A 65-year-old man presents with a long-standing history of poorly controlled acid reflux symptoms. He uses over-the-counter

omeprazole, which partially relieves his symptoms. He reports consuming approximately 30 mL of whiskey per day.

His BMI is 35; otherwise, his physical examination is unremarkable. He had an upper endoscopy 6 months ago, which showed evidence of a hiatal hernia and Barrett esophagus with high-grade dysplasia. A carbon-13 urea breath test is positive. For which type of cancer is this patient most at risk?

A 55-year-old woman with a history of dry eyes and hypothyroidism is found to have an isolated elevated serum alkaline phosphatase

level. Her serum aminotransferase, total bilirubin, and albumin levels are normal. She does not have abdominal pain. Her only medication

is levothyroxine. She does not use over-the-counter medications or any complementary or alternative therapy. Examination reveals no hepatosplenomegaly or features of chronic liver disease. Her repeat serum alkaline phosphatase level is 180 U/liter (reference range, 30–120), and her level of bone-specific alkaline phosphatase is normal. Which one of the following tests is most likely to be diagnostic in this case?

A 66-year-old man with hypertension, hyperlipidemia, and documented coronary artery disease returns to discuss the results of a fasting

lipid panel. He is feeling well. His current medications include aspirin 81 mg once daily, simvastatin 40 mg once daily, atenolol 50 mg

once daily, and lisinopril 20 mg once daily. Laboratory testing reveals lipid values of 203 mg/dL for total cholesterol, 125 mg/dL for LDL cholesterol, 40 mg/dL for HDL cholesterol, and 190 mg/dL for triglycerides.

In addition to reinforcing recommended therapeutic lifestyle changes, which one of the following management approaches is most

appropriate for this patient?

A 64-year-old woman with hypertension and osteoarthritis reports 2 weeks of epigastric pain that worsens with eating, as well as

several episodes of dark stools. She has been restricting her oral intake because of the pain and has lost 2.7 kg of body weight. She takes

hydrochlorothiazide regularly and has been taking ibuprofen 600 to 800 mg three times daily for the past 3 months for pain related to

her arthritis. She smokes a half-pack of cigarettes daily, drinks no alcohol, and identifies as non-Hispanic white on the patient intake questionnaire. She is not aware of any family history of peptic ulcer disease or gastric cancer. On physical examination, she is afebrile with a blood pressure of 120/65 mm Hg, a heart rate of 75 beats per minute, and an oxygen saturation of 98% while she breathes ambient air. She has tenderness to palpation in the epigastric area without rebound or guarding. Rectal examination reveals black stool and no masses.

Which one of the following diagnoses is most likely in this case?

A 50-year-old man with a history of mild chronic obstructive pulmonary disease presents to the emergency department during influenza

season with 2 days of fever, chills, myalgias, dry cough, and dyspnea. On examination, he has a temperature of 38.5°C, a blood pressure of 140/90 mm Hg, a heart rate of 104 beats per minute, a respiratory rate of 24 breaths per minute, and an oxygen saturation of 93% while he is breathing ambient air. Pulmonary examination reveals scattered expiratory wheezes and fine crackles in the right upper lobe. Rapid testing for influenza A is positive. A chest radiograph reveals no focal opacities. The patient is given prednisone and inhaled bronchodilators.

Which one of the following treatments is most appropriate for this patient's influenza?

A 77-year-old man returns for follow-up after a workup for dyspnea and weight loss revealed diffusely metastatic lung cancer. Three

days earlier, his oncologist informed him that his prognosis was poor, estimating his survival at “weeks to months.” Since that

appointment, he has been tearful, thinking about the things that he will never get a chance to experience. He reports some difficulty

sleeping, low energy, difficulty concentrating, and a loss of appetite. He has not informed his wife or children of his diagnosis or

prognosis.

Which one of the following statements is most appropriate to facilitate the coping process and minimize distress in this patient?

A 44-year-old man with HIV infection seeks advice about HIV treatment and initiation of antiretroviral therapy. He feels well, has never taken antiretrovirals, and has a CD4 count of 450 cells per mm (reference range, 400–1600) and an HIV viral load of 10,000 copies/mL. An HIV genotype shows no resistance mutations. Baseline laboratory results are normal.

Which one of the following management approaches is most appropriate for this patient?

A young man, 18 years of age, presents 2 days after feeling a pop along the back of his thigh while running. The pain, which prevented

him from returning to activity, is exacerbated by ambulation. Nonsteroidal antiinflammatory medications have provided some relief.

He has tenderness and visible ecchymosis along the posterior-medial aspect of his upper leg; there is no tenderness at the ischial

tuberosity. Resisted knee flexion demonstrates minor weakness and reproduces the pain.

Which one of the following next steps is most appropriate for this patient?

A 59-year-old man with gout who has been prescribed allopurinol, 300 mg daily, for 5 years reports 2 days of pain and swelling in his

right first metatarsophalangeal joint and generally throughout his right foot. This is his typical location for gout. He reports feeling well,

except for the localized pain and swelling, and has had no fevers or chills. This is his first gout flare in 3 years. Laboratory testing 6

months ago identified a uric acid level of 4.2 mg/dL (reference range, 2.5–8.0). Physical examination reveals swelling, erythema, limited range of motion of the right first metatarsophalangeal joint, swelling and erythema in the midfoot, difficulty with eversion and inversion of the foot, and pain on ambulation. The patient is afebrile and has normal vital signs.

The flare resolves with colchicine treatment. When the patient returns for follow-up 2 weeks later, his uric acid level is 10.2 mg/dL.

Which one of the following factors is most likely to have caused this patient’s flare?