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 a. Sunstroke b. Heat cramps c. Heat exhaustion d. Heat stroke e. Heat syncope

4-42. The most appropriate cooling measure for this patient is a. Immersion in an ice water bath b. Iced gastric lavage c. Ice packs to the groin, axilla, and neck d. Evaporative cooling e. A cool and shaded environment

4-43. In addition to proper hydration, rest, and attention to heat index guidelines, the patient should be advised to avoid reexposure to heat for at least a. 1 day b. 1 wk c. 2 wk d. 3 wk e. 4 wk

4-44. A 28-year-old nulligravid patient complains of bleeding between her periods and increasingly heavy menses. Over the past 9 mo she has had two dilation and curet-tages (D&Cs), which have failed to resolve her symptoms, and oral contraceptives and antiprostaglandins have not decreased the abnormal bleeding. Of the following options, which is most appropriate at his time?

a. Performing a hysterectomy b. Performing a hysteroscopy c. Performing an endometrial ablation d. Treating with a GnRH agonist e. Starting the patient on a high-dose progestational agent

4-45. A 46-year-old woman complains of headache, sweating, and diaphoresis that occurs on a daily basis or sometimes twice a day while she is at work. She has gone to the company nurse during these episodes and was told that her blood pressure was elevated. Aside from that, the nurse could not find any other problem. Physical examination is normal, including blood pressure, which is 130/80 mm Hg. Which of the following is the most likely diagnosis?

a. Carcinoid syndrome b. Thyroid storm c. Pheochromocytoma d. Syndrome X

e. CHAOS

4-46. A 25-year-old man presents with morning back pain and stiffness and tenderness over the sacro-iliac joints. The patient denies any previous history of eye or genitourinary problems. On physical examination, there is diminished chest expansion with breathing. Which of the following is the most likely diagnosis?

a. Rheumatoid arthritis b. Ankylosing spondylitis c. Sjogren syndrome d. Systemic lupus erythematosus e. Reiter syndrome

4-47. A 65-year-old woman with a history of prolonged alcohol abuse cheerfully greets the resident doctor of her nursing home, whom she has met many times before, and calls him "My dear friend Jack." The physician explains who he is and tells the patient his name. Two minutes later, when he asks the patient if she knows who he is, she answers with a smile: "Of course, you are my cousin Anthony from New Jersey." Deficiency of which vitamin can cause this particular form of alcohol-induced amnesic disorder?

a. Panthotenic acid b. Folate c. Thiamin d. Riboflavin e. Niacin

4-48. A 34-year-old investment banker complains of intermittent episodes of vertigo associated with a feeling of fullness in his right ear. These last for several hours. He has had progressive hearing loss in the right ear. There are no other symptoms. He takes no medications and has no history of head trauma. This man probably has a. Meniere's disease b. Cholesteatoma c. Vestibular schwannoma d. Benign positional vertigo e. Aminoglycoside toxicity

4-49. At 43 wk of gestation, a long, thin infant is delivered who is apneic, limp, pale, and covered with "pea soup" amniotic fluid. The first step in the resuscitation of this infant at delivery should be a. Suction of the trachea under direct vision b. Artificial ventilation with bag and mask c. Artificial ventilation with endotra-cheal tube d. Administration of 100% oxygen by mask e. Catheterization of the umbilical vein

4-50. A 50-year-old black man with a history of alcohol and tobacco abuse has complained of difficulty swallowing solid food for the past 2 mo. More recently, swallowing fluids has also become a problem. The patient has noted black, tarry stools on occasion and has lost 10 lb. Which of the following statements is correct?

a. The patient's prognosis is good b. Barium contrast study is indicated c. The most likely tumor is an adeno-carcinoma d. The patient has achalasia

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