Property:Prompt
Jump to navigation
Jump to search
This is a property of type Text.
W
A 35-year-old man with HIV and documented trimethoprim-sulfamethoxazole allergy is placed on dapsone for pneumocystis prophylaxis when his CD4 count dropped below 200/mm3. Three weeks later, the patient presents to the emergency department with a 12-hour history of dyspnea, headache, dizziness, and blue discoloration of the lips and extremities. Pulse oximetry reveals an oxygen saturation of 82% on room air. When blood is drawn for arterial blood gas measurement, the nurse notices that it has a chocolate-brown color. Which of the following would be the most effective pharmacotherapy to manage this patient's condition? +
A 65-year-old woman is brought to the emergency department by her husband for loss of consciousness during sexual intercourse. After full cardiovascular and neurological workup she is discharged. Three days later, she presents for a second episode of loss of consciousness during intercourse. Further questioning reveals that the husband applied his prescribed anti-anginal agent on his penis to help him achieve an erection prior to intercourse. The vasodilatory agent responsible for this woman’s presentation is normally produced from which of the following amino acids? +
A 43 year old male is brought to the emergency department with complaints of sudden onset of severe abdominal pain for the past five hours. The pain is generalized and is increasing in severity since then. He also had two episodes of non-bloody vomiting on the way to the emergency department. On further review of his history, he reveals that he was having recurrent episodes of abdominal pain for the past three months, especially after meals that persisted for one to two hours. He denies any blood or mucus in stools or any recent travel outside the country. His past history is significant for mitral valvular disease and is on ACE inhibitors and thiazide diuretics for that. He is a chronic smoker, but consumes alcohol occasionally. His family history is insignificant. On examination his vitals are pulse: 114/min, BP: 100/60 mmHg and temperature: 38 degree Celsius. Abdominal examination reveals generalized tenderness with no rebound tenderness and guarding. Bowel sounds are normal. Other system examinations are normal except for a murmur at the mitral area. What is the most likely diagnosis at this point in this patient? +
A 53 year old male is brought to the emergency department with complaints of sudden onset of severe abdominal pain for the past three hours. The pain is generalized and is increasing in severity since then. He also had two episodes of non-bloody vomiting on the way to the emergency department. On further review of his history, he reveals that he was having recurrent episodes of abdominal pain for the past three months, especially after meals that persisted for one to two hours. He denies any blood or mucus in stools or any recent travel outside the country. His past history is significant for mitral valvular disease and is on ACE inhibitors and thiazide diuretics for that. He is a chronic smoker, but consumes alcohol occasionally. His family history is insignificant. On examination the patient is conscious and his vitals are pulse: 102/min, BP: 90/60 mmHg and temperature: 38 degree Celsius. Abdominal examination reveals generalized tenderness with rebound tenderness and guarding. Other system examinations are normal except for a murmur at the mitral area. The patient is kept on NPO and started on intravenous fluids and broad spectrum antibiotics. Which of the following would be the most appropriate next step in the management of this patient? +
A 45 year old male is brought to the emergency department with complaints of sudden onset of severe abdominal pain for the past five hours. The pain is generalized and is increasing in severity since then. He also had two episodes of non-bloody vomiting on the way to the emergency department. On further review of his history, he reveals that he was having recurrent episodes of abdominal pain for the past three months, especially after meals that persisted for one to two hours. His past history is significant for valvular heart disease and is on ACE inhibitors and thiazide diuretics for that. He is a heavy smoker, but consumes alcohol occasionally. His family history is insignificant. On examination the patient is lethargic and his vitals are pulse: 120/min, BP: 80/70 mmHg and temperature: 38 degree Celsius. Abdominal examination reveals generalized tenderness with rebound tenderness and guarding. Other system examinations are normal except for a murmur at the mitral area. The patient is kept on NPO and started on intravenous fluids and broad spectrum antibiotics. Initial set of laboratory investigations and abdominal X-ray are ordered. Despite the initial aggressive fluid therapy, the patient’s pulse and blood pressure is dropping. Which of the following would be the most appropriate drug in the management of the patient’s vitals? +
