An 18-year-old girl comes to the clinic because she is conce...

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A 56-year-old man comes to the clinic complaining of back pa...

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A 28-year-old female patient with a history of schizophrenia, type 2 diabetes mellitus, and hypothyroidism comes to clinic stating she would like to be put back on a medication. She recently stopped taking her haloperidol as it made it hard for her to "sit still." She requests to be put on olanzapine as a friend from a support group said it was helpful. Why should this medication be avoided in this patient?

A 35-year-old man presents to the emergency department with a complaint of shortness of breath over the past 5 days. He has had a worsening dry cough over the past 4 weeks and has also noted a 12 lb weight loss. He was diagnosed with HIV two years ago but is unable to afford the medications he was prescribed. Vital signs are as follows: T 102.8 F, HR 78 bpm, BP 122/78 mmHg, RR 14 bpm, SpO2 96%. Physical examination is unremarkable. Chest radiography is obtained and shown in Figure A. Bronchoalveolar lavage is performed and reveals the findings in Figure B. Apart from starting HAART therapy, what other treatment is recommended for this patient?

A 27-year-old HIV positive female presents to your office with fatigue, fever, and a non-productive cough that started 2 weeks ago. She states that she gets very tired while walking short distances. Vital signs are as follows: T 103.2 F, HR 84 bpm, BP 116/72 mmHg, RR 19 bpm. Physical examination reveals light rales in the base of of the lungs bilaterally. Chest radiography is shown in Figure A. Bronchoalveolar lavage results are shown in Figure B. An ABG is performed and reveals a PaO2 of 64 mmHg. HAART therapy and IV trimethoprim-sulfamethoxazole are initiated. What other treatment is recommended for this patient?

A 33-year-old male presents to the emergency room with fatigue and a non-productive cough that started a month ago. Review of systems is positive for chills, fevers, and dyspnea on exertion. Vital signs are as follows: T 102.7 F, HR 90 bpm, BP 124/85 mmHg, RR 16 bpm. Physical examination reveals cervical lymphadenopathy. An HIV test returns positive. Chest radiography is performed and results are shown in Figure A. Which of the following diagnostic modalities is the most appropriate for this patient?

A 52-year-old female presents to her rheumatologist with complaints of fatigue, a sore mouth, and occasional nausea and abdominal pain over the past several months. Her medical history is significant for 'pre-diabetes' treated with diet and exercise, hypertension managed with lisinopril, and rheumatoid arthritis well-controlled with methotrexate. Her vital signs are within normal limits. Physical examination is significant for an overweight female with the findings as shown in Figures A and B. The physician orders laboratory work-up including complete blood count with peripheral blood smear as well as basic metabolic panel and serum methylmalonic acid and homocysteine levels. These tests are significant for a hematocrit of 29.5, a decreased reticulocyte count, normal serum methylmalonic acid level, increased homocysteine level, as well as the peripheral smear shown in Figure C. Which of the following could have reduced this patient's risk of developing their presenting condition?

A 69-year-old patient presents to the emergency department w...

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A 75-year-old Caucasian man presents to the emergency depart...

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A 51-year-old white female presents to her primary care physician for a regular check-up. She endorses eating a healthy diet with a balance of meat and vegetables. She also states that she has a glass of wine each night with dinner. As part of the evaluation, a complete blood count and blood smear were performed and are remarkable for: Hemoglobin 8.7 g/dL, Hematocrit 27%, MCV 111 fL, and a smear showing macrocytes and several hypersegmented neutrophils. Suspecting an autoimmune condition with anti-intrinsic factor antibodies, what other finding might you expect in this patient?

A 65-year-old man arrives to the emergency department (ED) complaining of pain and swelling in his right leg. The patient reports he recently underwent a total hip replacement. His past medical history is significant for hypertension and diabetes. His current medications include aspirin, lisinopril, metformin, and atorvastatin. On arrival, his temperature is 99°F (37.2°C), blood pressure is 135/82 mmHg, pulse is 88/minute, and oxygen saturation is 99% O2. He denies chest pain or shortness of breath. On physical exam, his right leg appears moderately erythematous, swollen, and is tender to palpation. Other physical exam findings are negative. A complete blood count (CBC) was performed with the following findings: Hemoglobin: 13.0 g/dL Leukocyte count: 6500/mm^3 Platelet count: 150,000/mm^3 The appropriate anti-coagulation therapy is started. Seven days later the patient arrives back to the ED complaining of crushing substernal chest pain. An electrocardiogram is performed and is shown in Figure A. A CBC was performed with the following findings: Hemoglobin: 13.5 g/dL Leukocyte count: 8500/mm^3 Platelet count: 58,000/mm^3 INR: 2.5 aPTT: 34 seconds Fibrinogen level: 200 mg/dL Troponin T: 0.2 ng/mL On physical exam, the right leg is again swollen and tender to palpation. However, a new lesion has also formed, as shown in Figure B. In addition to sending the patient for cardiac catherization, what is the most appropriate next step in management?

