A 24-year-old male presents to his primary care physician fo…
A 24-year-old male presents to his primary care physician for evaluation of recurrent fever, night sweats, and weight loss. The patient reports that he has been experiencing these symptoms for the past several weeks. After a complete physical exam and a series of laboratory and diagnostic tests, the patient undergoes an excisional lymph node biopsy (see image). He is determined to have Stage IIB disease. Which of the following clinical findings would be an adverse prognostic factor in this patient?
Read DetailsA patient develops fever, chills, and back pain shortly afte…
A patient develops fever, chills, and back pain shortly after starting a blood transfusion. Laboratory tests show an increase in bilirubin and a decrease in haptoglobin levels. Which of the following is the most appropriate diagnostic test to confirm an acute hemolytic transfusion reaction?
Read DetailsA 25-year-old female presents to her primary care provider f…
A 25-year-old female presents to her primary care provider for evaluation of fatigue which has persisted for the past 6 months. She has tried multiple diets and sleep schedules to improve her condition, but none have succeeded. She has no significant past medical history. She is currently taking a multivitamin daily. Vital signs: T: 98.8°F (37.1°C), BP: 107/58 mmHg, HR: 90/min, RR: 13/min, and oxygen saturation is 98% on room air. Laboratory values are seen below. Hemoglobin: 8 g/dL Hematocrit: 24% MCV: 118 Leukocyte count: 6,500 with normal differentialPlatelet count: 147,000 Physical exam is notable for decreased proprioception in the lower extremities. Which of the following is the most appropriate next step in management to confirm the diagnosis?
Read DetailsA 65-year-old man presents to the hospital with complaints o…
A 65-year-old man presents to the hospital with complaints of fatigue, nausea, vomiting, and diarrhea for the past five days. He also states numbness and tingling of the legs, joint pain, and decreased urination that developed around the same time. He was recently diagnosed with non-Hodgkin lymphoma and started on chemotherapy two weeks ago. Vital signs show a blood pressure of 95/65 mm Hg, a pulse of 98/min, a respiratory rate of 19/min, and a temperature of 100˚F. Physical examination reveals a pale and cachectic man. Laboratory investigations reveal serum potassium 6.0 mEq/L (normal: 3.5-5.0 mEq/L), serum creatinine 3.2 mg/dL (normal: 0.6-1.2 mg/dL), serum calcium 7.0 mg/dL (normal: 8.6-10.2 mg/dL), and serum uric acid 9 mg/dL (normal: 2.4-6.5 mg/dL). What could have been done to prevent this condition?
Read DetailsA 59-year-old woman is brought to the emergency department b…
A 59-year-old woman is brought to the emergency department by ambulance complaining of acute onset shortness of breath and a “racing pulse” that began after a 16-hour flight for a business trip. Her past medical history is significant for Type 2 diabetes mellitus and for a hospitalization 2 months ago for a myocardial infarction, during which she received low-molecular-weight heparin following cardiac catheterization. Her current medications include metformin, aspirin, propranolol, and atorvastatin. On arrival, her temperature is 99.1°F (37.3°C), blood pressure is 112/74 mmHg, pulse is 96/min, respirations are 22/min, and oxygen saturation is 88% on room air. A chest radiograph is normal and an EKG shows sinus tachycardia. Lab results are obtained with the following results:Serum:Hemoglobin: 14.0 g/dLLeukocyte count: 6,800Platelet count: 260,000After appropriate imaging is performed, intravenous unfractionated heparin is started for treatment of possible pulmonary embolus and the patient is admitted to the hospital overnight. The next morning, the patient reports she is feeling better. Vital signs: T: 98.9°F (37.1°C), BP: 118/73 mmHg, HR: 88/min, RR: 15/min, and oxygen saturation is 97% on room air. Repeat lab results are as follows:Serum:Hemoglobin: 13.5 g/dLLeukocyte count: 7,200Platelet count: 118,000Which of the following statements about this condition is correct?
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