Basic med q101 to 161 ex

101. A 62-year-old woman suddenly deteriorates 2 days after receiving TPA for an acute myocardial infarction.She complained of severe shortness of breath during the course of the afternoon and when the nurses examined her, her 02 saturation was only 91% on oxygen delivered via re-breather. On exami nation her BP is 105/70 mmHg, with a pulse of 105/min regular.She has an apical systolic murmur and marked left ventricular failure. Which of the following is the most likely cause?

102. A 52-year-old man is admitted to the intensive therapy unit with left ventricular failure postmyocardial infarction.Despite prompt activity including angioplasty within a few minutes of the onset of chest pain, his systolic BP on admission to the unit was only 80 mmHg, with a pulse of 105/mi n. Auscultation of the chest revealed crackles up to the mid zones on both sides consistent with cardiac failure.The team decide to insert an intra-aortic balloon pump timed to coincide with the dicrotic notch.What does the dicrotic notch refer to?

103. A 32-year-old female is seen in the emergency department for acute shortness of breath.A helical CT shows no evidence of pulmonary embolus, but incidental note is made of dilatation of the ascending aorta to 4.3 cm.All the following are associated with this finding except?

104. A 70-year-old woman presents to the emergency department with acute pulmonary edema with evidence of myocardial ischemia on ECG.Inspite of maximal medical management, she develops cardiogenic shock.A second ECG shows ST segment elevation of 3 mm in the precordial leads.She has no contraindications to thrombolytic therapy. Which of the following statements regarding thrombolytic therapy is true?

105. A 42-year-old white man presents to your office as a new patient.He has been in good health and has not seen a physician in many years.While attending a local health fair recently, the patient was told that he had high blood pressure, and he was advised to seek medical help.He seeks your advice about hypertension. His blood pressure is 145/95 m m Hg.Which of the following general statements about hypertension is false?

106. A 64-year-old black man presents to your office for routine follow-up care.You have treated him for many years for hypertension with a calcium channel blocker and a thiazide diuretic.His hypertension has been moderately well controlled with this regimen. He asks you whether having a home blood pressure monitor would be useful for his care.Which of the following statements regarding ambulatory blood pressure monitoring (ABPM) is true?

107. A 25-year-old black man presents to your office seeking to establish primary care.The patient has no complaints and denies any known medical history.His blood pressure is noted to be 185/115; otherwise, his physical examination is normal.After measuring the patient's blood pressure a total of four times during two office visits, you diagnose hypertension. Which of the following statements regarding the initial evaluation of hypertension in this patient is true?

108. A 40-year-old white woman whom you have been treating for resistant hypertension presents for routine follow-up.Laboratory results of screening tests were normal. There is electrocardiographic evidence of LVH. The patient's lipid profile is normal.The patient has been receiving a thiazide diuretic, a calcium channel blocker, and an ACE inhibitor at near maximal doses for several weeks.Her blood pressure today remains very elevated, at 175/100 m m Hg.She experienced a mi nimal response to titration of her antihypertensive medicines. With the exception of elevated blood pressure and a fourth heart sound, the patient's physical examinations have been consistently normal.Today, the physical examination is unchanged, except that you notice a soft bruit in the left upper quadrant. Which of the following statements regarding reno-vascular hypertension is true?

109. A previously healthy 47-year-old woman presents with a complaint of palpitations of sudden onset.Her symptoms have been present for 12 hours.Her evaluation includes an electrocardiogram, which reveals atrial fibrillation (AF) with a ventricular response of 135 beats/min.Her cardiac examination is unremarkable except for an irregularly irregular pulse. She has no other medical problems and takes no medications.A transthoracic echocardiogram (TTE) is normal. Which of the following is the most likely classification of this patient's AF according to guidelines from the American College of Cardiology (ACC), the American Heart Association (AHA), and the European Society of Cardiology (ESC)?

