1. 42.yea.ld man wh s HIV paste comes to the physician for immurnzatons prior tip to Meco He leaving in weeks dunng auturn He plans to engage i pial ‘ourst seivtis m mattopoli reas He kes righty ace anirevovral rap) Thea yeas ao, he had pneumecoccs preumonla snd feclved te prernococeal ‘saccharide vaccne,22-vaent lat time, He raceved a etas booster 9 years ago adhe hepsiis snd 8 vaccines 3 yeas ago. He had al appropatachuchcod ‘aczraions. Hs val sign ae wit nornal rls Exarantion shows ro abnormal Labor studios show a CDs Tymphocyle cout of Gt (Netre2400) and an {stetable plasma HV wr! oad Wie o he folonng vaccratens s most appcpraie a ths ima? 1A) Human paplomavius O 8) inacwated nnuenza vies © 6) Messies mumps ubota ves © 0) Moningzenccl OE) Rabies F) No vaccines av indicated at his ime2. As2.yearolé woman s bought tothe emergency departnent 30 minutes ater she was fund confused in her home, Te weather has been extremely ht. and the temperature in ‘er room was °F She hs mule (secur) dementia ang hat! a myocardial ntarcton 30 years ago She = stuporous Her temperature = 9-¢ (102°F) pues "mn {Saf eguar respirators are Thm and Siood presse B1B0 mm Hg Examination shews dy macau memtranes, There na jugular ven detention The unge ae lar on ‘Ssculabon A ade 26 nasysalc murmar Is haa tte lver laf lal Borda Tha emandet of fe examination shows ne donomaties. Test of Te steal fx secu eed S| ‘agatve Which ofthe felewingapelated changes the most aly explanation for he fens ths pation? |) Docresed away slasiciy S 8) Decreases barratex © ) Decreased micoclary cearance © 0) Docteasea nyo tuncbon SE) Diastolic care stinetion F) Impaied cara rosponse to excise © 6) paves Fymonacytetancton OO) ipaices tist 1) increase ung compliance 4) Renal sat nasting3 Aa2.yearolé woman s bought tothe emergency deparnent because o ver an confusion or 4 hours. Se has 25 year hoy o systemic pus ehematasus. She had pecan Cortese td Sas sow ences: A Gam sn shows put Aepate Opococ Men ake ehonng machanes he mst ay Cae ese ange? |) Common variaieinmunedeieney © 8) Deficiency oFteminal components of complement © 6) Impaiedcal.medatesimorunty © 0) Loukas aesiondocioncy 5 €) Phagocyte cl sive metbaem defiency4 previously nelly 25a man comes othe physician because of 10-day history of evr soe throat enc generalized fatigue He akes ro medications. He became “erualyactve wa new temala partner 6 weeks ago and doss not ws condom Hs Goes luce nravenous dupe ra rpersture = 1 8° (100), plese Bm fesprstons sr {min and blood pressure 12078 nm Hg. There ae numerous eryhemstous macules ovr the upper chest. Examinaton shows mule less than, ‘Corvcel octal nd wc mphagenopathy Thee © acm tender ora cer na estates or hush The teat sycted. Tne romance ofthe exanation shows no ‘Shermer Monospot and apd steptococal sts ae hagalve Which ofthe folowing she mest appreprao et slap hmanegemont? |) Measurement of plasma HV val oad © 8) Serology forhorpes sngtoxvrus © 6) Throat stab utr or intenze © by Acyelovr meray OE) Axthremyein tnrapy5. An asymptomatic 67-year-old man comes for a routine heath manteance examination Hs las vist was 2 yrs ago, and he has been hea nce hn. His teratreis 37°C (G80) puse's 65m, respratons ae Wmn. and Deed pressure 15040 mm Hg Examinston shows"mid splenomegaly Laborstry udlee shaw Hemtocit 35% Leukocyte count 20.d001mm! ‘Segments netropis Soe Bence ie sips * Bescphis a Lymprocytes 20% Netamyeloeyies ie ysis oe patel count 700 000m! Wiich of tho folowng the mest ikely agnosis? OA) civenic once evo © 8) Chronic myelogenous leukemia © €) chronic myetonenocytc ukemi © 0) Pana oa myetome ) Ractive leukocytosis{6 AdT.yoacld woman weh a 5.year sory of eumatid atts comes tothe physician fr folew.up examination She has maring sfness in he hands bu otherwise fels ‘wal Medications are prednisone and methtonaio Vial sgrs ae wttn normal mis, Exarinaton stows mld swell of he melacrpepnaigeal 2 prounaarpraanges! ‘Finis ofboth hands: The remander oe examination shows na eonomaltes Lanes stam thon ematoct ae Moan corpscusrvoure 75 m9 Eyvoeyieseameniston roto 60 mm ‘Sum “eal rontinding capaciyy 150 yd (N-250-400) Ferran 00 nam Irom Dea ‘inch ef te fotowng the mos appropata nex ste n management of hs patos anema? Oa) anon mecaoy © 8) Supeutaneous enptopoetn therapy © 6) Transtusion