Property:Prompt
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A 33 year old man presents to the emergency department (ED) complaining of severe abdominal pain and vomiting. He has no significant past medical history except for bouts of red urine and yellow skin color, especially in the early morning following late night exercise. Physical examination is remarkable for skin jaundice, hepatomegaly, abdominal distention with shifting dullness, and lower extremity edema. Following appropriate imaging, the patient is diagnosed with Budd-Chiari syndrome and adequate management is initiated. Further investigation including flow cytometry shows decreased expression of CD59 and CD55 on red blood cells. Which of the following is an appropriate pharmacologic therapy for this patient's condition? +
A 22-year-old man with mental retardation and a history of seizures presents to the physician's office with several papulonodular lesions on the face. He explains that the lesions have been present since childhood, but have been slowly increasing in size. Physical examination is remarkable for well-demarcated hypopigmented lesions on his right lower extremity and his back. Biopsy of the facial lesions is consistent with angiofibroma. Which of the following is most likely to be an additional finding in this patient? +
A 65-year-old woman presents to emergency department with complaints of breathlessness, sharp pleuritic chest pain, and cough for the past week. She also reports mild joint pain and intermittent fever. On physical examination, a right-sided pleural rub is appreciated. Her blood pressure is 110/60 mm Hg, heart rate is 92/min, respiratory rate is 21/min, and temperature is 36.7 ᵒC (98 ᵒF). Upon further questioning, the patient explains that she has been receiving a medication for an irregular heart beat for the past year, whose name she cannot recall. Which of the following antibodies are likely to be present in this patient? +
A 20-year-old man presents with complaints of chronic dry cough that has recently become associated with bloody sputum. His cough is associated with intermittent low-grade fever, malaise, shortness of breath, chest pain, and bloody urine. Chest X ray demonstrates bilateral patchy areas of consolidation. Urine examination is remarkable for the presence of red blood cell casts and protein. Serologic assays are positive for anti-GBM antibodies and negative for ANCAs. Which of the following types of hypersensitivity reactions is responsible for this patient’s condition? +
54 year old female comes with complaints of cough from 2 weeks with fever and shortness of breath. She has no other significant complaints other than joint pains for which she takes over the counter analgesics. Her past medical history is significant for hodgkin’s disease, which was treated with radiation and chemotherapy 20 years ago. Which of the following adverse effects are most likely to present now as a result of hodgkin’s disease treatment? +
A 60 year old male comes to the clinic with complaints of abdominal pain, nausea, constipation, fatigue and feeling depressed from few months. He also suffers from increased frequency of urination and has been feeling confused from few weeks. His vital signs are; blood pressure, 145/100 mmHg; pulse, 95/min and RR, 16/min. Serum values are as follows:<br>
Hb: 8.5 mg/dL<br>
Sodium: 140 mEq/L<br>
Potassium: 4.5 mEq/L<br>
Calcium: 12.5 mEq/L<br>
Creatinine: 1.5 mg/dL<br>
What is the next best step in management of this patient’s hypercalcemia? +
A 27 years old female comes to ER, complaining of dysuria and mucopurulent discharge per urethra, she had these symptoms for 5 days. She is sexually active, with no other medical problems. On examination, there is no other positive finding, except for the mucopurulent discharge. What is the most likely diagnosis? +
30 year old HIV positive man recently diagnosed with tuberculosis, present to ED complaining of increasing fever and fatigue, he said that the cough was improving till 3 days ago when he had sputum and chest pain. Antiretroviral therapy has begun immediately once he was diagnosed with AIDS defining tuberculosis 3 weeks ago, and since then he was taking all his medication regularly. On examination, his temperature is 39°C(103.2 F), blood pressure 130/82 mm Hg, pulse 100/min, respiration is 22/min. Chest X-Ray shows new parenchymal opacities, and worsening intrathoracic lymph node enlargement. Aspiration of the lymph node produces purulent materials with no organisms are seen on acid fast stain. Gram stain and culture of expectoration is negative. His CD4 count at time of diagnosis was 90/mm3 with HIV viral load was 130,000 copies/ml, today his CD4 is 230/mm3 and HIV viral load is < 10,000 copies/ ml. What is the most appropriate management of this condition? +
30 year old female nurse accidentally pricks her finger with a needle used to draw a blood sample from HIV-positive patient. The patients laboratory testing showed CD4 count of 410/mm3 and HIV load of 12,000copies/mL. HIV test to the nurse turn to be negative, she has no significant medical history and taking no medications. Her immunizations are up to date. What is the best approach to handle this situation? +
19 year old boy present to the ER with generalized rash, he had fever and sore throat one week ago and got antibiotic prescription from his primary care physician 4 days ago. His past medical history is insignificant. He doesn’t smoke or consume recreational drugs or alcohol. He is sexually active with one partner and uses condoms regularly. Vital signs are normal except for temperature of 37.8 C(100 F). His physical examination reveals generalized maculopapular rash and posterior cervical lymphadenopathy. What is the most likely mechanism of rash development in that patient? +
