
63F with RA and is taking prednisone and
methotrexate. She has a failed R hip
arthroplasty and tells you her surgeon is
interested in doing a revision. On exam, she
has weakness of R grip, generalized
hyperreflexia and hypertonia, and synovitis.
What is the next step?
A. Obtain ANA, anti-DNA, and anti-Sm ab
B. Test for cryoglobulins
C. Add tumor necrosis factor alpha inhibitor
D. Obtain images of cervical spine
35F on OCPs for 10 y develops a PE and
is found to be heterozygous for
prothrombin g20210A mutation. She was
anticoagulated for 6 months.
How should she be counseled?
A. Take a daily aspirin
B. Continue life-long anticoagulation
C. Offer genetic counseling for family
members
D. Do nothing further




You are told that test X has a sensitivity of
85% and a specificity of 70%.
Calculate the positive likelihood ratio.
Is this a good test?

26F marathon runner present to clinic with
fatigue and mild dyspnea with exertion.
You check a hgb and find that it is 7.8
g/dl.
All the following might explain her anemia
except:
A. Dilutional pseudoanemia
B. Intravascular hemolysis
C. Iron deficiency anemia
D. Splenic sequestration
Match sensitivity reaction with type




Type
Type
Type
Type
I
II
III
IV
A.
B.
C.
D.
mast cell-mediated
reaction
Immune complex
mediated
T-cell mediated
Antibody-mediated
reaction
Match cancer and bone lesion
A.
B.
C.
D.
E.
F.
G.
Breast
Prostate
Lung
Kidney
Myeloma
Thyroid
Melanoma



Blastic
Lytic
Blastic and Lytic

35M presents with Hep C with cirrhosis
presents with general malaise for last week.
On exam, he has an open skin lesion on R arm,
no hepatosplenomegaly or signs of
decompensated liver failure. Blood cultures are
drawn and grow out a gram negative rod. You
suspect he became infected through close
contact with his dogs.
What is the best next step?
A. Start a fluoroquinolone
B. Start a penicillin
C. Start a tetracycline
D. Initiate contact isolation


A.
B.
C.
D.
E.
50M presents with hematuria,
fatigue. Initial labs show a
normocyctic anemia, nl RBC’s
on urine microscopy. Because
of worsening renal function, a
kidney biopsy was performed
which showed.
All of the following can be
associated with this condition
except:
MicrocyticAnemia
Hypertension
Hypercalcemia
Secondary amyloidosis
SIADH
55F with CKD on HD presents
with progressive pain in RUE.
Also with itching, burning. No
trauma to this region. Ca x
Phos is 35. Picture is shown
on R.
What is the most like cause of her
condition?
A.
Calciphylaxis
B.
Nephrogenic systemic fibrosis
C.
Stevens-Johnson’s syndrome
D.
Secondary amyloidosis due to
HD


35M with HIV presents
with severe HA and
vomiting x 2 days. Fevers
at home and in ED. No
complaints on mental
status changes. You are
worried about a
meningitis, so you
perform a lumbar
puncture. OP 35 mmhg.
CSF stain shown.
What is the next best step?
A. Start vancomycin,
ampicillin, ceftriaxone
B. Start antifungals
C. Start dexamethasone
D. Consult neurosurgery
45F life-long nonsmoker presents
to clinic with progressive DOE
and RUQ pain. She works in
an office setting, no recent
travels. On exam, she has
decreased B sounds at her
bases, panniculitis of her
abdomen. She is not anemic.
Because of suspicious lesions
on CXR, a CT chest was done
and is shown.
What is the next best step?
A.
Consult pulm for
bronchoscopy and biopsy
B.
Consult CT surgery for open
lung biopsy
C.
Start bronchodilators,
steroids, oxygen
D.
Put patient on airborn
precautions and check AFB’s
in sputum
80M with NICM, EF 30% presents with
increasing of SOB. Has been taking diuretics
as prescribed and has adhered to dietary
restrictions. On exam, he has JVD to his ear at
30 degrees, crackles to mid-lung, and B LE
edema- symmetric. His labs: serum Na 127, Cr
1.1, Urine Na 5, U P/C ratio 0.1.
What is the most likely cause of his hyponatremia?
A.
CHF exacerbation
B.
Renal salt wasting
C.
SIADH
D.
Nephrotic syndrome


78M presents with ataxia for 2 weeks. He
reports one episode of urinary incontinence 3
days ago. His family brings him in to clinic
saying, “He is becoming more forgetful.” You
obtain a CT head and await the results.
What is the next best step?
A.
Lumbar puncture
B.
Consult neurology for concerns of evolving
CVA
C.
Start antibiotics
D.
Obtain a CTLS MRI and start dexamethasone
35M with CKD stage V on
HD presents with severe
HA. In the ED, his BP is
230/120. He has a
seizure and a brain MRI
is obtained and shown.
Blood cultures drawn
and were negative.
What is the most likely
diagnosis?
A. Septic emboli
B. Hypertensive
encephalopathy
C. Toxoplasmosis
D. Nocardia infection

You are preparing for EBM and come across an
RCT with a power calculation. You find out
that the trial did not enroll enough people to
reach power.
What is the major concern with this trial?
A.
There is a chance of missing a true difference.
B.
There is a chance that the results show that
the treatment is effective when it is not.
C.
We will not be able to calculate the number
needed to treat.