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3,531 questions
A 44-year-old man presents with fears that his mathematical abilities have been slowly sucked out of his brain for the last 4 years. He believes an "alien force disguised as a human being" is responsible. To avoid contacting this being, he has isolated himself in a room in a boarding house. His wife divorced him and left with their children. After 10 years teaching math at a local high school, he resigned about 3 years ago. He supports himself by "collecting cans." His affect is blunted. His appearance is disheveled, unshaven, and unwashed. Which of the following hypotheses is the leading hypothesis to explain the patient's psychotic symptoms?
A 44-year-old man presents with fears that his mathematical abilities have been slowly sucked out of his brain for the last 4 years. He believes an "alien force disguised as a human being" is responsible. To avoid contacting this being, he has isolated himself in a room in a boarding house. His wife divorced him and left with their children. After 10 years teaching math at a local high school, he resigned about 3 years ago. He supports himself by "collecting cans." His affect is blunted. His appearance is disheveled, unshaven, and unwashed. Considering the information learned thus far, which of the following would be an appropriate first-line treatment for this patient? thiamine
A 17-year-old is brought by emergency medical services to the emergency room in a postictal state after a witnessed grand mal seizure. No family member is available and the patient is unable to answer questions. Afriend who is with him says that he takes some medicine for seizures, but he doesn't know the name. On examination, you note that he has prominent gingival hyperplasia. Of the medications listed below, which one is he most likely to be taking?
A 17-year-old girl is brought in by her parents because of their concerns about her weight loss. She is petite, and a normal weight for someone her height is 100 lbs, but she weighs 78 lbs. She reports menstrual irregularity. The patient believes she is obese. She does not believe she has a problem. Her mother reports that she found laxatives on her daughter's nightstand, and heard her vomiting in the bathroom yesterday after dinner. Which of the following is the most likely diagnosis?
A 4-year-old boy returns for his second visit to the emergency room. Three days ago he was brought in with a 4-day history of fever up to 102°F. At that time, his physical examination was significant for injection of the oropharynx and an enlarged left anterior cervical lymph node. His left TM was nonbulging and nonerythematous. He was sent home on amoxicillin with a diagnosis of streptococcal pharyngitis. He returns today with a persistent fever, edema of both hands, bilateral conjunctivitis, and a polymorphous truncal rash. What is the most likely diagnosis?
A 17-year-old girl is brought in by her parents because of their concerns about her weight loss. She is petite, and a normal weight for someone her height is 100 lbs, but she weighs 78 lbs. She reports menstrual irregularity. The patient believes she is obese. She does not believe she has a problem. Her mother reports that she found laxatives on her daughter's nightstand, and heard her vomiting in the bathroom yesterday after dinner. Which of the following is the best initial treatment?
A 4-year-old boy returns for his second visit to the emergency room. Three days ago he was brought in with a 4-day history of fever up to 102°F. At that time, his physical examination was significant for injection of the oropharynx and an enlarged left anterior cervical lymph node. His left TM was nonbulging and nonerythematous. He was sent home on amoxicillin with a diagnosis of streptococcal pharyngitis. He returns today with a persistent fever, edema of both hands, bilateral conjunctivitis, and a polymorphous truncal rash. What is the treatment for this condition?
A 70-year-old man is brought to his primary care doctor by the man's son. According to his son, who had not seen his father for about a year, the father seemed to have some personality changes. He was no longer interested in his hobbies and seemed apathetic. He seemed to forget easily, and he repeatedly asked the same already answered questions. On at least two occasions, the father wandered out of the house and was found by neighbors, who thought he was confused. Which of the following is the most common cause of dementia in a 70-year-old man? Alzheimer's disease
Parents bring their 6-year-old son to the emergency room following an acute onset of vomiting and combative behavior. The parents state that the child has recently had chickenpox. They have been giving him medication to reduce his fever, which has been as high as 102 F. Which medication is the likely cause of his current condition?
