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Which of the following factors in patients with chronic venous insufficiency predisposes them to development of skin ulcers?

A. Increased intravascular oncotic pressure

B. Leakage of fibrinogen and growth factors into the interstitial space

C. Decreased capillary leakage

D. Inherited deficiency of protein C B. Leakage of fibrinogen and growth factors into the interstitial space, leukocyte aggregation and activation, and obliteration of the cutaneous lymphatic network can predispose a patient to skin ulcers

A 26 year-old monogamous female presents with cyclic pelvic pain that has been increasing over the last 6 months. She complains of significant dysmenorrhea and dyspareunia. She uses condoms for birth control. On physical examination her uterus is retroverted and non-mobile, and she has a palpable adnexal mass on the left side. Her serum pregnancy test is negative. Which of the following is the most likely diagnosis?

A. Ovarian cancer

B. Endometriosis

C. Functional ovarian cyst

D. Pelvic inflammatory disease B. With endometriosis, the uterus is often fixed and retroflexed in the pelvis. The palpable mass is an endometrioma or “chocolate cyst”. The patient with endometriosis also often has dysmenorrhea, dyspareunia, and dyschezia.

At what age does the first tooth usually erupt in an infant?

A. 2-4 months

B. 6-8 months

C. 10-12 months

D. 14-16 months B. The first tooth in an infant to erupt is the central incisor at the average age of 6-8 months.

A 7 year-old boy wets the bed on most nights. Which of the following is the preferred pharmacological agent to decrease the incidence of bed wetting episodes?

A. Imipramine (Tofranil)

B. Phenytoin (Dilantin)

C. Pramipexole (Mirapex)

D. Hyoscyamine (Urised) A. Imipramine is an anti-cholinergic and when given before bedtime has been shown to decrease the incidence of bed wetting.

A newborn is being evaluated for perioral cyanosis while feeding associated with sweating. Vital signs are rectal temperature, 37.8 degrees C (100 degrees F), blood pressure 80/45 mmHg, pulse 180/min, and respirations 40/min. A grade 3/6 harsh systolic ejection murmur with a single loud S2 is heard at the left upper sternal border. Electrocardiogram (ECG) shows right ventricular hypertrophy with right axis deviation. Chest x-ray shows a boot-shaped heart and decreased pulmonary vascular markings. Which of the following is the most likely diagnosis?

A. Atrial septal defect

B. Total anomalous pulmonary venous return

C. Coarctation of the aorta

D. Tetralogy of Fallot D. This is a common presentation for tetralogy of fallot.

Which of the following is considered to be the modality of choice for the identification of a pituitary macroadenoma that is suspected on the basis of a visual field deficit?

A. Skull x-ray

B. PET scan

C. CT of the brain

D. MRI of the brain D. MRI of the brain provides the best visualization of pituitary tumors.

A 2 year-old male presents with a four day history of fever and general malaise. On examination the vitals reveal an oral temperature of 102 degrees F. The child appears to have rubor on the trunk which started one day prior to this visit. Physical examination reveals a maculopapular rash with defervescence. Which of the following is the most appropriate management at this time?

A. Ibuprofen (Motrin)

B.