Otázky s chybnou odpovědí, č.j. 9206032
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TEST:usmle1en  Varianta:8         Tisknuto:04/06/2019
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 22. (  6.orig.) A 36-year-old woman has a hysterectomy and bilateral salpingo-oophorectomy because of uncontrolled hemorrhage. She is very concerned because her mother has vertebral compression fractures due to osteoporosis. Which of the following is the most appropriate single treatment to prevent bone loss?
 2) - Vitamin D (zaškrtl-a)
 3) + Estrogen (nezaškrtl-a)
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 25. ( 31.orig.) An asymptomatic 26-year-old man has a scrotal mass.  When he is standing, the left scrotal sac is enlarged with a tubular, worm-like, freely movable, nontender mass. The mass is not palpable when he is supine.  The most likely diagnosis is 
 2) + varicocele (nezaškrtl-a)
 3) - indirect inguinal hernia (zaškrtl-a)
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 27. ( 10.orig.) A 16-year-old girl is incoherent and has a fever, severe lower abdominal pain, and a foul-smelling cervicovaginal discharge. A self-induced abortion is suspected. Which of the following methods should be used to collect a sample of the cervical discharge for bacterial culture? 
 3) + Taking samples of the discharge with a syringe and transferring them directly to the laboratory (nezaškrtl-a)
 4) - Smear  + Gram stain (zaškrtl-a)
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 50. ( 30.orig.) A neonate develops meningitis. Streptococcus is isolated from the mother's vagina. The organism agglutinates with antiserum directed against type B surface carbohydrate. The virulence of this organism is related to a bacterial constituent that interferes with	 which of the following host phagocyte functions? 
 3) - Chemotaxis (zaškrtl-a)
 4) + Ingestion (nezaškrtl-a)
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 53. ( 27.orig.) A patient with an injury to the gluteal region has difficulty rising from a seated position and straightening his trunk but no difficulty walking on level ground or flexing his leg. Which of the following muscles is affected? 
 2) - Iliopsoas (zaškrtl-a)
 5) + Gluteus maximus (nezaškrtl-a)
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 58. ( 22.orig.) A 52-year-old woman is admitted to the hospital because of  breast cancer metastatic to the liver. Her prognosis is poor. She begs her husband to stay with her at the hospital because she is afraid to be left alone. Which of the following defense mechanisms best explains her behavior? 
 1) - Sublimation (zaškrtl-a)
 2) + Regression (nezaškrtl-a)
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 60. ( 18.orig.) A 23-year-old woman has a progressive increase in serum human chorionic gonadotropin (hCG) concentrations over an 8-week period. A hydatidiform mole is removed, but the hCG concentration continues to increase. The most likely diagnosis is 
 3) - a second noninvasive mole (zaškrtl-a)
 4) + choriocarcinoma (nezaškrtl-a)
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 63. ( 15.orig.) A 53-year-old woman dies 4 days after an automobile collision. She sustained multiple injuries including a femoral fracture. Widespread petechiae are found in the cerebral white matter at autopsy. Which of the following is the most likely cause of these findings? 
 1) - Contrecoup injury (zaškrtl-a)
 3) + Fat embolization (nezaškrtl-a)
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 72. ( 28.orig.) A 60-year-old man undergoes excision of an obstruction in the large intestine. Which of the following microscopic features in the obstructing lesion most strongly suggests malignant growth? 
 2) + Sheets and cords of epithelial cells in the serosal layer (nezaškrtl-a)
 3) - Formation of new vascular channels and hemorrhage (zaškrtl-a)
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 81. (  8.orig.) Moderate alcohol consumption may protect against coronary artery disease by which of the following mechanisms? 
 1) - Increasing thromboxane B2 release from platelets (zaškrtl-a)
 4) + Increasing serum concentration of HDLs (nezaškrtl-a)
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 82. ( 29.orig.) Lactation does not occur during pregnancy because the action of prolactin is blocked by increased concentrations of which of the following hormones? 