A 30 year old male comes to the emergency department with complaints of fever, generalized abdominal pain and bloody stools. He was diagnosed with ulcerative colitis 1 year back and has been on and off sulfasalazine treatment. His flare up started 2 days ago that quickly progressed to severe abdominal pain and multiple bloody stools. He does not have any other complaints. He does not smoke, but consumes alcohol occasionally. On examination his vitals are pulse: 94/min, BP: 140/80 mmHg and temperature: 38 degree Celsius. Abdominal examination reveals hypoactive bowel sounds and generalized distension with rebound tenderness. Abdominal X-ray shows colonic dilatation of > 6cm with some air fluid levels. There is no pnueumoperitoneum. Initial lab evaluation shows Hb: 10 g/dl, WBC: 18,500/mm3, platelets: 330,000/mm3, blood glucose: 100 mg/dl, serum creatinine: 1mg/dl and potassium: 3 mEq/L. Stool studies are negative for infectious etiology. Which of the following would the most appropriate next step in the management of this patient? +
A 50 year old male comes to the emergency department with complaints of abdominal pain, loose watery stools and fever for the past 2 days. The patient has no nausea and vomiting and denies any blood or mucus in stools. His past history is significant for treatment of upper respiratory tract infection with penicillin two weeks back. He denies any recent travel outside the country or contacts with sick patients. He is a known diabetic and hypertension on regular medications. He is not a smoker and does not consume alcohol. On examination his vitals are pulse: 102/min, BP: 110/80 mmHg, temperature: 38 degree Celsius. His mucus membrane is dry. Abdominal examination reveals diffuse tenderness and active bowel sounds with no distension. Initial lab evaluation shows Hb: 12 g/dl, RBC: 4.5 million/mm3, WBC: 18,000/mm3, sodium: 147 mEq/L, potassium: 3 mEq/L, chloride: 107 mEq/L, BUN: 50 mg/dl, serum creatinine: 2 mg/dl and serum albumin 2.5 g/dl. Which of the following would be the most appropriate next step in the management of this patient? +
A 40 year old male comes to the emergency department with complaints of fever, generalized abdominal pain and bloody stools. He was diagnosed with ulcerative colitis 2 years back and has been on and off sulfasalazine treatment. His flare up started 2 days ago and quickly progressed to severe abdominal pain and multiple bloody stools. On examination his vitals are pulse: 104/min, BP: 140/80 mmHg and temperature 38 degree Celsius. Abdominal examination reveals hypoactive bowel sounds and generalized distension with rebound tenderness. Abdominal X-ray shows colonic dilatation of > 6cm with some air fluid levels. There is no pnueumoperitoneum. Initial lab evaluation shows Hb: 10 g/dl, WBC: 18,500/mm3, platelets: 330,000/mm3, blood glucose: 100 mg/dl, serum creatinine: 1 mg/dl and potassium: 3 mEq/L. Stool studies are negative for infectious etiology. Patient is started on intravenous fluids, intravenous steroids, and broad spectrum antibiotics. On the 3rd day of hospitalization his symptoms began to improve. Which of the following would the most appropriate next step in the management of this patient? +
An 18 year old male come to the office for periodic abdominal cramps. The abdominal cramp typically starts after having his meals and is associated with flatulence and non bloody diarrhea sometimes. These episodes are more often associated with intake of dairy products. Otherwise his past history is insignificant. His family history is remarkable for lactose intolerance in his mother. He does not smoke and does not consume alcohol. On examination his vitals are normal. All system examinations are normal. Which of the following would be the next step in the management of this patient? +
28 year old female, gravida 1 para 0 at 16 weeks of gestation presents to the office for routine prenatal screening. She does not have any specific complaints, except for mild bloating and tiredness. She is able to do her daily activities without any trouble. She has been taking her iron and folic acid supplements regularly. She is not a smoker and does not consume alcohol. Her bowel and bladder habits are normal. Her previous laboratory evaluations were normal. Her past history is insignificant and her family history is unremarkable. On examination pulse is 80/min, BP: 130/80 mmHg, temperature 37 degree Celsius. Cardiovascular and respiratory system examinations are normal. Abdominal examination is normal and fetal heart rate is assuring. Pelvic examination reveals vaginal discharge and the vaginal pH is 4.6. Microscopic examination reveals motile protozoans. Which of the following would be the most appropriate management in this patient? +
A 23 year old female present to the office for routine health check up and currently has no complaints. She is sexually active with her boyfriend for the past 3 years and does not use any contraception. Her menses are regular every 28 days and lasts for 3-4 days. She is currently not on any medications. She is a non-smoker, but consumes alcohol occasionally. Her past history and family history is unremarkable. Her vitals are within normal limits and all system examinations are normal. Pap smear is done and the results come back as atypical squamous cells of undetermined significance. Which is the most appropriate next step in the management of this patient? +
