Packrat exam 100% VERIFIED ANSWERS 2024/2025 PERFECT, Exams of Nursing

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Packrat exam 100%

VERIFIED ANSWERS

2024/2025 PERFECT

23 yo male with recent URI sxs presents c/o chest pain. His pain is worse when lying down and better sitting up and leaning forward. ECG shows widespread ST segment elevation. Dx Pericardial friction rub 75 yo woman presents to the office with complain of vision loss. Exam reveals a palpable cord in the temporal region. Most helpful initial test to order ESR Recommended LDL tor educe risk of CAD in a diabetic pt 100mg/dL What is the reason for giving IV mag sulfate to a pt with pre-eclampsia prevention of seizure by increasing the seizure threshold 53 yo man with h/o HTN presents c/o recent 4/10 left sided chest pain with exertion that is relieved with rest. Heart exam reveals regular rate and rhythm with no S3, S4 or murmur. Lungs are CTA bilat. ECG reveals no acute changes. Most appropriate initial test Nuclear Stress Test 36 yo AA female comes to the clinic for an insurance physical which requires a CXR. She denies any respiratory sxs. Exam of her chest is negative. Xray results

show marked LAD in the right paratracheal region. ACE levels are elevated. Most likely dx Sarcoidosis 33 year old presents to your office with a c/o right knee injury associated with pain and swelling. He states he was running after his loose dog and suddently stopped, hyperextended his knee, heard a pop, and noticed immediate swelling. On PE, the Lachman test and anterior drawer test demonstates joint laxity. Most likely injury ACL 22 yo woman comes to the office because her urine is cola colored and she hasnot urinated since yesturday morning. Her past medical hx is significant for pharyngitis two weeks ago. Her mother and grandmother have type 2 diabetes. Her BP is 146/92 mmHg. On PE she has edema of her face and hands. Dx glomerulonephritis 15 yo girl hit in the right eye by a golf ball. There is swelling and echymosis of the orbit. She c/o double vision. The right eye doesn't move with downward gaze or right lateral gaze. Dx test that will provide the most information facial x-ray A 48 yo male with DM presents for routine PE. Of note his BP each of his last two f/u visits was 150/90. Today his BP is 148/88. The pt denies c/o chest pain, change in vision, or headache. Most appropriate management linsinopril (Zestril) 68 yo male with a h/o a-fib treated with warfarin (Coumadin) presents to the ED after vomiting large amounds of bright red blood. INR is 3. Most appropriate treatment to rapidly lower the patient's INR

administer FFP 72 yo farmer comes to the office for eval of a pearly ulcerated papule on his right nostril. The papule has been bleeding off and on for hte past couple weeks. Which of the following findings would be most concerning on the PE of this pt Telangiectasia 24 yo female presents with c/o abd pain, bloating, and chronic diarrhea. She says she felt worse last month while on vacation in Italy. Despite eating well she lost weight. What would be the most appropriate traetment for this pt Gluten-Free diet Hypoglycemia in an elderly pt with diabetes is most likely to manifest as what sx Mental confusion An 85 yo nursing home resident presents witha abrupt onset of cough, sore throat, HA, myalgias, and malaise. On exam pt temp is 102F, the rest of the exam is unremarkable. Nasal smear is positive for Influenza B. Tx of choice for this pt Oseltamivir (tamiflu) 36 yo female presents for routine PE. She has no current complaints and her only medication is oral contraceptives. The pt is preparing for a trip in Australia and is worried about the long flight as her Mom has a hx of DVT after a long trip several yaers ago. PE reveals BP 110/60. HR 66, regular. Heart is regular rate and rhythm without murmur, lungs are clear to auscultation bilaterally and extremities are without edema. Most appropriate recommendation recommend walking frequently during the flight 43 yo woman presents with episodes of facial flushing with increased skin temp. followed by the development of tiny papules and pustules primarily on her cheeks and chin. These sxs worsen when she eats spicy food. On exam,

