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

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

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

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

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

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

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A 15-year-old female presents to her pediatrician’s office for severe menstrual cramping. The patient underwent menarche at age 11, and her periods were irregular every 2-3 months for two years. After that, her cycles became roughly regular every 28-35 days, but she has had extremely painful cramps and often has to miss school. The cramps are intermittent and feel like a dull ache in the center of her abdomen, and there is usually accompanying back pain. The patient has been using heating pads with limited relief. She reports some periods being “really heavy” and requires a superabsorbent pad every 6 hours for 2 days each cycle, but this does not limit her activities. She denies any bowel or bladder changes. The patient had normal development throughout childhood, is on the soccer team at school, and is not sexually active. Her father has hypertension and her mother has endometriosis and heavy periods. On exam, the patient is 5 feet 5 inches and weighs 158 pounds (BMI 26.3 kg/m^2). She is well appearing and has no abdominal tenderness. She has Tanner IV breasts and Tanner IV pubic hair, and external genitalia are normal. Which of the following is the best next step for this patient’s menstrual cramps?

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

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A 12-year-old female presents to the emergency department for cough. Her mother reports that the child has had rhinorrhea and cough for almost three weeks. The cough seems to be getting worse and often wakes the patient up from sleep. The patient has also had several episodes of post-tussive emesis. The patient’s mother has been treating the patient with oral antihistamines for presumed allergies, and an albuterol inhaler borrowed from the patient’s older brother. The patient has not been seen by a pediatrician for several years and her mother is unsure of her vaccination history. The patient’s temperature is 98.8°F (37.1°C), blood pressure is 96/71 mmHg, pulse is 90/min, and respirations are 14/min. On physical exam, the patient appears well. Her lungs are clear to auscultation bilaterally. The patient has the physical exam finding seen in Figure A. Which of the following is the best next step in management?

A 22-month-old girl presents to the emergency department wit...

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A 19-year-old male with a past medical history of surgical r...

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

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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?

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

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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 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 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 25-year-old woman with a history of polycystic ovary syndrome, depression, and chronic bilateral ear infections presents to the otolaryngologist's clinic 12 weeks after right ear tympanoplasty. Her audiology report 1 week prior showed that her hearing improved as expected by 20 decibels. However, she reports that she has occasional shooting pain with eating and when she wears earrings. She states that she has a stressful job as a cashier at the local department store and often sleeps poorly. She denies any neck pain or tenderness when she washes her face. Her temperature is 98.6°F (37°C), blood pressure is 115/74 mmHg, pulse is 86/min, and respirations are 12/min. On physical exam, no tenderness is elicited with preauricular or mandibular palpation bilaterally. No jaw-clicking is heard. Right postauricular tapping causes tenderness in her right tonsillar area. Her molar teeth appear even and symmetric bilaterally. Her uvula is midline and her gag reflex is intact. Which of the following is the most likely diagnosis?

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

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A 54-year-old man presents to the emergency department for f...

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A 55-year-old man presents to urgent care for weakness and w...

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A 67-year-old man presents to his primary care physician for...

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A 72-year-old man presents to his primary care physician wit...

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

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

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A 7-year-old boy presents to his pediatrician with a 2-day history of fatigue and easy bruising. He came back from soccer practice with large bruises all over his legs recently. He had a cold about 1 week ago that resolved without treatment. Otherwise, he has been healthy without any significant medical history. His vaccinations are fully up to date. His temperature is 98.6°F (37°C), blood pressure is 108/67 mmHg, pulse is 79/min, respirations are 13/min, and oxygen saturation is 98% on room air. The patient has the finding shown in Figure A. Labs are performed with the following results: Blood: Hemoglobin: 8.0 g/dL Leukocyte count: 7,210/mm^3 with normal differential Platelet count: 200,000/mm^3 Electrophoresis: HgS: absent HgA2: within normal limits The patient most likely has which of the following underlying diagnoses?

A 2-year-old male presents to the pediatrician for abdominal...

