Multiple Choice Questions (MCQ)

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

Question 11# Print Question

You are covering the general medical service one evening when contacted by the nursing staff about a “critical” lab test on a patient. The patient in question is a 62-yearold man who was admitted to the hospital with community-acquired pneumonia. His comorbidities include diabetes mellitus and chronic kidney disease. The patient had a scheduled chemistry panel, which showed potassium of 6.5 mEq/L. You immediately order an EKG. 


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

A. Administer IV calcium gluconate
B. Administer oral sodium polystyrene sulfonate (Kayexalate)
C. Administer subcutaneous insulin
D. Administer IV bicarbonate
E. Repeat the serum potassium

Question 12# Print Question

A 48-year-old man is admitted to your service after an inhalational chemical exposure. He develops respiratory distress and requires endotracheal intubation and mechanical ventilation. Which of the following is the best way to decrease his risk of developing ventilator-acquired pneumonia?

A. a. Daily interruption of sedation to assess respiratory status
B. Nasopharyngeal rather than oropharyngeal endotracheal intubation
C. Institution of protocol to keep bed flat during ventilation
D. Intermittent nasopharyngeal suctioning
E. Prophylactic broad-spectrum intravenous antibiotics

Question 13# Print Question

You have been following a 72-year-old man admitted to the hospital with pneumonia. On the third day of his hospitalization you are called to the bedside by the nurse because of a heart rate of 150 beats/minute. The nurse has already printed an EKG (see below). The patient’s current blood pressure is 118/89. He reports feeling weak and appears anxious but denies chest pain and does not appear to be confused or drowsy.

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

A. Administer IV beta-blocker such as metoprolol
B. Administer IV dihydropyridine calcium-channel blocker such as nicardipine
C. Arrange emergent electrical cardioversion
D. Order STAT cardiac biomarkers including troponin levels
E. Begin therapeutic IV heparin

Question 14# Print Question

A 78-year-old woman is admitted to the hospital after losing consciousness at home. She reports that she was walking from the kitchen to the bedroom and began to feel “light-headed.” Within a few seconds, symptoms progressed to the point of unconsciousness and she fell to the floor. Her daughter, who witnessed the event, reports that she regained consciousness almost immediately after falling to the floor. She had one prior similar episode the week before. The patient has no significant past medical history except for hypertension, for which she takes hydrochlorothiazide and metoprolol. Blood pressure is 138/64 standing and 140/70 supine. Physical examination is otherwise unrevealing. ECG shows a sinus rhythm. An echocardiogram reveals no structural heart abnormality. What is the best next test to evaluate her sudden loss of consciousness?

A. Carotid ultrasound
B. Electroencephalogram (EEG)
C. Fasting glucose study
D. MRI of brain with contrast
E. Overnight observation with continuous cardiac monitoring

Question 15# Print Question

A 42-year-old man was admitted to the hospital with pneumonia. On the third day of his hospitalization he becomes agitated and confused. He reports feeling “spiders” crawling on his skin. You note that he has a blood pressure of 172/94 mm Hg, heart rate of 107/minute, and temperature of 38°C (100.4°F). With the exception of agitation and tremor, the remainder of his physical examination is unchanged from earlier in the day. What is the best initial step in management of this patient? 

A. Emergent non-contrast CT scan of the brain
B. Emergent administration of intravenous haloperidol
C. Emergent administration of intravenous lorazepam
D. Emergent administration of intravenous labetalol
E. Placement of physical restraints for patient safety

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