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3,531 questions
The patient is a 7-year-old boy brought in for evaluation by his father. He has been concerned with his son's behavior. At school conferences, he has been told that his son will not stay in place and moves around the room despite being informed about the rules. He neither listens at home nor at school when given feedback. For example, he continues to have difficulty waiting in line, completing his homework, and cleaning up his toys, regardless of numerous consequences. In department stores, he will run around and grab at items, and this has resulted in his breaking merchandise on many occasions. The father states that his son has been this way "since he could walk" and is worried about his son's future. After further history is obtained and consultation with the school is initiated, a definitive diagnosis is made. The recommendation to begin a stimulant is presented to the father, but he has concerns regarding that treatment choice. How should he be counseled regarding the use of this medication?
A40-year-old previously healthy man presents with sudden onset of severe abdominal pain that radiates from the right loin (flank) to groin. This pain is associated with nausea, sweating, and urinary urgency. He is distressed and restless, but an abdominal examination is normal. Which of the following is the most appropriate next step in management?
A19-year-old male United States Army veteran presents to the outpatient clinic. He recently returned from combat in Iraq where he was assigned to the infantry. While on patrol 1 month ago, he witnessed several friends killed by a road-side bomb. Since that time he has had difficulty sleeping, with frequent awakenings after recurrent nightmares about the event. He finds himself "jumpy" at times, especially with loud noises. He stayed in his parents' house around the July 4th holiday, and he became acutely anxious when hearing firecrackers. He has not spent time with friends or family. He refuses to watch any television or listen to the radio for fear of hearing news of more casualties. He complains of a sense of "numbness" and gets easily distracted. He denies suicidal ideation but sometimes feels that "my life ended over [in Iraq]." What is his likelihood of a complete recovery in1 year if not treated?
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 likely diagnosis?
The patient is a 7-year-old boy brought in for evaluation by his father. He has been concerned with his son's behavior. At school conferences, he has been told that his son will not stay in place and moves around the room despite being informed about the rules. He neither listens at home nor at school when given feedback. For example, he continues to have difficulty waiting in line, completing his homework, and cleaning up his toys, regardless of numerous consequences. In department stores, he will run around and grab at items, and this has resulted in his breaking merchandise on many occasions. The father states that his son has been this way "since he could walk" and is worried about his son's future. Which of the following is his most likely diagnosis?
A 5-week-old infant presents with a 1-week history of progressive nonbilious emesis, associated with a 24-hour history of decreased urine output. The infant continues to be active and eager to feed. On examination, the infant has a sunken fontanelle and decreased skin turgor. The abdomen is scaphoid, and with a test feed, there is a visible peristaltic wave in the epigastrium. Electrolytes and a urinalysis are evaluated. Which of the following laboratory findings are most likely to be seen in this patient?
A 52-year-old man presents to the ED with a complaint of rectal bleeding and hematuria. He has a medical history significant for atrial fibrillation diagnosed 10 years ago and states that he takes metoprolol as well as warfarin for this condition. Upon examination, you find that his blood pressure is 122/78, his pulse is 84, his respiratory rate is 18, and his O2 saturation is 98% on room air. He has an irregularly irregular heart rhythm, gingival bleeding, and some bruises on his extremities. He has a positive fecal occult blood test, and laboratory studies return showing an international normalized ratio (INR) of 16.5. Reviewing the patient's medication list, you note that he mentions a "medication for depression" but does not recall the name. Which of the following is most concerning given the patient's current condition?
A54-year-old Asian female with no significant medical history presents with frontal headache, eye pain, nausea, and vomiting. Her abdominal examination shows mild diffuse tenderness but no rebound or guarding. Her mucous membranes are dry. Her vision is blurry in both eyes, her eyes are injected but her extraocular muscles are intact. Her pupils are mid-dilated and fixed Which of the following is appropriate initial management of this patient?
A55-year-old man presents to the physician's office for his yearly physical examination. He is asymptomatic. Past history is pertinent for hypertension. Family history is positive for breast cancer in his mother at age 70 and colon cancer in his father at age 65. His examination is unremarkable except for guiac positive stool. Barium enema shows a sigmoid colon polyp. Colonoscopy confirms a 3-cm pedunculated polyp in the sigmoid colon, and snare polypectomy is performed. Pathologic examination reveals an adenomatous polyp with a focus of invasive carcinoma in the head, with a 4-mm resection margin and no tumor noted in the stalk. Which of the following is the most appropriate next step in management?
