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| | #249024 |
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How abt we post qs n follow thru with answers , that way we'll be sure of whatever we choose..... No arguements, just plain this is what i think! U can support ur answer if u want, not if u don't! Anyone???? Right here! |
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| #1077595 |
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26. IF THAT'S THE FIGURE THEN DEFINITELY A.
30 Cud be anything..if u know for certain plz make it clear for me.......I'm too sleepy.
31. Surgery is definite? was meant to do cardio today but u know what happened. :P
33. i was going to pick C but :P
34. ok get it.
36. Y wud they do a bone scan, that's for osteoporosis n mineralization abnormalities. |
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| #1077599 |
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ok, after u clear the above, these are the rest from BLOCK 1 Form 1. Form 2. tomorrow.
36. An 18-year-old man comes for an examination prior to participation in school sports. He states that he has had a dull ache in the scrotum since being hit in that area during a basketball game 2 months ago. Examination shows a 2-cm, hard, nontender mass in the right testicle. The mass does not transilluminate or change in size when the patient is placed in the supine position. Which of the following is the most likely cause?
A
) Cystic dilations of the efferent ductules
B
) Dilated pampiniform venous plexus
C
) Fluid accumulation within the tunica vaginalis testis
D
) Germinal cell tumor
E
) Vascular trauma
37. A 14-year-old boy is brought to the physician by his parents because of a 2-year history of increasing academic problems. His parents say that he has always been hyperactive and distractible, but now his academic performance has deteriorated to the point that he is failing ninth grade. His teachers say that his hyperactivity is disrupting the classroom. He weighs 54 kg (120 lb) and is 152 cm (60 in) tall. Sexual development is Tanner stage 5; examination shows macro-orchidism, which was not shown on previous examinations. He has a high forehead and long, protruding ears. He exhibits poor eye contact during the examination. Psychoeducational testing shows an IQ of 70. Which of the following is the most likely diagnosis?
A
) Attention-deficit/hyperactivity disorder
B
) Autistic disorder
C
) Down syndrome
D
) Fetal alcohol syndrome
E
) Fragile X syndrome
F
) Lesch-Nyhan syndrome
G
) Pervasive developmental disorder, not otherwise specified
H
) Prader-Willi syndrome
I
) Rett's disorder
J
) Seminiferous tubule dysgenesis (Klinefelter's syndrome)
38. A 32-year-old woman comes to the physician because of vaginal discharge for 2 weeks. She has been sexually active with one female partner for 5 years. She has not been treated with antibiotics over the past 2 years. Her last Pap smear was 6 years ago when she was sexually active with a male partner. She has not used illicit drugs or alcohol. Examination shows a grayish vaginal discharge with a pH greater than 4.5. A wet mount preparation of the vaginal discharge is most likely to show which of the following?
A
) Budding yeast
B
) Clue cells
C
) Ferning
D
) Leukocytes in sheets
E
) Trichomonas vaginalis
39. A 57-year-old woman with breast cancer comes to the physician because of increasing neck pain over the past 3 days. She has fallen frequently because of muscle weakness. Vital signs are within normal limits. Examination shows hyperreflexia of all extremities. There is tenderness over the cervical spine. Serum calcium level is 11 mg/dL. X-ray films show metastases to the cervical spine. Which of the following is the most appropriate next step in management?
A
) Application of a soft cervical collar
B
) Physical therapy
C
) Mithramycin therapy
D
) Tamoxifen therapy
E
) Spinal cord decompression and cervical stabilization
40. A 57-year-old man comes to the physician because of intermittent urinary incontinence over the past 6 months. He has loss of small amounts of urine when he coughs or sneezes. He has not had pain or blood with urination. He has a 15-year history of type 2 diabetes mellitus with peripheral neuropathy, retinopathy, and gastroparesis. Current medications include metoclopramide and glyburide. He appears well. Rectal examination shows a normal-sized prostate. Neurologic examination shows decreased sensation in a stocking-glove distribution. Achilles tendon reflexes are absent bilaterally. Test of the stool for occult blood is negative. Urinalysis shows 2+ protein with no leukocytes or erythrocytes. His postvoid residual volume is 500 mL. Which of the following is the most likely mechanism of this patient's incontinence?
