A 32-year-old woman presents to your outpatient clinic with concerns regarding a 6-month history of both a pulsatile buzzing sound in her ears and headaches. There is no history of hearing loss, vertigo, ear pain, or discharge from the ears. There is a long-standing history of prolonged exposure to occupational noise. She has a BMI of 32. Otoscopic examination is unremarkable, and there are no neck masses present. You determine that the buzzing sound is synchronous with her radial pulse. Which of the following investigations should be ordered next?

• A. Magnetic resonance imaging of the brain
• B. C-reactive protein
• C. Audiogram
• D. Electroencephalography

A 30-year-old man comes to the office and asks you to write him a note for his employer that recommends a stress leave. He says he feels entitled to a rest. He comes across as irritable and impulsive. He appears to show little regard for the law and admits to recently embezzling $5,000 from his employer. He justifies his actions and shows no remorse. He has a history of attention-deficit/hyperactivity disorder as a child. Which one of the following is the most likely diagnosis?

• A. Borderline personality disorder.
• B. Narcissistic personality disorder.
• C. Antisocial personality disorder.
• D. Klinefelter syndrome.
• E. Bipolar II disorder.

A 30-year-old woman presents to your office for a follow-up assessment of a sports-related musculoskeletal injury to her right leg. She requests a letter for her employer regarding her return to work. You feel she should be able to manage some aspects of her factory work. Which one of the following is most appropriate to include in your medical note to this patient ' s employer?

• A. Required workplace accommodations
• B. Diagnosis
• C. Medical imaging results
• D. Physiotherapist ' s evaluation
• E. Treatment options

A 59-year-old woman is referred to you because of a 2-month history of left nipple discharge. She is otherwise healthy and is not on any medication. There are no palpable lesions on breast examination. She is able to express a small amount of blood-tinged liquid from her breast. Which one of the following would be the best next step?

• A. Serum prolactin.
• B. Magnetic resonance imaging of breast.
• C. Biopsy of nipple complex.
• D. Mammography.
• E. Galactography.

A 35-year-old woman presents to your clinic for follow-up regarding her persistent primary immune thrombocytopenic purpura. She was admitted to hospital with a relapse and received treatment with dexamethasone, intravenous immunoglobulin, and rituximab. She was recently discharged from hospital with a platelet count of 55 × 10#/L (130-360), and also continues to take 10 mg of prednisone once daily. She is scheduled for a splenectomy in 4 weeks. Which one of the following is the best next step in preparation for the patient ' s surgical procedure?

• A. Prescribe daily azithromycin 1 week preoperatively
• B. Transfuse 5 units of platelets 1 week preoperatively
• C. Start calcium and vitamin D supplementation
• D. Stop prednisone 2 weeks preoperatively
• E. Arrange for preoperative vaccination