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A 26-year-old woman presents with weight gain, lethargy, dry skin, sweatiness, cold intolerance, and thinning hair. You suspect hypothyroidism and order the appropriate laboratory tests. Her TSH is high, and her free T 3 and free T 4 are both low. Which of the following is the most likely diagnosis?

0. You have been following a 45-year-old man for hypothyroidism for the past 2 years without significant complaints. He was prescribed 100 g of levothyroxine 1 year ago, when the diagnosis was made, and his TSH fell to normal levels at the 3- month and 6-month visits. He returns for a routine annual recheck and manifests a normal blood pressure and apical heart rate of 80, regular. As he has a family history of adenomatous colon polyps, you arrange for colorectal cancer screening annually this decade. Then you draw routine fasting lipids because he has gained 5 lb (2.26 kg) during the past year and also draw in the same specimen serum TSH. The test results return normal except for TSH, whose level is 6.2 IU/mL (normal is 0.4 to 4.8). Each of the following may constitute explanations for this finding, except which factor?

A 25-year-old woman complains of fatigue and cold intolerance increasing over the past 3 months. On examination, she manifests a somewhat dry skin, which she says is a change from her usual. She admits to being puzzled and saddened over the situation. Her apical heart rate is 68 in a regular rhythm. Blood pressure is 110/68. The TSH level is 0.3 IU/mL (0.4 to 4.8). She gives a further history of being on bromocriptine for a microprolactinoma. Which of the following is the likely cause of her condition?

You are caring for a 35-year-old man who is complaining of fatigue and an inability to gain weight. Laboratory evaluation reveals a TSH of 6.0 mIU/L (H) but a normal free T 4. Which of the following is the best next step?

3. Which of the following statements about hyperglycemic hyperosmolar nonketotic coma is true? B

Which of the following test results supports the diagnosis of Graves' disease?

In screening for primary thyroid disease (hypothyroidism or hyperthyroidism), which of the following serum tests is the most sensitive?

A 45-year-old white woman is undergoing a routine annual preventive health examination. After reviewing the routine mammogram and before performing the routine breast and pelvic examination, you proceed to a head-to-toe brief physical examination. You discover a palpable thyroid nodule that seems to be about 2.5 cm in diameter. Which of the following blood tests would be the most logical, in addition to certain routine medical profiles?

Which of the following is consistent with a diagnosis of hyperthyroidism?

A 28 year-old woman is noted to have had 10-Ib unintended weight gain hair loss, dry skin and fatigue. She is diagnosed with probable hypothyroidism. Which of the following laboratory test results is most consistent with hypothyroidism?

A 30-year-old female complains of fatigue, constipation, and weight gain. There is no prior history of neck surgery or radiation. Her voice is hoarse and her skin is dry. Serum TSH is elevated and T4 is low. The most likely cause of these findings is

A 35-year-old woman presents to her primary care physician because of 2 weeks of neck pain. The pain is constant and sharp (rated at 10 of 10) and is felt in the anterior portion of her neck. She also notes several weeks of loose stools and fatigue. Past medical history is significant for a viral upper respiratory infection about 1 month ago. She has a temperature of 37.9°C (100.2°F), heart rate of 96/min, and blood pressure of 136/82 mm Hg. On neck examination there is diffuse enlargement of the thyroid and it is exquisitely tender to even mild palpation. Her oropharynx. Laboratory studies are sent and reveal a white blood cell count of 14,100 cells/ML with a normal differential, erythrocyte sedimentation rate (ESR) of 53 mm/h. Thyroid antibodies are negative. What is the most likely

A 40-year-old woman presents to the outpatient clinic for a routine visit. On physical examination a 1-cm nodule is palpated in her thyroid. Her physical examination is otherwise unremarkable. Her heart rate is 70/min and regular, blood pressure is 126/82 mm Hg, and temperature is 36.7oC (98.0o F). Which of the following is a poor prognostic indicator for the thyroid nodule?

A 72-year-old man with atrial fibrillation presents with complaints of fatigue and feeling cold. He also notes constipation and dry skin. His daughter states he has seemed more forgetful over the past several months. His temperature is 37.3°C (99.1°F), heart rate is 48/min, and blood pressure is 130/82 mm Hg. Cardiac examination shows bradycardia but normal rhythm, and normal S1 and S2 with no murmurs; the lungs are clear to auscultation bilaterally and the abdomen is soft and nontender. The patient’s extremities are cool and puffy with dry, coarse skin. Laboratory studies show a thyroid-stimulating hormone level of 32 μU/L, free thyroxine of 0.3 ng/dL, and total triiodothyronine of 30 ng/dL. What medication is the patient likely taking for his atrial fi brillation?