 1) + Estrogen and progesterone (nezaškrtl-a)
 3) - Growth hormone and oxytocin (zaškrtl-a)
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 92. (  7.orig.) A 58-year-old man with chronic congestive heart failure requires ongoing hydrochlorothiazide therapy. His monthly serum chemistry profile shows persistent hypokalemia.  The most appropriate next step is to add which of the following diuretics to the regimen? 
 2) - Furosemide (zaškrtl-a)
 4) + Amiloride (nezaškrtl-a)
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 95. ( 25.orig.) A 50-year-old man is awakened in the middle of the night with acute pain and tenderness of the right knee.  He has a low-grade fever.  His knee is hot, red, tender, and swollen. Analysis of the fluid from the right knee shows: Leukocytes: 70,000/mm3 with 75%  neutrophils; Crystal analysis: negatively birefringent; Gram's stain: negative. The most likely diagnosis is 
 2) - Septic arthritis (zaškrtl-a)
 3) + Gout (nezaškrtl-a)
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 98. ( 36.orig.) A 4-year-old girl has been unable to eat for 2 days because of a gastrointestinal tract disorder. Which of the following is the major source of fuel being oxidized by her skeletal muscles? 
 1) + Serum fatty acids (nezaškrtl-a)
 2) - Muscle triglycerides (zaškrtl-a)
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117. ( 35.orig.) A 45-year-old man has abnormal circadian variation disruption of the sleep-wake cycle, and an impaired nocturnal surge of secretion of melatonin. An MRI of the head is most likely to show a lesion involving which of the following nuclei? 
 4) - Pretecal (zaškrtl-a)
 5) + Suprachiasmatic (nezaškrtl-a)
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TEST:usmle2en  Varianta:8         Tisknuto:04/06/2019
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  6. ( 14.orig.) A 20-year-old woman is brought to the emergency department because of fever, severe myalgias diarrhea, and a diffuse scarlatiniform rash for hours. She recovered from a similar illness 6 months ago. She is menstruating and using a tampon. She appears very ill.  Her temperature is 40°C (104°F), pulse is 130/min, and blood pressure is 75/30 mm Hg Which of the following is the most appropriate pharmacotherapy?
 3) - Gentamicin (zaškrtl-a)
 4) + Oxacilin (nezaškrtl-a)
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 15. ( 30.orig.) A 22-year-old man with a seizure disorder has had increasing cough and shortness of breath for 3 days and fever for 1 day. He has foul-smelling sputum. He had a generalized tonic-clonic seizure 1 week ago. His temperature is 39,4°C (103°F). Crackles are heard on auscultation of the chest. An x-ray of the chest shows a right upper-lobe infiltrate of the lung. Which of the following is the most likely cause?
 2) + Pneumonia secondary to anaerobes (nezaškrtl-a)
 5) - Pneumonia secondary to gram-negative aerobes (zaškrtl-a)
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 18. ( 37.orig.) A 7-year-old boy is brought to the physician 3 days after sustaining a small laceration of the left eyebrow. His temperature is 38.8°C (101.8°F). Examination shows erythema and edema of the left eyelid and periorbital region with moderate proptosis and decreased ocular movement; eye movement is painful. The disc margins are sharp, and there are no retinal abnormalities. Which of the following is the most likely diagnosis? 
