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3,531 questions
A 3-month-old infant is brought to your office in the winter with a history of 1 day of vomiting, followed by 3 days of diarrhea. She has had six to eight stools per day, which are loose and foul smelling. On examination, she looks well. Which of the following viruses is the most likely cause of her illness?
A meta-analysis of randomized-controlled trials was published comparing two methods of managing postterm pregnancies. The question studied was whether the routine induction of labor at 41 weeks' gestation would result in improved maternal or fetal outcomes compared with expectant management. The authors reported that the odds ratio for caesarian delivery rate in the induction group compared to the expectant management group was 0.88 with a 95% confidence interval (CI) of 0.780.99. A second outcome studied was perinatal mortality. For this outcome, the odds ratio for the induction group compared to the expectant management group was 0.41 with a 95% CI of 0.141.18. Which of the following statements is true?
A 65-year-old man presents to your office for evaluation of abdominal pain. The patient states that he has epigastric pain that radiates to his back. The pain is worse with eating and improves with fasting. The pain has been present for 6 months and is gradually worsening. The patient has lost 15 lbs but feels his oral intake has been adequate. He complains of greasy stools and frequent thirst and urination. Examination reveals a thin male with temporal wasting and oderate abdominal pain with palpation. The patient consumes approximately 1015 beers per day and smokes a pack of cigarettes per day for the past 20 years. The patient's weight loss would be best treated by which of the following regimens?
A 13-year-old boy is brought into the emergency room with a laceration of his right arm. According to his parents, he received the injury when he fell on the ground while playing at the family farm about 1 hour ago. He has no known history of any medical problems. His parents say that they haven't brought him to the doctor in years. On questioning, they report that he only received one of his "baby shots" and they are not sure which one that was. On examination, he is healthy appearing. He is appropriately apprehensive but calm and consolable. His right arm has a 5 cm linear laceration with visible soil particles in and about the wound. The remainder of his examination is unremarkable. You carefully clean and irrigate the wound and then primarily repair the laceration with sutures. What immediate tetanus prophylaxis would be optimal in this case?
A 14-year-old boy is brought to the emergency department for evaluation of fever and headache. The mother relates that her son has had a worsening headache for 56 days. She says that she took him to a walk-in clinic, and he was put on amoxicillin for a sinus infection. His headaches have been getting worse and that he is now having fevers as high as 103.6°F. The mother says that he normally is very active and that he currently has a summer job at a local park clearing out underbrush. Since he has become ill, he has had such a decrease in energy that he cannot go to work. He has had a decrease in his appetite and has been sleeping more. He denies any sore throat, abdominal pain, chest pain, dysuria, vomiting, or diarrhea. On examination, he is an uncomfortable young man whose vital signs are: temp 101.9°F, RR 26, HR 124, and BP 79/56. is head, ear, eye, nose, and throat examination reveals normal TMs, a mildly erythematous hypopharynx, and some shotty cervical lymphadenopathy. His lungs are clear. His cardiac examination is normal. His liver edge is palpable just below the right costal margin and is mildly tender. His spleen is not palpable. His skin examination is normal with the exception of scattered petechiae around his ankles and wrists. A CBC reveals WBC 13,000 with 65% segs and 22% lymphs, hematocrit of 35, and platelet count of 95,000. His electrolytes reveal a Na 125, K 5.1, Cl 102, and bicarbonate 21. His BUN and Cr are normal. What is his most likely diagnosis?
A 42-year-old man presents to your clinic with a 1-week history of pain and inflammation involving his right first metatarsophalangeal (MTP) joint. He describes the pain as sudden in onset and worse at night. He denies experiencing any fever or traumatic injury to the joint and states that he has never had this type of pain before. He denies any chronic medical conditions, any prior surgery, and any current medication use. Besides an erythematous and exquisitely tender right first MTP joint, the remainder of his physical examination is unremarkable. Aspiration of the patient's right first MTP joint space is likely to reveal which of the following?
A 17-year-old male is evaluated for a painless neck mass. You assess the mass as lymphadenopathy and arrange for a biopsy. The pathology report subsequently notes the presence of Reed-Sternberg cells. Which of the following is the most likely diagnosis?
A65-year-old female presents with ascites, multiple peritoneal implants, and a large abdominopelvic mass. At laparotomy, she is found to have omental disease, splenic metastases, retroperitoneal lymphadenopathy, and bilateral pelvic masses with rectosigmoid involvement posteriorly and bladder involvement anteriorly. The appropriate surgical management for this patient would be which of the following?
