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A 23-year-old woman presents to her primary care physician with complaints of depression, insomnia, and decreased appetite. She reports that these symptoms often alternate with episodes of excited mood and euphoria. The patient is referred to a local psychiatrist for appropriate management. Two months later, the patient returns and reports improvement of her mood swings following daily intake of a medication whose name she cannot recall. She now complains of recent menstrual irregularities, constipation, and fatigue. Which of the following drugs was this patient most likely prescribed? +
A 68-year-old man presents to the Emergency Room after losing consciousness while climbing stairs. He denies any pre-syncopal symptoms, or any past history of neurologic conditions. However, the patient reports having experienced increasing shortness of breathe and chest pain on exertion over the past 3 years. Which carotid pulse pattern is most likely to be observed in this patient? +
A 56-year-old man presents to the urgent care clinic for constant epigastric pain. He reports a history of gastrointestinal ulcers, which felt similar to the patient's current presentation. He recalls taking one week of a 2-week course of medication several years ago after which his ulcers resolved. While waiting for preliminary laboratory results, the patient's condition rapidly deteriorates. He suddenly complains of severe pain in his upper abdomen and turns pale. His blood pressure acutely rises to 150/110 mmHg and his heart rate increases to 120 bpm. What is the optimal imaging study for diagnosing the most likely condition? +
A 34-year-old man presents to the health center concerned that he has contracted a venereal disease. He nervously shows you an ulcerated lesion on the shaft of his penis and states that it has been present for over 1 week. On physical exam, the man is afebrile and except for mild lymphadenopathy in the neck, has a nontender ulcer on his penis measuring 1.5 x 1 x 0.5 cm. Laboratory testing demonstrates that he is VDRL positive. What is the next step in diagnosis? +
A 32-year-old man is brought to the emergency department by his wife for progressive bilateral weakness, loss of sensation, and distal paresthesias in his lower extremities over the past 5 days. The patient can no longer walk and must be carried onto the examination bed. He denies any recent history of trauma. The only illness he can recall is an episode of nausea, vomiting, and bloody diarrhea 3 weeks ago, from which he recovered spontaneously without medications. Neurological examination is remarkable for a motor strength of 1/5 in both lower extremities with loss of deep tendon reflexes. What is the most likely organism responsible for this patient's condition? +
A 32-year-old man is brought to the emergency room by his wife for progressive loss of sensation and motor function of his lower extremities over the past month. The patient can no longer walk and must be carried onto the exam bed. He denies any recent history of trauma and the only illness he can recall consists of an episode of nausea, vomiting, and diarrhea 3 months ago, from which he recovered fully without medications. On exam, motor strength is 1/5 in both legs and deep tendon reflexes are impaired. What is the most appropriate next step in treatment of this patient? +
A 23-year-old HIV-positive woman recently started on HAART therapy comes to the health center for a checkup. Her CD4 count has been decreasing over the last 5 months, although she remains asymptomatic. Physical examination is unremarkable but her current CD4 count is 192 cells/mm<sup>3</sup>.
Which of the following prophylactic medications is most appropriate at this time? +
A 13-year-old boy is brought to the clinic with a fever of 5 days duration accompanied by a diffuse rash. His mother states that the fever has been as high as 103.0°F (39.4°C) leading her to keep him home from school. Observed upon physical examination is a diffuse morbilliform rash over his trunk and extremities, which also becomes confluent in the groin. Both sclerae are infected and his tongue is red and bumpy on appearance. Notable lymphadenopathy is present in the anterior and posterior cervical chains.
What is the next step in management of this patient? +
A 13 year-old boy is brought to the clinic for a gradually worsening fever of 10 days duration accompanied by a diffuse rash. His mother states that the fever has been as high as 103.0°F (39.4°C) and she has kept him out of school because of this. Observed upon physical exam is a diffuse morbilliform rash over his trunk and extremities, which also becomes confluent in the groin. Both sclerae are infected and his tongue is red and bumpy on appearance. Notable lymphadenopathy is present in the anterior and posterior cervical chains.
Which of the following complications is the most common and life-threatening in this patient? +
A 35-year-old woman presents to the outpatient department with gradually worsening symptoms of fatigue, dyspnea, and pedal edema over the past 6 months. There is a past medical history of rheumatic fever. The physical examination is positive for hepatomegaly and mild ascites. Echocardiographic studies show thickening and stenosis of tricuspid valve leaflets.