A
) Central nervous system disorder
B
) Functional incontinence
C
) Intrinsic sphincter deficiency
D
) Overflow incontinence from acontractile bladder
E
) Overflow incontinence from bladder outlet obstruction
F
) Pelvic floor muscle weakness
G
) Retroperitoneal fibrosis
H
) Retroperitoneal lymphadenopathy
I
) Urinary tract infection
41. A 27-year-old primigravid woman at 38 weeks' gestation is admitted in labor. Her pregnancy has been uncomplicated, and a routine prenatal visit 2 days ago showed no abnormalities. On admission, fetal heart tones cannot be heard. Ultrasonography shows little amniotic fluid, fetal edema, and no evidence of a fetal heartbeat. After 1 hour, she delivers a 3175-g (7-lb) stillborn infant; examination of the infant shows no obvious abnormalities except for mild edema. The placenta and membranes appear normal. Which of the following is the most appropriate immediate course of action?
A
) Notify the hospital liability department
B
) Obtain consent for fetal organ donation from the parents
C
) Recommend autopsy of the infant
D
) Tell the mother not to worry since she can get pregnant again
E
) Tell the parents that there is a 1 in 4 chance of recurrence in future pregnancies
42. A previously healthy 16-year-old high school wrestler comes to the physician because of a rash on his forearms and the back of his legs for 1 week. He is allergic to pollen and dust. Examination shows patches of erythema with mild lichenification over the antecubital and popliteal fossae. There are clusters of painful umbilicated vesicles at sites of active skin inflammation. Which of the following is the most likely diagnosis?
A
) Eczema herpeticum
B
) Herpes zoster
C
) Keratosis pilaris
D
) Lichen planus
E
) Pityriasis rosea
43. A 5-week-old boy is brought to the physician because of vomiting for 3 days. Switching from a cow's milk-based formula to a soy-based formula and one bottle of an electrolyte solution has not decreased his vomiting. His mother says that there is no yellow color to the vomitus, but it is forceful and occurs immediately after he has had 1 to 2 ounces of liquid. He appears to vomit more liquid than he drank. He has one mustard-colored seedy stool daily. Examination shows no abnormalities. Which of the following is the most likely explanation for his vomiting?
A
) Duodenal atresia
B
) Gastroesophageal reflux
C
) Hypertrophic pyloric stenosis
D
) Lactose intolerance
E
) Protein malabsorption
F
) Rotavirus infection
44. A 28-year-old woman is hospitalized after taking a massive overdose of acetaminophen tablets in a suicide attempt. She has type 1 diabetes mellitus and major depressive disorder refractory to tricyclic antidepressant therapy. Despite appropriate therapy, she develops rapidly progressive hepatic failure and becomes progressively encephalopathic. On the 6th day of hospitalization, she is comatose. A CT scan of the brain shows mild diffuse swelling. An appropriately crossmatched, size-appropriate donor liver is available. Which of the following is the most appropriate course of action regarding transplantation?
A
) Do not proceed with the transplantation because diabetes mellitus is a contraindication
B
) Do not proceed with the transplantation because hepatic function is likely to return over the next week
C
) Do not proceed with the transplantation because major depressive disorder places the patient at risk for another suicide attempt
D
) Do not proceed with the transplantation because the onset of encephalopathy and CT findings suggest bacterial meningitis
E
) Proceed with the transplantation
45. A 3-year-old boy who is HIV positive is brought for a routine examination. His diet is appropriate for age. His medications include three antiretroviral drugs and trimethoprim-sulfamethoxazole for Pneumocystis carinii prophylaxis. Laboratory studies show:
Hemoglobin 8.6 g/dL
Mean corpuscular hemoglobin 38 pg/cell
Mean corpuscular hemoglobin concentration 30% Hb/cell
Mean corpuscular volume 101 μm3
Leukocyte count 5600/mm3
Segmented neutrophils 60% (many hypersegmented)
Bands 3%
Lymphocytes 37%
Red cell distribution width 21% (N=10–16)
Which of the following is most likely to have prevented this patient's anemia?
A
) Folic acid supplementation
B
) Iron supplementation
C
) Thyroid supplementation
D
) Vitamin B12 (cyanocobalamin) supplementation
E
) Monthly intravenous immune globulin therapy
46. A 20-year-old man is brought to the emergency department on a summer day 20 minutes after developing headache, nausea, and unsteady gait while running the last 2 miles of a marathon. On arrival, he is confused and disoriented. His temperature is 40 C (104 F), blood pressure is 100/60 mm Hg, and pulse is 155/min. His skin is warm and dry. Neurologic examination shows no focal findings. Which of the following is the most likely mechanism of this patient's condition?
