11-06-2009, 10:11 PM
18. A 52-year-old woman comes to the office because of a 4-day history of increasing pain of the right hip and thigh. The pain is exacerbated by lying on her right side while sleeping. She says the pain often awakens her and is accompanied by a burning sensation along the right side of her posterior thigh that radiates to her knee. She usually has stiffness and pain in the hip during the following morning that gradually diminishes as she walks around her house and does house chores. She says the pain is also triggered by sitting with her right leg crossed over the left leg. The patient is otherwise healthy and takes no medications. She is 168 cm (5 ft 6 in) tall and weighs 63 kg (140 lb); BMI is 23 kg/m2. Vital signs are normal. Physical examination discloses tenderness on deep palpation of the right trochanter. Which of the following is the most likely diagnosis?
[A) Arthritis of the hip]
B) Aseptic necrosis of the femoral head
C) Bursitis
D) Gout
25. A 25-year-old woman returns to the office because of intermenstrual spotting since beginning oral contraceptive therapy 6 months ago. This is her first attempt at oral contraceptive therapy; she and her partner primarily used condoms for contraception in the past. Before this current therapy her menstrual periods had always been regular. Which of the following is the most appropriate management?
A) Advise her to take two pills daily until the bleeding stops
B) Discontinue the oral contraceptive therapy and have her resume use of condoms for birth control
C) Reassure her that the bleeding problem will resolve in a few months
[D) Switch the current oral contraceptive pill to one containing a higher estrogen dose]
E) Switch to a progestin-only oral contraceptive pill
[A) Arthritis of the hip]
B) Aseptic necrosis of the femoral head
C) Bursitis
D) Gout
25. A 25-year-old woman returns to the office because of intermenstrual spotting since beginning oral contraceptive therapy 6 months ago. This is her first attempt at oral contraceptive therapy; she and her partner primarily used condoms for contraception in the past. Before this current therapy her menstrual periods had always been regular. Which of the following is the most appropriate management?
A) Advise her to take two pills daily until the bleeding stops
B) Discontinue the oral contraceptive therapy and have her resume use of condoms for birth control
C) Reassure her that the bleeding problem will resolve in a few months
[D) Switch the current oral contraceptive pill to one containing a higher estrogen dose]
E) Switch to a progestin-only oral contraceptive pill