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MMLU / A 34-year-old white woman comes to the emergency department because of a…

Problem

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question

A 34-year-old white woman comes to the emergency department because of a persistent dull headache for the past 3 days. She has been taking acetaminophen without relief. She says, "I haven't slept in 3 days and I am having trouble focusing at work." There is no history of trauma and she takes no medications. She has smoked one pack of cigarettes daily for 14 years but does not drink alcoholic beverages. Vital signs are temperature 37.5°C (99.5°F), pulse 86/min, respirations 19/min, and blood pressure 182/100 mm Hg. Examination of the head shows no abnormalities. Pupils are equal, round, and reactive to light; there is mild photophobia. Funduscopic examination is normal. A serous effusion is noted on examination of the left tympanic membrane. Neck is stiff with painful flexion; when the patient's neck is flexed forward, she reports and electric shock sensation. Mild expiratory wheezes are heard on auscultation of the chest. A midsystolic click is heard best at the left sternal border; there are no murmurs or gallops. Abdominal examination shows striae, but is otherwise noncontributory. Examination of the lower extremities shows varicosities bilaterally and 1+ edema; muscle strength is 4/5. Neurologic examination shows no other abnormalities. Which of the following physical findings is most indicative of the need for immediate further evaluation?

choices

  1. Abdominal striae
  2. Expiratory wheezes
  3. Midsystolic click
  4. Neck stiffness

subject

professional_medicine

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Source and history

task_id
4c73ef1b-71ab-5755-91db-12db56d5207b
task_key
all--test--4c73ef1b-71ab-5755-91db-12db56d5207b
task_revision_id
1
config / split
all / test

Official source

initial import