of packed ed bod cols © 0) Colonscapy ) Bone marow biopsy ) No tute evaluaton or Yeatment cated al hs tne7. Prorto dschargeto 2 stile nursing care acy, an 80.year-old woman s evaluaied n he hospi because ofa decreased hemoglobin concent ton. She undant ‘namical 10 days ago fa gostontetnal laedng secondary to dvetcose Four ee of packed ed blood cals were anche dung ie procedure Sa haz Iyportensen and ype dabei tts, Hor medcalons are lsrepi an mtr. Today largerate ie 377°C (QDO"F) pulsas hin, respons ae 1m, ond ‘lod pessare 14042 mm Hg Physteal aramnaten shows rucval alot end conjunctiva eras Abdominal examen shows a welLheaing nase Sse Neroglbn Concentaton on pestoporave day vas 100 1 Hemegebin concunraiontaays 7 8 gid. Labora studies are most ely to show whe he follonng abana findings? On Oa Oo Direct Antigtobutin (Coombs) Test Nera Serum Btubin ‘Concentration increased direct creased ovect incroased droct increased indvect, otal8. As2.yearcid mans baught tote emergency department 1 hour ater a 30-minute episode of weakness in height am and eg and ticuty speak, The sympims resolved “Spontaneously Histact wet oa physician was 36 jear= ago He plese &2mn. ad lees pressure e TOOT mm Cardiac exaanaton shows 9 afuce pon of maxed ‘ipubse end an, galop Alet teal at is hears Neveogeeramnbon shows ne ecal ndings. Laboratory ties show Hemoglobin e708, Senn {Glucose (nofasing) 166 mp Creatinine 22mgd ‘slenoestral 240mg. |ANECG shows et vonticulahypervophyTreament of ahich of he allowing is most hay to have prevented hese Trngs? OA) congesive nest ate O 8) Myperchotesteroteia © ©) Hypertension © 0) Renal nsuticieney OF) Type 2eabotos melts8. An oherws neathy62.year-oé woman is bought te he physican by ber tamily because ofa 1.year iste of cogntive dine: Her daugtier pats hatte patent seems to “fn or words” and of peste quortone The patents il year od husband har nat icticed 2 poblm. Twenty years ogo, she Sustanec a cantusson ater fling oe hoes, ‘Shee shgh school graduate Her M0 jor ad ster ha ignticant memory prablame: ner a younger ohers ave no reamaryprbiems. The pain! akes no mesetone On ‘aminaton, she pleasant and cooperative. Sne anos the Year but nal fhe mon date Sh can recal aracnt hakday Sn fae nec naming cect by but vihon asked e name as many arias as sa can nme she can ony rae ve. She fecal ee ef vee ems alr 3 ranuts. Wich a te olowrg ste stergest ‘redspsing factor rs patent's eanaen? DA) Age O 8) Educaton evo! 6) Fam ristory © 0) Gena OE) Mstory of hese trauma|Apreveusly heathy 42-year-old man comes to te cfce because of severe right sided headaches forthe past 3 weeks. He says that he awakens avery nigh al 3am wih a sharp ‘Sasbing pan ben thang ye tht usualy ants abou. 99 mntas There eno associated nasean He has smokes ho pack of igre ly fr 25 years ad ens soe Back of ter dai His vial signe are wifi ner imis. Examen dung an epsode shows poss On be righ ad eahng ar conuncival econ, the ight pups 2 mam rahe lots Wach of be eloweng is ne most kay ogress? |) Custer headache © 8) loner mecrana mypetension 6) grains © 0) subaial nema ©) Tamera ibe gona OOF) Tensiontype headache11. AS-yoar-ckiman comes to ho ofico becauso oa 1-year histor ofa slowly ering. panloss, non lesen on his right inner tagh Ho notices be fesion ony when ho tate and betoves ne might be developing a ear one on hs ih erearm Hs has fi fecton well cancelled wth anrtoural foray. Ho alo takes 2 daly mtv, He Goes not smote cgareies or donk alcohol He wed et inavenus heroin fr 3 years bd sapped 39 years ago He has worked ona farm fr 40 years Vil sgn ae ‘thn normal ls. ptograph ofthe ston verte right hgh e shor. Examination ofthe igh forenm shows a -em,rasod itn wh well domarcaes borders and dark Pigmentation Tho emando’ fo examaton shows no abnormaltes Which of te folowng hsterca factors mest Ik creased fs pal’ ek fr develop bose sone? Ay Age 8) Gnd ©) Medial story ©) Medction isto ) Occupation Oa Eo12. AST.yeaold woman comes to th plysician becauso of parsison actinic Keats dsp treatment wh §fuorouracl. Examination shows 120.5% cm esion Aghetogras cf fe lesion = shown Mich ofthe folowing isthe mot aporopraa next lepn managemen? 