105. A 67-year-old man with Parkinson disease is admitted to the hospital for treatment of pneumonia. The patient's daughter, who
is visiting the patient, says he has had increased lethargy for the past day and decreased ambulation during the past 6 months.
She also says that there are times during the day when his tremors increase in severity, although he continues to care for
himself at home. Medical history is also remarkable for hypertension. Medications include hydrochlorothiazide, atenolol,
levodopa, and carbidopa. He is 168 cm (5 ft 6 in) tall and weighs 78 kg (172 lb); BMI is 28 kg/m
2
. Vital signs are
temperature 38.9°C (102.0°F), pulse 60/min supine and 68/min standing, respirations 22/min, and blood pressure
100/60 mm Hg supine and 80/50 mm Hg standing. The patient appears ill and older than his stated age. He is fully oriented
but lethargic. Auscultation of the chest discloses rhonchi in the right mid lung field. Abdominal examination discloses no
abnormalities. Neurologic examination discloses masked facies, bradykinesia, and cogwheel rigidity; gait was not assessed
on admission. Chest x-ray shows a right lower lobe infiltrate. ECG shows no abnormalities. Appropriate intravenous
antibiotic therapy is initiated. Prior to discharge, which of the following is the most appropriate step?
(A) Obtain CT scan of the chest
(B) Obtain a swallowing evaluation
(C) Place a percutaneous endoscopic gastrostomy (PEG) tube
(D) Prescribe fludrocortisone
(E) Prescribe prophylactic levofloxacin
106. A 47-year-old man is admitted to the hospital through the emergency department because of the sudden onset of palpitations,
left-sided chest pain, light-headedness, and shortness of breath that began while he was watching television 2 hours ago.
Medical history is remarkable for paroxysmal atrial fibrillation. The patient is 180 cm (5 ft 11 in) tall and weighs
82 kg (180 lb); BMI is 25 kg/m
2
. ECG obtained in the emergency department showed atrial fibrillation with narrow QRS
complex. Pulse was 146/min. Physical examination was remarkable for rapid heart rate. The patient was given oxygen via
nasal cannula and intravenous metoprolol 5 mg every 5 minutes for a total of 15 mg. His pulse slowed to 90/min. Two hours
after admission, he is pain free but his pulse is now 160/min. Blood pressure is 122/78 mm Hg. In order to decrease the
patient's pulse, which of the following should be administered intravenously?
(A) Adenosine
(B) Digoxin
(C) Enalapril
(D) Lidocaine
(E) Metoprolol
107. A 23-year-old man comes to the clinic to establish care after moving to the area for his first job since graduating from college.
He has felt well. Medical history is remarkable for Hodgkin lymphoma diagnosed 10 years ago, which was treated with
radiation therapy and a chemotherapy regimen of vinblastine, doxorubicin, methotrexate, and prednisone. BMI is 20 kg/m
2
.
Vital signs are within normal limits. The patient appears well. Physical examination discloses no abnormalities. Which of the
following screening studies is most appropriate to include in this patient's annual examinations?
(A) Bone marrow aspiration and complete blood count
(B) CT scan of the chest, abdomen, and pelvis
(C) Echocardiography
(D) Fine-needle aspiration biopsy of the thyroid gland
(E) Nerve conduction studies
NOTE: THIS IS THE END OF BLOCK 3.
ANY REMAINING TIME MAY BE USED TO CHECK ITEMS IN THIS BLOCK.