docdoc9
Forum Guru
Topics: 63
Posts: 513
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11.
A 62-year-old man comes to the emergency department
because of
progressive shortness of breath for 3 days. He has
not had chest pain,
orthopnea, or paroxysmal nocturnal dyspnea. He
completed chemotherapy for
small cell carcinoma of the lung 10 months ago. He
has a history of twice
nightly nocturia that has resolved over the past 3
days. He smoked two
packs of cigarettes daily for 30 years but quit 1 year
ago. His blood
pressure is 96/60 mm Hg, and pulse is 116/min. There
is jugular venous
distention to the angle of the jaw. The lungs are
clear to
auscultation. Cardiac examination shows distant heart
sounds, an S1 and S2, and no
gallops or rubs. The liver has a span of 12 cm and is
tender. There
is no pedal edema. Laboratory studies show:
Hemoglobin 10 g/dL
Serum
Na+ 135 mEq/L
Cl– 110 mEq/L
K+ 4.2 mEq/L
HCO3– 22 mEq/L
Urea nitrogen (BUN) 40 mg/dL
Creatinine 1.6 mg/dL
An ECG shows diminished amplitude of the QRS
complexes. An x-ray film
of the chest shows clear lung fields with an enlarged
cardiac
silhouette. Which of the following findings is most
likely to be accentuated?
A
) Cardiac output
B
) Fall in systolic arterial pressure with
inspiration
C
) Left ventricular end-diastolic pressure
D
) Mitral regurgitation
E
) Ventricular septal wall motion
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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3. An obese 33-year-old woman has had four 12-hour
episodes of
severe, sharp, penetrating pain in the right upper
quadrant of the abdomen
associated with vomiting but no fever. She has no
diarrhea, dysuria, or
jaundice and is asymptomatic between episodes. There
is slight
tenderness to deep palpation in the right upper
quadrant. Which of the
following is the most appropriate next step in
diagnosis?
A
) Supine and erect x-ray films of the abdomen
B
) Upper gastrointestinal series
C
) Ultrasonography of the upper abdomen
D
) CT scan of the abdomen
E
) HIDA scan of the biliary tract
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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14. An otherwise healthy 19-year-old woman comes to
the physician
because of a 3-year history of intermittent facial
blemishes. She drinks
wine occasionally on weekends. She takes no
medications. Examination
shows multiple 1- to 2-mm red and white papules and
larger red nodules
on the forehead and cheeks. Which of the following is
the most
appropriate initial pharmacotherapy?
A
) Oral isotretinoin
B
) Systemic corticosteroids
C
) Topical benzoyl peroxide
D
) Topical corticosteroids
E
) Topical metronidazole
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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A 10-year-old girl is brought to the physician because
of temperatures
to 40 C (104 F) and headaches for 1 week. Her mother
says that fever
and chills occur every other day and typically last
for several hours.
She appears ill and is lethargic during febrile
episodes. She and her
family returned from a trip to West Africa 2 weeks
ago. She currently
appears ill. Her temperature is 40 C (104 F), blood
pressure is 94/64
mm Hg, pulse is 146/min, and respirations are 20/min.
Examination shows
mild scleral icterus and conjunctival pallor. The
liver edge is
palpated 3 cm below the right costal margin, and the
spleen tip is palpated 3
cm below the left costal margin. Laboratory studies
show:
Hemoglobin 8 g/dL
Leukocyte count 6400/mm3
Segmented neutrophils 46%
Eosinophils 5%
Lymphocytes 40%
Monocytes 9%
Serum
Na+ 132 mEq/L
Cl– 98 mEq/L
K+ 4.2 mEq/L
HCO3– 16 mEq/L
Urea nitrogen (BUN) 21 mg/dL
Bilirubin
Total 5.2 mg/dL
Direct 0.8 mg/dL
Aspartate aminotransferase (AST, GOT) 64 U/L
Alanine aminotransferase (ALT, GPT) 98 U/L
Urine
Color tea
Blood strongly positive
RBC occasional
Which of the following measures is most likely to have
prevented this
condition?
A
) Hepatitis A vaccine
B
) Typhoid vaccine
C
) Oral isoniazid prophylaxis
D
) Oral mefloquine prophylaxis
E
) Oral trimethoprim-sulfamethoxazole prophylaxis
F
) Intramuscular immune globulin
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
|
17.
A 42-year-old woman comes for a follow-up examination.
Two weeks ago,
her blood pressure was 152/94 mm Hg during a routine
visit. Her blood
pressure today is 150/94 mm Hg, pulse is 76/min, and
respirations are
14/min. Examination shows no other abnormalities.
Serum studies show:
Na+ 142 mEq/L
Cl– 105 mEq/L
K+ 4 mEq/L
HCO3– 26 mEq/L
Urea nitrogen (BUN) 12 mg/dL
Glucose 101 mg/dL
Creatinine 0.8 mg/dL
An ECG shows no abnormalities. Which of the following
is the most
appropriate next step in management?
A
) Measurement of plasma renin activity
B
) Serum lipid studies
C
) 24-Hour urine collection for measurement of
metanephrine level
D
) Echocardiography
E
) Captopril renal scan
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| nightflight1945
banned
Topics: 32
Posts: 920
|
11- B )Fall in systolic arterial pressure with inspiration
Cardiac tomponade with pulsus paradoxus
3-C) Ultrasonography of the upper abdomen
it is biliary colic and is not acute colecystitis
14 ) Topical benzoyl peroxide
and also it can be topical vit A or topical erythro or clinda
D ) Oral mefloquine prophylaxis
Malaria and mostly falciparum
17- B ) Serum lipid studies
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| docdoc9
Forum Guru
Topics: 63
Posts: 513
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Agree on all the answers expect the acne one
UW says that
moderate to severe acne that is predominantly nodulocystic and those who develop scars should be treated with oral retinoids.
?????
|
| nightflight1945
banned
Topics: 32
Posts: 920
|
It is a moderate form of acne. I suppose we first should try a course of oral antibiotic therapy at least for 4-8 weeks and if it fails the next step would be systemic vit A. As far as I know , sys vit A is never the first choice except vey severe form of disease
Edited by nightflight1945 on 08/27/08 - 01:26 AM
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| docdoc9
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Topics: 63
Posts: 513
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