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123690 Surgery

A 20-year-old female comes to the physician because she has never had a perioD. She has no medical problems, has never had surgery, and takes no medications. Examination shows that she is a tall female with long extremities. She has normal size breasts, although the areolas are pale. She has little axillary hair. Pelvic examination is significant for scant pubic hair and a sho, blind- ended vaginal pouch. Which of the following is the most appropriate next step in the management of this patient?

ANo intervention is necessary
BBilateral gonadectomy
CUnilateral gonadectomy
DBilateral mastectomy
Surgery
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123694 Physiology

A 65-year-old man presents to his primary care physician complaining of dyspnea, chest pain, and several syncopal episodes. His symptoms have worsened over the past few months and his third syncopal episode prompted this visit. On examination, a systolic ejection murmur is auscultated with an ejection click in the right second intercostal space. Rales are present at the lung bases. He has a history of rheumatic fever in his twenties. Which of the following might explain the angina pectoris in this patient?

AIncreased ventricular wall tension limits perfusion
BLeft ventricular hyperophy accelerates atherosclerotic disease
CPulmonary hypeension decreases the PO2 of aerial blood
DStenotic valves occlude the coronary aeries
Physiology
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