A 40 year-old female presents to your office complaining of frequent urination and feeling thirsty all the time, started gradually over the last 6 months, when she also noticed her increased appetite, and weight gain. She has moved to United States three months ago with her husband. The patient has insignificant past medical history. On examination, she has normal vital signs. She is obese, no lower limb edema. She has insignificant chest and abdominal examination. Which of the following is the most appropriate diagnostic criterion for her condition? +
A 40 year-old female presents to your office complaining of frequent urination and feeling thirsty all the time, started gradually over the last 6 months, when she also noticed her increased appetite, and weight gain. She has moved to United States three months ago with her husband. The patient has insignificant past medical history. On examination, she has normal vital signs. She is obese, no lower limb edema. She has insignificant chest and abdominal examination. Which of the following is the best initial therapy for her condition? +
A 45 year-old female comes to your office for follow up after being diagnosed with type 2 diabetes mellitus 1 month ago. She has been following a diet and exercise to control her hyperglycemic state without medication, but so far it has no effect on her blood glucose level. Her recent laboratory test results are shown below:
*Hemoglobin 13 mg/dL
*Total blood cholesterol of 270mg/dL
*LDL of 190mg/dL
*HDL of 28 mg/dL
*Glucose 190 mg/dL
*HgbA1C 9.8%
*BUN 35
*Creatinine 3.4
*eGFR <30 mL/min
*ALT 15 IU/L
*AST 10 IU/L
You decided to start a medical therapy to control her hyperglycemia. Which of the following is the best initial medical therapy for her condition? +
A 35 year-old female comes to your office for follow up after being diagnosed with type 2 diabetes mellitus 1 month ago. She has been following a diet and exercise beside her metformin as an oral hypoglycemic therapy. The patient is hypertensive with blood pressure 160/90 mmHg on beta blockers, and smokes ½ pack per day for 10 years. Her labs have been sent to your office and shows:
* Total blood cholesterol of 270mg/dL
* LDL of 190mg/dL
* HDL of 28 mg/dL
* HgbA1C 9.8%
* ALT 15 IU/L
* AST 10 IU/L
In addition to diet, exercise, and smoking cessation, which of the following would have the greatest effect in reducing her cholesterol? +
A 35 year old male comes to the emergency department with sudden onset of chest pain for the past 3 hours. The pain is retrosternal without any radiation to other areas and is exacerbated by inspiration. He is not a smoker and does not consume alcohol. His past history is insignificant and family history is unremarkable. On examination, his vitals are temperature 38.2 degree Celsius, pulse: 106/min, blood pressure: 130/70 mmHg and respirations: 22/min. His pulse oximetry reading is 94 % in room air. Cardiovascular system examination reveals a high pitched, scratchy sound at the left sternal border with regular heart sounds. Other system examinations are normal. An urgent electrocardiogram done reveals diffuse ST segment elevation in leads V2 to V5 with reciprocal ST depression in leads aVR and V1. What is the most appropriate next step in the management of this patient? +
62-year-old man has been hearing voices from 2 weeks. The voices have instructed him to rob a bank and send money to Queen Elizabeth of England,as she is getting old. He believes that he was a British soldier in a past life. He was diagnosed with schizophrenia and admitted to a hospital. Because of agitation, nursing staff decided to have a 24 hour sitter. Several weeks after the patient's admission, he developed polyuria, vomiting, diarrhea, and restlessness but his temperature is normal. His medication includes haloperidol, zolpidem PRN, Olanzepine at bedtime, and B complex vitamins. What is the most likely reason behind his recent changes in the health condition? +
The patient has an absolute right to his privacy. It’s a physician’s duty to respect this privacy and not share health information with anyone, including patient's family, colleagues or other parties. This is known as the principle of confidentiality. In which of the following cases is a physician legally bound to overlook this principle? +
A teenager complains that he has episodes of uncontrollable swears at people. Sometimes it is accompanied by grimacing, clicking sound. These episodes are becoming more frequent. It has been interfering his social life and is concerned that he will not be able to get a date for prom. He has a family history of similar symptoms. He also has symptoms suggestive of obsessive compulsive disorder. Which of the following is best likely to alleviate his symptoms? +
A 40 year old woman comes to a pediatrician with her 6 year boy. They recently shifted from Houston to Boston. The boy was enrolled in a new school. In a recent teacher-parents meeting, mother was surprised to learn that boy was keeping quiet in the class. He hardly talked to anybody in the class. He is very reserved with other kids in class. However, mother says that the boy is very social at home and enjoys leisure time with cousins. Which of the following is the next best step in management? +