Too Much To Juggle?: ANSWERS Cont'd
Too Much To Juggle?: ANSWERS Cont'd
6.) C: Children with Downs syndrome are at an increased risk for leukemia. A. One would expect a neutrophil predominance and elevated ESR with septic arthritis, as well as unilateral findings and a fever. The x-ray should show joint space widening. B. Toxic synovitis would have a normal WBC count and ESR. D. Pauciarticular juvenile rheumatoid arthritis should not cause WBC count elevation. E. Fussiness would not elevate the WBC count. 7.) D: This patient has porphyria cutanea tarda, characterized by blistering, increased hair on temples and cheeks, and no abdominal pain. The disease is transmitted via an autosomal dominant pattern, thus the similarity in her siblings. The urine of these patients fluoresces an orange-pink color under the Woods lamp as a result of increased uroporphyrins. A. A skin biopsy, often the gold standard for diagnosis in dermatology, would not be helpful in this case. B. Pemphigus vulgaris has immunofluorescence surrounding epidermal cells, showing a tombstone pattern; immunofluorescence in bullous pemphigoid shows a linear band around the basement membrane, with increased eosinophils in the dermis. Therefore, a skin biopsy with immunofluorescence would not be helpful. C. Although some dermatologic conditions have known chromosomal abnormalities, diagnosis usually is obtained clinically or through biopsy and only confirmed by chromosomal analysis. E. Urine porphyrobilinogen is the test for acute intermittent porphyria, which is associated with abdominal pain. 8.) E: Polycythemia vera is characterized by symptoms related to increased blood viscosity: headache, fatigue, and blurred vision. Pruritus classically occurs during showers and results from histamine release because of increased basophilia. Plethora, splenomegaly, and a high hematocrit level with normal morphology are also present in polycythemia vera. A. Hepatic failure may result in pruritus but would not be expected to result in the other findings. B. Chronic renal failure would result in a decreased hemoglobin and hematocrit. C. Idiopathic myelofibrosis results in a decreased hemoglobin level and abnormal morphology. Red cells are described as teardrop cells. D. An elevated platelet count is not present in this patient; therefore, this response is incorrect. 9.) D: Criteria for receiving influenza vaccine include age >50 years, presence of heart disease/lung disease, and those who work in high-risk environments such as health care workers. This patient fulfills both the age cutoff as well as the pulmonary disease criteria. A. This response fulfills none of the criteria. B. This patient is considered too young, and her controlled hypertension would not place her at risk. C. This patient would qualify if not for her allergy; the vaccine is made in eggs and is contraindicated in those with a chicken egg allergy. E. Well-controlled minor asthma would not call for a vaccine.
LOOK INSIDE FOR: I Tips from students who have been through it all I The best in review and rotations resources I Practice Q&A from Boards and Wards, Fourth Edition
For more information, contact your Lippincott Williams & Wilkins Publishers Representative. Available at your Health Science Bookstore.
Entire catalogue 2009 Lippincott Williams & Wilkins
INTERNAL MEDICINE
UNDERGROUND CLINICAL VIGNETTES STEP 2: INTERNAL MEDICINE I: CARDIOLOGY, ENDOCRINOLOGY, GI, HEMATOLOGY/ ONCOLOGY, 4E
Kim: 978-0-7817-6835-1 2007
IN A PAGE MEDICINE, 2E
Kahan: 978-0-7817-7035-4 2008 Quickly review etiology/pathophysiology, differential diagnosis, signs and symptoms, diagnostic evaluation, prognosis, and treatment options for over 250 diseasesall in an innovative 2-page spread.
UNDERGROUND CLINICAL VIGNETTES STEP 2: INTERNAL MEDICINE II: DERMATOLOGY, ID, NEPHROLOGY, UROLOGY, PULMONARY, RHEUMATOLOGY, 4E
Kim: 978-0-7817-6836-8 2007
BLUEPRINTS MEDICINE, 5E
Young: 978-0-7817-8870-0 2009 Concise, accurate, clinical high-yield content covers the essentials for rotation and USMLE review.
New!
POCKET MEDICINE, 3E
Sabatine: 978-0-7817-7144-3 2007 A handy summary of key clinical information designed to form the basis of an individual pocket notebook or to be integrated into ones own notebook.