It is common for throat pain to be referred to the

The mother of a 9-month-old infant brings him in for irritability. The child has been fussy and has not been sleeping well for 2 days. His highest temperature has been 100°F, and he has had a clear runny nose and cough. On examination, the child is crying and irritable. Which physical examination finding, by itself, is insufficient to diagnose acute otitis media?

A 60 year old female patient has been complaining of left earache of 3 months duration. One month ago a swelling appeared in the left side of the neck that progressively increased in size. 2 days ago cot complained of change of her voice together with dysphagia. On indirect laryngoscopy there was froth in the region behind the larynx. What is the most possible diagnosis

A 35-year-old male graduate student complains of intermittent difficulty swallowing for the last 3 months. He notes that this happened 6 years ago and lasted for about 7 months. Which of the following symptoms would most enable you to reassure the patient that he does not have an organic basis for the dysphagia?

A 25 year old male presented to the ENT emergency room with severe right side throat pain, inability to swallow, accompanied by right earache of 2 days duration. The patient was unable to open his mouth and was feverish 40 C. On examination there was a tender swelling at the angle of the mandible The patient gave a history of sore throat and fever 39 C during the last week. What is the most possible diagnosis in this case?

A 12-year-old female patient is diagnosed as having streptococcal pharyngitis. To prevent rheumatic fever in this child, how soon must the treatment begin to eradicate the Streptococcus

A 22-year-old female patient is diagnosed as having streptococcal pharyngitis. To prevent rheumatic fever in this child, how soon must the treatment begin to eradicate the Streptococcus

A 21-year-old woman presents with a complaint of sore throat. She was in her usual state of health until 3 days ago, when she developed a nonproductive cough, nasal drainage, ear pain, and a sore throat. She denies having shortness of breath, sputum production, fever, rash, joint pains, or gastrointestinal symptoms. She also denies having been in contact with sick persons. For the past 2 years, she has been in a sexual relationship with a single sexual partner. On physical examination, the patient is found to have erythema of the posterior pharynx and nasal turbinates. Small, bilateral, serous, middle-ear fluid collections are noted. Lung examination is normal. The patient is afebrile. She requests antibiotics, stating that she always improves much more quickly with this therapy. Which of the following statements regarding pharyngitis is true?

A 35 year-old boy presents to the physician's office complaining of fatigue, headache, myalgias, and sore throat that have been continuous for 1.5 weeks. The patient has generalized lymphadenopathy of the cervicaland submandibular nodes, in addition to splenomegaly. His tonsils are significantly enlarged with exu- date. Peripheral blood smear shows 65% lymphocytes, with 15% atypical lymphocytes. Which is the most likely cause of his syndrome?

Which of the following causes of Abdominal Pain Based on Location is correct

What is true about abdominal pain?

A 53-year-old obese woman presents to your office complaining of the recent onset of abdominal pain. She describes pain that starts in the mid epigastric region, radiating to the back. It is associated with nausea and vomiting. Past history of alcohol use is negative. What is the most likely diagnosis?

A 42-year-old woman presents to your office complaining of the recent onset of abdominal pain. She describes pain that starts in the midepigastric region, radiating to the back. It is associated with nausea and vomiting. What is the most likely diagnosis?

A 28-year-old man comes to your clinic complaining of diarrhea of 10 months’ duration. He is a graduate student and is currently writing a thesis. He has been sexually active with men in the past but not during the past 2 years. He denies experiencing weight loss or other constitutional symptoms. He notes no blood in the stool. He has no medical history. He explains that he has not sought attention before now because the problem is intermittent, and he notes that he sometimes experiences constipation rather than diarrhea. You include irritable bowel syndrome in your differential diagnosis. Which of the following descriptions is characteristic of irritable bowel syndrome?

Which of the following best describes irritable bowel syndrome?

A 58-year-old woman presents to her internist with a 2-day history of low-grade fever and RUQ abdominal pain. She reports nausea but denies vomiting or diarrhea. On physical examination, she is pale and jaundiced. Her temperature is 38.1°C. She has RUQ tenderness without rigidity or rebound tenderness. Bowel sounds are normal. Her white blood cell count is 16,000/μL and urinalysis shows no red or white blood cells. Which of the following is the most likely diagnosis?

