Henoch-Schonlein’s vasculitis is a type of vasculitis that affects small blood vessels, primarily in children. It is characterized by a purpuric rash, joint pain and swelling (arthritis), abdominal pain, and sometimes kidney involvement. The purpuric rash is typically located on the lower extremities and may also be present on the buttocks and ankles.

The guaiac-positive stool and presence of red blood cell casts and mild proteinuria on urinalysis suggest gastrointestinal and renal involvement, which are common in Henoch-Schonlein’s vasculitis. The normal platelet count distinguishes this condition from other forms of thrombocytopenic purpura.

Systemic lupus erythematosus (SLE) (B) is a chronic autoimmune disease that can affect various organs, including the skin, joints, and kidneys, but it is less likely to present with a purpuric rash and gastrointestinal symptoms.

Rocky Mountain spotted fever (C) is a bacterial infection transmitted by ticks that can cause fever, rash, and other symptoms, but it is less likely to present with joint pain and gastrointestinal symptoms.   Idiopathic thrombocytopenic purpura (D) is a condition characterized by low platelet count and purpura, but it is less likely to present with joint pain and gastrointestinal symptoms.

Poststreptococcal glomerulonephritis (E) is a type of glomerulonephritis that can occur after a streptococcal infection, but it is less likely to present with a purpuric rash and joint pain.   Therefore, based on the information provided, the most likely diagnosis for the child is Henoch-Schonlein’s vasculitis. It is important to seek prompt medical attention and treatment for this condition, which may include supportive care, nonsteroidal anti-inflammatory drugs (NSAIDs), and sometimes corticosteroids or other immunosuppressive drugs.

Ultrasound is a non-invasive imaging technique that uses high-frequency sound waves to create images of the inside of the body. It is a safe and effective method for detecting the location of the fetus in early pregnancy.

In this case, the woman has a positive pregnancy test and is experiencing slight dark bloody discharges and mild pains in the lower part of the abdomen. Bimanual investigation reveals a uterus indicating about 5-6 weeks of pregnancy, but there is also a retort-like formation in the left appendage, 7 x 5 cm large, mobile, and painless.

An ultrasound can be used to determine the location of the fetus, whether it is in the uterus or outside of it (such as in an ectopic pregnancy), and to evaluate the size and condition of the uterus and any other pelvic organs.

Hysteroscopy (B) is an invasive procedure that involves inserting a thin, lighted tube through the cervix to examine the inside of the uterus. It is not typically used to determine the location of the fetus in early pregnancy.

Hromohydrotubation (C) is a diagnostic procedure that involves injecting a contrast material into the uterus and fallopian tubes to evaluate their patency. It is not typically used to determine the location of the fetus in early pregnancy.

Colposcopy (D) is a procedure that involves examining the cervix and vagina with a special instrument called a colposcope. It is used to evaluate abnormal cervical cells, but it is not typically used to determine the location of the fetus in early pregnancy.

Cystoscopy (E) is a procedure that involves inserting a thin, lighted tube through the urethra to examine the inside of the bladder. It is not typically used to determine the location of the fetus in early pregnancy.   Therefore, based on the information provided, the most appropriate examination for detection of fetus localization in this case is ultrasound. It is important to consult with a qualified medical professional for an accurate diagnosis and appropriate treatment plan.

The woman is in her 40th week of pregnancy and the cervix is undeveloped. The negative oxytocin test indicates that the woman is not yet ready for labor. At 32 weeks, the woman had elevated blood pressure, proteinuria, and peripheral edema, which are signs of preeclampsia or gestosis.

Based on this information, the most appropriate tactic is to prepare the woman for labor and then initiate labor stimulation. This may involve cervical ripening with prostaglandin medications and then induction of labor with oxytocin. This approach can help to avoid complications associated with prolonged pregnancy, such as fetal distress or placental insufficiency, while also monitoring and managing the preeclampsia or gestosis.