A
) Depletion of total body potassium
B
) Depletion of total body sodium
C
) High-output cardiac failure
D
) Inadequate dissipation of body heat
E
) Release of creatine kinase from muscle cells
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Form 1--Section 2:--
1. A 77-year-old woman is brought to the physician by her son for a routine health maintenance examination. She says that she feels well. Her son reports that 1 month ago, she got lost while driving home from the local supermarket. Two weeks ago, she forgot to turn off the stove after cooking dinner. She has been wearing bilateral hearing aids since audiometry 2 years ago showed bilateral high-frequency hearing loss. Her visual acuity corrected with glasses is 20/25 in both eyes. Neurologic examination shows mild fine tremors of the hands when the arms are outstretched; the tremor is not present at rest. Muscle strength is 5/5 in all extremities. Deep tendon reflexes are decreased at the ankles and 2+ elsewhere. Her gait is normal. Sensation to vibration is mildly decreased over the toes. On mental status examination, she is awake, alert, and conversant. Her language function is normal. She is oriented to person, place, and time and recalls one out of three objects after 10 minutes. Which of the following findings in this patient warrants further evaluation?
A
) Decreased deep tendon reflexes at the ankles
B
) Decreased sensation to vibration over the toes
C
) High-frequency hearing loss
D
) Memory loss
E
) Tremor of the outstretched hands
2. A 10-year-old girl is brought to the emergency department because of diffuse, aching abdominal pain, nausea, and recurrent vomiting over the past 5 hours. She has an 8-year history of type 1 diabetes mellitus treated with 20 U of NPH and 6 U of regular insulin in the morning and 14 U of NPH and 5 U of regular insulin in the evening. She appears lethargic but is easily arousable. There is an obvious odor of ketones on her breath. Her blood pressure is 100/70 mm Hg, pulse is 95/min, and respirations are 20/min and deep. Serum studies show:
Na+ 142 mEq/L
K+ 5.3 mEq/L
HCO3– 6 mEq/L
Glucose 710 mg/dL
Which of the following laboratory findings is most likely to be increased?
A ) Arterial pH
B ) Serum C-peptide level
C ) Serum magnesium level
D ) Serum osmolality
E ) Serum phosphorus level
3. A healthy 24-year-old woman comes for a routine health maintenance examination. Menses occur at regular 28-day intervals and last 5 to 6 days. Her last menstrual period was 3 weeks ago. She takes no medications. Bimanual examination shows a 5-cm, mildly tender left adnexa. A pregnancy test is negative. Which of the following is the most appropriate next step in management?
A
) Repeat examination in 2 weeks
B
) Measurement of serum CA 125 level
C
) Measurement of serum α-fetoprotein level
D
) CT scan of the pelvis
E
) Diagnostic laparoscopy
4. A 24-year-old primigravid woman at 18 weeks' gestation comes for a routine prenatal visit. She has had increased bowel movements over the past 9 weeks; the stools are sometimes covered with mucus and blood. Use of over-the-counter antidiarrheal drugs has not relieved her symptoms. Pregnancy has been otherwise uncomplicated. She has never traveled outside the USA. Examination shows erythematous, tender nodules over the anterior surface of both lower extremities; some of the nodules have a violaceous hue. The uterus is consistent in size with an 18-week gestation. Rectal examination shows no hemorrhoids or fissures. Fetal heart tones are audible by Doppler. Which of the following is the most likely diagnosis?
A
) Amebiasis
B
) Diverticulitis
C
) Hyperperistaltic diarrhea
D
) Inflammatory bowel disease
E
) Viral gastroenteritis
5. A 32-year-old woman at 38 weeks' gestation comes for a routine prenatal visit. During routine screening at 28 weeks' gestation, she tested positive for hepatitis B surface antigen. Her pregnancy has been otherwise uncomplicated. Examination shows a uterus consistent in size with a 38-week gestation. Which of the following measures is most likely to decrease the risk for hepatitis B infection in her newborn?