TM
STEP-UP TO MEDICINE, 2E
Agabegi: 978-0-7817-7153-5 2008 Primary review tool to prepare students for both the internal medicine clerkship and the corresponding end-of-rotation examination. A wealth of illustrations, charts, tables, graphs, and mnemonics speed and supplement learning.
NMS MEDICINE, 6E
Wolfsthal: 978-0-7817-6975-4 2007 Offers a quick review of medicine in an outline format that allows rapid study and retention. Each chapter is followed by USMLE-style questions and answers. Includes online access to the complete text plus additional content and a comprehensive exam.
MEDICINE, 5E
Fishman: 978-0-7817-2543-9 2003 Crystal-clear and easy-to-read, this popular text focuses on the essential pathophysiology, diagnoses, and management of the most common clinical situations.
IN A PAGE CARDIOLOGY
Prasad: 978-0-7817-6496-4 2006 Provides a quick overview of the most commonly seen cardiac diseases and disorders. Each disease is presented on a two-page spread in boxes with consistent headings.
Tips for working with other students, residents, attending physicians, and nurses
Marissa: Introduce yourself to everyone; including nurses with your name and say you're a medical student. It should always be the first thing you do when you step into the OR or need to ask for help with something. Arash: Respect your colleagues, try to learn from them and teach them when possible. Do not make other students look bad in front of residents or attendings. Be a team player. Always be positive and volunteer to make your residents life easier. They will love you for it, and it will be reflected in your evaluations. Be prepared to present cases in front of attendings. Make sure to do your homework beforehand. Show confidence, but with humility; arrogance is your enemy on wards. Patrick: You should try at all times to be nice to people during rotations. It seems pretty obvious, but in the craziness of the day it can be lost. A little bit of kindness can go a long way in making a good impression with the physicians, nurses, and other members of your team. You are being evaluated not just for your knowledge and skills but your interpersonal skills as well. It is a good idea to ask your residents and attendings what they want and expect from you in the beginning of a rotation that way you will not have any major surprises at the end of a rotation. Ask for feedback often if possible. Always volunteer to help and do procedures and answer questions with confidence. Edwin: My best advice for working with residents and attending physicians is to always know everything about your patients and do any work that you can handle yourself aim to make their lives easier. When working with other students and staff on the wards, just play nice and remember your people skills.
OBSTETRICS/GYNECOLOGY
OBSTETRICS AND GYNECOLOGY, 6E
Beckmann: 978-0-7817-8807-6 April 2009 Now published in collaboration with ACOG! Targets medical students needing information for the 6-8 week OB/GYN clerkship. All chapters have been thoroughly updated by a panel of Junior Fellows in the American College of Obstetricians and Gynecologists. A website offers access to the full text online and a question bank.
BLUEPRINTS UROLOGY
Zaslau: 978-1-4051-0400-5 2005
PEDIATRICS
UNDERGROUND CLINICAL VIGNETTES STEP 2: PEDIATRICS, 4E
Kim: 978-0-7817-6844-3 2007
Marissa: If you're asked about a patient's labs or physical exam findings and you didn't look them up or do the exam, just admit it and let the resident/attending know you will get back to them with the results right after rounds. Arash: Give yourself at least 30 minutes to pre-round. Print out an interesting paper regarding your patient's case to discuss during rounds. Volunteer to give a 5 minute presentation during next round. Try to learn as much as possible during rounds; the best way to remember a disease is to associate it with a person. Patrick: For rounds and pre-rounds make sure you know your patient. See the patient before and review all pertinent information or changes in their care. When presenting at rounds it is a good idea if you have time to practice beforehand. We accumulate a tremendous amount of information and it is a skill distilling the information down to what is pertinent to patient care. Many attendings and residents have different expectations on how they want patients presented so if you are unsure it is a good idea to ask. Edwin: Many physicians will round on patients differently, so ask for advice from other students or residents who have worked with your staff. If that information isnt available, know your patients better than anyone else and try to have a good understanding of the major medical issues of each.
IN A PAGE PEDIATRICS, 2E
Kahan: 978-0-7817-7045-3 2008 Featuring a uniquely visual two-page-spread design that is great for rapid reference or review, In a Page Pediatrics provides a quick overview of the diseases, symptoms, and injuries most commonly seen in children.
BLUEPRINTS PEDIATRICS, 5E
Marino: 978-0-7817-82517 2009 Concise, accurate, clinical high-yield content covers all you need to know for the USMLE and rotations.
