You see a 16-year-old white female for a preparticipation evaluation for volleyball. She is 183 cm (72 in) tall, and her arm span is greater than her height. She wears contacts for myopia. What should be performed at this time?
A 78-year-old asymptomatic male is found to have a platelet count of 90,000 and a slightly decreased WBC count. What type of anemia is consistent with a diagnosis of myelodysplastic syndrome?
A 20-year-old male presents with complaints of abdominal pain and diarrhea. He says he often has abdominal cramping that is relieved with defecation. The pain is accompanied by frequent loose, mucous stools, and his symptoms tend to get worse with stress. Your evaluation leads to a diagnosis of diarrhea-predominant irritable bowel syndrome. What would be the most appropriate treatment?
A 54-year-old female presents with painful sores in her mouth that appeared a few days ago. She has had some trouble eating due to the pain, but she is able to swallow without difficulty. She also began to have some pain around her right ear today. She has no fever, chills, nasal congestion, cough, or difficulty hearing. Her medical history is significant only for an anxiety disorder. On examination her vital signs are all normal. You see vesicles on the right side of the hard palate and she has a swollen, red right pinna, with vesicles in the external auditory canal. Which organism is responsible for this condition?
A 59-year-old male college professor presents with a 2-month history of right medial knee pain. There is no history of injury or overuse. He has no other specific joint pain except for occasional myalgias and arthralgias of his legs and arms. On most days he has morning stiffness lasting 15–20 minutes after getting out of bed. On exam the right knee has full range of motion. There is tenderness at the medial joint line, but no clicking or ligamentous instability. There is crepitus with movement in both knees.
Which diagnostic tests would be most appropriate at this time?
A 12-year-old female with asthma sees you for a follow-up visit. The girl’s mother states that she is currently coughing several days per week and uses her albuterol (Proventil, Ventolin) inhaler 3–4 times weekly. She has awakened with a cough during the night 3 times in the last month. The patient thinks her asthma only mildly affects her day-to-day activity. In-office spirometry reveals that her FEV1 is 83% of predicted, with a normal FEV1/FVC ratio. Which asthma classification best fits this patient’s presentation?
A 25-year-old male has developed a painless ulcer on the glans of his penis. After an appropriate examination and testing you diagnose primary syphilis and treat him with penicillin intramuscularly in a single dose. Eight hours later, while you are working the evening clinic, he returns because he has a fever of 100.6°F and a bad headache, which he rarely gets. He says he “aches all over.”
What would be most appropriate at this time?
According to the American Diabetes Association, screening for diabetes mellitus in the asymptomatic patient with no risk factors should begin at which age?
An 80-year-old male nonsmoker with Parkinson’s disease is treated for community-acquired pneumonia with azithromycin (Zithromax), 500 mg/day for 10 days. On follow-up the patient feels better but still has a productive cough. A repeat chest radiograph reveals a single thin-walled cavity lesion in the left lower lobe. It would be most appropriate to replace this patient’s azithromycin with?
Where is my puzzle?