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1. A 53-year-old patient is admitted to the hospital with diarrhea. He has been experiencing five unformed stools daily for 2 days. The patient had a previous admission 6 weeks ago for C.
difficile diarrhea, which was treated successfully with oral metronidazole. Stool tests are again positive for C. difficile toxin A.
On presentation, his vital signs are: BP 128/86 mm Hg, HR 75 bpm, RR 14 bpm, and T37.8°C.
WBC count shows 12,300 cells/ul (80% neutrophils-segs, 10% neutrophils-bands), serum creatinine 1.2 mg/dL, and albumin 3.4 g/dL. The patient has no evidence of colitis, toxic megacolon, or perforation on imaging studies of the abdomen.
What is the most appropriate treatment recommendation for this patient?

A) Vancomycin 125mg orally four times daily
B) Metronidazole 500mg orally three times daily
C) Rifaximin 550mg orally three times daily
D) Vancomycin 125 mg orally four times daily plus metronidazole 500 mg three times daily intravenously

2. A 60-year-old patient has a 15-year history of type 2 diabetes mellitus, hypertension, and dyslipidemia. The patient, who denies smoking or drinking, complains of early satiety, a full feeling, bloating, and vomiting, for the past 2 months. Current medications include glipizide, metformin, and atorvastatin. The most recent A1C was 9.8%. Liver and renal function test results are within normal limits.
Which of the following would be most appropriate for managing these complaints?

A) Start simethicone.
B) Begin intravenous fluids.
C) Start metoclopramide.
D) Discontinue metformin.

3. An investigator decides to perform a correlation analysis of the relationship between the number of cigarettes smoked per day and age. Results show a positive correlation between the two, with an r value of 0.50 and ap value for the correlation equal to 0.03. What is the most reasonable interpretation of this correlation?

A) Increased age causes students to Smoke more.
B) There is no relationship between age and amount of smoking.
C) Increased age does not cause students to smoke more.
D) There is a statistically significant numerical association between age and amount of smoking.

4. A 78-year-old woman presents to the outpatient clinic for workup for depression. Medical history includes hypertension, simple partial seizures, and osteoporosis. The patient reports a
6.8 kg non-intentional weight loss over the past month. Home medications include lisinopril, hydrochlorothiazide, carbamazepine, and alendronate. The patient has been diagnosed with severe depression. Which antidepressant should be recommended for this patient?

A) Nortriptyline 25 mg daily
B) Bupropion XL 150 mg daily
C) Escitalopram 20 mg daily
D) Mirtazapine 15 mg daily

5. A 60-year-old man who is HIV-positive describes symptoms of erectile dysfunction and requests therapy. Current medications include tenofovir 300 mg orally daily, emtricitabine 200 mg orally daily, atazanavir 300 mg orally daily, and ritonavir 100 mg orally daily. In addition to counseling on preventing HIV transmission, which recommendation is appropriate?

A) Start sildenafil 50 mg/dose (maximum 200 mg in 48 hours).
B) Start sildenafil 50 mg/dose (maximum 200 mg in 48 hours) and decrease atazanavir to
150 mg orally daily.
C) Start sildenafil 25 mg/dose (maximum 25 mg in 48 hours) and decrease atazanavir to
150 mg orally daily.
D) Start sildenafil 25 mg/dose (maximum 25 mg in 48 hours).

問題與答案：

問題 #1 答案： B

問題 #2 答案： B

問題 #3 答案： D

問題 #4 答案： C

問題 #5 答案： D