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| | #204874 |
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31. A 34-year-old man comes to the office with his wife and daughter because he has had some dusky lesions on his shoulder for the past 2 months. He says that two have become larger during the past week. He and his wife have recently adopted an 18-month-old girl from the Ukraine who has a similar rash. He is an environmental scientist and his work requires him to travel overseas and work outdoors. He is concerned about the possibility of skin cancer. Vital signs are normal. Physical examination shows a cluster of six discrete papular lesions on his left shoulder that are slightly tender. These lesions have a central depression containing some pus-like material. There is no axillary or cervical adenopathy. His rash is shown. Which of the following is the most appropriate management for the patient?
A) Acyclovir
B) Scabicidal cream
C) Topical corticosteroid cream
D) Topical fluconazole
E) Topical liquid nitrogen
22. A 64-year-old retired teacher comes to the office with her husband. She has felt fatigued for several months and feels she is losing her memory. She says, "I feel slowed and can't remember what happened yesterday." Her husband reaffirms this history and notes that she recently got lost in a local mall and called him at home to come and get her. She was frightened by this episode and had insomnia that night, even though she otherwise has been sleeping longer than usual. She has a good appetite. There is a family history of senile dementia in her father and two uncles. Her only medication is daily conjugated estrogen. Her height is 163 cm (5 ft 4 in) and her weight is 64 kg (142 lb), which is an increase of 2.5 kg (6 lb) since you saw her 8 months ago. Pulse is 54/min and regular, and blood pressure is 140/86 mm Hg. On physical examination she appears pale. Deep tendon reflexes have a slow relaxation phase; the remainder of the examination is normal. A Mini-mental state test shows a delayed recall of one of three items and failure on serial 7s. She cannot recall any past presidents but she knows the current president. Based on these findings, which of the following is the most likely working diagnosis?
A) Early dementia, Alzheimer type
B) Hypothyroidism
C) Pernicious anemia
D) A transient ischemic attack
E) Vascular dementia
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| * Re:q; share your opinion |
| #854823 |
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3. A 54-year-old African American woman has been in the intensive care unit (ICU) for the past 10 hours because she has failed to regain consciousness after passing out at a restaurant 11 hours ago. Upon initial arrival at the emergency department the patient's friend stated that the patient had remarked about the sudden onset of a terrible headache and neck stiffness while they were having lunch. A few minutes after the onset of the headache, she became confused, vomited, and lost consciousness. She regained consciousness briefly en route to the hospital, but she has been unconscious since admission. On arrival she was intubated and mechanically ventilated and transferred to the ICU, where intravenous fluids were started. Vital signs are: pulse 110/min and blood pressure 174/96 mm Hg. She exhibits no spontaneous movement and is unresponsive to verbal or painful stimuli. Lung fields are clear to auscultation. CT angiogram confirms subarachnoid hemorrhage from a ruptured cerebral aneurysm and impaired intracranial circulation. The family should be counseled regarding which of the following?
A) The futility of continued life support
B) The need for screening of first-degree relatives for aneurysms
C) The need for them to sustain hope
D) The need to have a guardian ad litem appointed to make informed decisions about the patient's care
E) The probability that the patient will not regain consciousness
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