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127 questions
A 50-year-old man comes to the emergency room (ER) with a history of vomiting of 3 days' duration. His past history reveals that for approximately 20 years he has been experiencing epigastric pain that lasts for 23 weeks during spring and autumn. He remembers getting relief from pain by taking milk and antacids. Physical examination showed fullness in the epigastric area with visible peristalsis, absence of tenderness, and normal active bowel sounds. What is the most likely diagnosis?
A 65-year-old man presents to your office for evaluation of abdominal pain. The patient states that he has epigastric pain that radiates to his back. The pain is worse with eating and improves with fasting. The pain has been present for 6 months and is gradually worsening. The patient has lost 15 lbs but feels his oral intake has been adequate. He complains of greasy stools and frequent thirst and urination. Examination reveals a thin male with temporal wasting and oderate abdominal pain with palpation. The patient consumes approximately 1015 beers per day and smokes a pack of cigarettes per day for the past 20 years. On further evaluation, the patient is found to be diabetic. He has an elevated HgbA1C and fasting hyperglycemia. The patient is sent for diabetic teaching sessions and begun on insulin therapy, but is unable to achieve euglycemia. He experiences frequent bouts of symptomatic hypoglycemia requiring ER visits. What is the most likely cause for these episodes?
A42-year-old man without prior significant medical history comes to your office for evaluation of chronic diarrhea of 12 months duration, although the patient states he has had loose stools for many years. During this time he has lost 25 lbs. The diarrhea is large volume, occasionally greasy, and nonbloody. In addition, the patient has mild abdominal pain for much of the day. He has been smoking a pack of cigarettes a day for 20 years and drinks approximately five beers per day. His physical examination reveals a thin male with temporal wasting and generalized muscle loss. He has glossitis and angular cheilosis. He has excoriations on his elbows and knees and scattered papulovesicular lesions in these regions as well Which of the following is the best test to confirm the suspected diagnosis?
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?
In an adolescent presenting with pityriasis rosea, which of the following would be an appropriate blood test to order?
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?
A 45-year-old female develops fever, dysuria, and back pain and is admitted to the hospital after evaluation in the ER discloses pyelonephritis. The patient is placed on broad-spectrum antibiotics and has a good improvement in her symptoms. On hospital day 4, the patient develops a new fever, leukocytosis, and profuse watery diarrhea. A colonoscopy is performed and the following finding is seen What is the first-line therapy for treating this disorder?
A92-year-old man is referred from his nursing home for evaluation of lethargy. Examination is unrevealing, but laboratory results are significant for a serum sodium level of 118 meq/L (normal, 135 148). Serum osmolality is 260, urine osmolality is 450, and urine sodium is 80. Which of the following is the most likely cause of this patient's lethargy?
A 48-year-old man complains of fatigue and shortness of breath. His hematocrit is 32% and hemoglobin is 10.3 g/100 mL. Peripheral blood smear reveals macrocytosis. His serum vitamin B12 level is 90 pg/mL (normal, 170940); serum folate level is 6 ng/mL (normal, 214). Which of the following is the most likely cause of this patient's symptoms?
A 45-year-old male with type II diabetes, hypertension, and hyperlipidemia presents to your clinic as a new patient. He has been out of his cholesterol medications and came to your office requesting a refill. The patient brought his most recent lipid profile (done after he was off his cholesterol medication for 3 months) which revealed: Cholesterol (total): 242 mg/dL HDL cholesterol: 38 mg/dL Triglycerides (TGs): 660 mg/dL LDL cholesterol = unable to calculate due to high TGs He also had recent liver function tests that were normal. Based on Adult Treatment Panel (ATP) III guidelines, which of the following medications should be the initial pharmacologic treatment for this patient?
A 31-year-old female health care worker presents to your clinic after a needlestick injury from a patient who subsequently left against medical advice prior to laboratory analysis for HIV or hepatitis. You advise your colleague that:
A 23-year-old man presents complaining of severe crampy abdominal pain and blood in his stool over the past 2 days. Asimilar episode occurred a few months ago and spontaneously resolved. No history of travel. Abdominal x-ray shows mild colonic dilatation. Which of the following is the most likely diagnosis?
A42-year-old patient suffering from alcoholism has advanced liver disease with ascites. He is hospitalized for agitation and bizarre behavior. Which of the following findings is most helpful in making the diagnosis of hepatic encephalopathy? In the patient above, his blood ammonia level is twice his baseline. Which of the following is a likely precipitating factor?
A42-year-old patient suffering from alcoholism has advanced liver disease with ascites. He is hospitalized for agitation and bizarre behavior. Which of the following findings is most helpful in making the diagnosis of hepatic encephalopathy?
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 Which statement best describes this clinical situation?
Apreviously healthy 19-year-old woman has a sudden onset of headache, profound myalgias, profuse vomiting, and diarrhea. The woman is near the end of her menstrual period and is using tampons. She appears to be suffering from toxic shock syndrome (TSS). Which of the following is the most likely skin finding? papular rash on the trunk
Bupivacaine is a local anesthetic agent that is much more potent and the duration of action of which is considerably longer than procaine. Possible reasons for this difference include which of the following?
A 43-year-old prison cook becomes ill with jaundice, malaise, and fever. Shortly thereafter, multiple prison inmates develop similar symptoms. According to the above symptoms, select the most likely type of viral hepatitis.
A 45-year-old woman presents with fever, anorexia, nausea, and diarrhea. Other patients in the community have presented similarly and have a common exposure at a local restaurant. In the above case of hepatitis, select the most likely type of viral hepatitis.
A 46-year-old woman presents with a 4-hour history of left flank pain with fever and chills. On examination, her temperature is 103°F, pulse rate is 120/ min, respiratory rate is 40/min, and supine BP is 80/40 mmHg. She has marked tenderness over the left flank and left upper quadrant of the abdomen without rebound. Urinalysis shows multiple red blood cells (RBCs), multiple WBCs, and WBC casts. Which of the following is the most likely diagnosis? appendicitis