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3,531 questions
A 38-year-old married female is brought in to the primary care clinic by her husband. She is minimally responsive to questioning, head bowed, and staring at the floor. Most of the history is obtained from her spouse. He denies any known personal or family history of mental illness, but he claims for the past several months his wife has become increasingly depressed and withdrawn. Instead of taking part in her usual hobbies, she is lying around the house. "She tosses and turns" throughout the night. Her husband ensures that she eats a limited amount of food, but she has lost a significant amount of weight. She has been ruminating about guilty feelings regarding a number of issues and recently has been speaking about suicide, although she has no plan or intent. She has refused to come in to see a doctor. Her husband insisted that she come today, as she informed him that the devil has possessed her and told her she will "go to hell." What is the most effective pharmacologic treatment for this patient?
A 40-year-old woman presents to the emergency room with a 3-day history of worsening abdominal pain, with nausea and vomiting. Examination reveals a low-grade fever and abdominal tenderness in the right upper quadrant with guarding, especially during inspiration. Laboratory findings include a mild leukocytosis and a slightly elevated bilirubin. For the above patient with abdominal pain, select the most likely diagnosis. gastroenteritis regional enteritis acute appendicitis perforated peptic ulcer sigmoid diverticulitis acute pancreatitis
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. Which of the following ranges represents the lifetime risk for breast cancer that should be quoted for this patient?
A young White female, age unknown, is brought into the emergency room after being found unresponsive at the bus station. She is obtunded and her vitals signs are temperature 97.8°F, blood pressure (BP) 9 4/60, pulse 55, and respirations 8. Her physical examination is notable for a markedly underweight, poorly groomed woman. She appears pale with cold, dry skin and mucous membranes. She is uncooperative with the examination. Her pupils are pinpoint and minimally reactive to light. Her cardiac examination demonstrates bradycardia without murmurs or rubs. Her lungs are clear with shallow breathing. Her abdomen appears to be slightly distended. Administration of which of the following would be most appropriate?
A32-year-old female presents to the outpatient clinic with complaints of ongoing headaches. For the past 8 months, she has had recurrent headaches which she describes as bilateral, occipital, with a tight/squeezing pain, lasting for several hours and relieved with nonsteroidal anti-inflammatory medication (NSAIDs). Further questioning reveals chronic feelings of fatigue and poor concentration. She admits to "constantly worrying" about her job performance as well as issues involving her relationship with a live-in boyfriend. In fact, her focusing on these concerns interferes with her sleep. As a result, she has on more than one occasion awakened with extreme panic, tremors, diaphoresis, nausea, and palpitations. Her medical problems include gastroesophageal reflux disease that is treated with famotidine. She drinks an occasional glass of wine and denies drug use. Which of the following medications would be the most appropriate in the long-term treatment of this patient's symptoms?
Which of the following is regulated by the parathyroid gland?
A40-year-old man with a history of alcohol abuse presents after an episode of binge drinking. He is complaining of epigastric pain, radiating to the back, associated with nausea and vomiting. On examination, he has marked tenderness in the epigastrium, with guarding, decreased bowel sounds, and moderate abdominal distention. Laboratory findings include leukocytosis and increased serum amylase and lipase. Abdominal roentgenograms demonstrate several dilated bowel loops in the upper abdomen. For the above patient with abdominal pain, select the most likely diagnosis. gastroenteritis regional enteritis acute appendicitis perforated peptic ulcer sigmoid diverticulitis acute pancreatitis
A 65-year-old man presents to the physician's office for his yearly physical examination. His only complaint relates to early fatigue while playing golf. Past history is pertinent for mild hypertension. Examination is unremarkable except for trace hematest-positive stool. Blood tests are normal except for a hematocrit of 32. A UGI series is performed and is normal. A barium enema is performed, and one view is shown in the figure below. Which of the following is the most appropriate therapy following colonoscopy?
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. A history of infection with which of the following organisms would be most likely in this patient?
A 45-year-old woman, mother of four children, comes to the ER complaining of the sudden onset of epigastric and right upper quadrant pain, radiating to the back, associated with vomiting. On examination, tenderness is elicited in the right upper quadrant, bowel sounds are decreased, and laboratory data show leukocytosis as well as normal serum levels of amylase, lipase, and bilirubin. What is the most likely diagnosis?
