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Board Review Bingo

A 71 year old man with recent diagnosis of adanocarcinoma
of the left lung presents to the ED with acute onset of
shortness of breath. When he woke up this morning he had
no shortness of breath. It came on suddenly when he got up
to walk to the bathroom. PMH: Adenocarcinoma of the left
lung (receiving radiation therapy). Exam: BP 90/60 P 120
RR 36 T 37.8 O2 sat 80% Chest- clear cardiac- Nl S1S2
ABd soft, nontender. Ext- RLE edema. Lab: Hb 13 HCT 39
WBC 11,00 ABG 7.45/Po2 45/PCo2 34/Sat 80% Chest
Xray- LUL mass, no infiltrates.Spiral CT shows a large clot
in the left pulmonary artery. What is the most likely effect on
the heart?
A) Pericarditis
B) Acute right ventricular dilation
C) Acute left ventricular dilation
D) Acute left atrial dilation
E) Ventricular arrythmia
What is the most common side effect of
ACE inhibitors?
A) Rash
B) Cough
C) Angioedema
E) Neutropenia
F) Hypokalemia
In a study of 2271 patients with a history of colon
cancer fecal occult blood testing (FOBT) is done to
screen for recurrent colon cancer. One hundred and
forty six patients have positive FOBT and 2125 patients
have negative FOBT. Colonoscopy is done on all the
patients, finding 46 cancers. Twelve patients with
positive FOBT have colon cancer and 34 with negative
tests have colon cancer. What is the sensitivity for
FOBT?
A) 8.2%
B) 26.1%
C) 94%
D) 98.4%
Interpretation of Test Results
Disease Present
Present
Not Present
Absent
+ True Positive
False Positive
_ False Negative
True Negative
Sensitivity
Cancer
+
-
No Cancer
12
134
34
2091
Sensitivity
Sensitivity= 12/12+34=26.1%
A study is done to evaluate mammography as a
screening tool for women between the ages of 40 and 45.
11,000 mammograms are obtained . Twenty five women have a
positive mammogram and turn out to have breast cancer. One
hundred and seventy five women have positive mammograms
and do not have cancer. Eight hundred and ninety women have
negative mammograms and do not have cancer and ten women
with negative mammograms end up having breast cancer. What
is the PPV for mammography?
A) 71.4%
B) 98.9%
C) 12.5%
D) 83.5%
E) 31.4%
Positive Predictive Value

Positive predictive value is the
proportion of positive tests who have
the disease

TP/ TP+ FP
A 27 y.o. female whose brother died of cystic
fibrosis is married to a 25 y.o. whose sister (age
16) has cystic fibrosis. What is the risk their
first child will have CF?
a.
b.
c.
d.
e.
1/4
1/9
1/12
1/16
1/64
Risk of Child Having CF in Both
Parents Sibs of CF patient

Each parent does not have CF, so their
risk of carrying the gene is 2/3

2/3 X 2/3 X 1/4 = 4/36= 1/9
A 20 yo man is concerned about his risk
for developing Huntington’s disease. His father
was diagnosed last year at the age of 43. What
is the chance he will have inherited the disease
from his father?
A) 1/4
B) 1/2
C) 1/9
D) 1/16
A 70 yo man is started on hydrochlorathiazide
for hypertension. What set of side effects are
most consistent for this medication?
A) Diarrhea, hypokalemia
B) Headache, hyperkalemia
C) Gout, hypokalemia
D) Hyperglycemia, diarrhea
E) Erectile dysfunction, headache

A)
B)
C)
D)
A 60 year old woman presents with hand
stiffness. A picture of her hands is shown.
What is her diagnosis?
Osteoarthritis
Rheumatoid arthritis
Gout
Psoriatic arthritis
A 22 y.o. woman comes to the Urgent Care Clinic for
evaluation of dysuria and frequency which has been
present for the past 3 days. She has also noticed
hematuria. She denies fever or flank pain. Her
physical exam in unremarkable.
What would you recommend?
a) Urinalysis
b) Urinalysis and urine culture
c) Urinalysis, urine culture and CBC
d) Urinalysis, urine culture and KUB
e) Urinalysis, urine culture and renal function
Workup of Simple Cystitis
Urinalysis
 No urine culture
 No such thing as simple cystitis in a
man


