Medicament ECN+Prof.+USMLE of BASIC (HKS)

Vous recevez en consultation sevrage tabagique devant un patient de 51 ans qui fume 10 paquet-année depuis 5 ans. Il a une bronchite chronique sans trouble ventilatoire obstructif sur explorations fonctionnelles respiratoire. Il s’inquiète les effets néfastes du tabac surtout substance radioactif. Quel est le substance de la fumée de tabac contient le substance radioactif ?

Vous recevez en consultation sevrage tabagique devant une patiente de 27 ans qui fume 5 paquet-année depuis 5 ans. Elle est enceinte 17 semaine-aménorrhée. Elle s’inquiète les effets néfastes au foetus. Quel est le substance de la fumée de tabac provoque une hypotrophie du nouveau-né le plus probable?

Vous recevez en consultation sevrage tabagique devant un patient de 61 ans qui fume 30 paquet-année depuis 25 ans. Il a une bronchopathie chronique obstructive (BPCO) avec trouble ventilatoire obstructif sur explorations fonctionnelles respiratoire. Il veut s’arrêter du tabac. Quel est le substance de la fumée de tabac responsable de BPCO plus probable ?

A 1-year-old child with ALL in remission for 3 months is in the office for a health maintenance visit. He is due for multiple vaccinations including hepatitis B vaccine, inactivated polio vaccine (IPV), varicella vaccine H. influenzae B vaccine (Hib), and pneumococcal vaccine (PCV). You remember that some of these vaccines are live attenuated viruses and are contraindicated in immunocompromised patients. Which vaccine will you not give to this patient?

A 12-year-old girl comes to the physician for an annual examination. She has been in good health for the past year and has no complaints. She began having menses this year and, after a few irregular cycles, is now having a monthly period. Past medical history is significant for multiple episodes of otitis media as a child. Past surgical history is unremarkable. She takes no medications and has no known drug allergies. Physical examination is unremarkable. If not currently immune, which of the following immunizations should this patient most likely receive?

A 12-year-old girl comes to the physician for chronic weight loss and fatigue. She has a history of bulky, floating, foul-smelling stools, flatulence and meteorism. She also has bone pain and easy bruising. Laboratory studies show anemia with serum iron: 25 mg/dl , ferritin: 25 mg/dl and serum total iron binding capacity 600 mg/dl (normal 300-360 mg/dL); PT is 16 sec. Physical examination shows loss of subcutaneous fat, pallor, hyperkeratosis and abdominal distention; bowel sounds are increased. Which of the following is most likely associated with this patient's condition?

A 16-year-old boy who is the backup quarterback for the local high school team is in your office complaining of worsening acne. For the last few months he has noted more acne and more oily hair. On his examination, you note gynecomastia and small testicular volume. He is SMR 5. Which of the following drugs of abuse is the likely explanation for all of his findings?

A 16-year-old female complains of headaches and visual impairment for the past month. She says that the headaches are worst in the morning and are associated with nausea. Her medical history is also significant for severe acne for which she takes oral isotretinoin. On physical examination, her temperature is 36.7°C (98°F), blood pressure is 130/80 mm Hg, pulse is 70/min, and respirations are 15/min. She has papilledema and decreased visual acuity. There is no neck stiffness. Motor examination shows 5/5 power, 2+ deep tendon reflexes, and a normal plantar response. Sensory examination is unremarkable. CT scan of the head is within normal limits. Lumbar puncture reveals the following: Opening pressure 250 cm H20, CSF glucose 40 mg/dL, CSF protein 40 mg/dL, WBC 3/mm3. Which of the following is the most likely cause of her symptoms?

A 17 -year-old boy is brought to the emergency department by his father after the boy began threatening him at home. Over the last several months, the father reports, the boy has been increasingly abusive. He was recently involved in a fist fight at school. The boy states that there is nothing wrong. He is otherwise healthy. He denies alcohol use, but does admit to occasional marijuana use. On examination he has acne on his forehead and back and his hairline is receding. There is palpable tissue underneath his nipples bilaterally Heart and lung exams are normal. What substance is this boy most likely abusing?

A 17-year-old male presents to clinic for routine check-up. He is a long distance runner and has beenachieving outstanding results recently. He is very proud of his athletic achievements, remarking that his effort "pays off." He does not smoke or consume alcohol. His family history is significant for diabetes mellitus in his mother and skin cancer in his father. Chest examination is normal. His liver span is 8 cm and his spleen is not palpable. His current laboratory findings include: Hematocrit 59%, WBC count 7,500/mm3, Platelet count 170,000/mm3, ESR 15 mm/hr. Which of the following is the most likely explanation for the high hematocrit in this patient?

