1/10
A 65-year-old man comes to the emergency department due to fevers, chills, and confusion. He has a history of poorly controlled diabetes mellitus with a nonhealing ulcer of the left foot. His temperature is 38.3 C (101 F), blood pressure is 90/60 mm Hg, pulse is 112/ruin, and respirations are 22/min. On examination, there is slight erythema surrounding his left foot ulcer with foul-smelling discharge. No heart murmur is auscultated, the lungs are clear, and the abdomen is soft and nontender. Blood cultures are obtained, and he is started on broad-spectrum antibiotics. Twenty-four hours later, blood cultures grow β-lactarnase-producing Bacteroides species. Which of the following is most likely to provide appropriate antimicrobial coverage for this patient?
- Azilhrorycin
- Ceftriaxone
- Ciprofloxacin
- Piperacillm-tazobactam
- Vancomycin
2/10
A 47-year-old Caucasian female was diagnosed with hyperlipidermia that responded poorly to dietary changes. Her past medical history is significant for acute cholecystitis that required a five-day hospitalization. Her father died of a myocardial infarction at the age of 54 and her mother had diabetes mellitus. Which of the following drug combination is most likely to precipitate gallstone formation in this patient?
- Atorvastatin and ezetimibe
- Atorvastatin and cholestyramine
- Atorvastatin and gemfibrozil
- Gemfibrozil and cholestyramine
- Niacin and ezetimibe
- Niacin and gemfibrozil
3/10
A 64-year-old female develops severe nausea and vomiting soon after receiving high-dose chemotherapy for ovarian cancer. Which of the following agents would be most helpful to treat her symptoms?
- N-acetylcysteine
- Folinic acid
- Ondansetron
- Filgrastim
- Dexrazoxane
- Amifostine
- Allopurinol
4/10
An elderly patient is diagnosed with aggressive non-Hodgkin's lymphoma. The tumor cells are shown to stain strongly for the CD20 marker. Which of the following biologic agents can be added to this patient's chemotherapy regimen to help improve the treatment response?
- Infliximab
- Rituximab
- Interleukin-2
- Imatinib
- Abciximab
5/10
A 52-year-old mate with advanced HIV infection is treated with high-dose ganciclovir for hemorrhagic colitis. Antiretroviral therapy is also begun. Giving zidovudine to this patient is most likely to precipitate which of the following conditions?
- Pancreatitis
- Hepatitis
- Neutropenia
- Renal failure
- Hypocalcemia
- Toxic epidermal necrolysis
6/10
A 60-year-old Caucasian male cornea to your office with a 2-month history of back pain that is not responsive to over-the-counter pain relievers. The pain is worse at night and interferes with his sleep. Lumbar vertebrae are tender to percussion, and the prostate is enlarged and firm. After a thorough evaluation. you decide to proceed with leuprolide therapy. Which of the following changes in testosterone (T) and dihydrotestosterone (DHT) levels are most likely in this patient after initiation of the therapy?
- Steady decrease in both T and DHT levels
- First concordant increase, then concordant decrease in T and DHT levels
- Discordant decrease in DHT level
- First discordant increase, then discordant decrease in DHT level
- No change in T and DHT levels
7/10
A 48-year-old woman with a complex medical history comes to the clinic due to a change in her body habitus. She says her legs are 'like sticks' while her 'belly is getting bigger.' The patient also feels Increasingly fatigued but does not have excessive daytime somnolence. She has been homeless for much of the last 5 years but has been living in a residential care facility for the last 12 months. On physical examination. she is distractible and has an inappropriate affect but is cooperative. Neurologic and mental status examination is otherwise normal. There is loss of adipose tissue from the extremities and face, with a noticeable increase in abdominal girth. Which of the following types of medications is most likely to be responsible for this patient's symptoms?
- Antiretroviral medication
- HMG-CoA reductase inhibitor
- Loop diuretic
- Nonsteroidal antiinflammatory drug
- Proton pump inhibitor
- Selective serotonin reuptake inhibitor
- Thyroperoxidase inhibitor
8/10
A 22-year-old woman comes to the physician because of palpitations, weight loss, and insomnia. She has lost 15 lb (7 kg) in the past 3 months. She has no other medical problems and takes no medication. She does not use tobacco, alcohol, or illicit drugs. Her blood pressure is 130/80 mm Hg and pulse is 104/min and regular. Laboratory studies show markedly decreased serum TSH and elevated T 4 levels. Methlmazole monotherapy is initiated. Two months later, her condition has significantly improved. Inhibition of which of the following processes is the most likely explanation for this patient's improvement?
- Iodine uptake by the thyroid
- Iodine organification and coupling of ioclotyrosines
- Colloid deposition
- Peripheral T4 to T3 conversion
- T3fT4 effect on target tissues
9/10
An 8-year-old male is brought to your office by his mother for a routine check-up. He was diagnosed with absence seizures one year ago and has been undergoing treatment with ethosuximide. The mother says that the patient *is doing weir and his school performance improved significantly. Which of the following is the most likely mechanism of action of ethosuximide in this patient?
- Decreases calcium current in thalamic neurons
- Decreases sodium current in cortical neurons
- Binds to GABA receptors and increases chloride current
- Blocks NMDA receptors in hippocampal neurons
10/10
An 8-year-old Asian immigrant is brought to the ER after a recent episode of brief loss of consciousness. His mother, who accompanies him to the hospital, says that he lost consciousness suddenly, fell on the floor and 'started shaking and jerking'. She also claims that her son has had episodes of 'staring in the space' that occur several times a day for the last year. The boy seems sleepy although he is oriented in time and place. Several hours later, he is alert and says that he wants to go home. Which of the following agents is the best long-term treatment for this patient?
- Ethosuximide
- Phenytoin
- Phenobarbital
- Valproate
- Carbamazepine
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