Internal-Medicine

Questions: 99–114 21
with morning stiffness lasting 1 hour, and then
it improves after activity. On examination, there
are no active inflammatory joints but he has
limited forward and lateral flexion of the lumbar
spine, as well as decreased chest expansion. X-
rays of his pelvis and lumbar spine show
changes of sacroilitis. (SELECT ONE)
108. A 31-year-old woman has new-onset headaches
and blood pressure elevation. She also notices
that the symptoms come episodically and consist
of palpitations, headache, anxiety, and
marked blood pressure elevation. She undergoes
a workup for secondary causes of hypertension,
and is found to have elevated free
catecholamines in her urine. (SELECT ONE)
109. A 22-year-old university student notices unintentional
weight loss and palpitations for
1 month. She also complains of sweating and
feeling hot all the time. On examination, her
pulse is regular at 110/min, blood pressure
96/60 mm Hg; she has a diffuse enlargement of
the thyroid gland. Her thyroid-stimulating hormone
(TSH) is low and free T3 and T4 are elevated.
(SELECT ONE)
110. A 60-year-old man presents with SOB, increasing
abdominal distention, and lower leg edema.
He has no prior history of cardiac, renal, or liver
disease. On examination, the JVP is at 8 cm with
a negative Kussmaul’s sign but prominent x and
y descent. The blood pressure is 95/75 mm Hg, no
pulsus paradoxus, pulse 100/min with low
volume, and normal heart sounds. There is
shifting dullness of the abdomen and pedal
edema. His blood glucose and hemoglobin A1C
are elevated. (SELECT ONE)
Questions 111 through 116
(A)
(B)
(C)
(D)
fibric acid derivatives (clofibrate,
gemfibrozil)
nicotinic acid
bile acid-binding resins (cholestyramine,
colestipol)
hepatic hydroxymethylglutarylcoenzyme
A (HMG-CoA) reductase
inhibitors (lovastatin, simvastatin,
pravastatin)
(E)
(F)
lifestyle modification
estrogens (Premarin, estradiol)
For each patient with dyslipidemia, select the
most appropriate treatment.
111. A 63-year-old woman with Type II diabetes is
seen for follow-up after a fasting lipid profile.
She has no other medical conditions and feels
well. Her diabetes is well-controlled and the last
hemoglobin A1C value was 6.5%. Her total cholesterol
(T-chol) is 240 mg/dL, HDL 50 mg/dL,
low-density lipoprotein (LDL) 160 mg/dL, and
triglycerides 150 mg/dL. (SELECT TWO)
112. A 42-year-old woman, who is an executive at a
large company, is seen for her annual evaluation.
She is concerned about her risk for future
cardiac events since a collegue was just diagnosed
with angina. She has no other medical
illness and is a lifetime nonsmoker. Her fasting
lipid profile is T-chol 240 mg/dL, HDL 55
mg/dL, LDL 160 mg/dL, and triglycerides 140
mg/dL. (SELECT ONE)
113. A 57-year-old man comes to see you for followup
4 weeks after being discharged from hospital
for unstable angina. His coronary
angiogram showed moderate nonstenotic disease
in two vessels. The cardiologist asks you
to follow up on his fasting lipid profile since it
was not checked in the hospital. His T-chol is
240 mg/dL, LDL 120 mg/dL, HDL 50 mg/dL,
and triglycerides 130 mg/dL. (SELECT TWO)
114. A 58-year-old woman is admitted to hospital
with left-sided hemiparesis. She is diagnosed
with an ischemic right cortical stroke, and
started on aminosalicylic acid (ASA) for secondary
prevention. Her carotid ultrasound
reveals no arterial stenosis. She has no other significant
past medical history but she does smoke
half pack a day. Her fasting lipid profile is T-chol
240 mg/dL, HDL 50 mg/dL, LDL 160 mg/dL,
and triglycerides 130 mg/dL. (SELECT TWO)