A 28-year-old man presents with vague complaints of fatigue, nausea, and dyspnea. He has had occasional episodes of hemoptysis and some burning with urination. Laboratory studies reveal a mild anemia and an elevation of both blood urea nitrogen (BUN) and creatinine. Urinalysis reveals the presence of blood, protein, and red cell casts. Antibodies against which of the following is the cause of this condition?
A10-year-old boy presents with a 1-day history of fever, cough, and chest pain. He has not been eating and has been listless. He does not have any previous history of health problems. On physical examination, his temperature is 40°C, and he is tachypneic. He looks ill. He has rales on his left posterior lower lung fields. You order a chest x-ray. Which of the following organisms is most likely responsible for his pneumonia?
A45-year-old man is brought to the emergency department after being involved in an automobile crash. He is alert and oriented, with a normal neurologic examination. His respiratory rate is 20/min, with clear lungs, pulse rate of 120/min, and blood pressure of 80/40 mmHg. On examination, he is noted to have a distended abdomen, with decreased bowel sounds, and a fracture of the right ankle. IV access is established, and the patient receives a rapid infusion of 2 L of saline, without changes to pulse rate or blood pressure. Which of the following is the most appropriate next step in his management?
A 30-year-old married male with a history of depression presents to the family medicine clinic. He appears embarrassed and somewhat anxious during his appointment. He denies significant sadness or crying spells. He is sleeping adequately and eating well, without recent changes in his weight. His energy and concentration are normal, and he denies any suicidal or homicidal ideation. He claims to be compliant with his citalopram (Celexa), which he is taking for his depression, but he complains of "problems with sex." Consideration is given to switching the patient to another antidepressant in order to minimize his side effects. Which of the following would be the most appropriate medication to choose?
A 16-year-old girl is brought into the family practice clinic for her yearly health maintenance examination. Her height is average and her weight is above average. When this is mentioned to her, she blushes and quickly states that she is trying to lose weight. When asked further about her dieting habits, she eventually admits to routinely eating large amounts of food at one sitting, such as two pizzas, a large sandwich, and a gallon of ice cream. She also confides that she frequently will self-induce vomiting in order to compensate but denies laxative use. She realizes that her behavior is unhealthy, but she feels "out of control." After discussion of her condition with her parents, it is decided to begin her on psychotropic medication and refer her to an eating disorder program. What class of pharmacotherapy would be the most efficacious in this patient?
You would like to design a study to evaluate the prevalence of a certain disease in your patient population. Which study design would be the most appropriate?
A40-year-old alcoholic is brought to the emergency epartment with frostbite to both lower extremities. His core body temperature is 36°C. hich of the fol lowing is the most appropriate initial treatment for the patient's thermal injury?
A 35-year-old woman presents to the clinic for a discussion on breast cancer risk. Her family history is pertinent for a grandmother who died of breast cancer at age 53, a mother who died of premenopausal breast cancer, and one of three sisters with breast cancer diagnosed at age 42. The sister with breast cancer underwent genetic testing and was found to have a BRCA1 mutation. Subsequently, the 35- year-old woman underwent genetic testing and was found to be a carrier of the same deleterious BRCA1 mutation. For this patient, which of the following strategies represent an accepted management option for her high-risk status?
A 30-year-old married male with a history of depression presents to the family medicine clinic. He appears embarrassed and somewhat anxious during his appointment. He denies significant sadness or crying spells. He is sleeping adequately and eating well, without recent changes in his weight. His energy and concentration are normal, and he denies any suicidal or homicidal ideation. He claims to be compliant with his citalopram (Celexa), which he is taking for his depression, but he complains of "problems with sex." Which of the following symptoms would this patient most likely exhibit?
A 67-year-old female was admitted to the hospital because of chronic fatigue and low back pain. An x- ray of the vertebral column showed diffuse osteoporosis and compression fractures of L1 and L2 vertebral bodies. The complete blood count (CBC) was within normal limits. The peripheral blood smear showed rouleaux formation. The immunoelectrophoresis showed a monoclonal spike of more than 3 g. A bone marrow biopsy was performed and showed an increase of more than 20% in plasma cells see Figure below Microscopically, the bone marrow examination will reveal which of the following?
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 appropriate approach for this patient?
An 83-year-old woman presents to a mammographic facility for a screening mammogram. The technician notices a mass in the lateral right breast. The patient denies any breast pain, nipple discharge, skin changes, or breast trauma. A right breast CC view is shown in Which of the following is the most appropriate next step in management?