A
) Recommendation of bottle-feeding rather than breast-feeding
B
) Maternal administration of hepatitis B immune globulin (HBIG) now
C
) Neonatal administration of HBIG after delivery and hepatitis B vaccine at 3 months of age
D
) Neonatal administration of HBIG and hepatitis B vaccine immediately after delivery
E
) Cesarean delivery
6. A 37-year-old woman comes to the physician because of progressive shortness of breath over the past 5 years; she now has fatigue and shortness of breath with mild exertion. She has a history of mitral stenosis secondary to rheumatic fever at the age of 15 years. She was asymptomatic until 5 years ago when she developed severe shortness of breath during pregnancy. She was treated with diuretics, low-sodium diet, and bed rest, and she was able to deliver the baby at term. Her only medication is hydrochlorothiazide. Her temperature is 37 C (98.6 F), blood pressure is 110/80 mm Hg, pulse is 100/min and regular, and respirations are 26/min. Cardiac examination shows an obvious opening snap in S2. A grade 3/6, late diastolic murmur is heard at the apex. A right ventricular lift is palpated along the left sternal border. Which of the following is most likely increased in this patient?
A
) Blood flow to the lower lung fields
B
) Diastolic filling time
C
) Left-to-right shunt of blood
D
) Left ventricular end-diastolic pressure
E
) Pulmonary artery pressure
7. A 5-year-old girl with ventricular septal defect is scheduled for tonsillectomy in 2 weeks. She has no known drug allergies. Her temperature is 37 C (98.6 F). Examination shows no abnormalities. Which of the following is the most appropriate prophylaxis prior to tonsillectomy?
A
) Amoxicillin
B
) Ciprofloxacin
C
) Rifampin
D
) Tetracycline
E
) Trimethoprim-sulfamethoxazole
F
) No prophylaxis indicated
8. An 8-year-old girl with type 1 diabetes mellitus is brought to the emergency department 10 minutes after being involved in a motor vehicle collision. She was in the back seat of a small automobile that was rear-ended. Initially, she was alert during transport and reported bilateral thigh pain, but then she stopped talking, closed her eyes, and became unresponsive to voice; on arrival, she responds to noxious stimuli with brief grimaces and no withdrawal. Her blood pressure is 40/palpable mm Hg, pulse is 148/min, and respirations are 28/min. Air entry is symmetric. The pupils are equal and react to light. No cardiac murmur is heard. The abdomen is soft. There is swelling of the upper portions of both thighs. Her hematocrit is 37%. Which of the following is the most appropriate next step in management?
A
) Measurement of arterial blood gases
B
) X-ray film of the chest
C
) CT scan of the head
D
) Administration of 50% dextrose in water
E
) Infusion of 0.9% saline
9. A previously healthy 16-year-old boy is brought to the emergency department 20 minutes after an episode of left arm shaking that lasted approximately 3 minutes. Over the past 2 days, he has had fever and emotional lability. On arrival, his temperature is 38.9 C (102 F). He is somnolent and disoriented to person, place, and time. He responds poorly to pain. Neurologic examination shows no other abnormalities. Laboratory studies show:
Hematocrit 34%
Leukocyte count 6000/mm3
Segmented neutrophils 50%
Lymphocytes 50%
Platelet count 280,000/mm3
Analysis of cerebrospinal fluid shows:
Leukocyte count 120/mm3
Segmented neutrophils 20%
Lymphocytes 80%
Erythrocyte count 300/mm3
Glucose 60 mg/dL
Protein 400 mg/dL
Which of the following is the most likely cause of this patient's neurologic findings?
A
) Bacterial infection
B
) Congenital malformation
C
) Fungal infection
D
) Hemorrhage
E
) Immune-mediated demyelination
F
) Parasitic infection
G
) Viral infection
10. A 72-year-old man with hypertension has had increasingly severe back pain over the past 2 months. He had a myocardial infarction 4 years ago. He has marked tenderness over T11, T12, L1, and L2. An x-ray film of the lumbosacral spine shows osteoblastic lesions in these vertebrae. Which of the following is the most likely diagnosis?