telangiectasias are noted along the nasal folds and tiny pustules on both cheeks. Dx rosacea 25 yo male presents to the ED for eval of a wound on his hand. He cut his hand while tearing down a chicken coop. On exam of his right hand you note a dirty 3cm jagged laceration. The pt is unaware of his tetanus immunization status. Besides cleaning and debriding the wound, what is the recommended intervention administer tetanus-diptheria toxoid (Th) and tetanus immune globulin (TIG) 25 yo female presents for a routine gynecological exam. You palpate a 2cm breast mass in her right breast. Her menstrual period was last week. She has no family hx of breast cancer. What is the modality of choice to further evaluate her breast mass ultrasound 60 yo right hand dominant male presents to your office complaining of right shoulder pain and progressively worsening arm weakness. His sxs are aggravated when working above the shoulder level. On PE, there is no evidence of muscle atrophy. He has strong (5/5) adduction of his right shoulder but considerable weakness (1/5) with abduction when raising his arm above his head. Passive range of motion is intact. Dx rotator cuff tear Newborn weighs 8 pounds at birth. what would you expect her to weigh at 1 year of age 24 pounds

3 month old female presents with her Mom for PE. The pts Mom denies any complaints. On exam you note a well developed, well nourished infant in no apparent distress. There is no cyanosis noted. Heart exam reveals a normal S with a physiologically split S2. There is a grade III/VI high pitched, harsh pansystolic murmur heard best at the 3rd and 4th left intercostal spaces with radiation across the precordium. Initial study of choice echocardiogram 62 yo male smoker presents to the clinic with c/o chronic cough, hemoptysis, and weight loss. Chest CT shows a mass obstructing the bronchus with hilar and mediastinal lymph node abnormalities. Bronchoscopy with biopsy is performed. On reviewing pathology results you explain to the pt that his type fo lung cancer is prone to early hematogenous spread, is rarely amenable to surgical resection and has a very aggressive course. Dx small cell lung cancer Otitis externa can be differentiated from uncomplicated otitis media by which of the following PE findings normal pneumatic otoscopy 20 yo male presents with complaint of brief episodes of rapid heart beat with a sudden onset and offset that have increased in frequency. He admits to associated SOB and lightheadedness. He denies syncope. Electrocardiogram reveals a delta wave prominent in lead II. Which of the following is the most appropriate long term management in this pt Radiofrequency ablation 26 yo woman requests screening after her boyfriend was treated for an STD. On exam you find a painless vulvar ulcer. Most likely dx syphilis

57 yo male recently on a high protein diet presents with an exquisitely tender, erythematous, warm right great toe. Treatment of choice NSAID 55 yo female presents to the clinic with lethargy, fatigue, constipation, and menorrhagia. PE reveals an enlarged thyroid, dry skin, and a haert rate of 50bpm. Lab results show a decrease in free T4, and an elevation in TSH. Dx primary hypothyroidism Which of the following diagnostic studies is indicated in the eval of an upper GI bleed upper endoscopy 45 yo male presents to the clinic c/o morning slugishness, daytime fatigue, headaches. he admits to drinking two cocktails each evening. His bed partner reports loud cyclical snoring, breath cessation, and admits thrashing movements of his extremities during sleep. BMI is 40. Heart exam reveals regular rate and rhythm without S3, S4, or murmur and lungs are clear to auscultation. Polysomnography shows apneic episodes lasting as long as 60 seconds. Which of the following clinical interventions would most likely provide for the acute cessation of apneic episodes nasal continuous positive airway pressure (CPAP) 45 yo female presents with her daughter who is concerned because her Mom will not leave the house. The patient descrives feeling anxious in crowds and places where there are no easy means of escape. Most likely dx agoraphobia 18 yo female with DM presents to the ED with altered LOC, deep breathing, and fruity odor to her breath. Which med is indicated for this pt

