12-18-2011, 10:12 AM
21. Three hours after biopsy of a 2-cm mass in the upper outer quadrant of the left breast, a 45-year-old woman has pain and swelling of the left breast. She has no history of bleeding problems and takes no medications. Examination shows an expanding hematoma. A biopsy specimen shows a fibroadenoma. Which of the following is the most likely diagnosis?
O A) Factor VIII deficiency
O B) Factor IX deficiency
O C) Inadequate hemostasis
O D) Platelet dysfunction
O E) Thrombocytopenia
22. A previously healthy 23-year-old woman comes to the physician because of pain and burning with urination for 3 days and loss of urine several times over the past 24 hours. She has not had fever or chills. Examination shows no flank or costovertebral angle tenderness. Urinalysis shows leukocytes too numerous to count and numerous rod-shaped bacteria. Which of the following is the most likely mechanism of this patient's urinary symptoms?
A) Decreased bladder muscle tone
B) Delayed neuromuscular maturation
C) Ectopic insertion of the ureters
D) Trigonal inflammation
E) Uninhibited detrusor muscle conditions
2. An asymptomatic 57-year-old man comes to the physician before beginning a jogging program. He has a sedentary lifestyle and has smoked two packs of cigarettes daily for 30 years. His blood pressure is 150188 mm Hg. Examination shows no other abnormalities. An ECG shows normal findings. His serum cholesterol level is 250 mgfdL. Which of the following is the most appropriate next step in management?
O A) Referral to a supervised exercise program
O B) Ambulatory blood pressure monitoring
O C) Ambulatory ECG monitoring
O D) Exercise stress test
0 E) Echocardiography
28. One hour ago, a 33-year-old man had the sudden onset of a shaking chill and fever. Two weeks ago, he was diagnosed with acute myelogenous leukemia and was hospitalized for initiation of chemotherapy. He is pale and has rigors. His temperature is 38.6°C (101.5°F), blood pressure is 120/76 mm Hg, pulse is 110/min, and respirations are 32/min. There are multiple petechiae over his antecubital fossae. Physical examination is otherwise normal. Laboratory studies show:
Hematocrit 24%
Leukocyte count 4001mm3
Segmented neutrophils 1%
Lymphocytes 98%
Monocytes 1%
Platelet count 15,000/mm3
Blood is drawn for culture. Which of the following should be administered intravenously?
O A) Clindamycin and cefazolin
O B) Ticarcillin and tobramycin
O C) Vancomycin
O D) High-dose penicillin
O E) High-dose trimethoprim-sulfamethoxazole
29. Seven days after sustaining partial- and full-thickness burns in a house fire, a 7-year-old boy has brain asphyxia, acute respiratory distress syndrome, multiorgan system failure, and sepsis. He is being mechanically ventilated. After consultation with his parents, a do-not-resuscitate order is written, and the boy is removed from the ventilator. Twenty minutes later, his blood pressure is bp86/42 mm Hg, pulse is 130 min. and respirations are 8/min. He periodically moans in pain. His current pain medication is intravenous morphine (20 mg/h). Which of the following is the most appropriate next step in pain management?
O A) Decrease the morphine until the patient's respirations are greater than 12/min
O B) Increase the morphine
O C) Administer midazolam
O D) Administer naloxone
0 E) Administer pancuronium
31. A 37-year-old man with paraplegia comes to the physician for a follow-up examination. He has a decubitus ulcer over the sacrum that has not healed despite wound care and repeated debridement over the past 3 months. Over the past 2 weeks, he has had a low-grade fever and a 3.6-kg (8-Ib) weight loss. His temperature is 38.1°C (100.6°F), and blood pressure is 120180 mm Hg. Examination shows a deep 4-cm ulcer over the sacrum. His leukocyte count is 14,0001mm3, which is consistent with previous leukocyte counts over the past month. His erythrocyte sedimentation rate is 98 mm1h. Which of the following is the most likely diagnosis?
