01-16-2012, 01:23 AM
14 A 57-year-old woman comes to the physician because of a 6-month history of moderate penumbibcal pain that occurs within 1 hour after eating She has had an 11-kg (25-Ib) weight loss as a result ot eating less to avoid the pain She has a 5-year history of hypertension and claudication Current medications include a diuretic. a 3-adrenergic
blocking agent. and an antiplatelet agent She is 165 cm(5 ft 5 in) tall and weighs 50kg (110 Ib). BMI is 18 kgm2 Her pulse is 75min, and blood pressure is 145190mm Hg The abdomen is soft, nondistended, and nontender there are no masses or organomegaly Femoral pulses are palpable bilaterally, and popliteal arid distal pulses are absent bilateraly Test of the stool for occult blood is negative WlIch of the following is the most appropriate next step in diagnosis?
O A) HIDA scan
O B) Colonoscopy
O C) Upper gastrorntestinal endoscopy
o D) Arteriographv
o E) Endoscopic retrograde cholangiopancreatography
22 A 23-year-old man with schizophrenia is brougN to the emergency depariment by ls mother 28 hours after the onset of progressive confusion and agitation He has had increased tlirst during this period One week ago, he was discharged after treatment for the second exacerbation of sctzophrenia Current medications include halopendol and benztropine He appears flushed His temperature is 38°C (100 4°F), pulse is 100min, and blood pressure is 16090mm Hg Examination shows dry mucous membranes Pupils are 4 mm and reactive to light On mental status examination, he is not oriented to person, place, or time Which of the foflowing is the most hkely explanation for these findings?
o A) Antichohnergic delirium
o 6) Exacerbation of sctizophrenia
o C) Neuroleptic malignant syndrome
o D) Oxycodone overdose
o E) PCP (phencyclidine) intoxication
41 A 23-year-old pnmigravid woman at 10 weeks gestation comes to the physician for her first prenatal isit She follows a vegetarian diet and eats no meat or fish Exanwnahon shows a uterus consistent in size with a 10-week gestation She intends to breast-teed her newborn Which of the tolowing is the most appropriate additional supplemental vitamin for this patient dunng pregnancy and lactation?
O A) 812 (cyanocobalamin)
o B)C
OC)D
O D) E
0 E)K
46 A previous’y heahw 18-year-old pnmigravid African Amencan woman at 18 weeks’ gestation is brought to the emergency department because of a 2-day history of fever and
a 12-hour history of severe left-sided back pain She has had no prenatal care Her family history is unknown because she was adopted Her temperature is 39 1.C
(102 4F), pulse is 1 101mm. and blood pressure is 100;62 mm Hg Examination shows left costovertebral angle tenderness The uterus is consistent in size with an 18-week
gestation. Laboratory studies show
Hemoglobin 7 9 gdL
Hemoglobin electrophoresis
Hemoglobin Ai 14%
Hemoglobin A2
Hemoglobin F 7%
Hemoglobin S 75%
Mean corpuscular volume 90 urn3
Platelet count 1 59000/mm3
Unne
Bactena 3+
WBC5 3+
In addition to antibiotic treatment, which of the following is the most appropriate pharmacotherapy?
O A) Ervthropoietmn
O B) Folic acid
o C) Iron
o D) Vitanin B12 (cyanocobalammn)
o E)VitarrwnC