Absolute bed rest for 1 month (B) is not appropriate in this case as it may increase the risk of thromboembolic events and other complications associated with prolonged bed rest. Moreover, the woman is already at 40 weeks of pregnancy and waiting for another month is not advisable.   Complex therapy of gestosis for 2 days (C) or 7 days (E) may not be sufficient to manage the preeclampsia or gestosis and prepare the woman for labor. Moreover, delaying labor induction may increase the risk of complications for both the mother and the baby.

Caesarean section immediately (D) is not recommended in this case as it may not be necessary and may increase the risk of complications associated with surgery.   Therefore, based on the information provided, the most appropriate tactic in this case is labor stimulation after preparation. It is important to consult with a qualified obstetrician for an accurate diagnosis and appropriate treatment plan.

Atony of the uterus refers to the failure of the uterus to properly contract after childbirth, which can lead to postpartum hemorrhage. This condition can be caused by a variety of factors, including prolonged labor, multiple pregnancies, oxytocin administration, and large fetal size.

In this case, the woman had her second labor within the last 2 years with oxytocin application and delivered a large baby weighing 4080 grams. After the delivery of the placenta, there was massive bleeding with signs of hemorrhagic shock, despite the introduction of contractive agents and good contraction of the uterus. Atony of the uterus is the most likely cause of bleeding in this scenario, even in the absence of any cervical and vaginal disorders.

Injury of cervix of the uterus (B) and hysterorrhexis (C) can also result in bleeding, but they are less likely in this case as there are no cervical or vaginal disorders reported.   Delay of the part of placenta (D) can cause bleeding, but it would typically occur before the delivery of the placenta and would be unlikely to continue after the placenta has been delivered.

Hypotonia of the uterus (E) is a less severe form of uterine atony and can also lead to postpartum hemorrhage, but it is less likely to cause massive bleeding and hemorrhagic shock.   Therefore, based on the information provided, the most probable cause of bleeding in this case is atony of the uterus. It is important to seek prompt medical attention and treatment for postpartum hemorrhage, which may include medications, uterine massage, and sometimes surgical intervention.

Metroendometritis is an infection of the endometrium and myometrium of the uterus that can occur after childbirth. Risk factors for metroendometritis include prolonged labor, premature rupture of membranes, and maternal infection.   In this case, the woman had a temperature rise up to 39oC on the first day after labor.

The examination of the bacterial flora of the cervix of the uterus revealed hemocatheretic streptococcus of A group. The uterus body is soft, tender, and discharges are bloody with admixtures of pus. These symptoms and findings are consistent with metroendometritis.   Thrombophlebitis of veins of the pelvis (B) is a less likely complication in this case, as there is no mention of symptoms such as pain, swelling, or redness in the legs.

Infectious hematoma (C) is also a less likely complication in this case, as there is no mention of a palpable mass or swelling in the pelvic area.   Infective contamination of the urinary system (D) is a less likely complication, as there is no mention of symptoms such as dysuria, urinary frequency, or urgency.

Apostasis of sutures after the episiotomy (E) is a less likely complication, as there is no mention of a perineal wound or sutures.   Therefore, based on the information provided, the most probable postnatal complication in this case is metroendometritis. It is important to seek prompt medical attention and treatment for this condition, which may include antibiotics, pain management, and supportive care.

Women with a history of chronic pyelonephritis are at increased risk for urinary tract infections (UTIs) during pregnancy and after delivery. UTIs can lead to complications such as pyelonephritis, which is a kidney infection that can cause fever, loin pain, and frequent urination.   In this case, the woman complained of fever and loin pains, as well as frequent urination, the day after delivery.

These symptoms are consistent with pyelonephritis or a UTI. Therefore, infectious contamination of the urinary system is the most probable complication in this case.   Thrombophlebitis of veins of the pelvis (B) is a less likely complication in this case, as loin pain and frequent urination are not typical symptoms of this condition.   Infectious hematoma (C) is also a less likely complication in this case, as there is no mention of a palpable mass or swelling in the pelvic area.

