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1. A 31-year-old man presents with nocturnal non-exertional chest pain. During an exercise stress test, he does not experience chest pain, and there are no significant ST segment changes on the electrocardiogram. He achieves 17 metabolic equivalent of task (MET), a blood pressure of 190/96 mm Hg (resting blood pressure of
130/80 mm Hg), and a maximum heart rate of 162/min (85% of age-predicted maximum). Which one of the following is the most appropriate next step?

A) Prescribe hydrochlorothiazide
B) Offer reassurance
C) Advise against vigorous exercise
D) Schedule cardiac catheterization
E) Prescribe acetylsalicylic acid and metoprolol

2. A 16-year-old boy presents to the emergency department with a 12-hour history of fever and rigors. He has sickle cell anemia. On examination, his vital signs include the following:
Heart rate
110/min (60-100)
Respiratory rate
20/min (12-18)
Temperature
38.8 °C, oral (36.5-37.5)
Which one of the following places this patient at risk for sepsis?

A) Systemic iron overload
B) Immunoglobulin deficiency
C) Functional asplenia
D) Chronic anemia
E) Neutrophil dysfunction

3. An intoxicated 28-year-old man is brought to the Emergency Department after being found in the snow. His vital signs are as follows:
Temperature: 33°C
Respiratory rate: 22/min
Heart rate: 123/min
The patient is shivering and displays some dysarthria and ataxia. After his wet clothing is removed, he is provided with a warm blanket. The results of the subsequent physical examination are unremarkable, except for frostbite of the ears and fingers. Which one of the following is the best next step?

A) Continuous warm bladder irrigation.
B) Perform a peritoneal lavage.
C) Start continuous arteriovenous rewarming.
D) Apply heating pads to extremities.
E) Set the room temperature to 28°C.

4. A 66-year-old woman has a 3-month history of dry cough and weight loss. A new chest radiograph reveals a large 2-cm mass in her right upper lobe, which is consistent with carcinoma. You look at her previous films and realize that you had read her chest radiograph as normal 1 year ago, but now clearly see a faint opacity in precisely the same location as her current lesion. Which one of the following is the best next step?

A) Remark only on the new chest radiograph in your report
B) Comment on the previous chest radiograph and the new one in your report
C) Write a report only after communicating with your professional insurer
D) Prepare a report only after communicating with your department head
E) Create a report only after communicating with your medical regulatory authority

5. A 30-year-old man (assigned female at birth) presents to your clinic for a periodic health examination. He declines a gynecologic examination because such examinations lead to intense emotional distress for him. He also believes that he does not require a Papanicolaou (Pap) test because he is not in a sexual relationship with a man. After acknowledging the patient's distress and providing education regarding the need for Pap screening, which one of the following would be the best next step?

A) Ask permission to learn more about his distress in a subsequent appointment.
B) Record his directives in the chart.
C) Advise him to reconsider his decision and to allow the examination to proceed.

問題與答案：