110. An 81-year-old man with a history of symptomatic permanent AF presents to your office to discuss options for reestablishing sinus rhythm. He hopes to decrease his symptoms of dyspnea. In addition to AF, the patient has congestive heart failure and echocardiographically documented significant mitral regurgitation.Which of the following is NOT a risk factor for cardioversion failure in this patient?

111. A 19-year-old man presents to the emergency department complaining of dyspnea and palpitations of acute onset.He has been short of breath for 2 hours now but denies having any chest pain.He has never had these symptoms before, and he denies having any cardiac disorders in the past.He is taking no medicines and has no significant family history of sudden cardiac death or arrhythmias. On examination, the patient is tachycardic but the heartbeat is regular. The patient's lungs are clear.His blood pressure is 110/72 mm Hg, and he is afebrile.ECG reveals a narrow complex tachycardia with a retrograde P wave noted in the ST segment.You diagnose the patient as having atrioventricular reentry tachycardia (AVRT). Which of the following statements regarding AVRT is true?

112. A 60-year-old man presents to his primary care physician for evaluation of dizziness and increased fatigue.An electrocardiogram is performed as part of his evaluation. The ECG demonstrates complete heart block, with a ventricular rate of 44 beats/min.The patient is referred for implantation of a pacemaker.Which of the following is NOT an indication for implantation of a cardiac pacemaker?

113. A 67-year-old female patient of yours is admitted to the hospital. She has a permanent pacemaker and sees a cardiologist.Inreviewing her chart, you note that her pacemaker program code is VVI, with a lower rate of 60 beats/min. Which of the following statements regarding this patient's pacemaker program code is false?

114. A 76-year-old man with a permanent pacemaker is admitted to the hospital with a diagnosis of pneumonia. The patient unfortunately develops respiratory failure and is intubated.A central venous line is placed for administration of antibiotics and pressors.He improves clinically but develops fever. Blood cultures are positive for Staphylococcus aureus.Appropriate antimicrobial therapy is instituted, and the central line is removed.The patient remains febrile with persistently positive cultures.Which of the following statements regarding pacemaker infection is true?

115. A 53-year-old black man presents to the emergency department with a complaint of chest pain of 2 hours' duration. The pain woke him from sleep.It is substern al and radiates to his left shoulder.The patient has vomited twice and is diaphoretic.He has no history of coronary artery disease but has hypertension and hypercholesterolemia. Which of the following statements regarding acute myocardial infarction (Ml) is false?

116. A 49-year-old white man who presented to the emergency department with an ST segment elevation MI was given thrombolytics, oxygen, and aspirin. He is now free of chest pain and will be admitted to the coronary care unit for further monitoring. Which of the foilowing statements regarding adjuvant medical therapy for acute MI is false?

117. A 69-year-old woman presents to the emergency department for evaluation of dyspnea and nausea.An ECG reveals ST segment depression of 1mm in leads II, ill, and aVF.The patient is given an aspirin, a beta blocker, and nitroglycerin sublingually, and the ST segment depression resolves.A diagnosis ofunstable angina is made. For this patient, which of the following statements regarding antiplatelet therapy with a thienopyridine is false?

118. A 62-year-old man with long-standing hypertension presents to your office for evaluation of a nonproductive cough. He has had the cough for 2 or 3 months, and it is getting progressively worse. He is without other complaint.The patient's blood pressure is 168/94 mm Hg; other vital signs are unremarkable.A chest x-ray reveals a widening of the mediastinum.Spiral CT reveals a thoracic aortic aneurysm with impingement upon the trachea. Which of the following statements regarding thoracic aortic aneurysms is true?

119. An 84-year-old man comes to your office complaining of a severe left temporal headache, which he has had for the past 2 days.In addition, the patient states that over the past 2 days, he has had a low-grade fever, fatigue, and loss of appetite.Upon questioning, the patient admits to muscle weakness and ja w pain with mastication but has no visual complaint.The physical examination is within normal limits, with the exception of a tender, palpable left temporal artery. Laboratory evaluation reveals a slight elevation in the white blood cell count and a marked elevation in the erythrocyte sedimentation rate.Which of the following statements regarding giant cell arteritis is true?

