A 25-year-old nulligravida woman presents after trying to conceive for 2 years without success. She is healthy, with regular menstrual periods. She denies any unusual hair growth, weight changes, or breast discharge. She gets occasional outbreaks of acne. Blood work done with her next menstrual period produces the following results:
Follicle-stimulating hormone, follicular phase: 6.2 U/L (5.0–20.0) on day 3 of menstrual cycle
Luteinizing hormone, follicular phase: 6 U/L (5–22) on day 3 of menstrual cycle
Estradiol: 163 pmol/L (50–200) on day 15 of menstrual cycle
Thyrotropin (thyroid-stimulating hormone): 2.5 mU/L (0.4–5.0)
Prolactin: 40 µg/L (4–30)
Given the results of her blood work, which one of the following is the best next step?
An 8-year-old boy is brought to the Emergency Department because he is experiencing sudden respiratory distress. You suspect that he has a spontaneous tension pneumothorax. On physical examination, which one of the following best supports this diagnosis?
An 18-year-old woman presents to the Emergency Department with a 3-day history of vomiting and right upper quadrant pain. She is alert but appears unwell and jaundiced. She was previously healthy and has not travelled recently. She has no risk factors for blood-borne pathogens. She denies hematemesis or hematochezia. On further history, she reports that she took a full bottle of pills that she found in her parents’ medicine cabinet several hours before she started vomiting. Without intervention, which one of the following is the most likely outcome?
A 24-year-old man presents to your clinic with a 6-month history of fatigue. On examination, he is pale. His BMI is 16, and his blood pressure is 92/58 mm Hg. Initial laboratory work shows the following:
Creatinine: 64 µmol/L (49–93)
Potassium: 3.0 mmol/L (3.5–5.1)
Sodium: 138 mmol/L (136–146)
TSH: 2.40 mIU/L (0.34–5.60)
CBC: Normal
Which one of the following is the best next step?
A 30-year-old man comes to the office and asks you to write him a note for his employer that recommends a stress leave. He says he feels entitled to a rest. He comes across as irritable and impulsive. He appears to show little regard for the law and admits to recently embezzling $5,000 from his employer. He justifies his actions and shows no remorse. He has a history of attention-deficit/hyperactivity disorder as a child. Which one of the following is the most likely diagnosis?
A 29-year-old woman presents with vaginal spotting after 6 weeks of amenorrhea. She is asymptomatic otherwise. Serum β-hCG is 2150 IU/L, and pelvic ultrasound shows an empty uterus. She has been trying to conceive for 7 months. Which one of the following is the best next step?
A 46-year-old woman presents with concerns because she has not had a period for the past 13 months. She has not had any hot flashes or night sweats, but she has noted some problems staying asleep for the past 6 months. She feels “foggy,” which has made her work more difficult. She is in a same-sex relationship and has no pain with sexual activity. In discussing options with her, which one of the following is most appropriate?
A 70-year-old hypertensive woman with a history of congestive heart failure (CHF) secondary to left ventricular dysfunction presents to your office with a persistent dry hacking cough. She claims it began when she was started on ramipril. Which one of the following medications would be most appropriate to replace ramipril, to ensure that the risk of morbidity associated with CHF remains low?
A 77-year-old woman is brought to the Emergency Department by ambulance because she has severe heel ulcers and dehydration. Her husband reports that she has been sick for the past 6 to 8 weeks with a cough and congestion. He shares that he has tried to bring her to medical attention on several occasions, but she refused. The paramedics reported that her bed at home was soiled and that they could hardly reach her room due to clutter. On questioning, her answers seem reasonable. Which one of the following is the most critical next step?
You are on duty in the Emergency Department when 5 patients are brought in by ambulance after a high-speed motor vehicle collision. Which one of the following patients requires the most urgent medical care?
