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3,531 questions
A 17-year-old male presents for evaluation of shortness of breath. He has episodes where he will audibly wheeze and have chest tightness. His symptoms worsen if he tries to exercise, especially when it is cold. He has used an OTC inhaler with good relief of his symptoms, but he finds that his symptoms are worsening. He now has episodes of wheezing on a daily basis and will have nighttime wheezing and coughing, on average, five or six times a month. You suspect a diagnosis of asthma. Your diagnostic workup confirms the diagnosis of asthma. What clinical classification of asthma does this patient have?
A healthy 27-year-old male and his partner have been attempting to conceive for more than 1 year. As part of their evaluation he has a semen analysis. His ejaculate volume is 3.5 mL, sperm concentration is 8 million/mL, sperm motility is 65%, oval forms comprise 60% of the sperm, and fructose is present in the ejaculate. The man is treated with clomiphene for a presumptive diagnosis of male factor infertility. Though clomiphene is an unproven and unapproved therapy for male infertility, what is the earliest that a semen analysis should be done to detect an improvement in his semen parameters?
A 17-year-old male presents for evaluation of shortness of breath. He has episodes where he will audibly wheeze and have chest tightness. His symptoms worsen if he tries to exercise, especially when it is cold. He has used an OTC inhaler with good relief of his symptoms, but he finds that his symptoms are worsening. He now has episodes of wheezing on a daily basis and will have nighttime wheezing and coughing, on average, five or six times a month. You suspect a diagnosis of asthma. Which of the following is the most appropriate pharmacologic regimen for this patient?
A 39-year-old pregnant woman with chronic hypertension and one prior pregnancy is now at 38 weeks' gestation. She comes to labor and delivery with profuse vaginal bleeding and abdominal pain of sudden onset. Which of the following is the most likely diagnosis?
A 39-year-old pregnant woman with chronic hypertension and one prior pregnancy is now at 38 weeks' gestation. She comes to labor and delivery with profuse vaginal bleeding and abdominal pain of sudden onset. This patient has an external fetal monitor placed. Uterine tone seems to be increased, and there are occasional variable decelerations of the fetal heart to 90 BPM. Which of the following is the most appropriate management?
A 48-year-old woman presents for evaluation of progressively worsening dyspnea. She relates the onset of symptoms to a "walking pneumonia" that she had a year ago. Her breathing has worsened progressively since that time. She has a "smoker's cough" productive of some clear or white phlegm, for which she frequently sucks on cough drops. She started smoking regularly at the age of 18. She currently smokes about a pack of cigarettes a day, down from as much as two packs per day. She is not on any medications regularly. She has no history of heart disease and has always had normal blood pressure. Which of the following physical examination findings are you most likely to find in this patient?
A pediatrician asks you to see a 13-year-old girl who has not begun to menstruate and has a 6-month history of pelvic and lower abdominal pain at approximately month interval. She has Tanner stage 3 pubic hair and breast development. Her growth spurt occurred about 1 year ago and her current height is 65 in. (165 cm). She has never had sexual intercourse. On examination of her external genitalia the presence of Tanner stage 3 pubic hair is confirmed. The labia are normal. There is no obvious vaginal opening and there is bulging between the labia minora. Which one of the following is the most likely diagnosis?
A pediatrician asks you to see a 13-year-old girl who has not begun to menstruate and has a 6-month history of pelvic and lower abdominal pain at approximately 1-month interval. She has Tanner stage 3 pubic hair and breast development. Her growth spurt occurred about 1 year ago and her current height is 65 in. (165 cm). She has never had sexual intercourse. On examination of her external genitalia the presence of Tanner stage 3 pubic hair is confirmed. The labia are normal. There is no obvious vaginal opening and there is bulging between the labia minora. Which one of the following laboratory tests is increased in women with gonadal dysgenesis? serum FSH concentrations
A 48-year-old woman presents for evaluation of progressively worsening dyspnea. She relates the onset of symptoms to a "walking pneumonia" that she had a year ago. Her breathing has worsened progressively since that time. She has a "smoker's cough" productive of some clear or white phlegm, for which she frequently sucks on cough drops. She started smoking regularly at the age of 18. She currently smokes about a pack of cigarettes a day, down from as much as two packs per day. She is not on any medications regularly. She has no history of heart disease and has always had normal blood pressure You recommend smoking cessation to your patient. She asks why, at this point, she should quit. Which of the following statements is true?