120. A 24-year-old man presents to the emergency department complaining of chest pain.He reports having substernal chest pain of 2 days' duration. The pain is worse with inspiration and is alleviated by maintaining an upright position. He also reports having had a fever recently.His medical history and physical examination are unremarkable.An ECG shows 2 mm elevation of the ST segment in precordial leads, without reciprocal changes and with concomitant PR segment depression. An echocardiogram is normal. What is the most likely diagnosis and the most appropriate treatment approach for this patient?

121. A 63-year-old woman with diet-controlled diabetes, hypertension, and a 45-pack-year history of cigarette smoking has intermittent left leg claudication and exercise-induced calf pain, which occurs when she walks three to four blocks.Her ankle brachial index is 0.7. The patient is most likely to experience which of the following adverse health outcomes in the next 5 years?

122. A 44-year-old man presents to your office complaining of right leg pain and swelling of 3 days' duration. The patient was well until he had a wreck while riding his dirt bike 1week ago. The patient states that he injured his right leg in this accident.Initially, his leg was moderately sore on weight bearing, but swelling and persistent pain have now developed. On physical examination, you note an extensive bruise on the patient's right calf and 2+ edema from the foot to the midthigh. You suspect trauma-associated deep vein thrombosis (DVT). Which of the following statements regarding DVT is true?

123. A 43-year-old man presents to the emergency department complaining of chest pain of 2 hours' duration. The patient denies having any dyspnea.He has no significant medical history, nor does he have a family history of early coronary artery disease.He is a nonsmoker and an avid jogger.His chest pain is constant, is pleuritic, and does not radiate.His chest x-ray is clear, and his ECG reveals only sinus tachycardia. Blood gas measurements reveal a partial pressure of oxygen (P02) of 58 mm Hg with a widened alveolar-arterial difference in oxygen (A-aD02). Helical CT reveals segmental and subsegmental filling defects in the right lung. Which of the following statements regarding anticoagulation and thrombolysis for thromboembolism is true?

124. A 72-year-old man presents to the hospital with a hip fracture.An orthopedist is planning surgical repair and asks you to see the patient in consultation for preoperative assessment and advice.In particula r, the orthopedist asks you to assess the patient's need for prophylaxis against venous thrombosis and to comment on the best prophylactic regimen for the patient. Which of the following statements regarding primary prophylaxis against venous thrombosis and thromboembolism is true?

125. An 80-year-old patient of yours is scheduled to undergo total knee replacement.He is in excellent health, and except for osteoarthritis, his medical history is not significant.The orthopedic surgeon asks you for advice regarding VTE prophylaxis.What would you advise for this patient?

126. A 24-year-old man comes to your office with complaints of a diffuse, mildly pruritic rash that developed over the past 1to 2 weeks.Examina tion reveals a papular eruption involving the trunk and extremities.You suspect pityriasis rosea.Which of the following statements regarding the clinical features of pityriasis rosea is false?

127. A 59-year-old man with long-standing psoriasis has had a recent worsenin g of his disease. About 2 weeks ago, several new psoriatic lesions developed; this was followed by diffuse skin involvement with erythema and subsequent scaling.The patient complains of skin tightness, pruritus, fever, and malaise of 2 days' duration. You suspect an exfoliative erythroderma reaction. Which of the followin g statements regarding this patient' s condition is true?

128. A 26-year-old woman presents to your pri mary care clinic for the evaluation of a rash.The patient has no significant medical history and is not taking any medications.The family history is unrevealing. Physical examination reveals sharply demarcated, erythematous scaling plaques at both elbows and knees. Examination of the fingernails reveals groups of tiny pits.A presumptive diagnosis of psoriasis is made.Which of the following statements regarding the epidemiology of psoriasis is accurate?

129. An 18-year-old woman presents for treatment of chronic dry skin and scaling. The rash typically involves the extensor surfaces of her extremiti es.She notes that she has had this condition since infancy and that her father has it as well.Her medical records indicate that she has been diagnosed with ichthyosis vulgaris by a dermatologist. Which of the following statements is false?