 2) + Orbital cellulitis (nezaškrtl-a)
 3) - Preseptal (periorbital) cellulitis (zaškrtl-a)
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 35. (  7.orig.) A 64-year-old woman comes to the physician because of a 5-month history of increasing shortness of breath, sore throat, and a cough productive of a small amount of white phlegm. Over the past week, she has had nausea related to excess coughing.  Over the past year, she has had a 3.2-kg (7-lb) weight loss. She has asthma treated with theophylline and inhaled beta-adrenergic agonists and corticosteroids. She has smoked one pack of cigarettes daily for 44 years and drinks one alcoholic beverage daily. She appears thin. Examination shows a 2-cm, nontender lymph node in the right supraclavicular area. Examination shows no other abnormalities. An x-ray of the chest shows a large right lower lobe density. A CT scan of the chest shows a 7.5 x 7.5 x 6-cm right lower lobe mass with some scattered calcifications. The lesion abuts the posterior chest wall without clear invasion. There are right lower peritracheal, precarinal, right hilar, and subcarinal lymph nodes. There is a 1.5-cm mass in the right adrenal gland. A biopsy specimen of the lung mass is most likely to show which of the following? 
 1) - B-cell lymphoma (zaškrtl-a)
 5) + Non-small cell lung carcinoma (nezaškrtl-a)
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 48. ( 11.orig.) A 10-year-old boy with chronic sinusitis is brought to the emergency department following a 3-minute generalized tonic-clonic seizure. He has a 3-day history of increasingly severe headaches and a 2-day history of vomiting and temperatures to 38.7°C (101.7°F). His temperature is 39.5°C (103.1°F), pulse is 80/min, respirations are 16/min, and blood pressure is 135/90 mm Hg. He is slightly lethargic but answers questions appropriately. Examination shows papilledema. No other abnormalities are noted. Which of the following is the most appropriate initial step in management? 
 4) + CT scan of the head (nezaškrtl-a)
 5) - Measurement of serum ammonia concentration (zaškrtl-a)
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 59. ( 38.orig.) A 14-year-old boy is brought to the walk in clinic by his father late on Saturday afternoon because his left ear is swollen and painful. The boy´s ear has been black and blue since he injured it in a wrestling match 3 days ago. Symptoms have increased significantly following a repeat injura 3 hours ago. On physical examination, his left ear is markedly swollen and tender to palpation. Which of the following is the most appropriate next step?
 1) - Recommend that he apply cold pycks to the ear for the next 12 hours (zaškrtl-a)
 3) + Refer him to a surgeon for immediate drainage of the lesion (nezaškrtl-a)
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 61. ( 21.orig.) An asymptomatic 18-year-old primigravid woman at 18 weeks´ gestation is found to be positive for hepatis B surface antigen (HBsAg) on routine prenatal screening. Her husband was diagnosed with hepatitis B 3 months ago. She states that the intends to breast-feed her infant. Examination shows a firm liver with a span of 12 cm. Serologic testing for hepatis shows: anti-HbsAg - negative; IgM-anti-HbcAg - positive; anti-HAV - negative. Which of the following should be administered to the newborn to prevent transmission of hepatitis?
 2) + HBIG and hepatitis B vaccination at birth (nezaškrtl-a)
 3) - HBIG at birth and hepatitis B vaccination with the cessation of breast-feeding (zaškrtl-a)
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 73. ( 40.orig.) A 6-year-old man with emphysema is brought to the emergency department 1 hour after becoming lethargic and incoherent. Over the past 3 days, he has had increasing episodes of dyspnea, cough, and sputum production. Oxygen was administered en route to the hospital. On arrival, the patient is confused and lethargic but responsive to painful stimuli. Arterial blood gas analysis while breathing 6l/min of oxygen shows: pH 35 [H+] nmol/l (36-44), pCO2 12,7 kPa (4,4-5,9), pO2 13,3 kPa (10,0-14,0). Which of the following is the most appropriate next step in management?