Which of the following findings on the jugular venous pressure (JVP) tracing is most likely to be observed in this patient? +
A 5-year-old boy with a past medical history significant for tonic clonic seizures is found to have a focal infiltrate in the right upper lobe on a routine chest radiograph. The parents report a history of chronic constipation from which he has received daily oral doses of mineral oil laxative. They also describe occasional episodes of coughing and choking during food intake in the past 2 weeks. His physical examination is mostly unremarkable, except for coarse crackles in the right upper lung field. The pediatrician advises the parents to discontinue mineral oil administration and prescribes clindamycin for 10 days. Six weeks later, persistence of the right upper lobe infiltrate is noted on imaging. Diagnostic bronchoscopy with bronchoalveolar lavage (BAL) is scheduled to identify the etiology of the patient's findings. What is the most likely BAL finding associated with this patient's condition? +
30-year-old male presents to the emergency room with complaints of low-grade fever associated with severe retrosternal chest pain that is referred to the back and the left lower part of the scapula. Upon further inquiry the patient states that the pain is aggravated by lying supine and relieved by sitting and leaning forward.
What is the most appropriate diagnosis? +
A 30 yr old male presents to the ER with complaints of moderate grade fever associated with severe retrosternal chest pain that is referred to the back and the left trapezius ridge. Upon further enquiry the patient states that the pain is aggravated by lying supine and relieved by sitting and leaning forward. What are the expected EKG findings in this patient? +
A 45 year old male presented to the office with complaints of dyspnea and mild retrosternal chest pain radiating to the back and the shoulders. It is aggravated with lying down and coughing, and is relieved by sitting up and leaning forward. Physical examination is essentially normal. EKG shows widespread ST elevations and PR segment depressions. Echocardiogram showed mild effusion in the pericardial sac. Over the subsequent days, he developed progressive dyspnea. A therapeutic pericardiocentesis showed bloody fluid. What is the most likely diagnosis? +
A-65-year old male presents to the ER due to a crushing retrosternal chest pain, which started 20 minutes ago. Additionally, he has nausea and diaphoresis. Following 2 hours of ER arrival, percutaneous coronary intervention is performed; he recovers over the next 5 days. 6 weeks following discharge, he returns to the office due to a mild retrosternal chest pain, which is aggravated when lying flat, and relieved when sitting up. Concomitantly, he has a mild cough and runny nose consistent with a recent upper respiratory tract infection. Complete blood count is within normal limits. What is the most likely diagnosis? +
A-52-year old female undergoes percutaneous coronary intervention at a local community hospital. 5 weeks following discharge, she presents to her primary care physician complaining of sharp retrosternal chest pain, aggravated when lying flat and inspiration, and relieved when sitting up. What is the treatment of choice of the most likely diagnosis? +
A 75-year-old male presents to the ER with chest pain of 20 minutes duration. His EKG shows ST-elevation in the anterior precordial leads, and laboratory studies show an elevation of cardiac enzymes. The patient is found to have 3 vessel disease on coronary angiography. Immediate CABG is performed and the patient recovers post-surgery. He is discharged in stable condition. The patient presents again to the ER two weeks later, this time complaining of severe retrosternal chest pain that radiates to the back. On further inquiry, he mentions that his pain is aggravated by lying down and alleviated by sitting up and leaning forward. What is the most probable diagnosis? +
A 60 yr old female with chronic kidney disease presented to the ER with symptoms of breathlessness, orthopnea, chest pain, and dizziness. On auscultation, heart sounds were faint. An EKG showed low voltage complexes. Blood pressure was 90/50 mm Hg. Lung fields were clear. What additional finding is expected on palpation of radial pulse? +
A 50-year-old man presents to the clinic with complaints of fatigue, shortness of breath on exertion and weight gain . He reports difficulty sleeping for the past 3 weeks because his shortness of breath worsens when he lies down. His past medical history is significant for non-Hodgkin lymphoma treated with chemoradiotherapy 6 years ago. His blood pressure is 110/60 mmHg, heart rate is 110/min, and temperature is 36.7 ᵒC (98 ᵒF). Physical examination is remarkable for abdominal swelling and lower extremity edema. Heart sounds are muffled and jugular venous pressure (JVP) is 6 cm above the sternal angle. Abdominal examination reveals hepatomegaly and minimal ascites. EKG shows low voltage QRS complexes and flattened T waves. What is the most likely diagnosis? +