1A) obseraton ony ) 8) Exasenalbiopsy ©) Punch biopsy © 0) Rasen therapy OE) Systemic chemotherapy flowed by surgical excision13, A.7-yeacold woman with a8year istry of heumatid artis comes to the physician because cf a 10 cay son ofnceasing right knee pan and etgue, She now rates the Ban gs. Won 10port sca She hasta sere oat cougy shaking chile, fash Her trperture 300°C (108 6°) puse © &2/mn and load rescue = {2080 mm g The ng roe s warm euch wih ance often Artvosonesi © pefomad analysts shows trbd Mud wih apeer mucin Ct and uke cunt of ‘75 cocen (Bt segmented aeurophis) Which of along she most kay causal organs? |) Moisseriagonerhoese © 8) Pseudomonas aeruginosa O ) Staphylococcus sueus © 0) stepiccoceus agetactae group 8) OE) Yaranientowcatica"4, A42,year-ol man comes to the physcian because of ght sheuider pa for 24 nous The pn Dogan & nous ane e span the day Bang hs house. Th pain Peroaves when ho sesh net a, hot unable acel abduct te shoulder beyond 60 cogress Pssive ange of moto of he shoulders fl and eauses oly mld acomfor An ay ef he shoul shown. Which of he lowing is tho most nay hgrests? |) ices tendon uptve 2 8) Carica nar cot compression 5c) Glononumeral subnuaton 1) Retatr cfennis 9 E) Tom glonoid labrum:15. Aesyoacla woman evaluate inthe NosptalDecause of ight oo gan 1 day ae lapatoscope cholecstecomy. She says the gan fs Sha and ens. and she has never tell anyeg ke soe She as ro hstoxy of ama We tho tea. He lomparative 37 OC (05 6°). pulse s 100m, respratons av 15!mn. and Dood presses "40TO mm ip PUS® oxmety on foom ar sows an oxygen salut o 95% Pryscal exameion shows Heborden nodes othe Inger: and crops the anaes. The Pht teat crytematous. xtreme enae opal. and warm ouch John asprin sported. Aphotoyapn ol he fest eng photomeragagh oe symoa Tad 37 Shown Aaminstaon of when ote slowing tie msl appropate nex tpn management? 1A) Acetaminopnen15. Aesyoacla woman evaluate inthe NosptalDecause of ight oo gan 1 day ae lapatoscope cholecstecomy. She says the gan fs Sha and ens. and she has never tell anyeg ke soe She as ro hstoxy of ama We tho tea. He lomparative 37 OC (05 6°). pulse s 100m, respratons av 15!mn. and Dood presses "40TO mm ip PUS® oxmety on foom ar sows an oxygen salut o 95% Pryscal exameion shows Heborden nodes othe Inger: and crops the anaes. The Pht teat crytematous. xtreme enae opal. and warm ouch John asprin sported. Aphotoyapn ol he fest eng photomeragagh oe symoa Tad 37 Shown Aaminstaon of when ote slowing tie msl aprvoote nex tpn management? 1A) Acetaminopnen 8) Aloputne ©) Coteneine ) Hydreaycheroqune E) Mothoterato18, An asymptomatic 47-year-old woman comes othe physician fra rautne examination, Sh has hypetanscn and hypothyr, Dung childhood, sh was ld she had a hea ‘murmur Curent moditons nude step tyarechvahiae, and eveyone. She does ret smoke cigartios of nk achel Sho s 168 cry (S46 intl and wets (2g (126), Bis 22 kgm Her pulse is 70min, snd blood pressures 1200 mm Hg. Ora examination shows @ dak, cracked, rght wer mols wih sweling eryhema, end tenderness athe gum The lungs ae lato useitaion. Caria: exarnaon shows gnoria Sad S, ih vafiabon of San espration The patents schodle © Under ‘ot canal tthe dent next week. Wien te folowng isthe mes appropareconmenaston fr aitbebe prepaes pr tothe Schedow denl procedure? |) Oralamextiin 1 hour bere he dental pocecre © 8) Oral amoxein 24 nous before te procedure © 6) imravenous vancomycin 1 nour beterethe dena procedure © 0) imravenous vanoomyen 2¢ nous betoe te Sota proonaue OE) No entice prophyatsis indicted17. 8. yeacold man has a ron istry of pain both butocks when he walks and eecle dysfunction. He as been a heavy stoke for 20 years. Hs bloodpressure inthe ‘Gur extrema ae tan natch he ams He serum clear concertsion 288 mgldt. When et the flowng the moat ely egos? |) Aoticaneunsm © 8) Antic assecton ©.) Averasclrtenaraning ofthe distal aoa © 0) comtaton ort aoa ) Thromboanaits siterens (Buergarazeeee)18, 62-year-old man comes ot emergency department because of 3-day istry of progressive stertnes of breath He has nothad chest pain, orthopnea 0: parxysmal ‘octal dyspnea. He completed chomothrapy for smal cllexcinera ol he ng 10 months ago, He has along term istry of nocura uc righ thal asad over te ‘Sey. He smoked to pacts of cgsetes da for 30 years but qu yer 290. He pulse © Termin. ae Blood prssure ic Gb60 ram Mg. The ugly venous steno ‘he anf ofa The Lege ae lao auscutaon Head seunds re detent The ver tender and haz span ct Ta em The sro pel edema, Laboratory uses snow Hemogetin so gid. Scum Ne 125 meg o Momeat « a2 meat Feo, Dime Ureahogen 40 mga Creapnne Veena, ‘ARECG shows dcreased QRS voRage. An xa ofthe chest shows an enlarged carac shovel. The mes Ialy cause ofthese fndegs an abnormally of wich of he ‘slowing? DA aorta 8) Endocarsium 6) Myocardium ) 0) Peicardium ) Puimonary artery > F) Purmonary veinsee seal ee Bf Zi af ae Bee repeater 18. 