a) advise him again to stop smoking and refer him to another transplant program
b) advise him that the transplant program cannot turn him down on the basis, according to the Americans with Disabilities Act
c) contact the transplant program to learn their reasons for turning him down
d) explain to the patient that transplantation is out of the question as a result of what has occurred
e) write to the transplant program and insist that they give him another opprotunity

View Answer C:

32. A 16 year old boy comes to the office for a sports participation physical examination. He has been playing in a summer basketball league and now wants to try out for the high school varsity team. His last physical examination was 2 years ago and, according to him, he has been healthy and has no complains except for a cold 2 weeks ago. Before you begin the physical examination, the nurse informs you that his routine urinalysis shows:

Color: Tea-colored/dark
Specific gravity: 1.030
pH: 5.5
Protein: 2+
Blood: Positive
WBC: 7/hpf
RBC: >100/hpf, a few red cell casts
Glucose, ketones and bacteria: Negative

These laboratory results are most indicative of:

a) cystitis
b) glomerulonephritis
c) nephrotic syndrome
d) pyelonephritis
e) renal calculi

View Answer B:

A 24 y/o woman comes to the office for a gynecologic examination. This is her first visit and has no complaints. She tells you that she has not had a PAP smear in several years,Her menarche was at 12 years and she has had regular cycles since then. She has has several sexual partners in the past but has been with her current partner in a monogamous relationship for one year. Dhe reports that she had a chlamydial infectionthat was treated several years ago, but she denies a history of other sexually transmitted diseases. She has never been pregnant. On physical examination her cervix appears friable with a slight area of ulceration. There are several perineal and vaginal lesions which appear as small "cauliflower-like" projections. The results of the PAP smear which return in 1 week, show a "low-grade squamous intraepithelial lesion (mild dysplasia, CIN I)." The factor in this patient's case most closely correlated with the abnormal finding on the PAP test is:

A. condyloma acuminata
B. condyloma lata
C. early age at menarche
D. history of chlamydia
E. nulliparity

View Answer A:

A 68 y/o woman undergoes flexible sigmoidoscopy as part of a yearly screening. At the most recent screening, a 3cm polyp is found in the sigmoid colon and removed. She returns to the office 6 hours later complaining of lower quadrant pain, nausea,, and vomiting. On the physical exam, temp is 38.1 C (100.6 F), pulse 110x', respirations 26x' and BP= 120/60mm Hg. Abdominal exam discloses bowel sounds, tenderness, and gaurding in the left lower quadrant. Rectal exam shows no stool and only tenderness superiorly. the most appropriate managment is to:

A. obtain an angiogram to rule out intestinal ischemia.
B. obtain immediate consultation with a surgeon.
C. pass a soft rubber rectal tube under flouroscopy.
D. repeat the flexible sigmoidoscopy in order to evaluate the operative site.
E. start hydrocortisone, intravenously, to decrease any inflamatory response.

View Answer B:

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