A 75-year-old woman is brought to the emergency department from a nursing home for abdominal pain, distention, and obstipation over the last 2 days. Past history is pertinent for stroke, diabetes, atrial fibrillation, and chronic constipation. Examination reveals a temperature of 98.6°F, pulse rate 90/min and irregularly irregular, and BP 160/90 mmHg. Heart examination reveals irregularly irregular rhythm with no murmurs; lung examination reveals few bibasilar rales; and abdominal examination reveals a distended, tympanic abdomen with mild tenderness and no rebound tenderness. Plain abdominal x-rays reveal dilated loops of bowel, and a barium enema is obtained and shown in the figure below. Which of the following is the most appropriate next step in management following NG tube decompression and resuscitation?
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. Further history would most likely reveal which of the following comorbid diagnoses?
The patient is an 18-year-old male brought into the emergency room in the early morning by his friends after attending a dance party. He is agitated, pacing the hallway but unsteady. Despite this, he claims that he feels "wonderful" and states, "Everything will be all right." He also seems focused on seeing many colored flashes and hearing "all conversations at once." He has no known medical problems and is not taking any medication. He does admit to ingesting something early on, which he was told would help him "party all night." On physical examination, he has an elevated BP and pulse, dilated pupils, and significant diaphoresis. Which of the following is the most likely pharmacologic effect of the substance taken?
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 In this particular patient what would be the electrophoretical characteristic changes?
A 55-year-old man presents to the emergency department with left lower quadrant abdominal pain. The pain has been present for 1 week, but has increased in intensity over the last 2 days associated with nausea, constipation, and dysuria. Past history is unremarkable. Examination reveals a temperature of 101°F, pulse rate of 95/min, BP of 130/70 mmHg, and normal heart and lung examinations. Abdominal examination reveals fullness and marked tenderness in the left lower quadrant, with voluntary guarding and decreased bowel sounds. Laboratory tests reveal a WBC count of 18,000 with a left shift and 20 50 WBCs in the urinalysis. A CT scan of the abdomen reveals a thickened sigmoid colon with pericolonic inflammation. He is admitted to the hospital for treatment. Which of the following is the most appropriate management of this patient? NPO, IV fluids, and IV antibiotics for gram-negative and anaerobic coverage
A 55-year-old woman presents with a 6-month history of weight loss, abdominal cramps, and intermittent nonbloody diarrhea. On examination, her abdomen is mildly distended and there is a palpable mass in the right lower quadrant. Stool cultures yield normal fecal flora. CT scan with oral contrast demonstrates an inflammatory mass in the right lower quadrant, with thickening of the terminal ileum and ileocecal valve. Which of the following is the best diagnostic test to confirm the diagnosis?
A 56-year-old woman presents to the physician's office with complaints of a new left breast mass. She denies any pain, nipple discharge, or skin dimpling. She has a prior history of breast cysts 5 years ago, treated by aspiration at that time. Her last mammogram was at age 53. Past history is pertinent for a 30 pack-year smoking history, prior total abdominal hysterectomy-bilateral salpingo-oophorectomy (TAH-BSO) at age 54 for leiomyomas, and current use of hormone replacement therapy (HRT). Family history is negative for breast disease. Examination reveals a firm, welldefined, mobile, 1.5-cm nodule in the upper outer quadrant of the left breast without any regional lymphadenopathy. Which of the following is the most appropriate next step in management?
A 55-year-old woman presents with a 6-month history of weight loss, abdominal cramps, and intermittent nonbloody diarrhea. On examination, her abdomen is mildly distended and there is a palpable mass in the right lower quadrant. Stool cultures yield normal fecal flora. CT scan with oral contrast demonstrates an inflammatory mass in the right lower quadrant, with thickening of the terminal ileum and ileocecal valve. Which of the following is the most likely diagnosis?
A 45-year-old male comes to your office for his first annual checkup in the last 10 years. On first impression, he appears overweight but is otherwise healthy and has no specific complaints. He has a brother with diabetes and a sister with high blood pressure. Both of his parents are deceased and his father died of a stroke at age 73. He is a long-standing heavy smoker and only drinks alcohol on special occasions. On physical examination, his blood pressure is 166/90 in the left arm and 164/88 in the right arm. The rest of the examination is unremarkable. He is concerned about his health and does not want to end up on medication, like his siblings Which of the following describes the patient's blood pressure status?
A 4-year-old previously healthy girl presents to the emergency department with a 24-hour history of rectal bleeding and dizziness. She has no other gastrointestinal symptoms. On examination, she appears pale. Her heart rate is 140 beats/min, and she has a 20 mmHg postural drop in systolic blood pressure. The child's abdomen is nondistended and nontender, and fresh blood and clots are in the rectal vault on rectal examination. Which of the following is the most appropriate diagnostic study to order for this patient?