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3,531 questions
A 32-year-old man comes to the office for his annual checkup. He is asymptomatic and his physical exam is normal. He reports that his father died of colon cancer at age 46 and his older brother was recently diagnosed with colon cancer at age 37. His paternal aunt was previously diagnosed and treated for endometrial cancer. He is concerned about his family history of malignancy and wants to discuss cancer screening. What would be the most appropriate recommendation at this time?
An 8-year-old African American boy is brought in for evaluation of a mass on the scalp. On examination, he is afebrile and nontoxic. There is a boggy mass on his scalp with alopecia. His posterior cervical lymph nodes are enlarged but nontender. Which of the following is the most appropriate treatment?
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. A34-year-old woman, gravida 5, has a 17-hour first stage, a 3.5-hour second stage ending with a spontaneous vaginal delivery of a 4400-g infant, and a 15-minute third stage of labor. Immediately after the placenta delivers, she has profuse vaginal bleeding. On examination, her perineum is intact and there are no vaginal or cervical lacerations. Her uterus is soft and the uterine fundus is 45 cm above her umbilicus. threatened abortion gestational trophoblastic disease cervicitis placenta previa placental abruption uterine rupture
Which of the following risk factors has the strongest association with the development of malignant melanoma?
A 2-year-old child was recently adopted from India. She appears to be healthy, and there are no abnormal symptoms. Her weight and height are at 25th percentile for age. Her examination is normal. On screening, you find a positive TB skin test using purified protein derivative (PPD) with 20 mm induration. She has a history of receiving a BCG vaccination at birth. Your management plan is to do which of the following?
A54-year-old man without significant past medical history presents to his primary care physician complaining of epigastric discomfort and early satiety. He subsequently undergoes an endoscopic procedure revealing an ulcerated mucosal lesion. The biopsy of this lesion is interpreted as a well-differentiated lymphoma. Which of the following statements regarding his treatment and prognosis is most accurate?
A baby is born to a mother who is positive for hepatitis B surface antigen (HBsAg). Your plan is to do which of the following?
In an adolescent presenting with pityriasis rosea, which of the following would be an appropriate blood test to order?
A 72-year-old man with a diagnosis of prostate cancer was recently seen in the clinic for restaging and re-evaluation. His bone scan showed development of widespread osseous metastases and his PSA was rising. He was started on leuprolide acetate, a gonadotropin releasing-hormone (GnRH) agonist. He now returns to the clinic complaining of new severe mid-thoracic back pain, which is worse with recumbency and worse with Valsalva maneuver. He also reports that he has a brief but intense electric shock sensation in his lower extremities when he bends over to tie his shoes. On physical exam, he had localized tenderness over the mid-thoracic spine, but his motor strength, sensation, and deep tendon reflexes are all intact. What is the most important prognostic factor regarding this patient's ultimate neurological outcome?
A parent brings in a 5-year-old boy being treated for acute lymphocytic leukemia (ALL). He states a friend who is staying with them at their home has just come down with chicken pox. Your patient has not had chicken pox or received immunization with varicella vaccine. What is the appropriate treatment?
A 72-year-old man with a diagnosis of prostate cancer was recently seen in the clinic for restaging and re-evaluation. His bone scan showed development of widespread osseous metastases and his PSA was rising. He was started on leuprolide acetate, a gonadotropin releasing-hormone (GnRH) agonist. He now returns to the clinic complaining of new severe mid-thoracic back pain, which is worse with recumbency and worse with Valsalva maneuver. He also reports that he has a brief but intense electric shock sensation in his lower extremities when he bends over to tie his shoes. On physical exam, he had localized tenderness over the mid-thoracic spine, but his motor strength, sensation, and deep tendon reflexes are all intact. What is the most likely explanation for the rapid onset of back pain and neurological difficulty after the initiation of leuprolide? The patient's tumor was likely androgen-independent and so did not respond to hormonal therapy, with rapid progression of his cancer.
A young mother claims that her 4-week-old child sleeps best on his stomach. You tell her that the safest sleep position for infants is which of the following?
You receive a call from the parents of a 1 year old who is due for his well-child visit next week. They have just received a letter from their daycare center that an employee has hepatitis A. Which of the following is the best treatment plan? Give hepatitis A immune globulin and hepatitis A vaccine.
A 48-year-old woman with metastatic breast cancer presents to the Emergency Center complaining of a 4-day history of nausea, anorexia, and generalized weakness. Her husband reports that she has been more somnolent, sleeping 1214 hours per day, and at times she seems confused. CT scan of the brain reveals no abnormalities. Initial laboratory evaluation reveals a normal CBC, but her BUN is elevated at 32 mg/dL with a slight elevation of serum creatinine above her baseline. Her serum calcium is elevated at 15 mg/dL. What is the most likely cause of her hypercalcemia?
A5-year-old child was hit in the right eye by a toy. He is rubbing at his eye, which is watering profusely. There is a small abrasion at the corner of the eye. He is mildly photophobic, but his pupils are equal, symmetric, and reactive to light and accommodation. His vision is normal. Which of the following is the most appropriate next step in the management of this patient?
A 9-month-old male is in for a well-child checkup. He is greater than 90th percentile for height, and he weighs 25 lbs. He no longer fits in his infant car seat, which is only recommended for use by children under 20 lbs. Which of the following is the safest car seat option for him?
A 2-month-old infant is brought to the emergency department with irritability and lethargy. The parents state that he was well until he rolled off the couch on to the floor yesterday. On examination, he is inconsolable and afebrile. The fontanels are full and tense. He has a generalized tonic-clonic seizure. Which of the following is the most important initial diagnostic study to order?
A 7-year-old girl presents with hives, which developed after a bee sting. She has no other symptoms. The hives resolve with diphenhydramine. Which of the following is the most appropriate management?
A 25-year-old woman with acute myelocytic leukemia is undergoing induction chemotherapy and presents to the Emergency Center complaining of a 1-day history of fever to 102º F with no other symptoms. Other than having a fever, her vital signs and physical examination are normal. Laboratory evaluation reveals pancytopenia, with a WBC count of 0.3 k/L, hemoglobin concentration of 9.2 mg/dL, and platelet count of 23,000/L. What is the most appropriate initial management?
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 the most important risk factor for development of this skin condition?