Regular Insulin 69 yo male with a hx of CLL presents to the clinic c/o cough, dyspnea, and production of copious amounts of foul smelling sputum. PE reveals crackles at the lung bases. CXR shows dilated and thickened bronchi that appear as ring-like markings. Most likely dx bronchiectasis Bony and cartilaginous enlargement of distal interphalangeal joints is commonly seen in which medical condition OA 9 yo male is brought by his mother who reports the pt has exhibited an extremely negative attitude for the past year. He seems angry much of the time and frequently loses his temper. Arguing over even trivial details is common place and he seems to take delight in annoying his family. His grades and conduct at school remain excellent. He has few friends, though he has never been seen bullying or destroying others' property. Dx oppositional defiant disorder Pt presents c/o gradual hearing loss over the past 3 months. He admits to use of Q-tips and otherwise doesn't wear ear plugs or palce other foreign objects in his ear. On exam external auditory canals are obstructed with cerumen. After remvoal of cerumen, hearing is equal on both sides. Appropriate counseling of this pt includes what Advise him to discontinue use of cotton swabs Dysmenorrhea would most likely occur in which of the following pts 35 year old woman with regular cycles

49 yo female presents complaing of several episodes of chest pain recently. Initial ECG i nthe Ed shows no acute changes. Two hours later, while the pt was having pain, repeat electrocardiogram revealed ST segment elevation in leads II, II, and aVF. Cardiac Cath shows no significant obstruction of the coronary arteries. Treatment of choice nifedipine (Procardia) 62 year old male presents with c/o dyspepsia, early satiety, and dysphagia. diagnostic study for initial workup upper endoscopy 6 yo male, recent immigrant from Latin America, is brough to the ED with difficulty swallowing and breathing. On PE you note a gray-tan pseudomembrane in the back of the pharynx. There is also tender cervical LAD. What PE finding is most specific for dx in this pt pseudo-membrane in pharynx 40 yo male non smoker in good health undergoes a routine CXR for an insurance physical. Results show an isolated, well defined, coin lesion 1cm in size. Which of the following is the next step in teh eval of this problem review old radiographs Lesions of the optic chiasm will produce what deficit bitemporal hemianopsia 75 yo female with a hx of long-standing HTN presents with SOB. On exam you note a diastolic murmur at the left upper sternal border. What maneuver would accentuate this murmur Sitting up and leaning forward

25 yo female, G2 P1001, presents to your office at 11 wks gestation with vaginal bleeding, mild lower abdominal cramping, and bilateral lower pelvic discomfort. On exam, blood is noted at the dilated cervical os. No tissue is protruding from the cervical os. The uterus by palpation is 8-9 wks gestation. No other abnormalities are found. Likely dx inevitable abortion what lab test should be closely monitored in pts on long term lithium treatment for bipolar disorder TSH 16 yo female comes to the office because her acne has become more severe and she would like to discuss treatment. She was originally prescribed tropical clindamycin gel 1 yr ago to treat open and closed comedones on her face. Despite regular use of the medication, she now has several comedones and papulopustules across her nose, cheeks, chin, and forehead. Which of the following would be an appropriate additional treatment for moderate acne oral doxycycline 50 yo male with history of alcohol abuse presents with complaint of worsening dyspnea. PE reveals bibasilar rales, evelated JVP, an S3 and lower extremity edema. CXR reveals pulmonary congestion and cardiomyopathy. ECG shows frequent ventricular ectopy. Echo shows left ventricular dilation and an ejection fraction of 30%. Most likely dx dilated cardiomyopathy 25 yo female with hx of diarrhea presents to teh ED with Buillian-Barre syndrome. Most likely causative pathogen Campylobacter jejuni

