04-05-2006, 01:30 AM
A previously healthy 67-year-old man comes to the physician because of a 4-month history of hand weakness, intermittent tingling of the small fingers of his hands, and mild neck pain. Examination shows wasting, weakness, and fasciculations of the interossei muscles. Sensation is decreased to pinprick and vibration in the small fingers of each hand. Triceps tendon reflexes are decreased. Which of the following is the most likely diagnosis?
A
) Amyotrophic lateral sclerosis
B
) Cervical spondylosis
C
) Multiple sclerosis
D
) Myasthenia gravis
E
) Myasthenic (Lambert-Eaton) syndrome
F
) Myotonic muscular dystrophy
G
) Polymyalgia rheumatica
H
) Polymyositis
I
) Progressive neuropathic (peroneal) muscular atrophy
____________________________________________
A 5-year-old girl is brought to the physician because of a 2-day history of temperatures to 39.5 C (103.1 F) and pain in the right side. She has had two episodes of vomiting during this period but no diarrhea or symptoms of upper respiratory tract infection. She has vesicoureteral reflux and a history of recurrent urinary tract infections. She appears ill. Her temperature is 39.8 C (103.6 F), blood pressure is 110/60 mm Hg, pulse is 150/min, and respirations are 25/min. Examination shows right-sided costovertebral angle tenderness. In addition to obtaining urine cultures, which of the following is the most appropriate next step in management?
A
) Intravenous pyelography
B
) Renal ultrasonography
C
) Voiding cystourethrography
D
) Intramuscular antibiotic therapy and reexamination in 24 hours
E
) Intravenous antibiotic therapy
_______________________________________________
A 27-year-old primigravid woman at 29 weeks' gestation comes to the emergency department because of a 24-hour history of increasingly severe right-sided abdominal pain and no appetite. She has vomited twice over the past 4 hours. She has not had vaginal bleeding. Her temperature is 38.2 C (100.8 F). Examination shows exquisite tenderness of the right lateral flank and the fundus. There are no peritoneal signs. Bowel sounds are absent. The fetal heart rate is 144/min. Laboratory studies show:
Hematocrit 37%
Leukocyte count 16,000/mm3
Serum
Total bilirubin 1.1 mg/dL
Amylase 32 U/L
Lactate dehydrogenase 110 U/L
Urine WBC 3“5/hpf
Which of the following is the most likely diagnosis?
A
) Abruptio placentae
B
) Appendicitis
C
) Cholelithiasis
D
) Colitis
E
) Pyelonephritis
_____________________________________________
A 42-year-old woman comes to the physician because of increasing low back pain for 2 days. She is a daily intravenous drug user. She has a history of pyelonephritis, abscesses at injection sites, and pelvic inflammatory disease. Her temperature is 39 C (102.2 F), blood pressure is 130/70 mm Hg, pulse is 84/min, and respirations are 20/min. Examination shows warm, dry skin, a supple neck, and no jugular venous distention. There is tenderness over L4. Pelvic examination shows mild erythema around the cervical os and scant discharge; there is no adnexal or cervical motion tenderness. Her hematocrit is 30%, leukocyte count is 10,600/mm3, and serum glucose level is 110 mg/dL. Urinalysis is within normal limits. Which of the following is the most appropriate next step in management?
A
) Echocardiography
B
) Renal ultrasonography
C
) MRI of the back
D
) Colposcopy
E
) Laparoscopy
A
) Amyotrophic lateral sclerosis
B
) Cervical spondylosis
C
) Multiple sclerosis
D
) Myasthenia gravis
E
) Myasthenic (Lambert-Eaton) syndrome
F
) Myotonic muscular dystrophy
G
) Polymyalgia rheumatica
H
) Polymyositis
I
) Progressive neuropathic (peroneal) muscular atrophy
____________________________________________
A 5-year-old girl is brought to the physician because of a 2-day history of temperatures to 39.5 C (103.1 F) and pain in the right side. She has had two episodes of vomiting during this period but no diarrhea or symptoms of upper respiratory tract infection. She has vesicoureteral reflux and a history of recurrent urinary tract infections. She appears ill. Her temperature is 39.8 C (103.6 F), blood pressure is 110/60 mm Hg, pulse is 150/min, and respirations are 25/min. Examination shows right-sided costovertebral angle tenderness. In addition to obtaining urine cultures, which of the following is the most appropriate next step in management?
A
) Intravenous pyelography
B
) Renal ultrasonography
C
) Voiding cystourethrography
D
) Intramuscular antibiotic therapy and reexamination in 24 hours
E
) Intravenous antibiotic therapy
_______________________________________________
A 27-year-old primigravid woman at 29 weeks' gestation comes to the emergency department because of a 24-hour history of increasingly severe right-sided abdominal pain and no appetite. She has vomited twice over the past 4 hours. She has not had vaginal bleeding. Her temperature is 38.2 C (100.8 F). Examination shows exquisite tenderness of the right lateral flank and the fundus. There are no peritoneal signs. Bowel sounds are absent. The fetal heart rate is 144/min. Laboratory studies show:
Hematocrit 37%
Leukocyte count 16,000/mm3
Serum
Total bilirubin 1.1 mg/dL
Amylase 32 U/L
Lactate dehydrogenase 110 U/L
Urine WBC 3“5/hpf
Which of the following is the most likely diagnosis?
A
) Abruptio placentae
B
) Appendicitis
C
) Cholelithiasis
D
) Colitis
E
) Pyelonephritis
_____________________________________________
A 42-year-old woman comes to the physician because of increasing low back pain for 2 days. She is a daily intravenous drug user. She has a history of pyelonephritis, abscesses at injection sites, and pelvic inflammatory disease. Her temperature is 39 C (102.2 F), blood pressure is 130/70 mm Hg, pulse is 84/min, and respirations are 20/min. Examination shows warm, dry skin, a supple neck, and no jugular venous distention. There is tenderness over L4. Pelvic examination shows mild erythema around the cervical os and scant discharge; there is no adnexal or cervical motion tenderness. Her hematocrit is 30%, leukocyte count is 10,600/mm3, and serum glucose level is 110 mg/dL. Urinalysis is within normal limits. Which of the following is the most appropriate next step in management?
A
) Echocardiography
B
) Renal ultrasonography
C
) MRI of the back
D
) Colposcopy
E
) Laparoscopy