130. A 45-year-old woman with a history of malaise, weight loss, and recurrent upper respiratory infections of several months' duration was picnicking with friends.Within a few minutes, most of the picnickers realized that they were developing a pruritic, erythematous skin reaction on skin exposed to the lush ground cover around them.One person belatedly recognized the plant as poison ivy. The patient, however, did not develop a reaction. What is the most likely reason for this patient's failure to develop a reaction?

131. A 43-year-old woman with a long history of chronic actinic dermatitis was experiencing frequent upper respiratory infections, weight loss, and malaise.She was pleased that her chronic actinic dermatitis was improving to the point of being nearly resolved but was concerned about her recurrent infections and weight loss.She presented to a physician, who diagnosed HIV in her blood; the patient had a high viral load count and a very low helper T cell count. The physician started her on didanosine (DDI), zidovudine (AZT), and indinavir.A week later, the patient felt better, but there was evidence of her rash recurring in its previous pattern of distribution.What is the probable reason for the recurrence of this patient's dermatitis?

132. A 35-year-old woman with HIV was recently started on trimethoprim-sulf amethoxazole for Pneumocystis carinii prophylaxis.She now presents with fever, sore throat, malaise, and a desquamating rash on her trunk.Laboratory studies are notable for the following abnormalities: serum creatinine, 2.1mg/di; aspartate transaminase (AST), 215 mg/di; and alanine transami nase (ALT), 222 mg/di. Which of the following statements regarding the care of this patient is true?

133. A 64-year-old retired Navy officer presents to clinic for a routine health maintenance visit. He has no complaints, but when asked about a pinkish papular lesion near the corner of his left eye, he states that it has been present ''for years'' and that it has become irritated on occasion with minor trauma or rubbing.The lesion is 4 to 5 mm in diameter and appears pearly. You recommend that the patient undergo biopsy because you are concerned about the possibility of basal cell carcinoma (BCC). Which of the following epidemiologic and clinical statements is NOT true of BCC?

134. A 50-year-old construction worker with hypertension presents for a return office visit.His blood pressure appears well controlled, and you are discussing other health maintenance issues as you exam I ne him. You notice several rough-surfaced, irregularly shaped lesions on his face, scalp, and dorsa of the hands. On closer inspection, they appear hyperkeratotic and have a small rim of surrounding erythema.He says they are not painful, do not itch, and have been appearing over the course of years.Which of the following statements regarding this patient's risk of skin cancer is true?

135. A 35-year-old white man presents at a walk-in clinic with a complaint of lesions in his mouth and over his trunk.These lesions developed over the past several months.His medical history is unremarkable.He states that he is homosexual, that he has practiced unsafe sex in the past, and that he has had the same partner for the past 18 months.He denies having previously had any sexually transmitted diseases, but he says he has not had regular health care visits since high school.On examination, you note numerous purple-red, oval papules distributed on the trunk and two deep-purple plaques on the soft palate and buccal mucosa. The patient also has several small, firm, nontender, palpable lymph nodes in the posterior cervical, axillary, and inguinal chains.Results of routine blood work are unremarkable except for a white blood cell count of 3,000 cells/mm3 and a differential with 5% lymphocytes.Which of the foilowing statements regarding our current knowledge of Kaposi sarcoma (KS) is false?

136. A middle-aged woman comes to clinic complaining of a long-standing rash involving her chest and left thigh, which she first noted over a year ago.She says the areas are chronically red and scaly and are occasionally mildly pruritic.She has not been able to identify any precipitating factors or irritants that have come into contact with those particular areas. She states that exposure to the sun has intermittently made the lesions improve to an extent. Approximately 6 months ago, she was prescribed a topical steroid cream, which did seem to cause improvement of the rash, but the rash soon returned after discontinuation. She thought that the rash likely represented psoriasis, and she had not been overly concerned about it until recently, when she has noticed that the lesions had become larger and more prom inent. On examination, you note a large erythematous, scaly patch on the trunk. The lesion on the upper thigh is a thicker plaque that is deeper red in color.Skin biopsy reveals atypical lymphoid cells in the epider1nis that have hyperconvoluted (cerebriform) nuclei.There is also a bandlike lymphocytic infiltrate in the upper dermis.A diagnosis of mycosis fungoides is made on the basis of the histologic report.Which of the following clinical and therapeutic statements is NOT characteristic of this disorder?

