Medical
Browse, search and filter 3,531 questions.
3,531 questions
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:
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 3-month-old boy is admitted to the hospital for evaluation of failure to thrive. His birthweight was at the 50th percentile and length at the 75th percentile. Currently, his weight is below the 5th percentile and length is at the 25th percentile. His vital signs and physical examination results are otherwise normal. He appears well hydrated. Measurement of serum electrolytes reveals: sodium, 139 mEq/L (139 mmol/L); potassium, 4.7 mEq/L (4.7 mmol/L); chloride, 114 mEq/L (114 mmol/L); bicarbonate 12 mEq/L (12 mmol/L); blood urea nitrogen, 8 mg/dL (2.9 mmol/L); and creatinine, 0.3 mg/dL (26.5 mcmol/L). A consulting nephrologist recommends measurement of urine pH (which is 7.5) and urine ammonium (which is 12,000 mcM/L) (normal, >60,000 mcM/L). Of the following, the MOST likely cause of this child's acidosis is
A 3-year-old boy who has spina bifida has a history of recurrent urinary tract infections (UTis). He is currently being treated for a UTI. Monitoring laboratory evaluation shows a blood urea nitrogen of 23 mg/dL (8.2 mmol/L) and a creatinine concentration of 1.1 mg/dL (97.2 mcmol/L). Of the following, the class of antibiotics that is MOST commonly associated with renal toxicity is
During a repair of a primary ing11inal hernia, you are asked to name the nerve that is located within the spermatic cord. Which of the following is the nerve that is fot1nd within the spermatic cord?
A 12-year-old girl presents to the emergency department with abdominal pain. Her parents report that she awakened with a temperature of 101°F (38.4°C) this morning, complained of abdominal pain, and has vomited twice. There is no diarrhea, and there are no sick contacts. She reports nausea and no interest in food or drink. She was previously entirely healthy. Urinalysis reveals a specific gravity of 1.015 and is otherwise normal. Of the following, the finding that MOST indicates the need for immediate surgical intervention is
Retinopathy of prematurity (ROP) is the leading neonatal cause of blindness in the United States. Of the following, the population at GREATEST risk for severe ROP comprises infants
As part of your clinic responsibilities, you supervise allergy shots for patients who have allergic rhinitis. The nurse calls you about a 12-year-old girl who received her allergy shot 30 minutes ago and now is experiencing warmth and erythema over the injection site. On physical examination, the patient appears healthy and in no distress. Vital signs include a temperature of97.5°F (36.4°C), heart rate of 90 beats/min, and respiratory rate of 18 breaths/min. At the injection site, there is a 4 x 4 cm raised, erythematous, warm area. There is no edema of the tongue or uvula, and findings on her pt1lmonary, cardiovascular, and skin examinations are otherwise normal. Of the following, the NEXT most appropriate action is to
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
You diagnose attention-deficit/hyperactivity disorder in a 10-year-old boy and recommend treatment with methylphenidate. His mother asks about potential adverse effects of the treatment. Of the following, the MOST common adverse effect of treatment is
Physical examination of a newborn female reveals meningomyelocele; dysmorphic features, including a narrow bifrontal diameter, epicanthal folds, a broad and low nasal bridge, and midface hypoplasia; and a short systolic murmur. Results of echocardiography document coarctation of the aortic arch. Of the following, the MOST likely prenatal exposure to explain these findings is
A 17-year-old girl presents with amenorrhea of 6 months' duration. One year ago she joined the cross country team at school. At that time, her periods had been regular, about every 26 days, and remained so for the 3-month running season. At the end of the season, she continued to run 5 miles a day to be more competitive for the subsequent season. She noticed that her menstrual flow was lighter for a few months preceding the amenorrhea. You suspect exercise-induced amenorrhea and recommend a decrease in exercise. Of the following, the factor MOST likely to be associated with a low bone density and stress fractures in this patient is
You review a patient on the ward who has suspected cardiac tamponade following insertion of a pacemaker. You are asked to perform a rapid initial assessment of the patient. Which one of the following clinical signs from the list below would you expect to see in a patient with cardiac tamponade?
A 14-year-old boy has a body mass index that is greater than the 95th percentile for age and an accelerating weight curve. His blood pressure is 135/85 mm Hg. His mother has type 2 diabetes that developed during her first pregnancy, and several paternal relatives also have type 2 diabetes. The family emigrated from the Caribbean when he was a toddler. He has dark velvety thickening of the skin on his neck and under his arms. Of the following, the findings that are MOST supportive of a diagnosis of metabolic syndrome in this young man are
You are speaking to the mother of a child who attends a junior high school where one of the students was diagnosed with meningococcal disease 24 hours ago. Her child does not have any classes with the index patient and, except for passing him in the hall during lunch 3 days ago, has had no other contact with the patient. The child's mother is frantic because the school sent home a notice asking parents to bring their children to the public health department or their private physician to receive antibiotic prophylaxis. Of the following, the MOST appropriate advice for this parent is that her child:
A 6-year-old boy is registering with a new GP, having just moved to the area. He is in a wheelchair but is able to mobilize with a fast scissoring gait over short distances. He has increased tone in his legs and has scars from previous tendon release surgeries. His upper limbs are normal. His mother says that his school performance is good and he is writing well. She thinks he was going to have a Statement of Special Educational Needs assessment before they moved. As the GP, what is the most appropriate next step in management?
You are evaluating a 6-year-old boy who has Duchenne muscular dystrophy. He is doing well in a regular classroom and will be attending second grade in a different school next year. On physical examination, you note a healthy-appearing boy who has pseudohypertrophy of the calf muscles and uses a Gower maneuver to rise from the floor. In gathering information to help this child's transition to a new school, yon are MOST likely to ask about
A 2-year-old child is brought to cardiology clinic due to a heart murmur heard by the GP after an examination when she was recently unwell. She was born at 40 weeks by normal vaginal delivery but was noted to have a cleft palate at birth. She was kept in hospital for establishment of feeding but during this time she had a seizure, noted later to be because her calcium was low. You hear a harsh, grade 3/6 pansystolic murmur, loudest at the left lower sternal edge, consistent with a ventral septal defect (VSD) as seen on echocardiogram. With this history and current examination fmding, you wish to exclude DiGeorge's syndrome. What is the best diagnostic test?
A 15-year-old boy attends his GP with a week of cough productive of yellow sputum, fever to 39°C and chest pain on the right side of the chest on coughing. There is no history of foreign travel or unwell contacts. On examination there is reduced air entry in the right lower zone with crepitations and bronchial breathing. You diagnose a right-sided chest infection. What is the most likely causative organism?
A 10-day-old baby boy was brought to accident and emergency with a distended abdomen. On questioning, he was born at term with no antenatal concerns. Until 2 days ago he had been feeding well and not vomiting, he had been wetting nappies, but mother has not witnessed a good urinary stream. On examining the child, you find a mass, dull to percussion, arising out of the pelvis, and he has had no wet nappies for the last day. You suspect he may have posterior urethral valves. Which one test will help to diagnose this underlying condition?