A64-year-old man with a long history of smoking but no significant past medical history presents to his physician's office complaining of a 12 week history of worsening dyspnea, facial swelling, and discoloration. He has also had swelling and discomfort of his right arm. Physical examination reveals edema with plethora of the face and right arm, with prominent collateral veins over the chest wall. What test is most likely to establish the cause of the patient's symptoms?
A45-year-old woman has bilateral breast pain that is most severe premenstrually. On palpation, there is excessive nodularity, tenderness, and cystic areas that diminish in size after menses. Which of the following is the most likely diagnosis?
A 19-year-old woman begins chemotherapy for an acute leukemia. Although you determine that her renal function is unimpaired prior to the initiation of treatment, you feel that she may be at high risk for development of tumor lysis syndrome given her condition's typically good response to chemotherapy. Which of the following is an appropriate medication to use as a preventative measure prior to and during her treatment for leukemia?
A 35-year-old woman at 30 weeks' gestation discovers a lump in her left breast. Examination reveals a 23 cm, firm nodule in the upper outer quadrant. Which of the following is the most appropriate next step in the management of this patient?
A 19-year-old woman begins chemotherapy for an acute leukemia. Although you determine that her renal function is unimpaired prior to the initiation of treatment, you feel that she may be at high risk for development of tumor lysis syndrome given her condition's typically good response to chemotherapy. Which of the following is typically seen as a feature of tumor lysis syndrome?
A75-year-old man undergoes a right colectomy for stage 3 colon cancer. He has a history of emphysema requiring chronic steroid use. He also has diabetes and coronary heart disease. On postoperative day 2, the surgeon is called because the patient acutely began to have a large amount of pinkish, serous drainage from the wound. There is no evidence of infection. Which of the following factors probably contributed to this complication?
A56-year-old Black male construction worker comes for evaluation of a worsening, nonproductive cough that he first noticed 2 months before. During the last week the cough has worsened and has become productive of yellow, blood-tinged sputum. He reports his appetite is poor, and he has lost approximately 15 lbs over the past 2 months. You take a social history and find out he has smoked two packs of cigarettes a day since he was 16 years old. He states that he drinks approximately 10 beers per week. You perform a physical examination. He appears chronically ill; however, his vital signs are normal. The head and neck examination is within normal limits. There are decreased breath sounds in the left upper chest. Breath sounds are distant in the other lung fields. The diaphragms are low. There is no palpable hepatosplenomegaly. You order a posterior-to-anterior (PA) and lateral CXR. The chest radiogram shows opacity of the left upper lobe. There are no pleural effusions. The cardiac silhouette is not enlarged. The mediastinum does not appear enlarged. What next should be ordered?
A1-cm carcinoma of the breast is diagnosed by an excisional biopsy in a 36-year-old woman at 14 weeks' gestation. The axillary nodes are negative. Which of the following is the best management of this patient?
A37-year-old White executive secretary comes to you after she found a lump in her right breast while she was showering. She describes a lesion beneath her right nipple. You question her about her personal and family history. She began menarche at age 12, and she is still having regular menstrual periods. She has had two children; the first was born when she was 25 years old. She has no family history of breast, ovarian, or colon cancer on either her maternal or paternal side. You perform a physical examination including a careful examination of her breasts. You note that her breasts contain many small cysts bilaterally. However, you also palpate a localized, firm, nontender mass below the right areola. You also describe a peau d'orange appearance of the areola. What should you advise her?
A woman at 31 weeks' gestation complains of feeling dizzy and lightheaded when she lies on her back. She is Rh negative but denies vaginal bleeding, abdominal trauma, or abdominal pain. The diagnosis is probably the supine hypotensive syndrome. This results in which of the following?
A37-year-old White executive secretary comes to you after she found a lump in her right breast while she was showering. She describes a lesion beneath her right nipple. You question her about her personal and family history. She began menarche at age 12, and she is still having regular menstrual periods. She has had two children; the first was born when she was 25 years old. She has no family history of breast, ovarian, or colon cancer on either her maternal or paternal side. You perform a physical examination including a careful examination of her breasts. You note that her breasts contain many small cysts bilaterally. However, you also palpate a localized, firm, nontender mass below the right areola. You also describe a peau d'orange appearance of the areola. Amammogram is performed; however, the mammogram demonstrates no abnormality involving either breast. What next should be done?