Endometritis (D) is a less likely complication in this case, as the symptoms are more consistent with a UTI than with an infection of the uterus.   Apostasis of sutures after the episiotomy (E) is not likely to cause fever or loin pain, and is therefore a less likely complication.

Therefore, based on the information provided, the most probable complication in this case is infectious contamination of the urinary system. It is important to seek prompt medical attention and treatment for UTIs and pyelonephritis, which may include antibiotics, pain management, and supportive care.

The second stage of labor begins when the cervix is fully dilated (10 cm) and ends with the delivery of the baby. Therefore, the beginning of the second stage of labor is defined by the onset of complete cervical dilation.

In this case, the woman is in her 39th week of pregnancy and is experiencing regular uterine contractions every 3 minutes. However, the information provided does not specify the degree of cervical dilation, so it cannot be assumed that the second stage of labor has begun.

Cervical smoothing over 90% (B) is a less precise criterion for the beginning of the second stage of labor, as it depends on the subjective assessment of the healthcare provider and may vary.   Duration of uterine contractions over 30 seconds (C) is not a precise criterion for the beginning of the second stage of labor, as uterine contractions can vary in duration and intensity throughout labor.

The presenting part being in the lower region of the small pelvis (D) is a sign that the baby is descending and progressing through the birth canal, but it does not necessarily indicate the beginning of the second stage of labor.

Rupture of the fetal bladder (E) is not a criterion for the beginning of the second stage of labor, as the onset of the second stage is defined by cervical dilation, not the rupture of membranes.   Therefore, based on the information provided, the criteria that describe the beginning of the second stage of labor most precisely is cervical dilation by no less than 4 cm. It is important to monitor the progress of labor and consult with a qualified healthcare provider for an accurate assessment and management.

Antenatal discharge of the amniotic waters refers to the rupture of the amniotic sac before the onset of labor. In this case, the 24-year-old primipara was hospitalized with complaints about the discharge of the amniotic waters, and internal examination revealed a 2.5 cm long, dense cervix with a closed external os and light amniotic fluid leakage.

The fact that the uterus is tonic on palpation and the position of the fetus is longitudinal with the head in the pelvic outlet suggests that labor may not have yet started. The rhythmical palpitation of the fetus at 140 bpm, auscultated on the left below the navel, is consistent with a normal fetal heart rate.

Early discharge of the amniotic waters (B) refers to the rupture of the amniotic sac before 37 weeks of gestation, which can lead to preterm labor. However, there is no information in this case to suggest that the patient is less than 37 weeks pregnant.   The beginning of the 1st stage of labor (C) is characterized by the onset of regular uterine contractions and cervical dilation. However, there is no mention of uterine contractions or cervical dilation in this case.

The end of the 1st stage of labor (D) is characterized by complete cervical dilation (10 cm) and the transition to the second stage of labor. However, there is no information in this case to suggest that the patient has completed the first stage of labor.   Pathological preterm labor (E) is labor that begins before 37 weeks of gestation and is associated with various maternal and fetal complications. However, there is no information in this case to suggest that labor has begun or that the patient is less than 37 weeks pregnant.

Therefore, based on the information provided, the correct component of the diagnosis is antenatal discharge of the amniotic waters. It is important to monitor the patient closely for signs of infection or preterm labor and to provide appropriate management and care.

Hormonotherapy may be necessary to regulate hormonal imbalances that may have been caused by the tumor or the surgery. Proteolytic enzymes may be prescribed to aid in the healing process and to reduce inflammation.

Antibacterial therapy (B) may be necessary if there is an infection present, but there is no information in this case to suggest that the patient has an infection.   Laser therapy and enzymotherapy (C) are not typically prescribed for the rehabilitational period following surgery for a benign ovarian tumor.

Magnitotherapy and vitamin therapy (D) may be helpful in certain cases, but there is no information in this case to suggest that the patient requires these therapies.   The patient does require further care (E) after surgical treatment for a benign ovarian tumor, but the specific care required will depend on the individual patient’s needs and the details of their case.

