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3,531 questions
A 40-year-old male comes to your office as a new patient to get established for care, as he recently moved into your city from another state. He has been on medical therapy for type 2 diabetes mellitus for 3 years and has had good glycemic control. He takes metformin 500 mg bid and reports having fasting glucose levels of less than 100 on home monitoring. He has records from his previous physician that show that he had a dilated eye examination 6 months ago that was normal and a hemoglobin A1C (HgbA1C) level of 6.2 that was taken 3 months ago. He has no known history of coronary artery disease. His last fasting lipid measurement was 14 months ago. You order a fasting lipid panel today and get the following results: Total cholesterol: 235 mg/dL Triglycerides: 210 mg/dL HDL cholesterol: 45mg/dL LDL cholesterol: 162 mg/dL Your management today should include which of the following?
A 50-year-old woman with a history of essential hypertension presents to the emergency department with sudden onset of a severe headache, nausea and vomiting, and photophobia. On examination, her BP is 160/100 mmHg. She is mildly confused and has nuchal rigidity, without focal neurologic signs. Which of the following is the most likely diagnosis?
A65-year-old White female presents to the office for her annual gynecologic examination. She has been a patient of yours for many years. She also sees you on a routine basis for treatment of hypertension and hypothyroidism. Her last pap smear was 5 years ago and she has never had an abnormal pap smear. She had a mammogram 1 year ago that was normal. She does not perform self- breast examination. She is without complaint today. Past medical 1. Hypertension for 15 years history: 2. Graves' disease, treated with radioactive iodine thyroid ablation at age 50 OB/GYN history: 1. Menarche at age 14 Four term pregnancies with vaginal deliveries (at age 22, 25, 27, and 32) Total abdominal hysterectomy and bilateral salpingo oophorectomy (TAH/BSO) age 47 for fibroids On estrogen replacement therapy from age 47 to 55 Past surgical 1. Appendectomy at age 16 history: 2. TAH/BSO as noted above Medications: 1. Hydrochlorothiazide 25 mg daily 2. Levothyroxine 0.1 mg daily 3. Potassium chloride 20 meq daily Allergies: None Family history: Parents, siblings unknown as patient was adopted Children are alive and well without known chronic medical conditions Social history: Widowed for 5 years, has not been involved in a sexual relationship since the death of her husband; retired school teacher; college educated; does not smoke cigarettes, drink alcohol, or use drugs; walks 3045 min a day for exercise Which of the following vaccinations would be routinely recommended for this patient?
A65-year-old White female presents to the office for her annual gynecologic examination. She has been a patient of yours for many years. She also sees you on a routine basis for treatment of hypertension and hypothyroidism. Her last pap smear was 5 years ago and she has never had an abnormal pap smear. She had a mammogram 1 year ago that was normal. She does not perform self- breast examination. She is without complaint today. Past medical 1. Hypertension for 15 years history: 2. Graves' disease, treated with radioactive iodine thyroid ablation at age 50 OB/GYN history: 1. Menarche at age 14 Four term pregnancies with vaginal deliveries (at age 22, 25, 27, and 32) Total abdominal hysterectomy and bilateral salpingo oophorectomy (TAH/BSO) age 47 for fibroids On estrogen replacement therapy from age 47 to 55 Past surgical 1. Appendectomy at age 16 history: 2. TAH/BSO as noted above Medications: 1. Hydrochlorothiazide 25 mg daily 2. Levothyroxine 0.1 mg daily 3. Potassium chloride 20 meq daily Allergies: None Family history: Parents, siblings unknown as patient was adopted Children are alive and well without known chronic medical conditions Social history: Widowed for 5 years, has not been involved in a sexual relationship since the death of her husband; retired school teacher; college educated; does not smoke cigarettes, drink alcohol, or use drugs; walks 3045 min a day for exercise Which of the following conditions results in the most deaths of American women over the age of 65?
