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A 29-year-old woman presents with a three-year history of increasing dyspnea on exertion associated with chest tightness and lightheadedness. Physical examination is notable for palpable double apical impulses, fourth heart sounds, and systolic murmurs at the left lower sternal border. Echocardiography demonstrates systolic anterior motion of the mitral valve. Which of the following disorders has the same pattern of inheritance as the disorder likely to be present in this patient? +
A 32-year-old woman delivers a newborn at 33 weeks gestation. The newborn is found to have persistent pulmonary hypertension and is promptly administered high frequency ventilation and inhaled nitric oxide therapy. Six hours later, the newborn becomes cyanotic and lethargic and develops a seizure. What is the most appropriate initial therapy for this patient? +
A newborn boy is evaluated for vomiting when fed for the first time. Physical examination is remarkable for flat facies, an unusually large tongue, and prominent epicanthal folds. Upper gastrointestinal studies demonstrate gas in the stomach and the duodenal bulb. Which of the following cardiovascular defects is mostly associated with his newborn's underlying genetic disease? +
A 24-year-old male gets involved in a school fight and is shot in the arm with a .38-caliber revolver. He is brought to the ER with the following vital signs: 88 bpm, T 37C, BP: 110/70mmHg, 22 respirations/min. Upon arrival to the hospital, the patient is exposed by the trauma team. The surgical resident on call observes an entrance wound in the medial aspect across the left extremity and an exit wound located on the lateral aspect of the left arm. He has a large hematoma in the medial aspect of the arm, radial pulse is non palpable. Fluid resuscitation is started and the radiologic bone survey reveals a shattered humerus fracture. Which of the following is the correct order in management? +
A 72-year-old male falls at home and hits his right chest wall against the bed frame. He is brought to the ER after his wife called 911. His vitals are T 37C, 86 bpm, 21 respirations/min, BP: 126/80 mmHg. His head, eyes, ears, nose and throat are unremarkable. His carotid pulse is 2+ without bruits. His chest is symmetric with decreased expansion on the right side. Upon palpation he has exquisite tenderness over the eight right rib at the anterior axillary line level. His lungs are clear to auscultation and percussion bilaterally. The rest of the physical exam is unremarkable. A chest x-ray reveals a rib fracture and no other abnormal findings. Which of the following is the most appropriate management in this patient? +
A 34-year-old male gets into a street fight. He is stabbed in the right chest. He develops shortness of breath and is brought to the ER. His vitals upon admission were T 37C, BP= 110/70mmH, 85 bpm, 18 respirations/min. His chest has an 1 cm entrance wound on the right mid-axillary line at the 9th rib level. His lungs have no breath sounds at the right base and distant apical breath sounds. There is dullness to percussion over the right base. The rest of the physical exam is unremarkable. The CXR reveals a hemothorax. A chest tube is placed at the right pleural base recovering 260mL of blood per hour during the first four hours and starts deteriorating. What is the most appropriate next step in management? +
A 62-year-old-female is brought to the ER after getting involved in a high-speed motor vehicle accident. Her vitals upon admission to the hospital are T 36C, 82bpm, BP=100/60 mmHg, 20 respirations/min. She has multiple bruises on her anterior chest. Her sternum is tender to palpation. A CXR reveals a widened mediastinum. What is the next best step in management? +
A 25-year-old man presents to the clinic with abdominal cramps, general malaise, fever, and bloody diarrhea 6 hours after consuming undercooked poultry. Two of his family members also have similar symptoms. Laboratory studies identify the causal agent as microaerophilic, gram-negative, curved rods. Which of the following descriptions of the causative pathogen is true? +
A 26-year-old man presents to the emergency department with abdominal cramps, general malaise, fever, and profound diarrhea 3 hours after a potluck dinner. Three of his friends also have similar symptoms. Stool samples demonstrate numerous polymorphonuclear leukocytes and are positive for growth on a selective medium under CO2 incubation at 42 °C (108 °F). The microorganism responsible for this patient's condition is also found to possess an enzyme that catalyzes the transport of electrons from NADPH to oxygen. Which of the following descriptions best explains the pathogenesis of this microorganism? +
A 27-year-old man presents to the clinic with abdominal cramps, general malaise, fever, and diarrhea 5 hours after consuming hamburgers. He has dry mucosa and decreased skin turgor. Few leukocytes are found in his fecal specimen. Growth of colorless colonies on sorbitol-MacConkey agar is noted. Which of the following descriptions best explains the pathogenesis of the organism responsible for this patient's condition? +
A 28-year-old man presents to the clinic with abdominal cramps, general malaise, fever, and diarrhea 6 hours after consuming ground beef. Few leukocytes are found in his fecal specimen. Growth of colorless colonies on sorbitol-MacConkey agar is noted. The pathogen produces toxins which contain enzymatic subunits that interfere with protein synthesis. Which of the following antibiotics has a similar mechanism regarding to the toxin's action on translation? +
A 29-year-old man presents to the clinic with symptoms of abdominal pain, malaise, and watery diarrhea that begin a day after coming back from a travel to Bangladesh. He complains of orthostatic dizziness and has dry mucosa and decreased skin turgor. Few leukocytes are found in his fecal specimen. Growth of purple colonies on Eosin methylene blue agar is noted. Presence of the heat-labile enterotoxin is confirmed by enzyme-linked immunosorbent assay (ELISA). Which of the following events best describes the mechanism of action of this toxin? +
A 35 year old man presented with right upper quadrant abdominal pain. Initial ultrasound confirmed the presence of gall stones and an elective cholecystectomy was performed. Post operatively he is stable with vitals BP 130/90, Pulse 100/min and RR 18/min, but complains of tremulousness, increasing anxiety and “bugs crawling on his hands”. On examination patient is confused and tremors are noted in both hands. Rest of the neurological examination is within normal limits. What is the most common cause of his present complaints? +