Re: Question for EvilMasterMind
some more:
A 45-year-old African-American man comes to the office for the first time because he says, "I had blood in my urine when I went to the bathroom this morning." He reports no other symptoms. On physical examination his kidneys are palpable bilaterally and he has mild hypertension. Specific additional history should be obtained regarding which of the following?
A. Chronic use of analgesics
B. Cigarette smoking
C. Occupational exposure to carbon tetrachloride
D. A family history of renal disease
E. Recent sore throats
A 38-year-old white woman, who is a part-time teacher and the mother of three children, comes to the office for evaluation of hypertension. You have been her physician since the birth of her first child 8 years ago. One week ago, an elevated blood pressure was detected during a regularly scheduled examination for entrance into graduate school. Vital signs on examination today are temperature 37.0°C (98.6°F), pulse 100/min, respirations 22/min, and blood pressure 164/100 mm Hg (right arm, supine).
2. The physical examination is most likely to show which of the following?
A. An abdominal bruit
B. Cardiac enlargement
C. Normal retinas
D. Thyroid enlargement
E. Decreased femoral pulses
3. The most appropriate next step is to order which of the following?
A. Complete blood count
B. Urine culture
C. Determination of serum glucose concentration
D. Determination of serum thyroxine concentration
E. Determination of serum electrolyte and creatinine concentrations
4. To assess this patient's risk factors for atherogenesis, the most appropriate test is determination of which of the following?
A. Serum cholesterol concentration
B. Plasma renin activity
C. Serum triglycerides concentration
D. Urinary aldosterone excretion
E. Urinary metanephrine excretion
A 24-year-old man comes to the office because of intermittent chest pain that began a few weeks ago. You have been his physician for the past 2 years and he has been in otherwise good health. He says he is not having pain currently. A review of his medical record shows that his serum cholesterol concentration was normal at a pre-employment physical examination 1 year ago. You have not seen him since that visit and he says he has had no other complaints or problems in the interim. He reminds you that he smokes 1 pack of cigarettes per day. When you question him further, he says that he does not use any alcohol or illicit drugs. Although the details are vague, he describes the chest pain as a substernal tightness that is definitely not related to exertion.
5. Which of the following findings on physical examination would be most consistent with costochondritis as the cause of his chest pain?
A. Localized point tenderness in the parasternal area
B. Deep tenderness to hand pressure on the sternum
C. Crepitance over the second and third ribs anteriorly
D. Pain on deep inspiration
E. Normal physical examination
6. In light of the patient's original denial of drug use, which of the following is the most appropriate next step to confirm a diagnosis of cocaine use?
A. Ask the laboratory if serum is available for toxicologic screening on a previous blood sample
B. Call his family to obtain corroborative history
C. Obtain a plasma catecholamine concentration
D. Present your findings to the patient and confront him with the suspected diagnosis
E. Obtain a urine sample for routine analysis but also request toxicologic screening
Cocaine use is confirmed. The patient admits a possible temporal relationship between his cocaine use and his chest pain and expresses concern about long-term health risks.
7. The patient should be counseled regarding which of the following?
A. Cocaine-induced myocardial ischemia can be treated with blocking agents
B. The presence of neuropsychiatric sequelae from drug use indicates those at risk for sudden death associated with cocaine use
C. Death can occur from cocaine-induced myocardial infarction or arrhythmia
D. Q wave myocardial infarction occurs only with smoked "crack" or intravenous cocaine use
E. Underlying coronary artery disease is the principal risk for sudden death associated with cocaine use
lemme call maddy here 
