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3,531 questions
An 80-year-old woman is admitted to the medical service for treatment of a UTI. While she is hospitalized, she is evaluated for confusion. On her mental status examination (MSE), she appears somnolent at times, fluctuating with an alert state. She is not cooperative, is hostile, and clearly is hallucinating at times. Her insight and memory are poor. The differential diagnosis includes both delirium and dementia. Which of the following is the most appropriate pharmacotherapy for her behavioral management?
An 80-year-old woman is admitted to the medical service for treatment of a UTI. While she is hospitalized, she is evaluated for confusion. On her mental status examination (MSE), she appears somnolent at times, fluctuating with an alert state. She is not cooperative, is hostile, and clearly is hallucinating at times. Her insight and memory are poor. The differential diagnosis includes both delirium and dementia. Which of the following signs/symptoms is the most specific for delirium?
A54-year-old woman presents to her physician for an opinion regarding additional therapy following curative resection of recently diagnosed colon cancer. She underwent uncomplicated sigmoid resection for invasive colon cancer 4 weeks ago. The pathology revealed carcinoma invading into, but not through, the muscularis propria, with one of eight positive mesenteric nodes. There was no evidence of liver metastases at the time of operation. Preoperative chest x-ray and CT scan of the abdomen showed no evidence of distant disease. Preoperative carcinoembryonic antigen (CEA) level was normal. Past history is positive for diabetes and mild hypertension. Examination is unremarkable except for a healing abdominal incision. Which of the following is the correct stage of this patient's colon cancer?
A pediatrician asks you to see a 13-year-old girl who has not begun to menstruate and has a 6-month history of pelvic and lower abdominal pain at approximately 1-month interval. She has Tanner stage 3 pubic hair and breast development. Her growth spurt occurred about 1 year ago and her current height is 65 in. (165 cm). She has never had sexual intercourse. On examination of her external genitalia the presence of Tanner stage 3 pubic hair is confirmed. The labia are normal. There is no obvious vaginal opening and there is bulging between the labia minora. Which one of the following laboratory tests is found in women with the androgen insensitivity syndrome? normal adult female testosterone concentrations
The patient is a 26-year-old male graduate student presenting to his health maintenance organization. He is having ongoing difficulty completing his thesis. When he is working on the computer, he finds it necessary to print out and save every draft of his paper. Even though he realizes that it is unnecessary to do so, he feels compelled to read and reread all of his versions in case he made a mistake. As a result, he has been unable to move forward with his dissertation. He is consumed with doubts about his thesis, but at the same time he cannot throw away discarded sections. In fact, his apartment contains stacks of paper spread throughout his rooms. He understands that these thoughts and behaviors are "not rational," and he is greatly distressed by them and the problems they have caused. The patient does not wish to take medication but is interested in psychotherapy. Which of the following would be the most efficacious in reducing his symptoms?
A 65-year-old man presents to the physician's office with complaints of abdominal discomfort and jaundice for the past 3 weeks. Past history is pertinent for 30 pack-year smoking history, occasional alcohol intake, and a 5.5-mm ulcerating melanoma removed from his back 21/2 years ago. Examination reveals a mildly jaundiced patient with normal vital signs and a slightly distended abdomen with mild right upper quadrant tenderness and significant hepatomegaly. For above patient with jaundice, select the one most likely diagnosis. hepatitis A hemolysis choledocholithiasis biliary stricture
A 30-year-old woman with a prior history of depression is attending her postpartum followup appointment after the birth of her first child. She has no physical complaints and her examination demonstrates no significant problems. She appears anxious. When asked, she describes intrusive thoughts of wanting to harm her baby but quickly states, "I'm not like that. I would never do anything to hurt him." Which of the following is the most appropriate next step in her management?
A 75-year-old woman is brought to the emergency department from the nursing home for jaundice and mental confusion. The nursing home notes state that she has become less responsive and has developed jaundice over the last 2 weeks. Past history is pertinent for hypertension, diabetes, and prior colon resection for cancer at age 55. Examination reveals mild jaundice with vital signs of temperature 101.5°F, pulse rat e 110/min, and BP 100/60 mmHg. She does not respond to verbal commands, but withdraws to pain. Abdominal examination reveals tenderness in the epigastrium and right upper quadrant. For above patient with jaundice, select the one most likely diagnosis. hepatitis A hemolysis choledocholithiasis biliary stricture
A75-year-old man is brought to the emergency department by his family for evaluation of jaundice. He complains of pruritus of 2 weeks' duration and a recent 10-lb weight loss. On examination, he is deeply jaundiced and has a nontender, globular mass in the right upper quadrant of the abdomen that moves with respiration. For above patient with jaundice, select the one most likely diagnosis. hepatitis A hemolysis choledocholithiasis biliary stricture
A 19-year-old newly married female presents to the emergency room, accompanied by her spouse. She states that she awoke this morning to find that she could not move her legs. She denies any pain but claims that she is unable to feel anything below her abdomen. She denies any trauma or past medical history. She is 24 weeks' pregnant, has had an uneventful pregnancy, and only takes prenatal vitamins. She is concerned if her symptoms will get better and wonders whether the "baby is pulling on my spinal cord." Her neurologic examination is remarkable for 0/5 motor strength in her lower extremities bilaterally, with decreased sensation to light touch and pinprick below the level of her umbilicus. Her cranial nerves and reflexes are normal, and she does not display any upper motor neuron signs. A STAT MRI performed is read as normal. Which of the following is the most likely explanation for her current symptoms?
