A 53-year-old man presents to his primary care provider with...

Sorry, only PEAK Subscribers can view this question

A 31-year-old African American woman presents to her primary...

Sorry, only PEAK Subscribers can view this question

A 61-year-old woman presents to the emergency department wit...

Sorry, only PEAK Subscribers can view this question

A 58-year-old African-American male presents to the emergenc...

Sorry, only PEAK Subscribers can view this question

A 67-year-old man is seen on the surgical floor after a tran...

Sorry, only PEAK Subscribers can view this question

A 23-year-old man presents to the emergency department after...

Sorry, only PEAK Subscribers can view this question

A 48-year-old nurse presents with left-sided chest pain and ...

Sorry, only PEAK Subscribers can view this question

A 22-year-old man presents to his primary care physician for...

Sorry, only PEAK Subscribers can view this question

A 27-year-old male presents to the emergency department after being brought in from a house fire. The patient has extensive burns covering his body and is conscious but in severe pain. The patient has a past medical history notable for marijuana use. He is not currently on any medications. Physical exam is notable for extensive burns covering the patients back, chest, thighs, and legs. The patient's oropharynx reveals no signs of damage or extensive smoke inhalation. The patient is breathing on his own and has normal breath sounds bilaterally. His temperature is 99.5°F (37.5°C), pulse is 145/min, blood pressure is 100/70 mmHg, respirations are 27/min, and oxygen saturation is 93% on room air. Which of the following interventions is most likely to reduce mortality in this patient?

A 27-year-old woman presents to her primary care physician for foot pain. The patient states that she has pain in her foot and toes whenever she exerts herself or is at work. The patient is an executive at a medical device company and works 60 hours/week. She is currently training for a marathon. She has a past medical history of anxiety, constipation, and irritable bowel syndrome. Her current medications include clonazepam, sodium docusate, and hyoscyamine. Her temperature is 99.5°F (37.5°C), blood pressure is 100/60 mmHg, pulse is 50/min, respirations are 10/min, and oxygen saturation is 99% on room air. Cardiac and pulmonary exams are within normal limits. Examination of the lower extremity reveals 5/5 strength with 2+ reflexes. Palpation of the interdigital space between the third and fourth toes elicits pain and a clicking sound. Which of the following is the most likely diagnosis?

A 46-year-old man presents with his wife to his primary care...

Sorry, only PEAK Subscribers can view this question

A 69-year-old man is brought to the emergency room by his daughter due to confusion. She reports that her father did not remember who she was yesterday, and his refrigerator was completely empty when she tried to make him lunch. She states that he was acting like himself when she visited him last week. She also notes that he has struggled with alcoholism for many years and has not seen a doctor in over two decades. She is unsure if he has any other chronic medical conditions. In the emergency room, the patient’s temperature is 101.2°F (38.4°C), pulse is 103/min, respirations are 22/min, and O2 saturation is 92% on room air. His BMI is 17.1 kg/m^2. Physical exam reveals an extremely thin and frail man who is not oriented to person, place, or time. As he is being examined, he becomes unresponsive and desaturates to 84%. He is intubated and admitted to the intensive care unit for what is found to be pneumonia, and the patient is started on total parental nutrition as he is sedated and has a history of aspiration from a prior hospitalization. Two days later, physical exam is notable for new peripheral edema. Laboratory tests at that time reveal the following: Serum: Na+: 133 mEq/L Cl-: 101 mEq/L K+: 2.4 mEq/L HCO3-: 24 mEq/L BUN: 22 mg/dL Glucose: 124 mg/dL Creatinine: 1.1 mg/dL Phosphate: 1.1 mg/dL Mg2+: 1.0 mg/dL Which of the following could have prevented the complication seen in this patient?

A 69-year-old man arrives at your clinic complaining of prog...

Sorry, only PEAK Subscribers can view this question

A 17-year-old girl is brought to her primary care physician ...

Sorry, only PEAK Subscribers can view this question

A 37-year-old G2P1001 woman presents to her obstetrician’s o...

Sorry, only PEAK Subscribers can view this question

A 25-year-old woman with a history of polycystic ovary syndr...

