A young man and woman who are in a relationship present to the office for prenatal counselling. During the visit, you observe that the man's lips appear as shown in the referenced photo.

[Image shows grouped vesicular lesions on erythematous base affecting the lips-classic for herpes labialis (HSV-1).] Which one of the following is the best advice?

• A.The woman should have viral cultures of her cervix
• B.The man needs herpes simplex virus type-specific serology
• C.The woman should take acyclovir throughout her pregnancy
• D.The woman must have a cesarean delivery
• E.The man should avoid performing oral sex during her pregnancy

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You are being consulted for a 79-year-old man who is about to undergo a total hip arthroplasty. His orthopedic surgeon is aware of the diagnosis of Alzheimer disease and would like your suggestions to help avoid acute postsurgical delirium. To that end, which one of the following is the most effective strategy?

• A.Avoid medications with anticholinergic potential
• B.Refrain from prescribing opiate analgesics to treat postoperative pain
• C.Screen the patient with the Mini-Mental Status Examination prior to surgery
• D.Treat postsurgical insomnia with benzodiazepines
• E.Keep family visits to a minimum to avoid postsurgical overstimulation

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A 65-year-old man presents to your clinic with a 2-month history of persistent erectile dysfunction. He reports having difficulties maintaining an erection. His last hemoglobin A1c level result was 6.4% (4.8-6.0). He had a negative result on his cardiac stress test 1 month ago. He has been taking stable dosages of citalopram, metformin, and ramipril for the past 2 years. His physical examination findings are normal, and his mood appears euthymic. Which one of the following investigations should be ordered before initiating treatment with sildenafil?

• A.Complete blood count.
• B.Echocardiography.
• C.Prostate-specific antigen.
• D.Urine culture.
• E.No further investigations.

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A 19-year-old woman with a long-standing history of abuse and borderline personality disorder presents to your office. She has a number of superficial lacerations over her arms and legs. They look like they were caused by a sharp edge such as a knife. They are at various stages of healing, and some look like they are a few hours old, though none require stitches. Which one of the following is the most likely comment she would make about the injuries?

• A.She uses them to get attention.
• B.She feels better afterward.
• C.She is too afraid to kill herself.
• D.She is obsessed with the look of blood.
• E.She is experimenting with body modification.

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A 73-year-old woman is seen in the office 2 weeks after a coronary bypass surgical procedure. The site of saphenous vein removal in the left thigh shows an area of tenderness and a 3 × 5 cm palpable mass. The skin is intact. Her temperature is 37.7 °C, hemoglobin is 110 g/L (125-167), and white blood cell count is 8 × 10#
/L (4-10). Which one of the following is the most likely diagnosis?

• A.Acute venous bleeding
• B.Femoral artery aneurysm
• C.Thrombophlebitis
• D.Wound hematoma
• E.Wound abscess

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