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PEDIATRICS, contd
PEDIATRICS FOR MEDICAL STUDENTS, 2E
Bernstein: 978-0-78172941-3 2002 Evaluative skills and a logical approach are honed in this problem-oriented approach to clinical practice designed to teach students the basics of pediatric clinical practice.
PSYCHIATRY
PEDIATRICS RECALL, 3E
McGahren: 978-0-78177118-4 2007 Rapid-fire Q&A review; perfect for the wards.
BRS PEDIATRICS
Brown: 978-0-7817-2129-5 2004 This concise, outline formatted book serves as a preparation for USMLE examinations and for course review.
HIGH-YIELDTM PSYCHIATRY, 2E
Fadem: 978-0-7817-4268-9 2003 Provides a succinct review in outline format of psychiatry for students during their rotation and while preparing for the USMLE Step 2.
PSYCHIATRY RECALL, 2E
Fadem: 978-0-7817-4511-6 2003
NMS PEDIATRICS, 5E
Dworkin: 978-0-7817-7075-0 2008 Presents material in a narrative outline with a concise yet comprehensive review. Study questions appear at the end of each chapter.
BLUEPRINTS PSYCHIATRY, 5E
NMS PSYCHIATRY, 5E
Thornhill: 978-0-7817-65145 2007 Offers a quick review of psychiatry in an outline format that allows rapid study and retention. Each chapter is followed by USMLE-style questions and answers. Includes online access to the complete text plus a comprehensive exam.
Murphy: 978-0-7817-8253-1 2008 USMLE-style questions and answers with full explanations; Key Points in every section; and a color-enhanced design that increases the usefulness of figures and tables.
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SURGERY
STEP-UP TO SURGERY
McFadden: 978-1-60547-393-2 2008 The newest addition to the Step-Up series, Step-Up to Surgery serves as a premier resource for students preparing for both the surgery clerkship and the corresponding end-of-rotation examination.
SURGERY, contd
NMS SURGERY, 5E ESSENTIALS OF GENERAL SURGERY, 4E*
Lawrence: 978-0-7817-5003-5 2005 Provides the most need-to-know information about specific diseases and areas of surgery and meets all the guidelines of the Association of Surgical Educators.
BLUEPRINTS SURGERY, 5E
Karp: 978-0-7817-8868-7 2009 Concise, accurate, clinical high-yield content covering all you need to know for the USMLE and rotations.
Jarrell: 978-0-7817-5901-4 2007 Offers a quick yet thorough review of surgery in an outline format that facilitates rapid study and retention. It focuses on the essential information that students need to successfully complete their clerkship. Includes online access to the complete text plus a comprehensive exam.
BLUEPRINTS ORTHOPEDICS
Cooper: 978-1-4051-0401-2 2005
SURGICAL RECALL, 5E
Blackbourne: 978-0-78177076-7 2008 Written in rapid-fire questionand-answer format, this popular resource enables quick study prior to surgical rounds. Purchasers of this edition will get both the print book and access to MP3 audio files of the entire text. All Q&A material will also be posted online in the form of electronic flashcards for self-quizzing.
IN A PAGE SURGERY
Kahan: 978-1-4051-0365-7 2003
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EMERGENCY MEDICINE
NMS CLINICAL MANUAL OF EMERGENCY MEDICINE, 2E
Biddinger: 978-0-7817-3551-3 2002 Contains condensed information that provides quick access protocols and extensive treatment modalities for ER medicine.
Reading/Studying Strategies
Marissa: There's much less free time to study than during the pre-clinical years. I recommend always having a book with you that you can read during down time, even if it's just 10 minutes. References that fit into your white coat are a plus! Arash: Read about each of your patients diseases right after you see them. Study as much as you can at the beginning of the rotation so you can be better prepared on the wards. Make a schedule to study everyday and stick to it. It is hard to study when you're tired from a long day on the wards, so give yourself a break, use the gym or see your friends, or take a nap so you can be refreshed. Don't forget to save some time to relax. You'll be more productive. Patrick: Always read about the diseases that are affecting the patients you are following. It helps you look good in rounds and improves patient care, and it will be easier to remember the information in the long term with a patient context. Try to read a little bit everyday, over time it adds up to a tremendous amount of information. Set a goal and try to stick to that goal whatever it is each day. Edwin: Reading around cases is a great way to remember information well, but wont necessarily cover everything you need to know. Its probably best to combine this with a core topics reading schedule. At the end of the day, go with what works best for you - youve already made it this far in school and probably have a good idea of how you study best.
