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3,531 questions
A 45-year-old man with HIV is being evaluated in the clinic. His HIV diagnosis was made 6 months ago and he wants to know more about medication treatment options. Which of the following is an indication to initiate HIV medication treatment?
A50-year-old woman complains of worsening dyspnea of 1-month duration, but is otherwise asymptomatic. Lung examination is normal; her CXR is shown in the figure below. Which of the following is the most likely diagnosis?
A 72-year-old diabetic is transferred to your hospital for fever and altered mental status in the late summer. Symptoms started in this patient 1 week prior to admission. On physical examination, the patient was disoriented. There were no focal neurologic findings. There was a fine rash on the patient's trunk. On oral examination, there were tongue fasciculations. A lumbar puncture was performed which showed a glucose of 71 and a protein of 94; microscopy of the cerebrospinal fluid (CSF) revealed 9 RBC and 14 WBC (21 P, 68 L, 11 H). The creatinine phosphokinase was 506. An electroencephalogram and MRI of the brain were normal. What is the best interpretation of these findings?
A24-year-old female is infected with HIV from an unprotected sexual exposure. What is the median time for this patient to develop clinical disease if she is not treated?
A 72-year-old diabetic is transferred to your hospital for fever and altered mental status in the late summer. Symptoms started in this patient 1 week prior to admission. On physical examination, the patient was disoriented. There were no focal neurologic findings. There was a fine rash on the patient's trunk. On oral examination, there were tongue fasciculations. A lumbar puncture was performed which showed a glucose of 71 and a protein of 94; microscopy of the cerebrospinal fluid (CSF) revealed 9 RBC and 14 WBC (21 P, 68 L, 11 H). The creatinine phosphokinase was 506. An electroencephalogram and MRI of the brain were normal. What further diagnostic test is the most appropriate?
A52-year-old woman has had diabetes mellitus since childhood. She has controlled her glucose well and kept her glycohemoglobin (HgbA1C) below 7% (normal, 2-6%). For which of the following complications is she still at risk, despite excellent glucose control? A. autonomic dysfunction
A 24-year-old male presents with sore throat, subjective fever, abdominal pain, and bad breath. He says that a neighbor's child is currently being treated for strep throat. On examination, his temperature is 101.1° F and his other vital signs are normal. He appears well. His throat is erythematous and his tonsils are enlarged, but there are no pharyngeal or tonsillar exudates. He has no cervical adenopathy. He has an occasional cough but his lungs are clear. His abdominal examination is normal. The presence of which of the following findings is a clinical predictor for the diagnosis of streptococcal pharyngitis?
A 35-year-old pharmacist complains of "hurting all over." Her pain is particularly bad in her upper back and shoulders, and she notes morning stiffness. On examination, her joints are not inflamed, but she has symmetric "tender points" in the posterior neck, anterior chest, lateral buttocks, medial knees, and lateral elbows. You make a preliminary diagnosis of fibromyalgia. Which one of the following diagnostic tests should you order?
A 24-year-old male presents with sore throat, subjective fever, abdominal pain, and bad breath. He says that a neighbor's child is currently being treated for strep throat. On examination, his temperature is 101.1° F and his other vital signs are normal. He appears well. His throat is erythematous and his tonsils are enlarged, but there are no pharyngeal or tonsillar exudates. He has no cervical adenopathy. He has an occasional cough but his lungs are clear. His abdominal examination is normal. The presence of which of the following findings is a clinical predictor for the diagnosis of streptococcal pharyngitis? Which of the following is the recommended first-line agent for the treatment of group A streptococcal pharyngitis?
A42-year-old patient suffering from alcoholism has advanced liver disease with ascites. He is hospitalized for agitation and bizarre behavior. Which of the following findings is most helpful in making the diagnosis of hepatic encephalopathy?
A22-year-old male presents to an acute care clinic in order to have two genital lesions evaluated. He first noticed the lesions about 2 weeks ago, but delayed seeking medical care because he believed they were harmless due to the lack of any discomfort. He states that he does engage in unprotected sexual intercourse, with the most recent time being 1 month ago. On examination, the glans penis features two distinct nontender papules with elevated edges surrounding ulcerated craters. They each measure 1 cm in diameter. There is also nontender bilateral inguinal lymphadenopathy. Which of the following is true about this patient's condition?
A 34-year-old amateur spelunker develops cough, dyspnea, and fever 2 weeks after a caving expedition to caves in Kentucky. On physical examination, the patient's temperature is 102°F and respiratory rate is 24. On pulmonary examination, there are diffuse crackles bilaterally. A CXR is shown in Figure. Which of these is the most appropriate statement about infection control of this patient if the patient is hospitalized?
A42-year-old patient suffering from alcoholism has advanced liver disease with ascites. He is hospitalized for agitation and bizarre behavior. Which of the following findings is most helpful in making the diagnosis of hepatic encephalopathy? In the patient above, his blood ammonia level is twice his baseline. Which of the following is a likely precipitating factor?
A22-year-old male presents to an acute care clinic in order to have two genital lesions evaluated. He first noticed the lesions about 2 weeks ago, but delayed seeking medical care because he believed they were harmless due to the lack of any discomfort. He states that he does engage in unprotected sexual intercourse, with the most recent time being 1 month ago. On examination, the glans penis features two distinct nontender papules with elevated edges surrounding ulcerated craters. They each measure 1 cm in diameter. There is also nontender bilateral inguinal lymphadenopathy. The drug of choice for treating this patient works by which of the following mechanisms?
A44-year-old secretary presents with a fever of 103°F, headache, and stiff neck. You entertain a diagn osis of bacterial meningitis and begin antibiotics immediately. With bacterial meningitis, which of the following is a likely finding in the cerebrospinal fluid (CSF)?
A 26-year-old HIV-positive man is admitted to the hospital for treatment of a varicella-zoster infection. On the fourth day of treatment, he develops an acute renal insufficiency. What is the most likely treatment-related mechanism accounting for the patient's acute renal insufficiency?
In this otherwise healthy adult woman, what is the most likely infecting organism?
A 63-year-old man complains of a new cough and of breathlessness after walking up a flight of stairs. Chest examination reveals late inspiratory crackles but no wheezes. There is a mild clubbing of the fingers. His CXR is shown in figure. Which of the following would be found on pulmonary function testing (PFT)?
A 53-year-old insulin-dependent diabetic, who underwent a cadaveric renal transplant 1 year prior to admission, presents with fever and cough of 3 weeks duration. He works as a long-haul trucker, carting fruit from McAllen, Texas (on the Texas- Mexico border) to Fresno, California. He does not smoke. His PPD skin test prior to admission was positive. On physical examination, his respiratory rate is 25, his oral temperature is 101°F, his lungs have rhonchi and de creased breath sounds on the left. His CXR is shown in Figure. What organism besides Mycobacterium tuberculosis leads your differential as a cause of pneumonia in this case?
A 23-year-old man presents complaining of severe crampy abdominal pain and blood in his stool over the past 2 days. Asimilar episode occurred a few months ago and spontaneously resolved. No history of travel. Abdominal x-ray shows mild colonic dilatation. Which of the following is the most likely diagnosis?