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3,531 questions
A22-year-old nulliparous woman who desires future fertility is found to have a pap smear consistent with high-grade squamous intraepithelial lesion (HGSIL). The final pathology report indicates a single focus of squamous carcinoma invasive into the cervical stroma to a depth of 2.0 mm. An ECC is negative. There is no lymphvascular space invasion, and the cone margins are negative. The most appropriate therapy for this patient is which of the following?
Which of the following medications may be appropriate for treating children with attention deficit disorder?
Which of the following is considered a negative symptom of schizophrenia?
A22-year-old nulliparous woman who desires future fertility is found to have a pap smear consistent with high-grade squamous intraepithelial lesion (HGSIL). Initial management should be which of the following?
A 40-year-old woman with no previous psychiatric history seeks help from her internist for a sleep problem. Initially, she is able to fall asleep but then sleeps fitfully, and finally around 4:00 a.m. decides to stay up. She averages approximately 34 hours of sleep per night, and this has been occurring for the last 3 weeks. She finds herself quite tired and "blue" during the day but is unable to nap. Mornings are "the worst" for her, but she feels better toward the end of the day. There has been a 15-lb weight loss because "I'm just not hungry." She denies any physical problems except for constipation. As a gradeschool teacher, she feels extremely stressed but sees no way out and no way to improve the situation. At times, suicide seems like a possible option, and she admits to spending long hours brooding on how to do it. A physical examination is unremarkable Which of the following is the most appropriate treatment choice?
A37-year-old woman (gravida 3, para 3) presents with a 4-month history of postcoital spotting On pelvic examination, you visualize a 2-cm friable lesion on the anterior lip of the cervix. The next most appropriate step is which of the following?
A 40-year-old woman with no previous psychiatric history seeks help from her internist for a sleep problem. Initially, she is able to fall asleep but then sleeps fitfully, and finally around 4:00 a.m. decides to stay up. She averages approximately 34 hours of sleep per night, and this has been occurring for the last 3 weeks. She finds herself quite tired and "blue" during the day but is unable to nap. Mornings are "the worst" for her, but she feels better toward the end of the day. There has been a 15-lb weight loss because "I'm just not hungry." She denies any physical problems except for constipation. As a gradeschool teacher, she feels extremely stressed but sees no way out and no way to improve the situation. At times, suicide seems like a possible option, and she admits to spending long hours brooding on how to do it. A physical examination is unremarkable. Which of the following is the most likely diagnosis?
In your internal medicine clinic you are caring for a 42-year-old woman with hereditary nonpolyposis colon cancer (HNPCC), Lynch syndrome II, which is a hereditary, autosomal dominant, cancer syndrome that results from a mutation in a mismatch deoxyribonucleic acid (DNA) repair gene. These patients have a lifetime risk of colon cancer nearly 6080%, but are also at risk for several other malignancies. For which gynecologic malignancy is this woman most at risk?
A 40-year-old man has been unsuccessfully treated for depression with two different medications for the past 3 months. He has a number of medical problems, and he recently was hospitalized after threatening suicide. His psychiatrist is considering the use of ECT for the patient. The patient has consented to ECT, and the pre ECT workup has been completed. Which of the following medications could routinely be continued through a course of ECT?
A 61-year-old postmenopausal woman, who has been on continuous combined hormone replacement therapy for 5 years, presents to your office complaining of vaginal bleeding. Which of the following is the most appropriate next step in her management?
A 78-year-old woman is seen by a psychiatrist for depression. She is fairly cooperative in responding to questions. She admits to feeling blue; she "catnaps" throughout the day and is up at night; and her appetite is very poor. She thinks of death frequently but denies feeling suicidal. There is no past psychiatric history. On the MMSE, she obtains a score of 14. Her depressive symptoms have been present for "several days." Which of the following is highly suggested by the findings?
A 30-year-old woman complains that she has had sleep disturbances since the start of her depression 2 months ago. Which of the following is an accurate description of typical sleep abnormalities in depression?
During the course of psychotherapy with a woman who has a severe phobia of cars, it is discovered that her first sexual experience, which was a humiliating one for her, took place in an automobile. What is the defense mechanism illustrated by this phobia called?
A41-year-old woman, recently diagnosed with a 2-cm, stage IB1 cervical cancer, undergoes a radical hysterectomy, bilateral salpingooophorectomy, and retroperitoneal pelvic lymph node dissection. Her surgery and postoperative course are uncomplicated. Four weeks postoperatively, she presents to the ER complaining of left leg swelling and left lower quadrant abdominal pain. On physical examination, she is afebrile, has a normal WBC count, and you palpate a 5 4 cm mass in the left lower quadrant. You order a pelvic ultrasound that shows a 5 5 cm simple cyst in the left lower quadrant.
A45-year-old woman, seen by her medical internist, has been experiencing fears that she may have a serious illness. She complains that after eating she experiences "a lot of gas" and abdominal pain, followed by diarrhea on occasion. Her heart at times seems to be beating rapidly, and she feels faint at times, has chest "discomfort," and wonders if she is having a heart attack. Multiple tests have identified only a mild irritable bowel syndrome. The woman's fears are not allayed by this. She makes repeated calls to be seen by her doctors as well as seeking consultation from other specialists. She insists that "there's something there" and believes the doctors are not taking her seriously. Which of the following most appropriately describes this woman's disorder?
A 63-year-old woman with a grade 2 endometrioid adenocarcinoma of the uterus diagnosed by endometrial biopsy is taken to the operating room for surgical treatment with a total abdominal hysterectomy, bilateral salpingooophorectomy, and pelvic and paraaortic lymphadenectomy. No complications are noted intraoperatively. On postoperative day 1, the patient complains of numbness in her medial thigh. Your neurologic examination suggests absence of cutaneous sensation to the medial thigh and an inability to adduct her hip. Which of the following is the most likely etiology for this clinical presentation?
A 45-year-old homeless schizophrenic patient presents to you with suicidal ideation. You interview him and find out he is a divorced Roman Catholic. He recently lost his job after being caught a second time drinking on the job. He had attempted suicide impulsively 5 years previous by overdosing. He is not currently psychotic. He bought a handgun and ammunition recently and has been thinking about shooting himself in the head. He has gotten as close to acting on it as having loaded the gun and held it up to his head this morning. Someone walking by stopped him and convinced him to come and see you. He is ambivalent about seeking help Which of the following is the most appropriate immediate treatment recommendation?
A 44-year-old female has a history of endometriosis resulting in chronic pelvic pain. She presents to you 6 months after her total abdominal hysterectomy and bilateral salpingooophorectomy. She reports continued pelvic pain. Which of the following would be your most appropriate recommendation for medical management?
A 45-year-old homeless schizophrenic patient presents to you with suicidal ideation. You interview him and find out he is a divorced Roman Catholic. He recently lost his job after being caught a second time drinking on the job. He had attempted suicide impulsively 5 years previous by overdosing. He is not currently psychotic. He bought a handgun and ammunition recently and has been thinking about shooting himself in the head. He has gotten as close to acting on it as having loaded the gun and held it up to his head this morning. Someone walking by stopped him and convinced him to come and see you. He is ambivalent about seeking help. Which of the following is not associated with an increased suicide risk?
A patient with a persistent headache following a postpartum hemorrhage is diagnosed with Sheehan's syndrome. If the patient were subsequently amenorrheic and infertile, what treatment would you recommend to assist this patient to conceive?