. A 40-year-old Asian woman presents to the emergency department complaining of intermittent epigastric pain. The pain is severe, lasts for a few hours, and is sometimes accompanied by nausea and vomiting. Her bowel movements have been normal. Her temperature is 38.3°C (100.9°F), pulse is 100/min, blood pressure is 150/80 mm Hg, and respiratory rate is 22/min. Physical examination reveals moderate obesity and mildly icteric sclerae. Bowel sounds are normal, with an abrupt halt of inspiration upon palpation of the RUQ, and guarding is noted. Laboratory values reveal a WBC count of 13,000/mm³, total bilirubin of 3.3 mg/dL, and normal liver enzymes and alkaline phosphatase levels. Which of the following is the fi rst diagnostic imaging study that should be performed?

All of the following statements is correct, except:

Which of these is correct?

An 80-year-old man presents with mild, crampy, bilateral lower quadrant pain, decreased appetite, and low-grade fever for about 48 hours. Which of the following is the most likely diagnosis?

50 year-old women presents with mild, crampy, right lower quadrant pain, decreased appetite, and low-grade fever for about 48 hours. Which of the following is the most likely diagnosis

Pain from distended intestines is appreciated in

The diagnosis of GERD is typically made by

You are seeing a 75-year-old patient with complaints of heartburn, regurgitation, and belching. You suspect GERD. Which symptom, if present, would necessitate a referral for an upper endoscopy?

. A 55-year-old female enters an urgent care center with a complaint of acute abdominal pain. She relates two attacks of less severe abdominal pain within the past 3 months. The pain radiates through to the back opposite the epigastric area and seems to be relieved by leaning forward. Each of the following is true regarding this case except

A 72-year-old woman is in the surgical intensive care unit after a carotid endarterectomy. She has been taking clindamyein and ciprofl oxacin for the past 13 days. On postoperative day 2 the patient is febrile and tachycardic with a high WBC count and a low RBC count. She is also noted to be dehydrated and hypotensive. On physical examination she is distended and has abdominal tenderness with rebound andguarding. Stool is sent for Gram stain and analysis for fecal leukocytes, fecal occult blood, and Clostridium diffi cile toxin. Which of the following is most likely present in the stool sample?

A 45-year-old HIV-positive woman comes to her primary care physician complaining of a 2-day history of bloody diarrhea. She states that she has been feeling well until 2 days ago, when she developed abdominal pain. She denies fevers, chills, night sweats, nausea, or vomiting. She admits to feeling tired over the last couple of weeks and has had a 2.3-kg (5-lb) weight loss over the past 2 weeks. Her stool sample shows WBCs and RBCs. Her Gram stain is shown in the image. Her CD4+ cell count is 201/mm³. Which of the following is the most likely cause of this woman’s symptoms? Image courtesy of the Centers for Disease Control and Prevention’s Public Health Image Library

A 63-year-old man with diabetes is called by his primary care physician because of abnormal liver function test results, as follows: Aspartate aminotransferase: 85 U/L, Alanine aminotransferase: 102 U/L, Alkaline phosphatase: 180 U/L, Total bilirubin: 1.9 mg/dL On physical examination his liver is enlarged. His skin has a slightly yellow hue, especially on his face. The review of symptoms is signifi cant for some weight loss, weakness, arthritis in his hands, and inability to achieve an erection. What test would generate the most likely diagnosis

. A 41-year-old man presents for evaluation of upper Gl discomfort present over the last 2 months. He says that he has a "full" sensation in the epigastric region. He denies blood in his stool, denies vomiting, and has had no dysphagia. He has lost 10 lb in the last few weeks unintentionally, which he attributes to not eating. His mother has hemorrhoids, and no family member has ever had colon cancer. Which of the following is the most appropriate next step in workup of this patient?

Which of the following H pylori eradication therapy regimen is correct

60-year-old man comes with persistent epigastric pain and nausea. Pain began after taking NSAIDs for headache. He took PPI for 2 weeks with mild relief. After stopping PPI pain began again. He has loss of appetite and occasionally nausea. He is a smoker, without other medical problems. Physical examination shows tenderness in epigastric area. Upper endoscopy reveals gastric erythema and a mass in the body of the stomach. Biopsy is competent with low-grade lymphoma from the mucosa associated lymphoid tissue (MALT). Which of the following is most likely involved in the pathogenesis of this condition?

