You Should Have Completed Approximately 25 Questions and Have 30 Minutes Remaining

A 23-year-old student presents to your office for health clearance to play collegiate sports. He is asymptomatic and exercises daily. On physical examination his blood pressure is 160 50 mm Hg and his pulse rate is 60 beats min. There is pulsus bisferiens. Heart examination reveals an early diastolic rumble at the apex and a blowing diastolic murmur at the left sternal border. Nailbeds reveal a Quincke pulse. Which of the following is the most likely diagnosis 7-27. A 24-year-old white...

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The answer is c. (Greenberg, 2 e, pp 94-97. Hennekens, pp 206-208.) Intent-to-treat analysis, that is, including in the final results all the subjects who were initially randomized to receive either the drug or the placebo, is the preferred method of analysis for intervention studies. Although it may be tempting to include only those who complied with the medication, the results can be misleading. This study is a classic example of this pitfall. Indeed, the study showed that the difference...

Items 415 through 416

A 1-day-old infant who was born by a difficult forceps delivery is alert and active. She does not move her left arm, however, but keeps it internally rotated by her side with the forearm extended and pronated she also does not move it during a Moro reflex. The rest of her physical examination is normal. This clinical picture most likely indicates a. Fracture of the left clavicle b. Fracture of the left humerus c. Left-sided Erb-Duchenne paralysis d. Left-sided Klumpke paralysis e. Spinal...

Answers

The answer is b. (Behrman, 16 e, p 35. McMillan, 3 e, pp 756-761. Rudolph, 21 e, pp 121-128.) Infants who are developing normally should be able to smile and coo when smiled at or talked to by 8 wk of age. By 3 mo of age, infants should be able to follow a moving toy not only from side to side but also in the vertical plane. When placed on his or her abdomen, a normal 3-mo-old infant can raise his or her face 45 degrees to 90 degrees from the horizontal. Not until 6 to 8 mo of age should...

Items 818 through 819

A 57-year-old man develops acute shortness of breath shortly after a 12-h automobile ride. The patient consults his internist, and findings on physical examination are normal except for tachypnea and tachycardia. An electrocardiogram reveals sinus tachycardia but is otherwise normal. 8-18. Which of the following is correct a. A definitive diagnosis can be made by history alone b. The patient should be admitted to the hospital, and if there is no contraindication to anticoagulation, intravenous...

Items 746 through 747

A 24-year-old primigravid woman, who is intent on breast feeding, decides upon a home delivery. Immediately after the birth of a 4.1-kg (9-lb) infant, the patient bleeds massively from extensive vaginal and cervical lacerations. She is brought to the nearest hospital in shock. Over 2 h, 9 units of blood are transfused, and the patient's blood pressure returns to a reasonable level. A hemoglobin value the next day is 7.5 g dL, and 3 units of packed red blood cells are given. 7-46. The most...

Items 441 through 443

A 34-year-old woman is brought in from a sporting event complaining of headache, nausea, and weakness. She was jogging outside in sunny weather where the temperature was 90 F with a relative humidity of 70 . She started a training program 2 wk ago. She is hyperventilating, her skin is moist, and her core body temperature is 38.8 C. 4-41. The patient most likely suffers from 4-42. The most appropriate cooling measure for this patient is a. Immersion in an ice water bath c. Ice packs to the...

Items 548 through 549

A 50-year-old man presents to a health center for routine care. His last visit was 5 years ago and he has no complaints. He has been smoking 1 pack of cigarettes a day since he was 15 years old. When counseled about his smoking, he says he has no intention to quit and feels fine. He drinks two alcoholic beverages per week. Records show that his blood cholesterol is 235 mg dL, with a HDL level of 40 mg dL and a LDL level of 140 mg dL. The patient has no family history of coronary artery disease...

Items 519 through 520

A 24-year-old woman presents with lethargy, anorexia, tachypnea, and weakness. Laboratory studies reveal a BUN of 150 mg dL, serum creatinine of 16 mg dL, and potassium of 6.2 meq L. Chest x-ray shows increased pulmonary vascu-larity and a dilated heart. 5-19. Management of this patient includes a. Emergency kidney transplantation b. Creation and immediate use of a forearm arteriovenous fistula c. Sodium polystyrene sulfonate (Kayexalate) enemas e. Cardiac biopsy via femoral vein...

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A 30-year-old primigravida complains of headaches, restlessness, sweating, and tachycardia. She is 18 wk pregnant and her blood pressure is 200 120 mm Hg. 8-39. Appropriate workup might include 8-40. Appropriate treatment might consist of b. Urgent excision of the tumor and a therapeutic abortion c. Phenoxybenzamine and propranolol followed by a combined cesarean section and excision of the tumor d. Metyrosine (Demser) blockade followed by a combined cesarean section and excision of the tumor...

Items 640 through 641

A 57-year-old woman with a history of diabetes mellitus and hyperthyroidism presents to the emergency room with a history of 2 days of vertical and horizontal diplopia. There is moderate orbital pain. On examination the patient's left eye is deviated downward and outward. It can be passively moved medially and upward. The pupils both react normally. 6-40. The patient most likely has a(n) 6-41. The etiology of the patient's diplopia is most likely 6-42. A 42-year-old woman, G2,P2, presents with...

Items 69 through 610

A 53-year-old woman presents with complaints of weakness, anorexia, malaise, constipation, and back pain. While being evaluated, she becomes somewhat lethargic. Laboratory studies include a normal chest x-ray serum albumin, 3.2 mg dL serum calcium, 14 mg dL serum phosphorus, 2.6 mg dL serum chloride, 108 mg dL BUN of 32 mg dL creatinine of 2.0 mg dL. 6-9. Appropriate initial management includes a. Intravenous normal saline infusion b. Administration of thiazide diuretics c. Administration of...

Questions

A 5-year-old boy comes to the emergency department at midnight with a complaint of severe scrotal pain since 7 p.m. There is no history of trauma. Your first step is to a. Order a surgical consult immediately b. Order a radioisotope scan on an emergency basis c. Order a urinalysis and gram stain for bacteria d. Arrange for an ultrasound examination 3-2. A 30-year-old woman in the last trimester of pregnancy suddenly develops massive swelling of the left lower extremity from the inguinal...

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You are a public health physician working at a city health department. You receive a report of a case of hepatitis A virus HAV infection in a 32-year-old man who lives with his wife and 1-year-old twins. He is a self-employed contractor who often eats on the run. His wife works part-time at a book store and his children attend day care. He has no history of travel, eating raw fish, or known contact with other cases of HAV infection. 7-6. The first step in investigating this case is to confirm...