pain. His mother frequently has to take him home because of his symptoms. At night, he tries to sleep with his parents. When they insist that he sleep in his own room, he says that there are monsters in his closet. Which of the following best explains his behavior?

a) Childhood schizophrenia
b) Normal concerns of latency-age children
c) Separation anxiety disorder
d) Socialized conduct disorder
e) Symbiotic psychosis

4. A 14-year-old boy is brought to the walk-in clinic by his father late on Saturday afternoon because his left ear is swollen and painful. The boy's ear has been black and blue since he injured it in a wrestling match three days ago. Symptoms have increased significantly following a repeat injury three hours ago. On physical examination, his left ear is markedly swollen and tender to palpation. Which of the following is the most appropriate next step?

a) Reassure him and start aspirin therapy
b) Reassure him and start codeine therapy
c) Recommend that he apply cold packs to the ear for the next 12 hours
d) Recommend that he apply hot packs to the ear for the next 12 hours
e) Refer him to a surgeon for immediate drainage of the lesion

5. A 27-year-old man comes to the office because of a one-week history of right knee pain. He says he jogs 3 miles a day and that the pain in his knee worsens during his run. On physical examination his gait appears to be normal. Examination of the right knee reveals tenderness and fullness over the medial collateral ligament. The most accurate statement concerning the patient's condition is that he will need which of the following?

a) A different type of activity for his exercise program
b) Initial treatment with rest, ice packs, and isometric exercises
c) Referral for an orthotic device
d) Referral for athroscopy
e) Treatment with knee immobilization and crutches

6. A 48-year-old man with alcoholism comes to the physician because of fever, a facial rash, and rapidly progressive swelling of the left side of the face. The swelling began 12 hours ago when a scab on his left cheek began to itch. His temperature is 102.5 degrees. He is unable to open his left eye because of the severity of the swelling. Which of the following is the most likely causal organism?

a) Group A streptococcus
b) Haemophilus influenzae
c) Herpes simplex virus
d) Neisseria meningitidis
e) Streptococcus pneumoniae

7. A 17-year-old boy is brought to the office by his mother who says that he has been increasingly withdrawn and preoccupied for several weeks. He has been sleeping poorly and has refused to leave the house for the past week because he believes he is being followed. When his father insisted he attend school this morning, the patient threatened him with a knife. On examination, the patient is sweating, has dilated pupils, and is obviously fearful. Rapport with this patient can best be established by asking which of the following?

a) "Are you hearing voices?"
b) "Do you have a special mission to accomplish?"
c) "Do you think you are being persecuted?"
d) "How do you feel others are treating you?"
e) "Who do you think is following you?"

8. A 19-year-old woman comes to the physician because of recurrent severe headaches for one year. The headaches are unilateral and throbbing and are accompanied by nausea, vomiting, and light sensitivity. The headaches occur once or twice monthly, reach their peak intensity in one hour, and last 12 to 24 hours. There is no aura. Examination shows no abnormalities. Select the most likely diagnosis.

a) Acute sinusitis
b) Chronic sinusitis
c) Cluster headache
d) Intracranial tumor
e) Meningoencephalitis
f) Migraine
g) Pheochromocytoma
h) Post-traumatic headache
i) Subarachnoid hemorrhage
j) Temporal arteritis
k) Temporomandibular joint syndrome

9. A 43-year-old man comes to the emergency department at 3:00 a.m. because of a constant severe headache for one hour. The pain is localized behind the left eye. He also has had a water discharge from the left nostril. He has had similar episodes nightly over the past week. He has a history of similar symptoms over a three-week period two years ago. His left pupil is smaller than his right, and there is ptosis on the left. A water discharge is visible in the left naris. Select the most likely diagnosis.

a) Acute sinusitis
b) Chronic sinusitis
c) Cluster headache
d) Intracranial tumor
e) Meningoencephalitis
f) Migraine
g) Pheochromocytoma
h) Post-traumatic headache
i) Subarachnoid hemorrhage
j) Temporal arteritis
k) Temporomandibular joint syndrome

10. A 50-year-old woman comes to the office for the first time because of recurrent abdominal pain. Review of her extensive medical chart, which she has brought with her, discloses that she has a long history of varying physical complaints. Definitive causes for these complaints have not been found despite extensive diagnostic studies, consultations with many physicians, and several surgical explorations. She gives dramatic and exagerrated descriptions of her present and past symptoms, and she makes conflicting statements about her history. She has been hospitalized at least 23 times since age 18 years. Which of the following is the most likely diagnosis?

a) Borderline personality disorder
b) Conversion disorder
c) Histrionic personality disorder
d) Occult medical disorder
e) Somatization disorder

 

 

 

 

 

Answers: 1. d; 2. e; 3. c; 4. e; 5. b; 6. a; 7. d; 8. f; 9. c; 10. e.

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