Ann George

A 32 year old woman is seen for follow up evaluation of chronic anemia that has been stable for at least the past 5 years. She has no history of transfusions. She had one pregnancy at age 29 years, ending in intrauterine fetal demise in the early third trimester. Her father has anemia. the patient is Chinese.

On physical examination, vital signs and the remainder of the physical examination are normal.

Hgb: 10.8

MCV: 62

Reticulocyte count: 2% of erythrocytes

Ferritin: 200ng/mL

Iron 200 ug/dL

TIBC: 280 ug/dL

Hemoglobin electrophoresis reveals a normal migration pattern of hemoglobin A and normal hemoglobin A2 and hemoglobin F levels.

What is the most likely diagnosis?

Dale Howard

A 19 year old woman is evaluated in the ED for a 3 day history of progressively severe sore throat. She cannot swallow liquids due to pain and has drooling.

On physical examination, temperature is 101.3F, BP is 110/70, pulse is 110, and respiration rate is 25/min. There is no stridor. She is drooling. The oropharynx is hyperemic, and the patient has difficulty opening her mouth fully. The uvula is engorged. Antibiotics are initiated.

Which of the following is the most appropriate next step in management?

Rebecca Lainez

A 36yo woman is evaluated for a 10 year history of fluctuating, migratory burning pain and parasthesia involving multiple parts of her body. Her symptoms are stable but disruptive. She has previously undergone extensive evaluation, with normal results. She has tried nortriptyline, gabapentin, pregabalin, and topical lidocaine without benefit. Medical history is significant for migraine, temporomandibular joint dysfunction, and irritable bowel syndrome. Results of recent screening for depression and generalized anxiety disorder were negative. Current medications are duloxetine, propanolol, and sumatriptan.

Vital signs and findings on general and neurologic examinations are normal.

Review of electronic health record documents normal CBC, electrolytes, liver enzymes, vitamin B12, TSH, fasting glucose, serum protein electrophoresis.

Results of EMG and skin biopsy for small nerve fiber neuropathy are normal.

Which of the following is the most appropriate management?

Armando Perez

A 36 year old woman was hospitalized 3 days ago with fever of 4 days' duration. Medical history is significant for injection drug use. She takes no medication.

On initial physical examination, temperature was 102.1F, blood pressure was 106/70, pulse rate was 100/min, and respiration rate was 20/min.

Empiric vancomycin and ceftazidime treatment was initiated.

Today, the patient is improved. Temperature is 100.5F, all other vital signs are normal. Blood cultures are positive for methicillin-resistant Staphylococcus aureus (Vancomycin minimum inhibitory concentration 1 ug/mL). Vancomycin trough level is 18 ug/mL. Ceftazidime is discontinued.

Transthoracic echocardiogram shows a vegetation on the tricuspid valve.

Which of the following is the most appropriate management?

Ashok Shah

A 57 year old man is evaluated during routine follow-up of hypoparathyroidism. He underwent resection of locally advanced squamous cell carcinoma of the tongue base with laryngectomy, thyroidectomy, tracheostomy, and percutaneous gastrostomy tube placement 2 years ago.. He also received adjuvant radiation therapy. Hypoparathyroidism developed after treatment. He has no evidence of cancer recurrence and has maintained a normal weight and hydration. Medications are levothyroxine, calcium citrate, calcitriol, hydrochlorothiazide, and potassium chloride.

Serum calcium, magnesium, and urine calcium excretion are measured today.

Which of the following measurements should also be obtained for management of this patient's hypoparathyroidism?

Rishab Tandon

A 57 year old woman is evaluated during her first physician visit in many years. She feels well and has no symptoms. She has a sedentary office job and exercises rarely. She doesn't smoke cigarettes. her medical history is unremarkable. her father had a heart attack at age 54 years. She takes no medications.

On physical examination, blood pressure is 122/82, pulse rate is 66, and respiration rate is 16/min. BMI is 27.5. All other findings are normal.

Alfred Quaicoe

A 75 year old man is evaluated in the ED for several episodes of maroon blood per rectum and cramping abdominal pain of 18 hours' duration. He is admitted to the hospital and colonoscopy preparation is initiated. He has HTN, atrial fibrillation, and coronary artery disease. At a colonoscopy performed 1 week ago, a 1-cm pedunculate polyp was removed from the transverse colon. Medications are apixaban, low dose aspirin, metoprolol, and atorvastatin.

On initial physical examination, blood pressure was 95/40 and pulse rate was 105/min and irregular. The abdomen was soft, with lower abdominal tenderness.

After admission and administration of 2L of IV fluid, blood pressure is 110/60 and pulse rate is 80/min.

Which of the following is the most appropriate management of this patient's anti platelet and anticoagulant therapy?

Nicholas Teague

A 49 year old woman is evaluated in the ICU with septic shock due to suspected pyelonephritis. She was treated with piperacillin-tazobactam upon arrival and received 30mL/kg bolus of LR followed by several more fluid boluses. She remained hypotensive and began receiving norepinephrine and vasopressin 4 hours ago. She has no other medical problems.

On Physical Examination, temperature is 37.1C, blood pressure is 86/48, mean arterial pressure is 61, pulse rate is 106/min, and respiration rate is 22/min. A passive leg raise test shows a lack of fluid responsiveness.

Laboratory studies:

Leukocyte count: 15.000

Creatinine: 2.6

Glucose: 160

Lactate: 4,1

Which of the follow is the most appropriate next step in treatment?

Vineeth

A 46 year old woman is evaluated for a 5 day history of nonproductive cough, headache, fever, and chills accompanied by 3 days of diarrhea. She reports no dyspnea. She has 2 parakeets as pets at home.

On physical examination, temperature is 38.2C (100.8F), blood pressure is 132/78, pulse is 92/min, and respiration rate is 16/min. Oxygen saturation is 96% breathing ambient air. Crackles are heard at the left lung base. The remainder of the examination is unremarkable.

Laboratory Studies:

Leukocyte Count: 9200

The remainder of her complete blood count and a comprehensive metabolic panel are normal. Rapid nucleic amplification tests for influenza and SARS-CoV-2 are negative.

A chest radiograph shows consolidation in the left lower lobe.

Which of the following is the most likely cause of this patient's symptoms?

Robert

A 32 year old man is evaluated for 2 month history of painless, violaceous skin nodules on the chest, back, and lower extremities. He reports that he has sex with men. Medical history is significant for AIDs, with a CD4 count of 54. he is not taking antiretroviral therapy.

On physical examination, vital signs are normal. Several nodules are seen in the mouth during oral examination

Which of the following is the most likely cause of these findings?