137. A woman brings her 13-year-old son to your clinic for evaluation of multiple lumps and bumps.She states that her husband had similar problems and died of a nervous system disease. She does not remember the name of her husband 's disease, but notes that his tumors were at times large and painful and that on numerous occasions he had to have some surgically removed. The patient has just experienced his ''growth spurt'' and is havin g some troubles with acne.He denies having any pain but admits that other children make fun of him at school.On examination, you note multiple large, skin-colored, pedunculated tumors.He also has evidence of acne, and there is a tan, oval macule measuring 3 cm on his chest.You believe he may have neurofibromatosis-1(NF-1, also known as von Recklinghausen disease). Which of the following statements about neurofibromatosis is false?

138. A 17-year-old African-American adolescent presents with swelling of her earlobes; she had them pierced a few months ago.She can no longer put her earrings on and is distraught about her appearance.She notes that the involved areas itch and burn. Examination is remarkable for hyperpigmented, shiny, smooth tumors measuring 1to 2 cm that are located around the areas of her ear piercing. There are small, crablike extensions from the lesions.There is no evidence of erythema or purulence.You believe the patient has developed keloids at the sites of her ear piercing. Which of the following statements about keloids is false?

139. A 32-year-old woman presents to your office complaining of hair loss.The hair loss is occurring all over her head and seems to spare no area.She notes that it worsens when she showers, and she has begun showering every other day in an attempt to decrease the hair loss. She has been healthy all her life, and other than an uneventful pregnancy and vaginal delivery 3 months ago, she has no medical history. This patient 's clinical presentation and history are most consistent with which of the following hair disorders?

140. A 76-year-old man is being evaluated for osteoporosis.He had a hip fracture 4 weeks ago.A dual-energy absorptiometry scan showed a decrease in bone mineral density consistent with osteoporosis.The serum concentration of total testosterone is in the low-normal range.Which of the following is the most accurate description of the physiologic changes in testosterone seen with senescence?

141. A woman was admitted this morning in the medical intensive care unit for elective cholecystectomy. Before surgery, her physical examination, including vital signs, was normal. The procedure went well, and there were no noticeable complications.However, 3 hours after returning to her room, she was noted to be unresponsive and her blood pressure was barely palpable.She was intubated for respiratory failure.Her blood pressure has been refractory to intravenous fluids and pressors. You are consulted to help in the workup of suspected adrenal insufficiency. Which of the following statements regarding adrenal insufficiency is true?

142. A 32-year-old man presents to your clinic for evaluation of headaches.He has had episodic pounding headaches for 6 months.He never had headaches like this before inhis life.He denies using illicit drugs.He has no family history of hypertension.On physical examination, the patient is hypertensive, with a blood pressure of 180/105 mm Hg. No further abnormalities are noted. You begin a workup for secondary causes of hypertension.Which of the following statements regarding pheochromocytomas is true?

143. A 32-year-old man presents to your clinic as a new patient to establish primary care.He has a 2-year history of hypertension, which is managed with a calcium channel blocker.He has no knowledge of the cause of his hypertension. He is currently without complaints and only wants a refill on his medication. His physical examination is unremarkable, but laboratory results show hypokalemia. Which of the following statements regarding hyperaldosteronism is true?

144. A 37-year-old man presents to the local emergency department with a swollen and tender right calf.The patient has had these symptoms for 4 days.He denies having undergone any trauma.He has no history of cancer, and he has had no similar episodes in the past.He denies having a family history of venous thrombosis.Ultrasound confirms deep vein thrombosis, and the patient is provided with appropriate anticoagulation.Several days later, the patient sees you for a follow-up visit.The laboratory studies made in the emergency department included a factor V Leiden mutation analysis.Which of the following statements is true regarding this patient's test for factor V Leiden mutation?

