10.2011 internal

40 year old female patient is presented with left chest pain. the pain is located mid clavicular on the 4th intercostal space. There is a trigger point and the pain is increased with inspiration. What is the most likely diagnosis?

Treatment of a severely infected diabetic foot ulcers should involve:

Subclinical hypothyroidism is diagnosed with?

A 68-year-old white woman comes in to discuss the results of her dual-energy x-ray absorptiometry (DEXA) scan. Her T score is –2.7. You explain that she has osteoporosis and requires treatment. Management of osteoporosis includes:

A 41-year-old business executive presents to your office and complains of palpitations and shortness of breath. After further questioning, he admits to heavy alcohol consumption the previous evening. On examination, he is found to have an irregular heartbeat of 130 bpm. The most likely diagnosis is

Which of the following is a potentially severe complication of using warfarin that is unrelated to excessive bleeding?

A 60-year-old woman presents with chronic dyspnea and a long history of smoking. Based on the history and physical examination, you diagnose chronic obstructive pulmonary disease and initiate treatment to relieve the patient’s symptoms. In addition to this therapy, additional recommendations should include:

A 36-year-old African American woman with systemic lupus erythematosus presents with the acute onset of lethargy and jaundice. On initial evaluation, she is tachycardic and hypotensive, appears pale, is dyspneic, and is somewhat difficult to arouse. Physical examination reveals splenomegaly. Her initial hemoglobin is 6 g/dL, white blood cell count is 6300/μL, and platelets are 294,000/μL. Her total bilirubin is 4 g/dL, reticulocyte count is 18%, and haptoglobin is not detectable. Renal function is normal, as is urinalysis. What would you expect on her peripheral blood smear?

A 24-year-old intravenous drug abuser presents with fever, night sweats, chest pain, and arthralgias. On examination, painless erythematous lesions are noted on the palms of the hands; round, erythematous lesions with central clearing are noted in the retina; and splinter hemorrhages are noted on the fingernails. The most likely diagnosis is

A 45-year-old previously healthy male presents for a physical examination. His last physical was performed 10 years earlier and was normal. He has no significant past medical history and is on no medications. He does not smoke and consumes two to three alcoholic drinks weekly. His family history is significant for hypertension in his mother. He denies any physical complaints. His physical examination is normal with the exception of a BP of 148/98. You recommend a recheck on his BP in 1 month; the repeat measurement is then found to be 150/100. Further evaluation of this patient should include which of the following:

A healthy 62-year-old woman returns to your clinic after undergoing routine colonoscopy. Findings included two 1.3-cm sessile (flat-based), villous adenomas in her ascending colon that were removed during the procedure. What is the next step in management?

Which of the following findings is associated with chronic myelocytic leukemia (CML)?

A 20-year-old woman presents with concerns that her thyroid gland is overactive, because her mother had a similar condition and she has not been feeling well. In the evaluation of this patient, which of the following would be a symptom of hyperthyroidism? not been feeling well. in evaluating this patient, what would strongly suggest hyperthyroidism?

Which of the following should prompt investigation for hereditary nonpolyposis colon cancer screening in a 32-year-old man?

Definition of chronic bronchitis is?

A 30-year-old woman from Minneapolis presents to your office complaining of paresthesias, weakness, lack of coordination, and difficulty with gait. Her symptoms are worse after a hot shower. Examination of the cerebral spinal fluid shows oligoclonal bands of immunoglobulin G (IgG). The most likely diagnosis is

A 65-year-old man presents complaining of back pain and generalized fatigue. Laboratory findings include anemia with Rouleau formation, a monoclonal spike seen with serum protein electrophoresis, and hypercalcemia. Radiographs of the lumbar spine show lytic lesions. The most likely diagnosis is

A 68-year-old man presents for routine physical examination. In addition to obtaining a complete history and examination, which of the following would you routinely recommend?

A 56-year-old man presents to your office with complaints of “chronic” diarrhea. He states that he has had loose stools for the past 2 days. He denies blood in the stool, fever, and has no weight loss and no recent travel. Appropriate management at this time includes

Mitral valve prolapse (MVP) is associated with:

A 42-year-old woman returns from a business trip and notes the sudden onset of dyspnea along with a pleuritic right-sided chest pain. Her past medical history is unremarkable. She is currently on birth control pills. Her vital signs are BP 120/70, heart rate 100, regular respiratory rate 24, and temperature 98.6°F (37.0°C). Cardiac and lung examinations are unremarkable. There is no chest wall tenderness. Examination of her extremities reveals no cyanosis or clubbing, but there is pitting edema in her right leg. Testing should be done promptly to exclude the following:

A 72 years old female with severe osteoporosis presents for evaluation of shortness of breath. She is a lifetime nonsmoker and has had no exposures. On physical examination you note kyphoscoliosis. All the following pulmonary abnormalities are expected except:

A 28-year-old homosexual man presents to your office complaining of a nonproductive cough, shortness of breath, fever, and chills. A chest radiograph shows bilateral interstitial infiltrates. The best treatment is

A 50-year-old man complains of recurrent chest pain that radiates down his left arm and has been occurring over the past 9 months. The pain is described as a retrosternal pressure. It is brought on by walking or other strenuous exercise and is relieved by 2 minutes of rest. His vital signs are stable and the physical examination is unremarkable. The most likely diagnosis is:

A 23-year-old male is climbing Mount Kilimanjaro. He has no medical problems and takes no medications. Shortly after beginning the climb, he develops severe shortness of breath. Physical examination shows diffuse bilateral inspiratory crackles. Which of the following is the most likely etiology?

Which of the following electrolyte abnormalities is associated with bulimic patients?

Of the following conditions, which is related to the development of osteoporosis in men?

Which of the following sequences represents how a typical anteroseptal MI progresses on ECG? sequences represents how a typical anteroseptal myocardial infarction progresses on ECG?

High fever, tachycardia, tachypnea, diaphoresis, hypertension, and seizures develop in a psychiatric patient who is receiving haloperidol. The most likely diagnosis is

A 52-year-old man presents with a complaint of dyspnea, which has troubled him for the preceding 8 months. He has had minimal prior medical care, notes no prior medical problems, and denies any medication use. He admits to having smoked a pack of cigarettes daily for the past 30 years. He is currently stable and his physical examination is remarkable for a prolonged expiratory phase and diminished breath sounds bilaterally. In evaluating this patient, which of the following is the most likely cause for his chronic dyspnea?

A 65-year-old with a history of chronic atrial fibrillation is being monitored while on warfarin therapy. The nurse calls to inform you the patient’s international normalized ratio (INR) is measured at 7. He has no active signs of bleeding, but is at increased risk of bleeding. Appropriate management at this time includes which of the following:

A 58-year-old secretary presents with asthenia and hyperpigmented changes on her elbows and inner cheek. She also has noted her blood pressure is low and she is dizzy when she stands. She has lost 10 pounds and has some nausea but no vomiting. A recent test for coccidioidomycosis was positive. Appropriate testing at this time includes

A 40-year-old man presents with a painful, swollen right knee and a low-grade temperature. The most useful test for this individual is:

When is a comprehensive evaluation necessary when a patient is affected by deep vein thrombosis (DVT):

Which of the following statements about polycythemia vera is true?

A previously healthy 26-year-old man presents with abdominal cramping and fever that has lasted for 2 days. He has had 10 stools in the last 24 hours. A stool specimen reveals the presence of blood and WBCs. The most likely diagnosis is:

Anemia that is seen in patients with chronic renal disease is usually caused by insufficient:

Which of the following drugs is commonly used in the treatment of CHF related to systolic dysfunction?

A 76-year-old man complains of progressively worsening fatigue over the preceding 6 months. He has difficulty walking two blocks because of this. He also has a poor appetite and has lost 15 pounds. Physical examination reveals pale conjunctivae. The lungs are clear to auscultation bilaterally. The heart rhythm is regular and the rate is 96 beats per minute. There are no heart murmurs. The CBC shows hemoglobin of 7 with decreased mean corpuscular volume (MCV). The total iron-binding capacity is increased and the ferritin level is low. This patient’s anemia is most likely secondary to:

Iron deficiency anemia is associated with:

A 65-year-old man is admitted to the hospital with complaints of shortness of breath. He has no prior medical care. The laboratory notifies you of a B-natriuretic peptide (BNP) value of 1500 pg/dL.
You suspect the following diagnosis:

A 60-year-old woman presents with complaints of fatigue for the past 6 months. Her condition has been worsening progressively. Now she is beginning to notice weakness and unsteadiness in her gait. Physical examination shows pale conjunctivae. Her lung and heart examinations are unremarkable, but the neurologic examination shows a decreased vibration sense. The hemoglobin level is 8 and the MCV is high. The most common cause of her condition is:

Which of the following ECG findings is associated with sudden cardiac death?

Which of the following can distinguish atrial flutter from sinus tachycardia?

A Patient is diagnosed with Grave’s disease. What would be the findings?

The best medication to use in the emergent treatment of supraventricular tachycardia is:

A hospitalized patient is receiving a blood transfusion. The floor nurse reports that the patient is flushed, is complaining of abdominal discomfort, and has a temperature of 38.4°C. The most appropriate management is to