Items 839 through 840

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 a. Exploratory laparotomy b. Mesenteric angiography c. Head CT scan d. Abdominal CT scan e. Abdominal ultrasonogram

8-40. Appropriate treatment might consist of a. Therapeutic abortion 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 e. Phenoxybenzamine and propranolol followed by a combined vaginal delivery at term and excision of the tumor

8-41. A 40-year-old literary agent has had worsening tremor of the hands. This has been present for 2 years, but has increasingly impaired her ability to work because she is frequently required to take her clients to lunch, and she is embarrassed by her inability to eat and drink normally. A glass of wine with the meal typically helps somewhat. On exam, there is a mild head tremor, but no rest tremor of the hands. When the patient holds a pen by the tip at arm's length, however, a coarse tremor is readily apparent. Exam is otherwise normal. What is the most likely diagnosis?

a. Meigs syndrome b. Dopa-responsive dystonia c. Parkinson's disease d. Whipple's disease e. Essential tremor

8-42. A 9-year-old girl has breast and pubic hair development. Evaluation demonstrates a pubertal response to a gonadotropin-releasing hormone (GnRH) stimulation test and a prominent increase in lutein-izing hormone (LH) pulses during sleep. These findings are characteristic of patients with a. Theca cell tumors b. Iatrogenic sexual precocity c. Premature thelarche d. Granulosa cell tumors e. Idiopathic/constitutional precocious puberty

8-43. A mother brings her 14-year-old daughter to your office because she is concerned about her child's eating patterns. The daughter's nutritional history reveals that she generally eats very little because she says she is not hungry. She occasionally engages in junk food binges with friends. She is often constipated. She exercises regularly. She is 5 ft, 6 in. tall and weighs 108 lb. Her menarche was at age 13, but she stopped having periods 4 mo ago. She says she has no concerns about her body image, and thinks her mother is exaggerating because everyone in the family is tall and thin. The history and findings are most likely associated with a. Typical adolescent behavior b. Depression c. Hyperthyroidism d. Bulimia e. Anorexia

8-44. A 32-year-old woman presents to the hospital with a 24-h history of abdominal pain in the right lower quadrant. She undergoes an uncomplicated appendectomy for acute appendicitis and is discharged on the fourth postoperative day. The pathologist notes the presence of a carcinoid tumor (1.2 cm) in the tip of the appendix. Which of the following statements is true?

a. The patient should be advised to undergo ileocolectomy b. The most common location of car-cinoids is in the appendix c. The carcinoid syndrome occurs in more than half of patients with car-cinoid tumors d. The tumor is an apudoma e. Carcinoid syndrome is seen only when the tumor is drained by the portal venous system

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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