поиграем?

[FOLEY]

Донат и другие кто хочет...давайте играть!

1. A 45-year-old African-American man comes to the
office for the first time because he says, "I had blood in
my urine when I went to the bathroom this morning." He
reports no other symptoms. On physical examination his
kidneys are palpable bilaterally and he has mild
hypertension. Specific additional history should be
obtained regarding which of the following?


A. Chronic use of analgesics
B. Cigarette smoking
C. A family history of renal disease
D. Occupational exposure to carbon tetrachloride

E. Recent sore throats

[FOLEY]

2. A 24-year-old man comes to the office because of
intermittent chest pain that began a few weeks ago. You
have been his physician for the past 2 years and he has
been in otherwise good health. He says he is not having
pain currently. A review of his medical record shows
that his serum cholesterol concentration was normal at a
pre-employment physical examination 1 year ago. You
have not seen him since that visit and he says he has had
no other complaints or problems in the interim. He
reminds you that he smokes 1 pack of cigarettes per day.
When you question him further, he says that he does not
use any alcohol or illicit drugs. Although the details are
vague, he describes the chest pain as a substernal

tightness that is definitely not related to exertion.
Which of the following findings on physical

examination would be most consistent with
costochondritis as the cause of his chest pain?



A. Crepitance over the second and third ribs
anteriorly
B. Deep tenderness to hand pressure on the sternum
C. Localized point tenderness in the parasternal area
D. Pain on deep inspiration

E. Normal physical examination

3. In light of the patient’s original denial of drug use,
which of the following is the most appropriate next
step to confirm a diagnosis of cocaine use?



A. Ask the laboratory if serum is available for
toxicologic screening on a previous blood sample
B. Call his family to obtain corroborative history
C. Obtain a plasma catecholamine concentration
D. Obtain a urine sample for routine analysis but
also request toxicologic screening
E. Present your findings to the patient and confront

him with the suspected diagnosis

[Akela]

Донат и другие кто хочет...давайте играть!

A 45-year-old African-American man comes to the
office for the first time because he says, "I had blood in
my urine when I went to the bathroom this morning." He
reports no other symptoms. On physical examination his
kidneys are palpable bilaterally and he has mild
hypertension. Specific additional history should be
obtained regarding which of the following?


A. Chronic use of analgesics
B. Cigarette smoking
C. A family history of renal disease
D. Occupational exposure to carbon tetrachloride

E. Recent sore throats

D...

[FOLEY]

4. Cocaine use is confirmed. The patient admits a possible
temporal relationship between his cocaine use and his
chest pain and expresses concern about long-term health

risks.

The patient should be counseled regarding which of
the following?


A. Cocaine-induced myocardial ischemia can be
treated with blocking agents
B. Death can occur from cocaine-induced
myocardial infarction or arrhythmia
C. The presence of neuropsychiatric sequelae from
drug use indicates those at risk for sudden death
associated with cocaine use
D. Q wave myocardial infarction occurs only with
smoked "crack" or intravenous cocaine use
E. Underlying coronary artery disease is the
principal risk for sudden death associated with

cocaine use

[FOLEY]

D...

sorry. incorrect. (although Carbon Tetrachloride CAN cause kidney damage, this is not the BEST choice)

[elfy]

sorry. incorrect. (although Carbon Tetrachloride CAN cause kidney damage, this is not the BEST choice)

я знаю, я знаю :znaika: :lad:
C

[FOLEY]

когда кто-то угадает правильно с первого раза, получает плюс. только я рассчитываю на честность ваши и что вы не станете спрашивать у знакомых.

(врачи: отвечайте мне в личке...чтоб не выдавать ответ)

[FOLEY]

я знаю, я знаю :znaika: :lad:
C

Correct!

(can you explain your reasoning?)

[elfy]

Correct!

(can you explain your reasoning?)

just by means of elimination

[FOLEY]

just by means of elimination

actually, all of the choices in question 1 CAN give you the symptoms of blood in the urine...so you are one hell of an eliminator! good job!!!

(in that particular question they are trying to get you to pick up on the fact that the kidneys can be felt (palpable), which means they are larger than normal and probably the result of APKD - adult polycystic kidney disease. Of course in cancer the kidney could also be larger, but not on both sides!!!)