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* medicine form 4, please help me to get right ans;
  honey123rich - 12/05/17 12:40
  1. A 37 year old man comes to the physician because of a 1 year history of progressive shortness of breath.He now has shortness of breath after walking 200 feet.He coaches a soccer team and is unable to keep up with his players on the field. He occasionally has wheezing and a nonproductive cough.He doesn't smoke or drink alcohol.His wife resumed smoking 18 months ago after quitting for 3 years. He has three healthy children.His father died of alcoholic cirrhosis at the age of 55 years.The patient's temperature is 36.9'c (98.5'F), pulse is 76 min. respiration are 20 min and blood pressure is 124/76 mmHg. Pulse oximetry on room air shows an oxygen saturation of 90%. End-expiratory wheezes and occasional rhonchi are heard bilaterally. The remainder of the examination shows no abnormalities.An xray of the chest shows increased luncency and bullous changes at both lung base, which of the following is the most likely cause of this patients's condition?
a, alpha 1 antitrypsin deficiency
b,exposure to asbestos
c,exposure to radon
d,exposure to secondhand smoke(wrong)
e,pulmonary fibrosis

2.The life table shown compares the natural disease histroy of gp A and B. which group at which time has the poorest 1 year survival rate? (ps coming with graph)
a,gp A at time 0-1
b,gp B at time 0-1
c,gp A at year 2-3
d,gpB at year 3-4
e,gpB at year 4-5 (wrong)

3.A 27 year old man is brought to the emergency department 40 minutes after the sudden onset of shortness of breath while scuba diving.He reports the he had to ascend rapidly from a 70-foot depth because he was running out of compressed air.During the ascent, he had the sudden onset of mid-chest pain; he had shortness of breath by the time he reached the surface. He has no history of serious illness and takes no medications. He is in moderate respiratory distress and unable to speak in complete senteces. His respirations are 28 mins. Pulse oximetry on room air shows an oxygen saturation of 88%. He is using accessory muscles of respiration.The trachea is midline. Pulmonary examination shows decreased breath sounds and hyperresonance to percussion on the left. The remainder of the examination shows no abnormalities. Which of the following is the most appropriate next step in diagnosis?
a,measurement of serum D-dimer concentration
b,chest x ray
e CT scan of the thorax (wrong)

4.67 year old man is brought to the emergency department because of 2 day history of episodes of vomiting blood. He has no history of similar episodes.He has eophageal adenocarcinoma, hypertension, type 2 DM,osteoarthritis and coronary artery disease. He has a prosthetic, mechanical aortic valve.He is receiving radiation therapy.He notes that the therapy makes him tired and he naps several hours daily. His other medications are lisinopril, metformin,glipizide, simvastatin, warfarin, aspirin.Which of the following is the strongest indication for anticoagulant therapy in this patient?
b,coronary artery disase ( wrong)
c,decreased activity
d,prosthetic aortic valve
e,radiation therapy

5.A 67 year old man had the acute onset of bilateral weakness of the lower extremities and urinary incontinence 2 days ago. He has had carcinoma of the prostate for 2 years and bone metastases to the pelvis for 6 months. His temperature is 37.4'c ( 99.3'F) , pulse is 86 min , respirations are 18 min and blood pressure is 160/86 mmHg. There is tenderness to palpation over the lumbosacral spine most prominent at S1. He is unable to lift his legs against gravity; DTR are absent at knees and ankles.Which of the following is the most appropriate initial step in diagnosis?
a,Radionuclide bone scan
b, electromyography and nerve conduction studies
c,CT scan of the head
d,MRI of lumbosacral spine
e,lumbar puncture

6.A 21 year old woman comes to the physician because of 8 day history of sore throat ,cough and fever. The cough is nonproductive but keeps her awake at night. She subsequently develops hoarseness. Her temperature is 38.3'c (100.9;F) Crackles are heard over the right posterior lower chest.Xrays of the chest show patchy lower right alveolar infiltrates with increased interstitial markings. Her leukocyte is 10,000 mm3 with 75% segmented neutrophils and 1 %bands
b,hemophilus influenzae (wrong)
c,klebsiella pneumoniae
d,legionella pneumophila
e,mycoplasma pneumoniae
h. RSV
i, streptococcus pyogenes (gp A)

6. A 24 year old man come to the physician for follow up examination.2 months ago, he was seen for a red scaly rash over his groin. A 6 week course of topical clotrimozole resolved the rash completely, but it recurred 2 days ago. He is sexually active with one partner and uses condoms consistently. Examination shows an erythematous, excoriated rash over the groin and similar rash over the instep of the left foot.KOH preparation shows hyphar.Which of the following is the most likely cause of this patieints recurrent infection?
b,clotrimozole resistance
c,impaired cellular immunity (wrong)
d, imparied humoral immunity
e,reinfection from sexual partner

7. A 58 year old man comes to the physician because of extreme fatigue and malaise for 3 weeks.He has felt well except for a toothache 5 weeks ago treated with a root canal procedure. He has histroy of cardiac murmur first noted at the age of 19 years. His temp is 37.8'C (100'F) pulse is 110 mins and blod pressure is 120/80 mmHg. The lungs are clear to asucultation. Cardiac examination shows a grade 2/6 systolic ejection murmur heard best at the right second intercostal space,an S4 and an ejection click. Laboratory studies show Hb 9.3 g/dl, Leucocyte count 10,000/mm3, segmented neutrophils 90%, bands 10%, ESR 90 mm/h, Urine blood +
Blood cultures are obtained. Which of the following is the most likely underlying cardiac abnormality?
a, calcification of a bicuspid aortic valve
b,calcidied mitral annulus
c,myxomatous degeneration of aortic valve
d, myxomatous degeneration of mitral valve(wrong)
e,myxomatous degeneration of tricuspid valve
f,Rheumatic diasease of mitral valve
g,Rheumatic diasease of tricuspid valve

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