Question bank

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. In which of the following circumstances is the administration of anti-D immune globulin not necessary? threatened abortion and first-trimester bleeding

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. The patient has the follow-up test that you recommend. It shows a 5-cm mass compressing the left upper lobe bronchus with consolidation of the left upper lobe. Two 1 cm peribronchial lymph nodes near the left main stem bronchus and several 1.52.0 cm mediastinal lymph nodes are seen. The hilar nodes do not appear enlarged. There are no enlarged lymph nodes visualized in the right chest. There are no lesions seen in the right lung. There are emphysematous changes involving both lungs. A biopsy of the lung mass shows a small cell carcinoma. What should be done next?

Why does ligation of the hypogastric (internal iliac) artery effectively control intractable pelvic hemorrhage?

A 45-year-old female develops fever, dysuria, and back pain and is admitted to the hospital after evaluation in the ER discloses pyelonephritis. The patient is placed on broad-spectrum antibiotics and has a good improvement in her symptoms. On hospital day 4, the patient develops a new fever, leukocytosis, and profuse watery diarrhea. A colonoscopy is performed and the following finding is seen What is the first-line therapy for treating this disorder?

A45-year-old male presents to the hospital for acute abdominal pain and is found to have acute pancreatitis. He has no past medical history but recently has noticed urinary frequency and muscle weakness. He takes no medications. He denies alcohol use. His liver function tests during the episode are normal and magnetic resonance cholangiopancreatography study (MRCP) demonstrates an absence of stones in the biliary tree as well as a normal pancreatic duct. His serum calcium is found to be markedly elevated during this episode. The patient recovers clinically, and repeat serum calcium is also found to be elevated 1 month after hospital discharge. What is the most likely cause of his hypercalcemia?

In the adult neutropenic patient, which of the following is the most likely organism to cause bacterial meningitis?

A 53-year-old woman with five adult children complains of losing urine shortly after coughing or jumping. She occasionally loses urine while lying in bed if she happens to cough vigorously. She is unable to stop the urine once it has begun to flow. Which of the following would most likely confirm the cause of this woman's incontinence?

A 53-year-old woman with five adult children complains of losing urine shortly after coughing or jumping. She occasionally loses urine while lying in bed if she happens to cough vigorously. She is unable to stop the urine once it has begun to flow. Which of the following is the treatment of choice for this woman's urinary incontinence? a course of nitrofurantoin

A 16-year-old girl presents because she has not begun to menstruate. Also, breast development and pubic hair have not developed. She is 59 in. (150 cm) tall and weighs 115 lbs (52 kg). On examination, her vital signs are normal. She has skin folds on the lateral sides of her neck. She has evidence of cubitus valgus. Breasts are Tanner stage 1 and the nipples appear to be spaced wider than average. Pubic hair is Tanner stage 1. The external genitalia are normal. The vagina is of normal depth and a small cervix is seen on speculum examination. The uterus is present but small. There are no adnexal masses. Which of the following is the most likely diagnosis?

A 16-year-old girl presents because she has not begun to menstruate. Also, breast development and pubic hair have not developed. She is 59 in. (150 cm) tall and weighs 115 lbs (52 kg). On examination, her vital signs are normal. She has skin folds on the lateral sides of her neck. She has evidence of cubitus valgus. Breasts are Tanner stage 1 and the nipples appear to be spaced wider than average. Pubic hair is Tanner stage 1. The external genitalia are normal. The vagina is of normal depth and a small cervix is seen on speculum examination. The uterus is present but small. There are no adnexal masses. What is the most likely karyotype of this 16 year old?

A 63-year-old Native American male, with a 6-year history of DM, hypertension, and hyperlipidemia, comes to your office as a new patient for a routine examination. He has been experiencing frequent lower back pain and headaches for which he is taking ibuprofen daily for the past 5 weeks. Moreover, he is complaining of mild fatigue. In addition, he is taking aspirin, atorvastatin, verapamil, and glipizide. His physical examination shows a blood pressure of 165/80 and heart rate of 90 bpm. In general, he was not in any distress. His funduscopic examination reveals no signs of diabetic retinopathy. Cardiac examination reveals a regular rate and rhythm with an S4 gallop. His lungs are clear and abdominal examination is unremarkable without any bruit auscultated. He also has 2+ lower extremity pitting edema. Rectal examination reveals brown stool, negative for occult blood. His laboratory results are as follows: Which of the following is a typical finding in this patient's condition?

