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3,531 questions
A 43-year-old man with AIDS complains of shortness of breath and worsening diarrhea. His temperature is 98°F, respiration rate is 26/min, pulse rate is 1 00/min, and BP is 100/70 mmHg. His lung and heart examination are unremarkable. A room air ABG reveals: pH 7.10/PCO2 5/PO2 130/calculated bicarbonate 6. What is the primary acid-based disorder?
A21-year-old Asian female, with past medical history of exertional asthma, comes to your office complaining of mild low back pain. It started after her working out in the gym 3 days ago. The pain is 24 out of 10 in intensity, has no radiation, increases with bending or lying down for a long time, and improves with warm showers. You examine the patient, diagnose her with paravertebral muscle spasm, and give her prescriptions for cyclobenzaprine and naproxen to use as needed for pain and stiffness. You receive a call from your patient 2 hours later. She is having generalized itching, dizziness, and swelling of the tongue and lips. She is having difficulty breathing. She tells you that she took the first dose of the medication you prescribed about 30 minutes ago. The most beneficial immediate intervention for this patient would be which of the following?
A 60-year-old man with a history of severe chronic obstructive pulmonary disease (COPD), which is steroid dependent, is admitted to the ICU with pulmonary infiltrates and a sepsis syndrome. His hospital course is complicated by acute renal insufficiency and respiratory failure. Therapy includes glucocorticoids and dopamine. He has no history of thyroid disease. Several weeks into his hospital course, the following laboratory studies are performed: Based on these laboratory studies, which of the following is the most appropriate next step?
A 17-year-old girl notes an enlarging lump in her neck. On examination, her thyroid gland is twice the normal size, firm to rubbery, multilobular, nontender, and freely mobile. There is no adenopathy. Family history is positive for both hypo- and hyperthyroidism. Her serum triiodothyronine (T3) and thyroxine (T4) levels are low normal, and serum thyroid-stimulating hormone (TSH) is high normal. Technetium scan shows nonuniform uptake. Serum and antithyroglobulin titer is strongly positive. Which of the following is the most appropriate treatment for this patient?
A28-year-old woman presents for evaluation of primary infertility. She has had fewer than four periods per year since menarche at age 14, facial hirsutism, acne, and weight gain. On examination, she has a BP 150/100. Her body mass index (BMI) is 40. Acanthosis nigricans is noted along the posterior surface of her neck. Which of the following laboratory studies is most likely to be abnormal in this patient?
An obese 21-year-old woman complains of increased growth of coarse hair on her lip, chin, chest, and abdomen. She also notes menstrual irregularity with periods of amenorrhea. Which of the following is the most likely cause of this patient's symptoms?
A28-year-old woman presents for evaluation of primary infertility. She has had fewer than four periods per year since menarche at age 14, facial hirsutism, acne, and weight gain. On examination, she has a BP 150/100. Her body mass index (BMI) is 40. Acanthosis nigricans is noted along the posterior surface of her neck. Which of the following would be her most likely fasting lipid profile?
A28-year-old woman presents for evaluation of primary infertility. She has had fewer than four periods per year since menarche at age 14, facial hirsutism, acne, and weight gain. On examination, she has a BP 150/100. Her body mass index (BMI) is 40. Acanthosis nigricans is noted along the posterior surface of her neck. How would you counsel this patient?
The mother of a 3-year-old girl brings her daughter to see you because the girl developed breasts 6 months ago. The girl has had no vaginal bleeding, and there is no pubic hair. She takes no medication. Which of the following is the most appropriate next diagnostic step?
A 34-year-old female sex worker presents with a several week history of fatigue, malaise, fever, and a 10-lb weight loss. Over the last 2 weeks, the patient noted a rash on her face, torso, arms, legs, palms, and soles. The patient is HIV negative on a test 2 months ago, has had hepatitis B, gonorrhea, and chlamydia. The patient has an oral temperature of 100.6°F, and generalized lymphadenopathy. The patient does not have any lesions in the mucous membranes. What is the diagnostic test most likely to explain this clinical presentation?
The mother of a 3-year-old girl brings her daughter to see you because the girl developed breasts 6 months ago. The girl has had no vaginal bleeding, and there is no pubic hair. She takes no medication The tests you ordered are normal for a prepubertal girl. Which of the following is the most likely diagnosis?
Which of the following statements is true regarding contraception?
The mother of a 3-year-old girl brings her daughter to see you because the girl developed breasts 6 months ago. The girl has had no vaginal bleeding, and there is no pubic hair. She takes no medication Which of the following is the most appropriate management of this girl? pituitary suppression with a gonadotropin-releasing hormone (GnRH) agonist
A 58-year-old male presents to your office for a well-male examination. It has been several years since he last visited a doctor, but he states that he has been in "excellent health." He denies any history of drinking, smoking, or using illegal drugs. He maintains a diet low in sodium and fat. An avid sports enthusiast, he also spends at least 2 hours per day engaged in some type of outdoor physical activity. On physical examination, you discover a translucent waxy papule with raised borders on the posterior aspect of his left shoulder. Which of the following is true of this patient's skin condition?
After an appropriate diagnostic evaluation, a 59-year-old woman with postmenopausal bleeding had a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO). The pathologic diagnosis is adenocarcinoma of the endometrium. An endometrial adenocarcinoma that is confined to the uterus and extends more than 50% through the myometrium is at which stage?
A 39-year-old woman at 16 weeks' gestation complains of headaches, blurred vision, and epigastric pain. Her blood pressure is now 56/104 mmHg. Her uterine fundus is palpable 2 cm above her symphysis pubis. Fetal heart tones could not be heard with a handheld Doppler. She has 3+ proteinuria. Which of the following is the most likely diagnosis?
A 58-year-old male presents to your office for a well-male examination. It has been several years since he last visited a doctor, but he states that he has been in "excellent health." He denies any history of drinking, smoking, or using illegal drugs. He maintains a diet low in sodium and fat. An avid sports enthusiast, he also spends at least 2 hours per day engaged in some type of outdoor physical activity. On physical examination, you discover a translucent waxy papule with raised borders on the posterior aspect of his left shoulder. The treatment modality associated with the lowest recurrence rate is which of these?
A23-year-old woman develops painful vulvar vesicles that contain intranuclear inclusions on cytologic examination. She is 22 weeks' pregnant. Which of the following statements about genital herpes is correct?
A63-year-old woman has a 3-cm pruritic lesion on her right labia majora that she has noted for approximately 9 months. She has been treated with various topical creams and ointments for vulvar candidiasis without resolution of her symptoms or lesion. When you examine this woman, the lesion is still present. Which of the following is the most appropriate intervention?
An 18-year-old female presents for evaluation of facial acne. On examination, she has multiple comedones, papules, and pustules on her forehead, nose, cheeks, and chin. She also has several distinct nodules, each greater than 5 mm in diameter. After 6 months of appropriate treatment, the severity of your patient's acne remains essentially unchanged. You rule out several potential causes for the patient's recalcitrant acne and decide that more aggressive therapy is warranted. As you discuss this option with your patient, which of the following side effects of the proposed treatment necessitates extensive counseling prior to initiation of therapy?