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A 65 year old man comes to the clinic with a weakness and not feeling well. He has been in bad mood since he lost his best friend, that died of cancer. Since then, he has been worried alot about his health. He noticed that he has difficulty raising his right eyelid for the last 6 weeks. His medical history is significant for an ischemic brain stroke 5 years ago, with no residual motor or sensory deficits. He drinks a two glass of red wine every night with dinner with his wife. He has been smoking 1 PPD for the last 30 years. He is treated for COPD by Formeterol and Tiotropium. The physical examination shows a ptosis of right eye lid, however the extraocular muscles movement are intact. The full neurological examination does not reveal any abnormality.The Chest X-ray shows a solitary lung mass on the apex of right lung, confirmed by CT. What would be the best next step in management? +
A 65 year old man comes to the clinic with a weakness and not feeling well. He has been in bad mood since he lost his best friend, that died of cancer. Since then, he has been worried alot about his health. He noticed that he has difficulty raising his right eyelid for the last 6 weeks.He reports that eyelid weakness is equal all through the day and denies any weakness related to stress or in relation with daytime. He also complains of tender mass on his left chest. His medical history is significant for an ischemic brain stroke 5 years ago, with no residual motor or sensory deficits. He drinks a two glass of red wine every night with dinner with his wife. He has been smoking 1 PPD for the last 30 years. He is treated for COPD by Formeterol and Tiotropium. The physical examination shows a ptosis of right eye lid, however the extraocular muscles movement are intact. Other than mild enlargement of both breasts and solitary tender sub areolar nodule. the full neurological examination does not reveal any abnormality.The Chest X-ray shows a solitary lung mass on the apex of right lung, confirmed by CT. A lung biopsy is ordered. What would be the most likely the histological findings of the biopsy? +
A 65 year old man comes to the clinic with a weakness and not feeling well. He has been in bad mood since he lost his best friend, that died of cancer. Since then, he has been worried alot about his health. He noticed that he has difficulty raising his right eyelid for the last 6 weeks.He reports that eyelid weakness is more at the end of the day than early morning but not related to stress. His medical history is significant for an ischemic brain stroke 5 years ago, with no residual motor or sensory deficits. He drinks a two glass of red wine every night with dinner with his wife. He has been smoking 1 PPD for the last 30 years. He is treated for COPD by Formeterol and Tiotropium. The physical examination shows a ptosis of right eye lid, however the extraocular muscles movement are intact. The full neurological examination does not reveal any abnormality.The Chest X-ray shows a solitary lung mass on the apex of right lung, confirmed by CT. A lung biopsy is ordered What would be the most likely the histological findings of the biopsy? +
A 54 year old man comes to the clinic for asthma follow up, he was diagnosed with asthma 5 years ago. He is on inhaled albuterol as needed, he has persistent cough and complains of episodes of shortness of breath every other day. His history is unremarkable except for hypertension diagnosed recently and taking metoprolol for it. He is otherwise healthy, his vitals are temperature:37.2 c, heart rate:78 beat/minute, blood pressure: 134/84 and respiration rate is 16/minute. The physical examination is normal. What is the best next step in management of this patient? +
A 32 year old woman G1P1 comes to the clinic complaining of urgency, frequency and burning during urination for the last 4 days. She never had this problem before. She denies any fever, night sweating or pain. Her past medical history unremarkable except for caesarian section 3 years ago. She doesn’t smoke, drinks alcohol occasionally and sexually active with her husband, her vitals are Temperature: 37, 1 , heart rate: 78 , respiration: 17, blood pressure: 134/67. The physical examination is normal except for mild tenderness over the pubic area. Tapping on Costco vertebral angel doesn’t show any tenderness. No vaginal discharge.
What’s the preferred treatment for this patient? +
A 20 year old female college student comes to the Students health center complaining of urgency, frequency and itching for the last 3 days. She’s never had this problem before. She denies any fever, night sweating or pain. She smokes 2 pack/year, drinks 2 beers/day and she is sexually active with her new boyfriend and since then she started using oral contraceptives and her boyfriend uses condoms. Vitals are Temperature: 37, 1 c, heart rate: 78 respiration: 17 blood pressure: 134/67. The physical examination is normal except for mild tenderness over the pubic area. Tapping on Costco vertebral angel doesn't show any tenderness. No vaginal discharge.