32 yo female presents with an 8 wk history of a burning sensation deep in the chest which starts about 30 minutes after she eats, worsens when she lays down at night. She ahs had some relief with an antacid and denies dysphagia. What intervention would be beneficial avoiding mint 45 yo female presents c/o the worst HA of her life. Most appropriate initial diagnostic study CT Which physical exam finding differentiates allergic rhinitis from other rhinitis etiologies pale nasal turbinates 56 yo female with a 35 pack year smoking hx presents to the clinic with SOB and cough. On exam she is think with no recent weight loss. She appears uncomfortable, breath sounds are diminished without adventitious sonds. PFT shows a marked increase in TLC and a decreased FEV1. Dx chronic obstructive pulmonary disease Which of the following Rh genotypes in a mother and father would represent a risk for hemolytic disease of the newborn Mother Rh-negative, Father Rh-positive 76 yo active female with history of HTN and hypothyroidism presents with c/o palpitations and DOE. On exam vital signs are BP 120/80, HR 76 and irregular, RR

16. Heart exam reveals an irregularly ireggular rhythm without murmur. Lungs are clear to auscultation and extremities are without edema. Most important med for chronic therapy in this pt coumadin

32 yo male presents with a one month hx of weakness, anorexia, and weight loss. On PE he is hypotensive and his skin has diffuse hyperpigmentation. Plasma Cortisol levels drawn at 8am are low. Dx Addison Disease Antinuclear antigen (ANA) is most commonly associated with and monitors the progress of what disorder systemic lupus erythematosis (SLE) 72 yo woman presents to your clinic c/o constipation. Which presentation is most concerning weight loss 58 yo male presents for a six week follow up after an acute anterior wall MI. He denies chest pain and SOB. ECG shows persistent ST segment elevation in the anterior leads. Echo reveals a sharply delineated area of scar that bulges paradoxically during systole. Most likely dx left ventricular aneurysm what is recommended to reduce the risk for perinatal transmission of HIV in a pt with a viral load of > 1000 copies/mL cesarean section prior to onset of labor and rupture of membranes 48 yo male with a recent episode of nephrolithiasis comes to the office to discuss prevention of further urinary stone disease. What recommendation can reduce recurrence of nephrolithiasis increased fluid intake

A 70 yo male is admitted to the ICU with fever, leukocytosis, and purulent sputum. Sputum culture shows methicillin-resistant gram positive cocci in clusters. What medication should be ordered for this pt vancomycin (vancocin) 75 yo female with history of CAD and dyslipidemia presents for routien follow up. Physical exam reveals loss of hair on the lower extremities bilaterally with thinning of the skin. Femoral pulses are +2/4 bilaterally, pedal pulses are diminished bilaterally. Ankle brachial index is reduced. what S&S are most likely to be present calf pain with walking 37 yo right handed male presents with daily HA for the past 2 months. They are wrose in the morning and awaken him from sleep. In the past week, he has noticed a tendency to drop things. Neuro exam reveals UE strength 4/5 on right and 5/5 on left. Most appropriate next step MRI What pt history is typical of RA insidious onset, morning stiffness, symmetrical joint swelling and tenderness Low molecular weight heparin dosage is based on which of the following weight 23 month old male presents to the office with his father who reports the pt has had an acute onset of severe pharyngitis, fever of 103.5, and what sounds like harsh, high pitched breath sounds. His dad states the child has started drooling and seems to be worsening. The child is not presently cyring but has muffled voice sounds. The child has not been immunized due to religious reasons. Next step

emergent transfer On PE of a pregnant pt, what can be considered a normal finding increased second heart sound split with inspiration MCC of ascites portal HTN 55 yo male with hx of HTN and DM presents to the ED. Pt's wife states tha tthe pt developed progressive irritability and confusion today after c/o a HA. PE reveals BP 230/130 and papilledema. Dx malignant HTN 19 yo man comes to the office because he has had a fever, frequent urination, urgency, dysuria, and scrotal pain for the past 2 days. On PE, he has a temperature of 101, scrotal swelling, and purulent urethral discharge is visible on penile exam. Gram stain on the discharge shows gram negative intracellular diplococci. Abx of choice ceftriaxone (rocephin) 74 yo male with a hx of CAD and A Fib presents to the clinic for follow up of his SOB. Pts meds include amiodarone, and metoprolol. His CXR reveals patchy ground glass infiltrates. Dx pulmonary fibrosis Pt demographic at highest risk for anorexia single, 20 yo, homosexual male. Also at high risk are high school wrestlers and ballet dancers. 58 yo female comes to the office because she noticed a white spot on her tongue. She has a 42 pack yr smoking hx. On exam she has an 8mm white thickened,

