Which of the following statements best describes the genetic mutation which results in sickle cell anemia?    

A 22-year-old nulligravida female whose last menstrual period was 2 weeks ago, presents to your office with a 3-day history of profuse malodorous gray vaginal discharge. She has also noted mild pelvic pain during the same period of time. She is sexually active with 2 male partners and states that she “uses condoms occasionally.” On wet mount, motile protozoans and white blood cells are noted.  The patient is noted to have a ‘strawberry cervix’ on examination.  She has no known drug    allergies.  Based on this information, which of the following medications is the recommended treatment for this patient?

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 patient is 12-hours post closed reduction of a tibial fracture and is in a long leg cast.  Despite an injection of narcotic analgesia, the patient complains of unrelieved pain and cannot move his toes.  Which of the following interventions is most appropriate for the management of this problem?

You are asked to evaluate a 58-year-old patient who presents with clinical findings including splenomegaly, elevated WBC, and elevated platelet count.  You are concerned that the patient may have Chronic Myelogenous Leukemia (CML).  Which of the following test results would support your diagnostic suspicion?    

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 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?              

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 28-year-old female is brought to the ER by her husband because of bizarre behavior 4 days after the uncomplicated delivery of a full-term healthy boy. Her personal and family history of mental illness is negative. The second day after delivery, she accused her husband of poisoning her food. She has problems falling asleep, generally sleeping only 2-3 hours nightly and complaining of unpleasant smells waking her up. She started arranging toys and the newborn’s things in a specific symmetrical order and became aggressive when someone moved them. She would stop the ongoing activity from time to time with a blank expression and was found several times staring at the wall and silently counting. Even simple tasks require the help of others, and she often forgets what she started doing. This makes her irritable and sometimes tearful. She feels guilty about being a terrible mother and states that she did not deserve to have a baby. The morning when her husband asked for your advice, she told him that she hears voices telling her to take her son and jump out the window. What is the most likely diagnosis?

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?