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This blood smear is most consistent with:   

This xray is most consistent with:   

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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?  

In a sexually reproducing animal, the gametes are produced by meiosis rather than mitosis because

1.       15. A 61-year-old Asian female presents with headache, fever and photophobia of 5 day duration.  She has never had anything like this before.  In the emergency room, she appears lethargic and uncomfortable, but mentally clear.  T101.9F, 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. She has recently returned from a trip to Ohio. A Lumbar puncture is performed immediately.  Results from the fluid: WBC 100/ml (80% lymphocytes) 25 RBCs, total protein 68, glucose 80.  Gram stain shows no organisms.  Tube 4 shows the same results as tube 1.  Opening pressure is 30 cm H2O.   This is most consistent with:

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       A 52 year old white male presents with increased abdominal distention over 3 weeks.  Patient has noticed a 14 lb weight gain over the last 4 months and increasing fatigue.   Patient has also noticed edema in his ankles over the same time frame.  He has history of mild hypertension. On physical exam, patient is awake alert in no acute distress. Blood pressure is 100/60.  Respiratory 12, heart rate 73, temperature is afebrile.  HEENT is significant for no scleral icterus.  Skin exam has no jaundice.  Chest was clear to auscultation.  Heart was regular rate and rhythm. Abdomen is protuberant with some shifting dullness. Patient has 3+ edema bilaterally to the mid calf. Lab values are significant for a normal CBC, normal basic chemistry, creatinine of 0.9.  Albumin is 2.7, AST 33, ALT 43, total bili 1.2, LDH 458, alkaline phosphatase 337. Patient subsequently has a paracentesis of 4 L of cloudy fluid.   Fluid lab values: Albumin 1.2, total protein 3.2.  LDH 345.  Cell count 400 with 85% histiocytes.  Cultures of the fluid were sent.   What is the most likely cause of patient’s ascites?

1.       If you are concerned a pleural effusion may be secondary to pancreatitis, what would be the appropriate lab to order on the pleural fluid?

A researcher has obtained the number of hours worked during the first week of the semester for a sample of fourteen students. 11, 6, 34, 38, 10, 2, 32, 12, 5, 14, 16, 24, 8, 20 What is the median?   Enter your answer [a] Retype your answer [b]