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3,531 questions
A 22-year-old man comes to your clinic for evaluation of chronic abdominal pain. The patient has been experiencing pain for 1 year. Initially, the pain was episodic, but lately it has become constant. It is felt in the epigastrium and radiates to the back. Sometimes the pain is accompanied by nausea and vomiting. The patient denies having diarrhea. Physical examination is unremarkable. An upper endoscopy and abdominal CT scan are unremarkable. You suspect chronic idiopathic pancreatitis. Which of the following would be the most appropriate test to confirm the diagnosis?
A 23-year-old female patient presents to your office for a routine annual visit. She mentions that her mother tested positive for the ''breast cancer genes.'' She asks you for general information regarding these tests and about the need for her and her family to be tested for these mutations. Which of the following statements is correct regarding BRCAl and BRCA2 testing?
A 67-year-old man presents to accident and emergency with a 3-day history of shortness of breath. On examination you palpate the radial pulse and notice that the patient has an irregular heart beat with an overall rate of 140 bpm. You request an electrocardiogram (ECG) which reveals that the patient is in atrial fibrillation. Which of the following would you expect to see when assessing the JVP?
A 65-year-old man presents with central crushing chest pain for the first time. He is transferred immediately to the closest cardiac unit to undergo a primary percutaneous coronary intervention. There is thrombosis of the left circumflex artery only. Angioplasty is carried out and a drug-eluding stent is inserted. What are the most likely changes to have occurred on ECG during admission?
A 26-year-old woman is being evaluated for dyspnea, which she experiences when she engages in physical activity. She has been having these symptoms for the past 4 months. She denies having chest pain, orthopnea, or paroxysmal nocturnal dyspnea. The patient's medical history is significant for her having one episode of atrial fibrillation 1 month ago. Her physical examination shows fixed splitting of S2 and a 2/6 systolic murmur in the pulmonic area. An electrocardiogram shows mild right ans deviation and an rSR' pattern in Vl. A chest x-ray reveals an enlarged right atrium and main pulmonary artery. Which of the following is tl1e most likely diagnosis for this patient?
A 44-year-old African-American woman presents to your clinic with a complaint of weight gain. She reports increasing weight gain over the past year despite any noticeable change in her dietary intake. She notes that most of the added weight is around her abdomen. During the review of symptoms, she notes recent onset of amenorrhea without associated hot flushes. All women in her family experienced menopause after 50 years of age. On physical examination, the patient is hypertensive, with a blood pressure of 152/94 mm Hg. You notice that she has classic moon facies with purple abdominal striae. Which of the foilowing statements regarding the testing for Cushing syndrome is true?
A 36-year-old man comes to your clinic complaining of lack of energy. He was diagnosed with diabetes 2 years ago. Review of systems is positive for decreased libido and energy for the past several months. He has been married for 3 years. He and his wife have been trying to conceive a child for the past year. Physical examination shows decreased pubic and axillary hair; his testicular volume is 15 ml. Total testosterone levels are low; LH and follicle-stimulating hormone (FSH) are in the low-normal range. The prolactin level is normal. Which of the following would be the most appropriate test in the evaluation of this patient?
A 56-year-old man with a long history of alcohol abuse presents to the emergency department with abdominal pain. On examination he bas a distended abdomen with shifting dullness and has a temperature of 38.2°C. What is the most likely diagnosis?
A 58-year-old male with known small cell lung cancer presents to accident and emergency with a 5-day history of severe headache and recurrent vomiting. He has recently commenced chemotherapy for small cell carcinoma of the lung. On examination of the visual fields, there is a left inferior homonymous quadrantinopia. The most important diagnostic investigation is:
Two months after returning from an expedition to the Amazon, a 42-year-old archeologist notices a red-brown papule on her nose. On skin examination, she is suntanned. She also has a verrucous nodule with early ulceration where she first noted the papule on the nose. What would you do for this patient at this point?
A 21-year-old man presents to the acute care clinic complaining of itching. He states that since childhood, he bas had a recurrent rash characterized by ''red, itchy, dry patches'' of skin. Sometimes the rash is associated with ''little bumps.'' Examination of his skin reveals USMLE IM2e/Paraclinic erythematous, scaling plaques on the flexural surfaces of his arms with associated excoriations. You suspect the patient has atopic dermatitis. Of the following findings, which is NOT among the major diagnostic criteria of atopic dermatitis?
