Property:Prompt
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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 maneuver fixes this condition ? +
A 54-year-old female with history of diabetes mellitus, hypertension, hypercholesterolemia comes to your primary care clinic with complaints of facial asymmetry since 2 hours. On examination she has one-sided facial droop, asymmetrical smile, difficulty completely closing one eye, and impaired tearing and salivation on left side. She denies any headache or loss of consciousness but she complains of mild weakness of right lower limb and pain on the left side of her chest. On examination, power is 5/5 in all extremities. Her vitals are within normal range. Her EKG is normal. She has multiple red papules about 3-5 mm in diameter in the left 5th inter costal space. What is the next best step? +
A 65-year-old male who smokes 1 pack per day for 35 years was brought to the emergency oepartment for acute shortness of breath. The emergency room physician administers 5L of Oxygen, orders an arterial blood gas, CXR, start inhaled albuterol plus ipratropium bromide and a steroid bolus. Initially he responds well, but after 15 min he complains of increasing difficulty breathing . A repeat steroid bolus and inhaled albuterol fails to relieve the shortness of breath. Which of these is the most probable cause of his increasing breathing difficulty? +
A 45 year old long standing diabetic, on a vegan diet being treatment with oral hypoglycemic drugs, presents to your office with fatigue and tingling - numbness in his both feet. Physical examination revealed a bilateral loss of pinprick and vibration sense just above the ankles. However, both ankle jerks were present and brisk. Which of these the most likely cause of his symptoms? +
A 75-year-old male is brought to the emergecny room in an unconscious state. He has been brought to your hospital for a neurosurgical consultation after X-ray reports at an outside hospital showed a fracture of his left temporal bone after a fall on his head. Definitive reports are still not available. Relatives say he was normal after the fall. Soon after, he had 2 episodes of vomiting and gradually lost consciousness over a period of 4 hours. His vital signs are maintained within normal range. Glasgow coma scale - is 8/15 and breathing spontaneously without effort. What is the next best step in management? +
A 26-year-old male who works in a college library comes to you with a complaint of running nose. He says that this is not the first time he had this symptoms. He sometimes also presents with a cough, nasal congestion and sneezing. He claims that his jobs requires cleaning the library shelf which usually has a lost of dust on it. On inquiry he said that the physician who saw him last time prescribed him with a medication, which after a few days made his running nose worse. What medication could it be? +
A 26-year-old male who works in a college library comes to you with a complaint of running nose. He says that this is not the first time he had this symptoms. He sometimes also presents with a cough, nasal congestion and sneezing. He claims that his jobs requires cleaning the library shelf which usually has a lost of dust on it. On enquiry he said that the physician last time prescribed him with a medication, which after a few days made his running nose worse. What could the physician have suggested to prevent this side effect? +
A 57-year-old male comes to your office for follow up. He is a newly diagnosed lung cancer patient, and undergoes his first round of cisplatin. He has insignificant past medical history. On examination, his BP is 100/80 mmHg, irregular heart rate 50 beat per minute, temperature 37 C (98.6 F), respiratory rate is 17/minute. His laboratory tests are:
:Sodium 135
:Potassium 6.8
:Chloride 108
:CO2 20
:BUN 35
:Creatinine 3.4
:Glucose 152
:Calcium 7.5
What would be the most likely finding on this patient’s EKG? +
A 65-year-old male comes to emergency department complaining of chest pain, sweating, and fatigue. He is a newly diagnosed lung cancer patient, and undergoes his first round of cisplatin. He has insignificant past medical history. On examination, his BP is 90/60 mmHg, irregular heart rate 50 beat per minute, temperature 37 C (98.6 F), respiratory rate is 19/minute. His laboratory tests are:
:Sodium 135
:Potassium 7.6
:Chloride 108
:CO2 20
:BUN 35
:Creatinine 3.4
:Glucose 152
:Calcium 7.5
Which of the following is the best urgent step in the management of this patient? +
A 42-year-old sailor from Panama comes the office with symptoms of diarrhea. On enquiry he says that he has a history of on and off diarrhea from the past 8 years. He states that his appetite has been decreased recently and the episodes of diarrhea are often associated with nausea and vomiting. On examination vitals are temperature of 99 F, pulse of 76/ minute and respiratory rate of 12/ minutes. On examination of the skin a rash is noticed on the extremities. This rash resembles likes a sunburn and burns when touched. Abdominal examination and cardiovascular examination are insignificant. On examination of the tongue it appears to be swollen and dark red in color resembling like ”beef’’. Neurological examination doesn’t reveal any focal neurological findings except for an irritable mood and poor memory and concentration. What is the most likely cause of his symptoms? +