ICU RECALL, 3E
Tribble: 978-0-7817-76530 2009 This edition includes new techniques for cardiac support, renal support, and immunosuppression and thoroughly updated information on pharmacology, radiology, and monitoring.
Favorite resources
Marissa: Blueprints Obstetrics and Gynecology & Step-Up to Medicine Arash: The Washington Manual of Medical Therapeutics was essential during my medicine rotation. I took it everywhere, used it for my presentations and for the shelf. I started every rotation by reading the Blueprints series, as it is very easy to read and covers the main subjects. Surgical Recall was always in my pocket. The question and answer format make it very easy to use whenever you have a few minutes to study, ex: between cases in the OR. Patrick: For third year you should always have Pocket Medicine in your coat at all times it will save you on rounds especially with internal medicine. For review during clerkships the Blueprints series, the Underground Clinical Vignettes series, and the Step-Up series were really helpful for me for different rotations. Look at each and see which one fits your learning style best. It is always a good idea to have a question book and the NMS series was very helpful for board review questions. Edwin: I really like that the Pocket Medicine handbook is a concise and organized resource that you can have with you all the time. For the diagnostic and treatment approach to common chief complaints and referrals, I find The Washington Manual series extremely helpful.
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FAMILY MEDICINE
ESSENTIALS OF FAMILY MEDICINE, 5E
Sloane: 978-0-7817-8188-6 2007 This updated Fifth Edition continues to serve as a comprehensive introduction to family medicine. Its user-friendly style makes the book a lasting companion tool to approaching diagnoses and treating common problems. Includes online access to the complete text plus a comprehensive exam.
AMBULATORY MEDICINE
IN A PAGE AMBULATORY MEDICINE
Kahan: 978-0-7817-6495-7 2007 Provides a quick overview of the diseases, symptoms, and injuries most commonly seen in outpatient settings. Each disease is presented on a two-page spread in boxes with consistent headings.
6E Available THE ONLY EKG Fall 2009 BOOK YOULL EVER NEED, 5E
Thaler: 978-0-7817-7315-7 2006 This popular and practical text presents all the information clinicians need to use the EKG in everyday practice.
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NEUROLOGY
BLUEPRINTS NEUROLOGY. 3E
Drislane: 978-0-78179685-9 2009 Key Points highlight the most important, high-yield information. 100 boardformat questions and answers with complete correct and incorrect answer explanations appearing at the end of the book.
RADIOLOGY
NEUROLOGY RECALL, 2E CLINICAL RADIOLOGY-THE ESSENTIALS, 3E
Daffner: 978-0-7817-99683 2007 Written for medical students by an experienced educator, this text covers the topics most often included in introductory radiology courses in an easy-to-read format. Organized by organ system, the text presents technical, anatomic, and pathologic aspects of each region, featuring high quality illustrations. Includes online access to the fully searchable text.
RADIOLOGY RECALL, 2E
Gay: 978-0-7817-6559-6 2007 Q&A format with questions on one side, answers on the other. Includes up-to-date info on CT, PET, interventional radiology and nuclear medicine
Miller & Fountain: 978-07817-4588-8 2003 The book is written by residents and clinicians and facilitates rapid review and memorization with a concise question-andanswer format covering the basic and specialized areas of neurology.
RADIOLOGY 101, 2E
Erkonen and Smith: 978-07817-5198-8 2004 Provides the basic groundwork necessary for interpreting imaging studies and understanding the functions of the various imaging modalities.
BLUEPRINTS RADIOLOGY, 2E
Uzelac: 978-1-4051-0460-9 2005 Covers the essentials that students need to know on rotations and while preparing for the USMLE.