Sorry, only PEAK Subscribers can view this question

A 6-month-old male infant is brought to the clinic because the mother thinks that her child is "cross-eyed." The mother's prenatal history was unremarkable. The child was delivered vaginally without complications. His nutrition has been stellar, and his well-child visits documented appropriate reflexes and milestones. The mother reports that the infant's eyes are constantly crossed, and she is concerned that her child will need surgery. On physical exam, there is no white reflex seen with the ophthalmoscope in either eye. The infant's eyes are shown in Figure A. What is the best next step in management?

A 31-year-old G2P1001 presents to the labor floor for external cephalic version (ECV) due to breech presentation at 37 weeks gestation. Her pregnancy has been complicated by an episode of pyelonephritis at 14 weeks gestation, treated with intravenous ceftriaxone. The patient has not had urinary symptoms since that time. Otherwise, her prenatal care has been routine and she tested Rh-negative with negative antibodies at her first prenatal visit. She has a history of one prior spontaneous vaginal delivery without complications. She also has a medical history of anemia. Current medications include nitrofurantoin for urinary tract infection suppression and iron supplementation. The patient’s temperature is 98.5°F (36.9°C), pulse is 75/min, blood pressure is 122/76 mmHg, and respirations are 13/min. Physical exam is notable for a fundal height of 37 centimeters and mild pitting edema in both lower extremities. Cardiopulmonary exams are unremarkable. Bedside ultrasound confirms that the fetus is still in breech presentation. Which of the following should be performed in this patient as a result of her upcoming external cephalic version?

A 73-year-old male presents to his primary care provider for...

Sorry, only PEAK Subscribers can view this question

An 11-year-old boy presents to his pediatrician for a wellne...

Sorry, only PEAK Subscribers can view this question

A 25-year-old male medical student presents to the student h...

Sorry, only PEAK Subscribers can view this question

A 32-year-old man presents to his primary care provider for ...

Sorry, only PEAK Subscribers can view this question

A 30-year-old G3P0 woman who is 28-weeks pregnant presents for a prenatal care visit. She reports occasionally feeling her baby move but has not kept count over the past several weeks. She denies any bleeding, loss of fluid, or contractions. Her previous pregnancies resulted in spontaneous abortions at 12 and 14 weeks. She works as a business executive, has a history of previous blood clots, and has had no surgeries. She states that she hired a nutritionist and pregnancy coach to ensure good prospects for this pregnancy. On physical exam, fetal heart tones are not detected. Abdominal ultrasound shows a 25-week fetal demise. The patient requests an autopsy on the fetus. What is the best next step in management?

A 15-year-old male presents to the pediatrician with his mot...

Sorry, only PEAK Subscribers can view this question

An 11-year-old boy presents to the pediatrician with his mot...

Sorry, only PEAK Subscribers can view this question

A 71-year-old woman arrives to clinic with sudden vision los...

Sorry, only PEAK Subscribers can view this question

A 32-year-old G1P0000 presents to labor and delivery triage at 38 weeks gestation after several hours of contractions. Currently, they are timed about four minutes apart. Her contractions started after she tripped on a rug and fell on her side. She denies leakage of fluid and the baby has been moving normally, but she noted a small amount of blood on her underwear just before coming into the hospital. The pregnancy has been uncomplicated thus far. The patient has a past medical history of endometriosis, and this fetus was conceived by in vitro fertilization. Pelvic exam in triage reveals a cervix that is three centimeters dilated with a small amount of blood near the introitus. Fetal heart rate tracing at this time is shown in Figure A. Which of the following is the most likely diagnosis?

A 68-year-old gentleman presents to the emergency department for decreased responsiveness. The patient was a successful businessman who managed a multi-billion dollar corporation until several months ago when he retired. Since then, he has had trouble taking care of himself as well as being reclusive and depressed. The patient's wife states that he no longer engages in any activities he once enjoyed and spends most nights awake, staring at the ceiling in tears. The patient has trouble getting out of bed and feels that his limbs are heavy and difficult to manipulate for everyday tasks. He has also been complaining of a numb and tingling sensation in his extremities for the past week. The patient no longer interacts with his wife and does not join her for meals or vacations. Since retirement, he typically stays in his room drinking yam-flavored schnapps all day. The patient does not have a significant past medical history. On physical exam, you see a confused gentleman who responds occasionally to your questions. He has a cough that recently started. He is poorly kempt, unshaven, and wearing a bathrobe. He does not cooperate with a neurological exam. On physical exam you note the findings in Figure A. The patient's skin is dry and unwashed. A chest radiograph is obtained and seen in Figure B. Lab values are below. Serum: Na+: 135 mEq/L K+: 4.2 mEq/L Cl-: 100 mEq/L HCO3-: 24 mEq/L Urea nitrogen: 9 mg/dL Glucose: 50 mg/dL Creatinine: 0.8 mg/dL Thyroid-stimulating hormone: 0.9 µU/mL Ca2+: 9.1 mg/dL Mg2+: 1.5 mEq/L Hemoglobin: 13.5 g/dL Mean corpuscular volume: 100 µm^3 Reticulocyte count: 1.5% Platelet count: 150,000/mm^3 Leukocyte count: 4,900/mm^3 Administration of which of the following is the next best step in management?