Therefore, based on the information provided, it is necessary to prescribe hormonotherapy and proteolytic enzymes for the rehabilitational period following surgical treatment for a benign serous epithelial tumor of an ovary. It is important to consult with a qualified healthcare provider for an individualized treatment plan and appropriate management.

The middle clavicular line is an imaginary line that runs vertically down the center of the clavicle. The 2nd intercostal space is located just below the 2nd rib. This site is the recommended location for pleural puncture to drain the pleural cavity in cases of pneumothorax.

The other options listed are not the recommended locations for pleural puncture in this case:   B) In the 6th intercostal space along the posterior axillary line is a location that may be used for chest tube insertion in some cases of pleural effusion, but is not the recommended location for pleural puncture in pneumothorax due to rib fracture.

C) In the 7th intercostal space along the scapular line is a location that may be used for chest tube insertion in some cases of pleural effusion, but is not the recommended location for pleural puncture in pneumothorax due to rib fracture.

D) In the projection of pleural sinus is not a specific location for pleural puncture and may not be appropriate for drainage in pneumothorax due to rib fracture.   E) In the point of the greatest dullness on percussion is not a specific location for pleural puncture and may not be appropriate for drainage in pneumothorax due to rib fracture.

Therefore, based on the information provided, the pleural puncture for drainage of pleural cavity in this patient with right-sided pneumothorax due to rib fracture should be made in the 2nd intercostal space along the middle clavicular line. It is important to consult with a qualified healthcare provider for appropriate management and care.

The clinical presentation described in this case is consistent with severe preeclampsia, a potentially life-threatening complication of pregnancy. The appropriate medication to administer in this case is A) Droperidolum of 0.25% – 2.0 ml.

Droperidolum is an antipsychotic medication that can be used to manage the neurological symptoms associated with severe preeclampsia, such as headache and seizures. The dosage of 0.25% – 2.0 ml is appropriate for this patient based on the information provided.

Dibazolum (B) is a vasodilator that can lower blood pressure, but it is not the first-line treatment for severe preeclampsia.   Papaverine hydrochloride (C) is also a vasodilator that is not typically used for the management of severe preeclampsia.

Hexenalum (D) is a sedative that is not typically used for the management of severe preeclampsia.   Pentaminum (E) is a medication used for the treatment of heart failure and is not appropriate for the management of severe preeclampsia.

Therefore, based on the information provided, the appropriate medication to administer in this case is droperidolum of 0.25% – 2.0 ml to manage the neurological symptoms associated with severe preeclampsia. It is important to consult with a qualified healthcare provider for appropriate management and care in cases of severe preeclampsia.

The most often symptoms that precede the malignization in changes of the mammary gland in a 40-year-old woman is A) skin induration with inverted nipple.   Skin induration or thickening, along with an inverted nipple, can be early signs of breast cancer. Inverted nipple means that the nipple, which normally protrudes outwards, is pulled inwards or pointed inwards.

Painful movable induration (B) and painless movable induration (C) are also symptoms that can occur in breast cancer, but they are not necessarily early signs that precede malignization.   Bloody discharges from the nipple (D) are typically a later sign of breast cancer and may not occur until the cancer has progressed.

Pure discharges from the nipple (E) are more commonly associated with benign breast conditions, such as fibrocystic breast changes, and are not necessarily an early sign of breast cancer.   Therefore, based on the information provided, the most often symptom that precedes the malignization in changes of the mammary gland in a 40-year-old woman is skin induration with inverted nipple. It is important to consult with a qualified healthcare provider for appropriate management and care in cases of breast changes.

In a patient who takes diuretics and has developed arrhythmia as a result of cardiac glycoside overdose, the appropriate treatment tactic is to increase potassium concentration in the blood. Therefore, the correct answer is A) Increased potassium concentration in blood.

Cardiac glycosides, such as digoxin, work by increasing the force and efficiency of heart contractions. However, they can also cause arrhythmias, especially when taken in excess. Diuretics can exacerbate this effect by reducing potassium levels in the blood.