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A 45-year-old male comes into the trauma bay by EMS transport with a known history of gross contamination of an unknown dry/powder chemical from a research laboratory accident. Currently his vital signs are stable but he is in obvious discomfort with diffuse skin irritation. What should be done for this patient during the primary survey?

A 3-month-old boy presents to the pediatrician with his moth...

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An 8-year-old boy presents to his pediatrician for a well visit. He has been doing well in school and has many friends. The patient is a member of the chess club and enjoys playing video games. He has a medical history of asthma which is treated with albuterol. The patient is in the 99th percentile for weight and 30th percentile for height. His temperature is 99.5°F (37.5°C), blood pressure is 122/88 mmHg, pulse is 90/min, respirations are 11/min, and oxygen saturation is 98% on room air. The patient's body mass index is 39.1 kg/m^2 at this visit. The patient maintains eye contact and is excited to be at the doctor's office. Cardiopulmonary exam is within normal limits. Abdominal exam reveals normal bowel sounds and is non-tender in all 4 quadrants. Neurological and musculoskeletal exams are within normal limits. Which of the following is the most likely outcome in this patient within the next 10 years?

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

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

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A 46-year-old woman presents to her primary care doctor to r...

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

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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 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...

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A 38-year-old female presents to the emergency department for cough. She reports that two days ago she developed a nonproductive cough with moderate shortness of breath. On review of systems, the patient also endorses chills and sweats as well as several episodes of diarrhea over the past three days. Her husband also reports that the patient seemed confused this morning when he spoke to her before he left for work. The patient’s past medical history is significant for diabetes mellitus type II for which she takes metformin and glipizide. She drinks 8-10 beers per week and has a 15 pack-year smoking history. She works as a sales manager at a local retail company. Her temperature is 102.6°F (39.2°C), blood pressure is 126/72 mmHg, pulse is 82/min, and respirations are 18/min. On physical exam, she is alert and oriented to person and place only. She has crackles bilaterally extending up to the mid-lung fields. Her abdomen is soft and non-distended without rebound or guarding. Laboratory testing is performed and reveals the following: Serum: Na+: 129 mEq/L K+: 3.6 mEq/L Cl-: 99 mEq/L HCO3-: 17 mEq/L Urea nitrogen: 16 mg/dL Creatinine: 1.1 mg/dL Leukocyte count: 16,300/mm^3 Hemoglobin: 13.2 g/dL Mean corpuscular volume: 87 µm^3 Platelet count: 348,000/mm^3 A chest radiograph is performed and can be seen in Figure A. Which of the following is most likely to be elicited upon further questioning?

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?

A newborn girl is evaluated in the hospital nursery 1 hour a...

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A 16-year-old girl presents to the physician for delayed ons...

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A 5-year-old girl presents to the pediatrician for a routine...

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A 52-year-old homeless man presents to the emergency department intoxicated. He was found passed out in a park and brought in by police. The patient's medical history and medications are not known. He was brought in 1 week ago for an intravenous drug overdose which was treated appropriately at the time. His temperature is 99.5°F (37.5°C), blood pressure is 92/58 mmHg, pulse is 120/min, respirations are 8/min, and oxygen saturation is 98% on room air. The patient is started on IV fluids and given a dose of naloxone. Basic laboratory values are seen below. Hemoglobin: 10 g/dL Hematocrit: 32% Leukocyte count: 7,500/mm^3 with normal differential Platelet count: 167,000/mm^3 Serum: Na+: 139 mEq/L Cl-: 100 mEq/L K+: 5.1 mEq/L HCO3-: 25 mEq/L BUN: 52 mg/dL Glucose: 99 mg/dL Creatinine: 2.1 mg/dL Ca2+: 10.2 mg/dL AST: 62 U/L ALT: 50 U/L The patient is clinically sober 4 hours later and history and physical exam is able to be performed. The patient complains of joint pain and pain/tingling in his extremities. A cardiopulmonary exam is notable for a murmur along the left sternal border. The patient has decreased sensation in his legs bilaterally. A dermatologic exam reveals the finding in Figure A. Which of the following is the most appropriate next step in management?