A 75 year old woman with known COPD complains of worsening exertional dyspnea following a recent hospitalization for an acute exacerbation. CT scan obtained in the hospital demonstrated hyperinflation with emphysematous changes predominantly in the lower lobes. An ABG obtained several weeks after hospitalization demonstrates a PaO2 of 50 mmHg and PaCO2 of 42 mmHg. A course of oral prednisone started in the hospital has been tapered off. Which of the following treatments for COPD considered in this patient has been proven to prolong survival?

A 40 year old white male presents to your office complaining of increased shortness of breath. He has a history of repeated pulmonary and sinus infections. Physical exam is significant for crackles bilaterally. chest x-ray are shown

Which of the following is the most likely diagnosis?

A 48-year-old man with myasthenia gravis is admitted to the ICU with sepsis, worsening weakness, and hypercapnea. He reports having recurrent UTI caused by Pseudomonas species that have previously required treatment with IV antibiotics. His current urinalysis results reveal many WBCs and gram-negative rods. He has received a dose of vancomycin. Which of the following empirical antibiotic regimens should be initiated while awaiting culture results?

Which of the following is true regarding tuberculosis, pregnancy, and lactation?

A 43-year-old man presents to the ED with tongue and lip swelling due to angiotensin-converting enzyme inhibitor. The swelling significantly worsens and he is intubated for airway protection. In addition to his history of hypertension, he was placed on therapy 1 month ago for newly diagnosed pulmonary TB. Upon transfer to the ICU, he is placed on a nicardipine drip for BP control and a propofol infusion for continued agitation. The next morning, the ICU nurse calls with concerns about the patient’s urine.

What is the most likely cause of this finding?

A 43-year-old man recently was found to have an asymptomatic atrial septal defect that was closed using a percutaneous patch 1 month ago without complication. He is undergoing a root canal at the dentist next week and calls his primary care office to determine if antibiotic prophylaxis is indicated. Which of the following statements is true regarding antibiotic prophylaxis in this patient?

52-year-old woman has been having worsening cough for the past month. She is a nonsmoker. The cough is nonproductive and present throughout the day and night. It worsens when lying on her back. She has also noticed some upper chest pain and dyspnea on exertion for the past week. A chest radiograph shows a large mass (>5 cm) confined to the anterior mediastinum. Which of the following diagnoses is most likely?

A 32-year-old woman is evaluated for anticoagulation management after an uncomplicated vaginal delivery of a healthy newborn. She was diagnosed with a bilateral pulmonary embolism at 25 weeks' gestation and was treated with therapeutic LMWH . The LMWH was discontinued at the onset of labor and was restarted 6 hours after delivery. Anticoagulation for 3 months is planned. The patient wishes to breastfeed her newborn. Which of the following is the most appropriate anticoagulation option for this patient?

patient with metabolic acidosis, reduced anion gap, and increased osmolal gap is most likely to have which of the following toxic ingestions?

You are examining a 25-year-old patient in clinic who came in for a routine examination. Cardiac auscultation reveals a second heart sound that is split and does not vary with respiration. There is also a grade 2–3 midsystolic murmur at the midsternal border. Which of the following is most likely?

A 15-year-old boy was admitted to the intensive care unit for the second time with meningococcal septicemia. Investigations on admission were as follows: Hb 14.8 g/dl, WCC 18000 (neutrophils 80%), Platelets 190000. What investigation would you perform to identify the cause?

What is the mechanism of action of tocilizumab?

Which of the following is the most common manifestation of MEN1?

In chronic hepatitis B virus infection, presence of hepatitis B e antigen signifies which of the following?

A patient is followed closely by her nephrologist for stage IV chronic kidney disease associated with focal segmental glomerulosclerosis. Which of the following is an indication for initiation of maintenance hemodialysis?

A 45-year-old man with ulcerative colitis has been treated for the past 5 years with infliximab with excellent resolution of his bowel symptoms and endoscopic evidence of normal colonic mucosa. He is evaluated by a dermatologist for a lesion that initially was a pustule over his right lower extremity but has since progressed in size with ulceration. The ulcer is moderately painful. He does not recall any trauma to the area. On examination, the ulcer measures 15 × 7 cm, and central necrosis is present. The edges of the ulcer are violaceous. Which of the following is the most likely diagnosis?

Which of the following is the most common cause of Cushing syndrome?

Which of the following joints is often spared by osteoarthritis?

You are seeing a patient in follow-up in whom you have begun an evaluation for an elevated hematocrit. You suspect polycythemia vera based on a history of aquagenic pruritus and splenomegaly. Which set of laboratory tests is consistent with the diagnosis of polycythemia vera?