Total Cholesterol is a soft, fat-like, waxy substance found in the bloodstreamand in all of your body’s cells. Glucose is a type of sugar that travels through the bloodstream and is the primary source of energy for your cells.
Cortisol, a glucocorticoid (steroid hormone), is produced from cholesterol in the two adrenal glands located on top of each kidney. Creatinine is a chemical waste product in the blood that passes through the kidneys to be filtered and eliminated in urine.
TSH is produced by the pituitary gland, and is part of the body’s feedback system to maintain stable amounts of thyroid hormones. GlucometerA glucose meter (or glucometer) is a medical device for determining the approximate concentration of glucose in the blood. Blood glucose monitoring is a way of testing the concentration of glucose in the blood (glycemia). Healthcare professionals advise patients with diabetes on the appropriate monitoring regime for their condition.
Factors affecting accuracy of various meters include calibration of meter, ambient temperature, pressure use to wipe off strip (if applicable), size and quality of blood sample, high levels of certain substances (such as ascorbic acid) in blood, hematocrit, dirt on meter, humidity, and aging of test strips. Mixed cryoglobulinemia syndrome (B) is a type of immune vasculitis due to polyclonal IgG and IgM antibodies that causes a triad of purpura, arthralgia, and weakness due to peripheral neuropathy (“Meltzer’s triad”). Post-streptococcal glomerulonephritis (C) is caused by recent group A strep infection, and typically occurs in children. Rheumatic fever (D) is another complication of group A strep infection, usually occurring in children.
Scarlet fever (E) is a diffuse erythematous rash that may develop in association with group A strep pharyngitis. An ankle-brachial index (option A) is a relatively simple test to confirm the diagnosis of PAD. Beta blockers such as metoprolol (option C) are sometimes thought to cause erectile dysfunction, but some studies have suggested that this occurs in as little 0.5% of men taking beta blockers. Neither adenocarcinoma of the lung (option A) nor squamous cell carcinoma of the lung (option E) is commonly associated with ectopic ACTH production.
Contaminated water (option B) is the source of a number of infections, including those due to Giardia lamblia, Vibrio cholerae, and hepatitis A virus. Mosquitoes (option C) are vectors for many diseases, including some that affect the CNS, such as West Nile virus and St.
Option A is the mechanism of action of fluoroquinolone antibiotics, which are not indicated for treatment of MRSA infections since many strains of MRSA have developed resistance to fluoroquinolones.
Option C is the mechanism of action of linezolid, which is effective against MRSA but is not considered first-line therapy.
Option D is the mechanism of action of aminoglycoside antibiotics such as gentamicin, and also tetracycline antibiotics. Option E is the mechanism of action of aztreonam, a monobactam antibiotic commonly used to treat serious gram-negative infections.
Pulsus paradoxus (option C) is a >10 mm Hg decrease in the systolic blood pressure during inspiration.
Pulsus parvus et tardus (option D) is a weak, delayed arterial pulse found in patients with valvular aortic stenosis.
Quincke’s sign (option E) is pulsation in capillaries of the nail beds, visible when pressure is applied to the fingertip. Duty of care – The health care provider must have owed the patient a legal duty by being involved in the patient’s care. Breach of duty – The health care provider must have failed to perform that duty by failing to conform to the standard of care.
In the case described, the patient clearly suffered damage (option B) and injury (option D). Option A describes the mechanism of action of the direct thrombin inhibitors such as argatroban and dabigatran, and also the mechanism of action of heparin, which activates antithrombin and promotes the inactivation of both thrombin and factor Xa.
Option B describes the mechanism of action of direct factor Xa inhibitors such as rivaroxaban, the indirect Xa inhibitor fondaparinux, and heparin.
Option C describes the mechanism of action of NSAIDs (which inhibit COX-1 and COX-2) and also the selective COX-2 inhibitors such as celecoxib.
Since septic shock results from peripheral vasodilation, the systemic vascular resistance (SVR) is low. Pulmonary capillary wedge pressure (PCWP) is an indirect measure of pulmonary venous pressure and a good estimate of left atrial pressure. The preferred treatment for RMSF is doxycycline (option C), but tetracycline antibiotics are teratogenic and should be avoided in pregnant patients.
