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3,531 questions
A 4 year-old-boy presents to your clinic with anal itching of 2 weeks' duration. His mother denies itching in other family members. Tape applied to his perianal skin shows oval structures. Of the following, the most appropriate management of this patient is
Dupuytren's contracture is caused by a thickening of the palmar fascia. It is associated with the following conditions, except?
A 12-year-old girl presents to your office for the first time with a swollen, painful, erythematous right knee joint. She tells you that her left knee felt and looked similar yesterday, but now feels normal. She also is easily fatigued and has had fever. On physical examination, she has a temperature of 101.7°F (38.7°C), a heart rate of 125 beats/min, a respiratory rate of 24 breaths/min, and a blood pressure of 120/78 mm Hg. Her lungs are clear. On auscultation, you note a 3/6 holosystolic murmur (Item Q87A) at the cardiac apex with radiation to the axilla. Of the following, the BEST plan for management of this patient's joint swelling includes
The parents of an 8-year-old girl who has asthma would like to know more about possible triggers. The girl has had mild persistent asthma since age 5 years and frequently has increased symptoms in the fall that coincide with starting school. During the fall, she experiences increased rhinorrhea, sneezing, and ocular pruritus. These nasal and ocular symptoms have occurred each fall for the past 3 years but generally do not occur at other times of the year. Of the following, the MOST likely trigger for the patient's asthma exacerbations is
A 3-year-old boy who recently was adopted is brought to you for the first time. The adoptive mother explains that the biologic mother had a history of intravenous drug use, and the child is hepatitis C-positive. On physical examination, the happy, active child has no evidence of an enlarged liver or spleen. You discuss with the mother the possibility of referral to a specialist for antiviral therapy. Of the following, a TRUE statement about treatment of hepatitis C is that
A 40-year-old woman presents complaining that her right eye hurts and that she cannot tolerate the bright light in the room. She is protecting her right eye with her hand. There is no history of trauma or foreign body. Visual acuity is reduced in the right eye. Examination reveals redness at the junction between the cornea and sclera of the right eye. The right pupil appears small. Slit lamp examination reveals a collection of cells in the anterior chamber of the eye. What is the most likely cause of this woman's symptoms?
During a sports physical, you note that a 14-year-old boy has thoracic kyphosis. He cannot pull his shoulders back to correct the curvature in the standing position. The kyphosis persists in the prone position. A standing lateral radiograph reveals a kyphotic curve of 50 degrees between T3 and T12, with anterior wedging of vertebrae at T7 and TS and T9. The patient is at Risser stage 4. Of the following, the MOST appropriate management plan for this patient is to
A 45-year-old woman is diagnosed with a submandibular calculus, having presented with a tender lump below the jaw on eating. Which structure is likely to be obstructed?
A 15-year-old girl is rushed to the emergency department after slipping off a diving board and striking her head on cement. On physical examination, her mental status evaluation results are completely normal. She can abduct her upper extremities at the shoulder, but cannot flex or extend her arms and minimally moves her imgers. She cannot move her limp lower extremities. You order emergent magnetic resonance imaging of the brain and spine. Of the following, the MOST important therapy to implement before the patient is sent for imaging is
A patient is sent for emergency laparoscopic cholecystectomy after being diagnosed with acute cholecystitis, which failed to resolve after 48 hours. One step of this procedure entails clamping and dividing the arterial blood supply to the gallbladder to facilitate its resection. From the list of answers below, select the artery that supplies the gallbladder?
You are examining a patie.nt and looking for the second intercostal place by fmding the manubriosternal junction (also known as the 'angle of Louis'). From the list below, choose the vertebral level that corresponds to the manubriosternal junction?
A 19-year-old girl presents with a recent history of stumbling gait associated with frequent falls and increasing difficulty with her vision, requiring frequent prescription changes. She reports that her grandfather was approximately 40 years old when he died of heart failure, but she and the remainder of her family are otherwise well. Examination reveals bilateral clubbed feet, upward going plantar reflexes, scoliosis and a prominent fourth heart sound. A genetic test is performed, which shows that she is suffering from Friedrich's ataxia. This condition is the result of a defective gene on which chromosome?
His visual acuity is not significantly impaired. Which one of the following best describes this patient's eye disease?
A 6-year-old girl presents with a 1-year history of periumbilical, nonradiating abdominal pain. The pain occurs at least three times per week and lasts up to 30 minutes. There is no history of heartburn, constipation, or diarrhea. Physical examination, complete blood count, erythrocyte sedimentation rate, and urinalysis yield normal results. A Helicobacter pylori serology (immunoglobulin G antibody) is positive. Of the following, a TRUE statement regarding this patient is that:
While assisting in the repair of an inguinal hernia, you are asked to define the boundaries of the Hesselbach's triangle. This anatomical region is defined by?
A 67-year-old female is taken to theatre for suspected bowel perforation. The oncall anaesthetist is inserting a central venous catheter through the subclavian vein. From the list below which structure is at less risk of damage during this procedure?
You are observing an elective right hip replacement. The lead surgeon is accessing the hip joint via the posterior approach. From the list below, choose the correct order (from superficial to deep) and correct structures that are cut through during the posterior approach to the hip?
An 11-year-old girl was brought to accident and emergency in December with pain in her left leg. She is known to have sickle cell disease and her baseline haemoglobin is 7.0 g/dL. She has been admitted in the past with painful leg and chest crises. She has a cough and coryza. Today her blood results show: haemoglobin 6.8, white cell count (WCC) 12 x109/L, platelets 209 x109/L, C-reactive protein (CRP) 20 mg/L. What is not part of the appropriate initial management?
A father carries his 5-year-old child into the emergency department after a motor vehicle crash in which his vehicle rolled over several times. The accident occurred 1 minute away. The boy was restrained by lap and shoulder belts. He did lose consciousness. In his father's arms, the USMLE Pediatry2e/Emergency child moans softly but does not open his eyes. Of the following, the MOST dangerous consequence of transporting this injured child to the emergency department in this manner is
A sexually active adolescent male presents with the primary complaint of pubic and perianal pruritus. Careful examination reveals pubic or "crab" lice infestation. Of the following, the MOST characteristic feature of this infestation is that the lice: