A 68-year-old man presents to his primary care physician wit...

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A 32-year-old female presents to general medical clinic with a chief complaint of blood in her urine. She has no pain urinating and denies any fevers. Vital signs include Temp 37 C, HR 70, BP 185/95, RR 12, and O2 sat 99% on room air. Her urinary analysis is positive for heme but negative for white cells. Serum creatinine is 3.5. Later in the patient's course, she is treated with a transplant. A representative image of her organ is shown in Figure A. Which of the following is true regarding this illness?

A 17-year-old male is brought to the emergency department by...

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A 29-year-old G1P0 at 23 weeks of gestation presents to the ...

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A 33-year-old female nurse is referred to an infectious disease specialist after she exhibited a positive PPD skin test (reaction = 17 mm) as part of a pre-employment health screening. She denies any cough, shortness of breath, hemoptysis, weight loss, fatigue, fevers, or night sweats over the last several months. A chest radiograph is obtained and is shown in Figure A. Which of the following is the most appropriate management of this patient?

Mrs. Jones is a 56-year-old female that is admitted to a general medicine floor of the local university hospital. She is noted to have new onset ascites of unknown origin. Peritoneal fluid was sent for cell count (<50 leukocytes), albumin level (4.8), culture (pending), total protein (2.0), and Gram stain (pending). Serum albumin was noted to be 4.0. Of the options below, what is the most likely cause of this patient's ascites?

A 27-year-old woman is brought by ambulance to the emergency...

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A 74-year-old woman with a past medical history of hypertension, peripheral artery disease, and migraine headaches presents to the emergency department with a two hour history of severe abdominal pain. The patient cannot recall any similar episodes, although she notes occasional abdominal discomfort after eating. She describes the pain as sharp periumbilcal pain. She denies recent illness, fever, chills, nausea, vomiting, or diarrhea. Her last normal bowel movement was yesterday evening. Her temperature is 37.1°C (98.8°F), pulse is 110/min, blood pressure is 140/80 mmHg, and respirations are 20/min. On exam, the patient is grimacing and appears to be in significant discomfort. Heart and lung exams are within normal limits. The patient’s abdomen is soft and non-distended with diffuse periumbilical pain on palpation. There is no rebound tenderness or guarding, and bowel sounds are present. The rest of the exam is unremarkable. Labs in the emergency room show: Serum: Na+: 144 mEq/L Cl-: 105 mEq/L K+: 3.7 mEq/L HCO3-: 20 mEq/L BUN: 15 mg/dL Glucose: 99 mg/dL Creatinine: 1.2 mg/dL Ca2+: 10.7 mg/dL Phosphorus: 5.2 mg/dL Lactate: 7.0 mmol/L Amylase: 240 U/L Hemoglobin: 13.4 g/dL Hematocrit: 35% Leukocyte count: 12,100 cells/mm^3 with normal differential Platelet count: 405,000/mm^3 What is the next best step in diagnosis?

A 23-year-old woman with no significant past medical history presents to the Emergency Department with 2 days of worsening fever, vomiting, and myalgias. Physical exam is remarkable for a red, macular rash diffusely present across her chest and abdomen. Vital signs are as follows: BP 90/54 mmHg, HR 110 bpm, T 102.7F. Her last menstrual period was 5 days prior. Urine pregnancy test is negative. She denies respiratory or urinary symptoms. Which of the following organisms is most likely implicated in this patient's presentation?

A mother arrives to your clinic with her 5-year-old son afra...

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A 28-year-old homeless male with a past medical history sign...

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A 44-year-old male is rushed to the emergency department after he began complaining of blurry vision in both eyes that developed over the last 45 minutes. He has also experienced excessive sleepiness, having fallen asleep mid-sentence repeatedly over the last several hours. The patient has a past history of alcoholism and reports consuming 1 quart of locally-produced moonshine 12 hours ago. Which of the following sets of signs, symptoms, and findings would be expected upon further evaluation of this patient?

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A 69-year-old man is brought to the emergency room by his da...

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A 78-year-old female presents to her primary care provider complaining of shaking of her hands. She reports that her hands shake when she is pouring her coffee in the morning and when she is buttoning her shirt. She has noticed that her tremor improves with the several beers she has every night with dinner. She has a past medical history of hypertension, atrial fibrillation, moderate persistent asthma, acute intermittent porphyria, and urinary retention. Her home medications include hydrochlorothiazide, warfarin, bethanechol, low-dose inhaled fluticasone, and an albuterol inhaler as needed. On physical exam, she has an irregularly irregular heart rhythm without S3/S4. She has mild wheezing on pulmonary exam. She has no tremor when her hands are in her lap. A low-amplitude tremor is present during finger-to-nose testing. Her neurological exam is otherwise unremarkable. Which of the following is a contraindication to the first-line treatment of this condition?

A newborn male is evaluated in the hospital nursery two hour...

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A 4-day-old female is brought in by her mother for bilateral...

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A 61-year-old woman presents to her primary care physician c...

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A 45-year-old male with history of IV drug use presents to t...

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A 54-year-old male presents to the emergency department with...