Multiple sclerosis and optic neuritis are characterized by demyelinated plaques in the CNS, thought to be caused by autoimmune inflammation of the oligodendrocytes (option C) and eventually neuronal axons. Since this patient’s lesion is located in the left lateral medulla, disruption of the left spinothalamic tract would cause loss of pain and temperature sensation in the contralateral arm (option D), since the fibers carrying this sensory information decussate in the anterior white commissure of the spinal cord, before ascending to the brainstem. Loss of pain and temperature sensation in the face is due to a lesion of the spinal trigeminal nucleus (which extends from the pons into the medulla). Similarly, limb ataxia and past-pointing (option F) occur ipsilateral to the lateral medulla lesion, which can affect the inferior cerebellar peduncle. Spastic hemiparesis of the contralateral limbs (option G) is seen in strokes of the medial medulla (not the lateral medulla) because of damage to the corticospinal tract, which is located in the medullary pyramids and decussates in the medulla.
Proprioceptive information (option C) travels from the limbs to the brain in the posterior columns of the spinal cord before decussating in the medulla and then continuing up the brainstem as the medial lemniscus.
Deviation of the tongue (option B) would likewise be seen in a stroke of the medial medulla, which is the location of the hypoglossal nucleus (CN XII).
Facial droop (option A) could be caused by either a stroke of the cortex or a stroke of the facial nerve nucleus, which is located not in the medulla but in the pons (specifically the lateral inferior pons). The presence of Heinz bodies or degmacytes in a patient with hemolytic anemia is highly suggestive of G6PD deficiency. Basophilic stippling (option A) describes the presence of numerous basophilic granules within the RBC cytoplasm, due to precipitation of ribosomes and ribosomal RNA. Reticulocytes (option D) are immature RBCs which are normally found in circulation in very small amounts.
Spherocytes (option E) are spherical RBCs that are typically smaller than normal RBCs and are identified by the absence of the characteristic central pallor. The most important first step in treating hyperkalemia with ECG changes is IV calcium gluconate (option B) or IV calcium carbonate. Like insulin, ? agonists like albuterol (option A) will also shift potassium into the cells and lower serum potassium, but this takes about 90 minutes to start working. Loop diuretics like furosemide (option C) lower serum potassium by promoting renal excretion of potassium. Whipple’s disease is diagnosed primarily by endoscopic small bowel biopsy showing shows villous atrophy and so-called “foamy” macrophages in the lamina propria. Salicylates such as aspirin (option B) can cause a cinchonism-like presentation of tinnitus and vomiting, but does not typically cause headaches, vision disturbances, or rash. Amiodarone (option A) is a well-known cause of photosensitivity, and it can cause optic neuropathy that may lead to permanent blindness. Digoxin toxicity (option C) can cause many of this patient’s findings, including bradycardia, hypotension, vision disturbances, and headache, but digoxin is not associated with tinnitus. IV fluids (option A) might be appropriate in a patient with hypovolemic shock, such as from acute blood loss. This patient has a cluster headache, which is a severe unilateral headache that recurs at the same time and location daily for several weeks.
Cluster headaches can be aborted by administering 100% oxygen (option A) by non-rebreather mask for 15-20 minutes. High-dose glucocorticoids such as prednisone (option B) and checking the ESR (option D) would be appropriate for a patient with suspected giant cell arteritis (also known as temporal arteritis). Interferon beta (option B) is used to treat multiple sclerosis (MS), which can certainly cause spinal cord lesions, but usually also causes demyelinating lesions in the brain. Plasmapheresis (option C) might be an excellent treatment for a patient with Guillain-Barre syndrome (GBS) or myasthenia gravis (MG).
Riluzole (option D) is a drug used to treat amyotrophic lateral sclerosis, a disease of both upper and lower motor neurons that typically causes very little sensory disturbance. Acute stress disorder (option A) and posttraumatic stress disorder (option E) are closely tied to specific stressful or traumatic events, but the symptoms include intrusive memories of the traumatic event, avoidance of stimuli associated with the event, negative alterations in cognition or mood, and alterations in arousal.
