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A 55 year old man presents to your clinic because he is worried that he may have an abdominal aortic aneurysm. Which of the following factors is associated with the highest risk for development of an aortic aneurysm?                                                             

A 55 – year old man has degenerative hip disease and must undergo a total hip replacement. His BMI is 36.3. He is otherwise healthy and has never had an episode of Deep Vein Thrombosis (DVT). The most appropriate DVT prophylaxis for him is?

In acute mesenteric ischemia, emboli typically lodge at: 

A 21-year-old female is diagnosed with acute lymphoblastic leukemia when she presented with fatigue, bone pain, and a white count of 89,000.  She is started on high-dose induction chemotherapy.  Despite preprinted orders which specify that the patient is to receive IV fluids and allopurinol, the patient is mistakenly only given her chemotherapeutic regimen.  Over the next day, she becomes increasingly confused and lethargic with minimal urine output.  You are concerned that she has developed tumor lysis syndrome.  Which of the following serum electrolyte abnormalities would be MOST LIKELY in this adult patient?  Answer Na K Ca2+ (8.5-10.5) PO4 (2.5-5.0) BUN creatinine Uric acid A. 125 5.8 12.1 2.4 44 2.4 Low B. 128 3.1 9.3 3.4 50 2.4 Elevated C. 130 5.8 8.1 5.8 60 2.4 Elevated D. 145 4.2 9.8 3.5 18 0.8 Elevated E. 145 4.2 9.8 3.5 18 0.8 Normal F. 155 4.5 8.1 5.8 40 1.5 Normal  

1.       A 41-year-old Caucasian female presents with headache, fever and photophobia of 3 week duration.  She has never had anything like this before.  In the emergency room, she appears lethargic and confused.  T98.3 F, RR 18, P98, BP 104/62.  She has nuchal rigidity as well as photophobia.  Fundoscopic exam reveals no papilledema.  The rest of the physical exam is unremarkable.  A Lumbar puncture is performed immediately.  Results from the fluid: WBC 25/ml (80% lymphocytes) 250 RBCs, total protein 68, glucose 80.  Gram stain shows no organisms.  Tube 4 shows the same results as tube 1.  Opening pressure is 50 cm H2O.   Patient was diagnosed with HIV 20 years ago; CD4 count was 58 when it was checked 3 months ago.  Patient is not on HAART. This is most consistent with:

This upright chest xray shows:    

This blood smear is most consistent with:   

This xray is most consistent with:   

  Land biomes are most commonly defined by  

7. A 72 year-old black female presents with shortness of breath which has been progressive over the past 2 days. Patient does report having had a URI approximately one month ago.  On physical exam she is found to have decreased breath sounds on the left, suggesting a left pleural effusion, which is subsequently confirmed on chest x-ray.  Patient’s physical exam is otherwise remarkable for patient appearing ill, with shortness of breath. Vitals signs show patient to be afebrile, with HR of 112, BP 102/70 RR22.   Patient has a past medical history of coronary artery disease, hypertension, diabetes and temporal arteritis, as well as recurrent pneumonia.  Allergies are none.  Current medications include Metformin 1000 mg po twice daily, metoprolol tartrate 50 mg po twice daily, aspirin 81 mg po daily, simvastatin 40 mg po daily, Famotidine 40 mg po daily, and prednisone 50mg daily. Patient’s labs are significant for a white count of 14,000, with 75% neutrophils. Chemistries are significant for having a creatinine of 1.15.  LDH is 330, total protein is 7.2. Fluid analysis shows a cloudy turbulent fluid.  Thoracentesis fluid reveals :WBCs  20000/ml-  neutrophils 85%, Lymphocytes 10%.  Glucose is 20.  LDH 250.  Total protein 5.6.  PH is 5.0.  Gram stain reveals large numbers of neutrophils with both gram negative and gram positive bacteria.   What is the most likely cause of patient’s pleural effusion?