A 24-year-old woman comes to the office for a routine health maintenance examination


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  1. A 24-year-old woman comes to the office for a routine health maintenance examination. She has been generally healthy for the past year. She is 155 cm (5 ft 1 in) tall and weighs 68 kg (150 lb); BMI is 28 kg/m2. Vital signs are temperature 37.0°C (98.6°F), pulse 60/min, respirations 18/min, and blood pressure 118/54 mm Hg. Physical examination shows several small (<1 cm), smooth, slightly irregular, mobile, mildly tender lymph nodes palpable in her left groin just below the inguinal ligament. The most likely source of this lymphadenopathy will be found in which of the following?
  • (A) Adnexa
  • (B) Bone marrow
  • © Lateral thigh
  • (D) Lower abdomen
  • (E) Vulva

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  1. A 27-year-old man comes to the office with his wife because of a recent episode of loss of muscle control. He says, “I was at a reception, someone told a joke, and when I laughed, my legs collapsed!” His wife tells you that he recovered in a few seconds and he did not lose consciousness. He has a long history of sleepiness and he is able to go to sleep quickly. He usually awakens feeling refreshed after a short nap. He has no history of similar episodes or hallucinations. There is no family history of similar problems. Vital signs are normal. Physical examination shows no abnormalities. Which of the following is the most likely diagnosis?
  • (A) Narcolepsy
  • (B) Primary hypersomnia
  • © A seizure disorder
  • (D) Sleep paralysis
  • (E) Vasovagal syndrome

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  1. While you are on rounds at a local nursing facility, the nurse mentions that your patient, a 79-year-old woman, appears to be a “poor eater.” She was admitted to the nursing facility 3 months ago from the hospital where she was treated for congestive heart failure. Her daughter had moved away from the area, and nursing home placement was necessary because the patient could no longer function independently. Her present medications include furosemide and digoxin. Physical examination is normal except for a weight loss of 3.5 kg (7 lb) during the past 3 months. In your conversation with the patient, she says, “No, I’m not depressed, I just don’t have an appetite anymore. Nothing tastes good to me. I have a little bit of nausea most of the time.” Which of the following is the most appropriate initial diagnostic study?
  • (A) Chest x-ray
  • (B) Complete blood count
  • © Determination of serum albumin concentration
  • (D) Determination of serum digoxin level
  • (E) Upper gastrointestinal barium study

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