A 58-year-old man presents to his physician with shortness of breath on exertion for the last 2 years. He mentions that initially, he used to become breathless upon climbing 2 flights of stairs, but now he becomes short of breath after walking a couple of blocks. He has no known medical problems except for obesity. Auscultation of the chest reveals a loud pulmonic component of the second heart sound. Auscultation over the lung fields does not reveal any specific abnormality. His chest radiograph shows an enlargement of the central pulmonary arteries, attenuation of the peripheral pulmonary vessels, and oligemic lung fields. In addition to measures for weight reduction, which of the following is most likely to improve the shortness of breath in this patient?

A 35-year-old G1P0 woman at 30 weeks gestation is brought to the emergency department because of sharp abdominal pains. She reports feeling a little uneasy over the last 3 weeks. She mentions that her abdomen has not been enlarging as expected and her baby is not moving as much compared to the earlier part of her pregnancy. The physician notices that she is restless and sweating profusely. Her blood pressure is 90/60 mm Hg, pulse is 120/min. Ultrasonography reveals no fetal movement or heart motion. Laboratory studies show the following: hemoglobin, 10.3 g/dL; platelet count, 50,000/µL; bleeding time, 10 minutes; PT, 25 seconds; and PTT, 45 seconds. Which of the following is the most appropriate next step in management?

A scientist in Boston is studying a new blood test with increased sensitivity and specificity in the detection of parainfluenza virus antibodies. Her best attempt at creating this test reached an 82% sensitivity and an 88% specificity. She is hoping to increase these indices by at least 2% for each value. After several years of work, she believes that she has achieved a sensitivity and specificity that is even greater than what she had originally hoped for. She travels to South America to test her novel blood test. She finds 2,000 patients who are willing to participate in her study. Of the 2,000 patients, 1,200 of them are known to be infected with the parainfluenza virus. The scientist tests the blood of these 1,200 patients and only 120 of them tested negative with her new test. Of the following options, which option describes the sensitivity of the test?

A 37-year-old otherwise healthy man has a routine CBC done prior to donating blood for the first time. Results are as follows:

Hemoglobin - 10.8 g/dL

Mean corpuscular volume (MCV) - 82 μm3

MCHC - 42%

Reticulocyte count - 3.2%

White blood cell count - 8,700/mm3

Platelet count - 325,000/mm3

The patient is afebrile and his vital signs are within normal limits. On physical examination, his spleen is just palpable. A peripheral blood smear is shown in the image below. A direct antiglobulin test (DAT) is negative. Which of the following best describes the etiology of this patient’s most likely diagnosis?

A 23-year-old African American G1P0 woman at 18 weeks estimated gestational age presents with fatigue and lethargy. She says the symptoms began gradually about 1 week ago and have progressively worsened. She has been otherwise healthy. Past medical history is unremarkable. She denies smoking and any drug or alcohol use. The patient is afebrile and vital signs are within normal limits. Her physical examination is unremarkable. Her blood count shows the following:

Hemoglobin - 10.8 g/dL

Red blood cell count - 5.7 million/mm3

Mean corpuscular volume (MCV) - 76 μm3

Red cell distribution width (RDW) - 12.4% (ref: 11.5–14.5%)

She is started on ferrous gluconate tablets. Five weeks later, she shows no improvement in her hemoglobin level. Hemoglobin electrophoresis is normal. Which of the following is the most likely diagnosis in this patient?

A 48-year-old man presents with a productive cough and occasional dyspnea on exertion. He has experienced these symptoms for the past 6 years. He has h/o allergic rhinitis. The patient denies weight loss, night sweats, or hemoptysis. The patient reports a 30-pack-year smoking history. He works as a financial advisor and is physically inactive. His vital signs are within normal limits and his BMI is 44.9 kg/m2. The patient's lung auscultation is significant for occasional wheezes over both lungs. Spirometry shows an FEV1 of 59% of predicted. He is on lisinopril for hypertension. Which of the following interventions would be most useful to slow the progression of this patient’s most likely condition?

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