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Steps 2 & 3
Ayala: Boards & Wards: A Review for USMLE Steps 2 & 3, 4E 978-0-7817-8743- 7 Taylor: Board Buster Clinical Cases, Steps 2 & 3 978-1-4051-0465-4
Step 3
Clement: Blueprints Q&A for Step 3 978-0-7817-7821-3 Rosner: NMS Review for USMLE Step 3, 2E 978-1-58255-833-2 Ryan: USMLE Step 3 Recall Audio Only: 978-0-7817-6658-6
Print & Audio Package: 978-0-7817-8731-4
Van Kleunen: Step-Up to USMLE Step 3 978-0-7817-7963-0 Wahl: Blueprints Computer-Based Case Simulation Review, USMLE Step 3 978-1-4051-0445-6
MCCQE Part 1
Chowdhury: Essentials for the Canadian Medical Licensing Exam: Review and Prep for MCCQE Part I 978-0-7817-7650-9
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Questions
From BOARDS and WARDS: A Review for USMLE Steps 2 &3, Fourth Edition
4.) An overweight 48-year-old patient, who has had multiple incidences of vaginitis, presents with a global darkening of her skin color. The patient was previously on the Atkins diet but denies any abnormal eating habits now. You recommend: A. insulin B. steroids C. hydroquinone cream D. increased exposure to sunlight E. phlebotomy F. full disclosure of diet 5.) A 17-year-old boy presents to your office after being injured during a football game. He describes being blocked on the lateral aspect of the knee while his foot was planted in the ground. He heard a pop and felt significant pain that required him to limp off the field and stop playing. Plain radiographs were negative for fracture. On physical examination, the knee is swollen and the lower leg is easily pulled forward from the upper leg when the patient is supine. The patient is scheduled for an MRI of the knee. Based on the history and physical examination, which three structures are likely to have been damaged during this injury? A. Anterior cruciate ligament (ACL), medial collateral ligament (MCL), and medial meniscus B. ACL, posterior cruciate ligament (PCL), and medial meniscus C. ACL, lateral collateral ligament (LCL), and lateral meniscus D. MCL, LCL, and medial meniscus E. MCL, LCL, and lateral meniscus 6.) A 4-year-old with Downs syndrome is brought to his primary care doctor by his parents because he has refused to walk. On physical exam, the patient is afebrile. There is no calor, rubor, or tumor on the legs. There is full range of motion passively and bilaterally, although the patient is irritable with the exam. No change is seen on x-ray. White count is elevated to 50,000. This is most likely: A. septic arthritis B. toxic synovitis C. leukemia D. pauciarticular juvenile rheumatoid arthritis E. a fussy child 7.) A 31-year-old patient comes in with complaints of blistering on her skin. On physical exam, you realize that the pattern of distribution is consistent with areas of sun exposure. When you ask about sun exposure, the patient shows a picture of her at the beach with her family. You observe that all of the siblings are hirsute. Which of the following tests would most likely aid in the diagnosis? A. Skin biopsy B. Skin biopsy with immunofluorescence C. Serum chromosomes D. Woods lamp of urine E. Urine porphyrobilinogen
1.) A 78-year-old man has a past medical history significant only for gastroesophageal reflux disease (GERD). He presents to the clinic complaining of mild abdominal pain, chronic fatigue, and increasing dyspnea on exertion. He denies hematemesis or black or bloody stools. Physical examination reveals generalized and conjunctival pallor. Stool is guaiac negative. Laboratory results are as follows: Hemoglobin: 8.4 g/dL MCV: 77.8 mm3 Ferritin: 5.2 mg/L Upper endoscopy reveals mild gastritis but is otherwise unremarkable. Which of the following is the most appropriate next course of action? A. Ferrous sulfate 325 mg PO qd and reassurance B. Ferrous sulfate 2 g IV 1 and reassurance C. Bone marrow biopsy D. Abdominal CT E. Colonoscopy 2.) A 25-year-old pregnant woman undergoes routine prenatal screening ultrasound. During the test, the technician incidentally notes the presence of multiple, small gallstones. The patient has never had any pain or other symptoms related to gallstones but seeks a surgical opinion on whether or not she should have her gallbladder removed. Which of the following would you advise? A. Her lifetime risk of developing biliary colic is approximately 5% B. Her lifetime risk of biliary colic is approximately 20% and she should not undergo cholecystectomy unless symptoms develop C. Her risk of developing biliary colic within the next year is approximately 20% D. She should wait until after pregnancy before undergoing elective laparoscopic cholecystectomy E. She should undergo immediate laparoscopic cholecystectomy to prevent acute cholecystitis 3.) The mother of a 3-year-old boy calls because her childs temperature is 104F. He has no rash or other symptoms. The past medical history is significant only for recent adoption from Romania. The mother is concerned about preventing febrile seizures. Which of the following could you tell her? A. Give acetaminophen right away B. Give ibuprofen right away C. Give aspirin right away D. As long as the child is not drowsy after a seizure, he will be fine E. Febrile seizures occur as the temperature is rising; therefore, now that the temperature is already high, the child is not at as great a risk