keratinized lesion on teh ventral tongue. The lesion cannot be removed by rubbing the mucosal surface. Study to confirm the suspected dx incisional biopsy 26 yo male was lifting a heavy object two weeks ago when he felt a sudden onset of low back pain. He describes pain in the low mid back at the belt line aggravated with movement. Radicular sxs are noted in the left buttock down the leg to the dorsal aspect of the foot. He denies any urine or bowel complaints. Most appropriate diagnostic study MRI Household contacts of a pt with bacterial meningiitis are best treated with which of the following ciprofloxacin 45 yo male nonsmoker presents with a 3m hx of difficulty swallowing. He describes the gradual onset of dysphagia for solids and liquids. He now c/o substantial discomfort after eating. Dx achalasia 18 month old with chronic HTN and history of CAD is assessed in the office for routine eval. His HTN is well controlled with metoprolol and HCTZ. ECG reveals U waves. Likely cause of the U waves hypokalemia When is the recommendation for the next Pap Smear in a 36 yo pt with a hx of 3 consecutive negative annual Pap smears and no hx of cervical dysplasia Pap in 3 years

What behavior would be most typical for a pt diagnosed with schizoid personality disorder chooses solitary activities 65 yo male with CAD, HTN, and DM is admitted with dyspnea and LE edema. CXR reveals small bilateral pleural effusions. Echo shows an ejection fraction of 30% with no valvular disease. The pt is treated in the hospital with furosemide and lisinopril. What education should be given to this pt upon discharge to help prevent readmission monitor daily weights 67 yo AA male presents for a new pt eval. Hx reveals aphasic CVA which limits his history. Funduscopic exam reveals an abnormal vessel light reflex described as a silver or copperwire appearance. Where the vessels intersect, there appears to be some nicking. He has no carotid bruits and his cardiac exam is normal. MCC of ocular findings HTN retinopathy 14 yo male presents to the ED experiencing a severe asthma attack. His respiratory effort is shallow and he is using accessory muscle to breathe. Auscultation of his chest reveals no audible wheezing. Vital signs include BP 90/60, P 160, RR 52. ABG is orderd. Normal ABG values at your institution are. pH 7.35-7.45, CO2 35-45, pO2 80-95. ABG finding that would suggest the poorest prognosis pH 7.27 pCO2 46 pO2 56 22 yo male presents to the ED c/o right hand pain after punching a brick wall. Pain on ulnar aspect of his hand worsens with touch and movement. On exam you note obvious swelling and tenderness over the dorusm of the right hand proximal to the MCP joint of the fifth digit. Skin is intact. Xray shows fracture of the proximal 5th metacarpal with good alignment. Tx of choice

ulnar gutter splint to immobilize the fx site 22 yo female presents with onset of right eye vision loss 24 hours ago which has partially improved. She has experiences various widespread paresthesias, regional weakness, and fatigue over the past 6 months. Episodes vary in location, severity and duration but invariably lead to recovery. her exam is completely normal but MRI reveals numerous areas of periventricular gadolinium uptake. For this condition, what tx shows the greatest benefit with long term use interferon beta 1a (avonex) 18 month old male presents with his parents who report symptoms of a barking cough and intermittent stridor that has worsened over the past 12 hours. They note improvement in symptoms when he was taken outdoors to the cool night air. Causative organisim Parainfluenza Virus AA is palced on hydroxoychloroquine (Plaquenil) for travel to Africa. Within 6 wks he presents c/o fatigue. CBC shows anemia. Study of choice G6PD assay 60 male nonsmoker with h/o CAD presents c/o worsening dyspnea on exertion for 3 wks. He admits to orthopnea and lower extremity edema, but denies chest pain, palpitatinos, and syncope. The pts last echo revealed an ejection fraction of 30%. What are you likely to find on PE third heart sound 25 yo female presents with S&S of depression. She doesn't have any other known medical problems. Dx study indicated as part of the initial eval Thyroid Stimulating Hormone (TSH)

