Internal-Medicine

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204 10: Infection 25. A 4-year-old boy is sent to the emergency room because of clinical suspicion of meningitis. He has been ill for 2 days with fever and lethargy. On examination, he is febrile, the neck is stiff, and papilledema is present. There is no rash, the lungs are clear, and heart sounds normal. Which of the following is the most likely causative organism? (A) (B) (C) (D) (E) Neisseria meningitidis Streptococcus pneumoniae Haemophilus influenzae Staphylococcus Listeria species 26. Which of the following is a contraindication to receiving the live rubella vaccine? (A) (B) (C) (D) (E) children between 1 year old and puberty infants
Questions: 25–35 205 (A) (B) (C) (D) (E) an infected heart valve nasopharynx skin oral ingestion bowel 31. A 44-year-old renal transplant patient develops severe cough and shortness of breath on exertion. On examination, he appears dyspneic, respirations 24/min, pulse 110/min, and oxygen saturation 88%. His lungs are clear on auscultation and heart sounds are normal. CXR shows bilateral diffuse perihilar infiltrates. Bronchoscopy and bronchial brushings show clusters of cysts that stain with methenamine silver. Which of the following is the most appropriate next step in management? (A) (B) (C) (D) (E) amphotericin B cephalosporins trimethoprim-sulfamethoxazole aminoglycosides penicillins 32. A34-year-old man presents with diarrhea 3 weeks after returning from a trip to rural South America. Over the past few days, he has gradually developed lower abdominal pain and diarrhea. Now the symptoms are much worse with eight stools a day consisting mostly of mucus and blood. He is afebrile, the abdomen is tender in left lower quadrant, and the remaining examination is normal. His stool is mostly comprised of blood and mucus, and stools tests show trophozoites of Entamoeba histolytica. Which of the following is the most likely site of extraintestinal involvement? (A) (B) (C) (D) (E) genitals pleura pericardium liver cerebral cortex 33. A 20-year-old woman complains of headache and discomfort in both sides of her jaw. Physical examination reveals enlarged parotid glands that are slightly tender on palpation. There is reddening of the orifice of Stensen’s duct on intra oral examination; her temperature is 38.3°C, and the pulse rate is 80/min. Laboratory data show hemoglobin 14 g/dL; hematocrit 40%; WBC 11000/mL, with 33% segmented neutrophils, 7% monocytes, and 60% lymphocytes. Which of the following diagnostic tests will help to confirm the diagnosis of epidemic parotitis? (A) (B) (C) (D) (E) single blood sample for a specific immunoglobulin G (IgG) blood cell count blood culture single blood test for a specific immunoglobulin M (IgM) serum amylase 34. Three hours after a church social, eight people develop severe diarrhea. Other symptoms included nausea, vomiting, and abdominal cramps. Food served included chicken salad and cream-filled pastries. All affected individuals had the chicken salad. Which of the following is the most likely causative organism? (A) (B) (C) (D) (E) staphylococcal enterotoxin C. botulinum Clostridium perfringens Salmonella species ptomaine poisoning 35. A young woman complains of hair loss, loss of hair luster, and intense scalp irritation. Examination reveals patches of hair loss with tiny little black dots where the hair shaft has broken off. A Wood’s light examination is positive. Which of the following is the most likely diagnosis? (A) (B) (C) (D) (E) seborrheic dermatitis Aspergillus infection Trichophyton infection neurosis excess androgen levels
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FOURTH EDITION LANGE Q&A INTERNAL
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Professional Want to learn more? We
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iv Contents 9. Muscles and Joints .
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2 1: Cardiology 5. A 42-year-old ma
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4 1: Cardiology 14. A patient with
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6 1: Cardiology (A) (B) (C) (D) (E)
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8 1: Cardiology 31. A 63-year-old w
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24 1: Cardiology Calcium plays a ro
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26 1: Cardiology and other bradyarr
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28 1: Cardiology most useful initia
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30 1: Cardiology 73. (D) In Wolff-P
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32 1: Cardiology 102. (D) RVMI is c
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34 1: Cardiology function should be
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36 2: Skin DIRECTIONS (Questions 6
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38 2: Skin Figure 2-4. (Reproduced,
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40 2: Skin Figure 2-7. (Reproduced,
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42 2: Skin 32. A 32-year-old woman
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44 2: Skin DIRECTIONS (Questions 43
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46 2: Skin be difficult to differen
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48 2: Skin specific antibodies in t
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50 2: Skin 50. (C) Chloroquine is u
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52 3: Endocrinology 5. A 17-year-ol
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54 3: Endocrinology 12. A 56-year-o
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66 3: Endocrinology 91. Which of th
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70 3: Endocrinology It is most comm
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72 3: Endocrinology polygenic in it
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74 3: Endocrinology 57. (B) Risk of
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76 3: Endocrinology also be caused
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78 3: Endocrinology occur only in a
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80 4: Gastroenterology 5. A 57-year
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82 4: Gastroenterology 23. A 64-yea
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86 4: Gastroenterology 39. A couple
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90 4: Gastroenterology 66. Which of
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94 4: Gastroenterology 18. (B) Desp
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96 4: Gastroenterology 43. (B) In n
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98 4: Gastroenterology 67. (A) Anab
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100 5: Hematology 4. A 62-year-old
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106 5: Hematology 36. A 4-month-old
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114 5: Hematology 19. (E) Steroids
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116 5: Hematology 42. (C) Chorionic
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118 5: Hematology a chronic disease
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120 6: Oncology 3. A 42-year-old ma
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122 6: Oncology 14. You are seeing
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124 6: Oncology 25. A 63-year-old m
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126 6: Oncology Questions 38 throug
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128 6: Oncology Questions 60 throug
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130 6: Oncology H. pylori is anothe
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132 6: Oncology 25. (B) Barrett’s
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134 6: Oncology with other thyroid
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136 7: Diseases of the Nervous Syst
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Page 240 and 241: 230 11: Immunology and Allergy 6. A
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254 12: Diseases of the Respiratory
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260 13: Clinical Pharmacology 6. A
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264 13: Clinical Pharmacology 40. W
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268 13: Clinical Pharmacology 10. (
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276 14: Comprehensive Review 6. A 3
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278 14: Comprehensive Review 21. Wh
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280 14: Comprehensive Review 38. A
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286 14: Comprehensive Review 85. Wh
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288 14: Comprehensive Review Figure
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292 14: Comprehensive Review For ea
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Answers and Explanations 1. (A) Thi
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296 14: Comprehensive Review enceph
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298 14: Comprehensive Review antige
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300 14: Comprehensive Review peak i
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302 14: Comprehensive Review 76. (D
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304 14: Comprehensive Review At tim
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310 Index Antineutrophil cytoplasmi
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312 Index Dobutamine, 263, 270 Dono
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314 Index Infective endocarditis (C
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316 Index Pleuritis, 194 Pneumococc
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318 Index Toxoplasmosis, 148, 226 T
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