From her medical history, which one of the following is likely to be related to her
problem? +
A 35 year-old male comes to your office complaining of fever, along with chills, anorexia, malaise, and chest pain. These symptoms started suddenly over the last 5 days. His past medical history is not significant. He smoke one pack of cigarette per day for the last 10 years, and drink alcohol occasionally. He is sexually active, and use I.V drugs with the recent use one week ago. On examination, his temperature is 102.9°F (39.4° C), blood pressure 140/90 mmgH, heart rate 100/min, and respiratory rate of 21/min. There is a painful, red, raised lesion on the finger pulps. His chest x-ray shows patchy infiltrations, and his echocardiography shows tricuspid valve vegetation. What is the best next step in managing this patient? +
A 27 year-old female comes to your office complaining of fever, along with chills, anorexia, malaise, and chest pain. These symptoms started gradually over the last 2 weeks after she had been treated from serious urinary tract infections. The patient has a past medical history of rheumatic fever when she was 7 years old. She doesn’t smoke, but drink alcohol occasionally. She is sexually active. On examination, her temperature is 102.9°F (39.4° C), blood pressure 140/90 mmgH, heart rate 100/min, and respiratory rate of 21/min. Heart examination shows ejection systolic murmur on the apex that propagates to axilla. There is a painful, red, raised lesion on the finger pulps. Her chest x-ray shows patchy infiltrations, and her echocardiography shows mitral valve vegetations. What is the best next step in managing this patient? +
A 35 year-old male comes to your office complaining of fever, along with chills, anorexia, malaise, and chest pain. These symptoms started suddenly over the last 5 days. His past medical history is not significant. He smoke one pack of cigarette per day for the last 10 years, and drink alcohol occasionally. He is sexually active, and use I.V drugs with the recent use one week ago. On examination, his temperature is 102.9°F (39.4° C), blood pressure 140/90 mmgH, heart rate 100/min, and respiratory rate of 21/min. There is a painful, red, raised lesion on the finger pulps. His chest x-ray shows patchy infiltrations, and his echocardiography shows tricuspid valve vegetation. Blood culture results shows viridans group streptococci that is highly penicillin-susceptible. What is the best antibiotic choice for this patient? +
A 35 year-old male comes to your office complaining of fever, along with chills, anorexia, malaise, and chest pain. These symptoms started suddenly over the last 5 days. His past medical history is not significant. He smoke one pack of cigarette per day for the last 10 years, and drink alcohol occasionally. He is sexually active, and use I.V drugs with the recent use one week ago. On examination, his temperature is 102.9°F (39.4° C), blood pressure 140/90 mmgH, heart rate 100/min, and respiratory rate of 21/min. There is a painful, red, raised lesion on the finger pulps. His chest x-ray shows patchy infiltrations, and his echocardiography shows tricuspid valve vegetation. Blood culture results are negative. What is the best antibiotic choice for this patient? +
A 35 year-old male comes to your office complaining of fever, along with chills, anorexia, malaise, and chest pain. These symptoms started suddenly over the last 5 days. His past medical history is not significant. He smoke one pack of cigarette per day for the last 10 years, and drinks alcohol occasionally. He is sexually active, and use I.V drugs with the recent use one week ago. On examination, his temperature is 102.9°F (39.4° C), blood pressure 140/90 mmgH, heart rate 100/min, and respiratory rate of 21/min. There is a painful, red, raised lesion on the finger pulps. His chest x-ray shows patchy infiltrations, and his echocardiography shows tricuspid valve vegetation. Blood culture results shows viridans group streptococci that is highly penicillin-resistant. What is the best antibiotic choice for this patient? +
A 45 year-old male comes to your office complaining of fever, along with chills, anorexia, malaise, and chest pain. These symptoms started gradually over the last 2 weeks. The patient has a past medical history of rheumatic fever when she was 7 years old. He doesn’t smoke, but drink alcohol occasionally. She is sexually active. On examination, His temperature is 102.9°F (39.4° C), blood pressure 140/90 mmgH, heart rate 100/min, and respiratory rate of 21/min. Heart examination shows ejection systolic murmur on the apex that propagates to axilla. There is a painful, red, raised lesion on the finger pulps, and inflamed swollen right knee. His echocardiography shows mitral valve vegetation. His blood culture results shows streptococcus bovis that is penicillin-susceptible, and a treatment plan is started accordingly. What is the best next test that should be done for this patient? +
A 67 year-old male brought to ED by his son after he became disoriented and confused. His son mentioned that he is living alone, ¬¬and he was okay at his last visit 2 days ago, and he showed some seizures while on the way. The patient has a past medical history of alcoholic liver cirrhosis. On examination, the patient is confused, disoriented to time and place. His blood pressure is 90/60 mmHg, pulse 120 beat per minute, respiration 23/m, and temperature 37 C. Cardiopulmonary exam was unremarkable. Abdominal exam shows tense ascites and a shrunken liver. Lower extremities had 3+ pitting edema. His laboratory tests are shown below.
