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A 65 yr old male patient with chronic renal failure with uremia, on dialysis, presents to the clinic with progressive shortness of breath for the past few months. He also complains of weakness, fatigue and weight gain. Physical examination shows an increased abdominal girth, bilateral pedal edema, hepatomegaly and an increase in jugular venous pressure on deep inspiration. Auscultation revealed an extra diastolic sound. Chest X-ray shows calcification in the precordial area, and EKG showed diffuse low voltage QRS complexes with flattened T waves. What is the best initial therapy in this patient? +
A 65 yr old male with a past medical history of tuberculosis presents to the clinic concerned about progressive shortness of breath for the past few months. He also complains of weakness, fatigue, and weight gain during this period. Physical examination shows increased abdominal girth, bilateral pedal edema, hepatomegaly and an increase in jugular venous pressure on deep inspiration. Cardiac auscultation reveals an extra diastolic heart sound. Chest X-ray demonstrates calcification in the precordial area and EKG shows diffuse low voltage QRS complexes with flattened T waves. What is the most appropriate initial therapy for this patient? +
A 65 year old male presents with fever, weakness, and chest pain that is pleuritic in nature. The pain is relieved by sitting up and leaning forward. The patient describes the pain as sharp and brief. Auscultation reveals friction rub. What is the best initial test in this patient? +
A 62-year-old male presents to the ER with fever, fatigue, and sharp chest pain. The pain is relieved by sitting up and leaning forward. The patient describes the pain as "sharp and short". Auscultation reveals a friction rub. What is the most specific EKG finding in this patient? +
A 65 year old male initially presents to the ER with crushing, retrosternal chest pain aswell as nausea and diaphoresis for more than 20 minutes of duration. Percutaneous coronary intervention was performed within 2 hours of arrival to the ER. The patient recovered over the next few days. The patient presented to the doctors office 6 weeks after being discharged, with a mild, retrosternal chest pain that was aggravated by a supine position, and relieved by leaning forward. He also has a mild cough and runny nose consistent with recent upper respiratory tract infection. Complete blood count was normal. What is the most likely diagnosis? +
A 65 yr old male patient with chronic renal failure with uremia, on dialysis, presents to the clinic with progressive shortness of breath for the past few months. He also complains of weakness, fatigue and weight gain. Physical examination shows an increased abdominal girth, bilateral pedal edema, hepatomegaly and an increase in jugular venous pressure on deep inspiration. Auscultation revealed an extra diastolic sound. Chest X-ray shows calcification in the precordial area, and EKG showed diffuse low voltage QRS complexes with flattened T waves. What is the best initial therapy in this patient? +
A 65 year old male initially presents to the ER with crushing, retrosternal chest pain aswell as nausea and diaphoresis for more than 20 minutes of duration. Percutaneous coronary intervention was performed within 2 hours of arrival to the ER. The patient recovered over the next few days. The patient presented to the doctors office 6 weeks after being discharged, with a mild, retrosternal chest pain that was aggravated by a supine position, and relieved by leaning forward. He also has a mild cough and runny nose consistent with recent upper respiratory tract infection. Complete blood count was normal. What is treatment of choice for this patient? +
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 65 year old male presents with fever, weakness, and chest pain that is pleuritic in nature. The pain is relieved by sitting up and leaning forward. The patient describes the pain as sharp and brief. Auscultation reveals friction rub. What is the best initial test in this patient? +
A 65 year old male presents with fever, weakness, and chest pain that is pleuritic in nature. The pain is relieved by sitting up and leaning forward. The patient describes the pain as sharp and brief. Auscultation reveals friction rub. What is the pathognomonic EKG finding in this patient? +
A 26-year-old man is brought by his girlfriend to his primary care physician because she is concerned he has been acting odd lately. She reports that he has been very socially withdrawn for the last 3 weeks. She also describes several instances where he keeps whispering: "Aliens are chasing me and want to get me; I hear them talking about me." His employer called him several times in the past week complaining about his job performance and frequent absences. His girlfriend denies he has had any trauma, exposure to alcohol or illicit substances, or mood disturbances. His family history is remarkable for an uncle with schizophrenia. His blood pressure is 126/74 mmHg, heart rate is 74/min, and temperature is 36.9 °C (98.4 °F). He has a flat affect, appears unkempt, and laughs inappropriately. What is the most likely diagnosis? +
