July Questions

1. Drug X is investigated in a meta-analysis for its effect
on mortality after a myocardial infarction. It is found that mortality drops
from 10 to 2% when this drug is administered. What is the absolute risk
reduction conferred by drug X?

A. 2%

B. 8%

C. 20%

D. 200%

E. None of the above

2. A 45-year-old male with a long history of alcohol abuse
is admitted to the intensive care unit with severe pancreatitis, requiring
intubation and mechanical ventilation. On the third day after admission, fever
develops and imipenem-cilastatin is started for a possibly infected necrotic
pancreas. The patient defervesces and is extubated. However, on the tenth day
of hospitalization the patient becomes febrile again to 39.5°C
(103.1°F), and fever persists for the next 4 days with no positive culture
data, including samples of blood, urine, and sputum. On examination the patient
is hemodynamically stable and has an erythematous rash over the trunk. He has
no central venous catheter. Laboratories show a white blood cell count of
15,000 and a newly elevated creatinine of 3.2 mg/dL. Computed tomography (CT)
of the abdomen and thorax shows no pseudocyst or other source of infection.
Which of the following is the most appropriate next step in the management of this
patient?

A. Obtain an 111In-labeled white blood cell scan.

B. Discontinue imipenem-cilastatin.

C. Add amphotericin B.

D. Initiate hemodialysis.

E. Add vancomycin.

3. All the following are vitamin K–dependent
coagulation factors except

A. factor X

B. factor VII

C. protein C

D. protein S

E. factor VIII

4. A 40-year-old male presents to the emergency room with
headaches and nausea for 1 week. The patient's past medical history is
unremarkable. He takes a multivitamin and atorvastatin. The examination is notable
for pale conjunctiva and numerous petechiae on the skin and extremities. The
spleen is not palpable. The neurologic examination is nonfocal. Laboratory
examination shows a platelet count of 11,000/L and a hematocrit of 23%. Other
abnormalities include an elevated lactic dehydrogenase level and a low serum
haptoglobin. Serum creatinine is normal. INR is 1.1, and the aPTT ratio is 1.0.
A peripheral blood smear is shown in the figure. What is the diagnosis?

A. Autoimmune hemolytic anemia

B. Disseminated intravascular coagulation (DIC)

C. Immune-mediated thrombocytopenia (ITP)

D. Paroxysmal nocturnal hemoglobinuria

E. Thrombotic thrombocytopenic purpura

5. Several weeks after eating a meal in rural France that
included meat from locally bred horses and pigs, a 35-year-old woman presents
with muscle aches and swelling, particularly in both biceps and the neck.
Physical examination reveals periorbital edema. Laboratory evaluation reveals
eosinophilia, elevated serum IgE, and elevated creatinine phosphokinase levels.
The most likely diagnosis is

A. Ocular larva migrans (Toxocara canis infection)

B. Trichinosis

C. Viral myositis

D. Polymyositis (autoimmune)

E. Typhoid fever

6. Which of the following has been shown to decrease the
incidence of ventilator-acquired pneumonia?

A. Replacement of the ventilator circuit equipment every 24
h

B. Elevation of the head of the bed to more than 45 degrees

C. Selective gut decontamination with norfloxacin

D. Stress ulcer prophylaxis with sucralfate

E. Stress ulcer prophylaxis with a proton pump inhibitor

7. A 63-year-old male with end-stage ischemic cardiomyopathy
is offered a heart transplant from a 20-year-old female with brain death after
a skiing accident. Which of the following is not a risk that the patient should
be advised about if he decides to accept the heart?

A. Increased risk of malignancy

B. Risk of rejection of transplanted organ

C. Coronary artery disease

D. Increased risk of infections

E. Increased risk of bradyarrhymias

8. A 60-year-old female is seen in the clinic for follow-up
for ischemic dilated cardiomyopathy. She has no angina currently, and the most
recent echocardiogram shows an ejection fraction of 20%. Besides mild pedal
edema, the examination is normal. Which of the following agents will not confer
a mortality benefit on this patient?

A. Captopril

B. Isosorbide mononitrite

C. Metoprolol XL

D. Aspirin

E. An implantable defibrillator

9. Among the following pulmonary function test results, pick
those which are the most likely finding in familial pulmonary hypertension?

A. Increased total lung capacity (TLC), decreased vital
capacity (VC), decreased FEV1/FVC ratio

B. Decreased TLC, decreased VC, decreased residual volume
(RV), increased FEV1/FVC ratio, normal maximum inspiratory pressure (MIP)

C. Decreased TLC, decreased RV, normal FEV1/FVC ratio,
decreased MIP

D. Normal TLC, normal RV, normal FEV1/FVC ratio, normal MIP

10. All the following drugs can cause eosinophilic pneumonia
except

A. nitrofurantoin

B. sulfonamides

C. nonsteroidal anti-inflammatory drugs (NSAIDs)

D. isoniazid

E. amiodarone