06-09-2009, 08:08 PM
1. A previously healthy 52-year-old man comes to the emergency department because of hiccups for 1 week. He has smoked two packs of cigarettes daily for 30 years. He does not drink alcohol. He is alert and oriented. His temperature is 37 C (98.6 F), blood pressure is 150/95 mm Hg, pulse is 70/min, and respirations are 12/min. Physical and neurologic examinations show no abnormalities. His serum sodium level is 120 mEq/L. An x-ray film of the chest shows a right hilar mass. Which of the following is the most appropriate next step in treatment?
A
) Bisphosphonate therapy
B
) Calcitonin therapy
C
) Calcium therapy
D
) Dexamethasone therapy
E
) 5% Dextrose in 0.225% saline therapy
F
) 5% Dextrose in 0.45% saline therapy
G
) 5% Dextrose in water therapy
H
) Fluid restriction
I
) Hydrocortisone therapy
J
) Lactated Ringer's solution
K
) Mannitol therapy
L
) Potassium therapy
M
) 0.9% Saline therapy
N
) 3% Saline therapy
O
) Sodium bicarbonate therapy
12. A 52-year-old woman comes to the physician because of decreased libido; this symptom began 8 months ago, after she underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for leiomyomata uteri and menorrhagia. She has been taking hormone replacement therapy with conjugated estrogen since the operation. Examination shows a moist, rugated vagina. Which of the following is the most likely cause of these findings?
A
) Decreased androgens
B
) Decreased estrogen
C
) Decreased follicle-stimulating hormone (FSH)
D
) Decreased luteinizing hormone (LH)
E
) Decreased progesterone
F
) Decreased prolactin
G
) Increased androgens
H
) Increased estrogen
I
) Increased FSH
J
) Increased LH
K
) Increased progesterone
L
) Increased prolactin
30.
A 72-year-old man comes to the physician with his wife because of chronic abdominal pain and headaches for 4 months. His wife states that he has become more forgetful over the past 6 months. He has a history of gout. He has smoked one pack of cigarettes daily for 50 years and drinks 10 oz of homemade whiskey daily. He takes no medications. His temperature is 36.8 C (98.3 F), blood pressure is 160/98 mm Hg, pulse is 74/min, and respirations are 16/min. Neurologic examination shows mild short-term memory loss and decreased sensation to pinprick in the distal extremities. He has an ataxic gait. There are gouty tophi on the dorsal aspect of the left elbow. Laboratory studies show:
Hematocrit 33%
Mean corpuscular volume 70 μm3
Serum
Urea nitrogen (BUN) 17 mg/dL
Glucose 90 mg/dL
Creatinine 2 mg/dL
Uric acid 14 mg/dL
Which of the following is the most appropriate next step in management?
A
) Measurement of blood lead level
B
) Measurement of serum porphobilinogen level
C
) CT scan of the abdomen
D
) MRI of the brain
E
) Carbidopa-levodopa therapy
35. A 62-year-old woman comes to the physician because of bloating and cramping abdominal pain and intermittent diarrhea over the past 5 years. Her symptoms have increased over the past month since she started a new diet that emphasizes yogurt and cottage cheese as low-fat sources of calcium and protein. Vital signs are within normal limits. Abdominal examination shows diffuse tenderness to palpation with no rebound tenderness; there are no masses or organomegaly. Bowel sounds are increased. Test of the stool for occult blood is negative. Which of the following is the best explanation for this patient's diarrhea?
A
) Impaired intestinal motility
B
) Inflammatory process
C
) Malabsorption
D
) Secretory process
Guys thanks for your help
A
) Bisphosphonate therapy
B
) Calcitonin therapy
C
) Calcium therapy
D
) Dexamethasone therapy
E
) 5% Dextrose in 0.225% saline therapy
F
) 5% Dextrose in 0.45% saline therapy
G
) 5% Dextrose in water therapy
H
) Fluid restriction
I
) Hydrocortisone therapy
J
) Lactated Ringer's solution
K
) Mannitol therapy
L
) Potassium therapy
M
) 0.9% Saline therapy
N
) 3% Saline therapy
O
) Sodium bicarbonate therapy
12. A 52-year-old woman comes to the physician because of decreased libido; this symptom began 8 months ago, after she underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy for leiomyomata uteri and menorrhagia. She has been taking hormone replacement therapy with conjugated estrogen since the operation. Examination shows a moist, rugated vagina. Which of the following is the most likely cause of these findings?
A
) Decreased androgens
B
) Decreased estrogen
C
) Decreased follicle-stimulating hormone (FSH)
D
) Decreased luteinizing hormone (LH)
E
) Decreased progesterone
F
) Decreased prolactin
G
) Increased androgens
H
) Increased estrogen
I
) Increased FSH
J
) Increased LH
K
) Increased progesterone
L
) Increased prolactin
30.
A 72-year-old man comes to the physician with his wife because of chronic abdominal pain and headaches for 4 months. His wife states that he has become more forgetful over the past 6 months. He has a history of gout. He has smoked one pack of cigarettes daily for 50 years and drinks 10 oz of homemade whiskey daily. He takes no medications. His temperature is 36.8 C (98.3 F), blood pressure is 160/98 mm Hg, pulse is 74/min, and respirations are 16/min. Neurologic examination shows mild short-term memory loss and decreased sensation to pinprick in the distal extremities. He has an ataxic gait. There are gouty tophi on the dorsal aspect of the left elbow. Laboratory studies show:
Hematocrit 33%
Mean corpuscular volume 70 μm3
Serum
Urea nitrogen (BUN) 17 mg/dL
Glucose 90 mg/dL
Creatinine 2 mg/dL
Uric acid 14 mg/dL
Which of the following is the most appropriate next step in management?
A
) Measurement of blood lead level
B
) Measurement of serum porphobilinogen level
C
) CT scan of the abdomen
D
) MRI of the brain
E
) Carbidopa-levodopa therapy
35. A 62-year-old woman comes to the physician because of bloating and cramping abdominal pain and intermittent diarrhea over the past 5 years. Her symptoms have increased over the past month since she started a new diet that emphasizes yogurt and cottage cheese as low-fat sources of calcium and protein. Vital signs are within normal limits. Abdominal examination shows diffuse tenderness to palpation with no rebound tenderness; there are no masses or organomegaly. Bowel sounds are increased. Test of the stool for occult blood is negative. Which of the following is the best explanation for this patient's diarrhea?
A
) Impaired intestinal motility
B
) Inflammatory process
C
) Malabsorption
D
) Secretory process
Guys thanks for your help