Property:Prompt
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A 23 yr old male came to the emergency department with complaints of headache and palpitations. By time you attended the patient, he is asymptomatic. He reveals three similar episodes in the past that resolved spontaneously. He was recently diagnosed with hypertension, but she is currently on no medications for that. On examniation, you see a anxious and diaphorectic person. Physcial examination reveals severe hand tremors and excessive sweating. His temperature is 36.7 C, blood pressure is 190/100 mmHg, pulse is 102/min and respiartions are 16/min. Her oxygen saturation is 97% on room air. The neck is supple without any jugular venous distension or thyroid enlargement. While waiting for the biochemical results, a slow infusion of labetolol is started. What would be the reaction to the treatment given to the patient? +
A 60 year old male come for routine health check up. He is found to elevated alkaline phosphate levels. His serum calcium and phosphorus levels are normal. He denies any bone pain or bone deformity. His liver function tests are normal. Bone scan reveal increased uptake in the left knee and his urinary hydroxyl proline levels are increased. A diagnosis of Paget’s disease is made. What is the most appropriate line of management in this patient? +
A 43 year old female comes to the physician office with complaints of pain and morning stiffness in both hands for the past 6 months. She is on NSAID’s and steroids for the symptoms. She says the pain recurs when she stops taking her medications. She is an alcoholic, smokes 1 pack if cigarette/day. She hasn’t attained menopause and her menstrual periods are normal. After the examination, she was diagnosed with synovitis involving the metacarpophalangeal and the proximal interphalangeal joints. She is started on prednisone on a chronic basis with 7.5mg/day. What is the most appropriate action to prevent osteoporosis? +
A 56 year old man comes to the emergency department with severe pain in the right great toe. He says that this is the first time he is experiencing such a severe pain and it started suddenly when he woke up from his bed this morning. He is a chronic alcoholic and smokes 2 packs of cigarette a day. He denies any trauma to his leg. On examination, his right toe is swollen, erythematous and he did not allow touching because of severe pain. What is the most appropriate line of management? +
A 56 year old man comes to the emergency department with severe pain in the right great toe. He says that this is the first time he is experiencing such a severe pain and it started suddenly when he woke up from his bed this morning. He is a chronic alcoholic and smokes 2 packs of cigarette a day. He denies any trauma to his leg. On examination, his right toe is swollen, erythematous and he did not allow touching because of severe pain. The diagnosis of acute gout is made by visualization of urate crystals in a sample of fluid aspirated from an affected joint (or bursa). The patient feels better after treatment with anti-inflammatory agents. What is the most appropriate line of management of the patient at this stage? +
A 65 year old women comes to see you at the office with complaints of right wrist pain for the past 3 months. She has numbness and tingling sensation in the first two fingers and her symptoms increase with activities requiring prolonged flexion or extension of the wrist. Her other medical problems are hypothyroidism, diabetes, chronic renal failure, coronary heart disease, hypertension and osteoporosis. What is the most appropriate method to make the diagnosis of this condition? +
A 65 year old women comes to see you at the office with complaints of right wrist pain for the past 3 months. She has numbness and tingling sensation in the first two fingers and her symptoms increase with activities requiring prolonged flexion or extension of the wrist. Her other medical problems are hypothyroidism, diabetes, chronic renal failure, coronary heart disease, hypertension and osteoporosis. A clinical diagnosis of carpel tunnel syndrome is made. Which is the most appropriate initial approach to manage her symptoms? +
An 11 year old boy is brought to his pediatrician for recurrent episodes of involuntary muscle twitching. He reports that these episodes have grown more frequent and increased in duration over the past year. The patient also suffers from poor vision at night, and exercise intolerance that began at the age of six. A maternal aunt has epilepsy. The patient has achieved all developmental milestones, but has especially short stature relative to his peers. Which of the following is true of this patient’s condition? +
A 19-year-old man is referred for poor vision following annual school vision testing. Visual acuity testing reveals 20/30 vision in the left eye and 20/400 vision in the right eye with a centrocecal scotoma, and the patient was prescribed corrective lenses. Three weeks later, the patient returns complaining that his corrective lenses no longer allow him to see properly. Reassessment of his visual acuity demonstrates 20/80 vision in the left eye and near total blindness in the right eye. Fundoscopic examination reveals tortuous and dilated retinal blood vessels with a crowded and swollen nerve fiber layer. Head MRI is negative for an intracranial mass. The physician informs the patient that he will most likely become completely blind over the next several months. Which disease also shares the same mode of inheritance as the patient's condition? +
A 19-year-old woman is brought to the emergency department (ED) by EMS for transient loss of consciousness. Her roommate reports that she was watching television when she began to see the colors on the screen blend, and the room began to “wave”. As her vision normalized, she experienced a sharp migraine-like headache and vomited twice. She lost consciousness for 10 minutes but regained consciousness by the time EMS arrived. The patient explains that this is not the first time she experiences stroke-like symptoms, and she had multiple similar episodes in the past. Her past medical history is also significant for multiple hospitalizations for tonic-clonic seizures. Upon further investigation, the woman states that she has been intolerant to exercise ever since she was a child. Physical examination in the ED is remarkable for transient weakness in the right upper and lower limbs and a wide-based, ataxic gait. Laboratory studies demonstrate elevated serum lactate concentration. What is the most appropriate diagnostic modality for this patient's condition? +