 3) + Endotracheal intubation and mechanical ventilation (nezaškrtl-a)
 4) - Discontinuation of the oxygen (zaškrtl-a)
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 75. ( 32.orig.) A 28-year-old woman comes to the emergency department 6 hours after the onset of insomnia, flank discomfort, and constipation that she attributes to a kidney stone. She is a resident of another state and is here visiting relatives. She takes oxycodone (six to eight tablets daily) for chronic low back pain, sumatriptan for migraines, and amitriptyline (25 mg at bedtime) and paroxetine (30 mg daily) for bulimia nervosa. Her pulse is 100/min, and blood pressure is 130/80 mm Hg. Examination shows diaphoresis and dilated pupils. She is alert and cooperative but seems restless. She has not had hallucinations or suicidal ideation. She becomes angry when she is asked for the telephone numbers of her regular physicians. Serum amitriptyline concentration is 150 mg/100 ml. Urinalysis shows 0-2 RBC/hpf. Which of the following is the most likely explanation for her symptoms? 
 1) + Opiate withdrawal (nezaškrtl-a)
 4) - Tricyclic intoxication (zaškrtl-a)
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 76. (  2.orig.) A 43-year-old woman who works as a seamstress has a 3-month history of pain, weakness, and numbness of the right hand that is worse at night. Examination shows hypoesthesia and atrophy of the thenar eminence. These findings are most likely caused by compression of which of the following nerves? 
 1) - Ulnar (zaškrtl-a)
 5) + Median (nezaškrtl-a)
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 77. ( 16.orig.) A 32-year-old homosexual man comes to the physician because of a purulent urethral discharge for 2 days. A culture grows Neisseria gonorrhoeae sensitive to penicillin. One week after cessation of penicillin therapy, the patient has a recurrence of the urethral discharge. A culture again shows N. gonorrhoeae sensitive to penicillin.  Both the patient and his sexual partner are HIV negative. Examination of the patients sexual partner shows an anal fissure; urethral culture does not grow N. gonorrhoeae. Which of the following is the most likely cause of the recurrence of urethral infection? 
 4) - Inadequate treatment with penicillin (zaškrtl-a)
 5) + Reinfection from the partner (nezaškrtl-a)
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 84. ( 23.orig.) A 67-year-old man comes to the physician because of a nontender lesion on the top of his forehead that has recently bled. He states that the lesion has been there since he was hit on the head with a bottle 18 months ago. Examination shows erythematous areas on other parts of his forehead. The lesion is 1 cm in diameter with a rolled-up, darkened border and a translucent, ulcerated center. Which of the following is the most likely diagnosis? 
 1) - Kaposi sarcoma (zaškrtl-a)
 4) + Basal cell epithelioma (nezaškrtl-a)
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 86. ( 39.orig.) A 37-year-old woman, gravida 3, para 3, comes to the physician because of labor-like pains and a small amount of vaginal bleeding for 2 days. She has had increasingly heavy, regular menstrual periods over the past 3 years; her last menstrual period was 18 days ago. Her youngest child is 10 years old. The cervix is moderately effaced and 2 cm dilated; there is beefy red tissue in the os. Which of the following is the most likely diagnosis? 
 3) + Pedunculated submucous leiomyoma (nezaškrtl-a)
 4) - Incomplete abortion (zaškrtl-a)
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 96. ( 34.orig.) A 58-year-old man comes to the physician because of extreme fatique and malaise for 3 weeks. He has felt well except for a toothache 5 weeks ago treated with a root canal procedure. He has a history of a cardiac murmur first noted at the age of 19 years. His temperature is 37,8°C, pulse is 110/min, and blood pressure is 120/80 mm Hg. The lungs are clear to auscultation. Cardiac examination shows a grade 2/6, systolic ejection murmur heard best at the right second intercostal space as well as an S4 and an ejection click. Laboratory studies show: hemoglobi 1,4 mmol/l (2,09-1,71I), leukocyte count 10,000/mm3; segmented neutrophils 90%, bands 10%; erythrocyte sedimentation rate 90mm/h; urine, blood positive. Blood culture are obtained. Gram stain of the blood culture is most likely to show which of the following?
