A 51-year-old man presents to his primary care physician with a 1-year history of increasing weakness. He has no significant past medical history and does not currently take any medications. On physical exam, an upgoing big toe and fanning of the other toes are seen when a reflex hammer is scraped against the bottom of the foot. Which of the following structures is most likely abnormal in this patient?

A 2-year-old boy is brought to the pediatrician for recurren...

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A startup is working on a novel project in which they claim ...

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A 54-year-old man tells his physician that he has had troubl...

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A 1-year-old African American boy is brought to urgent care ...

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A 57-year-old Caucasian male presents to your office with heart palpitations and shortness of breath. On exam, he is tachycardic and his rhythm is irregularly irregular. He fails standard pharmacologic therapy and you refer to cardiology, where he is started on an antiarrhythmic medication. The action of this agent results in a longer action potential duration, an increased effective refractory period, and a longer QT interval. Which drug has been prescribed?

A 9-year-old boy is referred to an orthopedic surgeon after ...

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The brain of a 75-year-old man is reviewed at autopsy (Figur...

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A 65-year-old woman presents to the clinic with chest discom...

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A 21-year-old man is brought into the emergency department a...

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A 65-year-old man with a longstanding history of poorly-controlled hypertension and no recent illness or cardiac disease presents to clinic complaining of chest pain that is worse on inspiration and relieved by sitting forward. Vital signs are stable. On exam, you detect a friction rub. Routine labs show K 7.5 and Cr 5.1. If this patient's clinical signs and laboratory findings are indicative of a chronic condition, what would be expected on urinary analysis?

A 59-year-old presents with right-sided hemiparesis, right-...

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A 92-year-old man is brought to the emergency department by ambulance with a 1-hour history of severe substernal chest pain. He was walking in the garden with his wife when he started having pain and lightheadedness, causing him to suffer a ground-level fall. On presentation, he is found to have ST-segment elevations in the II, III, and aVF leads on ECG. The patient's baseline cardiac function curve is seen in Figure A as curve C. Which of the cardiac function curves seen in Figure A best represents this patient's cardiac function during this episode?

A 64-year-old male presents to the emergency room with diffi...

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A 52-year-old woman presents to the emergency department wit...

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A 35-year-old man is brought to the emergency department by ambulance after a motor vehicle accident. He was the restrained passenger in a passenger-side collision with passenger compartment intrusion. He is unresponsive to painful stimuli. The patient’s temperature is 100.2°F (37.9°C), blood pressure is 80/40 mmHg, and respirations are 22/min. Extensive ecchymoses are noted on his abdomen. His pulses are feeble and his extremities feel cool. A focused sonographic assessment of his abdomen reveals free abdominal fluid. What are the expected changes to this patient’s carotid sinus nerve activity, efferent parasympathetic outflow, and cardiac output (see Figure A)?

A physician is choosing whether to prescribe losartan or lisinopril to treat hypertension in a 56-year-old male. Relative to losartan, one would expect treatment with lisinopril to produce which of the following changes in the circulating levels of these peptides?

Researchers are studying a rare condition in a family notabl...

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An ill-appearing 70-year-old male smoker presents to your office at 4:00 p.m. The left panel of Figure A shows the patient's appearance when he wakes up in the morning and the right panel shows the patient as he appears after walking around during the day. He complains of dyspnea and cough for several weeks, and on examination you also note his distended neck veins. What is the most likely cause of this patient's illness?

A 5-year-old African American boy presents with extreme abdominal pain. He has a history of several such episodes, as well as acute episodes of extreme bone pain. He has previously presented with the findings illustrated in Figure A. A peripheral blood smear is obtained, and is shown in Figure B. What is the most likely mechanism responsible for this patient's disorder?

A young couple expecting their first child present to the ob...

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A 45-year-old male alcoholic presents with fever, productive cough, and foul-smelling sputum for the past two weeks. Vital signs are T 38.3 C, HR 106, BP 118/64 and RR 16. Oxygen saturation on room air is 90%. Given a diagnosis of aspiration pneumonia, initial chest radiograph findings would most likely include:

A 63-year-old woman presents to the emergency department wit...

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A 22-year-old medical student faints in the operating room during his surgical clerkship. Prior to the episode of fainting, he noted spots in his vision as well as darkness around the edges of his vision. He began to feel very warm and stepped back from the table before he collapsed. A few sporadic jerks of his extremities were observed by the operating room staff who transported him to the emergency department. On physical exam, he does not have any tongue injuries or abnormal neurologic findings. Which of the following is the most likely cause of this patient's symptoms?

A 37-year-old G2P1 woman undergoes an urgent cesarean section at 36 weeks of gestation for abruptio placentae. Apgar scores of the newborn at 1 minute, 5 minutes, and 10 minutes are 4, 4, and 3, respectively. The child has poor tone, diminished spontaneous movements, and absent primitive reflexes. Laboratory studies of blood from the umbilical artery show: pH: 6.96 (normal 7.18-7.38) PO2: 4.5 mmHg (normal 5.6-30.4 mmHg) PCO2: 22.5 mm Hg (normal 32.4-66.0 mmHg) Hypoxic-ischemic encephalopathy (HIE) is suspected. Which of the following interventions will best mitigate neuronal injury?

A 65-year-old woman comes to clinic complaining of pain with chewing solid foods. She reports that she has been feeling unwell lately, with pains in her shoulders and hips, and she has lost five pounds in the past few months. Her vital signs are T 39C, RR 18 breaths/min, HR 95 bpm, BP 120/65 mmHg. When you ask her to stand from her chair to get on the exam table she moves stiffly but displays preserved proximal muscle strength. Another potential symptom or sign of this disease could be:

A 67-year-old man presents to his primary care physician with his wife for an annual visit. He reports no health issues since his last visit. He has no known medical problems and takes a daily multivitamin. He is up to date on his pneumococcal and shingles vaccinations. He drinks 3-4 alcoholic beverages weekly and is a former smoker with a 40 pack-year history. He exercises for at least 30 minutes every day. The patient’s temperature is 98.6°F (37.0°C), blood pressure is 144/90 mmHg, pulse is 70/min, and respirations are 18/min. His body mass index (BMI) is 26.2 kg/m^2. A review of his chart reveals that his blood pressure was 148/92 mmHg at his prior visit and 154/90 mmHg prior to that. Physical exam reveals a well-appearing elderly man in no acute distress. Lung auscultation reveals vesicular breath sounds bilaterally. Initiation of hydrochlorothiazide is recommended. However, the patient adamantly refuses medication. Which of the following is the most appropriate response by the physician?

A 25-year-old woman presents to the emergency department with fever, headache, and double-vision. The patient states that she had her left wisdom teeth removed 3 days ago. She reports no other significant past medical history. Her temperature is 102°F (38.9°C), blood pressure is 90/70 mmHg, pulse is 105/min, and respirations are 22/min. On examination, there is exophthalmos and erythema of her left orbit. Her diplopia worsens with left sided horizontal gaze. Magnetic resonance imaging (MRI) is performed and shown in Figure A. Pathology of which of the following is most responsible for this patient’s ocular symptoms?

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A 27-year-old male arrives in the emergency department with a stab wound over the precordial chest wall. The patient is in distress and is cold, sweaty, and pale. Initial physical examination is significant for muffled heart sounds, distended neck veins, and a 3 cm stab wound near the left sternal border. Breath sounds are present bilaterally without evidence of tracheal deviation. Which of the following additional findings would be expected on further evaluation?

A 78-year-old woman is brought to the emergency department by ambulance for altered mental status. She is a resident at a skilled nursing facility, where she was noted to have lower abdominal discomfort 3 days ago. She had 1 episode of urinary incontinence on each of the last 2 nights. This morning, she was found to be disoriented to place and time. The patient has a history of diabetes mellitus, hypertension, and congestive heart failure for which she takes metformin, insulin, lisinopril, metoprolol, and spironolactone. She also had a stroke 3 years ago that left her with residual dysarthria. She received a left total knee arthroplasty 20 days ago. She is up to date on her vaccinations, including herpes zoster. She has a 30-pack-year smoking history and quit 15 years ago. She does not drink alcohol. She has a history of intravenous drug use. She is a retired librarian. The patient's temperature is 103.6°F (39.8°C), blood pressure is 90/56 mmHg, pulse is 120/min, and respirations are 22/min. Physical examination reveals an ill-appearing woman. She is oriented only to person. Cardiac exam reveals a normal S1 and S2 with an S4 gallop. There are no murmurs or rubs. Bronchial breath sounds are heard bilaterally. Her abdomen is soft and nondistended. There is right costovertebral angle tenderness. Which of the following is the most likely cause of this patient's condition?

