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A 5-year-old girl is brought to the physician 30 minutes after being bitten on the forearm by her cat. Examination shows a small puncture wound covered with dried blood. She is at increased risk of infection for which of the following reasons?
A) Arm wounds are more susceptible to infection
B) Salivary enzymes in cats augment infection
C) It is difficult to cleanse pathogens from this wound
D) The Staphylococcus species involved is particularly virulent
E) Young children are less able to resist infection than adults


A 16-year-old girl comes to the physician for her first prenatal visit at 12 weeks' gestation. She has not had any immunizations since the age of 5 years. She has received the following immunizations at the recommended ages: 5 Diphtheria-tetanus-pertussis 3 Hepatitis B 1 Measles-mumps-rubella 4 Oral poliovirus Examination shows no abnormalities. Which of the following is the most appropriate immunization to administer at this visit?
A) Diphtheria-tetanus-pertussis
B) Diphtheria (child)-tetanus toxoid
C) Diphtheria (adult)-tetanus toxoid
D) Haemophilus influenzae type b
E) Hepatitis B
F) Inactivated poliovirus


A 57-year-old man has been hospitalized for 2 days for treatment of unstable angina pectoris. He is currently receiving intravenous heparin and undergoing evaluation for coronary artery bypass grafting. His blood pressure is 160/90 mm Hg, pulse is 88/min, and respirations are 16/min. Laboratory studies show: Platelet count 90,000/mm3 Prothrombin time 12 sec (INR=1.1) Partial thromboplastin time 35 sec Which of the following is the most likely cause of these findings?
A ) Excessive platelet destruction
B ) Uncontrolled activation of coagulation and fibrinolytic cascades


An otherwise healthy 19-year-old woman comes to the physician because of a 3-year history of intermittent facial blemishes. She drinks wine occasionally on weekends. She takes no medications. Examination shows multiple 1- to 2-mm red and white papules and larger red nodules on the forehead and cheeks. Which of the following is the most appropriate initial pharmacotherapy?
A ) Oral isotretinoin
B) Topical benzoyl peroxide


A 27-year-old woman is brought to the emergency department by her mother who found her comatose 30 minutes ago. Her mother says that her daughter had been having lower abdominal pain and vaginal bleeding over the past week. The patient had an ectopic pregnancy 2 years ago and was also treated with doxycycline for pelvic inflammatory disease at that time. Her blood pressure is 40/20 mm Hg, pulse is 160/min, and respirations are 24/min. The abdomen is distended and rigid with decreased bowel sounds. Hemoglobin level is 4.2 g/dL, and leukocyte count is 12,500/mm3. Culdocentesis is positive. Which of the following is the most appropriate next step in management?
A ) Laparoscopy
B ) Exploratory laparotomy
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