A 12-month old female child is brought to the office for a routine examination. On enquiry the mother states that the baby was born prematurely and her weight was 4.4. Lbs. On examination of the child you notice that the child cannot sit unsupported. On examination of the head a smaller than usual head is noticed. Examination of the face reveals a smooth philtrum, thin vermillion and small palpebral fissures. What could be the most likely cause of these facial features? +
A 18-year-old female presents to you with chief complaints of fever, headache, running nose, nasal congestion. After careful examination you make a diagnosis of bacterial sinusitis. You decide to start her on oral Amoxicillin as that is the recommended treatment. The patient comes to you after a week and says that her symptoms have not improved. You suspect drug resistance micro-organism. Which of these antibiotics should be prescribed considering the fact that the organism has amoxicillin resistance? +
An 11-month-old previously healthy African American female from Haiti comes to Emergency room (ER) with generalized tonic clonic seizures with 1-day history of lethargy, fever and altered mental status. Enroute to hospital, emergency medical team intubated her and gave a dose of lorazepam, with no remission. In the ER 1 more dose of lorazepam was given and patient was transferred to ICU for further management, where vitals were within normal limits. Overnight EEG showed a pattern of status epileptics. The patient was medically paralyzed and put on a ventilator. Complete blood count, Chem 10 and CT scan all are within normal limits. She was given a dose of quinine for malaria, but stopped due to negative thick and thin smear. What is the next step in the management of this patient? +
An 11-month-old previously healthy African American female from Haiti comes to Emergency room(ER) with generalized tonic clonic seizures with 1-day history of lethargy, fever and altered mental status. Enroute to hospital, emergency medical team intubated her and gave a dose of diazepam, with no remission. In the ER 1 more dose of diazepam was given and patient was transferred to ICU for further management, where vitals were within normal limits. Overnight EEG showed a pattern of status epileptics. The patient was medically paralyzed and put on a ventilator. Complete blood count, other labs and CT scan all are within normal limits. She was given a dose of quinine for malaria, but stopped due to negative thick and thin smear. A Lumbar puncture was done which revealed:
CSF Glucose 60 mg/dl <br>
CSF protein 90 mg/dl <br>
CSF WBC 70 cell/ml <br>
Culture negative for any organism <br>
Opening pressure normal <br>
What is the most common cause? +
An 11-month-old previously healthy African American female from Haiti comes to Emergency room(ER) with generalized tonic clonic seizures with 1-day history of lethargy, fever and altered mental status. Enroute to hospital, emergency medical team intubated her and gave a dose of diazepam, with no remission. In the ER 1 more dose of diazepam was given and patient was transferred to ICU for further management, where vitals were within normal limits. Overnight EEG showed a pattern of status epileptics. The patient was medically paralyzed and put on a ventilator. Complete blood count, Chem 10 and CT scan all are within normal limits. She was given a dose of quinine for malaria, but stopped due to negative thick and thin smear. A Lumbar puncture was done which revealed:
CSF Glucose 60 mg/dl <br>
CSF protein 90 mg/dl <br>
CSF WBC 70 cell/ml <br>
Culture negative for any organism <br>
Opening pressure normal <br>
A CSF antibody test revealed positive for HSV-1. What is the best treatment for this patient? +
A previously healthy 25-year-old female medical student from India presents with high fever, myalgias and generalized body pain. She also presents with a macular rash all over her body. Her Vitals were stable except for a temperature of 39 degrees and a pulse rate of 102.Her platelet count is 90,000. What is the next best step in the management of the disease? +
A 42-year-old male smoker presents to his primary care physician for excessive post-prandial sweating on the right side of his face. Three months later, the patient returns with complaints of severe pain and tingling in his right arm. Physical examination is remarkable for right-sided ptosis and miosis. Chest x-ray demonstrates an apical mass. Biopsy of the mass demonstrates an adenocarcinoma with an ''EML4-ALK'' fusion. Which of the following neurological structures is most likely directly disrupted due to this patient's disease? +
A 64-year-old man presents to his primary care physician for shortness of breath, non-productive cough, fever and 15-pound weight loss. The patient denies a history of smoking, but reports working for 20 years as a sandblaster for a large construction firm. Chest X-ray shows diffuse micronodular opacities, particularly in the upper lobes. Chest CT shows enlargement of the hilum with eggshell-like calcifications. Which of the following would mostly likely be observed on lung biopsy? +
A 35-year-old female immigrant presents to the physician's for shortness of breath that occurs when she travels to the farm. Upon further questioning, the patient informs the physician that she belongs to the Kayan tribe of Burma that is known for a tradition in which the women gradually extend the length of their necks with coils. Prior to performing a methacholine challenge test, the physician obtains baseline measurements for the following:
* Tidal volume = 600mL
* PaCO <sub>2</sub> = 40 mmHg
* P <sub>expired</sub> CO <sub>2</sub> = 28 mmHg
* Respiratory Rate = 16/min
Which of the following represents the physiologic dead space in this patient? +