Increasing potassium levels in the blood can help counteract the effects of cardiac glycoside overdose and reduce the risk of arrhythmias. This can be done by administering potassium supplements or increasing the patient’s intake of potassium-rich foods.

Increased sodium concentration in blood (B) is not an appropriate treatment tactic in this case, as it can exacerbate the effects of cardiac glycoside overdose.   Reduced magnesium concentration in blood (C) is also not an appropriate treatment tactic, as magnesium is necessary for proper heart function and reducing magnesium levels can worsen arrhythmias.

Increased calcium concentration in blood (D) is also not an appropriate treatment tactic, as it can exacerbate the effects of cardiac glycoside overdose and increase the risk of arrhythmias.   Therefore, based on the information provided, the appropriate treatment tactic in a patient who takes diuretics and has developed arrhythmia as a result of cardiac glycoside overdose is to increase potassium concentration in the blood. It is important to consult with a qualified healthcare provider for appropriate management and care in cases of cardiac glycoside overdose and arrhythmias.

The onset of severe preeclampsia at 16 weeks gestation might be caused by A) hydatidiform mole.   A hydatidiform mole is a type of gestational trophoblastic disease that occurs when the fertilized egg develops into a mass of abnormal cells in the uterus instead of a normal embryo and placenta.

This can cause early-onset severe preeclampsia.   Anencephaly (B), twin gestation (C), maternal renal disease (D), and interventricular defect of the fetus (E) are not typically associated with early-onset severe preeclampsia.

Therefore, based on the information provided, the onset of severe preeclampsia at 16 weeks gestation might be caused by a hydatidiform mole. It is important to consult with a qualified healthcare provider for appropriate management and care in cases of severe preeclampsia.

In a 9-year-old girl with a history of intermittent wheezing who presents with agitation, perioral cyanosis, intercostal and suprasternal retractions, and bilateral wheezing, appropriate interventions might include all of the following except A) prescribe nebulized cromolyn sodium.

Cromolyn sodium is a medication used for the prevention of asthma attacks and is not recommended for the treatment of acute severe asthma attacks. Therefore, it would not be an appropriate intervention in this case.

Intravenous aminophylline (B), supplemental oxygen (C), intravenous corticosteroids (D), and nebulized metaproterenol (E) are appropriate interventions for the treatment of acute severe asthma attacks.   Intravenous aminophylline is a bronchodilator that can be used to relax the smooth muscles of the airways and improve breathing.

Supplemental oxygen can help increase the oxygen saturation in the blood and reduce the risk of complications. Intravenous corticosteroids can help reduce inflammation in the airways and improve breathing. Nebulized metaproterenol is a bronchodilator that can help relax the smooth muscles of the airways and improve breathing.

Therefore, based on the information provided, the inappropriate intervention in this case would be to prescribe nebulized cromolyn sodium. It is important to consult with a qualified healthcare provider for appropriate management and care in cases of acute severe asthma attacks.

In an otherwise healthy child with a history of bronchial asthma who presents with a blood pressure of 140/90 mm Hg, the most likely cause of the hypertension is A) renal disease.   Hypertension in children is usually secondary to an underlying medical condition.

The most common cause of hypertension in children is renal disease, which can be due to a variety of conditions such as renal artery stenosis, glomerulonephritis, or polycystic kidney disease.   Theophylline toxicity (B) can cause a variety of symptoms, including nausea, vomiting, tremors, and seizures, but it is not typically associated with hypertension.   Chronic lung disease (C) such as asthma can cause pulmonary hypertension, but this is not typically associated with systemic hypertension.

Coarctation of the aorta (D) can cause hypertension in children, but it is usually associated with other symptoms such as leg cramping, cold feet, and a weak or absent pulse in the legs.   Obesity (E) can also cause hypertension in children, but it would not be the most likely cause in an otherwise healthy child with a history of bronchial asthma.