A 70-year-old man is admitted to the ICU after repair of an abdominal aortic aneurysm. He has a prior history of hypertension and mild congestive heart failure, which were adequately controlled with digoxin and diuretics. To facilitate perioperative management, a Swan-Ganz (multilumen pulmonary artery) catheter was inserted in the operating room. During the first few hours postoperatively, the patient is noted to have a blood pressure of 140/70 mmHg, heart rate of 110/min, flat neck veins, a pulmonary arterial wedge pressure of 9 mmHg, and poor urine output. Several hours after this intervention, the patient is reassessed. The blood pressure is 150/85 mmHg, heart rate is 90/min, neck veins are distended, and the pulmonary arterial wedge pressure is 17 mmHg. Urine output is still low in volume. At this point, management should be which of the following? IV furosemide
A 50-year-old male presents to your office for a routine annual physical examination. He has no specific complaints for this visit other than wanting to be checked for all the usual stuff. His last visit with you was a year ago for a physical examination. At that time his examination was normal. You performed blood work that was within normal limits and included a total cholesterol of 172 with a high-density lipoprotein (HDL) of 45 and low-density lipoprotein (LDL) of 100. He reports that he had a tetanus shot 5 years ago. Past medical history: Unremarkable Past surgical history: 1. Appendectomy at age 17 2. Vasectomy at age 43 Medications: Daily multivitamin Allergies: NKDA (no known drug allergies) Family history: Father died at age 78 of a heart attack Mother is alive at age 76. She has hypertension and osteoarthritis Brother aged 48 without known chronic medical condition Children aged 16, 14, and 8--no known chronic medical illness Social history: Married, employed as an accountant; college graduate Denies tobacco or recreational drug use Drinks one alcoholic drink (either beer or wine) a day Does not exercise on a regular basis Which of the following interventions would be recommended for this patient?
A 70-year-old man is admitted to the ICU after repair of an abdominal aortic aneurysm. He has a prior history of hypertension and mild congestive heart failure, which were adequately controlled with digoxin and diuretics. To facilitate perioperative management, a Swan-Ganz (multilumen pulmonary artery) catheter was inserted in the operating room. During the first few hours postoperatively, the patient is noted to have a blood pressure of 140/70 mmHg, heart rate of 110/min, flat neck veins, a pulmonary arterial wedge pressure of 9 mmHg, and poor urine output. Which of the following is the most appropriate next step in management of this patient?
A 50-year-old male presents to your office for a routine annual physical examination. He has no specific complaints for this visit other than wanting to be checked for all the usual stuff. His last visit with you was a year ago for a physical examination. At that time his examination was normal. You performed blood work that was within normal limits and included a total cholesterol of 172 with a high-density lipoprotein (HDL) of 45 and low-density lipoprotein (LDL) of 100. He reports that he had a tetanus shot 5 years ago. Past medical history: Unremarkable Past surgical history: 1. Appendectomy at age 17 2. Vasectomy at age 43 Medications: Daily multivitamin Allergies: NKDA (no known drug allergies) Family history: Father died at age 78 of a heart attack Mother is alive at age 76. She has hypertension and osteoarthritis Brother aged 48 without known chronic medical condition Children aged 16, 14, and 8--no known chronic medical illness Social history: Married, employed as an accountant; college graduate Denies tobacco or recreational drug use Drinks one alcoholic drink (either beer or wine) a day Does not exercise on a regular basis Which of the following tests would be recommended for this patient?
A previously healthy 45-year-old woman is involved in a motor vehicle crash, sustaining multiple rib fractures, a complex duodenal injury, and a fractured pelvis. She is ventilated in the ICU. Because of a persistent high-output duodenal fistula, the patient has required prolonged parenteral alimentation. During her ICU course, the patient develops diarrhea, mental depression, alopecia, and perioral and periorbital dermatitis. Administration of which of the following trace elements are most likely to reverse these complications?
A42-year-old male presents to the office for a refill of the nasal steroid medication that he uses every spring to control his allergies. You notice on the vital signs taken by the nurse that his blood pressure is 150/95. Except for some sneezing and nasal congestion, the patient has no symptoms. He has no other medical history and his only medication is a nasal steroid. He does not smoke cigarettes, does not drink alcohol, and does not exercise. His body mass index is 24 kg/m2. The patient returns for a follow-up visit and his blood pressure is 165/105 mmHg. You diagnose him with which of the following?
A 50-year-old male presents to your office for a routine annual physical examination. He has no specific complaints for this visit other than wanting to be checked for all the usual stuff. His last visit with you was a year ago for a physical examination. At that time his examination was normal. You performed blood work that was within normal limits and included a total cholesterol of 172 with a high-density lipoprotein (HDL) of 45 and low-density lipoprotein (LDL) of 100. He reports that he had a tetanus shot 5 years ago. Past medical history: Unremarkable Past surgical history: 1. Appendectomy at age 17 2. Vasectomy at age 43 Medications: Daily multivitamin Allergies: NKDA (no known drug allergies) Family history: Father died at age 78 of a heart attack Mother is alive at age 76. She has hypertension and osteoarthritis Brother aged 48 without known chronic medical condition Children aged 16, 14, and 8--no known chronic medical illness Social history: Married, employed as an accountant; college graduate Denies tobacco or recreational drug use Drinks one alcoholic drink (either beer or wine) a day Does not exercise on a regular basis Which of the following office examinations would be recommended for this patient?
