2.A 7-year-old female is brought to your office by her mother, who says that the child has developed underarm odor and is beginning to develop acne. The patient has an unremarkable history, was born at full term, and has no chronic medical problems. There is no family history of endocrine disorders or precocious puberty.

An examination reveals normal vital signs and a normal BMI, and her height is stable on the growth curve with no increased velocity. Her sexual maturity rating is stage 1. She has some open and closed comedones on her forehead and back.

Which one of the following would be most appropriate at this point?  (check one)

An otherwise asymptomatic 7-year-old male has a blood pressure above the 95th percentile for gender, age, and height on serial measurements. Which one of the following studies would be most appropriate at this time?  (check one)

A 58-year-old female presents to your office after being seen in the emergency department last weekend for her first episode of renal colic. After undergoing CT urography she passed a calcium phosphate kidney stone. Which one of the following medications in her current regimen places her at higher risk for kidney stone formation?  (check one)

A 30-year-old female presents with pain over the proximal fifth metatarsal after twisting her ankle. Radiographs reveal a nondisplaced tuberosity avulsion fracture of the fifth metatarsal.Which one of the following would be the most appropriate initial management?  (check one)

A 48-year-old male presents with psychogenic erectile dysfunction in conjunction with depression. You decide that treatment of his underlying mood disorder is the best initial step. Which one of the following antidepressants would be most appropriate?  (check one)

Which one of the following is an indication for considering atrial ventricular nodal ablation in a patient with atrial fibrillation?  (check one)

A 34-year-old female presents to your office after she was bitten on the hand by a neighbor’s cat. The patient has no allergies and has been in good health. You decide to treat the patient with a prophylactic antibiotic.

Which one of the following would be the antibiotic of choice?  (check one)

Which one of the following is the leading cause of human death in the world as a whole?  (check one)

•A 25-year-old female who is 3 months post partum presents with multiple complaints, including increasing weakness and fatigue, intolerance to warm environments, a weight loss of 30 lb despite an increased appetite, difficulty sleeping, awareness that her heart is beating faster and “pounding” in her chest, increasing restlessness and difficulty concentrating, increased tremulousness, and a significant swelling in her neck. She takes no medication, has experienced no recent trauma, and has not ingested large amounts of iodine. When you examine her you find no exophthalmos or lid lag and no pretibial edema, but her skin is warm, smooth, and moist. You also find a smooth, non-nodular, nontender, enlarged thyroid gland, clear lungs, a resting tremor, and hyperactive reflexes. Laboratory testing reveals a low TSH level, elevated free T3 and free T4, and high uptake on a radioactive iodine uptake scan.

Which one of the following is the most likely diagnosis?  (check one)

A healthy 49-year-old female presents to your office for a routine health maintenance visit. Since her last visit a year ago she has had only two menstrual periods. She reports sudden sensations of extreme heat in her face, neck, and chest that last just a few minutes but occur throughout the day. These symptoms are very bothersome and interfere with the quality of her sleep.

A 30-year-old female presents for follow-up after an emergency department visit for an episode of symptomatic supraventricular tachycardia that was diagnosed as Wolff-Parkinson-White syndrome. Which one of the following would be most appropriate for the initial long-term management of this patient?  (check one)