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Old 03-27-2016
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Default clinical mastery IM Form 3 & 4 Please help!

29. A 42-year-old woman comes to the physician for a follow-up examination. She has a 5-year history of mild shortness of breath on exertion and cough productive of copious yellow-to-whitish sputum. She has not had fever or chills. She has reactive airways disease treated with daily salmeterol-fluticasone and albuterol and seasonal allergies treated with fexofenadine. She has a chronic cough that is not controlled by her medications. She has a 20-year history of multiple respiratory tract infections, including three episodes of pneumonia during the past 15 years and two episodes of sinusitis during the past 5 years. She usually requires antibiotic therapy for bronchitis three to four times yearly. She does not smoke. Her temperature is 36.9°C (98.4°F), pulse is 72/min, respirations are 20/min, and blood pressure is 132/78 mm Hg. Examination shows mild lymphadenopathy. There is mild thrush. Coarse breath sounds are heard bilaterally. Cardiac examination shows no abnormalities except for a slightly increased S2. There is no clubbing or edema. In addition to pulmonary function testing and antifungal therapy, which of the following is the most appropriate next step in diagnosis?
•WRONG A) Measurement of CD4+ T-lymphocyte count
B) Measurement of serum complement concentrations
C) Measurement of serum immunoglobulin concentrations
D) Sputum culture
E) Ventilation-perfusion lung scans

32. A 55-year-old woman comes to the emergency department 30 minutes after the sudden onset of ripping substernal chest pain. She has hypertension treated with hydrochlorothiazide. Her blood pressure is 220/128 mm Hg in both arms. Carotid, radial, femoral, and pedal pulses are within normal limits. An x-ray of the chest shows a widened aortic root and dilated ascending aorta. Which of the following is the most likely cause?
A) Aortic dissection due to Takayasu arteritis
•WRONG B) Degeneration of the aortic wall from Marfan syndrome
C) Medial degeneration of the aorta
D) Rupture of a sinus of Valsalva aneurysm
E) Traumatic disruption of the aorta from a fall

24. An asymptomatic 24-year-old man who is HIV positive comes to the physician for a follow-up examination. He has been seen by a physician regularly since he was diagnosed 3 years ago and has been following all recommendations. He currently takes no medications. Examination shows no abnormalities. Laboratory studies show:
Hematocrit 42%
Leukocyte count 4000/mm3
CD4+ T-lymphocyte count 550/mm3 (Normal~ 500)
Plasma HIV viral load 2000 copies/ml
Which of the following is the most appropriate recommendation for this patient?
A) Follow-up examination in 6 months
B) Two-drug antiretroviral therapy only
C) Two-drug antiretroviral therapy and Pneumocystis jiroveci (formerly P carinii) prophylaxis
•WRONG D) Three-drug antiretroviral therapy only
E) Three-drug antiretroviral therapy and P jiroveci prophylaxis
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