A 60-year-old woman presents to her primary care provider wi...

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A 4-year-old boy is brought to the emergency department by his mother for severe right leg pain. The pain began suddenly 6 hours ago and has been unremitting. He has been well other than having a mild nonproductive cough and runny nose 1 week ago that resolved 2 days ago. The patient has a history of asthma and sickle cell disease, for which he takes hydroxyurea, penicillin, and an albuterol inhaler as needed. He has not had any prior surgeries. He is up to date on his vaccinations, including pneumococcal, influenza, and meningococcal vaccines. He lives with his parents and has 2 siblings, who are healthy. The patient’s temperature is 98.6°F (37.0°C), blood pressure is 98/56 mmHg, pulse is 140/min, and respirations are 22/min. Physical examination shows a tearful boy holding his right calf in pain. A cardiopulmonary examination is unremarkable. His abdomen is soft, nontender, and nondistended. His right calf is diffusely painful without focal tenderness. There is no overlying erythema in the affected extremity. Passive range of motion of his right hip, knee, and ankle are full. He refuses to participate in the gait exam. The results of serum laboratory results are shown below: Hemoglobin: 9.2 g/dL Platelet count: 160,000/mm^3 Reticulocyte count: 5% Erythrocyte sedimentation rate (ESR): 10 mm/h Radiographs of the right tibia, fibula, and ankle are unremarkable. Which of the following is most likely to be decreased in this patient?

A 6-year-old girl is brought to the emergency department wit...

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A 45-year-old woman presents to the emergency room with a headache. The headache had an acute onset 30 minutes before admission and has not improved with ibuprofen. She has occasionally had headaches, but nothing as severe as the current episode. Her past medical history is significant for hypertension and Ehlers-Danlos syndrome. She does not drink alcohol but has smoked 2 packs of cigarettes per day for the past 25 years. Her temperature is 98.6°F (37.0°C), blood pressure is 175/95 mmHg, pulse is 115/min, respirations are 22/min, and O2 saturation is 99% on room air. A brief physical exam is notable for photophobia and nuchal rigidity. No focal neurologic deficits are noted. Computed tomography (CT) scan of the head is notable for blood in the interpeduncular, crural, ambient, and quadrigeminal cisterns. Which of the following is the most likely cause of this patient’s current presentation?

A 37-year-old male presents with difficulty eating solids an...

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A 47-year-old man presents to the clinic with a 2-week history of intermittent palpitations. He reports feeling dizzy during these episodes. His past medical history is significant for chronic rheumatic heart disease. His temperature is 98.8°F (37.1°C), blood pressure is 138/84 mmHg, pulse is 69/min, and respirations are 15/min. Physical exam is notable for a grade 2/6 diastolic rumbling murmur. ECG results are shown in Figure A. He is started on a medication appropriate for this condition. One week later, he returns to the clinic complaining of lower extremity swelling, constipation, and flushing of his skin. Physical exam reveals edema up to his lower shins. Which of the following medications was most likely prescribed?

A 68-year-old man presents with a hand tremor, which he firs...

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A 45-year-old man presents to his primary care physician complaining of a rash that has worsened over the past year. He first noticed the new lesions on his elbows while showering. His medical history is also significant for controlled hypertension, for which he takes amlodipine and hydrochlorothiazide. He notes that his rash had worsened when trialing metoprolol, so he had to stop taking it. He does not smoke and drinks socially. His temperature is 98.0°F (36.7°C), blood pressure is 125/95 mmHg, pulse is 101/min, and respirations are 17/min. Figure A is observed during the physical exam. Otherwise, his cardiopulmonary exam is unremarkable. Which of the following is a possible complication of this patient's condition?