A 15-year-old boy presents to his primary care doctor for "e...

Sorry, only PEAK Subscribers can view this question

A 12-month-old boy is brought in by his parents for a routin...

Sorry, only PEAK Subscribers can view this question

A 29-year-old G1P0 presents to her obstetrician for her first prenatal care visit at 12 weeks gestation by last menstrual period. She states that her breasts are very tender and swollen, and her exercise endurance has declined. She otherwise feels well. She is concerned about preterm birth, as she heard that certain cervical procedures increase the risk. The patient has a gynecologic history of loop electrosurgical excision procedure (LEEP) for cervical dysplasia several years ago and has had negative Pap smears since then. She also has mild intermittent asthma that is well controlled with occasional use of her albuterol inhaler. At this visit, this patient’s temperature is 98.6°F (37.0°C), pulse is 69/min, blood pressure is 119/61 mmHg, and respirations are 13/min. Cardiopulmonary exam is unremarkable, and the uterine fundus is just palpable at the pelvic brim. Pelvic exam reveals normal female external genitalia, a closed and slightly soft cervix, a 12-week-size uterus, and no adnexal masses. Which of the following is the best method for evaluating for possible cervical incompetence in this patient?

A 36-year-old G2P1 at 34 weeks gestation presents to the obs...

Sorry, only PEAK Subscribers can view this question

A 35-year-old G3P2 woman currently 39 weeks pregnant presents to the emergency department with painful vaginal bleeding shortly after a motor vehicle accident in which she was a passenger. She had her seat belt on and reports that the airbag deployed immediately upon her car's impact against a tree. She admits that she actively smokes cigarettes. Her prenatal workup is unremarkable. Her previous pregnancies were remarkable for one episode of chorioamnionitis that resolved with antibiotics. Her temperature is 98.6°F (37°C), blood pressure is 90/60 mmHg, pulse is 130/min, and respirations are 20/min. The fetal pulse is 110/min. Her uterus is tender and firm. The remainder of her physical exam is unremarkable. What is the most likely diagnosis?

A 35-year-old woman at 36 weeks gestation presents to the emergency department with voluminous bloody discharge from her vagina. The patient states that she was at home when her symptoms suddenly started. She states that she is currently experiencing abdominal pain and feels dehydrated. The patient has a past medical history of substance abuse, obesity, and hypertension. Her social history is significant for being a victim of domestic abuse. Her current medications include folic acid, ibuprofen, and sodium docusate. Her temperature is 99.5°F (37.5°C), blood pressure is 100/55 mmHg, pulse is 100/min, respirations are 19/min, and oxygen saturation is 98% on room air. External fetal monitoring is seen in Figure A. The patient is started on IV fluids and 100% oxygen. She continues to complain of abdominal pain. Which of the following best describes this patient's presentation?

A 69-year-old woman presents with pain in her hip and groin....

Sorry, only PEAK Subscribers can view this question

A 27-year-old woman who is an immigrant from Bolivia present...

Sorry, only PEAK Subscribers can view this question

An 8-year-old boy presents to his pediatrician for a well vi...

