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3,531 questions
A 19-year-old primigravida at term has been completely dilated for 21/2 hours. The vertex is at 2 to 3 station, and the position is occiput posterior. She complains of exhaustion and is unable to push effectively to expel the fetus. She has an anthropoid pelvis. Which of the following is the most appropriate management to deliver the fetus?
You are contacted by the regional Federal Bureau of Investigations (FBI) field office to evaluate a prisoner in custody. The prisoner has confessed to crimes for which he could receive the death penalty. The FBI believes that he has information that could lead to the arrest of multiple co-conspirators and end an on-going criminal enterprise. For which of the following actions is physician participation ethical?
A 22-year-old woman and her 24-year-old partner have been attempting to conceive for 12 months. They have sexual intercourse two to three times per week and use no contraception or coital lubricants. She has never been pregnant and her husband has fathered no pregnancies. She has no history to suggest damage to her Fallopian tubes and her menses occur at 28- to 31-day intervals. What is the probability of conception per ovulation in normally fertile couples? 5%
A 22-year-old woman and her 24-year-old partner have been attempting to conceive for 12 months. They have sexual intercourse two to three times per week and use no contraception or coital lubricants. She has never been pregnant and her husband has fathered no pregnancies. She has no history to suggest damage to her Fallopian tubes and her menses occur at 28- to 31-day intervals. The statistic in question 60 is fecundability. Fecundity is defined as the probability of having a liveborn child per ovulation. What is the fecundity of normally fertile couples?
You have been the geriatrician for a 79-year-old patient with a 10-year history of Alzheimer's disease, diabetes mellitus, and coronary artery disease. His 75-year-old wife has been his caretaker in the home. In the last 3 months, he has become progressively more combative and violent toward his wife. He was recently discharged from the hospital after intravenous antibiotic therapy for pneumococcal pneumonia but had to be readmitted to the intensive care unit with resistant, pneumococcal bacteremia, altered mental status, renal insufficiency, hypotension, CHF, and hypoxemia. When he was first aware of his early loss of memory, he told a family friend and his wife he would not want to be kept alive under such conditions. However, he did not execute an advanced directive. He does not have any surviving blood relatives and has no children. His wife refuses to sign the consent form to intubate her husband. Which of the following is the most appropriate action to take at this time?
A 23-year-old G1P0010 woman complains of severe dysmenorrhea (i.e., pain with menses). She misses work for the first 3 days of her menstrual cycle almost every month and states that this has been a problem for about 3 years, now getting worse. She is not currently sexually active and is not using any hormonal contraception. She complains of occasional deep abdominal pain after bowel movements. Subsequent laparoscopic evaluation reveals endometriosis. Which of the following is a true statement regarding this condition?
A49-year-old female noticed that, in the morning, the small joints of her hands are swollen, painful, and stiff. Her rheumatoid factor is reportedly strongly positive. Citruline tests (cyclic citrullinated peptide [CCP]) are also positive. What disease does the patient most likely have?
A 46-year-old G3P3 woman has had postcoital spotting for 6 months. On pelvic examination, she has a fungating, exophytic lesion arising from her cervix that is approximately 2 cm in diameter. Biopsy of this lesion is interpreted as invasive squamous cell carcinoma of the cervix. There is no evidence of extension of the cancer onto the vagina. The parametria are indurated on bimanual examination, though not to the pelvic sidewall. CT scan of her pelvis and abdomen discloses enlarged paraaortic lymph nodes and metastatic lesions in the parenchyma of her liver. Which of the following is the FIGO stage of her cancer?
A 46-year-old G3P3 woman has had postcoital spotting for 6 months. On pelvic examination, she has a fungating, exophytic lesion arising from her cervix that is approximately 2 cm in diameter. Biopsy of this lesion is interpreted as invasive squamous cell carcinoma of the cervix. There is no evidence of extension of the cancer onto the vagina. The parametria are indurated on bimanual examination, though not to the pelvic sidewall. CT scan of her pelvis and abdomen discloses enlarged paraaortic lymph nodes and metastatic lesions in the parenchyma of her liver. This woman's childbearing is complete. She is a healthy woman who is close to ideal body weight, exercises regularly, and does not smoke. Which of the following is the most appropriate treatment of this woman? TAH-BSO
A third-year medicine resident has taken a trip to Guatemala to assist in a medical clinic for 2 weeks. After returning to work at the hospital, she faints during her grand rounds presentation of a case and is admitted to the teaching hospital where she works. She has a high temperature that cycles every few hours. The attending physician, a professor in her program, works her up for Dengue Fever and Malaria. Blood and urine laboratory tests are drawn and she receives many visitors from her concerned colleagues and coworkers. A fellow resident in her program, who is not directly involved in her care, reviews her chart and sees that her urine test came back positive for a pregnancy. Another resident sees him with the chart and asks, "So does she have Dengue or Malaria?" How should he respond to this request for information?
A pregnant woman has been taking phenytoin (Dilantin) for a seizure disorder. She is concerned that the drug will cause fetal abnormalities. Which of the following defects is the most common anomaly associated with phenytoin?
A full-term baby boy was noted in the immediate neonatal period to fail to pass meconium. Progressive abdominal distention was noted. Multiple laboratory and clinical tests lead to a decision to perform a rectal biopsy. What is the most important histologic finding that you expect to see in the rectal biopsy?
When counseling pregnant women about the dangers of drug use during pregnancy, they should be told that the rate of spontaneous major malformations in newborns is what?
A full-term baby boy was noted in the immediate neonatal period to fail to pass meconium. Progressive abdominal distention was noted. Multiple laboratory and clinical tests lead to a decision to perform a rectal biopsy. What special stains would you use that would be helpful to confirm the finding of ganglion cells?
A 34-year-old woman just delivered a 4100-g boy after a 15-hour labor, including a 21/2-hour second stage. During the repair of a midline episiotomy, there is a marked increase in the amount of vaginal bleeding. Which of the following is the most common cause of immediate postpartum hemorrhage?
A full-term baby boy was noted in the immediate neonatal period to fail to pass meconium. Progressive abdominal distention was noted. Multiple laboratory and clinical tests lead to a decision to perform a rectal biopsy. The treatment of choice for Hirschsprung disease is which of the following?
A 34-year-old woman just delivered a 4100-g boy after a 15-hour labor, including a 21/2-hour second stage. During the repair of a midline episiotomy, there is a marked increase in the amount of vaginal bleeding. Which of the following is the best immediate management of the probable cause of this postpartum hemorrhage?
A 31/2-year-old female presented with a left upper quadrant abdominal mass. The child had no previous history of medical illnesses. An ultrasound examination revealed a markedly deformed left kidney with 12 cm nonhomogenous soft tissue mass arising from the upper pole. Medial displacement of the bowel loops was also noted. What would be the most likely diagnosis in this case?
A 31/2-year-old female presented with a left upper quadrant abdominal mass. The child had no previous history of medical illnesses. An ultrasound examination revealed a markedly deformed left kidney with 12 cm nonhomogenous soft tissue mass arising from the upper pole. Medial displacement of the bowel loops was also noted. Characteristically, Wilms tumors are histologically recognizable for which of the following?
An autopsy was performed following the death of a 72-year-old man. The kidney is shown in Figure below. Which of the following clinical scenarios is most likely to explain the changes seen in this kidney?