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A 20-year-old man presents with a sudden onset of vomiting, headache, vision changes, numbness and tingling of extremities, difficulty speaking, difficulty writing, loss of coordination, and loss of balance. His past medical history is significant for sickle cell anemia. Physical exam findings are consistent with acute cerebrovascular insufficiency. Early detection and prevention of stroke in sickle cell anemia is now possible by using screening tests. What imaging modality is recommended as a screening test for cerebrovascular disease/stroke in sickle cell disease (SCD) patients?

A 3-year-old boy is brought to your outpatient clinic. His parents are worried about the delayed language development and the child always appears to be “in his own little world.” You are told that his previous doctor had diagnosed the child with autism spectrum disorder and the parents are here for a second opinion. When observing the child, the presence of which of the following clinical findings most closely correlates with autism spectrum disorder?

Which of the following statements about gender dysphoria is true?

An 82-year-old man presents to the urology clinic accompanied by his wife, and requests evaluation of “problems down there.” He is a poor historian, but his wife helps with his review of systems. She reports that he does not have any voiding issues and states that he has never had to see a urologist previously. Genitourinary examination is suggestive of phimosis.  Which of the following physical examination findings would support this diagnosis?

A general surgery PA is paged to the bedside of a 56-year-old male who underwent a successful sigmoidectomy for treatment of recurrent diverticulitis. The patient’s nurse just recorded a temperature of 101.7⁰F, and relates that the patient is complaining of chills. The surgery was completed 8 hours ago and was complicated by extensive bleeding, with an estimated blood loss of 1,700 mL. Post-operative anemia was diagnosed after a hemoglobin of 5.9 g/dL was found; 2 units of packed red blood cells were ordered, and the transfusion was initiated 90 minutes ago. The patient’s vital signs are as follows: T 38.7 C, HR 88, BP 138/77, RR 18, SpO2 98%. Physical examination does not show any abnormalities. After immediately stopping the transfusion, which of the following is the best management of this patient’s condition?

A 50-year-old female comes into your office with concerns of falling. She states that over the last few months, she has a feeling of numbness and “tingling” in her feet. She denies any problems with her balance and denies vertigo, but does not feel “sure-footed.” She denies any neurological history. Past medical history is significant for hysterectomy 10 years ago for menorrhagia and a bowel resection for Crohn’s disease. On exam, the patient has decreased reflexes and sensation bilaterally in her lower extremities. CBC shows a Hgb of 9.1 with an MCV of 105. The peripheral blood smear is shown (see image below). The patient’s methylmalonic acid (MMA) level is elevated. What is the most likely cause of this patient’s clinical presentation?              

A 50-year-old female with PMH significant for HTN comes to your clinic for a refill of her lisinopril medication. She is also taking lovastatin and hydrochlorothiazide. Vital signs are: HR 80, BP 150/100, and BMI 40. Physical exam is remarkable for a waist-to-hip ratio of 1.0 and the presence of diffuse dark patches on her skin (see image below). Her fasting lab results are: Sodium: 145 mmol/L, Potassium: 5.0 mmol/L, Chloride: 105 mmol/L, Bicarbonate: 25 mmol/L, BUN: 10 mg/dL, Creatinine: 1.0 mg/dL, Glucose: 200 mg/dL, Triglyceride: 200 mg/dL, LDL: 250 mg/dL, Total cholesterol: 300 mg/dL, HDL: 30 mg/dL, and Hemoglobin A1C: 7.0%.                                                         The patient’s history, physical exam, and laboratory findings are most consistent with which of the following conditions?

A 6-year-old boy is brought to the pediatrician complaining of itchy eyes. The mother states that she has noted that he has been tearing and that both of his eyes have been red for the past 4 days. The patient denies any pain but has had a runny nose for the past week. The mother states that he has not had any sick contacts, and he has been home from school for summer vacation. She notices that his symptoms seem to improve in the evening after he showers. His temperature is 97.0°F (36.1°C), blood pressure is 100/66 mmHg, pulse is 90/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding illustrated in the image below. Which of the following is the most likely diagnosis?         

An 18-year-old male is evaluated in the ER, after being brought in by police for evaluation.  The police observed the patient sitting on a park bench, and he appeared to be responding to internal stimuli.  He was clearly agitated and was threatening to kill people in the park, “just like the voices told me to.”  The patient’s mother is later located, and she states that for the past 8 months, her son has demonstrated delusional behavior and disorganized speech, and has complained of threatening auditory hallucinations.  He has refused to seek psychiatric evaluation and has been living on the streets for much of the time.  He has returned home intermittently during this time for brief periods, but has run away again each time the family attempts to have him evaluated.  The patient cannot offer any insight into his behavior.  Which of the following conditions is the most likely diagnosis for this patient? 

A Rh-positive neonate is born to a Rh-negative mother who has received her first dose of. Rh immune globulin (RhoGAM®) at her 28-week prenatal visit.  What is the appropriate time frame following delivery for this patient to receive her second dose of RhoGAM®?