A 67 year old woman presents with neck pain
following a car accident. He has pain
radiating down her right arm. On physical
exam she has weakness of shoulder and
wrist extension and a diminished triceps
reflex. What is the most likely site of cervical
disk herniation?
A) C3/C4
B) C5/C6
C) C6/C7
D) C7/C8
E) T1/T2
A 66 year old man is evaluated for fatigue. He is
found to have a calcium level of 13 (NL 8.8-10.2). He
has normal renal function. A serum PTH level is
elevated (6X normal). What physiologically is causing
his increased calcium?
A) Increased gut absorption of calcium
B) Increased calcium reabsorption in distal tubule,
increased calcium release from bone
C) Decreased calcium resorption in distal tubule
D) Increased calcium release from bone and increased
oral intake of calcium
E) Decreased calcium release from bone, increased gut
absorption of calcium

All of the following factors contribute to an
increased risk for development of CAD/MI
except:
A) Diabetes
B) High level of high density lipoprotein
C) Hypertension
D) Family history
E) Cigarette smoking
F) High levels of C reactive protein


All of the following are directly from the
celiac trunk except:
A) Left gastric artery
B) Common hepatic artery
C) Gastroduodenal artery
D) Splenic arterty

Where was William Osler Born?
A) England
B) Baltimore
C) Canada
D) Germany

A 67 yo man with shortness of breath and
cough has trouble sleeping at night. He wakes up in
the middle of the night short of breath. On exam he
has crackles in his lung and a low pitched sound
heard best with the bell at the apex. This sound
follows S2. His xray shows pulmonary edema. What
is the abnormal heart sound?
A) S3
B) S4
C) Split S2
D) Murmur
E) Click
A 33 year old man comes to clinic for
evaluation of elevated blood pressure. He had a blood
pressure of 160/100 measured at a health fair 2
months ago. He has since obtained 5 measurements
at the fire station : 158/96, 166/100, 154/94, 170/98,
and 168/98. He does not smoke. His physical exam is
normal except for a BP of 166/104. What do you
recommend?
A) Urinalysis, Renal artery duplex
B) Urinalysis, ECG, Basic metabolic panel
C) Renin/Aldosterone ratio, urine catecholamines
D) Urinalysis, Tox screen, ETT
E) No testing at this time
Workup of the “routine”
hypertensive patient
 Basic
metabolic panel
(renal/electrolyte /glucose/Ca
panel)
 UA
 ECG
A 28 yo woman with type 1 diabetes presents
with nausea and vomiting. She has felt poorly for the
past four days and has not been able to eat much.
She has cut her insulin dose to avoid hypoglycemia.
Labs: Na 134, K-3.6, CL- 84, HCO3- 18. What is the
most likely cause of her metabolic problems?
A) Anion gap metabolic acidosis
B) Respiratory alkalosis
C) Non anion gap metabolic acidosis
D) Anion gap metabolic acidosis, metabolic alkalosis

Delta/Delta concept
Change anion gap
Change in bicarb
If ratio is > 2 then concurrent metabolic
alkalosis is present
 If ratio is < 1 then combined anion gap
and non anion gap acidosis are present

