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A 45-year-old Caucasian male presents to the primary care physician with a double vision complaint, which started suddenly with no precipitating trauma. Twelve years ago, he presented to his physician with painful vision loss, which has since resolved. Since the initial attack, he has had many episodes early in the disease process: two other episodes of painful vision loss, three episodes of weakness in the right arm, and three episodes of retention of urine that required catheterization. All his previous episodes have responded to supportive therapy and steroids.

Which of the following features of this patient’s disease is linked to a more benign disease course? 

A 16-year-old girl comes to the physician’s office with complaints of nausea, vomiting, headache, and blurry vision. The patient admits to falling during her volleyball practice and hitting her head on another girl’s shin due to her dizziness. The patient’s BMI is 17 kg/m^2. She also complains of recent-onset diarrhea, diffuse pruritus, and dryness of her skin. The patient has a past medical history of anxiety and depression. She exercises extensively and takes supplements.

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

A 33-year-old woman presents to the emergency department with diffuse, cramping abdominal pain, nausea, and vomiting that began early morning. She has a history of chronic pancreatitis, cholecystectomy, chronic bronchitis, and two cesarean sections. She states that she has had flatus but no bowel movements since her pain began. On physical examination, diffuse abdominal distention and high-pitched bowel sounds. There is no rebound tenderness. Supine and upright X-rays of the abdomen are ordered.

Her signs and symptoms likely result from? (Part 1 of 2)

A 33-year-old woman presents to the emergency department with diffuse, cramping abdominal pain, nausea, and vomiting that began early morning. She has a history of chronic pancreatitis, cholecystectomy, chronic bronchitis, and two cesarean sections. She states that she has had flatus but no bowel movements since her pain began. On physical examination, diffuse abdominal distention and high-pitched bowel sounds. There is no rebound tenderness. Supine and upright X-rays of the abdomen are ordered.

What is the next step in management? (Part 2 of 2)

A 16-month-old male was brought to the emergency department with vomiting, colicky abdominal pain, and several bowel movements containing both blood and mucus. Vitals signs: heart rate 114/minute, a respiratory rate 22 /minute, a blood pressure of 104/79 mmHg, and a temperature of 36.4C. Physical examination reveals right upper and lower quadrant tenderness on palpation without rebound tenderness or tympany, and a sausage-shaped mass palpated in the right lower quadrant. A stool sample appears as a “currant jelly” and is positive for blood. Laboratory findings: Hemoglobin 14.5 mg/dL, Hematocrit 47%, WBC 7,400 cells/mm3, Platelets 180,000 cells/mm3. Ultrasound confirms the diagnosis of intussusception.

What is the best treatment for this clinical presentation?

16-old-male is brought in by his mother to see the psychiatrist. She reports that her son spends an hour washing his hands because he does not believe they are clean and before leaving his home to go to school. He keeps checking all the locks in the house to make sure they are locked seven times before leaving. The boy appears very tidy, except his hands are erythematous and dry. The psychiatrist decides to put him on a medication preferred for obsessive-compulsive disorder.

Which of the following is the mechanism of action of this drug?

A 31-year-old woman comes to the primary physician because of a two-week history of periorbital edema and abdominal distention. She has no other complaints. Her temperature is 98.9 F. Blood pressure is 125/75 mm Hg, the pulse is 80/min, her respiration rate is 14/mi, Examination shows ascites and lower extremity edema. Urinalysis shows proteinuria, 24-hour urinary protein excretion is 4g/dl. Total serum protein is 5g/dl and serum albumin is 2.5 g/dL (N 3.5-5.5 g/dL) (N 6 -7.8g/dL). Renal ultrasound is unremarkable. A renal biopsy is performed. The patient is started on diuretics, and her salty and protein intake is restricted. Her edema improves. However, the patient suddenly develops severe right-sided abdominal pain, fever, and gross hematuria.

Which of the following was the most likely diagnosis that will be revealed by renal biopsy?

A 3-year-old boy is brought to the pediatrician due to failure to thrive and increased urinary frequency. According to the mother, the child appears to be very thirsty. He was born prematurely, and the mother states she was found to have polyhydramnios on ultrasonography while pregnant.

Laboratory findings:
Potassium: 2.5 mEq/l (3.5-5.1 mEq/l),
Chloride: 90 mEq/l (92-109 mEq/l),
Magnesium: 0.6 mg/dl (1.6-2.8 mg/dl),
Bicarbonate: 34 mEq/l (24-31 mEq/l). 

What is the diagnosis?

A 56-year-old female college professor is brought to the ED after fainting while giving a lecture. She is awake and alert in the ED but states that she still feels lightheaded. She reports that she has been feeling anxious recently because the college tenure committee was observing her lectures. She had read online that propranolol is used to treat public speaking anxiety, so she took some medication prescribed to her husband for his hand tremors. On the monitor, her pulse is 34/min, and her blood pressure is 90/66 mmHg. Electrocardiogram demonstrates a regular rhythm at a rate of 32/min and prolonged PR intervals. Pacing pads are placed, and she is administered intravenous fluids.

The most appropriate agent for treating this patient act by which of the following mechanisms?

A 70-year-old man presents to the emergency department with severe substernal chest pain for the past one hour. His past medical history includes coronary artery disease, hyperlipidemia, and hypertension. Medications include aspirin, losartan, and atorvastatin. An electrocardiogram reveals ST elevations in the inferior leads II, III, and avF as well as in leads V5 and V6.

The ST elevations found in leads V5-V6 are most indicative of pathology in which of the following areas of the heart?

A 45-year-old man presents to the clinic complaining of nausea, vomiting, abdominal pain, and bloating that have increased in severity over the past several months. He reports that he sometimes vomits after eating. He pointed out that vomiting contains undigested food particles. Even more than that, the patient states that he often is satiated after only a few bites of food at meals. Past medical history includes DM II and hypertension. Laboratory findings show hemoglobin A1c 14%.

Which of the following is the best initial treatment for this patient?