44 yo hairdresser presents to the clinic with a 2 month h/o pain and numness of her left hand that awakens her from sleep. Your exam reveals electric tingling sensations with percussion over the volar surface of the wrist just proximal to the palmar crease and paresthesias noted within 15 seconds of passively flexing the wrist. Initial tx nocturnal splinting 34 yo man comes to the urgent care clinic with fever of 102, chills, pernieal pain for the past 2 days. In addition he has difficulty voiding, dysuria, frequency, urgency, and nocturia. Likely PE findings prostate tender, warm, and swollen Pt was treated for CAP with Augmentin. On day 7 of therapy he develops fulminate diarrhea. The diarrhea is described as greenish and fould smelling. He admits to associated abdominal cramps. Treatment of choice Metronidazole (Flagyl) 48 yo G3P3003 female presents to the office c/o severe secondary dysmenorrhea and menorrhagia over the last 6 months. On PE her uterus feels enlarged and irregular. Which of the following is the most likely dx uterine leiomyomata MC anatomical location of anterior bleeding from the nose Kiesselbach Plexus 9 yo boy comes to the office with his mother to discuss tx for chronic dry skin, and pruritic inflammatory lesions of the flexor surfaces of the neck, hands, and wrists. PMHx is significant for AR in the spring and fall. On PE the skin lesions are excoriated, and lichenified with crusted patches. What strategy can help minimize sxs in this pt

avoid rubbing or scratching 68 yo female with a 30 pack year smoking hx c/o new onset SOB. On PE, dullness is noted on percussion with diminished breath sounds over her left base. CXR shows a new left pleural effusion. Next step in treatment perform diagnostic thoracentesis 50 yo female has a h/o severe, stabbing pains, lasting only seconds, over the cheek and chin areas. She also experiences intense pain in these areas with chewing, washing her face, and even smiling. Exam reveals no sensory or motor deficits. Head CT and ESR are normal. She has been unresponsive to max doses of carbamazepine. Next best option stereotactic (Gamma Knife) Radiosurgery 41 yo male with h/o intravenous drug abuse presents to your office with acute, nontraumatic right knee pain, chills, and sweats starting 2 days ago. On PE his temp is 102.9. The right knee is erythematous, edematous, and tender to palptation and range of motion. Plain knee xray reveals soft tissue swelling. Most likely dx Septic Arthritis 78 yo male with hx of CAD s/p coronary artery bypass grafting, HTN, and dyslipidemia presents for routine PE. He feels well except for occasional brief episodes of substernal CP with exertion that are relieved with rest. He denies associated dyspnea, nausea, or diaphoresis. PE reveals a BP of 110/70, HR 56 and regular, RR 14 and unlabored. Lungs are CTA bilaterally, heart is bradycardic, but regular with no S3, S4, or murmur. ECG done in the office shows no acute ST- T waves changes. Tx sublingual nitroglycerin

Pt is evaluated for extreme fears of abandonment and an inability to care for himself throughout his adult life. He avoids disagreements and has difficulty initiating projects or acting on his own thoughts and ideas. Advice and reassurance are sought for even minor daily details. There are no reported suicidal tendencies or signs of self harm. Most likely personality d/o dependent 52 yo female is dx with CML. Which of the following would you expect to find on PE splenomegaly Screening for hypothyroidism is indicated for what pt newborn Construction worker presents with severe eye pain after splashing concrete in his eye. Exam is complicated by the pts difficulty opening his eye. Most appropriate therapy irrigation with saline 57 yo man is being evaluated for SOB. The following spirometric data are obtained. VC 105% of predicted. FRC 110% of predicted. RV 128% of predicted. FEV1 67% of predicted. Findings are consistent with what obstructive lung disease Pt has just delivered her baby vaginally without difficulty. The pt has a laceration of the vaginal mucosa including the perineal body. On the chart you document this as what type of tear second degree

