A 27-year-old woman, gravida 2, para 1, at 20 weeks' gestation comes to the physician for a
prenatal visit. She has no complaints. Her obstetric history is significant for a primary low
transverse cesarean delivery because of a non-reassuring fetal tracing 3 years ago. She has no
medical problems. She takes prenatal vitamins and has no known drug allergies. She is debating
whether to have an elective repeat cesarean delivery or to attempt a vaginal birth after cesarean
(VBAC). She wants to know her chances for a successful VBA
C. Which of the following most accurately represents the patient's likelihood of having a
successful vaginal delivery?

A 7-year-old boy is brought to the clinic for a lifetime history of bedwetting. He has otherwise
been completely healthy and has met all development milestones. His parents deny a history of
trauma, and the history is not consistent with abuse. The patient has been wetting every night but
not during the daytime. He has no incontinence. Which of the following is the most appropriate
next step in his evaluation?

A 35-year-old man comes to the physician for a health maintenance examination. He
received blood transfusions for hypovolemic shock following a gunshot wound 10 years earlier.
He is currently in good health, and physical examination is unremarkable. A serum chemistry
panel shows:
ALT 250 U/L
AST 140 U/L
Alkaline phosphatase 70 U/L
Serologic evaluation for viral hepatitis reveals positive antibodies to hepatitis C virus (HCV). A
percutaneous liver biopsy shows marked portal inflammatory infiltrate disrupting the limiting
plate of hepatic lobules. Which of the following is the incidence rate of this complication
following HCV infection?

A 29-year-old patient comes to the physician for an annual examination. She has normal
menstrual periods every 30 days. She was 15 years old when she first began having intercourse.
She uses condoms for contraception. Her past medical history is significant for multiple
sclerosis. This condition has required her to use a wheelchair for the past 4 years, which makes
pelvic examination somewhat difficult for her. She smokes one pack of cigarettes per day. Given
her difficulty with the pelvic examination, she inquires as to how often she needs to have a Pap
smear performed. Which of the following is the correct answer?

A 32-year-old nulliparous woman at 38 weeks' gestation comes to the labor and delivery
ward with regular painful contractions after a gush of fluid two hours ago. Her temperature is
98.6 F (37 C). She is found to have gross rupture of membranes and to have a cervix that is 6
centimeters dilated. The fetus is in breech position. The patient is then brought to the operating
room for cesarean delivery. Which of the following represents the correct procedure for
antibiotic administration?

A 14-year-old girl comes to the physician for an annual examination. She has no complaints.
She became sexually active during the past year and uses condoms occasionally for
contraception. She has asthma, for which she occasionally takes an albuterol inhaler. She had an
appendectomy at age 9. Physical examination is unremarkable including a normal pelvic
examination. When should this patient begin having Pap testing?

A 42-year-old man presents for his annual physical examination. He was last seen 2 years
ago for a periodic health examination and was in good health. He is on no medications. His past
medical history is significant for a cholecystectomy 2 years ago and rheumatic fever at age 15.
He has been smoking approximately ten cigarettes daily for the past 23 years. On physical
examination, his blood pressure is 154/56 mm Hg, pulse is 68/min, and respirations are 14/min.
He is afebrile. A head and neck examination is normal. His lungs are clear. He has a regular
heart rhythm, with a II/IV blowing decrescendo diastolic murmur heard at the aortic area. His
abdominal and rectal examinations are normal. Complete blood count, electrolytes, and thyroid
function tests are normal. Which of the following is the most appropriate advice for this man
regarding future preventive health maintenance?

An 8-month-old boy is diagnosed with obstructive hydrocephalus. He was born prematurely
after a 26-week gestation to a 25-year-old primigravida and developed seizures and hypoxemia
soon after birth. Which of the following is the most likely underlying cause of this clinical
course?

A 50-year-old man is brought to the emergency department complaining of light-headedness.
He has a history of lung cancer, which was diagnosed a month ago and found to be widely
metastatic to the bone and pericardium. On physical examination, his blood pressure is 70/40
mm Hg, and his pulse is 100/min. His heart sounds are distant and soft. His ECG demonstrates
low voltage, and electrical alternans is present. A chest x-ray film shows that the cardiac
silhouette has a "water bottle" appearance.Which of the following is the most appropriate
intervention in this patient?

An AIDS patient develops symptoms suggestive of a severe, persistent pneumonia with
cough, fever, chills, chest pain, weakness, and weight loss. The patient does not respond to
penicillin therapy, but goes on to develop very severe headaches. The presence of focal
neurologic abnormalities leads the clinician to order a CT scan of the head. This demonstrates
several metastatic brain abscesses. Biopsy of one of these lesions demonstrates beaded,
branching, filamentous gram-positive bacteria that are weakly acid fast. Which of the following
is the most likely causative organism?