A 17-year-old woman is brought to the outpatient clinic by her mother because she is refusing to eat and is exercising more than usual. She has earned several awards because of her athletic skills in the past, and is extremely competitive in school. Five months ago her parents divorced. Shortly thereafter, the patient started a special diet and she has lost approximately 25 pounds. Her mom has tried to enforce a regular diet with sufficient calories, but the patient is reluctant to increase her caloric intake. She reports a strong fear of gaining weight and feels fat in front of the mirror. The patient reports that she stopped having a menstrual cycle 6 weeks ago. Her heart rate is 78/min, blood pressure is 123/80 mm Hg, temperature is 37°C (98.6 °F), and BMI is 16.5 kg/m<sup>2</sup>. Examination reveals hair thinning, dry skin with fine hair over the body, and mild parotid swelling. What is the most likely diagnosis? +
CG-23 is a bloodborne infectious organism that causes a self-limited acute infection among healthy adults. A group of investigators has developed a new diagnostic test for the detection of a serum marker, TAK, which is a structural component of the CG-23 capsule. A study is evaluating the performance of the new test among 500 healthy subjects who are followed-up for the development of symptoms. Blood is also withdrawn for real-time polymerase chain reaction (RT-PCR) analysis, the gold standard test for the detection of CG-23 DNA. The infectious organism's DNA is detected in 100 individuals by RT-PCR. The sensitivity and specificity of the novel test are 90% and 80%, respectively. What is the probability that a subject with a positive result in the new diagnostic test truly has the disease? +
A new vaccine is being developed to prevent a new H7N9 strain of influenza that has recently caused an outbreak in China. A clinical trial concludes that this vaccine provides a relative risk reduction of 96% for influenza infection in the general population. A committee of practicing physicians in China is attempting to understand the potential epidemiological effect of this intervention . Which of the following will be the most appropriate statement regarding this new vaccine's effect? +
A 47-year-old man presents to his primary care physician after being concerned about his current state of mind. He started developing extreme fatigue 3 weeks ago after his dog passed away, whom he considered his "best buddy" for 15 years. He never got married, but has had a girlfriend for 5 years. The patient reports being an avid swimmer in the past, but no longer has any interest in swimming these days. He has trouble falling asleep every night. The patient reports difficulty concentrating at work to the extent that his supervisors and colleagues are also concerned. He cries inconsolably several times during the day; and he cannot recall any time when he was not feeling down since his loss. When the physician asks about his overall status, he replies: "I feel worthless and think about ending my life”. The patient denies taking any medication or illicit drug use. His blood pressure is 122/84 mmHg, heart rate is 82/min, temperature is 37.1 °C (98.7 °F). On physical examination, he appears unkempt and has a flat affect. What is the most likely diagnosis? +
A 17-year-old male adolescent presents to the outpatient clinic accompanied by his mother for a routine check-up. The patient's mother explains that he developed a very strange behavior over the past year that is gradually worsening. Recently, his mother noticed that he spends a lot of time during the day washing his hands; although they are clean. She states that he washes his hands extensively at least 30 times a day. He doesn't touch any shared utensil in the house to "prevent germs from contaminating his hands". He spends a lot of time washing his hands to the extent he often arrives late to his classes and other scheduled meetings. When asked about his behavior, the patient replies: "I can't help it, it's so frustraing. I can't stop it although I tried. I feel that if I do not wash my hands every now and then I will get sick and die". Otherwise, the patient and his mother have no other complaints. On physical exam, his vitals are stable. The patient appears anxious; his hands are dry and cracking. What is the most likely diagnosis? +
A 21-year-old male college student suddenly loses consciousness and falls while playing football. The player is unresponsive to verbal or physical stimuli, and has an undetectable pulse. Despite CPR and resuscitation efforts, the patient dies. According to his family and friends, the patient has always been healthy and has been playing soccer since high school. Further history reveals that two of the patient's relatives also died the same way. Autopsy is obtained in order to determine the cause of death. Which of the following cardiac changes is most likely present in this patient? +