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+--- Thread: sugesstion needed - dr_usmle2012 (/showthread.php?tid=796072)
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0 - ArchivalUser - 01-21-2016
A 56-year-old African American man whom you have been treating for tic douloureux of the left trigeminal nerve comes to the office for a follow-up visit. He has been your patient for many years, and you have treated him for his current condition for the past 6 months. He is currently taking carbamazepine. Today he tells you that the episodes of tic activity have become more frequent, especially at night, and they seem to be more severe than when he was first diagnosed. The patient also reports that his face now feels numb and that he is having trouble hearing with the left ear. He is otherwise healthy. Vital signs are normal. There is decreased sensation over the left side of the face and decreased hearing on the left. Which of the following is the most appropriate next step?
A) Change his medication to phenytoin
B) Increase the carbamazepine dosage
C) Obtain consultation with an audiologist
D) Obtain MRI of the temporal bones
E) Refer him to a surgeon
0 - ArchivalUser - 01-22-2016
B.....
0 - ArchivalUser - 01-23-2016
AAAAAA
0 - ArchivalUser - 01-23-2016
The correct answer is A
0 - ArchivalUser - 01-23-2016
A 26-year-old white woman returns to the office for a follow-up visit because of oligomenorrhea and questions about her ability to conceive a child. Her menstrual periods are irregular, often occurring only every 4 to 6 months. She is 163 cm (5 ft 4 in) tall and weighs 85 kg (187 lb); BMI is 32 kg/m2. Blood pressure is 140/88 mm Hg. Skin examination shows facial acne, acanthosis nigricans, and excess hair on her face, around her nipples, and in a line from her umbilicus to pubis. External genitalia are normal. Pelvic ultrasonography shows slightly enlarged ovaries bilaterally. Pap smear at her last visit obtained 1 week ago was normal. Results of laboratory studies obtained 1 week ago are shown:
Serum ……………………… Blood
TSH 2.0 μU/mL Hematocrit 38%
Glucose, random 210 mg/dL ……. Urine
Testosterone 96 ng/dL (N=20–75) Pregnancy test Negative
Serum 17-hydroxyprogesterone concentration obtained 1 hour after injection of adrenocorticotropic hormone is normal. Today, random fingerstick blood glucose concentration is 230 mg/dL. After discussing your findings with the patient she says that she would like to have children in the future but does not want to get pregnant now. In addition to oral contraceptives, which of the following is the most appropriate pharmacotherapy?
A) Acarbose
B) Glyburide
C) Insulin
D) Metformin
E) Repaglinide
0 - ArchivalUser - 01-23-2016
Dd
0 - ArchivalUser - 01-24-2016
Metformin..
0 - ArchivalUser - 01-24-2016
I go with metformin.
0 - ArchivalUser - 01-24-2016
The correct answer is D
0 - ArchivalUser - 01-25-2016
An 81-year-old African American woman who has diabetes mellitus comes to the office for a routine appointment. The patient follows a prescribed diet and exercise regimen, and she takes metformin, enalapril, simvastatin, and aspirin. She says she feels well and has been active in her church and community. Vital signs are temperature 37.0°C (98.6°F), pulse 82/min, and blood pressure 145/78 mm Hg. Physical examination discloses a 2 × 2-cm, firm, mobile nodule in the upper outer quadrant of her left breast. The patient asks, "If I have cancer, what therapy is normally recommended for patients of my age?" Which of the following is the most appropriate recommendation?
A) Chemotherapy and radiation therapy
B) Lumpectomy and chemotherapy
C) Lumpectomy with radiation therapy
D) Radical mastectomy with radiation therapy
E) Observation only