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Questions contd
8.) A 65-year-old nonsmoking man presents to the clinic complaining of itching and redness of his face and body. These symptoms worsen after he takes a warm shower. In addition, he has frequent headaches and occasional blurred vision. Physical examination reveals generalized plethora, engorged retinal veins, and splenomegaly. On peripheral blood smear, red cell morphology is normal, and many basophils are present. A CBC reveals the following: Hemoglobin: Hematocrit: Leukocytes: Platelets: 22.2 g/dL 64% 12,000/mL 221,000/mL
Answers
1.)E: Iron-deficiency anemia in adults must be assumed to result from occult gastrointestinal bleeding until proved otherwise. Colorectal cancer is an important cause of iron-deficiency anemia that should be ruled out by colonoscopy in this patient. Even if upper endoscopy reveals a possible source of bleeding, colonoscopy should also be performed to evaluate for iron-deficiency anemia. Because bleeding is likely to be intermittent, stool guaiac testing is insufficient to rule out colorectal cancer. A and B are incorrect because iron replacement alone does not evaluate the cause of bleeding. C. Bone marrow biopsy is unnecessary for the diagnosis of iron-deficiency anemia. D. Abdominal CT is insensitive for the detection of colorectal cancer unless it has metastasized to the liver or outside the bowel lumen. 2.) B: Asymptomatic gallstones are common, and the vast majority of patients with them will not develop pain or other symptoms. However, there is a 2% to 3% yearly risk and 20% lifetime risk of developing biliary colic. Surgical intervention is not necessary unless symptoms arise. A and C are incorrect because the lifetime risk of biliary colic is approximately 20%. D and E are incorrect because surgical intervention is not indicated unless symptoms arise. 3.) E: The explanation of why this answer is correct is stated in choice E: the child is not at risk A. Acetaminophen is a fine adjuvant and may make the child more comfortable, but it does not prevent febrile seizures. B. Answer A is also true for ibuprofen. C. Aspirin should only be given under doctors orders (as in the case of Kawasakis syndrome). D. Many children are drowsy after a seizure; this has no known prognostic value. 4.) A: This patient has bronze diabetes, or primary hemochromatosis, requiring early phlebotomy to improve patient survival. The classic triad indicating liver disease includes increased skin pigmentation, cirrhosis, and diabetes mellitus. Multiple bouts of vaginitis in a patient with acanthosis nigricans (skin darkening around the neck, flexor surfaces, and intertriginous areas) can be seen with diabetes. B. Steroids are used for patients with dermatomyositis. C. Hydroquinone cream can be used generically to lighten hyperpigmentation. D. Sunlight can alleviate pityriasis rosea or psoriasis (for which one therapy is PUVA [Psoralens and UV A light]). E. Patients can get an orangey appearance with excessive consumption of foods rich in b-carotene. 5.) A: These structures are known as the unhappy triad and often are injured during football games. High-impact force to the lateral knee stretches the structures that provide stability to the medial knee: the anterior cruciate ligament (ACL), medial collateral ligament (MCL), and medial meniscus. The anterior drawer sign indicates likely ACL injury and is present in this patient. B. Posterior cruciate ligament is more often injured during bent-knee trauma such as motor vehicle accidents. The posterior drawer sign is present rather than the anterior drawer sign. C. The lateral collateral ligament and lateral meniscus are unlikely to be damaged by trauma to the lateral knee. They are injured less often than the medial structures. D and E are incorrect because damage to both collateral ligaments is rare during a single injury. The lateral collateral ligament is the least-injured knee ligament because it is under less tension than the MCL.
Of the following, which is the most likely diagnosis? A. Chronic hepatic failure B. Chronic renal failure C. Idiopathic myelofibrosis D. Essential thrombocythemia E. Polycythemia vera 9.) A patient presents to your office one autumn afternoon inquiring if she should receive an influenza vaccine. Which of the following profiles would indicate giving the vaccine to your patient? A. She is 25 years old, with no medical problems who works in a publishing office B. She is a 45-year-old federal judge with well-controlled hypertension C. She is a 25-year-old medical student, with a documented allergy to chicken eggs D. She is a 66-year-old retired teacher who has emphysema E. She is 17 years old, with mild, intermittent asthma who is about to enter college
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