A 19-year-old football linebacker is admitted following a motor vehicle accident. He had an extensive cerebral bleed, which led to a deep coma. He also has fractures of the C4 vertebra, pelvis, and right femur. Following admission, he is intubated and central lines are placed. During the next few days, he develops acute renal failure due to rhabdomyolysis. While he is recovering from acute renal failure, he is found to have a serum calcium level of 12.1 mg/dL. Other investigations are: Serum albumin 3.0 g/dL, Serum creatinine 2.8 mg/dL, Serum phosphorus 3.8 mg/dL, Blood glucose 108 mg/dL, PTH 9 pg/mL, PTHrP undetectable, 1, 25-dihyroxy vitamin D 19 pg/mL (normal 20-60 kg/mL). What is the most likely cause of this patient's hypercalcemia?

A 20-month-old male is brought to ER with high fever, confusion and a skin rash suggestive of measles. He has a history of recurrent respiratory infections over the last 6 months. The patient's family has recently emigrated from a rural Russian province. Which of the following forms of vitamin supplementation should be considered in this patient?

A 23-year-old woman is brought to the emergency room from a halfway house, where she apparently swallowed a handful of pills. The patient complains of shortness of breath and tinnitus, but refuses to identify the pills she ingested. Pertinent laboratory values are as follows:Arterial blood gases: pH 7.45, PCO2 12 mm Hg, PO2 126 mm Hg.Serum electrolytes (mEq/L): Na+ 138, K+ 4.8, Cl− 102, HCO3− 8.An overdose of which of the following drugs would be most likely to cause the acid–base disturbance in this patient?

A 24-year-old female is brought to the emergency room because of dizziness and near syncope. She says that every time she stands up, she feels lightheaded. She has no significant past medical problems. She does note having broken up with her boyfriend three months ago, which has caused her to have decreased appetite and an associated ten-pound weight loss. She has also missed her last two menstrual periods. She denies using tobacco, alcohol or drugs. On physical examination, her temperature is 36.7°C (98°F). When lying supine, her blood pressure is 100/70 mm Hg and her pulse is 88/min. When she stands up, her blood pressure is 80/50 mm Hg and her pulse is 120/min. Other than dry skin and mucous membranes, her physical examination is unremarkable. Initial laboratory studies reveal: Serum sodium low, Serum potassium low, Urine sodium increased, Urine potassium increased. This patient's dizziness is most likely due to which of the following?

A 28-year-old avid mountain climber and his friend are vacationing in Andes, South America. During their mountain climbing expedition, the pair somehow manages to get lost. It has been over 16 hours since their food supply ran out. Their glycogen stores are becoming depleted, and their bodies are beginning to utilize the process of gluconeogenesis. Which of the following intermediates is alanine being converted into during this process?

A 28-year-old woman with no past medical history presents for her initial prenatal visit. Her last menstrual period (LMP) was 6 weeks ago. Vital sign: BP, 125/78 mmi P, 73 beats/mini R, 13 breaths/min, T: 98°F (37 C). She denies leakage of fluid, denies vaginal bleeding, denies fetal movement, denies contractions, nausea and vomiting present. Labs: Complete blood count (CBC): white blood cells (WBCs), 8 x l03/ [1L hemoglobin(Hgb), 11.0 g/dL hematocrit (Hct), 33.5%; platelets, 167 x103/microL. CMP: Sodium, 128 mmol/ L; potassium, 4.5 mmol/L; chloride, 100 mmol/L; bicarbonate, 22 mmol/ L; blood urea nitrogen (BUN), 0.9 mg/dL; creatinine, 1 mg/dL; glucose, 97 mg/dL. Rubella IgG: positive. HIV: positive. CD4 count: 750. Viral load: 20,000 copies/mL. Hepatitis B sAg: Negative. HgbAlc: 5.6%. What drug is contraindicated in pregnancy?

A 45-year-old female presents complaining of constipation and abdominal pain for the past two weeks. She also complains of urinary frequency and constant thirst. Her past medical history is significant for obesity. She tells you that she has been trying very hard to lose weight, and over the past six months has even attempted various fad diets. She assures you that she supplements her intake with numerous over-the-counter vitamins and minerals. She has managed to lose 20 lbs during this time. Her medical history is also significant for atrial fibrillation for the past 4 years, for which she takes diltiazem. On physical examination, her temperature is 36.8°C (98.2°F), blood pressure is 120/70 mmHg, pulse is 90/min, and respirations are 13/min. Her mucous membranes are dry, and her abdomen is soft and non-tender without rebound or rigidity. Bowel sounds are present. Urinalysis is within normal limits. Which of the following is most likely responsible for her current symptoms?

A 50-year-old white male comes into your office for a routine check-up. He has no present complaints. His past medical history is significant for hypertension controlled with a low-dose thiazide diuretic. His family history reveals non-fatal myocardial infarction in his father at the age of 47. The patient does not smoke or consume alcohol. His blood pressure is 130/75 mmHg and his heart rate is 70/min. His previous records show that his HDL level is persistently low in spite of acceptable total cholesterol and LDL levels. You prescribe niacin to raise HDL level. The patient returns in a week complaining of intensive generalized pruritis and flushing. What is the most probable cause of the patient's complaint?

