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3,531 questions
A 12-year-old boy comes to the clinic for a sports physical. He is new to your practice. He comes with his foster mother, who states that he was recently placed in her care because of his mother's problems with drug abuse. Although a complete medical history is not available, she knows that he has not received regular care. He does not have any chronic medical problems. She also knows that his father died of heart disease when he was 35. On physical examination, the boy's height is greater than the 95th percentile. His arm span exceeds his height. As you continue your physical examination, you remember that congenital heart disease is common in this particular syndrome. Which of the following is the most likely congenital heart defect in patients with this syndrome? supravalvular aortic stenosis
A17-year-old girl comes to the clinic with several weeks of joint pain and rash. The joint pain is most prominent in the hands. She states that the pain is most severe in the morning and tends to improve over the day. She has noted some swelling of her fingers. She has also had a rash on her face that becomes more prominent when she is outdoors. She states that sunlight tends to bother her eyes. On further questioning, she states that she has not felt well for several months. She has had intermittent fever, has been more tired than usual, and has lost weight although she has not been restricting her diet. On physical examination, she looks tired. She has lost 5 lbs since her last visit 1 year ago. She has an erythematous rash on her cheeks. She has several shallow ulcers in her mouth. She has fusiform swelling of her fingers and pain with movement of her fingers. Which of the following is the most likelydiagnosis?
A 74-year-old female with a history of hypertension and hypothyroidism is admitted with easy bruising, guaiac positive stools, and anemia (Hgb 8.1 g/dL). Screening coagulation tests reveal a prolonged activated partial thromboplastin time (aPTT) with a normal prothrombin time (PT) and platelet count. What is the next step in the diagnosis of this woman's problem?
A 23-year-old African-American presents with acute-onset pain in the abdomen, back, and legs. On physical examination, his pulse is 115 bpm, respiratory rate is 20, blood pressure is 100/70 mmHg, and temperature is 101°F. There is scleral icterus, a s ystolic ejection murmur at the right upper sternal border, bilateral rhonchi, a right upper quadrant abdominal scar from a cholecystectomy, and a diffusely tender abdomen without rebound. A neurologic examination is normal. A peripheral blood smear is shown in Figure. Among the initial orders for this patient should be which of the following?
A 4-year-old child presents to your office in July with a history of a low-grade fever (38.1°C) and "s ores" in his mouth for 2 days. He has been refusing to eat but has been drinking an adequate amount of liquids. On examination, he is afebrile and seems well hydrated. He has ulcers on his tongue and posterior pharynx, which are 4 mm in diameter. You also note a few vesicles on his hands and feet, which are 34 mm in size and mildly tender. Which of the following is the most likely diagnosis?
A 23-year-old African-American presents with acute-onset pain in the abdomen, back, and legs. On physical examination, his pulse is 115 bpm, respiratory rate is 20, blood pressure is 100/70 mmHg, and temperature is 101°F. There is scleral icterus, a s ystolic ejection murmur at the right upper sternal border, bilateral rhonchi, a right upper quadrant abdominal scar from a cholecystectomy, and a diffusely tender abdomen without rebound. A neurologic examination is normal. A peripheral blood smear is shown in Figure. The patient develops pain in both hips and an MRI shows avascular necrosis. This is likely due to which of the following?
A 6-year-old girl has a low-grade fever, headache, and nasal congestion. She has a flushed face and has developed a lacy reticular rash on the trunk and extensor surface of her arms and legs. Palms and soles are spared. Her mother has been ill with a low-grade fever and some joint stiffness and pain. Which of the following is the most likely diagnosis?
A22-year-old male presents to the emergency department (ED) with complaints of right-sided chest pain and dyspnea. He has no other significant medical history. There is no history of trauma. On examination, he has a pulse of 95, BP of 110/70, and SpO2 of 95% on 2 L. A chest x-ray reveals a large right pneumothorax. Which of the following statements is true?
Gastrin secretion is enhanced by which of the following?
A 5-year-old febrile child presents with swelling of the right eyelid. Proptosis and limitation of ocular movements is noted. Which of the following is the most likely diagnosis?
A 4-week-old, previously healthy male presents with projectile emesis after feeds. His mother states that he has had 2 weeks of postprandial emesis, which became projectile in the past 2 days. She states that it looks like formula and has never been bilious. Which of the following statements is true?
A1-month-old female presents after an episode of bilious emesis. She became irritable 12 hours ago, began vomiting 6 hours ago, and is now lethargic. She had one small stool that was somewhat bloody 2 hours ago. Which of the following statements is true?
A 23-year-old married woman consults you because she and her husband have never consummated their marriage because she has severe pain with attempts at vaginal penetration. Her pelvic examination is normal except for involuntary tightening of her vaginal muscles when you attempt to insert a speculum. Which of the following conditions would best be treated with the use of vaginal dilators?
A 53-year-old Black male, with a history of hypertension, hepatitis C, and newly diagnosed nonsmall cell lung cancer, undergoes his first round of chemotherapy, which includes cisplatin. You are called to see this patient 5 days into his hospitalization for oliguria and laboratory abnormalities. Other than the chemotherapy, he is receiving lansoprazole, acetaminophen, and an infusion of D5-- 0.9% normal saline at 50 mL/h. On examination, his BP is 98/60 and heart rate is irregular, between 40 and 50 bpm. His physical examination shows a middle-aged male in no acute distress. His cardiac examination is unremarkable, his lungs show bibasilar crackles, and the abdominal examination is positive for a palpable spleen tip without any hepatomegaly or abdominal tenderness. He has trace bilateral ankle edema. His distal pulses are irregular. The neurologic examination was unremarkable. His laboratory (serum sample) results are as follows Which electrolyte/acid-base abnormality is most likely responsible for the findings on physical examination?
A 32-year-old woman presents with complaints of irritability, heat intolerance, hyperdefecation, and frequent palpitations. She has lost 20 lb over the past six months. She has always been in good health and does not take any prescription or OTC medications. She denies any prior history of thyroid disease or exposure to head/neck irradiation, but she states that one of her relatives was diagnosed with a thyroid disorder at roughly the same age. Vital signs are as follows: BP 138/78, HR 112, RR 22, temp. 98.8°F. On examination, her thyroid is diffusely enlarged and smooth. Auscultation of the thyroid reveals a bruit. Her hair is fine in texture, and she has warm velvety skin. She has hyperactive deep tendon reflexes. There is a fine tremor in her outstretched hands. Which of the following is a common finding in this condition?
For each item, select the ONE best lettered option that is most closely associated with it. Each lettered heading may be selected once, more than once, or not at all. A 42-year-old obese woman complains of hirsutism, amenorrhea, and difficulty becoming pregnant. Cushing's syndrome Addison's disease Klinefelter syndrome hyperparathyroidism hypothyroidism
A32-year-old female presents for her first pap smear in more than 10 years. She has a history of heavy alcohol use and IV drug use and has performed sexual acts for drugs on numerous occasions. Testing performed today reveals her to have chlamydia cervicitis and trichomonas vaginalis and to be seropositive for hepatitis B and hepatitis C. HIV testing is negative. Her pap smear subsequently returns with carcinoma in-situ of the cervix. What should be the next step in her work-up?
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. Following the establishment of a diagnosis, what is the most appropriate initial therapy?
A 70-year-old man presents with shuffling gait, tremor, masked facies, and rigidity which have progressed over the last 9 months. Parkinson's disease is diagnosed. In this patient, which neurotransmitter deficiency primarily is responsible for his symptoms?
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 appropriate initial therapy for the patient's hypercalcemia?