CMS Medicine Form 1

[Blind date18]

1) Previously healthy old man comes to the Physician with chief complaints of Fever ,chills ,dysuria ,Rectal pain . His temperature is 102.9 Pulse 120/min Bp 100/80 . O/ E rectal tenderness positive, U/ A shows nitrites and leukocyte esterase positive . Which of the following is most appropriate Pharmacotheraphy ?

Ampicillin
Azithromycin
Ciprofloxacin
Nitrofurantoin
Tetracycline

2) A 32 year old man comes to office for routine examination his previous visit was 5 years ago. He had a h/o appendectomy 8 years back . No Family h/o , examination normal . Which of the following is most appropriate screening test in this patient?

Measurement of blood Glucose
Measurement of blood cholesterol
ECG
CBC
Test for FOB


3)A 42 year old woman comes to the physician because of a 4 month history of weakness in the right hand and a 2 month history of weakness in the left leg. She has had occasional twitching of muscles in all 4 extremities that she attributes to nervousness. She has migraines treated with sumatriptan. No family history of neurologic disease. Examination shows atrophy and weakness of the hands more on the right than on the left. frequent random twitching in the shoulder girdle muscles and the left foot drop. DTRs markedly increased in the extremities. Babinski is present on the right. Jaw reflex is brisk. Her speech is slurred. Sensory exam normal. Her CK is 335. Nerve conduction studies show no abnormalities. EMG shows acute and chronic denervation in several muscles of all extremities. Most likely diagnosis?

A) Amyotrophic lateral sclerosis
B) Cervical myelopathy
C) inclusion body mysositis
D) multiple sclerosis
E) Polymyositis

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[Blind date18]

A 77 old women comes to the physician with complaints of ankle swelling and shortness of breath.She has no Orthopnea ,PND,JVD
She'z having a h/o of HTN, AF, Hypothyroidism for which she takes HCTZ, Verapamil , Levothyroxin .O/E She'z having superficial venous varicosities with bilateral pedal edema with hair loss and pigmentation. CXR and ECG normal , Oxygen saturation is 90% on ambulation and 96% at rest. Cardiac Echo showed Mitral annular calcification .V/Q scan shows two sub segmental perfusion defect's but no ventilation defects , what is the cause of dyspnea in this person?

Cardiac emboli secondary to intermittent arrhythmia
Coronary ischemia
Left ventricular diastolic dysfunction
Mitral insufficiency
Recurrent pulmonary emboli

 

[Blind date18]

Patient came to the office with a h/o of 2 weeks pain on the right side of the neck that radiates down the lateral aspect of the right arm to the 3rd digit , he also has mild tingling sensation in the digit & weakness in the arm.He work's as computer programmer and spend most of his time on the keyboard, O/E he is having weakness of right elbow and wrist extension and a decreased triceps reflex , but there is no sensory loss. Where will be the lesion?

-Basal ganglia
-Brachial plexus
-Cervical nerve root
-Cervical spinal cord
-Medial nerve
-Radial nerve
-Ulnar nerve
-Thoracic nerve root

 

[Blind date18]

32 year old man comes to ED with progressive left lower back pain,it began suddenly while he's working and did not respond to acetaminophen.All the vital's are normal holds his back rigid while walking.O/E there is spasm of para spinal muscles & there is increasing pain on straight leg raising, Muscle strength 5/5 . DTR & Sensory examination show's no abnormalities,which of the following is most appropriate in diagnosis?

-X ray of L- S spine
-MRI of L-S spine
-Myelography
-Complete blood picture ,electrolytes
-No further diagnosis needed

 

[Blind date18]

A patient came to ED with 5 hour h/o of blurring of vision, slurring of voice and numbness on the right side of her face ,she had similar episodes previously. In btwn the episodes is quite normal ,she has a h/o of chronic mastoiditis , osteoarthritis causing her tinitus & chronic neck pain
she's also having a h/o cabg 4 years back. She uses clopidogrel and isosorbide .o/ e vitals are pulse 84/min rr 20/min and bp 140/100 , neurological examination including head MRI and CT are normal but MR angiography shows dissection of right vertebral artery, which is the following is most accurate pharmacotheraphy?

-Warfain, oral
-Heparin, oral
-Dipyridamole,iv
-Urokinase,iv
-Tissue plasminogen activator,iv

 

[Blind date18]

26 month old boy is brought in for a follow up exam 2 weeks after completing a 10 day course of amoxicillin for an ear infection. His father is concerned b/c his son has had many ear infections since birth, and his speech is difficult to understand. The child walks and runs with only occasional falls and is able to climb on furniture. He can stack seven blocks without difficult. He is at the 10th percentile for height and weight. During the exam, he doesn’t say any intelligible words, and he intermittently babbles or screams. Exam shows retracted tympanic membranes with poor movement with pneumatic otoscopy. Which is the next best step?

A. reassurance

B. Measurement of blood lead concentration

C. Audiometry

D. CT scan of the head

E. 10 day course of high dose amoxicillin-clavulanate

F. Insertion of tympanostomy tubes