A patient with low-grade fever and weight loss has poor excursion on the right side of the chest with decreased fremitus

A patient with low-grade fever and weight loss has poor excursion on the right side of the chest with decreased fremitus, flatness to percussion, and decreased breath sounds all on the right. The trachea is deviated to the left. The most likely diagnosis is

  • a. Pneumothorax
  • b. Pleural effusion
  • c. Consolidated pneumonia
  • d. Atelectasis

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A 65-year-old male develops the sudden onset of severe knee pain. The knee is red, swollen, and tender. He has a history of diabetes mellitus and cardiomyopathy. An x-ray of the knee shows linear calcification. Definitive diagnosis is best made by

  • a. Serum uric acid
  • b. Serum calcium
  • c. Arthrocentesis and identification of positively birefringent rhomboid crystals
  • d. Rheumatoid factor

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A 45-year-old woman has pain in her fingers on exposure to cold, arthralgias, and difficulty swallowing solid food. The most useful test to make a definitive diagnosis is

  • a. Rheumatoid factor
  • b. Antinucleolar antibody
  • c. ECG
  • d. BUN and creatinine

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A 40-year-old female complains of 7 weeks of pain and swelling in both wrists and knees. The patient complained of fatigue and lethargy several weeks before noticing the joint pain. The patient notes that after a period of rest, resistance to movement is more striking. On exam, the metacarpophalangeal joints and wrists are warm and tender. There are no other joint abnormalities. There is no alopecia, photosensitivity, kidney disease, or rash. Which of the following is correct?

  • a. The clinical picture suggests early rheumatoid arthritis, and a rheumatoid factor should be obtained
  • b. The prodrome of lethargy suggests chronic fatigue syndrome
  • c. Lack of systemic symptoms suggests osteoarthritis
  • d. X-rays of the hand are likely to show joint space narrowing and erosion

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A 40-year-old male complains of exquisite pain and tenderness over the left ankle. There is no history of trauma. The patient is taking a mild diuretic for hypertension. On exam, the ankle is very swollen and tender. There are no other physical exam abnormalities. The next step in management is

  • a. Begin colchicine and broad-spectrum antibiotics
  • b. Obtain uric acid level and perform arthrocentesis
  • c. Begin allopurinol if uric acid level is elevated
  • d. Obtain ankle x-ray to rule out fracture

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19-year-old white man presents with hypertension, nephrotic syndrome, mild renal insufficiency, RBC casts in urine, and depressed third component of complement (C3). Renal biopsy shows thickened basement membranes and increased cellular elements. Electron microscopy shows dense deposits within the basement membrane.

  • a. Focal and segmental glomerulosclerosis
  • b. Anti-glomerular basement membrane disease
  • c. Membranous nephropathy
  • d. Membranoproliferative Glomerulonephritis

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After undergoing surgical resection for carcinoma of the stomach, a 60-year-old male develops numbness in his feet. On exam, he has lost proprioception in the lower extremities and has a wide-based gait and positive Romberg sign. A peripheral blood smear shows macrocytosis and hypersegmented polymorphonuclear leukocytes. The neurologic dysfunction is secondary to a deficiency of which vitamin?

  • a. Folic acid
  • b. Thiamine
  • c. Vitamin K
  • d. Vitamin B12

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A 50-year-old white man presents with mild hypertension, nephrotic syndrome, microscopic hematuria, and venous thromboses (including renal vein thrombosis). Renal biopsy reveals a thickened glomerular basement membrane with subepithelial immunoglobulin deposition.

  • a. IgA nephropathy
  • b. Focal and segmental glomerulosclerosis
  • c. Anti-glomerular basement membrane disease
  • d. Membranous nephropathy

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A 25-year-old male cigarette smoker has a history of respiratory infections and has also been found to have hematuria. A high value for diffusing capacity is noted during pulmonary function testing. This finding is consistent with which of the following disorders?

  • a. Anemia
  • b. Cystic fibrosis
  • c. Emphysema
  • d. Intrapulmonary hemorrhage

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