A
) Abdominal aneurysm
B
) Fibrosarcoma
C
) Metastatic prostate carcinoma
D
) Multiple myeloma
E
) Osteosarcoma
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| #1078302 |
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hey good morning!!! it's already afternoon:p
so,here r my ans;
1.D decreased vibratory sense is normal in aged...i guess
2.D it's DKA;^glucose levels = ^osmolality
3.A simple cyst (<7 cm).if it's larger than 7 cm and persists for > 2 months then shud b evaluated surgically
4.D
5.D
6.E SOB ;pul.edema;pul.HTN;.....my guess
7.F
8.E
9.G ^lympho,erythro in csf;emotional lability =HSV involving temporal lobes
10.C |
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| #1078350 |
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OK 2. Is D i accidently wrote B :P Still sleepy i guess! :D, btw, am going back to bed.
for 1. to me everything seemed correct. But I guess they want what's going to coz most problems.
6. I was debating between the 2. so E sud be it.
7. F sounds like it but plz give me the reason.
9. yup exactly y i changed.....thank God.
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11. A 64-year-old woman has moderately severe postoperative pain 1 day after a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Which of the following is the most appropriate analgesic pharmacotherapy?
A
) Oral aspirin-codeine compound
B
) Oral diazepam
C
) Oral ibuprofen
D
) Intermittent intravenous naloxone
E
) Patient-controlled intravenous morphine
F
) Transcutaneous administration of fentanyl
12. A 37-year-old woman comes to the physician because of a 1-day history of throbbing facial pain. She describes the pain as 7 out of 10 in intensity. Over the past 9 days, she has had nasal congestion, purulent nasal discharge, sore throat, and a nonproductive cough. She does not smoke. Her husband and children have had no recent illness. Her temperature is 38.5 C (101.3 F). Examination shows congested nasal mucosa and purulent discharge on the left. There is tenderness to palpation over the left cheek and no transillumination over the left maxillary sinus. The tympanic membranes are normal, and there is no erythema of the throat. Examination shows no cervical adenopathy. The lungs are clear to auscultation. Which of the following is the most likely causal organism?
A
) Haemophilus influenzae type b
B
) Moraxella catarrhalis
C
) Staphylococcus aureus
D
) Streptococcus pneumoniae
E
) Streptococcus pyogenes (group A)
13. A 42-year-old woman comes to the physician for an annual pelvic examination and Pap smear. Over the past year, she has had increasing fatigue and difficulty sleeping. She has two children who both attend college. She is currently looking for part-time work outside the home. Her husband has been busy in a new start-up business. Examination shows no abnormalities. Laboratory studies show:
Hemoglobin 15 g/dL
Mean corpuscular volume 95 μm3
Leukocyte count 6000/mm3 with a normal differential
Serum
Na+ 145 mEq/L
Cl– 102 mEq/L
K+ 4.5 mEq/L
HCO3– 25 mEq/L
Urea nitrogen (BUN) 18 mg/dL
Creatinine 1.0 mg/dL
Alkaline phosphatase 70 U/L
Aspartate aminotransferase
(AST, GOT) 22 U/L
Alanine aminotransferase
(ALT, GPT) 19 U/L
γ-Glutamyltransferase
(GGT) 83 U/L
(N=5–50 U/L)
Which of the following is the most likely explanation for this patient's laboratory abnormalities?
A
) Acetaminophen
B
) Alcohol
C
) Diphenhydramine
D
) Estrogen effect
E
) Ibuprofen
14. Five weeks after vaginal delivery of a healthy full-term newborn, a 22-year-old woman, gravida 1, para 1, is brought to the physician by her mother because of depressed mood for 2 weeks. Her mother is concerned that her daughter is not able to take care of her infant. Physical examination shows no abnormalities. She is quiet and tearful and does not engage in conversation easily. She states that she lives alone with her infant and has had thoughts of suicide and infanticide. Which of the following is the most appropriate next step in management?
A
) Reassurance
B
) Long-term outpatient counseling
C
) Antipsychotic therapy
D
) Selective serotonin reuptake inhibitor therapy
E
) Admission to the hospital for treatment
15. A 72-year-old man comes for a routine follow-up examination. He has chronic obstructive pulmonary disease treated with β-adrenergic agonists and ipratropium by metered-dose inhaler and mild arterial insufficiency of the lower extremities treated with aspirin. His blood pressure is 160/60 mm Hg, pulse is 70/min, and respirations are 12/min. Funduscopic examination shows arteriovenous nicking. Pedal pulses are decreased bilaterally. Which of the following antihypertensive drugs is most likely to cause adverse effects in this patient?