Therefore, based on the information provided, the most likely cause of hypertension in an otherwise healthy child with a history of bronchial asthma and a blood pressure of 140/90 mm Hg is renal disease. It is important to consult with a qualified healthcare provider for appropriate management and care in cases of hypertension in children.

To compare the degree of variability of the signs, the appropriate criterion is A) coefficient of variation.   The coefficient of variation (CV) is a statistical measure that compares the standard deviation of a variable to its mean. It is often used to compare the variability of different variables, such as body length and mass in this case, because it allows for the comparison of variables with different units of measurement.

The formula for calculating the coefficient of variation is:   CV = (standard deviation / mean) x 100%   By calculating the coefficient of variation for both body length and mass, we can compare the degree of variability of these signs.   Sigma (B) is a symbol used to represent the standard deviation in statistics, but it is not a criterion for comparing the variability of different signs.

Limit (C) is not a statistical measure used to compare the variability of different signs.   Amplitude (D) is a measure of the range of values for a variable, but it does not take into account the mean or standard deviation and is not suitable for comparing the variability of different signs.

Coefficient of association (E) is a measure of the strength and direction of the relationship between two variables, but it is not used to compare the variability of different signs.   Therefore, based on the information provided, the appropriate criterion for comparing the degree of variability of body length and mass in newborn boys is the coefficient of variation.

The appropriate method to establish the rate of correlation between age of men and their mortality due to myocardial infarction is A) Method of grade correlation (Spearman).   The method of grade correlation, also known as the Spearman rank correlation coefficient, is a statistical measure used to assess the strength and direction of the relationship between two variables.

It is a nonparametric measure that does not require the assumption of a linear relationship between the variables and is often used when the data is not normally distributed.

In this case, the age of men and their mortality due to myocardial infarction are two variables that may have a non-linear relationship. The Spearman rank correlation coefficient would be an appropriate method to establish the rate of correlation between these variables.

Correlation ratio (B), the quadrate method (C), the indirect method (D), and the graduated correlation method (E) are not appropriate methods for establishing the rate of correlation between these variables.   Therefore, based on the information provided, the appropriate method to establish the rate of correlation between age of men and their mortality due to myocardial infarction is the method of grade correlation (Spearman).

Adenosine triphosphate (ATP) may be expected to convert A) paroxysmal supraventricular tachycardia (PSVT) to sinus rhythm.

PSVT is a type of arrhythmia that originates above the ventricles, usually in the atria. It is often caused by reentry circuits or accessory pathways within the atrioventricular node or atrial tissue. Adenosine is a medication that works by blocking the atrioventricular node and interrupting the reentry circuits, which can convert PSVT to sinus rhythm.

Paroxysmal ventricular tachycardia (B) is a type of arrhythmia that originates in the ventricles, and it is not typically responsive to adenosine.   Atrial fibrillation (C) and atrial flutter (D) are types of arrhythmias that originate in the atria and are not typically responsive to adenosine.

Ventricular fibrillation (E) is a life-threatening arrhythmia that originates in the ventricles, and it is not typically treated with adenosine.   Therefore, based on the information provided, adenosine triphosphate may be expected to convert paroxysmal supraventricular tachycardia to sinus rhythm. It is important to consult with a qualified healthcare provider for appropriate management and care in cases of arrhythmias.

The possible causes to consider in a 48-year-old man with fatigue, shortness of breath, macrocytosis, low hemoglobin, low serum vitamin B12 level, and low serum folate level include all of the following except A) colonic diverticulitis.

Colonic diverticulitis (A) is not typically associated with vitamin B12 or folate deficiencies.   Vegetarianism (B) can lead to vitamin B12 deficiency if the individual is not consuming adequate amounts of vitamin B12 from fortified foods or supplements.

Regional enteritis (C), also known as Crohn’s disease, is a type of inflammatory bowel disease that can cause malabsorption of vitamin B12 and folate.   Pancreatitis (D) can lead to malabsorption of nutrients, including vitamin B12 and folate.