A 16-year-old girl presents because she has not begun to menstruate. Also, breast development and pubic hair have not developed. She is 59 in. (150 cm) tall and weighs 115 lbs (52 kg). On examination, her vital signs are normal. She has skin folds on the lateral sides of her neck. She has evidence of cubitus valgus. Breasts are Tanner stage 1 and the nipples appear to be spaced wider than average. Pubic hair is Tanner stage 1. The external genitalia are normal. The vagina is of normal depth and a small cervix is seen on speculum examination. The uterus is present but small. There are no adnexal masses. Which of the following is the treatment of choice for this patient? estrogen replacement therapy

A 55-year-old woman presents to your office with painful hands, causing difficulty opening jars and turning the key in the ignition of her car. She is fatigued and she notices joint stiffness, but limbers up by lunch. She has trouble getting her rings off because of enlarging knuckles. About a year ago, she tried some OTC ibuprofen, which seemed to help, but led to the development of a bleeding ulcer severe enough to require transfusion and ICU care. Otherwise, her health is good, and her review of systems is negative. Your physical examination reveals tenderness and swelling at the index proximal interphalangeal and metacarpophalangeal joints bilaterally. There are small effusions on both knees. She has tenderness to lateral compression of the forefoot area bilaterally. The following data are obtained: normal CBC; normal basic metabolic panel; ESR 40 mm/h; ALT 90 U/L; AST 110 U/L; alkaline phosphatase 70 U/L; bilirubin 0.2 mg/dL; uric acid 5.1 mg/dL; urinalysis is normal. ACE level is normal. Rheumatoid factor is 60 and ANA is positive 1:40 speckled pattern. The next most important test would be which of the following?

Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all. A 28-year-old pregnant woman at 32 weeks' gestation suddenly begins profuse, painless vaginal bleeding. Her prenatal care began at 7 weeks and had been uncomplicated. She last had sexual intercourse 7 days ago. She denies abdominal trauma. Her uterus is soft and nontender, and the fetal heart rate is 132 BPM. threatened abortion gestational trophoblastic disease cervicitis placenta previa placental abruption uterine rupture

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 of the following has been shown to prolong survival in patients with this condition?

Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all. A 23-year-old pregnant woman at 16 weeks' gestation begins to have light vaginal bleeding several hours after sexual intercourse. She has no abdominal discomfort. Her prenatal course has been uneventful and fetal heart tones were heard at 12 weeks. Her uterus is midway between her symphysis pubis and umbilicus, and is soft and nontender. Fetal heart tones are now 148 BPM. Her cervix is undilated. threatened abortion gestational trophoblastic disease cervicitis placenta previa placental abruption uterine rupture

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 factors is associated with the greatest lifetime risk for developing breast cancer? obesity

Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all. A 29-year-old pregnant woman at 38 weeks' gestation presents to your labor and delivery unit complaining of dizziness, heavy vaginal bleeding, and loss of fetal movement. She had been having uterine contractions for approximately 4 hours, but these stopped when the bleeding began. Her previous pregnancy was delivered by classical cesarean section because of a transverse lie. threatened abortion gestational trophoblastic disease cervicitis placenta previa placental abruption uterine rupture

An 82-year-old woman schedules an appointment to see you for neck and back pain. At age 50, she had an L4-L5 diskectomy and laminectomy. She also has long-standing hypothyroidism for which she takes levothyroxine 0.1 mg daily. Over the past few months, she has become more fatigued and describes pain in both of her arms, her low back, and the front of her thighs. She notes that the tops of her shoulders are also achy. She decided to call for an appointment because of worsening headache. She tells you that she has an appointment later this afternoon with her ophthalmologist, because she noticed some flickering of the vision in her left eye. Upon further questioning, she does acknowledge that she has cut her telephone conversation short with her daughter because her jaw begins to ache if she talks too long. Physical examination shows that she has normal vital signs. She has diffuse scalp tenderness. The oral mucosa is normal without aphthous ulcers and the salivary pool is normal. Her pupils are equal, round, and reactive to light and accommodation, and extraocular muscles are intact. The funduscopic examination appears normal for her age. Neck motion is slightly reduced to lateral flexion and rotation. Her trapezii are tender to palpation, but there is no significant loss of range of motion in her shoulders. Her supraspinatus and infraspinatus tendons appear intact. Her quadriceps are mildly tender, but her gastrocnemius muscles are normal. Her strength is normal for age. Her reflexes are normal and symmetrical. Which of the following should be done next?

Select the ONE best lettered option that is the most likely diagnosis of vaginal bleeding in pregnancy. Each lettered option may be selected once, more than once, or not at all. A 31-year-old woman has an uncomplicated labor and vaginal delivery of a healthy 3400-g male infant. However, her placenta has not yet delivered 2 hours after the delivery of her child. Under appropriate anesthesia manual extraction of the placenta is attempted, but the placenta is removed in fragments. She continues to have excessive vaginal bleeding after manual removal of her placenta. Her first child was delivered by a low transverse cesarean section because of fetal distress. threatened abortion gestational trophoblastic disease cervicitis placenta previa placental abruption uterine rupture