52-year-old woman comes fo he smergency depart because of I. istry of pressive shots of breath and gt upp atdomnal pan. She hasbeen unable {o sep whe supe Secause of fiat breafing. She uidewertchemotrapy 1 Yea’ ago for breast cancer Shu has vane ebstucve pulmeeary disease. She as ‘Sroked wo packs fogarais daly fr 20 yeas Her tomperaure s 7 2°C (OF) guises 11min, respite are 24min, an bod pressure 10480 mm Hg. Examnaton shows guar venots fulzatoe ate angle the wth the pant Stbag upg The urge are clear to auscasion Heart sound ae stant A god 28 Sysce murmurs heard Abdominal examen shove dfusa hepelemegaly Theres 2+ pod edoma. Het serum urea igen concaaraion 42 mg, and Saturn {eetnineconcenraions 18mg. An EC shown Which aff folowing i fhe most ely explanation or hase fangs? fort |) Anterior myocar ) 8) cov pumonato ) ) Pericardial efusonCaf naathntafiane Reet tea Ere 18. A52.yea-01¢ woman comes fo he emergency department because of 1-3 history a progessnve shortness of bea andra upper abdominal pan. She hasbeen unable {o sop whe supe docause of fiat breanng, She udrwee chenaacapy Yea! ago breast cancer Sho has von ebtitve puny ease. She Nas ‘moked to packs fogartsts da fv 30 yeas Hor tmporature s 37 2c (98°F) pulse Is TOMI, respons ao 24mn, and Dood pressure Te4a0 mm Ho. Exarnnabon shows jugar vanous pulsations ato angle oto jw the Dabo stbng upright The urge af clear to auscuftaton. Heart sounds ae sant A grado 2 ‘sole mimur heard Abdominal examinaton shows uso hepaomegal Theres 2 pedal edoma. He serum urea noon concostauo s 42 mg, and Seu ‘eatin concenatons 18 mga. AN ECGs shown Which ate olowg fhe met ike explant a hese mange? D A) Anterior myocar iar © 8) cor purmonate > ©) Ponca etuion © 0) Puimonary embod OE) Right ventncular myocardial ifr20. A previously heathy 42:yerot4 man s brought the emeraency department because fa 2-hur history of severe abdominal andback pain Hs tempera is 378°C (100), fuse's 120m and regular fespretons ae 22m, and lod pesture 160105 mn Hg he rh am and 860 rm Hg ne eh sr oath Seunds ste normal Caraac ‘Scaminabon snows 8 normal Sy and Sy Femara pues ere norelon the ight and absent hel Labs tins Son Hemant 20% Letkoeyia count 10800rmen? Serum Urea nivogen —32mgi. Creatine Spal Lor uncton ests aro win to rteronc range. An xay of he ches shows no abaomnalies Wie o ho folowing the mostly agnosis? O A) tac ocusve asease (Lec synerome) © 8) Renal atery embolus ©) Ruptuedstsominal aoe anys © 0) Ruptured thoracic aneurysm OO) Thorac act dissection21. 67-year-old woman said to the hospital 2 hours ater he cus set of pai nthe eft enet extrem. She has mid mialinsuficency and conc ata! brlaton She {ekes no medeasons Examen shows a cool lei lower exter ahd meting ef to sk Wo the Keo. Sarsabon soso bal the miaigh She's unable te mave her tt ‘oot Ate’ undergong let femoral anzntcony sensormcterfunchn Is lat anda fercral pop), dorsal ped, snd postrcr tba pubes are palpable. Transescpta ‘Shocarlegrapry shes sted et sium wthout aps! eramen orale o thevericua vous Wc ee ebowing the mest aperopai N slap Wo preve ‘Snbolzaton mths patent? |) Aspitntorapy © 8) Digoxin merany © ©) Verspa iery © 0) wartann nerapy SE) vale epacement22. One wook afr underging appendectomy and pottonea lvago lor ruptured apperccis, a provouslyhoathy 61-year-old man is evaluated because of fever, his, cough, and mid shores of rout Durr the procera, eporioweal dan was placed Fesloperavelyttavaneuscprofenacn and matronazolo apy was begun. A porn Hous tras Gagrosed on porteperae day'2 and-anacogarinc tube nas neorted Yesterday, the nasogasine tube os removed. andhe was advanced arequar et Today. Ns lemporete 981°C (10087) puce ls mn respratons are 22man aod blood prssures HOOD mm Hg. Pulse Gul on for a shows at oxygon saturation of 98% {races ae herd at em ok ung fei