 1) + Gram-positive cocci in chains (nezaškrtl-a)
 3) - Gram-positive diplococci (zaškrtl-a)
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100. ( 25.orig.) A 50-year-old woman comes to the physician because of a 4-week history of aching limbs, difficulty climbing stairs, and difficulty rising from a chair. Examination shows tenderness of the quadriceps muscles. There is purple-red discoloration of the skin over the upper forehead, eyelids, and cheeks and flat-topped, purple nodules over the elbows and knees. Which of the following is the most likely diagnosis? 
 2) + Dermatomyositis (nezaškrtl-a)
 4) - Systemic lupus erythematosus (zaškrtl-a)
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110. (  5.orig.) A full-term 2-month-old boy appeared well until 3 weeks ago when he became dyspneic and had difficulty feeding.  A loud holosystolic murmur is heard at the left lower sternal border.  An ECG shows left and right ventricular hypertrophy. Which of the following is the most likely diagnosis? 
 1) - Pulmonary hypertension (zaškrtl-a)
 2) + Ventricular septal defect (nezaškrtl-a)
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TEST:usmle3en  Varianta:8         Tisknuto:04/06/2019
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  4. (  9.orig.) A 44-year-old Irish-American woman has had arthritis for 10 years, for which she has seen many physicians. She has used many medications and devices, including copper bracelets from Mexico given to her by friends. She seeks your help because for the past several months she has had increasing pain and stiffness in her hands. Her hands now show moderate ulnar deviation of the fingers and she says her wrists and knees also hurt. She has had increasing fatigue for about 1 month, along with a weight loss of 1.8 to 2.2 kg (4 to 5 lb). Review of her medical records, which she has brought with her, convinces you that the initial diagnosis of rheumatoid arthritis is correct. She says, "I had several drop attacks during the past 3 months." She characterizes these attacks as episodes of weakness and loss of feeling in her legs for several minutes. During one of these episodes, she became incontinent. She currently takes aspirin about four times a day and an occasional dose of ibuprofen. On physical examination she has facial plethora and swollen and painful metacarpophalangeal and knee joints, bilaterally. The rest of the examination is normal. Which of the following is the most likely cause of her "drop attacks?" 
 2) - Adrenal insufficiency (zaškrtl-a)
 4) + Atlanto-axial instability (nezaškrtl-a)
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  9. ( 31.orig.) A 38-year-old Hispanic bank executive comes to the emergency department because of the sudden onset of shortness of breath, light-headedness, diaphoresis, and weakness. He is afebrile. On auscultation of the lungs, bilateral basilar rales are heard. Electrocardiogram is shown. Which of the following is the most likely diagnosis? 
 1) + Myocardial infarction (nezaškrtl-a)
 2) - Acute pericarditis (zaškrtl-a)
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 11. ( 12.orig.) A 50-year-old woman comes to the office for the first time because of recurrent abdominal pain. Review of her extensive medical chart, which she has brought with her, discloses that she has a long history of varying physical complaints. Definitive causes for these complaints have not been found despite extensive diagnostic studies, consultations with many physicians and several surgical explorations. She gives dramatic and exaggerated descriptions of her present and past symptoms, and she makes conflicting statements about her history. She has been hospitalized at least 23 times since age 18 years. Which of the following is the most likely diagnosis? 
 3) + Histrionic personality disorder (nezaškrtl-a)
 4) - Somatization disorder (zaškrtl-a)
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 17. ( 10.orig.) A 3-year-old boy is brought to the office by his father because of a 3-month history of decreased activity, poor appetite, sporadic vomiting, clumsiness and speech regression. Since his birth his family has lived in an old area of the city where there is demolition of old buildings. Examination of a peripheral blood smear is likely to show which of the following? 
 2) + Basophilic stippling of erythrocytes (nezaškrtl-a)
 5) - Macrocytic erythrocytes (zaškrtl-a)
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 19. ( 37.orig.) A male colleague asks you to write a prescription for a narcotic analgesic for one of his female patients. You have noticed that this patient frequently has been coming by the office to see your colleague, and that several of the visits have been marked "No Charge." When you ask your colleague why he cannot write the prescription himself, he seems defensive and says, "Because I don't want anybody to get the wrong idea." Which of the following is the most appropriate response to your colleague? 