145. A 21-year-old man comes to your office to establish primary care.He states that he has been generally healthy but that he has multiple colon polyps.He states that he tested positive for familial adenomatous polyposis (FAP).He says that his former physician told him that this illness can run in families, and he asks your opinion on whether or not his family needs further testing. Which of the following statements regarding FAP and the APC gene mutation is true?

146. A 24-year-old man with a history of increasing muscle cramps, myalgias, and calf muscle hypertrophy was recently diagnosed with Becker muscular dystrophy (BMD) through muscle biopsy.The lab report of the patient's leukocyte DNA analysis, however, states, ''no mutation known to be associated with BMD found.'' On further questioning, you discover that the patient has a reportedly healthy 2-year-old daughter; a 16-year-old maternal cousin who recently began suffering from muscle cramps similar to those of the patient; a sister in her teens who is reportedly healthy; a mother with a ''big heart''; and a maternal grandfather who died of an unspecified heart problem 20 years ago.You suggest further genetic linkage analysis and counseling for this patient and his extended family. Which of the following facts would serve as the basis of your recommendation?

147. A 12-month-old baby is brought in for a well-baby visit, during which the baby is noted to have leukokoria (a white pupillary reflex). On further evaluation, it is determined that the child has an ablatable, unifocal retinoblastoma, with an RBl cancer-predisposing mutation in a tumor and no evidence of a germline RBl in white cell DNA. The parents are concerned about the risk of retinoblastoma if they have other children. Regarding these parents' concern, which of the following statements is true?

148. A 25-year-old Ashkenazi Jewish woman is concerned about her risk of breast cancer.Her 60-year-old mother was recently diagnosed with stage II breast cancer and underwent bilateral mastectomy. Her grandmother was killed in World War II, so she does not know whether her grandmother had breast cancer.She read in a newspaper article that the prevalence of BRCAl and BRCA2 genes is increased in Ashkenazi Jewish women and that, as a result, this population is at increased risk for breast cancer.Now she would like to be tested for these genes because she is concerned about her risk status and wonders whether she needs a prophylactic mastectomy. Of the following statements, which would be appropriate to tell this patient?

149. A 57-year-old white man presents with a 2-week history of gnawing epigastric pain that seems to be relieved with food and antacid. His medical history is significant for hypertension. His medications include hydrochlorothiazide and 81mg enteric-coated aspirin. He does not smoke.Which of the following statements regarding ulcerogenesis is true?

150. Two months ago, a 53-year-old white man was diagnosed by esophagogastroduodenoscopy (EGD) as having an uncomplicated duodenal ulcer.At that time, the patient tested positive on rapid urease testing and was appropriately treated with a clarithromycin-based regimen for H. pylori.He now returns with recurrent epigastric pain.He has no other medical conditions.He has been maintained on a proton pump inhibitor.He denies using NSAIDs.His vital signs and physical examination are unremarkable.His complete blood count, serum electrolyte levels, and serum calcium level are all within normal limits.He is referred for an upper GI series and is found to have a recurrent duodenal ulcer.The patient's fasting gastrin level is 500 pg/ ml (normal value, < 100 pg/ml). For this patient, which of the following statements is true?

151. A 43-year-old woman presents to establish primary care.Her medical history is significant for an uncomplicated duodenal ulcer, which she experienced 18 months ago.At the time of diagnosis, she was treated with a clarithromycin-based regimen for H.pylori.She has since been asymptomatic.For this patient, which of the following statements is true?

152. Two 28-year-old men with inflammatory colonic disease are seen in clinic; one has ulcerative colitis and the other has Crohn disease.Each is concerned about complications of his disease. Which of the following is a correct assessment of these two patients?