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A 32-year-old female with no past medical history presents to the emergency department with complaints of fever, malaise, myalgias, abdominal pain, and vomiting. The patient's vital signs are: temperature is 102.2°F (39.0°C), blood pressure is 118/92 mmHg, pulse is 90/min, and respirations are 15/min. On physical exam, she is noted to be diaphoretic. She reports travel to Ghana several months ago as well as more recent travel to Wisconsin and Mexico. Upon further questioning, she notes that she camped overnight outside while in Wisconsin, and she swam in freshwater lakes and walked barefoot on the beach while in Mexico. She has noticed that her symptoms seem to be worse every other day. She is sexually active and has exposure to two sick contacts at home. Laboratory testing reveals the following: Leukocyte count: 8,000/mm^3 Hemoglobin: 10.4 g/dL Hematocrit: 35% Mean corpuscular volume: 81 µm^3 Platelets: 118,000/mm^3 Serum: AST: 66 IU/L ALT: 42 IU/L ALP: 55 IU/L Bilirubin: 1.8 mg/dL A peripheral blood smear is obtained (Figure A). Treatment of this disease must include which of the following?

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A 31-year-old African American female presents to her primar...

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A 35-year-old woman presents to the emergency department for shortness of breath. Her symptoms have been worsening gradually over the past several months. She is clutching her left chest and states she is experiencing pain in this area. The patient works in a shipyard and competes in bodybuilding competitions. The patient has a past medical history of asthma and rheumatoid arthritis. Her current medications include albuterol and ibuprofen. She admits to alcohol and anabolic steroid use. Her temperature is 99.5°F (37.5°C), blood pressure is 137/85 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 81% on room air. Laboratory values are ordered and are as follows: Serum: Na+: 136 mEq/L Cl-: 102 mEq/L K+: 4.2 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Glucose: 111 mg/dL Creatinine: 1.2 mg/dL Ca2+: 10.1 mg/dL AST: 32 U/L ALT: 33 U/L Brain natriuretic peptide: 845 pg/mL Hemoglobin: 10 g/dL Hematocrit: 29% Leukocyte count: 8,000 cells/mm^3 with normal differential Platelet count: 150,000/mm^3 An EKG is ordered as seen in Figure A. An ultrasound is performed demonstrating ventricular septal flattening and right ventricular dilatation with tricuspid regurgitation. On physical exam, the patient seems to be in distress and short of breath. Cardiac exam is notable for JVD and tachycardia. Pulmonary exam reveals mild wheezes bilaterally. Abdominal exam is notable for a liver edge that is palpable inferior to the rib cage. The patient has mild lower extremity pitting edema bilaterally. Which of the following treatments best addresses the underlying pathophysiology of this patient's presentation?

A 6-month-old male is brought to the pediatrician by his par...

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A 40-year-old South Asian male presents to a primary care provider complaining of a chronic cough that is worse at night. Through a translator, he reports that he has had the cough for several years but that it has been getting worse over the last few months. He recently moved to the United States to work in construction. He attributes some weight loss of ten pounds in the last three months along with darker stools to difficulties adjusting to a Western diet. He denies any difficulty swallowing or feeling of food getting stuck in his throat. He drinks alcohol once or twice per week and has never smoked. He denies any family history of cancer. On physical exam, his lungs are clear to auscultation bilaterally without wheezing. His abdomen is soft and non-distended. He has no tenderness to palpation, and bowel sounds are present. He expresses concern that he will be fired from work if he misses a day and requests medication to treat his cough. Which of the following is the best next step in management?

A 66-year-old man presents to his primary care physician endorsing easy bleeding. He reports that roughly 5 days ago, he began noticing excessive bleeding while brushing his teeth, and yesterday he had one episode of hematuria. He is otherwise healthy with a medical history including hypertension treated with amlodipine and depression for which he takes fluoxetine; he is up to date on all recommended screening. On examination, he is well-appearing; his lower extremities have numerous small non-blanching erythematous macules; no active bleeding is seen in his oropharynx. His primary care physician orders a complete blood cell count that reveals a white blood cell count of 7000/uL, hemoglobin of 12 g/dL, and platelet count of 34,000/uL. Peripheral blood smear is shown in Figure A. Which of the following is the most appropriate next step in management?

A 29-year-old woman presents to the emergency room with a painful and swollen leg. She noticed that over the past day her right leg and thigh have been larger than the other side (Figure A). She has no past medical history and has never had symptoms like this before. Her vital signs are stable. On physical examination, you find that dorsiflexion of her right foot at the ankle while the knee is fully extended causes her to have pain in her calf. Ultrasound of the right lower extremity reveals the following (Figure B). You suspect that the patient's symptoms are due to an inherited disease. Which of the following is the most common cause of this patient's condition?

A 38-year-old male with a past medical history of IV drug us...

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A 41-year-old woman from Ohio presents to her primary care p...

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A 21-year-old man presents to your office complaining of pain on urination and a watery discharge from his penis. Gram stain of the discharge is negative for bacteria but shows many neutrophils. When questioned about his social history, he says that he uses condoms most of the time but occasionally has unprotected sex. The patient responds to treatment with azithromycin. Which of the following organisms is most likely responsible for this man's infection?

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A 39-year-old G2P0020 female presents to her gynecologist fo...

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