 1) + "It sounds like there is more to this story than you are telling me; maybe we should talk about it." (nezaškrtl-a)
 4) - "I wish I could help you, but I never prescribe that medication for a patient unless I have seen the patient myself." (zaškrtl-a)
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 26. ( 15.orig.) A 19-year-old white woman returns to the office 2 months after having a medroxyprogesterone injection for contraception. She is complaining of nonstop bleeding since her menses 3 weeks ago. She is using eight pads a day. She denies any sexual activity since she received the injection. She realizes that spotting is a side effect; however, she is anxious about the length of time and the amount of the bleeding. She tells you, "I can't stand this, Doctor. I want the bleeding to stop now!" Repeat pregnancy test is negative. Which of the following is the most appropriate treatment option for her bleeding? 
 2) - Triphasic oral contraceptive therapy for one cycle (zaškrtl-a)
 4) + Conjugated estrogen therapy for 2 weeks (nezaškrtl-a)
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 31. ( 17.orig.) A 58-year-old man comes to the office because of a lesion on the lip, which is shown. The patient says he has had the lesion for about 9 months. He has not seen a physician for 5 years and he is in the office today only because, he says, "My wife made me come." On physical examination the lower lip is fixed to the anterior aspect of the mandible. Which of the following is the most likely diagnosis? 
 3) - Basal cell carcinoma (zaškrtl-a)
 4) + Squamous cell carcinoma (nezaškrtl-a)
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 42. ( 23.orig.) A 50-year-old woman is in the recovery room following an uneventful cholecystectomy. Two hours after the procedure she begins to have ventricular extra-systoles and her systolic blood pressure falls from 110 mm Hg to 90 mm Hg. Arterial blood gas values while breathing room air are: PO2 7,7 kPa (10,0-14,0),  PCO2 6,9 kPa (4,4-5,9), pH [H+]36,8 nmol/l (36-44). These signs are most likely the result of which of the following? 
 3) - Pulmonary embolus (zaškrtl-a)
 4) + Alveolar hypoventilation (nezaškrtl-a)
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 47. ( 35.orig.) A 47-year-old Italian-American man comes to the office for the first time for routine medical care. He has been referred to you by his psychiatrist who has informed you that the patient has paranoid personality disorder. The patient has no other medical problems at this time. He is unmarried, lives alone and has no close friends, but he occasionally attends family gatherings. He functions well working alone in a technical position in an engineering firm. Which of the following is the best way to structure the physician-patient relationship with this patient? 
 1) - Avoid giving him excessive details about possible, but infrequent, side effects and complications in order to avoid triggering his paranoia (zaškrtl-a)
 2) + Explain the rationale for any diagnostic procedures and treatment regimens in some detail, adopting a professional, but not overly friendly stance (nezaškrtl-a)
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 52. ( 36.orig.) A 12-month-old boy is brought to the office by his mother for his routine health check-up. She informs you that she has just been diagnosed with hypercholesterolemia. Her fasting serum total cholesterol concentration was 6,8mmol/l (3,9-6,2) and her LDL-cholesterol concentration was 3,41 mmol/l (<4,2). She is unaware of a family history of coronary artery disease because she was raised by her godmother when her parents died in their early 30s in a motor vehicle accident. A special diet has been recommended for her; however, she is very concerned about the risk of hypercholesterolemia for her son. Which of the following is the most appropriate management at this time? 
 2) - Have the child return for a fasting lipoprotein analysis (zaškrtl-a)
 5) + Do nothing until the child is 2 years of age (nezaškrtl-a)
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 62. (  8.orig.) A 56-year-old man is admitted to the hospital from the emergency department because of an acute myocardial infarction. He has no identified risk factors and no history of heart disease. He had no major complications and is discharged after 8 days. At discharge, which of the following diagnostic tests should be scheduled for the 2-week follow-up visit in order to predict most accurately his risk for another infarction? 
