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3,531 questions
A33-year-old female complains of a sore throat and general malaise over the past week after being treated for an upper respiratory infection. On examination, her thyroid gland is nodular and tender to palpation. Which of the following is the best treatment?
Deficiency of which of the following is the most common nutritional cause of anemia?
A28-year-old female shows clinical manifestations related to secretion of excess androgenic hormones and persistent anovulation. What would be the most likely finding in the ovary?
A 9-month-old male infant is brought to your office for evaluation of new skin lesions. The mother tells you that she recently had to return to work, and the child is now in day care. He has since developed new erythematous facial plaques. She also reports that the child has been irritable with chronic diarrhea. On examination, the child has dry scaly plaques symmetrically distributed in the perianal and perioral areas. Which deficiency does this child likely have?
A 4-year-old child is seen in the emergency department after having a seizure at home. This is the first time that this has happened. The mother says that the child was sitting on the couch watching television when she suddenly became limp, started drooling, and having generalized tonic-clonic movements of her arms and legs. The mother relates that the child felt like she was "burning up" and that the tonic- clonic activity stopped after a few minutes. The mother says that the child is otherwise healthy, does not take any medicines, and has never been hospitalized. The child's immunizations are up-todate, and she has no known drug allergies. On examination, the vital signs are temperature of 104°F, BP 97/49, HR 112, and RR 26. The child is sitting on the examination table playing with stickers and drawing. She has a mild amount of clear nasal congestion but her examination is otherwise normal. When asked, the child replies that she feels fine. Which of the following medications would be most appropriate to be given to the child while in the emergency department?
A2-week-old infant is brought to the office for a check-up. The father relates that they have no concerns except that the baby seems to have tearing from his left eye. They also point out some swelling at the edge of his left eye. The infant is eating, sleeping, stooling, and voiding well. On examination, you find a 1/2 × 1/2 cm firm nodule inferior to the medial canthus of the left eye. What does this most likely represent?
A 52-year-old male construction worker is seen in the emergency department (ED) at a local hospital with complaints of persistent cough for the past 4 months. He has been relatively healthy until a few months ago, when he lost his mother and developed severe depression which left him socially and professionally paralyzed. He has stopped doing any exercise or outdoor activity and spends most of his time at home eating, sleeping, and watching TV. In addition, he has noticed a 20-lb weight gain over this period but attributes it to his lack of exercise and increased food intake. His cough is worse at night, or any time when he lies down to sleep, and he notices a burning sensation in his throat associated with it. It is not associated with fever or chills, and his wife complains that he is constantly clearing his throat after meals. He smoked a few cigarettes per day as a young man in the Navy but quit more than 30 years ago. He denies recent travel or incarceration and has no recollection of any sick contacts. On examination, he is afebrile and appears mildly obese. His lung examination is clear. His oropharynx is red and mucosal membranes are dry and not inflamed.
A 52-year-old male construction worker is seen in the emergency department (ED) at a local hospital with complaints of persistent cough for the past 4 months. He has been relatively healthy until a few months ago, when he lost his mother and developed severe depression which left him socially and professionally paralyzed. He has stopped doing any exercise or outdoor activity and spends most of his time at home eating, sleeping, and watching TV. In addition, he has noticed a 20-lb weight gain over this period but attributes it to his lack of exercise and increased food intake. His cough is worse at night, or any time when he lies down to sleep, and he notices a burning sensation in his throat associated with it. It is not associated with fever or chills, and his wife complains that he is constantly clearing his throat after meals. He smoked a few cigarettes per day as a young man in the Navy but quit more than 30 years ago. He denies recent travel or incarceration and has no recollection of any sick contacts. On examination, he is afebrile and appears mildly obese. His lung examination is clear. His oropharynx is red and mucosal membranes are dry and not inflamed. Which of the following therapies would be most beneficial in alleviating this patient's symptoms?
