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)

a. Third nerve palsy b. Fourth nerve palsy c. Sixth nerve palsy d. Orbital fracture e. Graves' disease

6-41. The etiology of the patient's diplopia is most likely a. Hyperthyroidism b. Diabetes mellitus c. Cerebral aneurysm d. Orbital pseudotumor e. Orbital infection

6-42. A 42-year-old woman, G2,P2, presents with the chief complaint of severe bilateral breast pain that seems worse around the time of menses. Physical examination reveals bilateral breast tenderness with palpation. Multiple lumps are palpated in both breasts. Mammogram reveals dense bilateral breast tissue. Which of the following is the most likely diagnosis in this patient?

a. Fibroadenoma b. Fibrocystic disease c. Paget's disease d. Mastitis e. Mammary duct ectasia

6-43. A 32-year-old man presents with severe abdominal pain. He describes the pain as sharp and diffuse. He does not drink alcohol or take any medications. He has a past medical history significant for peptic ulcer disease over 5 years ago. The patient has stable vital signs and has no orthostatic changes. You observe the patient to be lying very still on the emergency room stretcher. On physical examination, he has a rigid abdomen and decreased bowel sounds. He has localized left upper quadrant guarding and rebound tenderness. There is referred rebound tenderness on palpation of the right upper quadrant. Rectal examination is FOBT negative. Which of the following is the best method of confirming the diagnosis in this patient?

a. Barium swallow b. Leukocytosis c. Upper endoscopy d. Abdominal radiograph e. Colonoscopy

6-44. A 27-year-old pregnant woman is brought to the emergency room with multiple ecchymoses to the chest and abdomen. Her breath smells of alcohol. The most likely cause of these findings is a. Hepatic failure b. Domestic violence c. An accidental fall d. An automobile accident e. Disseminated intravascular coagulation

6-45. An edentulous 72-year-old man with a 50-year history of cigarette smoking presents with a nontender, hard mass in his lateral neck. The simplest way to establish an accurate histological diagnosis of a neck mass suspected to be cancerous is a. Fine needle aspiration cytology b. Bone marrow biopsy c. Nasopharyngoscopy d. CT scan of the head and neck e. Sinus x-ray

6-46. A 55-year-old man is being evaluated for constipation and change in bowel habits. He has no history of gastrectomy or upper GI symptoms. Laboratory values are as follows:

Hemoglobin: 10 g/dL Mean corpuscular volume (MCV): 72 fL

27 |mol/L) Iron binding capacity: 75 |mol/L

(normal: 45 to 66 |mol/L) Saturation: 10% (normal: 20% to 40%)

The next step in the evaluation of this patient's anemia is a. Red blood cell folate studies b. Iron absorption studies c. Sigmoidoscopy d. Lead level study

6-47. You see five postmenopausal patients in the clinic. Each patient has one of the conditions listed below, and each patient wishes to begin hormone replacement therapy today. Which patient would you start on therapy at the time of this visit?

a. Mild essential hypertension b. Liver disease with abnormal liver function tests c. Malignant melanoma d. Undiagnosed genital tract bleeding e. Treated Stage III endometrial cancer

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