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A 22-year-old male complains of fever and shortness of breath. There is no pleuritic chest pain or rigors and no sputum production. A chest x-ray shows diffuse perihilar infiltrates. The patient worsens while on erythromycin. A silver methenamine stain shows cystlike structures. Which of the following is correct a. Definitive diagnosis can be made by serology b. The organism will grow after 48 h c. History will likely provide important clues to the diagnosis d. Cavitary disease is likely to...

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A 35-year-old woman develops an itchy rash over her back, legs, and trunk several hours after swimming in a lake. Erythematous, edematous papules are noted. The wheals vary in size. There are no mucosal lesions and no swelling of the lips (see photo). The most likely diagnosis is 396. The treatment of choice for this patient is c. Antihistamines and avoidance of offending agent 397. A 30-year-old black female has had a history of cough, and a chest x-ray shows bilateral hilar...

Questions

DIRECTIONS Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question. 308. A 55-year-old male is being evaluated for constipation. There is no history of prior gastrectomy or of upper GI symptoms. Hemoglobin is 10 g dL, mean corpuscular volume (MCV) is 72 fL, serum iron is 4 g dL (normal is 50 to 150 g dL), iron-binding capacity is 450 g dL (normal is 250 to 370 g dL), saturation is 1 (normal is 20 to 45 ), and...

Is Livergen Suitable For Three Months Pregnancies

The answer is d. (Braunwald, 15 e, pp 21-25, 501.) A lipid profile is recommended every 5 years for patients 20 years of age or older. With this patient's family history of early coronary artery disease, which suggests a possible dyslipidemia, a lipid profile is warranted. There is no indication in the history that screening liver function tests are required. A chest x-ray is not indicated for screening even if the patient is a tobacco user. Screening mammography is recommended for the...

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Match each symptom or sign with the appropriate diagnosis. g. Temporomandibular joint dysfunction 376. Bilateral, bandlike sensation around head dull, steady pain that may last days, weeks possible occipital or nuchal soreness (SELECT 1 DIAGNOSIS) 377. Unilateral, nonthrobbing headache more common in men nasal stuffiness and lacrimation (SELECT 1 DIAGNOSIS) 378. Unilateral headache with localized scalp tenderness in older patient may have transient visual loss (SELECT 1 DIAGNOSIS) 379. A...

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A 21-year-old female presents with complaints of dysuria for the past 48 h. She denies elevated temperature, chills, or nausea vomiting. She states she is having some difficulty sleeping at night. She is 28 weeks pregnant with her first child. You note she is wearing long sleeves in warm weather and she has bruising on her forearms and left lateral thoracic area. An appropriate way to explore your concerns with the patient would be to ask which of the following questions a. Do you know how...

Answers

The answer is c. (Braunwald, 15 e, pp 662-664.) The patient has a microcytic anemia. A low serum iron, low ferritin, and high iron-binding capacity all suggest iron-deficiency anemia. Most iron-deficiency anemia is explained by blood loss. The patient's symptoms of constipation point to blood loss from the lower GI tract. Colonoscopy would be the highest-yield procedure. Barium enema misses 50 of polyps and a significant minority of colon cancers. Even patients without a history of GI...

Items 398399

An elderly homeless male is evaluated for anemia. On exam, he has purpura and ecchymoses of the legs. Perifollicular papules and perifollicular hemorrhages are also noted. There is swelling and bleeding of gums around the patient's teeth as well as tenderness around a hematoma of the calf. The most likely diagnosis is 399. The best approach to the management of this patient is a. Obtain platelet ascorbic acid level and give ascorbic acid while in hospital b. Discharge with dietary consult...

Infectious Disease

DIRECTIONS Each item below contains a question or incomplete statement followed by suggested responses. Select the one best response to each question. 1. A 30-year-old male patient complains of fever and sore throat for several days. The patient presents to you today with additional complaints of hoarseness, difficulty breathing, and drooling. On examination, the patient is febrile and has inspiratory stridor. Which of the following is the best course of action a. Begin outpatient treatment...

Items 341342

A 58-year-old Scandinavian male presents with shortness of breath and is found to have anemia. Peripheral blood smear shows macrocytosis and hypersegmented polyps. The patient also has postural hypotension. Skin shows both vitiligo and hyperpigmentation. Romberg sign is positive. Serum sodium is 120 meq L normal is 136 to 145 meq L and potassium is 5.2 meq L normal is 3.5 to 5.0 meq L . Urinary sodium is increased. Which of the following is correct a. The patient's symptoms will be...