36 yo male presents for f/u of his HTN. The pt is currently on 3 anti-HTN meds without improvement of his BP. On exam BP is 170/86 and HR is 60 and regular. Heart exam reveals a regular rate and rhythm without S3, S4, or murmur and his lungs are CTA bilaterally. Abd exam reveals a bruit over his left upper abdomen. Most likely underlying etiology for this pts HTN renal artery stenosis 56 yo white post menopausal female had a recent surveillance DEXA bone densitometry. T Score is - 2.7 for her right hip. In counseling this pt, in addition to medications, what would you recommend weight bearing exercise What term is given to an ocular exam finding where small, irregular pupils are seen that react with near vision but not to light Argyll-Robertson 63 yo man comes to the office to discuss tx for ED. He is interested in learning more about the medication sildenafil (viagra). He has hx of CAD, asthma and BPH. What med is contraindicated with viagra due to the potential drug interaction nitroglycerin 62 yo female presents to the ED with significant back pain without radiation after lifting a box weighing approximately 15 lbs. She denies any previous trauma or injuries. Past hx includes hysterectomy at age 42 and a 49 pack year smoking hx. Her current weight is 107 lbs. Lumba-sacral spine film indicates a spinal compression fx at teh level of L4. What tx should be performed to futher investigate the findings DEXA

31 yo female c/o diarrhea. She admits to associated weight loss and steatorrhea, but denies melena or hematochezia. Most likely dx celiac disease 9 yo pt presents with conjunctivitis after swimming at the local pool. On exam there is visible lid edema with redness of the palpebral conjunctiva, copious watery d/c, and scanty exudate. The sanitation system of the public pool is through the use of a salt water system, therefore, the possibility of chemically induced conjunctivitis is almost non existent. Tx sulfacetamide opthalmic 36 yo male who is hospitalized because of severe injuries from a MVA develops rapid onset of profound dyspnea. Initial CXR shows a normal heart size with diffuse bilateral infiltrates. F/U CXR shows confluent bilateral infiltrates that spare the costophrenic angles. Best clinical intervention tracheal intubation 16 yo male presents with c/o syncope after basketball practice today. PE revelas a systolic murmur along the left sternal border that increases with valsalva maneuver. An ECG reveals LVH. ECG shows asymmetric left ventricular hypertrophy with a hypercontractile left ventricle. Med of choice metoprolol (lopressor) 37 yo right handed landscaper comes to the office for eval of recurrent itching and stinging of the skin on his right hand. PE reveals confluent papules, vesicles, erosions, and crusts on the dorsum of his right hand. Initial dx study of choice Patch testing What phase of the female menstrual cycle occurs at the time of elevated estrogen and LH/FSH surge

ovulation 27 yo male nonsmoker is dx with upper extremity venous thrombosis. What is the most likely factor abnormality found in this pt Factor V 34 female construction worker presents with episodic blanching of her fingers when exposed to cold weather. The PE of her extremities and digits is normal at this time. Dx Raynaud Phenomenon 67 yo Asian male in the ED for acute onset right eye pain. He states he was at the evening premier of a newly released movie when the pain started. He had acute, profound visual loss in the affected eye. The pain was intense enough for him to leave the theatre before the movie's conclusion and present to your location. On exam the eye appears injected and the cornea appears hazy. His pupils are 6mm on the affected side and 3mm on the unaffected side. They respond to light on the unaffected side but not on the affected side. On palpation, the globe feels tense. What hx question is most relevant to support the dx Visualizing halos around street lights 80 yo female presents with syncope and recent fatigue and lightheadedness over the past month. She denies CP or dyspnea. PE reveals BP 130/70, HR 40 and regular, RR 16. ECG reveals two P waves before each QRS. Treatment of choice permanent dual chamber pacemaker insertion Pt describes hx of intermittent and uncontrollable twitching of his right hand that spreads to involve the entire arm after a few minutes. Afterward, the arm is extremely weak. There are no other areas of involvement, sensory deficit or altered consciousness. Most likely seizure dx