19 year old boy present to the ER with generalized rash, he had fever and sore throat one week ago and got antibiotic prescription from his PCP 4 days ago. His past medical history is insignificant. He doesn’t smoke or consume recreational drugs or alcohol. He is sexually active with one partner and uses condoms regularly. Vital signs are normal except for temperature of 37.8 C(100 F). His physical examination reveals generalized maculopapular rash and posterior cervical lymphadenopathy. What is the best treatment for this patient? +
40 years old man IV drug abuser, present to ED complaining of fever, headache, vomiting, and blurring of vision. His symptoms started 10 days ago with a progressive course. He had never been tested for HIV before. Physical exam shows neck stiffness and bilateral papilledema. CSF fluid examination shows marked elevated opening pressure, low WBC count with lymphocyte predominance, low glucose, and elevated proteins. What is the best next step in the management of this patient? +
30 years old white male come to clinic for new hire routine check-up. He has no significant complain. He admits having multiple sexual partners, not using condoms frequently. He didn’t have HIV test before. His past medical history is insignificant. He doesn’t smoke but drink alcohol regularly. His physical examination is insignificant. You ordered HIV and RPR test which turned to be positive. His CD4 is 300 mm3 and RPR titer 1:70. What is the best next step in the management of this patient? +
30 years old white male come to clinic for new hire routine check-up. He has no significant complain. He admits having multiple sexual partners, not using condoms frequently. He didn’t have HIV test before. His past medical history is insignificant. He doesn’t smoke but drink alcohol regularly. His physical examination is insignificant. You ordered HIV and RPR test which turned to be positive. His CD4 is 300 mm3 and RPR titer 1:70. What is the best treatment option for this patient? +
30 years old white male come to clinic for new hire routine check-up. He has no significant complain. He admits having multiple sexual partners, not using condoms frequently. He didn’t have HIV test before. His past medical history is insignificant. He doesn’t smoke but drink alcohol regularly. He has no drug or food allergy. His physical examination is insignificant. You ordered HIV and RPR test which turned to be positive. His CD4 is 300 mm3 and RPR titer 1:70. The diagnosis of HIV infected patient with latent syphilis of unknown duration was established. The patient begins his treatment with benzathin penicillin G IM weekly for three weeks. Several hours later, the patient presents to ED with severe headache, muscle pain, fever and rigors. Which of the following could have prevented this condition? +
A 28 years old male comes to your office complaining loss of concentration in his work which affected his performance in last 3 weeks. He mentions a recurrent on and off fever for which some medications were prescribed, when he did his routine labs and turned to be normal. He is having a persistent dry cough, recurrent itchy rash over the face and axilla, and loss of 15 pound over the past 3 weeks. He is taking some vitamins to help him maintaining his performance at work. He admits having multiple sexual relations, and when he asked about using condoms he answered” I don’t feel comfortable using condoms”. Which of the following is the best next step in the diagnosis? +
A 74-year-old woman presents to the emergency department with severe upper abdominal pain for the past four hours. Past medical history is notable for hypertension, diabetes and polycythemia vera for which she receives hydroxyurea. The patient reports being non-compliant with her medications because of their many side effects. On physical examination, the liver can be palpated 5 cm below the costal margin and an abdominal fluid wave is present. What is the most likely diagnosis? +
A 19-year-old woman presents to the emergency department for sudden onset fatigue, fever, headache, and vomiting over the past 6 hours. Thirty minutes after presentation, she decompensates rapidly. Her temperature rises to 40 ˚C (104 ˚F), her blood pressure drops to 70/40 mmHg and she loses consciousness. Examination reveals diffuse petechiae, predominantly over the lower extremities. CT scan reveals bilateral adrenal hemorrhage. Which of the following is the most likely organism responsible for this patient's condition? +
A 30-year-old male competitive triathlete is brought to the emergency room after collapsing during a training run. He reports severe chest pain that radiates down his left arm. EKG shows ST-elevation in lead V1-V6 and cardiac enzymes are elevated. Routine labs are significant for a hematocrit of 65%. What is the most likely cause of this patient’s condition? +
A 7-year-old boy is brought to the physician by his parents for loss of appetite, abdominal pain, lethargy and constipation that has become worse over the past several weeks. The parents have received a notification that their son’s performance in school has deteriorated during this same period. On physical examination, the physician notes thin, grey-blue lines visible along the margin of the patient’s gums. The patient’s condition is most likely caused by exposure to which of the following? +