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A 24-year-old woman comes to the emergency department with suicidal ideation. She claims she was about to jump off a building but decided to come in for help. Her affect is depressed, and she cries frequently and expresses feelings of hopelessness and wurthlessness multiple limes during the interview. You call the staff psychiatrist for further evaluation. While waiting to be examined by the staff psychiatrist, the patient decides to leave, after saying it's hopeless anyway. What should you do...

Block 4

The answer Is A. (Surgery General) Smoking cessation is the best thing to keep patients healthy. Postoperative incentive spirometry, early ambulation, and minimal use of narcotics also help but are less effective than smoking cessation at least 1 week (preferably 1 month) before surgery. Withholding all narcotics is harsh in many cases because patients may be in severe pain alter surgery. Mechanical ventilation has complications of its own and is not used unless needed. Perioperative...

Block 5

The answer is 11. (Neurosurgery) Early detection coupled with minimal delay in treatment is associated with the best outcome in the setting of spinal cord compression. Delay s in treatment worsen the pretreatment function, which is well correlated with the patient's eventual outcome. The longer treatment is delayed, the more likely it is that increasing, irreversible neurologic damage will oceur. In severe injury, there often is little hope for meaningful recovery, 202. The answer is E....

Info

A student compiles data on two medical schools regarding specialty choice after graduation. She decides to group the graduates of the schools into one of two groups primary care or specialization. What lest might help her compare the schools in terms of the number of graduates that go into primary care from each school (A) 7-test < B> Paired -test (C> Analysis of variance (A NOVA J A 71-year-old healthy woman presents with a complaint of gradually decreasing vision in both eyes, right...

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140 mEq L 4.0 mEq L 108 mEq dL 27 mEq L 6 mg dL 1.0 mg dL 58 U L (normal 7-27) 20 U L (normal 1-21) 1.2 mg dL (normal 0.1-1) 3.2 mg dL (normal 3,5-5,0) Which of the following is true regarding this patient (A) The pattern of liver function tests indicates probable viral hepatitis, (B) Folate deficiency is likely to be the cause of the anemia. (C) Vitamin Bk> deficiency most likely is the cause of the anemia. (D) lie should receive narcotics for back pain. (E) His back pain most likely is due...

Block 3

OuJy the patient, if he or she is competent, should decide whether or rot information is withheld or disclosed- The family does not have a right to make that decision. When dealing with family members, however, you must remember their fears and concerns as well. Although you should ask the patient whether or not she wants to know the diagnosis, taking 5 minutes to discuss the family's fears with them may be all that is required to icsoive this issue. Telling the patient anywav is partly...

Bun

(im cell 155 mEq L 3,8 mEq dL 121 mEq L 19 mEq I. 48 mg dL 1.6 mg dL Normal other than elevated specific gravity An old emergency department record reveals a normal metabolic profile and renal func on 3 months ago. What is the likely cause of the patient's renal insufficiency (D) Diabetic hyperosmolar, hyperglycemic state What is the best way to dilTcrcntiate between nephrogenic and central diabetes insipidus (A) Administer antidiuretic hormone. ( B Admi n ister demeclocycii ne. (C) Administer...

Block 13

The answer is D. (Medicine Gastroenterology) The thousands of polyps that may be seen in the Peutz-Jeghers syndrome, which often can be recognized by the oral or buccal facial pigmentation, are hamartomatous and generally do not become malignant. These patients are. however, at an increased risk for cancer of the pancreas, breast, lung, ovary, and uterus. Patients with familial adenomatous polyposis are considered to have a 100 chance of getting colon cancer if they live long enough and...

Block 14

65 , The answer is C. (Pediatrics infectious Disease) This infant most likely has roseola infantum, usually caused by human herpesvirus type 6. The hallmark of the condition is extremely high fevers fur 3 to 5 Jays without localizing signs that may result in febrile seizures. The child is classically alert and active. The fever stops abruptly (as it usually begins) then a mild maculopapular rash classically appears on the chest and abdomen. Acetaminophen to reduce fever can help prevent further...

Block 10

Although adults can make their own decisions, children are protected by the state. In most instances, the parents1 wishes should be respected, but if they refuse a simple, life-saving intervention, the courts should be involved. It would be appropriate to involve the hospital ethics committee, although this was not an option. Always try to reason with the parents first in this setting, but if this fails, you should attempt to gain permission to do what you believe...

C 715 A 716 B 717 B 718 C

In many diseases, using epidemiology can help you concentrate your efforts toward specific diseases, For example, in 90 of cases, systemic lupus erythematosus affects women. Between the ages of 20 and 50, urinary tract infections are at least 20 times more common in women than men. Pyloric stenosis and Hirschsprung's disease are 5 times more common in males. This type of striking difference in sex-related incidence can make certain differential diagnoses less likely. Hemophilia is XTinked, so...