A 34-year-old woman comes lo the emergency department due to sudden onset of tingling and numbness in her left hand She is an assistant chef al a nearby restaurant and was lifting a box earlier in the day when she heard a “pop” and her left hand went numb.The patient’s numbness is in a glove distribution Her fingers, entire left hand, and wrist are numb, with normal sensation above her wrist. The patient describes her numbness as feeling like “pins and needles.” Medical history is insignificant The patient allows the nurse to take her vital signs but refuses any further physical examination, insisting that ii will worsen her discomfort. Temperature is 37.2C (99 F), blood pressure is 120170 mm Hg, pulse is 72/min, and respirations are 16/min. The patient asks for a doctor’s note to excuse her from work, fearing that her condition will worsen if she does not take some lime off to heal. Which of the following is the most likely diagnosis?
- A Conversiondisorder
- B Factilious disorder
- C Malingering
- D Mononeuropathy
- E Polyneuropathy
- F Radiculopathy
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29-year-old woman at 25 weeks gestation comes to clinic for routine prenatal care. She has a history of chronic hepatitis C infection
acquired approximately 10 years ago. Her pregnancy has been otherwise uncomplicated to date. She is married and is monogamous
with her husband, who is aware of her hepatitis infection. Her past medical history is significant only for an appendectomy at age 12.
She has not been immunized against hepatitis A or B. She takes no medications, aside from a daily prenatal multivitamin. Which of
the following recommendations should be given to this patient?
- Q A Avoid breastfeeding the baby
- Q B. Begin treatment with interferon-a and ribavirin
- Q C. Obtain hepatitis A and B vaccinations now
- Q D. Schedule an elective cesarean delivery
- Q E. Use barrier protection for all sexual intercourse
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4-year-old boy is brought to the pediatrician
for evaluation of frequent falls. His mother says
that for the past 6 months he seems to be moving
more slowly than usual, and he can’t run as
quickly and can’t climb stairs. The boy was
born at 39 weeks’ gestation via normal spontaneous
vaginal delivery with no complications.
He has been otherwise healthy and achieved
all of his appropriate motor and speech milestones.
Family history is signifi cant for a maternal
uncle who died at age 20 years from respiratory
failure. On physical examination the
patient has hyperlordosis of the spine. His
calves are very prominent bilaterally. When
asked to lie on his back and stand up, he fi rst
rolls over onto his stomach and then uses his
hands to climb up his legs until he is standing.
He has 3/5 strength in his shoulders and thighs
bilaterally, but 5/5 strength in his hands, calves,
and feet. The rest of the neurologic examination
is unremarkable. Serum creatine kinase
level is 1500 U/L. How was this boy’s disorder
most likely inherited?
- (A) Autosomal dominant
- (B) Autosomal recessive
- © Autosomal trisomy
- (D) Mitochondrial
- (E) X-linked recessive
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