You are asked to interview a young couple who wish to conceive a child. Their first and only son was born with a rare, autosomal recessive glycogen storage disorder known as Pompe disease. Both parents are healthy and unaffected by this disease, but the father believes that he has heard of a distant cousin who also has this disease. They are concerned about the possibility that their next child will also be born with the affliction. In giving them advice about their chances of having a healthy child, you should:
A 53-year-old female has made an appointment to see you concerning the recent onset of menopause. Her last menstrual period was 8 months ago and, over the last year, she had noticed that her periods were becoming lighter and less frequent. In addition, she has developed frequent hot flashes, and her mood has become very labile. She wishes to know what your advice is regarding hormone replacement therapy (HRT). She has heard recent reports in the news concerning an increased risk of developing cardiovascular complications, especially heart attacks and strokes. Although she is in great health, her father died at age 50 of a massive heart attack. Her mother is alive and well, and there is no history of breast cancer among the females in her family. Regarding postmenopausal HRT, which of the following statements would be correct?
Ayoung college student is brought to your office by his fiancé for evaluation of weight loss. He tells you that, over the past few months, he seems to be unable to gain any weight despite having a ferocious appetite and that he is steadily losing weight. He has also noticed increased thirst and urination. Over the past few nights, he has awakened several times to go to the bathroom. You suspect that he may have developed diabetes. Which of the following is a diagnostic criterion for diabetes mellitus (DM)?
A 67-year-old male with a history of type II diabetes and hypertension is hospitalized with complaints of retrosternal chest pain that radiates to the left arm and jaw. In the ED, an electrocardiogram (ECG) showed S-T segment depressions in the inferior and lateral leads. He has been given the diagnosis of acute coronary syndrome and admitted to the coronary care unit for further evaluation and treatment. Admission laboratory values reveal a total cholesterol of 270, a lowdensity lipoprotein (LDL) of 190, and a high-density lipoprotein (HDL) of 28. He is currently smoking a pack of cigarettes per day and lives a sedentary life. He is clearly overweight and his blood pressure, despite medication, remains elevated at 150/88. His last HgbA1C less than a month ago was 9.8%. After being discharged from the hospital, which of the following cholesterol lowering regimens should be recommended to this patient?
A 67-year-old male with a history of type II diabetes and hypertension is hospitalized with complaints of retrosternal chest pain that radiates to the left arm and jaw. In the ED, an electrocardiogram (ECG) showed S-T segment depressions in the inferior and lateral leads. He has been given the diagnosis of acute coronary syndrome and admitted to the coronary care unit for further evaluation and treatment. Admission laboratory values reveal a total cholesterol of 270, a lowdensity lipoprotein (LDL) of 190, and a high-density lipoprotein (HDL) of 28. He is currently smoking a pack of cigarettes per day and lives a sedentary life. He is clearly overweight and his blood pressure, despite medication, remains elevated at 150/88. His last HgbA1C less than a month ago was 9.8%. In addition to diet, exercise, and smoking cessation, which of the following would have the largest impact in reducing his cholesterol?
A 48-year-old female with a history of mild congestive heart failure (CHF) treated with furosemide presents to the emergency room (ER) for evaluation of 24 hours of epigastric pain, nausea, and vomiting after eating a large meal in a restaurant. Previously, the patient had experienced intermittent right upper quadrant pain after eating. On examination, the patient has a temperature of 98.5°F and a pulse of 100. Her examinat ion is remarkable for epigastric tenderness to palpation, normal bowel sounds, and no rebound tenderness or guarding. Laboratory studies are as follows: Leukocyte count 4800/mm3 Alanine aminotransferase (ALT) 258 U/L Aspartate aminotransferase (AST) 287 U/L Alkaline phosphatase, serum 350 U/L Bilirubin (total) 2.0 mg/dL Bilirubin (indirect) 0.4 mg/dL Amylase 2865 U/L Lipase 3453 U/L Which of the following is the most likely diagnosis?
