Superior Vena Cava Syndrome in a Patient with Non-Hodgkin Lymphoma

1. A 45-year-old female presents to the emergency department with a 1-week history of facial swelling and progressive dyspnea with exertion. She was diagnosed 1 week ago with non-Hodgkin lymphoma but her medical history is otherwise unremarkable. A chest radiograph is shown below. After hospital admission, which one of the following would be the most appropriate urgent next step in the management of this condition? A) B) C) D) E) Intravenous antibiotics Echocardiography Plasmapheresis Bronchoscopy Radiation 2. A 22-year-old male presents for follow-up of moderate persistent asthma. After discussing his treatment options, you decide to use a single maintenance and reliever therapy (SMART) approach. Which one of the following daily inhaled therapies is appropriate to prescribe in this setting? A) B) C) D) E) Budesonide (Pulmicort) Budesonide/formoterol (Symbicort) Fluticasone/salmeterol (Advair Diskus) Fluticasone/vilanterol (Breo Ellipta) Tiotropium/olodaterol (Stiolto Respimat) 3. Which one of the following is an indication for long-term, rather than short-term, proton pump inhibitor therapy? A) B) C) D) E) The eradication of Helicobacter pylori Gastroprotection in users of high-dose NSAIDs at high risk for gastrointestinal bleeding The prevention of rebleeding from a Mallory-Weiss tear The prevention of ulcers after band ligation of esophageal varices The treatment of an NSAID-related gastric ulcer 4. An 85-year-old male presents for an annual Medicare examination. His wife tells you that he has been repeating himself in conversations, buying the same item multiple times, and taking longer to complete routine tasks such as balancing the checkbook. He recalls 1 out of 3 items on the Mini-Cognitive Assessment Instrument (Mini-Cog) and is unable to draw a clock. A depression screening is negative. Which one of the following is the greatest risk factor for this patient’s condition? A) B) C) D) E) Advanced age Atrial fibrillation Diabetes mellitus A history of head trauma Smoking 1 Item #1 2 5. Which one of the following would be the most appropriate initial pharmacotherapy for a temporomandibular disorder in an otherwise healthy 54-year-old male? A) B) C) D) E) Amitriptyline, 25 mg at bedtime Gabapentin (Neurontin), 300 mg daily Naproxen, 500 mg twice daily Tramadol, 50 mg every 6 hours Corticosteroid injection into the temporomandibular joint 6. A 33-year-old female presents to your office concerned about feeling fatigued for the past few months. She says that she feels cold often, has intermittent joint discomfort, and has gained 5 lb. She has not experienced any pain or problems swallowing. She gave birth to her youngest child almost 3 years ago, and she recently started an oral contraceptive. She has not had any recent illnesses. Her family history is significant for rheumatoid arthritis. A physical examination reveals a mild goiter but is otherwise unremarkable. Her vital signs are stable. A CBC and comprehensive metabolic panel are normal. A TSH level is 6.48 U/mL (N 0.4–4.5) and a thyroid peroxidase antibody level is 378 IU/mL (N <34). A free T 4 level is normal. Which one of the following is the most likely diagnosis for this patient? A) B) C) D) Drug-induced thyroiditis Hashimoto thyroiditis Postpartum thyroiditis Subacute thyroiditis 7. A first-time mother brings her 12-month-old to your office for a well child check. She and the child’s father are both your patients as well. Upon routine screening for anemia, you discover the infant has microcytic anemia with elevated red cell distribution width. You ask the parent about the child’s diet. She looks down at the floor, exhibiting poor eye contact and a flat affect, and responds that she does not shop or cook often. She says the child is happy when eating just applesauce and milk. The mother reports that she has been unmotivated and crying frequently. In addition to checking the child’s lead level and starting iron supplementation, which one of the following would be the most important next step to help this dyad? A) B) C) D) E) Providing reassurance and validation for the mother Educating the mother about nutrition and the importance of iron-rich foods for the child Notifying the child’s father Evaluating and treating the mother for postpartum depression Referring the mother to a psychiatrist 3