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. Which of the following will be the most likely course of her illness?
A 65-year-old woman presents to the physician's office for a second opinion on the management options for recently diagnosed breast cancer. She presents with a 2.5-cm mass in the upper outer quadrant of the left breast associated with a palpable axillary node suspicious for metastatic disease. The remainder of her examination is normal. Mammography demonstrates the cancer and shows no other suspicious lesions in either breast. Chest x-ray, bone scan, and blood test panel, including liver function tests, are normal. Family history is positive for breast cancer diagnosed in her sister at age 65. Past history is unremarkable. The first physician recommended modified radical mastectomy. The patient has read about SLN biopsy. She avidly wants to avoid the risk of lymphedema that her sister must endure. She asks the question "Am I a candidate for a SLN biopsy instead of a complete axillary dissection?" Which of the following is the most appropriate answer to her question? Yes, and if the SLN if positive, then a complete axillary dissection should be performed.
A 49-year-old male postal worker presents to your office for the evaluation of a lesion on his left arm. The lesion started about a week ago as a red pustule but has grown and now has a thick black scab. The lesion is painless. A coworker showed the patient a similar appearing lesion that she developed on her arm for which her doctor prescribed an oral antibiotic. Examination reveals a 5 cm circular black eschar with some surrounding vesicles. A Gram stain of fluid drained from a vesicle reveals chains of gram-positive bacilli. What is the most appropriate management at this point?
For each of the following scenarios, select the gas exposure responsible for the signs and symptoms. A garage worker turns on the ventilation system in the winter time while testing a motor, and now complains of a headache and vertigo
Which of the following maternal cardiac conditions is associated with the highest mortality rate during pregnancy?
A fourth-year medical student on an emergency medicine clerkship is fascinated by the number of personality disordered patients who come to the emergency room on weekends. Which of the following personality disorders belongs to cluster A (odd, eccentric) in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th ed., Text Revision) classification of personality disorders?
Which of the following statements about diabetes in pregnancy is true?
A 30-year-old (G2P0101) female presents to the clinic for a new obstetric visit. She has an unknown LMP. She reports that she discovered she was pregnant when she took a urine pregnancy test at home a month ago. She vaguely recalls having a period about 2 months ago, but is not sure exactly when that occurred. She reports that she is generally healthy. She had a previous delivery at 36 weeks EGA, though she reports her doctor was not really sure about her due date in that pregnancy. She reports that she had a normal spontaneous vaginal delivery in her previous pregnancy, and the child is healthy. Her postpartum course was complicated by depression, which has since resolved and not recurred. She denies history of sexually transmitted diseases or abnormal pap smears. She has no surgical history. She does not smoke, drink alcohol, or use illicit drugs. She does not have any family history of hypertension, diabetes, twins, or congenital anomalies. She does report that her mother has a history of depression. Which of the following tests will provide the most useful information to determine this patient's EDD?
Identify the defense mechanisms with the descriptions below. Working as a nurse in a pediatric ward because one would like to have children but cannot acting out altruism displacement intellectualization passive-aggressive behavior projection
A35-year-old woman with two prior term pregnancies presents for her first prenatal visit at 12 weeks' gestation. She recalls having had hypertension near the end of her first pregnancy. She believes her blood pressure has been normal since, but admits that she rarely seeks preventive health care visits, and that her last examination by a physician was more than 2 years ago. Today, you find her blood pressure to be 160/100. Which of the following antihypertensive agents would be contraindicated for management of her hypertension during pregnancy?
You are asked to perform a high school physical examination for a 16-year-old female patient. She is on the track team. By history, she is healthy except for the fact that she has been amenorrheic for 4 months. She denies current or past sexual activity. On examination, she is 5 ft 9 in. tall and weighs 115 lbs. Her heart rate is 50 bpm. She has dry skin with lanugo. She has several sores in her mouth and obvious dental caries. She has several scratches on the backs of her hands. She is tanner stage III on breast examination. Her pelvic examination is remarkable for findings of urogenital atrophy. Her urine -hCG is negative. At this point in time, appropriate management of this patient would include which of the following?