Fish tapeworm infection (E) can cause vitamin B12 deficiency due to competition for the nutrient and subsequent malabsorption.   Therefore, based on the information provided, the possible causes to consider in this case include vegetarianism, regional enteritis, pancreatitis, and fish tapeworm infection. Colonic diverticulitis is not typically associated with vitamin B12 or folate deficiencies. It is important to consult with a qualified healthcare provider for appropriate diagnosis and management of these conditions.

Based on the clinical presentation and findings, the most likely diagnosis for the 56-year-old man is A) arterial septal defect (ASD).   ASD is a congenital heart defect that results in an opening between the left and right atria of the heart. The symptoms of ASD may not appear until adulthood, and they can include fatigue, dyspnea on exertion, and palpitations.

The murmur heard in ASD is typically a grade 2-3/6 mid-systolic ejection murmur heard at the left upper sternal border. In addition, ASD may cause right ventricular enlargement and prominent pulmonary arteries seen on a chest x-ray. The fixed splitting of S2 is a characteristic finding in ASD due to the increased blood flow across the pulmonary valve.

Coarctation of the aorta (B), patent ductus arteriosus (C), tetralogy of Fallot (D), and ventricular septal defect (E) are other congenital heart defects that can cause murmurs and other symptoms, but they would not typically present with the same clinical findings as seen in this case.

Therefore, based on the information provided, the most likely diagnosis for the 56-year-old man is arterial septal defect (ASD). It is important to consult with a qualified healthcare provider for appropriate management and care in cases of congenital heart defects.

Generalized low voltage on an ECG (QRS deflection < 5 mm in limb leads and < 10 mm in precordial leads) may be a marker for all of the following disorders EXCEPT A) hyperthyroidism.   Generalized low voltage on an ECG is a finding that can be seen in a variety of conditions that affect the heart or the body as a whole.

Some of the conditions that can cause this finding include pericardial effusion (B), cardiac transplant rejection (C), amyloidosis (D), and coronary artery disease (E).   Hyperthyroidism (A) is not typically associated with generalized low voltage on an ECG, and this finding would not be considered a marker for this condition.

Therefore, based on the information provided, generalized low voltage on an ECG may be a marker for pericardial effusion, cardiac transplant rejection, amyloidosis, and coronary artery disease, but it would not typically be associated with hyperthyroidism. It is important to consult with a qualified healthcare provider for appropriate diagnosis and management of these conditions.

Based on the clinical presentation and findings, the most likely diagnosis for the 72-year-old woman is A) pulmonary thromboembolism (PTE).   PTE is a serious condition in which a blood clot blocks one or more pulmonary arteries in the lungs, leading to acute shortness of breath, hypotension, and diaphoresis. The physical examination finding of mild jugular venous distension with prominent A waves is consistent with right heart strain due to the increased resistance from the blocked pulmonary arteries.

The ECG findings of sinus tachycardia with a new right bundle branch block and minor nonspecific ST-T wave changes are also consistent with right heart strain.   Acute myocardial infarction (B) typically presents with chest pain or discomfort, and the ECG findings would show ST-segment elevation or new Q waves.

Aortic dissection (C) can present with sudden onset of severe chest or back pain, and the physical examination findings may include differences in blood pressure between the arms and potentially aortic regurgitation or murmur.

Pericarditis (D) can cause chest pain, but it would not typically present with acute shortness of breath and hypotension. The physical examination findings may include a pericardial friction rub.   Aspiration (E) can cause respiratory symptoms, but it would not typically present with acute hypotension and diaphoresis.   Therefore, based on the information provided, the most likely diagnosis for the 72-year-old woman is pulmonary thromboembolism (PTE). It is important to consult with a qualified healthcare provider for appropriate management and care in cases of PTE.

The child is 6 years old and had a URI (upper respiratory infection) that lasted 8 days within the past year, but their physical state is currently satisfactory. According to the World Health Organization’s classification system for child health, this child would fall under group I, which represents children with no signs of any nutritional deficiencies or chronic diseases.