A 50-year-old woman presents to your office complaining of lower extremity edema that stated several weeks ago, and slowly progressed thereafter. Her past medical history is significant for hypertension, treated with metoprolol for 2 years. Amlodipine was added recently because of inadequate control of BP with metoprolol alone. She does not smoke or consume alcohol. She has no known drug allergies. Her blood pressure is 130/80mmHg and her heart rate is 64/min. The physical examination reveals bilateral symmetric 3+ pitting edema of both lower extremities, without any skin changes or varicosities. Her neck vein pulsation is normal. Other physical findings are within normal limits. Her laboratory studies reveal the following: Serum albumin 4.5 g/dL, Total serum bilirubin 0.8 mg/dL, Serum sodium 140 mEq/L, Serum potassium 4.0 mEq/L, Serum creatinine 0.8 mg/dL. Urinalysis is within normal limite. What is the most likely cause of the edema in this patient?

A 52-year-old woman presents with hypertension, obesity, and new skin striae. You are concerned about possible Cushing syndrome. Which of the following is the most common cause of Cushing syndrome?

A 58-year-old man presents with a one-year history of diarrhea. The stools are watery and accompanied by abdominal cramps. He denies any fever, blood per rectum, or foul-smelling stools. He has also experienced frequent episodes of dizziness, flushing, wheezing, and a feeling of warmth. He has taken herbal medicines, which failed to relieve his symptoms. He is depressed about his illness, and feels hopeless about diagnosis and treatment. He appears ill. Auscultation of the chest shows a 2/6 systolic murmur over the left lower sternal border. Abdominal examination shows hepatomegaly 3cm below the right costal margin, mild shifting dullness, and no abdominal tenderness. Laboratory studies show: Hb 13.0gm/dl, MCV 90fl, WBC 6,100/cmm, Platelets 210,000/cmm, AST101 U/L, ALT 99 U/L, Alkaline phosphatase 400 mg/dl. This patient is at risk of developing a deficiency of which vitamin or mineral?

A 6-year-old boy had been in his normal state of good health until a few hours prior to presentation to the ER room. His mother reports that he began to have difficulty walking, and she noticed that he was falling and unable to maintain his balance. Which of the following is the most likely cause for his condition?

A 65-year-old Caucasian male had undergone cardiac catheterization followed by aortic valve replacement for severe aortic stenosis and coronary artery bypass grafting for three-vessel disease. His postoperative course was complicated by atrial fibrillation and a urinary tract infection. His other medical problems include hypertension, diabetes, and hypercholesterolemia. He is also receiving heparin, ciprofloxacin, and amiodarone. On postoperative day five, he developed prolonged bleeding from the venipuncture site. His labs show: Hb 11.5 g/dL, MCV88 fl, Platelet count 50,000/cmm, Leukocyte count 7,500/cmm, Segmented neutrophils 68%, Bands 1%, Eosinophils 1%, Lymphocytes 24%, Monocytes 6%, Prothrombin time 12 sec (INR=1.0), Partial thromboplastin time 65 sec. His preoperative labs were unremarkable. What is the most likely cause of these findings in this patient?

A 65-year-old diabetic man with a creatinine of 1.6 was started on an angiotensin-converting enzyme inhibitor for hypertension and presents to the emergency room with weakness. His other medications include atorvastatin for hypercholesterolemia, metoprolol and spironolactone for congestive heart failure, insulin for diabetes, and aspirin. Laboratory studies include: K: 7.2 mEq/L, Creatinine: 1.8 mg/dL, Glucose: 250 mg/dL, CK: 400 IU/L. Which of the following is the most likely cause of hyperkalemia in this patient?

A 65-year-old woman complains of periodic headaches in the temporal region, visual disturbances, and neck stiffness. Treatment is initiated early and biopsy of a scalp artery is consistent with arteritis. Two months later, the patient presents to your office with weakness. She says that her headaches are gone but she has difficulty climbing stairs and getting up from a chair. Her serum CK level and ESR are normal. Which of the following is the most likely cause of this patient's current complaints?

A 74-year-old woman with a history of a previous total abdominal hysterectomy presents with abdominal pain and distention for 3 days. She is noted on plain films to have dilated small-bowel and air-fluid levels. She is taken to the operating room for a small-bowel obstruction. Which of the following inhalational anesthetics should be avoided because of accumulation in air-filled cavities during general anesthesia?

An obese 18-year-old woman is brought to the emergency department by her mother, who noted that she had been lethargic all day, and suffered a brief, seizure-like episode. One month earlier, the patient had been started on medication for type 2 DM. Lactic acid levels are normal. Which of the following medications most likely played a role in the patient’s current presentation?

An otherwise healthy 13-year-old boy has seasonal allergic rhinitis. He complains of excessive rhinorrhea, frequent sneezing, and nasal congestion. He has a nasal voice and breathes with his mouth. He derives some relief from keeping windows closed at home and spending as litde time as possible outdoors in periods of high pollen concentration. However, he is excessively bothered by nasal congestion. Which of the following drugs would be most effective in relieving nasal congestion?

An ovarian mass removed from a 49-year-old female has yellow coloration of its cut surface. The pathologist describes it as a granulosa-theca cell tumor. Based on this pathology report, the tumor is most likely to secrete?