A 35-year-old white male who has had diabetes mellitus for 20 years begins having episodes of hypoglycemia. He was previously stable and well controlled and has not recently changed his diet or insulin regimen. Which one of the following is the most likely cause of the hypoglycemia?

A 54-year-old male presents to the emergency department with an acute onset of chest pain. His cardiac risk factors include hypertension, hyperlipidemia, and a positive family history. His temperature is 37.0°C (98.6°F), pulse rate 80 beats/min, blood pressure 155/86 mm Hg, and respiratory rate 22/min. His oxygen saturation is 95% on room air. An EKG shows rare unifocal PVCs and nonspecific ST-T–wave changes. Initial cardiac markers are negative. Which one of the following would be most appropriate at this point?

A 19-year-old college freshman consults you at the request of her cross-country coach because she has not had a period in 2 of the last 3 months. She notes that her current training regimen is much more intense than in high school last year. She has an appropriate body image and denies caloric restriction. A pregnancy test at the student health center was negative. On examination she is lean and highly trained. Her examination is otherwise normal. Which one of the following would be the most appropriate recommendation for this patient?

A 2-year-old white male is seen for a well child visit. His mother is concerned because he is not yet able to walk. A routine physical examination, including an orthopedic evaluation, is unremarkable. Speech and other developmental milestones seem normal for his age. Which one of the following tests would be most appropriate?

A 50-year-old male comes to your office for a “doctor’s excuse” for days of work he missed last week. He attended a picnic where he and other guests developed nausea and vomiting 2 hours after eating. Within 48 hours, the symptoms had resolved. The most likely etiology of the illness is which one of the following?

A 20-year-old female with a history of persistent depression sees you for follow-up. She reports unplanned weight loss, chronic insomnia, fatigue, a loss of interest in hobbies that she previously enjoyed, and decreased concentration. She has seen other physicians and has tried antidepressant medications, including paroxetine (Paxil), bupropion (Wellbutrin), and citalopram (Celexa). She reports that there was a week when her mood felt much more normal. She needed only about 3 hours of sleep each night during that week. She admits she was somewhat impulsive, however, and experienced racing thoughts. She does not abuse any substances but has several family members who are drug abusers. Her mother and older sister committed suicide. Her examination, laboratory work, and drug screen are all unremarkable. Which one of the following is most likely to help this patient?

Which one of the following nutritional management strategies is associated with better outcomes in patients with mild acute pancreatitis whose pain and nausea have resolved?

The physician counseling a 4-year-old child about the death of a loved one should keep in mind that children in this age group:

A 35-year-old white male presents with dyspepsia. He has had no symptoms that suggest gastroesophageal reflux or bleeding, but a test for Helicobacter pylori is positive. After 2 weeks of treatment with omeprazole (Prilosec), amoxicillin, and clarithromycin (Biaxin), he is asymptomatic. Which one of the following is recommended to test for the eradication of H. pylori in this patient?

A 45-year-old male with diabetes mellitus sees you for the first time. If the patient has not previously received it, which one of the following vaccines is recommended for him by the Advisory Committee on Immunization Practices?

Which one of the following is recommended for the treatment of patients with obsessive compulsive disorder?

A 73-year-old male sees you for evaluation of a tremor. Based on the history and examination, you suspect Parkinson’s disease. Which one of the following would be most helpful for confirming the diagnosis?

Surgical management for an acute midshaft clavicle fracture would be appropriate in which one of the following?

A 32-year-old primipara is ready to be discharged after a full-term vaginal delivery that was complicated by a prolonged second stage of labor. She required a second-degree posterior vaginal repair, but had no periurethral trauma. A transurethral catheter was removed a few hours after delivery, but 48 hours later she complained of abdominal pain and a persistent need to urinate. The catheter was replaced and yielded approximately 2000 cc of straw-colored urine. Urinary symptoms quickly resolved, but the patient continues to be unable to void on her own. A perineal examination is normal, as is a urinalysis. Which one of the following would be the most appropriate management at this time?

A 5-month-old infant has had several episodes of wheezing, not clearly related to colds. The pregnancy and delivery were normal; the infant received phototherapy for 1 day for hyperbilirubinemia. He had an episode of otitis media 1 month ago. There is no chronic runny nose or strong family history of asthma. He spits up small amounts of formula several times a day, but otherwise appears well. His growth curve is normal. An examination is unremarkable except for mild wheezing. Which one of the following is the most likely diagnosis?