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3,531 questions
An 84-year-old man comes to your office complaining of a severe left temporal headache, which he has had for the past 2 days. In addition, the patient states that over the past 2 days, he has had a low-grade fever, fatigue, and loss of appetite. Upon questioning, the patient admits to muscle weakness and jaw pain with mastication but has no visual complaint. The physical examination is within normal limits, with the exception of a tender, palpable left temporal artery. Laboratory evaluation reveals a slight elevation in the white blood cell count and a marked elevation in the erythrocyte sedimentation rate. Which of the following statements regarding giant cell arteritis is true?
A 24-year-old man presents to the emergency department complaining of chest pain. He reports having substernal chest pain of 2 days' duration. The pain is worse with inspiration and is alleviated by maintaining an upright position. He also reports having had a fever recently. His medical history and physical examination are unremarkable. An ECG shows 2 mm elevation of the ST segment in precordial leads, without reciprocal changes and with concomitant PR segment depression. An echocardiogram is normal. What is the most likely diagnosis and the most appropriate treatment approach for this patient?
A 63-year-old woman with diet-controlled diabetes, hypertension, and a 45-pack-year history of cigarette smoking has intermittent left leg claudication and exercise-induced calf pain, which occurs when she walks three to four blocks. Her ankle brachial index is 0.7. The patient is most likely to experience which of the following adverse health outcomes in the next 5 years?
A 44-year-old man presents to your office complaining of right leg pain and swelling of 3 days' duration. The patient was well until he had a wreck while riding his dirt bike 1 week ago. The patient states that he injured his right leg in this accident. Initially, his leg was moderately sore on weight bearing, but swelling and persistent pain have now developed. On physical examination, you note an extensive bruise on the patient's right calf and 2+ ede.ma from the foot USMLE IM2e/Basic to the midthigh. You suspect trauma-associated deep vein thrombosis (DVT). Which of the following statements regarding DVT is true?
A 43-year-old man presents to the emergency department complaining of chest pain of 2 hours' duration. The patient denies having any dyspnea. He has no significant medical history, nor does he have a family history of early coronary artery disease. He is a nonsmoker and an avid jogger. His chest pain is constant, is pleuritic, and does not radiate. His chest x-ray is clear, and his ECG reveals only sinus tachycardia. Blood gas measurements reveal a partial pressure of oxygen (P02) of 58 mm Hg with a widened alveolar-arterial difference in oxygen (A-aD02). Helical CT reveals segmental and subsegmental filling defects in the right lung. Which of the following statements regarding anticoagulation and thrombolysis for thromboembolism is true?
A 72-year-old man presents to the hospital with a hip fracture. An orthopedist is planning surgical repair and asks you to see the patient in consultation for preoperative assessment and advice. In particular, the orthopedist asks you to assess the patient's need for prophylaxis against venous thrombosis and to comment on the best prophylactic regimen for the patient. Which of tl1e following statements regarding primary prophylaxis against venous thrombosis and thromboembolism is true?
An 80-year-old patient of yours is scheduled to t1ndergo total knee replacement. He is in excellent health, and except for osteoarthritis, his medical history is not significant. The orthopedic surgeon asks you for advice regarding VTE prophylaxis. What would you advise for this patient?
A 24-year-old man comes to your office with complaints of a diffuse, mildly pruritic rash that developed over the past 1 to 2 weeks. Examination reveals a papular eruption involving the trunk and extremities. You suspect pityriasis rosea. Which of the following statements regarding the clinical features of pityriasis rosea is false?
A 59-year-old man with long-standing psoriasis has had a recent worsening of his disease. About 2 weeks ago, several new psoriatic lesions developed; this was followed by diffuse skin involvement with erythema and subsequent scaling. The patient complains of skin tightness, pruritus, fever, and malaise of 2 days' duration. You suspect a.n exfoliative erythroderma reaction. Which of the following statements regarding this patient's condition is true?
A 26-year-old woman presents to your primary care clinic for the evaluation of a rash. The patient has no significant medical history and is not taking any medications. The family history is unrevealing. Physical examination reveals sharply demarcated, erythematous scaling plaques at both elbows and knees. E�amination of the fingernails reveals groups of tiny pits. A presumptive diagnosis of psoriasis is made. Which of the following statements regarding the epidemiology of psoriasis is accurate?
An 18-year-old woman presents for treatment of chronic dry skin and scaling. The rash typically involves the extensor surfaces of her extremities. She notes that she has had this condition since infancy and that her father has it as well. Her medical records indicate that she has been diagnosed with ichthyosis vulgaris by a dermatologist. Which of the following statements is false?
A 45-year-old woman with a history of malaise, weight loss, and recurrent upper respiratory infections of several months' duration was picnicking with friends. Within a few minutes, most of the picnickers realized that they were developing a pruritic, erythematous skin reaction on skin exposed to the lush ground cover around them. One person belatedly recognized the plant as poison ivy. The patient, however, did not develop a reaction. What is the most likely reason for this patient's failure to develop a reaction?
