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3,531 questions
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 most likely diagnosis?
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 is most likely to be found on a CXR?
A 29-year-old woman complains of fatigue and decreased exercise tolerance. She takes no medications and denies changes in the color of the stool. Physical examination is significant for pale skin and conjunctivae. Stool was negative for blood. Laboratory evaluation revealed Hgb of 7.8 g/dL, reticulocytopenia, microcytosis, and hypochromia. In vitamin B12 or folate deficiency, which of the following statements is correct?
You evaluate a 38-year-old man who complains of muscle weakness. Her appearance is remarkable for a periorbital heliotrope rash with edema and erythema on his upper chest, neck, and face. Which of the following is the most likely diagnosis? Which of the following examination findings would this patient most likely have?
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: With regard the workup of this man's proteinuria, what diagnostic test would you perform next?
For each antihypertensive agent listed below, select the set of undesirable side effects with which it is most commonly associated with hydralazine cough, hyperkalemia, angioedema
At a follow-up routine prenatal visit, the uterine fundus of a healthy 23-year-old pregnant woman is palpated halfway between her symphysis pubis and umbilicus. Which of the following is the most appropriate test to order at this stage of her pregnancy? serum human immunodeficiency virus (HIV) titer
A23-year-old presents with the history of a suspected spider bite to the left groin. On questioning, no one saw a spider. The patient has been healthy except occasional boils under his arms and in the groin. The patient is afebrile. No family members are sick. The patient is sent home and a day later develops chills, fever, and the lesion is spreading. Appropriate treatment would include which of the following?
A 34-year-old female sex worker presents with a several week history of fatigue, malaise, fever, and a 10-lb weight loss. Over the last 2 weeks, the patient noted a rash on her face, torso, arms, legs, palms, and soles. The patient is HIV negative on a test 2 months ago, has had hepatitis B, gonorrhea, and chlamydia. The patient has an oral temperature of 100.6°F, and generalized lymphadenopathy. The patient does not have any lesions in the mucous membranes. What is the appropriate treatment?
Apatient you see routinely in the clinic has elevated liver function tests. ALT is 89, AST is 75, and the total bilirubin and alkaline phosphatase are normal. The patient has no past history of hepatitis, taking medications, or excessive drinking. You order hepatitis serologies. The results are as follows: Positive: HBsAg and anti-HBc. Negative: anti-HBs, anti-HBc IgM, anti-HAV, and anti-HCV What is the most appropriate next step for this patient?
A 49-year-old woman with a history of migraine headaches reports 6 days of persistent headache, nausea, and recurrent vomiting. On examination, the patient is orthostatic. Electrolytes show a bicarbonate of 42 and a blood gas is obtained revealing a pH of 7.53, carbon dioxide of 53, and PO2 of What is the underlying acid-base abnormality?
A 17-year-old girl notes an enlarging lump in her neck. On examination, her thyroid gland is twice the normal size, firm to rubbery, multilobular, nontender, and freely mobile. There is no adenopathy. Family history is positive for both hypo- and hyperthyroidism. Her serum triiodothyronine (T3) and thyroxine (T4) levels are low normal, and serum thyroid-stimulating hormone (TSH) is high normal. Technetium scan shows nonuniform uptake. Serum and antithyroglobulin titer is strongly positive. What will thyroid biopsy of this patient most likely disclose?
A 58-year-old woman is concerned about her risk for osteoporosis and is seen by her general internist. Her mother was diagnosed with osteoporosis and had a hip fracture at age 84. She has no personal or family history of kidney stones or ulcer disease, and she has never had a fracture. She had a hysterectomy at age 48 and took estradiol for 2 years, but discontinued because of a fear of adverse effects. She does not have any vasomotor symptoms. She takes 1500 mg of calcium carbonate and 400 IU vitamin D daily. She is not on any other medications. On examination, she appears well developed and there is no evidence of kyphosis. ABMD test is performed that demonstrates a T score in the spine of 3.5 and in the hip of 2.8. CXR and mammogram are normal. Further evaluation demonstrates the following: Which of the following is the most likely diagnosis?
Which of the following patterns is most consistent with the physiologic profile of cardiogenic shock? CVP CO SVR SVO2
A 25-year-old man has the sudden onset of chest pain on the right side and dyspnea. On CXR, his trachea is deviated to the left. Which of the following should be anticipated on examination?
A30-year-old female presents to your office for the evaluation of a rash on her back. It has been present and growing for about a week. Along with this rash, she has had a fever, headache, myalgias, and fatigue. Her symptoms started about a week after returning from a camping trip to New England. She denies having any bites from ticks or other insects and exposure to poison ivy and has had no wounds to her skin. On examination, her temperature is 99.5°F and her v ital signs are otherwise normal. Her rash is shown in Figure. Her examination is otherwise unremarkable. What is the most likely cause of her rash?
A 34-year-old amateur spelunker develops cough, dyspnea, and fever 2 weeks after a caving expedition to caves in Kentucky. On physical examination, the patient's temperature is 102°F and respiratory rate is 24. On pulmonary examination, there are diffuse crackles bilaterally. A CXR is shown in Figure. What diagnostic test would be most appropriate?
A67-year-old female with past medical history of rheumatoid arthritis on chronic steroid treatment and past surgical history (PSH) of complete hysterectomy secondary to fibroids presents for routine visit. Patient states that she has had multiple arthralgias worsening over the last 2 years. She had a DEXA scan done that showed a T score of -1.5. She has been taking calcium + vitamin D, and even started an exercise program at her local gym. She was started on bisphosphonates, which she has tolerated well. Prior to discharging the patient, how soon would you counsel her to repeat the DEXA scan?
A 34-year-old amateur spelunker develops cough, dyspnea, and fever 2 weeks after a caving expedition to caves in Kentucky. On physical examination, the patient's temperature is 102°F and respiratory rate is 24. On pulmonary examination, there are diffuse crackles bilaterally. A CXR is shown in Figure. Which of the following is the most likely cause of disease in this patient?
Apatient you see routinely in the clinic has elevated liver function tests. ALT is 89, AST is 75, and the total bilirubin and alkaline phosphatase are normal. The patient has no past history of hepatitis, taking medications, or excessive drinking. You order hepatitis serologies. The results are as follows: Positive: HBsAg and anti-HBc. Negative: anti-HBs, anti-HBc IgM, anti-HAV, and anti-HCV What is your interpretation?