A
) α2-Adrenergic agonist
B
) α-Adrenergic blocking agent
C
) β-Adrenergic blocking agent
D
) Angiotensin-converting enzyme (ACE) inhibitor
E
) Calcium-channel blocking agent
F
) Loop diuretic
G
) Thiazide diuretic
H
) Vasodilator
The response options for the next two items are the same. You will be required to select one answer for each item in the set.
For each patient with loss of consciousness, select the most likely diagnosis.
A
) Aortic stenosis
B
) Carotid sinus hypersensitivity
C
) Conversion reaction
D
) Hypertrophic obstructive cardiomyopathy
E
) Hypoglycemia
F
) Mitral valve prolapse
G
) Orthostatic hypotension
H
) Pulmonary embolus
I
) Seizure
J
) Vasovagal syncope
K
) Vertebrobasilar insufficiency
16. A 15-year-old boy is brought to the emergency department 30 minutes after a 2-minute episode of loss of consciousness after completing a 400-meter race. On awakening, he says that he feels fine except for shortness of breath. He weighs 82 kg (180 lb) and is 191 cm (75 in) tall. His blood pressure is 110/70 mm Hg, pulse is 70/min and regular, and respirations are 15/min. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard at the left sternal border with minimal radiation to the neck; the murmur becomes louder when he stands.
For each patient with loss of consciousness, select the most likely diagnosis.
A
) Aortic stenosis
B
) Carotid sinus hypersensitivity
C
) Conversion reaction
D
) Hypertrophic obstructive cardiomyopathy
E
) Hypoglycemia
F
) Mitral valve prolapse
G
) Orthostatic hypotension
H
) Pulmonary embolus
I
) Seizure
J
) Vasovagal syncope
K
) Vertebrobasilar insufficiency
17. A 62-year-old woman is brought to the emergency department 1 hour after a 1-minute episode of loss of consciousness; her symptoms began when she stood up after she passed a dark, watery stool. She has had diarrhea and dark stools for 2 days. She has been receiving warfarin therapy for deep venous thrombosis for 2 weeks. On arrival, her blood pressure is 82/60 mm Hg, and pulse is 150/min and regular. She is unable to stand. The lungs are clear to auscultation. A grade 2/6 systolic murmur is heard at the second right intercostal space with no radiation. Examination shows a soft, nontender abdomen. There is 1+ edema of the right lower extremity with no tenderness. Test of the stool for occult blood is positive.
18. A 50-year-old woman has had progressive dyspnea over the past 2 weeks and constant, sharp chest pain for 4 days. The pain is localized to the center of the chest and is worse while supine. She underwent a right, modified radical mastectomy and adjuvant chemotherapy for breast cancer 3 years ago. She has a history of hypothyroidism treated with thyroid replacement therapy. She has smoked one pack of cigarettes daily for 30 years and drinks two ounces of alcohol daily. She is dyspneic and diaphoretic. Her temperature is 37.2 C (99 F), blood pressure is 90/70 mm Hg with a pulsus paradoxus of 20 mm Hg, pulse is 110/min, and respirations are 28/min. Examination shows jugular venous distention to the angle of the mandible. The liver span is 14 cm with 4 cm of shifting abdominal dullness. Arterial blood gas analysis on room air shows a pH of 7.50, PCO2 of 30 mm Hg, and PO2 of 70 mm Hg. An x-ray film of the chest shows an enlarged cardiac silhouette with a globular configuration. An ECG shows sinus tachycardia with nonspecific ST-segment changes diffusely. Which of the following is the most appropriate next step in management?
A ) Echocardiography
B ) CT scan of the abdomen
C ) Ventilation-perfusion lung scans
D ) Bronchoscopy
E ) Paracentesis
19. A 3-year-old boy is brought to the physician because of a 7-day history of fever and a painful swollen lymph node in his groin. This is his sixth episode of lymph node swelling; the previous episodes resolved after drainage and prolonged antibiotic therapy. He also had pneumonia at the age of 12 months that required chest tube placement for drainage. A maternal uncle died during childhood of recurrent infections. The patient is at the 5th percentile for height and weight. His temperature is 38.5 C (101.3 F). Examination shows a warm, tender, erythematous lymph node in the right inguinal area. There are several healed incisions over the inguinal area and neck from old drainage sites. Laboratory studies show:
Hematocrit 35%
Leukocyte count 17,000/mm3
Segmented neutrophils 65%
Bands 10%
Lymphocytes 25%
Platelet count 350,000/mm3
A Gram's stain of the lymph node aspirate shows numerous segmented neutrophils filled with bacteria; cultures grow Staphylococcus aureus. Which of the following is the most likely mechanism for these findings?