A 54-year-old menopausal woman comes to your clinic desperate for hormone replacement therapy (HRT) as her vasomotor symptoms are very troubling. Her next door neighbour recently developed a deep vein thrombosis while on HRT. She is concerned about the risks of venous thromboembolism (VTE) and wants your advice. Which of the following would you not advise?
A 43-year-old woman with a long history of chronic actinic dermatitis was experiencing frequent upper respiratory infections, weight loss, and malaise. She wa.s pleased that her chronic actinic dermatitis was improving to the point of being nearly resolved but was concerned about her recurrent infections and weight loss. She presented to a physician, who diagnosed HIV in her blood; the patient had a high viral load count and a very low helper T cell count. The physician started her on didanosine (DDI), zidovudine (AZT), and indinavir. A week later, the patient felt better, but there was evidence of her rash recurring in its previous pattern of distribution. What is the probable reason for the recurrence of this patient's dermatitis?
A 35-year-old woman with HIV was recently started on trimethoprim-sulfamethoxazole for Pneumocystis carinii prophylaxis. She now presents with fever, sore throat, malaise, and a desquamating rash on her trunk. Laboratory studies are notable for the following abnormalities: serum creatinine, 2.1 mg/di; aspartate transaminase (AST), 215 mg/di; and alanine transaminase (ALT), 222 mg/di. Which of the following statements regarding the care of this patient is true?
A 64-year-old retired Navy officer presents to clinic for a routine health maintenance visit. He has no complaints, but when asked about a pinkish papular lesion near the corner of his left eye, he states that it has been present ''for years'' and that it has become irritated on occasion with minor trauma or rubbing. The lesion is 4 to 5 mm in diameter and appears pearly. You recommend that the patient undergo biopsy because you are concerned about the possibility of basal cell carcinoma (BCC). Which of the following epidemiologic and clinical statements is NOT true of BCC?
A 50-year-old construction worker with hypertension presents for a return office visit. His blood pressure appears well controlled, and you are discussing other health maintenance issues as you examine him. You notice several rough-surfaced, irregularly shaped lesions on his face, scalp, and dorsa of the hands. On closer inspection, they appear hyperkeratotic and have a small rim of surrounding erythema. He says they are not painful, do not itch, and have been appearing over the course of years. Which of the following statements regarding this patient's risk of skin cancer is true?
A 35-year-old white man presents at a walk-in clinic with a complaint of lesions in his mouth and over his trunk. These lesions developed over the past several months. His medical history is USMLE IM2e/Basic unremarkable. He states that he is homosexual, that he has practiced unsafe sex in the past, and that he has had the same partner for the past 18 months. He denies having previously had any sexually transmitted diseases, but he says he has not had regular health care visits since high school. On examination, you note numerous purple-red, oval papules distributed on the trunk and two deep-purple plaques on the soft palate and buccal mucosa. The patient also has several small, firm, nontender, palpable lymph nodes in the posterior cervical, axillary, and inguinal chains. Results of routine blood work are unremarkable except for a white blood cell count of 3,000 cells/mm3 and a differential with 5% lymphocytes. Which of the foilowing statements regarding our current knowledge of Kaposi sarcoma (KS) is false?
A middle-aged woman comes to clinic complaining of a long-standing rash involving her chest and left thigh, which she first noted over a year ago. She says the areas are chronically red and scaly and are occasionally mildly pruritic. She has not been able to identify any precipitating factors or irritants that have come into contact with those particular areas. She states that exposure to the sun has intermittently made the lesions improve to an extent. Approximately 6 months ago, she was prescribed a topical steroid cream, which did seem to cause improvement of the rash, but the rash soon returned after discontinuation. She thought that the rash likely represented psoriasis, and she had not been overly concerned about it until recently, when she has noticed that the lesions had become larger and more prominent. On examination, you note a large erythematous, scaly patch on the trunk. The lesion on the upper thigh is a thicker plaque that is deeper red in color. Skin biopsy reveals atypical lymphoid cells in the epidermis that have hyperconvoluted (cerebriform) nuclei. There is also a bandlike lymphocytic infiltrate in the upper dermis. A diagnosis of mycosis fungoides is made on the basis of the histologic report. Which of the following clinical and therapeutic statements is NOT characteristic of this disorder?
A woman brings her 13-year-old son to your clinic for evaluation of multiple lumps and bumps. She states that her husband had similar problems and died of a nervous system disease. She does not remember the name of her husband's disease, but notes that his tumors were at times large and painful and that on numerous occasions he had to have some surgically removed. The patient has just experienced his ''growth spurt'' and is having some troubles with acne. He denies having any pain but admits that other children make fun of him at school. On USMLE IM2e/Basic examination, you note multiple large, skin-colored, pedunculated tumors. He also has evidence of acne, and there is a tan, oval macule measuring 3 cm on his chest. You believe he may have neurofibromatosis-1 (NF-1, also known as von Recklinghausen disease). Which of the following statements about neurofibromatosis is false?