A 70-year-old man is brought to his primary care doctor by the man's son. According to his son, who had not seen his father for about a year, the father seemed to have some personality changes. He was no longer interested in his hobbies and seemed apathetic. He seemed to forget easily, and he repeatedly asked the same already answered questions. On at least two occasions, the father wandered out of the house and was found by neighbors, who thought he was confused. Considering the information learned thus far, which of the following medications would be the most appropriate treatment here?
Use of which medication can result in enamel staining of primary teeth?
A 70-year-old man is brought to his primary care doctor by the man's son. According to his son, who had not seen his father for about a year, the father seemed to have some personality changes. He was no longer interested in his hobbies and seemed apathetic. He seemed to forget easily, and he repeatedly asked the same already answered questions. On at least two occasions, the father wandered out of the house and was found by neighbors, who thought he was confused. If this man had Pick's disease, where would the preponderance of pathology be found? cerebellum
A 10-year-old male has a history of seizures which are controlled with dilantin. The child also has asthma and often uses an albuterol inhaler. Which of the following asthma medications can lower the seizure threshold in children?
A 10-year-old boy presents to your clinic with right knee pain for 2 weeks. He is physically active at school and plays soccer and basketball. He describes pain in his knees when he runs or jumps. He denies any recent trauma. His physical examination is normal except for mild edema and tenderness over the right tibial tubercle. What is the most likely diagnosis?
A 25-year-old male graduate student presents at a university hospital emergency department complaining of a sudden onset of a pounding in his chest, a feeling of choking, and shortness of breath. He reports that things somehow suddenly seem unreal, and he is afraid he is dying of a heart attack. An electrocardiogram (ECG) shows normal sinus rhythm and no abnormalities If this patient continues to experience similar episodes over the next 2 months, with substantial apprehension about the episodes, which of the following drugs would be most appropriate for the treatment of this patient's condition?
A concerned mother brings in her 18-monthold infant girl. The baby's developmental milestones have been normal. The mother states that there is a "funny glint" in her baby's eyes. She also states that sometimes the infant's eyes look crossed. Which of these supports the diagnosis of a serious life- threatening disease?
A 25-year-old male graduate student presents at a university hospital emergency department complaining of a sudden onset of a pounding in his chest, a feeling of choking, and shortness of breath. He reports that things somehow suddenly seem unreal, and he is afraid he is dying of a heart attack. An electrocardiogram (ECG) shows normal sinus rhythm and no abnormalities You encounter this patient 1 year after the onset of his symptoms. He has not been very compliant with his medications, or appointments. Now he reports he rarely leaves his home and avoids places and social situations where he feels he cannot readily escape. When he does go places, he reports having an escape plan arranged. Which of the following best describes this condition? social phobia
Afamily brings in their 7-year-old boy because he has not been fitting in at school. The mother says he has not made any friends and tends to play mostly by himself. He exhibits repetitive hand flapping. When you interview him, he does not provide any eye contact, and the mother says this is typical for him. His speech seems age appropriate and per history has developed normally. This past year his IQ was tested to be normal. Which of the following is the most likely diagnosis? autism
A 4-year-old boy is brought to the emergency room by his mother after the child spontaneously admitted to swallowing part of a toy. The child is unable to describe what he ate further, although he appears to be in no distress. His vital signs are normal and his respiratory and abdominal examinations are unremarkable. The child is hungry and is demanding to eat something. ACXR reveals what appears to be a watch battery ("button battery") in the patient's esophagus. What is the best course of action in this situation?
A70-year-old woman was brought to the emergency department following her involvement in a minor car accident. She had sustained no injuries but was very upset and was, therefore, referred to a psychiatrist. After speaking at length about her part in the accident and sharing her reactions, she still remained tremulous, anxious, and tearful. She has no history of addiction. You decide to use an anxiolytic to help her. Which of the following is the best choice?