53- year- old man comes to the physician complaining of 4 months of progressively worsening dyspnea


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53- year- old man comes to the physician complaining of 4 months of progressively worsening dyspnea He also complains of

decreased appetite, weight loss, and nagging epigastric discomfort The patient has a history of peptic ulcer disease treated with

over- the -counter antacids. He has a 20-pack-year smoking history and has worked as a plumber for the past 30 years. Vital signs

are within normal limits. Physical examination shows fingernail clubbing and bibasilar end-inspiratory crackles on lung auscultation.

Chest x -ray shows atelectasis and bilateral pleural plaques over the diaphragm Chest computed tomography shows reticular

opacities of the lower lung fields, multiple pleural plaques, and a round 6-cm cavitary mass in the right lower lung field. Computed

tomography-guided biopsy of the mass is planned Which of the followi ng is the most likely finding on biopsy?

  • QA Bronchogenic carcinoma
  • 0 B. Metastatic colon cancer
  • 0 C. Metastatic pancreatic cancer
  • 0 D. Metastatic stomach cancer
  • 0 E. Peritoneal mesothelioma
  • 0 F Pleural mesothelioma

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44-year-cid man is brought to the emergency department after being found talking to himself in a park. When authorities asked him

to leave, he became agitated and combative, saying he was “destined to lead” and has to '\vait in the park for the sign" The patient

admits to not sleeping for the past week. His thoughts jump from topic to topic and he appears distractible, disorganized, and unable

to care for himself The patient is admitted to the hospital and started on daily haloperidol and valproate. Over the next week, he

becomes significantly calmer. Although he continues to believe that he will “lead a spiritual revolution,” he is sleeping 6 hours a night

and is better able to focus Ten days after admission, he fails to come out of his room for breakfast Nursing staff members find him

lying in bed, confused, sweating, and stiff Vital signs are temperature 39.2 C (102.6 F), blood pressure 164198 mm Hg, pulse

122/min, and respirations 28/min. As a precaution, all medications are stopped If the patient fails to improve with supportive

measures, which of the following medications would be most appropriate to administer at this time?

  • QA Benztropine
  • QB Bromocriptine
  • QC Cyproheptadine
  • Q D Physostigmine
  • Q E Propranolol
  • QF. Succinylcholine

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