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3,531 questions
A64-year-old female with no significant medical history presents with vague complaints of progressive generalized muscle weakness and fatigue. She denies any history of trauma or drug use and does not take any prescription, OTC or herbal medications. This is a new complaint and she has not had any prior workup. There is no evidence of trauma and a recent TSH was normal. On examination, you find mild muscle tenderness and atrophy. She has difficulty standing from a chair unless she pushes up with her arms at the same time. Her neurologic examination is normal. Which of the following tests would be most helpful in confirming your clinical diagnosis?
A 44-year-old woman had a normal Pap smear 3 years ago. Her menstrual periods occur monthly and last 5 days. She has had intermenstrual and postcoital spotting intermittently for the past 6 months. The pelvic examination is normal. Which of the following is the most appropriate test to perform?
A64-year-old female with no significant medical history presents with vague complaints of progressive generalized muscle weakness and fatigue. She denies any history of trauma or drug use and does not take any prescription, OTC or herbal medications. This is a new complaint and she has not had any prior workup. There is no evidence of trauma and a recent TSH was normal. On examination, you find mild muscle tenderness and atrophy. She has difficulty standing from a chair unless she pushes up with her arms at the same time. Her neurologic examination is normal. Which of the following tests would be most helpful in confirming your clinical diagnosis? Your patient's test result confirms your clinical suspicion. The patient's symptoms have become more severe. Which of the following treatment options would be most appropriate?
A 44-year-old woman had a normal Pap smear 3 years ago. Her menstrual periods occur monthly and last 5 days. She has had intermenstrual and postcoital spotting intermittently for the past 6 months. The pelvic examination is normal. All tests performed on the woman were normal. She returns 1 year later for her annual gynecologic examination. On speculum examination, she has a visible 7-mm lesion on her cervix that bleeds on contact. Which of the following is the most appropriate procedure to perform?
A 24-year-old woman lost her previous two pregnancies at approximately 20 weeks' gestation, without having noted any contractions. She is currently at 15 weeks' gestation and denies having uterine contractions. Her cervix is undilated and uneffaced. Which of the following is the most appropriate management of this patient?
A 55-year-old male is brought to the ED, by ambulance, because of crushing chest pain radiating to his left shoulder and arm that started 1 hour ago. He has a history of hypertension, high cholesterol, and has smoked a pack of cigarettes a day for 30 years. He has never had symptoms like this before. Which of the following would be most likely to be seen on an ECG?
A 69-year-old woman with diabetes mellitus complains of urinary incontinence. Her diabetesis well controlled with oral hypoglycemic agents. She has no complaints other than the wetness. Which of the following tests is most likely to demonstrate the cause? urinalysis
A 55-year-old male is brought to the ED, by ambulance, because of crushing chest pain radiating to his left shoulder and arm that started 1 hour ago. He has a history of hypertension, high cholesterol, and has smoked a pack of cigarettes a day for 30 years. He has never had symptoms like this before. While monitored in the ER, the patient's rhythm suddenly converts to ventricular tachycardia, and he becomes pulseless and unresponsive. Which of the following would be the most appropriate initial management of this situation?
A48-year-old G5P5 woman has genuine stress incontinence (GSI). Kegel exercises have not helped, and her incontinence is gradually worsening. Her urethrovesical junction (UVJ) is prolapsed into the vagina, and her urethral closure pressure is normal. Which of the following procedures will most likely cure her incontinence?
A 55-year-old male is brought to the ED, by ambulance, because of crushing chest pain radiating to his left shoulder and arm that started 1 hour ago. He has a history of hypertension, high cholesterol, and has smoked a pack of cigarettes a day for 30 years. He has never had symptoms like this before. The patient's rhythm converts to asystole. What is the most appropriate first action to take?
On a routine annual examination, a 43-yearold woman is found to have a 2-cm mass in the lateral aspect of her right breast. Which of the following is the most appropriate next step in management?
A 55-year-old male is brought to the ED, by ambulance, because of crushing chest pain radiating to his left shoulder and arm that started 1 hour ago. He has a history of hypertension, high cholesterol, and has smoked a pack of cigarettes a day for 30 years. He has never had symptoms like this before. Fortunately, the patient survives this episode. As part of his long-term treatment, which of the following would be an appropriate therapeutic intervention to initiate due to its proven effect on survival rate?
A 37-year-old pregnant woman has a genetic amniocentesis at 16 weeks' gestation. Aconcurrent ultrasound shows normal fetal anatomy. Her prenatal course has been unremarkable. Her prenatal laboratory tests include a B-negative blood type, a negative rubella antibody titer, a negative hepatitis B surface antigen, and a hematocrit of 31%. Which of the following is the most appropriate management for this woman?
A 23-year-old pregnant woman at 5 postmenstrual weeks took coumadin until about 3 days after her menses was due. She has monthly menses. A home pregnancy test was positive on the day she took coumadin. She takes coumadin because of a history of deep vein thrombosis and pulmonary embolism. She is concerned that the coumadin will cause birth defects. You tell her that the conceptus is most susceptible to teratogenesis at what stage of pregnancy?
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. Which of the following is most appropriate for initial inclusion in a regimen to treat this patient's acne?
A 23-year-old pregnant woman at 5 postmenstrual weeks took coumadin until about 3 days after her menses was due. She has monthly menses. A home pregnancy test was positive on the day she took coumadin. She takes coumadin because of a history of deep vein thrombosis and pulmonary embolism. She is concerned that the coumadin will cause birth defects. You advise this woman to do which of the following?
An 18-year-old female presents for follow-up of a rash. She states that she has been using OTC antifungal preparations without success. She used OTC cortisone cream with mild improvement, but the lesions never disappeared. Her condition also recurred with full severity once the cortisone cream was discontinued. Her family history reveals a first degree relative with similar rash. The rash is over the elbows, trunk, and scalp. Which of the following would be the appropriate initial treatment?
A 55-year-old woman has a bloody discharge from her left breast. A mammogram discloses a cluster of microcalcifications 3 cm beneath her left nipple. Which of the following is the best next step in her evaluation?
A 60-year-old morbidly obese man presents with complaints of fatigue, worsening exertional dyspnea, three-pillow orthopnea, lower extremity edema, and cough occasionally productive of frothy sputum. He has a long-standing history of type II diabetes and hypertension. On examination, you note the presence of bibasilar rales, an S3 gallop, jugular venous distention, and 2+ pitting edema in both legs up to the knees. There does not appear to be an arrhythmia present. Which test would be most sensitive for diagnosis of this condition?
A 55-year-old woman has a bloody discharge from her left breast. A mammogram discloses a cluster of microcalcifications 3 cm beneath her left nipple. Which of the following is the principal advantage of a fine-needle aspiration of a breast mass?