04-13-2016, 09:51 PM
A 21-year-old woman comes to the physician because of an 8-day history of sore throat, cough, and fever. The cough is nonproductive but keeps her awake at night. She subsequently develops hoarseness. Her temperature is 38.3°C (100.9°F). Crackles are heard over the right posterior lower chest. X-rays of the chest show patchy, lower right alveolar infiltrates with increased interstitial markings. Her leukocyte count is 10,000/mm3 with 75% segmented neutrophils and 1% bands.
A
)
Cytomegalovirus
B
)
Haemophilus influenzae
C
)
Klebsiella pneumoniae
D
)
Legionella pneumophila
E
)
Mycoplasma pneumoniae
F
)
Pneumocystis jiroveci (formerly P. carinii)
G
)
Pseudomonas aeruginosa
wrong H
)
Respiratory syncytial virus
I
)
Streptococcus pyogenes (group A)
A 77-year-old woman comes to the physician because of palpitations for 2 days. She has had a 4.5-kg (10-lb) weight loss during the past 6 months. Her temperature is 37.4°C (99.3°F), pulse is 120/min and irregular, respirations are 24/min, and blood pressure is 130/70 mm Hg. Examination shows nontender enlargement of the left lobe of the thyroid gland. Serum studies show a thyroid-stimulating hormone concentration less than 0.05 μU/mL and thyroxine (T4) concentration of 30 μg/dL. A 131I study shows a single area of increased uptake in the left lobe of the thyroid gland and suppressed uptake elsewhere in the gland. Which of the following is the most likely mechanism of these findings?
A
)
Autoimmune destruction of thyroid cells
B
)
Focal granulomatous inflammation
C
)
Parafollicular cell cytokine overproduction
wrong D
)
Production of thyroid-stimulating immunoglobulin
E
)
Autonomous T4 production
A 24-year-old man comes to the physician for a follow-up examination. Two months ago, he was seen for a red, scaly rash over his groin. A 6-week course of topical clotrimazole resolved the rash completely, but it recurred 2 days ago. He is sexually active with one partner and uses condoms consistently. Examination shows an erythematous, excoriated rash over the groin and a similar rash over the instep of the left foot. A KOH preparation of a skin scraping shows hyphae. Which of the following is the most likely cause of this patient's recurrent infection?
A
)
Autoinfection
B
)
Clotrimazole resistance
wrong C
)
Impaired cellular immunity
D
)
Impaired humoral immunity
E
)
Reinfection from a sexual partner
A 42-year-old woman comes to the physician for a follow-up examination. She was diagnosed with hypertension 6 months ago, and hydrochlorothiazide therapy was begun. Eight weeks ago, her blood pressure was 176/96 mm Hg, and lisinopril was added to her regimen. She says she feels well. She has no other history of serious illness. She occasionally takes ibuprofen for muscle pain or headache. She walks for 30 minutes three times weekly. She is 170 cm (5 ft 7 in) tall and weighs 66 kg (145 lb); BMI is 23 kg/m2. Her pulse is 76/min, and blood pressure is 160/98 mm Hg in the right upper extremity and 162/96 mm Hg in the left upper extremity while sitting and standing. Cardiopulmonary examination shows no abnormalities. There is no peripheral edema. Fasting laboratory studies show:
Serum
Na+ 140 mEq/L
K+ 4 mEq/L
Cl− 105 mEq/L
HCO3− 24 mEq/L
Urea nitrogen 16 mg/dL
Glucose 94 mg/dL
Creatinine 1 mg/dL
Urine protein 1+
The patient asks how she can decrease her risk for renal failure. Which of the following is the most appropriate recommendation?
A
)
Protein-restricted diet
B
)
24-Hour urine collection for measurement of protein concentration
C
)
Increasing the dose of lisinopril
D
)
Switching from hydrochlorothiazide to furosemide
wrong E
)
No further measures are indicated at this time