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1. You are called to the Emergency Department to see a 6-month-old boy with a 3-day history of fever. Physical examination reveals an irritable infant with a temperature of 38.1°C. His vital signs are:
Blood pressure: 87/50 mm Hg
Respiratory rate: 80/min
Heart rate: 140/min
Oxygen saturation: 92% on room air
The infant has no skin findings. On chest examination, you hear coarse crackles on the right side of the chest.
Which one of the following is the best next step in the management of this child?

A) Intravenous fluids.
B) Intravenous antibiotics.
C) Oral steroids.
D) Oral antibiotics.
E) Reassurance.

2. A 42-year-old man presents to your clinic for follow-up regarding his anxiety. He lost his job 1 year ago.
Since then, he constantly thinks about what happened, trying to understand what went wrong and how he could fix it or prevent it in the future. He is unable to sleep because of this. He has become socially isolated and when he does see friends, he worries constantly that he may say something hurtful. He wishes he could get past what happened and find another job but feels consumed by the fear that he may offend someone in the future. On history, his symptoms did not respond to escitalopram, sertraline, fluvoxamine, or venlafaxine, all at maximum tolerated doses. Which one of the following medications is the most appropriate?

A) Paroxetine
B) Vortioxetine
C) Amitriptyline
D) Clomipramine
E) Quetiapine

3. A 26-year-old man presents to your office with fever, chills, and malaise. Aside from an episode of dysuria 8 weeks ago, which spontaneously resolved, he has been healthy. On examination, his left wrist and right ankle are tender. There is a cluster of vesiculopustular lesions on his right hand. Which one of the following is the most likely diagnosis?

A) Reactive arthritis
B) Varicella
C) Rheumatoid arthritis
D) Disseminated gonococcemia
E) Primary HIV infection syndrome

4. A 26-year-old man presents with pain, numbness, and weakness in his right upper extremity. He works as a computer programmer, and his BMI is 32. Symptoms have worsened since he started spending more time on the keyboard. He reports that his right hand feels clumsier while he is typing. Physical examination reveals mild weakness in the intrinsic muscles of that hand, with a positive Tinel sign at the ulnar nerve. Which one of the following is the best next step?

A) Elbow extension brace for use during sleep.
B) Nerve conduction studies to localize the level of the lesion.
C) Physiotherapy.
D) Magnetic resonance imaging of the cervical spine.
E) Wrist splint to test for carpal tunnel.

5. A 60-year-old man presents because of a 6-month history of involuntary lip smacking and tongue movements.
His medical history is significant for schizophrenia, which has been very stable with haloperidol for the past
20 years. When educating the patient about these particular symptoms, which one of the following statements is accurate?

A) These movements occur in the majority of patients who are taking antipsychotics
B) Anticholinergics are effective treatments for this condition
C) The symptoms will gradually decrease in intensity as he gets older
D) His condition is potentially irreversible

問題與答案：