Multiple Choice Questions (MCQ)

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Category: Medicine--->Hospital-Based Medicine
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Question 1# Print Question

You are covering a busy hospital service at night when you are paged to evaluate a 78-year-old man with sudden onset of dyspnea. A quick review of the patient’s chart reveals that he was diagnosed with small cell lung cancer 2 months earlier. In spite of a regimen of radiation and chemotherapy, he was admitted to the hospital 3 days earlier with a suspected pathologic fracture to the right femur. He has no other known metastases. Thirty minutes ago he became acutely short of breath. Current vital signs include a heart rate of 115 beats/minute, blood pressure of 92/69, and respiratory rate of 32. Oxygen saturation is 94% on 4 L of oxygen via nasal cannula. He is anxious and tachypneic, but lung sounds are clear and symmetric. The heart rhythm is regular and no murmurs are appreciated. What is the best next step in the management of this patient? 

A. Immediately administer empiric antibiotics for coverage of hospital-acquired pneumonia
B. Immediately administer therapeutic dose of intravenous heparin
C. Arrange for synchronized electrical cardioversion
D. Order a ventilation/perfusion (V/Q) scan of the chest
E. Administer a benzodiazepine

Question 2# Print Question

You respond to the cardiopulmonary arrest of a 72-year-old woman in the intensive care unit. She has no palpable pulse, but the cardiac monitor shows sinus tachycardia at 124/minute. Breath sounds are symmetric with bag-mask positive-pressure ventilation. What is the best next step in management of this patient?

A. Immediate electrical cardioversion
B. Immediate transthoracic cardiac pacing
C. Immediate administration of high-volume normal saline
D. Immediate large-bore pericardiocentesis
E. Immediate administration of extended-spectrum antibiotics

Question 3# Print Question

A 64-year-old man presents with acute exacerbation of chronic obstructive pulmonary disease. The patient had a long smoking history before quitting 2 years ago. In spite of his poor baseline lung function, he has been able to maintain an independent lifestyle. The patient is in obvious respiratory distress and appears tired. He has difficulty greeting you secondary to shortness of breath. Respiratory rate is 32/minute. Auscultation of the lungs reveals minimal air movement. ABGs show:

  • PH = 7.28
  • PaCO= 77
  • PaO2 = 54

One dose of IV methylprednisolone has already been administered.

What is the best next step in the management of this patient’s disease? 

A. Urgent institution of BiPAP (bilevel positive airway pressure)
B. Urgent endotracheal intubation
C. Administration of 100% FiO2 by face mask
D. Start inhaled tiotropium immediately
E. IV levofloxacin

Question 4# Print Question

A 71-year-old woman is brought to the emergency room by her daughter because of sudden onset of right-sided weakness and slurred speech. The patient, a recent immigrant from Southeast Asia, has not seen a doctor in two decades. Her symptoms began 75 minutes ago while she was eating breakfast. A stat noncontrast CT scan of the head is normal. Labs are normal. Physical examination reveals an anxious appearing woman with dense hemiplegia of the R upper and lower extremities. Deep tendon reflexes are not discernible on the R side and 2+ on the left. Aspirin has been given. What is the best next step in management of this patient?

A. Immediate intravenous unfractionated heparin
B. Immediate thrombolytic therapy
C. Immediate administration of interferon-beta
D. Emergent MRI/MRA of head
E. Emergent cardiac catheterization

Question 5# Print Question

You are asked to see a 78-year-old woman prior to surgical repair of a femoral neck fracture. Her medical problems include hypertension, osteoporosis, and hypothyroidism. Morphine is the only medication ordered so far. She is comfortable at rest. Her BP is 136/82, HR 88, and RR 16. Her cardiac examination is normal and her lungs are clear. What is the best recommendation to prevent postoperative venous thrombosis?

A. Postoperative low-dose ASA
B. Postoperative SCDs (sequential compression devices)
C. Early mobilization and ambulation
D. Postoperative subcutaneous low-molecular-weight heparin
E. Postoperative intravenous unfractionated heparin

Category: Medicine--->Hospital-Based Medicine
Page: 1 of 3