Sorry, only PEAK Subscribers can view this question

A 27-year-old man presents to the emergency department after a motor vehicle accident. He was the unrestrained driver in a head-on collision. The patient is currently unresponsive and his clothes are soaked in blood. The patient is breathing on his own and grimaces in response to pain. His temperature is 99.5°F (37.5°C), blood pressure is 90/60 mmHg, pulse is 130/min, respirations are 19/min, and oxygen saturation is 95% on room air. The patient is started on intravenous fluids. A FAST exam is negative for signs of intra-abdominal trauma. A chest radiograph is within normal limits. Lacerations on the patient’s chest, back, and head are repaired, and the patient is given blood products. Repeat vitals reveal a blood pressure of 110/70 mmHg and a pulse of 90/min. The patient is observed in the trauma bay. Five hours later, his temperature is 99.5°F (37.5°C), blood pressure is 115/75 mmHg, pulse is 85/min, respirations are 23/min, and oxygen saturation is 84% on room air. A chest radiograph is ordered as seen in Figure A. An arterial blood gas is performed and reveals the findings below. Gases, arterial blood: pH: 7.56 PCO2: 23 mmHg PO2: 70 mmHg Which of the following is the best next step in management?

A 16-year-old female presents to her physician’s office after noticing a round lump in her left breast 2 months ago. She reports that the lump seemed to enlarge and became tender just preceding her last 2 menses. It is otherwise painless, and the patient denies any discharge or skin changes. She has no past medical history but her grandmother, age 72, was just diagnosed with invasive ductal carcinoma of the breast. The patient is an avid softball player at her high school and denies alcohol, smoking, or illicit drug use. On exam, the breasts appear symmetric and normal. A 3-cm round, mobile mass is palpated in the upper outer quadrant of the left breast. There is slight tenderness to deep palpation of the mass. There is no axillary lymphadenopathy on either side. Which of the following is the most likely outcome of this patient’s condition?

A 19-year-old male with cystic fibrosis is evaluated in the clinic for regular health maintenance. He is compliant with his respiratory therapy, but states that he often "forgets" to take the medications before he eats. A panel of labs is drawn which reveals a moderate vitamin D deficiency. Which of the following electrolyte abnormalities might be seen as a consequence of vitamin D deficiency?

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

Sorry, only PEAK Subscribers can view this question

A 41-year-old man presents to the emergency room with sudden onset of blurry vision one hour ago. He states that he was resting at home when he noticed he had difficulty reading. Currently, he is also starting to see double, and is seeing two images on top of each other. Earlier today, he felt ill with nausea, vomiting, and watery diarrhea, which he attributed to food he had eaten at a picnic the day before. When asked which foods he ate, he lists potato salad, a hamburger, deviled eggs, and pickles made by his neighbor. He also heard that his friend who went to the picnic with him has developed similar symptoms and was seen in another hospital earlier. While in the emergency room, the patient’s temperature is 98.4°F (36.9°C), pulse is 75/min, blood pressure is 122/84 mmHg, and respirations are 13/min. Cranial nerve exam is notable for fixed pupillary dilation, and difficulty depressing both eyes. The remainder of his exam is normal. Which of the following is the pathogenesis of this patient’s presentation?

A 27-year-old woman presents to the emergency department for...

Sorry, only PEAK Subscribers can view this question

A 68-year-old male presents with several years of progressiv...

Sorry, only PEAK Subscribers can view this question

A 52-year-old homeless man presents to the emergency departm...

Sorry, only PEAK Subscribers can view this question

A 72-year-old man presents to the primary care clinic for ev...

Sorry, only PEAK Subscribers can view this question

A 42-year-old G3P3003 presents for a 6-week postpartum obste...

Sorry, only PEAK Subscribers can view this question

A 66-year-old man presents to the clinic for evaluation of a...

Sorry, only PEAK Subscribers can view this question

A 69-year-old man presents to his primary care physician for...

Sorry, only PEAK Subscribers can view this question

A 26-year-old female presents to her primary care physician with several months of mood swings, which she feels are affecting her work and personal relationships. She states that on roughly a quarter of days each month, she feels highly irritable, sensitive to criticism and rejection, and easily saddened. She also feels that her appetite varies greatly, and on the days when she is particularly emotional, she also feels especially hungry. As a result of these symptoms, her performance at work has suffered, and her boyfriend has been complaining that she is difficult to live with. She is anxious that she cannot “get my mood under control.” The patient has no past medical history, regular periods every 28 days, and no obstetric history. She uses condoms for contraception. Her mother has major depressive disorder, and her father has hypertension and coronary artery disease. At this visit, the patient’s temperature is 98.4°F (36.9°C), pulse is 75/min, blood pressure is 130/76 mmHg, and respirations are 13/min. She appears slightly anxious but has overall normal affect and is pleasantly conversational. Physical exam is unremarkable. Which of the following is the best next step in management?