Abdoronal exarnaton shows @ bean, diy sapeal ison, The pertonea ram moby Gear of Rud. Lukoeyi counts {8 Tod (65% segmoriod nowrap, i0% bands, 28% hmpheytes) Chest ays are shown. Vic tho folowing tha sl appropiaa nent sop fn manageren? |) Adnan of cenravene an sztnvemyor 8) Adminstration of sutartnoxazole end cero C) Adinstaion of vancomycin and cetanidene ©) Bronehascopy for mirbialage assessment ) CT scan ofthe chest wth puimonary embolism pok23, 67-year-old man comes fo physician because of oneredutive cough, hemontys, and ak 20D) sight oss over te past month, eas smoked wo packs of pares ca lo 80 oars Steal sounds ee decreased over aright pose hamihorax Labo‘aoystases show no sinormalbos AN fa ofa chest sows calapse of ‘he nght ower be of fe ung Wick ote folowing she mostly patopnysiaogy of Ps pabants concn? |) Endobroncialebstrction © 8) Increases pumonsy capitan wedge pressure © 6) Pera iitarmaton with fut eration © 0) Proxima arway ntarmavon OE) Puimonary parenchymal necrosis OF) Puimonary vascular cbstucton24 A pvewousy hey 32.yea-018 man comes to the physica because ofa Bont istry of shorwess abou and sy cough wih ILSee rerio. Ho has scked ono pack of cares wooky for oars, Vial sors ara win nova ris, Fal alta xpralory \theezes are heer. Puimonaryuncion tests show adeccasod FEV, 2 noma FUC, and a deceased FEV VC ah, (G50 of preted). The fou volume lop shown Which of te folowing the est ke} dagness? OA) Ankylosing sponayits 8) Asma D 6) cystic cose O0) Emphysema (OE) Eatathoracte away obstcton F) kiopatic pulmonary fbosis25, ATO.yearcld man comes toe ofa beca fae shortness of breath He naw Res shoe of 6.menth str af progres Hernas nyportersion His mea nontnss of best wth exarten. Sat manihs 999, he 3 of treath ater wolong ane block He nas nat ad 9 able fo walk ve Doce bore25, ATO-year ‘Urea nvonen| Wmo Giucese 20mg. Greatnine F2mgat Protein, tl 28un ‘Aeumin 270i ‘hie of the folowing sos of figs isthe mos kay cxplanation fr ihis patent's increased srum glucose cncentaon? Insulin Glucagon Peripheral nsulln Production Producton Responee a Decreased decreased normal 58) Decreased iereased ———roxmal20% ean copuscuar volume 34 un? Loukosy cet 9000mm= ‘Sogetodneutophis 72% te io 250.0001mm?| ‘rea stropen| Imola. blucose 2ome, Creatine {2mgat Protein, tl Sane ‘Aburin 27a ‘me ote folowing ses of tings se most ely explanation fr his patents increased serum glucose concentaton? Insuin Glucagon Peripheral insu Production Producton Response. on Decressed decreased normal 8) Decreased increased normal oe Increases decressed ——cacreased D0) Increased ereased creased 5) Inerases ocreased F) ecreasedS31. A2ayear-oK woman comes to he office because of a 6:wosk str of aque and swetng of her eyes ankles, and feet She has no istry of sercus ness and kes ro ‘modest. Shes 103 cm (5 4) tal and weighs St ky (120 B), BI 21 kgm Vial sighs are winn eral mes. Examination shows 2: paral edema and 3+ dsl ‘Seema No oer stnormaltis ts noted.Factng serum studs sho toll colsteraconceniravono 8 mgd and lyse concentration o greater tan 400 mpl THE ‘stint st greatest for whch oe aang complestions? ) A) Deep venous tromtess 18) Hypotnyoism ) Nephrliasis © 0) Pergnera vascular asoase OE) Stasis cormettis422A 20.yeor-ok mans brought tote emergency department unconscious 20 mites aftr a mator vehi colin. His targets 262°C (87 2°F) pulse is 150mm ‘espratone ara 12min, end palpable nyo land pressure = 60 mim Ay Zxamnaon shows mapa lacerations end catusons ovr te ink ena dpper and lower Strerios ‘2 abominal dstanon Ar semeistaton of nvaverous lus splaneclomy, and anstusion oun of packed ed bod cll, ns cation stables. Twant cur Pours Iter nz ple 88mm, end land pressure e 12070 mm. Abdomnel exarinaten shows nmal sppeerng surgcal incon, Over the pac 2 ours, he urne op es bee TOD mL: Laboratory ster stow Serum Ne 140 mEq re 42st Karmen Sneat Creatine 22maid tne Ne Joma Sema Jad mosmebi Which of the folowing is the mestiksty diagnosis? > A) Rete tute neo 08) Hypovoiema C6) Intrsttalnephis 1) Transtusion reaction ) E) Urinary tact obstction33. ATT yeor-o man with osteoarhrts comes tothe fics because ofa eek histo ol creasing ight kee pan. He was diagnosed win ostecrtis 5 years ago Last yar, an $ciay othe ng knee showed mld dogeneraive changes He has Deon Weald wi creasing doses of bprlen ard now takes S00 my ol uote vee ies daly Has 0 {vol wang because ol he pan Ne has rath sbdominal pan change tappette, or ny oer symploms. He tomperalure 370°C 266°) On examine, flexion othe ‘opt knee ehmteato-20 degrees Thee are no eftsions. Ths remainder the examinaton shows no Senonmarios Lebortry suds snow Hemogibin 1389 Leukeeye count 2800 Serum Urea regen 2. mai Crean Smet sme ce rnegatve Proten negatve ree one wes one hich of the folowing the mest appropiao next stop in managoment? 