A 34-year-old male complains of extreme fatigue and weakness, lightheadedness, anorexia, and unintentional weight loss of 20 pounds over the last month. The patient has a history of tuberculosis as a child from age 4.
Current tuberculin PPD is pending. On physical examination, the patient is afebrile with heart rate 110 beats/min., resps 18 breaths / min, and BP 100/50. He has a tanned complexion, thin and frail looking, and looks younger than stated age. Heart: tachycardia, regular rate and rhythm. Lungs are clear to auscultation. Abdomen non-tender with no organomegaly. Extremities show no significant findings. No neurological deficits. C-x-ray demonstrates area of scar tissue. These signs and symptoms are characteristic of:
A. Congestive heart failure
B. Active tuberculosis
C. Cushing's disease
D. Addison's disease
Question 2A 15-year-old male presents to the clinic with fatigue, weakness, and sore throat for 4 days. The patient has no significant medical or surgical history.
On physical examination, there is fever of 102, erythematous pharynx and tonsilar enlargement, and prominent cervical lymphadenopathy. Heart has regular rate and rhythm. Lungs are clear to auscultation. Abdomen exam demonstrates left upper quadrant tenderness to deep palpation and splenomegaly. Extremities show no significant findings. No neurological deficits. These signs and symptoms are characteristic of:
A. Beta-hemolytic streptococcal infection
B. Scarlet fever
C. Infectious mononucleosis
D. Human immunodeficiency viral infection
Question 3A 32-year-old morbidly obese male complains of excessive fatigue, snoring, and awakening in the middle of the night, which prevents restorative sleep.
He is sluggish during the day due to the lack of sleep and feels like he is going fall asleep at the wheel when driving to work. Occupation: dishwasher. Medical history includes hypertension and type 2 diabetes. Current medications include ACE inhibitor and metformin. Denies use of alcohol, tobacco, or drugs. On physical examination, the patient is afebrile, pulse 88, resps 20/min, BP 178/95. BMI is 45. These are signs and symptoms of:
A. Obstructive sleep apnea
B. Primary insomnia
C. Heart failure
D. All of the above
Question 4A 66-year-old female presents with fatigue, shortness of breath with exertion, cough, and swelling of the ankles. Current medications include lipid-lowering medication for hyperlipidemia and beta blocker for hypertension.
On physical examination, vital signs are 98 degrees, 18 resps/min, pulse 56, and BP 100/60. Heart demonstrates S3 gallop and S4. Lungs reveal bilateral basilar crackles. Abdomen is distended with shifting dullness and hepatomegaly. Extremities show bilateral ankle edema. No neurological deficits. These signs and symptoms are characteristic of:
A. Chronic renal failure
B. Congestive heart failure
C. Metabolic syndrome
D. Liver failure
Question 5A 45-year-old female patient complains of nausea, vomiting, fatigue, and weakness. She admits to a history of heroin abuse for 11 years. She quit using the drug after rehabilitation last year and denies current use of the drug.
Habits include use of alcohol daily, 4-5 drinks a day, and tobacco use of 60-pack years. On physical examination, she is non-febrile, has a blood pressure of 148/98, pulse 78, and resps 16/min. The patient has periorbital edema. Lungs are clear to auscultation. Abdomen is non-tender and distended w/ mild hepatomegaly. No neurologic deficits. Laboratory testing reveals Hgb 10, BUN of 60, potassium 6.1, and serum creatinine 2.9 mg/dL. These findings are characteristic of:
A. Chronic renal failure
B. Dehydration
C. Congestive heart failure
D. Liver failure
Question 6A 67-year-old male with a smoking history of 120-pack years complains of fatigue with exertion, shortness of breath, chronic cough, and wheezing.
On physical examination, patient shows barrel-shaped chest, prolonged exhalation, circumoral cyanosis, and wheezing throughout both lung fields. Heart has regular rate and rhythm of 80 beats/min. Abdomen is obese and non-tender. Extremities show no significant findings. No neurological deficits. Arterial blood gases reveal acidosis. These signs and symptoms are characteristic of:
A. Congestive heart failure
B. Chronic obstructive pulmonary disease
C. Asthma
D. Lung cancer
Question 7A 44-year-old female comes in for a physical examination. She complains of having trouble losing weight, excessive fatigue, sluggishness, and loss of excessive blood with menses.
On physical examination, there are no significant findings except her BMI of 28 is in the overweight category. What other question(s) would assist in the diagnosis?
A. Is there a history of thyroid disorders in the family?
B. Do you feel excessively cold or hot when others are not ?
C. Have you had a recent upper respiratory infection?
D. A and B
Question 8A 22-year-old female patient complains of excessive thirst, feeling shaky when she misses meals and increased frequency of urination. Family history is positive for cardiovascular disease, cerebrovascular disease, and diabetes.
The patient denies use of tobacco, alcohol, or other drugs. She takes no medication. Daily diet is fast food, and the patient does not exercise regularly. On physical examination, there are no significant findings except obesity, demonstrated by a BMI of 35 and blood pressure of 145/ 90. The signs and symptoms are characteristic of:
A. Type 2 diabetes mellitus
B. Chronic fatigue syndrome
C. Cushing's disease
D. Clinical depression
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