Adjustment disorders (option B) are characterized by the development of behavioral or emotional symptoms (such as depressed mood, anxiety, or disturbance of conduct) in response to a specific stressor. Factitious disorder (option D) is the falsification of physical or psychological signs or symptoms, or induction of injury or disease, with a clear intent to deceive (even in the absence of obvious external rewards).
One characteristic of PFAPA syndrome is that the fever and pharyngitis respond very rapidly to a single low dose of a glucocorticoid such as prednisone (option C), often within a few hours.
Amoxicillin (option A) would be appropriate for a bacterial infection such as streptococcal pharyngitis, but this does not cause aphthous ulcers or a predictable, episodic fever. The DSM-5 diagnostic criteria include “deficits in developing, maintaining and understanding relationships,” which may include difficulty making friends (option A). Some individuals with ASD do exhibit special “savant” skills (option E) in memory, mathematics, music, or art despite deficits in other areas, but this is not required for the diagnosis, and is not particularly common. Because children with ASD tend to be inwardly focused, infants and toddlers are often content with playing by themselves and not demanding of caregiver attention (option D). Benzodiazepines (option B) are sometimes used for patients with mild or intermittent RLS symptoms, but may lead to dependence. Age-related macular degeneration (option B) most commonly causes slowly progressive, bilateral vision loss. The task force has found insufficient evidence to assess the benefits and harms of fecal DNA testing (option A) and CT colonography (option B), so neither of these modalities is recommended. A single stool specimen obtained during a rectal examination (option C) is not considered an adequate screen for colorectal cancer. NOTE: These recommendations may be altered by updated USPSTF guidelines scheduled for publication later in 2015. The negative predictive value equals the number of true negatives (780) divided by the total number of negative results (780 + 220), which is 78%. Monoamine oxidase inhibitors such as phenelzine (option D) and selective serotonin reuptake inhibitors such as sertraline (option E) may be associated with an increased risk of serotonin syndrome, which is characterized by altered mental status, autonomic instability, hyperreflexia, clonus, and in severe cases may result in muscle rigidity and hyperthermia. Hereditary spherocytosis will often result in a positive osmotic fragility test (option B), in which the patient’s RBCs readily lyse in a hypotonic solution. Generally speaking, measles is treated with supportive measures such as antipyretics and fluids. There is no role for antibiotics such as amoxicillin (option C) in the treatment of viral infections such as measles.
Cold agglutinins may be associated with chronic lymphocytic leukemia but not typically with AML (option A). Compartment syndrome is treated with fasciotomy, in which incisions are made in the bands of fascia to allow the intracompartmental pressures to normalize. Inhaled albuterol (option A) will reverse bronchoconstriction in anaphylaxis and is used as an adjunct to epinephrine.
H1 antihistamines such as cetirizine (option B) and diphenhydramine (option D) are adjuncts to epinephrine in treating anaphylaxis, primarily for treating pruritus and urticaria. Clustered particles of calcium (clustered microcalcifications) are often indicative of breast cancer.
Cholesterol is an important part of a healthybody because it’s used for producing cell membranes, some hormones andserves other needed bodily functions. Medical experts believe HDL carries LDL cholesterolaway from the arteries and removes excess cholesterol from arterial plaque, slowingits buildup. Nicotine is a chemical found in tobacco products, including cigarettes and chewing tobacco. It is normally released in response to events and circumstances such as waking up in the morning, exercising and acute stress. It is a key element of home blood glucose monitoring (HBGM) by people with diabetes mellitus or hypoglycemia.
Particularly important in the care of diabetes mellitus, a blood glucose test is performed by piercing the skin (typically, on the finger) to draw blood, then applying the blood to a chemically active disposable 'test-strip'. Models vary in their susceptibility to these factors and in their ability to prevent or warn of inaccurate results with error messages. This child’s presentation of palpable purpura, arthritis and arthralgias, abdominal pain and renal disease (hematuria) is classic for IgA vasculitis, an immune-mediated vasculitis caused by deposition of IgA immune complexes in multiple tissues, also known as Henoch-Schonlein purpura.