A 45-year-old man with a history of biliary colic presents with one-day of intractable nausea, vomiting, and abdominal pain radiating to the back. Temperature is 99.7 deg F (37.6 deg C), blood pressure is 102/78 mmHg, pulse is 112/min, and respirations are 22/min. On abdominal exam, he has involuntary guarding and tenderness to palpation in the right upper quadrant and epigastric regions. Laboratory studies show white blood cell count 18,200/uL, alkaline phosphatase 650 U/L, total bilirubin 2.5 mg/dL, amylase 500 U/L, and lipase 1160 U/L. Which of the patient's laboratory findings is associated with increased mortality?

A 27-year-old G1P0 female presents for her first prenatal vi...

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A group of investigators seeks to compare the non-inferiorit...

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A 33-year-old male with a history of HIV presents to the eme...

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A 60-year-old female presents to the emergency department with severe pain and vision loss in her left eye. She states that the pain and vision loss seemed to start when she was driving through a dark tunnel. She has never experienced symptoms like this before and has no prior history of ophthalmologic problems. Her left eye is demonstrated in Figure A, is poorly responsive to light, and feels hard to the touch. What is the most likely cause of this patient's presentation?

A 24-year-old woman presents with 3 days of diarrhea. She was recently on vacation in Peru and admits that on her last day of the trip she enjoyed a dinner of the local food and drink. Upon return to the United States the next day, she developed abdominal cramps and watery diarrhea, occurring about 3-5 times per day. She has not noticed any blood or mucous in her stool. Vital signs are stable. On physical examination, she is well appearing in no acute distress. Which of the following is commonly associated with the likely underlying illness?

A 70-year-old male patient comes into your office because of...

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A 34-year-old male presents to clinic today complaining that his medication has stopped working. He states despite being able to manage the side effects, a voice has returned again telling him to hurt his Mother. You prescribe him a drug which has shown improved efficacy in treating his disorder but requires frequent followup visits. One week later he returns with the following lab results: WBC : 2500 cells/mcL, Neutrophils : 55% and, Bands : 1%. What drug was this patient prescribed?

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A 25-year-old man presents to the emergency department with altered mental status. He was found down in the middle of the street. His past medical history is unknown. His temperature is 99.0°F (37.2°C), blood pressure is 104/64 mmHg, pulse is 70/min, respirations are 5/min, and oxygen saturation is 91% on room air. The patient is being resuscitated in the trauma bay. Which of the following was most likely to be found on exam?

A 23-year-old male presents with enlarged cervical nodes. The nodes are non-erythematous, non-tender, mobile, and have a rubbery consistency. He notes recurrent night sweats that soak through his clothes and nightly fevers. A lymph-node biopsy is performed, and is shown in Figure A. The patient also mentions that his urine is “frothy”. A urine dipstick is positive for albumin (3+). If a renal biopsy were to be performed, which of the following would most likely be found in this patient?

A 63-year-old female complains of weakness, light-headedness, palpitations, and soreness of the tongue. She has a past medical history of Hashimoto’s thyroiditis. Her hematocrit is 29%. On peripheral blood smear, you notice neutrophils with 7 lobes and large oval-shaped red blood cells. On physical exam, you notice the patient has decreased position sense and a loss in vibratory sensation in her lower extremities. Which of the following is most likely present in this patient?

A 5 day old neonate presents at night to the emergency room with "one day of green vomiting and a larger belly than usual" according to mom. The mother explains that the patient passed stool for only two days after birth and had been feeding well until this morning when the patient vomited after feeding and continued to vomit sporadically throughout the day. Newborn screening was normal for this patient, there were no pregnancy complications, the patient has been breastfeeding consistently with only some regurgitation, and the patient has no sick contacts. The abdomen is distended on physical exam without palpable masses, and there is no stool in the rectal vault. Upper gastrointestinal series film can be appreciated in Figure A. What is the most likely diagnosis of this patient?

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A 56-year-old man with a history of pancreatic cancer presen...

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A 33-year-old African American woman presents to the emergen...

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A study on cholesterol levels is performed. There are 1000 participants. It is determined that in this population, the mean LDL is 200 mg/dL with a standard deviation of 50 mg/dL. If the population has a normal distribution, how many people have a cholesterol less than 300 mg/dL?

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A 6-year-old boy is brought in by his mother for a well-visi...

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