A
) Adenosine deaminase deficiency
B
) Consumption of complement
C
) Defective opsonization
D
) Destruction of CD4+ T lymphocytes
E
) Developmental arrest of maturation of B lymphocytes
F
) Dysmorphogenesis of the third and fourth pharyngeal pouches
G
) Impaired chemotaxis
H
) Impaired phagocytic oxidative metabolism
20. A 67-year-old woman has been intubated for 1 week after undergoing a left lobectomy for lung cancer. She has chronic obstructive pulmonary disease. Her preoperative functional vital capacity was 40% of predicted. She is awake and alert. Her blood pressure is 130/75 mm Hg, and pulse is 72/min. The ventilator settings are a synchronized intermittent mandatory ventilation of 8/min, FIO2 of 40%, and positive-end expiratory pressure of 5 cm H2O. Arterial blood gas analysis shows:
pH 7.42
PCO2 47 mm Hg
PO2 90 mm Hg
O2 saturation 96%
Which of the following is the most appropriate next step in management?
A
) Antibiotic therapy
B
) Bronchodilator therapy
C
) Chest physiotherapy
D
) Decrease inotropes
E
) Diuretic therapy
F
) Fiberoptic bronchoscopy
G
) Heparin therapy
H
) Incentive spirometry
I
) Increase FIO2
J
) Increase inotropes
K
) Increase respiratory rate
L
) Placement of thoracostomy tube
M
) Tracheostomy
N
) Wean from the ventilator
21. A 67-year-old woman is brought to the emergency department because of severe chest pain 4 hours after undergoing outpatient endoscopy and dilatation of an esophageal stricture caused by reflux. At discharge, she reported no chest pain. Three hours later, she vomited a small amount of blood and had severe pain. She is pale. Her temperature is 38 C (100.4 F), blood pressure is 140/85 mm Hg, pulse is 125/min, and respirations are 22/min. Examination shows crepitus in the neck and moderate epigastric tenderness. The lungs are clear to auscultation, and breath sounds are equal bilaterally. Rectal examination shows no masses; test of the stool for occult blood is positive. Which of the following is the most likely cause of these symptoms?
A
) Bleeding from erosive esophagitis
B
) Esophageal perforation
C
) Mallory-Weiss syndrome
D
) Myocardial infarction
E
) Perforated gastric ulcer
22. An 87-year-old woman is brought to the physician by her son because of progressive memory loss over the past 2 years. Her son says that she repeats herself frequently and has been forgetting to take her routine medications. She takes hydrochlorothiazide for mild systolic hypertension and levothyroxine for hypothyroidism. She had vulvar cancer 10 years ago treated with wide excision. Her blood pressure is 138/78 mm Hg. Physical examination is within normal limits for her age. Mini-Mental State Examination score is 23/30. Laboratory studies, including serum vitamin B12 (cyanocobalamin), thyroxine (T4), and thyroid-stimulating hormone levels, are within normal limits. A CT scan of the head shows mild volume loss. Which of the following is the most appropriate pharmacotherapy?
A
) β-Adrenergic agonist
B
) Cholinesterase inhibitor
C
) Dopamine agonist
D
) Prednisone
E
) Selective serotonin reuptake inhibitor
23.
A newborn is in severe respiratory distress immediately following delivery. She was born at 35 weeks' gestation to a 35-year-old woman, gravida 2, para 1, aborta 1, who did not receive prenatal care. The newborn's pulse is 60/min, and respirations are irregular and labored. Examination shows pallor with perioral cyanosis, anasarca, hepatosplenomegaly, and scattered petechiae. Cord blood hemoglobin is 4 g/dL, and reticulocyte count is 18%. A direct antiglobulin (Coombs') test is positive. Which of the following sets of blood groups is most likely in the mother and her newborn?
Mother Newborn
A
)
A, Rh-positive O, Rh-positive
B
)
A, Rh-positive O, Rh-negative
C
)
A, Rh-negative O, Rh-negative
D
)
O, Rh-positive O, Rh-negative
E
)
O, Rh-negative O, Rh-positive
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