 2) + Exercise stress test (nezaškrtl-a)
 4) - Radionuclide ventriculography (zaškrtl-a)
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 66. ( 24.orig.) A 20-year-old woman who is 35 weeks pregnant with her first child is admitted to the hospital because of persistent hypertension and 1+ protein on urinalysis obtained 36 hours ago. She is confined to bed awaiting further diagnostic studies for preeclampsia. Her blood pressure is now 160/100 mm Hg. She is complaining of headaches, blurred vision and epigastric pain. At this time it is most appropriate to conclude that this patient has which of the following? 
 3) + Severe preeclampsia and requires immediate medical management and delivery (nezaškrtl-a)
 4) - Severe preeclampsia and should continue bed rest pending further diagnostic studies (zaškrtl-a)
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 71. ( 18.orig.) A 68-year-old man with documented alcohol abuse returns to the office because of abdominal pain and bloating. When you meet with him, he appears dejected and his eye contact is poor. Physical examination is normal. Since his last visit, he has moved from the neighborhood where he had lived for 40 years. In addition, he mentions that approximately 6 months ago breast cancer was diagnosed in his wife; she is currently receiving radiation therapy for bony metastases. The most important next step in management of his symptoms is evaluation for which of the following? 
 1) + Suicidal ideation (nezaškrtl-a)
 5) - Situational anxiety disorder (zaškrtl-a)
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 90. ( 29.orig.) A 38-year-old nurse comes to the emergency department after leaving work early because of a "horrible headache." She has had a "cold" with sinus congestion for the past week, and yesterday she began taking an over-the-counter combination of diphenhydramine and pseudoephedrine. She tells you she has a history of "migraines," multiple allergies, premenstrual syndrome and depression, for which she takes phenelzine (a monoamine oxidase inhibitor). Vital signs are: temperature 37.2°C (99.0°F), pulse 90/min, respirations 16/min and blood pressure 210/118 mm Hg. Which of the following is the most appropriate action? 
 1) + Administer phentolamine, intravenously (nezaškrtl-a)
 2) - Order CT scan of the head (zaškrtl-a)
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 93. ( 14.orig.) A 66-year-old African-American man who has been a patient for several years calls the office to report an episode of apparently bloody urine. He is instructed to come to the office, where urinalysis confirms gross hematuria without proteinuria or casts. The patient denies any pain and is anxious for an explanation. Physical examination is normal. Which of the following is the most appropriate next step? 
 2) - Schedule bilateral renal angiography (zaškrtl-a)
 3) + Schedule cystoscopy (nezaškrtl-a)
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 94. ( 38.orig.) A husband and wife, ages 29 years and 34 years, respectively, come to the office for advice regarding their risk for having hearingimpaired children. They are both hearing-impaired and require hearing aids. Their hearing loss is sensorineural and is not associated with any other health problems. The wife tells you, "We have both learned to live with this disability, but we want to take it into account before we decide to have children." Their pedigree is shown with the patients identified as II2 and II3. Which of the following is the most appropriate advice to the couple? 
 1) - It is unlikely that they will have hearing-impaired children (zaškrtl-a)
 5) + Accurate risk estimation is impossible without further evaluation (nezaškrtl-a)
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105. (  7.orig.) You plan to discharge an 81-year-old woman in a few days following a 3-week stay in the hospital for repair of a fractured hip that she sustained while gardening. She now ambulates with difficulty using a walker, but she is determined to become independent again and to return to her own home. Which of the following is most likely to prevent another fall and a possible fracture in this patient? 
 3) + Request a visiting nurse to assess the safety of her living environment (nezaškrtl-a)
 4) - Ensure that she does not have orthostatic hypotension (zaškrtl-a)