A 46 year old man is evaluated for a one week
history of fatigue and nausea. He had the
onset of nausea, anorexia and fatigue a week
ago. He also developed right upper quadrant
pain. He reports no change from his usual diet
of fast food (usually hamburgers and fried
chicken) until the past week, when he stopped
eating out because of profound anorexia. He
had been partying with friends 10 days ago
and had consumed a large amount of alcohol.
He has not had any alcohol use for the past 5
days.
Substance use history-no history of IDU, smokes ½
pack of cigarettes/day stopped this week. Meds:
Ranitidine, sertraline. Exam: BP 100/60 T-38.5
P-110 Eyes-icteric sclera Chest-clear cardiac
Normal S1S2 no murmur Abd-soft, liver span 24
cm and tender, edge soft, palpable 6 cm below
costal margin. Lab: HB 14 HCT 42 WBC 9,000
Bili-3.5 ALT 4300 AST 5400.
What is the most likely
diagnosis?
A)
B)
C)
D)
E)
Biliary obstruction due to
gallstones
Viral hepatitis
Alcoholic hepatitis
Metastatic cancer
Drug induced hepatitis
Differential Diagnosis of Very
High ALT
Viral hepatitis
Hep A> Hep B > Hep C
 Ischemia


Toxin
Acetominophen> mushroom
A 46 year old man is found to have an
elevated ALT test during an insurance
examination. Repeat testing of liver tests: ALT76 AST-60 Bili-.8 Alb-3.8 PT(INR)-1.0.
Hepatitis C testing is done and is positive.
PMH-Hx MVA with ruptured spleen in 1995
requiring 10 unit blood transfusion. Acute
renal failure after MVA requiring six weeks of
dialysis. Hx testicular cancer. Hx injection drug
use (cocaine) - none since 1987. Sexual
history: history of multiple sexual partners
(lifetime 15) all women.
What is his most likely exposure risk
for hepatitis C?
A)
B)
C)
D)
E)
Blood transfusion
Hemodialysis
Injection drug use
Sexual exposure
Motor vehicle accident
Risk For Hepatitis C

Injection Drug history (highest risk)

Transfusion before 1989 (high risk)

Tattoo (unknown risk)

Sexual exposure (low risk)

A 59 yo man is evaluated for muscle
pain. He has noticed discomfort in his lower
extremities for the past 3 weeks. Labs: CPK
900. Medications:, Benazapril, Simvastatin,
Omeprazole, Fluoxetine and Methotrexate.
Which medication is most likely responsible?
A) Benazapril
B) Simvastatin
C) Omeprazole
D) Fluoxetine
E) Methotrexate
Side Effects of Statins
 Rhabdomyolysis
(rare)
 Hepatotoxicity (rare)
 Myalgias
A 29 yo man employed as a hospital custodial
worker sustains a needlestick from a 20 gauge
needle used for a successful blood draw. The patient
the blood was drawn from has HIV (Viral load
60,000), Hepatitis C, and Hepatitis B (Sag +). The
custodial worker has never had Hep B vaccine.
What is the risk for acquiring infection?
A) HIV > Hep B > Hep C
B) HIV > Hep C > Hep B
C) Hep B > Hep C > HIV
D) Hep B > HIV > Hep C
E) Hep C > HIV > Hep B
F) Hep C > Hep B > HIV
A 33 yo woman comes to clinic
for counseling on weight loss. Her height is
1.7 meters and her weight is 80 kg. What is
her BMI?
A) 26
B) 28
C) 30
D) 32
E) 34
Body Mass Index (BMI)
BMI= Body weight in Kg
(Height in meters)2
A 72 y.o. male S/P AVR replacement two years ago
for aortic stenosis presents with wide spread
bruising on his back/legs and some bruising on
the back of both hands. His last INR was three
weeks ago and was 3.0. He states he saw an
M.D. six days ago for a cough and was put on a
medication described as a “white tablet.” His
chronic medications include: Coumadin 5 mg qd,
Albuterol inhaler 2 puffs 4 times a day and
Nortryptiline 25 mg qhs.
What medication was he placed on?
a) Amoxicillin
b) Codeine
c) Cefixime
d) Azithromycin
e) TMP/Sulfa
Warfarin Interactions
Decrease metabolism (increase PT)
Most Severe
TMP/Sulfa
Erythromycin
Amiodarone
Propafenone
Ketoconazole/fluconazole
Itraconazole
Metronidazole
Possible*
Ciprofloxacin
Omeprazole
Clarithromycin
* Especially in elderly
and polypharmacy