A 48-year-old female with a history of mild congestive heart failure (CHF) treated with furosemide presents to the emergency room (ER) for evaluation of 24 hours of epigastric pain, nausea, and vomiting after eating a large meal in a restaurant. Previously, the patient had experienced intermittent right upper quadrant pain after eating. On examination, the patient has a temperature of 98.5°F and a pulse of 100. Her examinat ion is remarkable for epigastric tenderness to palpation, normal bowel sounds, and no rebound tenderness or guarding. Laboratory studies are as follows: Leukocyte count 4800/mm3 Alanine aminotransferase (ALT) 258 U/L Aspartate aminotransferase (AST) 287 U/L Alkaline phosphatase, serum 350 U/L Bilirubin (total) 2.0 mg/dL Bilirubin (indirect) 0.4 mg/dL Amylase 2865 U/L Lipase 3453 U/L What would the most appropriate next test to order be?
A 48-year-old female with a history of mild congestive heart failure (CHF) treated with furosemide presents to the emergency room (ER) for evaluation of 24 hours of epigastric pain, nausea, and vomiting after eating a large meal in a restaurant. Previously, the patient had experienced intermittent right upper quadrant pain after eating. On examination, the patient has a temperature of 98.5°F and a pulse of 100. Her examinat ion is remarkable for epigastric tenderness to palpation, normal bowel sounds, and no rebound tenderness or guarding. Laboratory studies are as follows: Leukocyte count 4800/mm3 Alanine aminotransferase (ALT) 258 U/L Aspartate aminotransferase (AST) 287 U/L Alkaline phosphatase, serum 350 U/L Bilirubin (total) 2.0 mg/dL Bilirubin (indirect) 0.4 mg/dL Amylase 2865 U/L Lipase 3453 U/L The patient is made NPO (nothing by mouth) and vigorously hydrated. After 3 days, the amylase and lipase normalize, but the bilirubin rises to 4.2 mg/dL. An endoscopic retrograde cholangiopancreatography (ERCP) is performed, and the following cholangiogram is obtained. What is the best treatment option at this time?
Your patient who was recently prescribed an antibiotic returns to your clinic for a follow-up visit. Although she was feeling better, the instructions on the bottle were to take the medication for total of 10 days. She wants to know if she still has to take the medication three times daily as she has improved. You explain to her that the dosing regimen is based on the biological half-life of a drug, which is generally related to which of the following?
A 35-year-old woman with a history of major depressive disorder is brought into the ED by her boyfriend. He believes she may have overdosed on pain medication in an effort to hurt herself. He gives you three medication bottles which he discovered empty and states that they were nearly full before leaving for work earlier that morning. However, the timing of the ingestion is unclear. All three of the bottles apparently held acetaminophen- containing medications. Examination of the patient reveals a tired-appearing woman complaining of nausea and right upper quadrant abdominal pain. Depletion of which of the following is primarily responsible for the hepatotoxicity being experienced by the patient?
A 35-year-old woman with a history of major depressive disorder is brought into the ED by her boyfriend. He believes she may have overdosed on pain medication in an effort to hurt herself. He gives you three medication bottles which he discovered empty and states that they were nearly full before leaving for work earlier that morning. However, the timing of the ingestion is unclear. All three of the bottles apparently held acetaminophen- containing medications. Examination of the patient reveals a tired-appearing woman complaining of nausea and right upper quadrant abdominal pain. Which of the following pharmacologic treatments is most appropriate at this time?
A 72-year-old man comes to your clinic for the first time, accompanied by his wife. His wife states that she is concerned because he has been growing increasingly forgetful over the past year. Within the past month, he has forgotten to turn off the stove and has got lost while walking to the post office one block away from their home. His past medical history is significant for well-controlled diabetes and chronic lower back pain. He has no history of falls or traumatic injury to the head. Examination of the patient is significant for a score of 18 on a Mini Mental Status Examination (MMSE). During the administration of the MMSE, the patient blurts out that his wife brought him to the doctor because she is having an extramarital relationship. Despite appropriate treatment, the patient experiences a gradual decline in mental function. He develops erratic sleep habits, frequently awakening at night and wandering throughout his home. His wife states that she once found him sitting on the ground in their yard, unable to recall how he arrived there. During your latest examination of the patient, you note that he has lost the ability to sign his name, holding the pen as if he is unsure of what to do with it. Exasperated, his wife states that he is now dependent on her for performance of his activities of daily living. Which of the following is indicated in the treatment of the patient's condition at its current severity?