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A 23-year-old computer programmer comes to your office for
an annual examination. She has recently become sexually
active and wants to be placed on birth control. Her only
complaint is that the skin in her armpits has become darker.
She states it looks like dirt, and she scrubs her skin nightly
with soap and water but the color stays. Her past medical
symptoms consist of acne and mild obesity. Her periods have
been irregular for 3 years. Her mother has type 2 diabetes, and
her father has high blood pressure. The patient denies using
tobacco but has four to five drinks on Friday and Saturday
nights. She denies any illegal drug use. On examination, you
see a mildly obese female who is breathing comfortably. Her
vital signs are unremarkable. Looking under her axilla, you see
dark, velvet-like skin. Her annual examination is otherwise
unremarkable. What disorder of the breast or axilla is she most
likely to have? - ANSWER-Acanthosis nigricans
Which of the following is true of women who have had a
unilateral mastectomy?
- ANSWER-They should be examined carefully along the
surgical scar for
,masses.
A 76-year-old retired farmer comes to your office complaining
of abdominal pain, constipation, and a low-grade fever for
about three days. He denies any nausea, vomiting, or diarrhea.
The only unusual thing he remembers eating is two bags of
popcorn at the movies with his grandson, three days before his
symptoms began. He denies any other recent illnesses. His
past medical history is significant for coronary artery disease
and high blood pressure. He has been married for over fifty
years. He denies any tobacco, alcohol, or drug use. His mother
died of colon cancer and his father had a stroke. On
examination, he appears his stated age and is in no acute
distress. His temperature is 100.9 degrees and his other vital
signs are unremarkable. His head, cardiac, and pulmonary
examinations are normal. He has normal bowel sounds and is
tender over the left lower quadrant. He has no rebound or
guarding. His rectal examination - ANSWER-Acute diverticulitis
Jim is a 60-year-old man who presents with vomiting. He denies
seeing any blood with emesis, which has been occurring for
two days. He does note a dark, granular substance resembling
the coffee left in the filter after brewing. What do you suspect? -
ANSWER-Bleeding from a peptic ulcer
A 26-year-old sports store manager comes to your clinic,
complaining of severe right-sided abdominal pain for twelve
hours. He began having a stomachache yesterday, with a
decreased appetite, but today the pain seems to be just on the
, lower right side. He has had some nausea and vomiting but no
constipation or diarrhea. His last bowel movement was the
night before and was normal. He has had no fever or chills. He
denies any recent illnesses or injuries. His past medical history
is unremarkable. He is engaged. He denies any tobacco or drug
use and drinks four to six beers per week. His mother has
breast cancer and his father has coronary artery disease. On
examination, he appears ill and is lying on his right side. His
temperature is 100.4 degrees and his heart rate is 110. His
bowel sounds are decreased and he has rebound and
involuntary guarding, one-third of the way between the anterior
superior iliac spine and the - ANSWER-Acute appendicitis
Josh is a 14-year-old boy who presents with a sore throat. On
examination, you notice dullness in the last intercostal space in
the anterior axillary line on his left side with a deep breath.
What does this indicate? - ANSWER-His spleen is possibly
enlarged and close attention should be paid to further
examination.
Diminished radial pulses may be seen in patients with which of
the following? -
ANSWER-Arterial
emboli
A 42-year-old florist comes to your office, complaining of
chronic constipation for the last six months. She has had no
nausea, vomiting, or diarrhea, and no abdominal pain or
cramping. She denies any recent illnesses or injuries. She