A 23-year-old man presents with worsening pain and swelling in his right ankle, which he has had for the past month. He is otherwise healthy, though he admits to an unhealthy lifestyle, including nightshift work, heavy alcohol use on the weekends, and occasional unprotected sex with men, though he has had none in the past 12 months. He denies any history of sexually transmitted disease or intravenous drug use, diarrheal illness, fever, chills, weight loss, dysuria, penile discharge, or other joint pains. On examination, he is in no apparent distress. Removal of his baseball cap reveals a 6 x 15 cm patch of a sharply demarcated, erythematous, scaly rash on his anterior scalp and forehead. Skin and nail examination reveals no further rashes in the groin, gluteal fold, or umbilicus and no nail pitting. A few 1 cm nodes are found in his neck and groin. His right ankle is normal in color but swollen and boggy, with decreased range of motion and mild tenderness to palpation. Biopsy of his scalp suggests psoriasis. What otl1er testing should be performed on this patient?
A 32-year-old woman presents to clinic to establish primary care. She has recently relocated from another city. The patient's medical history is significant for psoriasis, for which she has been treated with methotrexate, 20 mg a week for 6 years. Which of the following should NOT be done to monitor for methotrexate toxicity?
A 28-year-old woman who is 18 weeks pregnant and is GlPO is referred to you by her obstetrician for advice regarding management of a possible VTE diathesis. Although she has no personal history of VTE, she reports that her mother and a cousin both had blood clots during pregnancy; she does not know whether they were tested for clotting disorders. She is feeling well, and her physical examination is remarkable only for her pregnancy. Which of the following actions would you take for this patient?
A 16-year-old male becomes unresponsive immediately after being hit in the chest by a baseball in a local game. A family member reports that the patient has a ''heart murmur.'' He takes no medications. The emergency medical service is called and finds the patient to be pulseless. Resuscitation attempts are started and are unfortunately unsuccessful. Which of the following is the most likely mechanism behind tbjs patient's cardiac arrest?
A 15-year-old girl is being evaluated for a heart murmur. She is asymptomatic. On physical examination, her blood pressure is 174/104 mm Hg on her right arm. Her pulses are 2+ on her upper extremities. The femoral pulses are slightly lower in amplitude than the radial pulses. Her cardiac examination reveals a short midsystolic murmur in the left infrascapular area. For this patient, which of the foilowing is most likely to be found on additional studies?
A 57-year-old woman with adenocarcinoma of the sigmoid colon with liver metastasis is attending for cycle six of her palliative FOLFOX chemotherapy. Which tumour marker can be measured in the blood test to indicate the effect of the chemotherapy?
A 23-year-old man reports a 3-day history of a constant left-sided chest pain, which worsens with inspiration and activity. His symptoms were preceded by several days of fatigue, rhinorrhea, and cough. He is worried that he has broken a rib from coughing. He reports no other symptoms and has no risk factors for cardiovascular disease. On examination, he is comfortable. Other findings on physical examination are as follows: blood pressure, 120/70 mm Hg; pulse, 94 beats/min; respiratory rate, 1.2 breaths/min; temperature, 100.2° F (37.9° C). His lungs are clear. Cardiovascular examination shows tachycardia, but otherwise the results are normal. Which of the following should be the appropriate step to take next in this patient's workup?
A 53-year-old man presents for evaluation of severe chest pain. The pain has been present for 2 hours and is radiating down both arms. He reports no previous similar episodes of chest pain. On examination, he is diaphoretic. His blood pressure is 160/100 mm Hg bilaterally, and his pulse is 100 beats/min. Chest and cardiac examinations are normal. An electrocardiogram shows sinus tachycardia but no ST segment changes. A chest x-ray is unremarkable. What would you recommend as the next step in the workup of this patient?
A 72-year-old man with a history of myocardial infarction 10 years ago and angina presents with complaints o.f recurrent chest pain, which he has been experiencing over the past 4 months. This pain is retrosternal, is brought on by exertion, and is relieved by rest. The patient has been taking aspirin, long acting diltiazem, simvastatin, atenolol, and isosorbide dinitrate at maximal doses. His blood pressure is 130/80 mm Hg; pulse, 62 beats/min; and respirations, 16 breaths/min. Physical examination is normal. ECG shows normal sinus rhythm, with left bundle branch block. Which of the following tests would be most useful in the evaluation of this patient's angina?