mohamed.ali
Forum Junior
Topics: 12
Posts: 39
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2. A 57-year-old woman comes to the physician because of depressed mood and daily crying episodes since the death of her father 6 weeks ago. She has had difficulty concentrating, decreased libido, and a 3.2-kg (7-Ib) weight loss during this period. She is less interested in her usual activities but continues to work productively. She sleeps for about 8 to 10 hours every night. Over the past 2 weeks, she has been smoking and drinking more frequently, she now smokes one-half pack of cigarettes daily and drinks two to three glasses of wine every other day. She has no history of serious illness and takes no medications. She is 163 cm (5 ft 4 in) tall and weighs 80 kg (176 Ib), BMI is 30 kg/m2. Her temperature is 37°C (98.6°F), pulse is 641min, and blood pressure is 108160 mm Hg. The remainder of the examination shows no abnormalities. Mental status examination shows a sad mood and restricted affect. Her speech is normal in rate and rhythm. There is no evidence of suicidal ideation or hallucinations. She can recall three of three objects after 5 minutes. Long-term memory is intact. Which of the following is the most likely diagnosis?
O A) Alcohol dependence
O B) Bereavement
O C) Bipolar disorder
O D) Cyclothymic disorder
O E) Dysthymic disorder
O F) Major depressive disorder
O G) Malingering
8. A 38-year-old woman comes to the physician because of a low-grade fever and generalized rash for 4 days. She is currently receiving cefazolin therapy for chronic osteomyelitis. Her temperature is 38.2°C (100.8°F), blood pressure is 1501108 mm Hg, and pulse is 1001min. There is a faint diffuse maculopapular rash. Examination of the back shows no costovertebral angle tenderness. Cardiac and pulmonary examinations show no abnormalities. Laboratory studies show:
Leukocyte count 10,8001mm3
Segmented neutrophils 60%
Bands 8%
Eosinophils 4%
Lymphocytes 20%
Monocytes 8%
Serum
Urea nitrogen (BUN) 20 mg/dL
Creatinine 1.6 mg/dL
Urine
WBC 121hpf
RBC 81hpf
RBC casts none
WBC casts rare
Eosinophils are found in the urine sediment. Which of the following is the most likely explanation for these findings?
O A) Acute tubular necrosis
O B) Fibromuscular dysplasia
O C) Interstitial nephropathy
O D) Polyarteritis nodosa
O E) Pyelonephritis
O F) Wegener's granulomatosis
15. A previously healthy 6-month-old boy is brought to the physician because of a 12-hour history of vomiting and diarrhea. He vomits after all feedings, the vomitus does not contain blood or bile. His mother says that he has had fewer wet diapers than usual during this period. He appears dehydrated and is crying without tears. He is at the 50th percentile for length and 30th percentile for weight. He appears lethargic. His temperature is 38°C (100.4°F), pulse is 180/min, and blood pressure is 60/40 mm Hg. Examination shows sunken eyes, dry mucous membranes, and a sunken anterior fontanel. Arterial blood gas analysis on room air shows:
pH 7.2
PCO2 38 mm Hg
PO2 90 mm Hg
Which of the following is the most likely explanation for this patient's arterial blood gas findings?
O A) Excessive metabolic acid formation
O B) Impaired ventilation
O C) Increased chloride loss (àincrease HCO3 which is not the case here)
O D) Increased CO2 concentration in the extracellular fluid
0 E) Increased metabolic acid produced by the gastrointestinal tract
19. Over the past 2 weeks, a 60-year-old man has had shortness of breath on exertion. He also has paroxysmal nocturnal dyspnea with two-pillow orthopnea. He has taken aspirin daily since a myocardial infarction 3 years ago. He has a history of atrial fibrillation well controlled with digoxin and type 2 diabetes mellitus treated with diet. His blood pressure is 136188 mm Hg, pulse is 98/min and irregular, and respirations are 20/min. Jugular-venous pressure is increased. Breath sounds are decreased over the right lung base.. there is dullness to percussion. Cardiac examination shows an S. gallop. There is 2+ edema of the lower extremities. Pulse oximetry shows an oxygen saturation of 90%. Which of the following is the most appropriate next step in diagnosis?
O A) X-ray film of the chest
O B) Ambulatory ECG monitoring
O C) Thallium stress test
O D) Echocardiography
O E) Ventilation-perfusion lung scans
37. A 2-year-old girl is found floating facedown in a swimming pool. On rescue, she immediately coughs and breathes spontaneously. She is conscious and oriented. Without treatment, which of the following is the most likely outcome for this child?
A) Complete recovery
B) Development of acute respiratory distress syndrome
C) Hemolysis
D) Pulmonary hypertension
E) Severe neurologic deficit
40. A study is conducted to investigate the prevalence of past infection with genital herpes among students attending a large coeducational Midwestern university. After obtaining informed consent, the study participants undergo antibody testing for herpes simplex virus 2 (HSV). Which of the following is the most important factor in determining the validity of a positive test?
A) The number of sexual partners of the student
B) The proportion of students infected with HSV
C) The proportion of students with negative tests
D) The proportion of students with positive tests
E) The total number of students screened
42. Twelve days after sustaining a cerebral infarction, a 72-year-old man has fever and cough. Initial symptoms included inability to move his right arm and leg, swallow, speak, or respond to questions. He has been receiving a diet of pureed foods since he recovered his ability to swallow 3 days ago. He is wearing false teeth. His temperature now is 38.8°C (101.8°F), blood pressure is 135/85 mm Hg, pulse is 94/min, and respirations are 28/min. Examination shows moderate weakness of the facial muscles and right extremities. Gag reflex is absent. Breath sounds are decreased, and there is dullness to percussion over the right lung base posteriorly. An x-ray film of the chest shows an infiltrate in the posterior basal segment of the right lung. Which of the following is most likely to prevent recurrence of this patient's lung condition?
O A) Removal of false teeth
O B) Suppression of gastric acid production
O C) Chronic antibiotic prophylaxis
O D) Administration of metoclopramide to increase gastrointestinal motility
O E) Insertion of a feeding jejunostomy tube
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| vibrio
Forum Newbie
Topics: 3
Posts: 18
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plz correct if iam wrong...
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