A 62-year-old man presents to the physician's office with complaints of worsening abdominal pain over the past four months. The pain is described as dull and localized in the mid-epigastric region. The patient denies any association between his pain and food intake or posture. Upon further questioning, he describes symptoms of increasing fatigue and recent unintentional weight loss. An abdominal CT scan shows a gastric mass, and an endoscopy-guided biopsy of the mass reveals clusters of thin, elongated, spindle cells. Immunohistochemistry of this patient's tumor is most likely to reveal expression of which protein? +
A 45-year-old man presents to the physician's office for an annual check-up. His father was diagnosed with colon cancer at the age of 55, and the physician now recommends that the patient undergoes a screening colonoscopy. The physician then explains that the majority of colon cancer cases are due to sporadic development, but familial forms are also present. A mutation in which gene is most likely associated with familial colon cancer? +
A 2-year-old boy is brought to the physician's office for an abdominal mass. The mother also reports that the child is frequently irritable, cries more than usual, and has a slowed growth. The infant's weight falls lower than the 3rd percentile on the standard growth chart. Physical examination is remarkable for opsoclonus-myoclonus, abdominal distention, and a palpable left abdominal mass. Urine testing demonstrates elevated levels of vanillylmandelic acid and homovanillic acid. Amplification of which gene is associated with worse clinical outcomes in this patient's condition? +
A 42-year-old fair-skinned man presents to the dermatology clinic for a rapidly growing nevus on his back. The patient reports that the lesion has recently been increasing in size and has been getting progressively darker over the past few months. Evaluation of the lesion reveals a 9 cm x 4 cm asymmetrical nevus with irregular border and heterogeneous dark color. Excisional biopsy of the lesion reveals extensive proliferation of melanocytes, intraepidermal growth, and cellular atypia. Mutation of which gene is associated with the development of this patient's condition? +
A 34-year-old woman presents to the physician’s office with complaints of fever and abdominal pain. The patient states that she is currently in day-10 of her menstrual period, but she noted vaginal spotting earlier this morning. She is sexually active and applies an intrauterine device for contraception. She denies smoking, alcohol intake, and any known drug allergies. Her temperature is 38.7 °C (101.7 °F), blood pressure is 128/86 mmHg, and heart rate is 98/min. Physical examination is remarkable for suprapubic tenderness upon light palpation. Pelvic exam shows local vaginal swelling with suppurative discharge. Immunofluorescence with direct smears reveals a non-acid-fast, gram-positive rods with branching filaments. The physician prescribes an oral pharmacological agent to treat the patient's condition. What is the mechanism of action of the prescribed pharmacological agent? +
A 28-year-old woman presents to the physician's office with complaints of vaginal odor and discharge. A thin, homogeneous, greyish-white fluid that is adherent to the vaginal mucosa is observed on physical examination. The labia, introitus, cervix, and cervical discharge appear normal. Microscopic examination of the discharge demonstrates a pH = 5 and clue cells. The physician decides to prescribe an antimicrobial agent to treat this patient's condition. What is the mechanism of action of the prescribed antimicrobial agent? +
A 46-year-old homeless man presents to the emergency department (ED) with complaints of fever, dyspnea, and non-productive cough. He explains that his symptoms did not occur acutely, but have progressively worsened over the past few weeks. The patient does not smoke, but drinks 6-8 beers every day. He lives in a shelter for the homeless. His past medical history is significant for end-stage renal disease and kidney transplantation, for which he currently receives immunosuppressive therapy. In the ED, the patient's temperature is 39.7 °C (103.5 °F), blood pressure is 138/86 mmHg, and heart rate is 102/min. He appears very thin and severely malnourished. Physical examination is remarkable for coarse crackles on anterior auscultation of the right upper lung field. Chest x-ray demonstrates nodular infiltrates and cavitations in the right upper lobe. The patient is admitted and is started on broad-spectrum antimicrobial therapy. The next day, sputum culture shows an aerobic, gram-positive rod with a beaded acid-fast appearance on microscopy. Which antimicrobial agent is the optimal monotherapeutic option to treat this patient's condition? +
An 86-year-old man is brought by EMS to the emergency department (ED) with an altered mental state. Blood work-up is remarkable for leukocytosis and elevated CRP. Chest-xray demonstrates consolidation in the left lower lobe. In the ED, the patient desaturates and requires mechanical intubation. The patient is admitted to the intensive care unit for antimicrobial therapy. A few days later, the patient develops subcutaneous ecchymoses. His lab tests reveal prolonged INR and aPTT at the upper limit of normal. The mechanism of the patient's clotting abnormality is similar to which of the following bleeding conditions? +
A newborn boy is born to a gravida-1 para-1 33-year-old woman by normal vaginal delivery. Following delivery, the child appears normal and has a normal physical examination. The next day, the child undergoes circumcision, but he bleeds excessively. The woman states that she received adequate prenatal care and had regular follow-ups with her obstetrician. The physician orders a blood work-up to investigate the boy's bleeding. His labs are remarkable for a prolonged aPTT, normal PT, and platelet count of 235 x 109/L. Further evaluation reveals factor VIII activity at less than 1% of normal. What is the mode of inheritance of this patient's condition? +
A 14-year-old girl is brought to her pediatrician's office for excessive menstrual bleeding. The patient is distressed because her periods are very heavy, and she fears that she may stain her pants during school. She has a long history of easy bruisability and nosebleeds, and she reports that her gums often bleed excessively after brushing her teeth. The physician orders laboratory tests which reveal the following findings: prothrombin time (PT) = 13 seconds (normal: 11-15); activated partial thromboplastin time (aPTT) = 70 seconds (normal: 30-50 seconds); platelet count = 287 x 10<sup>9</sup>/L (normal: 150-400 x 10<sup>9</sup>/L); and bleeding time = 22 minutes (normal: 2-15 minutes). What is this patient's most likely diagnosis? +