5 A} Continue buprofn at ho cuentdose and repeat he aboralony sts 2 Woks © 8) Continue tupaten at ne curent dose and begin orl mysrocarisone ©} Decrease tho dose of bupoton and bogin oral predhisone 1) Discontewe bupolen and administer an ita sic inecon of tiamcinlone ) E} Sieh rom buon to oral clecoxb4 An 62,year.ok man comes othe physician because ofa Lmnth str of urna Requency and cing of smal areuntsof wine. He has not had pan on sna or eer He s alot and enenod Hs temperature 367°C (95) puse = 80mm, resprains are Tein and iced pressures 100 rm Hg Rectal oxaration shows an nltged ‘Snooth, nortander prostate The emander che examinabon shows no éencrmales.ladercaeteraaton shows s posted resiil vole ot F30 m. Urnalye tes ‘somal. Who he flaming the most kay cause of hs paten’= nconnance? ) A) Blader neck cbstucton 1) Detwsorryperactty (6) Newrogen bade © 0) Prostatic ifcton OE) Urata permatiay{35 A67.year-oll man comes to the physician because of 22-day history of fever, nausea a continuous uge to void, and progressive fully wih ation. Every 30 mutes, he ‘seas ¢ sal emu of ung and has an unconvorabe buringsehsaion He says he has slept poorly curng fs poroa Prorat sel hs cute sjnpems, he had & "Zivoek nstry of acy nang a une steam and of awakening we totes imos righty to ual He has no str serious nose and takes ne medeatons HS 15 362°C (008°F) pulse Is 7m, and loed pressures T7000 nm Hg Cardiac examnstion shes no abrormates Abuornnal examinabon shows supraptic {ulhess: Rec eaminaton shows a symmsticalyerargd prostate wih ne lndernass or masses Laberioty sles Shaw Hematocnt 58% Leukoey count 18 400%rm Pistlsesune 230 Codie Seu a 2 meat « Simeqt &. osmeat Heo, 2imeat jeanitoren 8 mgdL ur Shcose s34mgd ygosine 8a ‘Ghocose negate Proton . RoC hot wee Samor Which of the folowing is the mest appropriataritialstepin management? OA) unvasonograpny or he manoys 8) CT scanofthe pois ) €) Furosemide therapyHoo, Urea ittoen Ghose Greatnne vine ‘Ghicose Proton Roc wee ‘inch of te along the most appropriate itil stpn management? |) Utrasonegrapy ofthe hdnoys 18) CT scanorine pews (Furosemide therapy 1) Lovotloxace merapy ) Placement of a urarycathote ) Hemodiyis 230.0002 $82mEqL 5 3meat {0991 2imeat Tamod rama Fong seaatve 3001 Samot38 A previously healthy 22-year-old woman comes othe emergency cepatmant because of a 7-day history of vaginal charge and 3-day istory of usta lesions over arches ‘Sess, Shoes been sowualy sce wif anew male patna or? weak, they do ot Use condoms Her aly medications a erlconacepive. On eal hor lamers 4383°C (ON) pulse © Bran and Dood pressure © 10070 mn Hg Examination shows spprotmataly 10 Fuster lesions ever tho thorax and Upp xaos WRN Te {olowng the mos! appropri pharmacotherapy? DA) Aaitomycin 1) cenrissone (6) Natetin ©) Penn OE) Vancamcin{38 42-year-old woman samt to he hospital because of meth history of uring ae taging othe skin over a he extremities an fabque She has hypetension and ron lon back pan Her onl madeston fyerocler%azide Sho appeus fed buts noth cule dstess Her terperature 372°C (00), pusels am rorprabors are ‘Ulm, and iced preseroe 1080 mmHg. Tappeg over the fcal nae produces an mvaulayceracon ote psierl muscle. The reander cf he examin sows ‘te abnormaltes: Serum stages exon hae 138 mot © imege cr toomeat Co Tega rosphate emgal Denial gat ‘eumn Sa, ‘mien oe falowing i the mest katy explanation forthe patients conaon? OA) tonomous secroton of aosterone © 8) Autonome secraton of paratyrodt homens ©) betiency of paratyoisnomane ) Decency of vin Beebe) ) E) Excess secretion of 25hycraxvtamin D F) Excess secretion of magnesium39 22 year-okt woman gravida 1 para 1 comes to th plysician because she has nt been able o conceive for 12 months. Her son was ben 4 years ago, Her menses were ‘pomal unt I Year age whon thy becaro eguar She has ol hada menstul pao kx te past O mons. She has es Pada snl amcurt milky section for her {rcase She dove nt ake mecestons Her a signe sre win noma mts Examnaton show no anomie: cep forgalacorhes, He serum polctn concrmaton eongmt Aprognancy tele nagsive Vien fhe folowng = he mot apprepaate nest stp in agrase? ) A) Cytologic examination of trast secretors 1B) Measurement serum estado! concentration (C} Measurement f scrum lice simulating and lsrizing homene conceneations © 0) Mammegrapy OE) MR oftnepeutary alana40. 