Groups II, III (a), III (b), and III (c) are used to classify children with varying degrees of malnutrition, chronic diseases, or disabilities, and the child in this scenario does not meet the criteria for any of these groups.   Therefore, based on the information provided, the child’s health group can be classified as I. It is important to continue monitoring the child’s health and seeking appropriate medical attention as needed.

Addison’s disease is a disorder that occurs when the adrenal glands do not produce enough cortisol and aldosterone. The symptoms of Addison’s disease can vary, but some common features include fatigue, weakness, weight loss, and low blood pressure. In addition, the following laboratory abnormalities are typically seen in Addison’s disease:   A. High serum Na+: This is NOT typical for Addison’s disease. Instead, hyponatremia (low serum sodium) is commonly seen due to the loss of salt in the urine.

B. High serum K+: This is a typical finding in Addison’s disease, as the lack of aldosterone can lead to hyperkalemia (high serum potassium).

C. Elevated BUN: This is a typical finding in Addison’s disease, as dehydration and decreased renal perfusion can lead to increased blood urea nitrogen (BUN).   D. Dilute urine: This is a typical finding in Addison’s disease, as the lack of aldosterone can impair the ability of the kidneys to concentrate urine.

E. Elevated hematocrit: This is a typical finding in Addison’s disease, as the lack of cortisol can lead to an increase in erythropoietin production, which stimulates the bone marrow to produce more red blood cells.   Therefore, based on the information provided, the laboratory abnormality that is NOT typical for Addison’s disease is A) high serum Na+.

Based on the clinical presentation and findings, the most likely diagnosis for the 38-year-old man is A) left-sided renal colic.   Renal colic is a condition in which a kidney stone becomes lodged in the ureter, causing severe pain that can radiate from the back or flank to the groin.

The pain is typically accompanied by other symptoms, such as nausea, sweating, and the need for frequent urination. The restlessness and tossing in bed that the patient is experiencing are also typical of renal colic.

• Herpes zoster (B) can cause pain and a rash in a specific dermatomal distribution, but it would not typically present with severe abdominal pain or the need for frequent urination.
• Sigmoid diverticulitis (C) can cause abdominal pain and tenderness, but it would not typically radiate to the groin or cause the need for frequent urination.
• Torsion of the left testicle (D) can cause severe scrotal pain and swelling, but it would not typically present with abdominal pain or the need for frequent urination.
• Retroperitoneal hemorrhage (E) can cause severe abdominal pain, but it would not typically present with the need for frequent urination or the radiating pain to the groin.

Therefore, based on the information provided, the most likely diagnosis for the 38-year-old man is left-sided renal colic. It is important to consult with a qualified healthcare provider for appropriate management and care in cases of renal colic.

Based on the clinical presentation, the procedure of choice for confirming the diagnosis of a self-detected hard breast mass in a 40-year-old woman is A) excision biopsy.

Excision biopsy is the gold standard for diagnosing breast cancer, as it involves removing the entire mass and examining it under a microscope for the presence of cancerous cells. This procedure is typically performed under local anesthesia in an outpatient setting.

Mammography (B) and ultrasonography (D) are imaging studies that can help detect breast abnormalities, but they cannot definitively diagnose breast cancer. These studies may be used in conjunction with other diagnostic tests, such as biopsy, to help confirm the diagnosis.   Thermography (C) is a non-invasive imaging test that uses infrared technology to detect changes in temperature on the skin surface of the breast.

However, it is not considered a reliable diagnostic tool for breast cancer.   Aspiration biopsy with cytology (E) involves using a needle to extract a small sample of cells from the breast mass and examining them under a microscope for the presence of cancerous cells. While this procedure can be useful in some cases, it is not as reliable as excision biopsy for diagnosing breast cancer.

Therefore, based on the information provided, the procedure of choice for confirming the diagnosis of a self-detected hard breast mass in a 40-year-old woman is excision biopsy. It is important to consult with a qualified healthcare provider for appropriate diagnosis and management of breast abnormalities.