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June 2005, Volume 35 Number 6 , p 70 - 71




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    1. An 80-year-old retired secretary comes to the ED because of difficulty having a bowel movement, saying that “it feels as if something's coming out.” She denies fever, chills, or weight loss. She's been constipated and has used an over-the-counter stool softener and increased her water intake. She denies pain with defecation. On physical examination of the anus, you see a doughnut of red tissue, with concentrically circular folds where the anus should be. What's the most likely diagnosis?

    a. thrombosed external hemorrhoid

    b. anal fissure

    c. rectal prolapse

    d. rectal cancer

    2. A 68-year-old retired kindergarten teacher has a swollen right arm. She recently had a mastectomy for right-sided ductal carcinoma in situ. What's the most likely diagnosis?

    a. orthostatic edema

    b. lymphedema

    c. lipedema

    d. chronic venous insufficiency

    3. In the ICU, you're preparing to obtain an arterial blood gas specimen from a patient's right wrist. First, you perform a physical examination maneuver to assess the patency of the ulnar artery. What's the name of this test?

    a. Murphy's test

    b. Phelan's test

    c. Allen's test

    d. obturator test

    4. A 55-year-old construction worker has swollen feet and reports pain in both legs when walking. The pain eases when he rests for 10 minutes. He's smoked two packs of cigarettes daily since age 15. On physical examination, you note that his dorsalis pedis pulses are decreased bilaterally in comparison with his femoral pulses. His feet are cool to the touch compared with his upper legs. He has no pedal edema. What's the most likely diagnosis?

    a. deep vein thrombosis

    b. arterial insufficiency

    c. venous insufficiency

    d. peripheral neuropathy

    5. A 62-year-old accountant has had ...

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