simple-partial 15 yo man comes to the office with acute onset nausea, severe pain, and swelling within the right testis. He has no fever of irritative voiding sxs. Expected PE finding high riding testis 56 yo DM male with a 3 month hx of epigastric pain after eating says he gets full really fast now. His test for H Pylori is negative. TOC metoclopramide (Reglan) Most appropriate management of acute psychosis in pt with schizophrenia Fluphenazine (Prolixin) Asx 60 yo female with a 30 pack year smoking hx presents to the clinic requesting a CXR for lung cancer. What do you recommend no testing and referral for smoking cessation Colpo exam of the cervix of a 38 yo woman with a high grade lesion on Pap smear yields a positive ECC as its only abnormality. Most appropriate next step perform a conization of the cervix Expected PE finding of a newborn dx with TOF palpable right ventricular lift What is the rationale for the utilization of beta blocker therapy in a pt with hyperthyroidism alleviate sxs What type of hip fx has the highest risk for AVN and nonunion

femoral neck You are counseling two newly diagnosed type 2 diabetics about the need for referral to ophthalmology for a dilated funduscopic exam. What is the rationale for this Retinopathy is present in 20% of pts with type 2 DM at time of diagnosis Pt is evaluated for an overblown sense of self-importance and sense of entitlement. He is described as being arrogant, envious, exploitative, and lacking in empathy. He is prone to mood swings and though he has a productive career in business he has few meaningful personal relationships. Most appropriate management Lithium (Lithobid) 54 yo man comes to the urgen care because he was awoken suddenly from his sleep this morning with severe left flank pain radiating to his left testicle with associated nausea and vomiting. He is afebrile and vital signs are normal. He is constantly moving to find a comfortable position. On PE, left flank tenderness is noted with no direct testicular tenderness. UA reveals pH of 5.5 and microscopic hematuria but is otherwise unremarkable. Dx nephrolithiasis 18 yo female presents to the office with fever, fatigue and sore throat. PE reveals an erythematous pharynx, cervical LAD, and splenomegaly. CBC reveals an increased WBC count with atypical lymphs, normal hemoglobin and hematocrit and normal platelet count. What additional lab test will help you heterophile test 67 yo male with history of mitral valve stenosis undergoes a mechanical valve replacement. Most appropriate duration of anticoagulation therapy if the pt has no other risk factors for thromboembolic events or significant bleeding risk

lifelong What nail finding is most consistent with cirrhotic liver disease Terry's nails 30 yo male presents with sudden onset chills, fever, chest pain, and a cough productive of greenish-brown sputum. On exam his temp is 102. He appears acutely ill and his respirations are shallow. CXR demonstrates left lower lobe consolidation. Most likely PE finding increased tactile fremitus 26 yo female reports progressive distal to proximal spread of extremity weakness over the last 36 hours without fever, HA, or syncope. Exam reveals symmetrical paresis of the hands and feet with loss of the brachioradialis and Achilles reflexes. Biceps and knee reflexes are present but diminished. Sensory exam is normal. Most likely CSF findings normal glucose, normal WBC count, elevated protein Which of the following PE findings is present in a 12 wk singleton pregnancy Chadwick's sign A blacksmith presents to your clinic after feeling like something went in his eye while he was grinding on a piece of metal. You stain the eye with fluorescein and can visualize uptake with what appears like a deep abrasion. You are unable to visualize any foreign body with your indirect ophthalmoscope. Although he makes an attempt, he c/o some visual loss in that eye. His last tetanus booster was 4 years ago. What is the most appropriate next step in the management of this pt refer to ophthalmologist What history is appropriate for a pt with spinal stenosis