1. A 29-year-old male presents to the office with the complaints of a pounding heart, poor sleep, and a generalized feeling of restlessness. He relocated 2 months ago to take a promotion and has found himself unable to concentrate on his new duties. He worries about his ability to adapt to his increase in responsibility at work and states that he has called in sick 3 days within the past 2 weeks. The most likely diagnosis is
2. A 42-year-old man comes to the physician because of malaise, muscle and joint pain, and temperatures to 38.4°C (101.1°F) for 3 days. Three months ago, he underwent cadaveric renal transplantation resulting in immediate kidney function. At the time of discharge, his serum creatinine concentration was 0.8 mg/dL. He is receiving cyclosporine and corticosteroids. Examination shows no abnormalities. His leukocyte count is 2700/mm3 , and serum creatinine concentration is 1.6 mg/dL; serum cyclosporine concentration is in the therapeutic range. A biopsy of the transplanted kidney shows intracellular inclusion bodies. Which of the following is the most appropriate next step in management?
3. A 44-year-old female presents to the office for evaluation of a lump on her neck that she noted 1 week ago. She denies any tenderness, fever, weight loss, or fatigue. Physical examination reveals a 2-cm freely movable mass in the lower left lobe of the thyroid. In addition to thyroid-stimulating hormone and free thyroxine levels, the most appropriate initial method to investigate this lesion is
4. A 68-year-old female has a history of breast cancer that has recurred twice in the past 5 years. She has undergone both radiation and chemotherapy for metastatic carcinoma to the bone. She presents to the office today to ask for help in dealing with midthoracic back pain to enable her to use less analgesic agents. The most appropriate osteopathic manipulative technique to treat this patient's spine is
5. A 31-year-old man with a 5-year history of HIV infection comes to the office because of anal pain, particularly on defecation, for the past 4 months. He says he has seen spots of blood on the toilet tissue but has not had any other noticeable bleeding. He reports no change in bowel habits and has not had recent fever, chills, or rectal drainage. He says he and his partner engage in anal-receptive intercourse. His most recent CD4+ T-lymphocyte count 2 months ago was 350/mm3 ; HIV viral load at that time was undetectable. He currently is being treated with antiretroviral therapy. He has had no opportunistic infections. Medical history is also significant for syphilis and genital herpes treated with penicillin and acyclovir, respectively. He does not smoke cigarettes or drink alcoholic beverages. Vital signs are normal. Physical examination shows small bilateral inguinal lymph nodes, but respiratory, cardiac, and abdominal examinations disclose no abnormalities. There are several tender fleshy lesions around the perianal area. Rectal examination produces tenderness, but there is no rectal discharge. Test of the stool for occult blood is trace positive. Which of the following is the most appropriate pharmacotherapy at this time?
