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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 is the best diagnostic approach?
A60-year-old man presents with a nonproductive cough for a week and generalized malaise. He also has noted some abdominal pain associated with diarrhea for the past few days. His temperature is 101.5°F and c linical examination is unremarkable. ACXR shows a left lower lobe infiltrate. His urinalysis shows 50 RBCs, and his BUN (30) and creatinine (1.6) are both mildly elevated. In light of the extrapulmonary symptoms and signs, which of the following is the most likely cause of his pneumonia?
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 of the following is another characteristic symptom associated with this syndrome?
A39-year-old woman known to have fibrocystic disease of the breast complains of persistent fullness and pain in both breasts. Which of the following drugs will be most effective in relieving her symptoms?
A 76-year-old alcoholic male with hypertension, type II diabetes, and a history of congestive heart presented with cough, fever, malaise, and chills. His initial vitals were: HR 110, T: 102°F, RR: 25, B P 90/60, O2 saturation 93% on 4L/NC. The patient decompensated in the ER and was intubated. Intubation was achieved after three attempts secondary to patient vomiting during the initial attempts. Patient was admitted to the ICU with a diagnosis of sepsis and respiratory failure secondary to suspected pneumonia. After obtaining blood and sputum cultures, the initial empiric antibiotic coverage should be which of the following?
A63-year-old man with chronic bronchitis presents to the emergency department with worsening shortness of breath. He is dyspneic, his respiratory rate is 32/min, and he has peripheral cyanosis. A chest examination reveals increased anteroposterior diameter and scattered rhonchi, but no wheezes or evidence of consolidation. His ABG determinations on room air are pH of 7.36, arterial oxygen pressure (PaO2) of 40 mmHg, and PaCO2 of 47 mmHg. He is given oxygen by face mask while awaiting a CXR. His respiratory rate falls to 12/min,but his ABGs on oxygen are now pH of 7.31, PaO2 of 62 mmHg, and PaCO2 of 58 mmHg. Which of the following is the most appropriate next step in the management of this patient?
A 31-year-old female health care worker presents to your clinic after a needlestick injury from a patient who subsequently left against medical advice prior to laboratory analysis for HIV or hepatitis. You advise your colleague that:
A26-year-old man presents with a hard, painless testicular mass. At operation, frozen section reveals testicular cancer. Which of the following is a risk factor?
A 35-year-old woman schedules an appointment in an outpatient clinic for evaluation and treatment of a "mouth problem." She says that she has white spots in her mouth that have been present for a few weeks. In response to your questioning, she states that she has been experiencing fatigue and a 20-lb weight loss over the past several months, although she attributes these symptoms to a dramatic increase in work hours at her job over the same period of time. She denies having any other chronic medical issues and does not use any prescription or OTC medications. As you examine her, you note the presence of white plaques on her buccal mucosa, palate, and tongue. Scraping of the plaques with a tongue depressor elicits pain as well as a small amount of bleeding. Nontender generalized cervical and submandibular lymphadenopathy is present. Which of the following questions would potentially yield the most useful information in this patient's diagnosis and treatment?
A26-year-old man presents with a hard, painless testicular mass. At operation, frozen section reveals testicular cancer. Which of the following is a risk factor? What is the most common cell type in testicular cancer?
A 35-year-old woman schedules an appointment in an outpatient clinic for evaluation and treatment of a "mouth problem." She says that she has white spots in her mouth that have been present for a few weeks. In response to your questioning, she states that she has been experiencing fatigue and a 20-lb weight loss over the past several months, although she attributes these symptoms to a dramatic increase in work hours at her job over the same period of time. She denies having any other chronic medical issues and does not use any prescription or OTC medications. As you examine her, you note the presence of white plaques on her buccal mucosa, palate, and tongue. Scraping of the plaques with a tongue depressor elicits pain as well as a small amount of bleeding. Nontender generalized cervical and submandibular lymphadenopathy is present. Which of the following immunizations is safe to administer to this patient?
A26-year-old man presents with a hard, painless testicular mass. At operation, frozen section reveals testicular cancer. Which of the following is a risk factor? What serum marker can be used to monitor therapy?
A 45-year-old male with type II diabetes, hypertension, and hyperlipidemia presents to your clinic as a new patient. He has been out of his cholesterol medications and came to your office requesting a refill. The patient brought his most recent lipid profile (done after he was off his cholesterol medication for 3 months) which revealed: Cholesterol (total): 242 mg/dL HDL cholesterol: 38 mg/dL Triglycerides (TGs): 660 mg/dL LDL cholesterol = unable to calculate due to high TGs He also had recent liver function tests that were normal. Based on Adult Treatment Panel (ATP) III guidelines, which of the following medications should be the initial pharmacologic treatment for this patient?
A 48-year-old woman complaining of dysuria is diagnosed with a UTI by urinalysis. Urine culture and sensitivities reveal that the causative organism belongs to the genus Klebsiella and is resistant to multiple antibiotics. Based upon the results available, you decide to begin therapy with gentamicin. Which of the following irreversible complications is also associated with gentamicin use?
A 65-year-old woman with a long history of uncontrolled hypertension and valvular heart disease presents for evaluation. She is fatigued and complains of swelling in her legs and shortness of breath. Which of the following is the distinguishing feature of left ventricular failure?
A 42-year-old man admitted with a high fever and leukocytosis is transferred to the intensive care unit in shock. Which of the following is a common finding in the early stages of septic shock?
A 35-year-old man presents with acute low back pain after lifting a couch in his home. Pain is in the lumbosacral area and increases with walking and bending. Examination reveals paraspinal muscle spasm and tenderness and negative straight leg raise bilaterally. Lower extremity strength is intact. Which of the following is the best next step in managing this patient?
A 53-year-old fisherman develops pain and swelling of the right hand 8 hours after suffering a fish hook injury to the finger. On physical examination, the patient's temperature is 102.8°F and the patient ap pears septic. The patient's hand and a Gram stain of material aspirated from a bulla are shown in Figures below. What is the most likely etiology of this bacteremia?
A 63-year-old male presents to your office with palpitations for the past 3 weeks. He has had no chest pains or dyspnea. He has no significant medical history and takes no medications. He does not smoke cigarettes and a recent lipid panel was normal. On examination, he is in no apparent distress. His pulse is 115 bpm and irregular. His BP is 125/77. His lungs are clear and his cardiac examination reveals an irregularly irregular rhythm with no murmurs, rubs, or gallops. An abnormal result of which of the following laboratory tests would be most likely to explain the cause of this condition?
A 42-year-old man admitted with a high fever and leukocytosis is transferred to the intensive care unit in shock. Which of the following is a common finding in the early stages of septic shock? Which of the following is an appropriate initial therapy for both septic shock and cardiogenic shock?