153. A 36-year-old man presents to your clinic complaining of fatigue.His fatigue started 3 or 4 months ago.His medical history is unremarkable.Review of systems is positive for occasional diarrhea, which the patient has been experiencing for several months, and for a 20-Ib weight loss.Physical examination shows pallor. Occult blood is found on rectal examination.The rest of the examination is normal.Laboratory tests reveal iron deficiency anemia, and the patient tests positive on a qualitative fecal fat test.Results of an upper endoscopy and a colonoscopy are normal. Which of the following tests would be most likely to provide helpful information in the workup of this patient?

154. A 44-year-old woman with a history of GSE is evaluated for refractory disease.She was diagnosed with GSE 8 years ago.Her disease was initially well controlled with a gluten-free diet. Over the past few months, she has had persistent diarrhea and malabsorption that has not responded to her usual diet.Findings on physical examination are consistent with chronic malnutrition.An abdominal CT scan shows no masses or anatomic abnormalities that would account for her symptoms.An endoscopy is obtained, and small bowel biopsy shows villous atrophy and a layer of collagen underneath the enterocytes.Which of the following is the most likely explanation for this patient's symptoms?

155. A 52-year-old man presents for follow-up after undergoing colonoscopy because he has a history of colon cancer.He was reassured to learn that no polyps or tumors were seen but was told that he has diverticulosis.He asks what the chances are that this will cause future difficulties.What is the likelihood that a patient with asymptomatic diverticulosis will go on to develop diverticulitis?

156. A 74-year-old man is transported to the emergency department by ambulance for evaluation of cough, dyspnea, and altered mental status.Upon arrival, the patient is noted to be minimally responsive.Results of physical examination are as follows: temperature, 102.1° F (38.9° C); heart rate, 116 beats/min; blood pressure, 94/62 mm Hg; respiratory rate, 34 breaths/min ; and 02 saturation, 72o/o on lOOo/o 02 with a nonrebreather mask. The patient is intubated in the emergency department, and mechanical ventilation is initiated. Coarse rhonchi are noted bilaterally. A portable chest x-ray reveals good placement of the endotracheal tube and lobar consolidation of the right lower lobe.Laboratory data are obtained, including sputum Gram stain and culture and blood cultures.Empirical antimicrobial therapy is initiated, and the patient is admitted to the medical intensive care unit for further management.The intern on call inquires about the appropriateness of initiating nutritional support (enteral or parenteral feeds) at this time.Which of the following statements regarding nutritional support is true?

157. A 32-year-old man with AIDS who is experiencing chronic diarrhea, anorexia, and wasting is referred for evaluation for nutritional support.Results of physical examination are as follows: temperatu re, 97.6° F (36.4° C); heart rate, 67 beats/min; blood pressure, 102/62 mm Hg; respiratory rate, 12 breaths/min; height, 70 in; and weight, 50 kg.The patient appears chronically ill; there is bitemporal wasting, and his hair is easily pluckable.The patient says he has friends with AIDS who are receiving ''I.V. nutrition,'' and he would like to know if such therapy would benefit him.Which of the foilowing statements regarding home total parenteral nutrition (TPN) is true?

158. A patient with known chronic hepatitis C and cirrhosis comes to your office wondering about liver transplantation.He read on the Internet that the waiting time for liver transplantation is long and that one should be in cluded ''early'' to improve the chances of getting a timely transplantation. The patient stopped smoking over 20 years ago and does not drink alcohol.He is otherwise in good health. Which of the following is NOT a contraindication for orthotopic liver transplantation?

159. A 40-year-old man with cirrhosis secondary to hepatitis B is being evaluated for orthotopic liver transplantation. He asks you what he should expect after his operation.Which of the following statements is true regarding this patient?

160. A 37-year-old woman with a history of cryptogenic cirrhosis who underwen t orthotopic liver transplanation 1year ago asks you to assume her posttransplantation care.Which of the following is true regarding this patient?

161. A 28-year-old patient with type 1diabetes mellitus of 5 years' du ration asks your opinion regarding pancreas transplantation.He is concerned that in spite of his best efforts, it is very likely that he will develop both microvascular and macrovascular complications.Which of the following statements about pancreas transplantation is false?