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QID: 107229
A 67-year-old woman is brought to the emergency room after complaining of back pain with a gradual loss of sensation in her lower extremities. She was recently diagnosed with radiosensitive metastatic breast cancer and was scheduled to receive chemotherapy and palliative surgery. Her temperature is 99.0°F (37.2°C), blood pressure is 133/81 mmHg, pulse is 82/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for decreased sensation bilaterally over the patient's lower extremities. She demonstrates 2/5 strength of leg extension on the left and 1/5 on the right which is slightly worse than her baseline neurological exam taken 2 months ago. Pain to her lumbar region worsens with coughing. An initial CT scan of the spine does not demonstrate any unstable fractures of the spine. A MRI of the spine is ordered and pending. Which of the following is the most appropriate next step in management?
Oncology
- Metastatic Cancer to Bone
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QID: 108970
A 32-year-old G1P0 presents to the antenatal testing unit at...
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Obstetrics
- Fetal Parameters
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QID: 108587
A 36-year-old G3P2002 at 34 weeks gestation presents to the ...
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Obstetrics
- Abruptio Placentae
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QID: 108992
A 64-year-old male presents to the emergency room with a sev...
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Ophthalmology
- Glaucoma
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QID: 108989
A 69-year-old man arrives to your clinic complaining of prog...
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Ophthalmology
- Retinal Detachment
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QID: 107369
A 35-year-old homeless man is admitted to the medical floor....
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Cardiovascular
- Endocarditis
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QID: 107246
A 7-year-old boy is brought to his pediatrician for evaluation of a sore throat. The sore throat began 4 days ago and has progressively worsened. Associated symptoms include subjective fever, pain with swallowing, cough, and fatigue. The patient denies any cough or rhinorrhea. Vital signs are as follows: T 38.6 C, HR 88, BP 115/67, RR 14, and SpO2 99%. Physical examination is significant for purulent tonsillar exudate; no cervical lymphadenopathy is noted. Which of the following is the best next step in the management of this patient?
Pediatrics
- Pharyngitis
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QID: 102991
A 35-year-old woman comes into the emergency room with compl...
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Heme
- Immune Thrombocytopenia (ITP)
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QID: 109835
A 67-year-old man presents to the emergency department with ...
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Oncology
- Chronic Myeloid Leukemia (CML)
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QID: 210398
A 27-year-old woman comes to her primary care physician comp...
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Endocrine
- Graves Disease
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QID: 213546
A 25-year-old man with a past medical history of alcoholism ...
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Pulmonary
- Mechanical Ventilation
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QID: 109097
A 69-year-old man presents to his primary care physician for...
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Psychiatry
- Insomnia Disorders / Hypersomnia
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QID: 109119
A 16-year-old male presents to an ophthalmologist as a new p...
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Orthopedics
- Marfan Syndrome
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QID: 108998
A 25-year-old male medical student presents to student healt...
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Psychiatry
- Obsessive Compulsive Disorder
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QID: 108986
A 57-year-old woman presents to the emergency department for...
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Psychiatry
- Lithium
QID: 106100
A 67-year old male with congestive heart failure with systolic dysfunction presents to the emergency department with several days of nausea, vomiting, and decreased appetite. He denies fever, chest pain, abdominal pain, or sick contacts. He reports shortness of breath at baseline. His heart rate is 84 beats/min and his blood pressure is 118/87. Physical exam is remarkable for +1 pitting edema in his bilateral lower extremities. His current medications include furosemide, lisinopril, carvedilol, and digoxin. At a recent cardiologist visit, his furosemide dose was increased due to worsening lower extremity edema. His EKG is shown below (Figure A). His lab values are below. Serum: Na+: 135 mEq/L K+: 3.7 mEq/L Cl-: 94 mEq/L HCO3-: 25 mEq/L Management of this patient will likely entail which of the following?
Cardiovascular
- Digoxin
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QID: 210559
A 65-year-old man is referred by his primary care provider t...
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Neurology
- Lumbar Spinal Stenosis
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QID: 213209
A 25-year-old man presents to his primary care physician for...
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Psychiatry
- Generalized Anxiety Disorder
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QID: 108982
A 25-year-old woman presents to her primary care physician w...
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Rheumatology
- Mixed Connective Tissue Disorder (MCTD)
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QID: 108520
A 25-year-old man presents to his primary care physician wit...
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Rheumatology
- Ankylosing Spondylitis
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