• Sodium 110 (N: 135-146 mmol/L)
• Potassium 3.8 (N: 3.5-5.3 mmol/L)
• Glucose 100 (N: 70-110 mg/dl)
• Chloride 98 (N: 98-108 mmol/L)
• Total CO2 25 (N: 23-27 mmol/L)
Which of the following is the cause of the patient’s altered mental status? +
A 67 year-old male brought to Emergency department by his son after he became disoriented and confused. His son mentioned that he is living alone, ¬¬and he was okay at his last visit 2 days ago, and he showed some seizures while on the way. The patient has a past medical history of alcoholic liver cirrhosis. On examination, the patient is confused, disoriented to time and place. His blood pressure is 90/60 mmHg, pulse 120 beat per minute, respiration 23/m, and temperature 37 C. Cardiopulmonary exam was unremarkable. Abdominal exam shows tense ascites and a shrunken liver. Lower extremities had 3+ pitting edema. His laboratory tests are shown below.
• Sodium 110 (N: 135-146 mmol/L)
• Potassium 3.8 (N: 3.5-5.3 mmol/L)
• Glucose 100 (N: 70-110 mg/dl)
• Chloride 98 (N: 98-108 mmol/L)
• Total CO2 25 (N: 23-27 mmol/L)
Which of the following is the best next step in managing his hyponatremia? +
A 67 year-old male comes to your office for follow up. The patient has a past medical history of alcoholic liver cirrhosis. On examination, his blood pressure is 110/90 mmHg, pulse 90 beat per minute, respiration 19/m, and temperature 37 C. Cardiopulmonary exam was unremarkable. Abdominal exam shows tense ascites and a shrunken liver. Lower extremities had 3+ pitting edema. His laboratory tests are shows serum sodium 127 (N: 135-146 mmol/L), urine sodium level > 20 mEq/L. Which of the following is the best next step in managing his hyponatremia? +
A 36 year old man was found unconscious in the alley. The police department brought him to emergency department where he was found to be unresponsive. On eye examinations pupils were dilated and there was a divergent squint. On cardio-vasular examination patient had tachycardia. On neuromuscular exam there is an increased muscle tone, increased reflexes and extensor plantar response. The emergency room nurses found an Amitriptyline prescription in his pocket. The patient was intubated immediately. What is the best next step ? +
A 47-year-old man with five years history of AIDS complains of blurry vision. On CD4 examination the count is 44. The patient doesn't have any other complaints. A dilated eye exam shows necrotizing retinitis. What is the best treatment for this patient? +
A 47-year-old man with five years history of AIDS complains of blurry vision. On CD4 examination the count is 44. The patient doesn't have any other complaints. A dilated eye exam shows necrotizing retinitis. The patient is started on Foscarnet , what should be used for the maintenance therapy ? +
A 34-year-old man who works as a manager in a big pharmaceutical company comes to your office with a headache since 3 days. On enquiry the headache appears to be only on the right side. He also reports of having some tearing, redness and rhinorrhea. Patient claims he had a similar episode 3 months back where the doctor gave him Sumatriptan and oxygen via nasal cannula, which subsided the pain. The patient also says that he has 5 large cups of coffee everyday. What measures should be taken to prevent this headache? +
A 50-year-old man comes to your office with complaints of dizziness only while turning his head left or right. He noticed that it happens when he is looking on the sides while driving. It stays only for 10 seconds and disappears when he looks again in the front. The patient reports no hearing loss, tinnitus and ataxia. What is the most probable diagnosis? +