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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®? 

A 68-year-old woman presents for evaluation of morning stiffness with pain in her shoulders. She reports that she has lost a few pounds over the past month, and has had intermittent fevers. The physical examination reveals tenderness over her deltoids with reduced shoulder abduction. Which of the following laboratory findings would be expected?

You are asked to evaluate a 62-year-old patient who presents complaining of fatigue and a “skin infection” and states that he has also noticed increased bruising recently.  On examination, you note that the patient has significant periorbital cellulitis.  There are also multiple areas of ecchymoses in various stages of resolution, as well as petechiae noted over the trunk and extremities.  There is no lymphadenopathy, hepatomegaly, or splenomegaly noted.  A stat CBC with differential is ordered and the results are as followsWBC: 80,000 (↑)Hgb:   9.0 (↓)HCT:  27% (↓)MCV: 90Plt: 60,000 (↓)Differential: 20% segs, 2% bands, 36% lymphs, 4% monos, 3% eosinophils, 1% basophils,34% blastsPeripheral blood smear: Blast cells with Auer rods noted Based on this information, which of the following conditions is the most likely diagnosis for this patient?      

A 22-year-old Caucasian female presents to the Emergency Department complaining of double vision. The patient was well until the morning of admission when she awoke with double vision “but only when I look to my right side.” On questioning further, she related having an episode of left leg numbness while at summer camp 6 years ago but it resolved over 3 days and she never told anyone. Also, three years ago she saw her primary care physician after a seven-day episode of right eye pain and visual blurring, which he attributed to ocular migraine. There is no history of head trauma, or recent infections, fever, or immunizations.   Exam revealed a young female who was awake, alert, and in no acute distress. Positive findings included mild pallor and atrophy of the right optic disc. Bedside visual fields and acuity were normal. Testing external ocular motion in both eyes together revealed that there was no left eye movement beyond midline when attempting to look to her right, accompanied by right eye lateral nystagmus. When the left eye was tested with the right eye closed, eye movements were full. No other motor signs were evident. There were no abnormal skin, sensory, or auditory findings. An MRI scan of the brain with gadolinium enhancement revealed a 2 x 3 cm lucency in the region of the right parietal white matter without swelling or enhancement. A diagnosis of multiple sclerosis (MS) is suspected.Which of the following groups of three ancillary tests would be the most helpful in establishing a diagnosis of MS? 

A 26-year-old male presents to the urology clinic for evaluation of a painless mass in his left testicle. He said he noticed it the other day when he was performing testicular self-examination. You palpate his scrotum and note a ‘bag of worms’ consistency in his left hemiscrotum. Which of the following conditions is the most likely diagnosis for this patient?