A 50-year-old man presents to the emergency department for increasing abdominal distention and jaundice over the last 46 weeks. Examination reveals mild jaundice, spider angiomas, and ascites. Enlarged veins are noted around the umbilicus. For above patient with jaundice, select the one most likely diagnosis. hepatitis A hemolysis choledocholithiasis biliary stricture
A40-year-old single male with chronic schizophrenia is seen for a routine primary care clinic appointment for diabetes management. He is currently taking glyburide 5 mg bid and aripiprazole (Abilify) 20 mg daily. He claims to be compliant with his medications but appears poorly groomed with noticeable body odor. He is reluctant to talk, being somewhat guarded, but he eventually confides that he has been programmed by the government to kill his landlord, who he is convinced is working for Al Qaeda. His orders have been transmitted through his apartment walls to a receiver in his brain. He has been informed that if he does not comply, he will be sent to hell, so he has recently purchased several knives and plans to carry out "my mission" as soon as possible. When the subject of voluntary admission is brought up, he adamantly refuses. After consultation with a psychiatrist, the decision is made to admit the patient involuntarily. This course of action is in compliance with which of the following forensic psychiatry provisions?
A 55-year-old man presents to the physician's office with complaints of hoarseness and left neck fullness for the past month. On examination, a firm, movable, left submandibular mass is noted. Past history is pertinent for a 30 packyear smoking history with occasional alcohol intake. For the above patient with a neck mass, select the most likely diagnosis. thyroid carcinoma cystic hygroma acute suppurative lymphadenitis thyroglossal duct cyst lipoma carotid artery aneurysm
A40-year-old single male with chronic schizophrenia is seen for a routine primary care clinic appointment for diabetes management. He is currently taking glyburide 5 mg bid and aripiprazole (Abilify) 20 mg daily. He claims to be compliant with his medications but appears poorly groomed with noticeable body odor. He is reluctant to talk, being somewhat guarded, but he eventually confides that he has been programmed by the government to kill his landlord, who he is convinced is working for Al Qaeda. His orders have been transmitted through his apartment walls to a receiver in his brain. He has been informed that if he does not comply, he will be sent to hell, so he has recently purchased several knives and plans to carry out "my mission" as soon as possible. When the subject of voluntary admission is brought up, he adamantly refuses. What is the most appropriate next step in his management?
A 35-year-old woman presents to the physician's office for evaluation of a left neck mass discovered 1 month ago on a routine physical examination. On examination, the mass measures 2 cm and is located anterolateral to the larynx and trachea. It is nontender and moves with swallowing. Past history is pertinent for a 15 pack-year smoking history and occasional alcohol intake. For the above patient with a neck mass, select the most likely diagnosis. thyroid carcinoma cystic hygroma acute suppurative lymphadenitis thyroglossal duct cyst lipoma carotid artery aneurysm
A4-year-old boy is brought into the emergency room by his mother for evaluation. When the child is asked regarding specific complaints, he looks anxiously away and states, "It hurts when I go pee-pee." His mother confidently adds, "He has another urinary tract infection (UTI)." She lists the antibiotics that he has been treated with in the past and then demands that he be admitted for a workup. On examination, his vitals signs are unremarkable except for a temperature of 102°F. His physical examination is notable for suprapubic tenderness and some evidence of recent urethral trauma. His urinalysis is consistent with a UTI. Further review of his medical chart reveals multiple emergency room visits for various physical complaints including similar presentations for recurrent UTIs. Prior inpatient and outpatient assessments have not been able to adequately account for any underlying etiologies. What is the most likely explanation for the mother's behavior?
A 50-year-old woman presents to the physician's office for evaluation of a right neck mass. The mass has been present for 3 years and is painless. On examination, a nontender, firm, 2.5-cm mass is noted slightly below and posterior to the angle of the mandible on the right. For the above patient with a neck mass, select the most likely diagnosis. thyroid carcinoma cystic hygroma acute suppurative lymphadenitis thyroglossal duct cyst lipoma carotid artery aneurysm mixed parotid tumor (pleomorphic adenoma)
A4-year-old boy is brought into the emergency room by his mother for evaluation. When the child is asked regarding specific complaints, he looks anxiously away and states, "It hurts when I go pee-pee." His mother confidently adds, "He has another urinary tract infection (UTI)." She lists the antibiotics that he has been treated with in the past and then demands that he be admitted for a workup. On examination, his vitals signs are unremarkable except for a temperature of 102°F. His physical examination is notable for suprapubic tenderness and some evidence of recent urethral trauma. His urinalysis is consistent with a UTI. Further review of his medical chart reveals multiple emergency room visits for various physical complaints including similar presentations for recurrent UTIs. Prior inpatient and outpatient assessments have not been able to adequately account for any underlying etiologies. What is the most appropriate next step in the management of this patient?
An 18-month-old girl is brought to the physician's office for evaluation of left neck mass. Examination reveals a 2-cm soft, nontender, fluctuant mass in the left lateral neck. This is located at the anterior border of the sternomastoid, midway between the mastoid and clavicle. For the above patient with a neck mass, select the most likely diagnosis. thyroid carcinoma cystic hygroma acute suppurative lymphadenitis thyroglossal duct cyst lipoma carotid artery aneurysm
A 6-year-old boy presents to the emergency department with a cough, sore throat, and malaise of 4 days' duration. Examination reveals a temperature of 101.5°F, erythematous pharynx, and a tender right neck mass with overlying erythema. For the above patient with a neck mass, select the most likely diagnosis. thyroid carcinoma cystic hygroma acute suppurative lymphadenitis thyroglossal duct cyst lipoma carotid artery aneurysm