A 14-year-old girl is admitted to the medical unit due to dehydration. She is found to be severely underweight, at 75% of expected weight. She has no significant medical problems, but she stopped menstruating 9 months ago after having regular periods since age 12. She has no prior psychiatric history and is a very successful student and athlete at school. She denies feeling depressed but does admit to feeling tired. When confronted about her weight loss, she does not appear concerned, stating, "I was very fat and still have more weight to lose." Which of the following treatment modalities is the most effective for her gaining weight?
Apreviously healthy 28-year-old woman develops significant postpartum hemorrhage, with a rapid drop in hematocrit to 18%. Despite aggressive IV fluid resuscitation, the patient has a persistent tachycardia, labile systolic blood pressure, and poor urine output. Ongoing resuscitation includes emergency transfusion with 2 units of O-negative packed red blood cells. During transfusion of the second unit, the patient develops chills, fever, vomiting, and hypertension. These symptoms are most likely the result of which of the following?
An 82-year-old woman is admitted to the surgical ward after suffering a fracture of her right hip due to a fall down her stairs. Her surgery and recovery are uneventful, but 3 days later, the nurses are frustrated when she does not let them take her vitals or draw blood. On interview, she exhibits drowsiness with occasional agitation. She is unable to answer questions well and is oriented only to person. She also picks at the empty air and begins yelling and swinging at the nurse who is present. 90. Which of the following most likely represents her mortality rate in 6 months after discharge?
A 6-month-old male infant presents to your clinic because the mother is concerned that he is not eating well and he has been constipated. The mother tells you that her prenatal course and delivery were uneventful. On physical examination, the infant has a puffy face, large tongue, and persistent nasal drainage The above condition can be caused by a deficiency of which of the following?
A61-year-old man comes to your office for a checkup. He currently feels well and has no focal complaints. He has a past medical history significant for wellcontrolled hypertension, and his gallbladder was removed 3 years ago in the setting of acute cholecystitis. He does not smoke and drinks one to two alcoholic beverages per day. Family history is remarkable for colon cancer in his mother at age 45 and a brother at age 49. He has a sister who developed endometrial cancer at age 53. He has never undergone colon cancer screening and is interested in pursuing this. Which colorectal cancer screening test would be best for this patient?
A74 year-old widowed man presents for evaluation to his physician. He has a history of several episodes of major depression, with one prior hospitalization many years ago although he cannot remember the medication he was prescribed. He complains of 3 months of depression, crying spells, terminal insomnia, poor appetite with weight loss, anhedonia, and passive suicidal ideation without plan. His medical history is significant for hypertension, peripheral vascular disease, hypercholesterolemia, and unstable angina. He is currently prescribed diltiazem, aspirin, metoprolol, and simvastatin. Which of the following antidepressants would be the most appropriate treatment option?
You have been asked to see a patient of one of your colleagues. He is a 67-year-old male with a long smoking history who has been having left foot pain at night. He tells you that dangling his feet over the bed relieves the pain. Previously, he had noted pain in his left calf with ambulation. Over the past several weeks, this pain has been worsening and the distance he could walk pain free had diminished. Which of the following is an indication for surgical revascularization?
An 86-year-old woman is brought to the emergency room by her daughter. The patient is a poor historian with limited insight. Her daughter understands that she has a history of high BP and is treated with an unknown medication. The patient has been living by herself in a retirement community. The daughter became concerned a year prior, when she noticed that her mother seemed more confused. She had attributed this to "old age," but 2 weeks ago she noticed an abrupt worsening in her condition. Her mother now has difficulty recognizing close relatives and remembering information. For the past 2 weeks, she has been getting lost, forgetting to turn off the stove, and has been unable to bathe herself. The daughter is concerned that she may inadvertently harm herself. An MRI of the brain would most likely demonstrate which of the following findings?
The patient is a 9-year-old girl brought into the urgent care clinic by both of her parents. Over the past 18 months, they have noticed emerging "habits" including repetitive squinting and grimacing, along with associated clearing of her throat and grunting noises. These behaviors occur almost every day and frequently occur together. She has gotten increasingly teased because of her peculiarities and her anxiety has only worsened her symptoms. She has no major illnesses and is not taking any medications. Her physical examination is within normal limits with the exception of the above stereotypes. Which of the following would be the most effective pharmacotherapy for her presenting illness?