2 yea-o woman comes to he emergency department 12 hous athe suse onset eer, diftse muscle and bone pan, and dizziness. She has noisy of sricus ‘rest and tates no medestens, Her emperatre30°¢ (1022'F), pulse 100mm. and aoa prssure ie SGD mm Hg nie supine Her palpable syrokctood presse = ‘Tommi vive sting Exarnnaton shows a Gace rybematous acer rah aver te face, funk hands, and fet There's esquaation aver fe palms atthe hand, The lungs ae Cea fo auscultation Cardiac exarnnaton shows re murmurs or gelops. Thee st» perperal adema beteralyPelve and eurcloge eeamnnatons stow no ‘Secomalies Which of tho folowng sthemest approprata nxt step nostro”? ) A) Oral prednisone > 8} Invavencus dopamine ©) Intaverous tuts © 0) intavercus metenaaz0.e 5 €) inavenous pani41 An 62year.o woman comes te ofice because fa 3.week hist of biateral ona headaches and a .day history of pain aver the prea skllregions. She abo has audiesion ofthe aw ar tongue ater she chews vigorously Examanaven and canpit blend taunt 6 mens ago shewed no borates Today Ne aperture 38 °C (1013) puse s 0m ard fequar respratens are 20!mn, ard bod pressure 16085 mm Hg. On physica examen there tondorness oe tpt repos [isteralynn ine et mre onda the the ight Results of beratry studs shou Hemstocnt ar ean corpuscular vtume Brum Leukocyte cure ‘52ddlmmswnt anormal citfrentis Pistaat count 45). 00am! Entncyo sedmantston rte 78mm ‘mien of talloning is the masta ophamie complication ofthis scder? |) Dena cornea uceration 8) Hyperuscosty of the etn ens Oc) Ischomic ope nowrpatny 5 0) Seleremaies peor DE) Uses42. 27-year-old woman comas tothe physician because ofa 6-month nist of har hands ard ngers becoming end and turning wire on exposure to cold. The symplems car {ourtmes maxy Shohas nol had ary ote! syrsors. She ha ne story of serous ess and akes no medcabons Sho iss smeked are pack of cares daly fx 8 years Examen stews ro abnormaltes Resul of aboralry studies are Wahi he olerencs range. n ation fe smoking cassaben, whch of thealowngis ne Pest apeophae tecommendston? ) A) Dressing warmly in cold weather 1) Doxazosm meraoy ©) Prednisone tharpy © 0) Proprencotmerapy OE) Smpatrecory42. A27-yeor-okdman who works fra lawn manenance sence, brought othe ensiency depariment by is supenso 10 mines aes ne was ound ncchecent and wander ‘Sound ne naghnomoed were they Were uerkng nthe fe flernoon His super raprs ra he Pont Was he when heaved a werk at 620 au, bu no oe could ‘neate hm ata hey foo lunch rear at oon, The temperatre outa 15" He takes an verti cnuneranthstemne for severe aero He ater died of a myocar) Inlreion at the age of 30 oars His mother ad ster have aufornmuno tyrodtis He ssl bul ret ented persen plate cc bne Hs tmperture & 304°C (1087), pulse {2 100m, respon ae Wim, and Dood pressure 10088 mm Fg examination shows warm cy sk The pups are 4 mm and sappeniy eectwe Neurigi examenaion ‘hows no muscle agety Which he febowng the most ily Gagnais?™ DA) Heat stoke > 8} Matgnantnyperecmia Oe) Myecaralisenama © 0} Nowrtepte magnant synarome ) Thyroid stom14 A24-yeor od man whos employed as landscapes troughs emergency department by a cous 20 mnutes afer he collapsed whe working na gars, hs had igre neadocnoss ust btere he lst conscouses= On ava es resparuve buts unable o ge a medical history Hs toperaures 372°C (0"F, pues 250 ‘appratens are 28min and palpable syste blood pressures 70 mim 4g Pulse aemety on eam ashes an oxygen saturation of 28, Wheezes at hear bistrly Which tthe olowng s te most appeprata mediate step m meneperan? ) A) Arterial led gas analysis 18) Detemnaton of eosinpit count ) G) Deteinaten of peskexpratory fow ato © 0) Measuroment ot pasma nstamine concentration OE) Toecogy serening OF) Administration of