A 62-year-old man presents with dark tarry stools and light-headedness. Upper endoscopy finds an ulcerating lesion in his stomach and biopsies confirm gastric cancer. Which of the following is a risk factor for carcinoma of the stomach?

Which of the following is the most important, productive, and practical reason to offer or refer for upper endoscopy in any patient over 45 years with persistent dyspepsia?

What may be the possible diagnosis for 3-week-old boy with 2 days of projectile nonbilious vomiting and constant feeding C

A new mother brings her infant to see you to discuss his vomiting. He is 4 weeks old and is exclusively breast-fed. He vomits with every meal. On examination, his abdomen is distended with normal bowel sounds, and he appears dehydrated. He has lost 4 oz since his visit with you 2 weeks ago. Which of the following is the most likely diagnosis?

You are caring for a 12-year-old boy with psychiatric and neurologic abnormalities. Laboratory evaluation show high serum and urine copper levels. Eye examination reveals Kayser Fleischer rings. Which of the following is the most likely cause of his condition?

A 15-year-old girl presents with malaise, fatigue, depression, and clinical evidence of hepatitis in the absence of viral causation. An older sister is awaiting liver transplantation. Which of the following blood studies may be most specifically helpful in establishing the diagnosis?

You are evaluating a 65-year-old man who complains about arthritis, heart disease, erectile dysfunction. Laboratory evaluation reveals high blood iron transferrin saturation. Which of the following is the most likely cause of her problem?

A 45-year-old woman presents with fatigue, anorexia, brown urine, and malaise. She denies alcohol intake entirely, illicit drug use, and history of treatment with blood products, and she is on no medications that may cause elevation of hepatocellular enzymes. Examination reveals scleral icterus and mildly tender hepatomegaly. Both AST and ALT levels are elevated to four times normal, and smooth muscle antibody (SMA) and antinuclear antibody (ANA) levels are positive. She has a history of Hashimoto thyroiditis, but no history suggestive of inflammatory bowel disease. Alkaline phosphatase and gamma-glutamyl transpeptidase are both elevated to twice normal limits. A hepatitis profile yields no evidence of hepatitides A, B, C, or E. Which of the following may be the best initial presumptive diagnosis?

Which of the following statements is true about chronic hepatitis B?

A 7 month male infant is brought to his pediatrician's office for a well-child visit. He has a temperature of 37.2°C (99°F) and clear nasal drainage. Physical examination is otherwise unremarkable. The infant is able to lift his head when prone, track past the midline, and coo. His immunization record indicates that he received is first hepatitis B vaccination at birth. Assuming this child is developing normally, which vaccines should this infant receive today?

A 19-years- old sexually active homosexual man asks you about his risks for viral hepatitis. He is currently asymptomatic and unsure of his immune status. Which of the following should you recommend?

Which of the following is the best indicator of a high degree of hepatitis B virus (HBV) replication, hence marker of infectivity?

You check serologies on a patient exposed to hepatitis B. His serologies are: HBsAg-Negative, HBeAg-Negative, Anti-HBs- Positive, Anti-Hb core IgGpositive. Which of the following terms best describes his disease status

You check serologies on a patient exposed to hepatitis B. His serologies are shown below: • HBsAg: Negative • HBeAg: Negative • Anti-HBs: Positive • Anti-HBe: Negative Which of the following terms best describes his disease status?

Which of the following forms of hepatitis does NOT have a chronic state?

Which of the following is the most easily passed by a blood donor?

The Center for Disease Control and Prevention recommends that the following high-risk individuals should be tested for HCV infection. Which of following are a high risk

Which of the following is the next most common cause of blood transfusion-related hepatitis after hepatitis B?

A 26-year-old woman presents to your clinic and is interested in getting pregnant. She seeks your advice regarding vaccines she should obtain, and in particular asks about the hepatitis B vaccine. She works as a receptionist for a local business, denies alcohol or illicit drug use, and is in a monogamous relationship. Which of the following is true regarding hepatitis B vaccination?

A patient that you follow has recently started volunteering at a drug treatment hospital and requires hepatitis B vaccination. You find that he is hepatitis B surface antibody positive. Which of the following would be the best guideline to follow in this case?

A patient requires hepatitis B vaccination. You find that he is hepatitis B surface antibody positive. Which of the following would be the best guideline to follow in this case

Which of the following immunizations should be given in the newborn period?