O A) Anaerobic infection
O B) Malnutrition
O C) Osteomyelitis
O D) Squamous cell carcinoma
O E) Type 2 diabetes mellitus
O A) Factor VIII deficiency
O B) Factor IX deficiency
O C) Inadequate hemostasis
O D) Platelet dysfunction
O E) Thrombocytopenia
22. A previously healthy 23-year-old woman comes to the physician because of pain and burning with urination for 3 days and loss of urine several times over the past 24 hours. She has not had fever or chills. Examination shows no flank or costovertebral angle tenderness. Urinalysis shows leukocytes too numerous to count and numerous rod-shaped bacteria. Which of the following is the most likely mechanism of this patient's urinary symptoms?
A) Decreased bladder muscle tone
B) Delayed neuromuscular maturation
C) Ectopic insertion of the ureters
D) Trigonal inflammation
E) Uninhibited detrusor muscle conditions
2. An asymptomatic 57-year-old man comes to the physician before beginning a jogging program. He has a sedentary lifestyle and has smoked two packs of cigarettes daily for 30 years. His blood pressure is 150188 mm Hg. Examination shows no other abnormalities. An ECG shows normal findings. His serum cholesterol level is 250 mgfdL. Which of the following is the most appropriate next step in management?
O A) Referral to a supervised exercise program
O B) Ambulatory blood pressure monitoring
O C) Ambulatory ECG monitoring
O D) Exercise stress test
0 E) Echocardiography
28. One hour ago, a 33-year-old man had the sudden onset of a shaking chill and fever. Two weeks ago, he was diagnosed with acute myelogenous leukemia and was hospitalized for initiation of chemotherapy. He is pale and has rigors. His temperature is 38.6°C (101.5°F), blood pressure is 120/76 mm Hg, pulse is 110/min, and respirations are 32/min. There are multiple petechiae over his antecubital fossae. Physical examination is otherwise normal. Laboratory studies show:
Hematocrit 24%
Leukocyte count 4001mm3
Segmented neutrophils 1%
Lymphocytes 98%
Monocytes 1%
Platelet count 15,000/mm3
Blood is drawn for culture. Which of the following should be administered intravenously?
O A) Clindamycin and cefazolin
O B) Ticarcillin and tobramycin
O C) Vancomycin
O D) High-dose penicillin
O E) High-dose trimethoprim-sulfamethoxazole
29. Seven days after sustaining partial- and full-thickness burns in a house fire, a 7-year-old boy has brain asphyxia, acute respiratory distress syndrome, multiorgan system failure, and sepsis. He is being mechanically ventilated. After consultation with his parents, a do-not-resuscitate order is written, and the boy is removed from the ventilator. Twenty minutes later, his blood pressure is bp86/42 mm Hg, pulse is 130 min. and respirations are 8/min. He periodically moans in pain. His current pain medication is intravenous morphine (20 mg/h). Which of the following is the most appropriate next step in pain management?
O A) Decrease the morphine until the patient's respirations are greater than 12/min
O B) Increase the morphine
O C) Administer midazolam
O D) Administer naloxone
0 E) Administer pancuronium
31. A 37-year-old man with paraplegia comes to the physician for a follow-up examination. He has a decubitus ulcer over the sacrum that has not healed despite wound care and repeated debridement over the past 3 months. Over the past 2 weeks, he has had a low-grade fever and a 3.6-kg (8-Ib) weight loss. His temperature is 38.1°C (100.6°F), and blood pressure is 120180 mm Hg. Examination shows a deep 4-cm ulcer over the sacrum. His leukocyte count is 14,0001mm3, which is consistent with previous leukocyte counts over the past month. His erythrocyte sedimentation rate is 98 mm1h. Which of the following is the most likely diagnosis?
O A) Anaerobic infection
O B) Malnutrition
O C) Osteomyelitis
O D) Squamous cell carcinoma
O E) Type 2 diabetes mellitus