Items 845 through 846

A 70-year-old man complains of 2 mo of low back pain and fatigue. He has developed a fever with purulent sputum production. On physical exam, he has pain over several vertebrae and rales at the left base. Laboratory results are as follows:

Hemoglobin: 7 g/dL

Creatinine: 3.2 mg/dL

Chest x-ray: LLL infiltrate

Reticulocyte count: 1%

8-45. The most likely diagnosis is a. Multiple myeloma b. Lymphoma c. Metastatic bronchogenic carcinoma d. Primary hyperparathyroidism

8-46. The definitive diagnosis is best made by a. 24-h urine protein b. Greater than 10% plasma cells in bone marrow c. Renal biopsy d. Rouleaux formation on blood smear

8-47. A 3-year-old child presents with a petechial rash but is otherwise well and without physical findings. Platelet count is 20,000/mm3; hemoglobin and WBC count are normal. The most likely diagnosis is a. Immune thrombocytopenic purpura (ITP)

b. Henoch-Schonlein purpura c. Disseminated intravascular coagulopathy (DIC)

d. Acute lymphoblastic leukemia e. Systemic lupus erythematosus (SLE)

8-48. The mother of a 7-day-old infant has developed chickenpox. Which of the following is the most appropriate measure?

a. Isolate the infant from the mother b. Hospitalize the infant in the isolation ward c. Administer acyclovir to the infant d. Administer varicella-zoster immu-noglobulin to the infant e. Advise the mother to continue regular well-baby care for the infant

8-49. A hypothetical study examining the association between serum cholesterol (>280) and cardiovascular disease (CVD) demonstrates a crude relative risk of 3.0. When the data is stratified by gender, the relative risk for men is 4.0 and the relative risk for women is 1.0. The adjusted risk is 3.0. The most appropriate interpretation of the results of this study is that a. Gender is both a confounder and an effect modifier b. Gender is a confounder only c. Gender is an effect modifier only d. Gender is neither a confounder nor an effect modifier e. Gender is causal pathway

8-50. A 34-year-old successful lawyer presents to the ER with chest pain. His pupils are dilated and his blood pressure is 160/95 mm Hg. The toxic screen is likely to be positive for a. Cannabinoids b. Opiates c. Cocaine d. LSD

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