Medical Tactics

A 30-year-old woman is involved in an automobile accident. The woman,  who was not wearing a seat belt, hits her chest against the steering wheel  . When she is brought by ambulance to the emergency room, she is noted to   be cyanotic. Her blood pressure is within normal limits and her heart rate   is fast but regular. Her respirations are rapid and very shallow. She   receives no medications in the ambulance. Chest x-ray demonstrates   multiple broken ribs, but no pleural effusion or obvious lung disease.    Which of the following mechanisms would most likely account for this patient's hypoxemia?

A normal, healthy, 24-year-old woman has regular menstrual cycles,  each lasting about 28 days. Daily serum samples from the woman reveal   decreasing progesterone and 17-b-estradiol levels. Serum LH and FSH    levels are low, and begin rising. Basal body temperature begins falling    . Within three days, which of the following events would be expected to     occur?

In an experiment, norepinephrine was injected intravenously and smooth muscle contraction was measured (control curve). Curves X, Y and Z are the result of three separate experiments, in which norepinephrine was administered shortly after an unknown pharmacological agent. What are the three most likely drugs (X,Y,Z) used in the three consecutive experiments?

A 2-month-old child is evaluated for failure to thrive. As the  pediatrician is examining the child, a convulsion occurs. Stat   serum chemistries demonstrate severe hypoglycemia, hyperlipidemia,    lactic acidosis, and ketosis. Physical examination is remarkable     for hepatomegaly, a finding confirmed by CT scan, which also reveals      renomegaly. Which of the following diseases best accounts for this       presentation?

A 34-year-old asthmatic male presents for a check-up. He has been  taking low dose oral prednisone for over 10 years and although his   asthma is well controlled, he is concerned about steroid-induced   osteoporosis, because his grandfather, a type 1 diabetic, recently    fell and broke his hip. A comprehensive metabolic profile as well     as a dual energy x-ray absorptiometry test (DEXA) of the spine and     hip are ordered. Which of the following additional tests would be      recommended?

A 20-year-old develops weakness accompanied by difficulty in relaxation  that is most pronounced in the hands and feet. Muscle biopsy demonstrates   prominent ring fibers, centrally located nuclei, chains of nuclei, and    disorganized sarcoplasmic masses. This condition been associated with    a mutation on which of the following chromosomes?

A 37-year-old woman who was diagnosed with AIDS 3 years earlier is  unable to work, is physically debilitated, and requests her physician   to provide her with medications with which to take her own life. The    most common emotional disorder that results in such requests by patients     is

A 57-year-old man presents with a steady, severe pain in the right  hypochondrium, nausea, vomiting, and a temperature of 102 F. He states   that his signs and symptoms began shortly after eating his favorite    pizza with extra cheese, pepperoni, and sausage. Laboratory examination     reveals a white blood cell count of 13,400/mL and a serum bilirubin      value of 2.8 mg/dL. If hepatobiliary imaging reveals an obstructed       cystic duct, which of the following agents would be the drug of       choice for the treatment of this patient's pain?

A pregnant woman presents at 22 weeks gestation for a routine prenatal  visit. Physical examination demonstrates ankle edema and new onset   hypertension. Urinalysis reveals marked proteinuria. Development of    which of the following would justify a diagnosis of eclampsia?

A 4-year-old girl is discovered pulling the tail of the family dog.  Her mother, who had warned her previously that this behavior was   unacceptable, now assigns the girl to a 5 minute time out period   . A timer is set up so that the girl can keep track of the time period.    After two minutes of the period, the girl begins to scream and cry. At     this point, the mother's best response would be to