Mcc qualifying exam-1

1.A very active 75-year-old man who has had a previous appendectomy and open cholecystectomy presents to the Emergency Department with a 3-week history of crampy lower abdominal pain with distention and obstipation. Physical examination shows a distended abdomen with mild diffuse tenderness. Rectal examination is normal. Abdominal x-rays show dilated loops of ascending, transverse and descending colon, with no gas in the rectum. Which one of the following is the most likely diagnosis?

Diverticulitis.
Carcinoma of the sigmoid colon.
Adhesive large bowel obstruction.
Fecal impaction.
Sigmoid colon volvulus.

2.The doctrine of informed consent requires that the physician recommending a surgical procedure to a patient

explains all risks of the procedure.
explains all material risks.
has the patient’s consent witnessed by a reliable person.
answers all questions the patient’s next of kin may have.
has the patient sign the hospital consent form.

A 63-year-old gravida IV, para II presents with a 2-year history of a sensation that something is “bulging” out of her vagina during straining. She is not emptying her bladder completely and often “double voids.” She has no urinary incontinence. She has no gastrointestinal symptoms. Past gynecologic history is unremarkable apart from an abdominal hysterectomy and oophorectomy. The most likely diagnosis is

enterocele.
cystocele.
rectocele.
detrusor dyssynergia.
procidentia.

A 16-year old girl is brought to the Emergency Department approximately 1 hour after ingesting 20 diazepam 5 mg tablets. She is slightly drowsy and said she took them because her boyfriend left her. After initial medical management, which one of the following is proper treatment?

Arrange involuntary admission to a psychiatric hospital.
Consider problem as “acting out” and send family home with behavioral management advice.
Psychiatric consult in the Emergency Department to assess suicide risk.
Refer her and her parents for family counseling.
Send the girl home with her parents with instructions to get rid of all pills at home.