4.6 of 5 Ratings
A 36-year-old female presents to the emergency department with right upper quadrant (RUQ) pain. She describes the pain as dull and getting progressively worse over the last several weeks. She denies any relationship to eating. Her past medical history is significant for endometriosis, which she manages with oral contraceptive pills, and follicular thyroid cancer, for which she underwent total thyroidectomy and now takes levothyroxine. The patient drinks a six pack of beer most nights of the week, and she has a 20 pack-year smoking history. She recently returned from visiting cousins in Mexico who have several dogs. Her temperature is 98.2°F (36.8°C), blood pressure is 132/87 mmHg, pulse is 76/min, and respirations are 14/min. On physical exam, her abdomen is soft and non-distended with tenderness in the right upper quadrant and palpable hepatomegaly. Laboratory testing is performed and reveals the following:Aspartate aminotransferase (AST, GOT): 38 U/LAlanine aminotransferase (ALT, GPT): 32 U/LAlkaline phosphatase: 196 U/Lgamma-Glutamyltransferase (GGT): 107 U/LTotal bilirubin: 0.8 mg/dLRUQ ultrasound demonstrates a solitary, well-demarcated, heterogeneous 6 cm mass in the right lobe of the liver. CT scan with contrast reveals peripheral enhancement during the early phase with centripetal flow during the portal venous phase. Which of the following is a risk factor for this condition?
Chronic alcohol abuse
Recent contact with dogs
Recent travel to Mexico
Oral contraceptive pill use
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A 22-year-old female presents to her PCP after having unprotected sex with her boyfriend 2 days ago. She has been monogamous with her boyfriend but is very concerned about pregnancy. The patient requests emergency contraception to decrease her likelihood of getting pregnant. A blood hCG test returns negative. The PCP prescribes the patient ethinyl estradiol 100 mcg and levonorgestrel 0.5 mg to be taken 12 hours apart. What is the most likely mechanism of action for this combined prescription?
Inhibition or delayed ovulation
Alteration of the endometrium impairing implantation of the fertilized egg
Thickening of cervical mucus with sperm trapping
Tubal constriction inhibiting sperm transportation
Interference of corpus luteum function
A 23-year-old woman presents to her primary care physician for a wellness checkup. She has been treated for gonorrhea and chlamydia 3 times in the past 6 months but is otherwise healthy. She smokes cigarettes, drinks alcohol regularly, and wears a helmet while riding her bicycle. The patient is generally healthy and has no acute complaints. Her vitals and physical exam are unremarkable. She is requesting advice regarding other forms of contraception and her sexual health. The patient has been taking oral contraceptive pills for the past year without issues. Which of the following would be the most appropriate recommendation for this patient?
Additional use of condoms
Switching to etonogestrel implant
Switching to intrauterine device
Pull out method