cortcosteross © 6) Aamnstiaton ot denennyranine OW) Adminstration of epneprine45. A .yeor-od woman is adr othe hosp folowing a myocardial nierson, Sne's confused andhas cool, clammy skin. Over the nxt hour he blond passite decreases {fom 148/74 mgt 840 mam Hg Arter blood gas analysts most helt show whch of allowing? ) A) Hypavamia wth neal pl OB) Netaboic actos Oe) Netaboic altalosis © 0) Respraioyacdoss OE) Respratery ataloss48, A52.yeo-od mans brought tothe emergency department because ofa 1. day history of ever and chil, He received he anrosis of smal cel carcinoma of he lung 1 month ‘go andis undergang remoterapy Argh subclavn cortal vous catheter sn pace Hs tempetalures 380°C (102 TF) use s 124m, respons are 24min eh ‘Sod possi is 10488 mm Hg’ Easington shove warm shed skin The caer ste Sigil erynamateus ana bere s tenderness ove he subeianecus pocket His leukocyte counts 12:00? A cst xray shows a nodule nthe git upper lobe. Wach ofthe folowing is he most My causal organs? ) A) Candida albicans 1) Gbstisum pertingens ) 6) schon at © 0) Pseudomonas aarginoss OE) Staphyiocceus gndemais47-37 year-old woman comes he pysician for HIV screening. She asymptomatic She has no history of sous ness and takes no mediators She doesnot dink leas or {ee le aug. She es hed tne Heme male sexual partors and ey used concerns consstently Exaranon shows so abnomaltes A ELISAs poste tr HV the Senstty ofthe ELISA's 85%. andthe specialy GOs. Wach of elewing represents he ost appopie senstvly a Speci ofan adaonal ate conn is patents diagnosis? - Senatvty Specitty Oa) 66 35% 8) ore oor ° oot 58 °) ows 0%48. Ast) conducted o assess a possible association between regular use of alco ae clon cancer. Cases const of pateisnosptalized with clon cance, contol consist of ‘Sg and gandor matched patents admsed fo he sare hosptal fr etmert ofan ace uy Cases and conta ae storvewad der inex conaonssaize The ‘enacts conclu hat Fag uae of leah ede he rek coon cancer Which oth folowng iste moat mora reason fo be oncermed about he uo ) A) Cenfoundeg by a0 £8) Ineperopate case group ) C)Ingppropriste cor! group © 0) Lack or nesones rates for acotot users and nonusers48. AT. yeor-od man as had interment confusion sce transfer frm the hospitals hospice care 6 days ago Hs lod pressure has ranged between 9045 mm Hg ae ‘Tard mim 49 dung is period He was West nthe hospi for a myecaraal narcn susie S wooks ago. Dung the past 8 Years hofas been aid oe spi ‘our tras" myocardial narcton Ho has boon ened uuccesstly fr al ard venue ahyhmas and fs been unable 1 lerale otepc agents He has hadi ‘bambaross since re sustaned a steko 30 years ago. Hs physio Pius exDarod loam and hs fy tel hecho canals fo ca Wasp impart of 2 Vortnculr assistance doves Tre pabent has svete chore back pan Me on mecieaton Is meyphine, Tho pte’ edvencedrecive desirates hs saugar ass heath {sro proxy andthe pation has explained ha he wants he daughia a maka mcdeal decsons fren Th ceugher says al te hospice cae sullen conboing het {aber pan and aks thet he be admits othe hosp Wh ofthe flowing iste ost appropiate next sep management? OA) discus ihe patents pan contol wth he hospice staf 8) Spitual cousoing (C) Psyehitic assessment 1) Aamsion to the nespeat OE) Echooardosraphy and feeding tbe placement50. ASA.yeor-ol mans hosptazes because ofa 5 day history of chills and moderate pan. edema and enema ofthe right oct. Hs symploms began 2 days atthe stepped on 2 ‘na Hema coronary are sees, ype 2 sbets melts, hypertension and hyeeipiama He has no koonn dug aletges His micas ae metformin, sun sop, inetcprool stovastain, and aspen He temperature e 38 °C (01 SF) ple 10m, respons ae Tm, and blood pecture = 14392 mm ag. Exarntion of os et {ower exrerty stows eer, warrth, en tenderness pabpaton Fam the proumal aspect fhe arioto the dou of to fot. The remarder of fo examin sews 7 ‘rcenales intayercus vancamyen aie pperaclinazobactom ey is begun ane patents homie medesten regimen cortnued Wile ling the prascipion, Be ‘Prammoast rettes a probem nthe meaeston oer Invesigaten shows tal he piysoan wrote the poscrpion in an eda felesse formation instoad cf an ‘tended lees termutson. When of he flowing best craratorzos ths ype of medica or"? OA) Act tare 1B) Adverse event ©) Latent certion 1) Naar miss OE) Sentinel event