Hepatic dysfunction is also quite common, and 20-30% of patients develop glomerulonephritis.
In addition to hematuria (which often causes cola-colored or tea-colored urine), symptomatic individuals will often have edema and hypertension. It causes arthritis as well as a rash called erythema marginatum, a well-defined ring-like erythematous rash that begins on the trunk and gradually spreads outward before resolving spontaneously.
It begins as a rough, “sandpapery” rash in the axillae and groin, then progresses to involve the trunk as well as other flexural areas. This patient has symptoms of claudication (exertional pain in the legs, thighs or buttocks) and a physical examination suggestive of peripheral artery disease (PAD). It is measured by calculating the ratio between the systolic blood pressure (SBP) at the ankle and the SBP in the brachial artery. Other studies have suggested that erectile dysfunction is more commonly seen in patients taking thiazide diuretics than beta blockers. This patient’s presentation is consistent with hypercortisolism (Cushing syndrome), which causes hyperglycemia, moon facies, truncal obesity and purple abdominal striae.
Pituitary adenomas may produce excessive amounts of ACTH which leads to hypercortisolism (a condition called Cushing disease).


A pheochromocytoma (option C), however, is a neuroendocrine tumor that usually arises in the adrenal medulla. This patient’s death was most likely due to primary amebic meningoencephalitis (PAM), caused by infection with Naegleria fowleri, a free-living ameba found in warm freshwater sources. One exception that does affect the CNS is variant Creutzfeldt-Jakob disease (vCJD), which is acquired by eating contaminated beef products. This patient has hip osteomyelitis and resultant sepsis caused by methicillin-resistant Staphylococcus aureus (MRSA). Of note, macrolide antibiotics such as erythromycin also work by binding to 50S ribosomal subunits, but most strains of MRSA are resistant to macrolides. While both classes may have some activity against MRSA, neither is considered appropriate therapy for serious MRSA infections. Normally, the jugular venous pressure decreases during inspiration, due to decreased intrathoracic pressure and increased filling of the right atrium. It is most commonly found in cardiac tamponade, and is not commonly found in constrictive pericarditis. Although this “sign” is historically associated with valvular aortic regurgitation, it can be seen in normal subjects as well, and is thus considered useless by some authors. The patient was under the direct care of the hospitalist, who clearly owed him a duty of care (option C). When platelets are activated they secrete numerous prothrombotic substances including thromboxane A2, fibrinogen, and adenosine diphosphate (ADP).
The blood smear shows evidence of sickle cell disease (SCD), which increases the risk of osteomyelitis. SVR is also low in anaphylactic shock and neurogenic shock, both of which result from peripheral vasodilation. PCWP is normal or low in septic shock, but is generally elevated in cardiogenic shock, in which blood in the left ventricle backs up into the left atrium.
This patient has Rocky Mountain spotted fever (RMSF), which is caused by the bacterium Rickettsia rickettsii and transmitted by a tick vector. Chloramphenicol (option A) is the recommended therapy for treatment of RMSF during pregnancy.
Astrocytes (option A) and microglia (option B) are also CNS glial cells, like oligodendrocytes, but they do not form myelin and are not targeted in MS. Infarction of the lateral medulla (Wallenberg syndrome) is one of the most common posterior circulation stroke syndromes.
These fibers, however, do not decussate, so in a stroke of the lateral medulla the ipsilateral face is affected.
Since the medial lemniscus is located in the medial medulla, it would not be affected by a lateral medullary stroke. A stroke of the left hypoglossal nucleus would cause weakness of the left tongue muscles, so that attempts to protrude the tongue would cause it to deviate leftward (toward the side of the stroke). This patient has hemolytic anemia following ingestion of fava beans, which strongly suggests a diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency. Heinz bodies are clumps of denatured hemoglobin that accumulate in these individuals’ RBCs due to oxidative damage. Basophilic stippling can be seen in lead poisoning, thalassemia, anemia of chronic disease, and alcohol abuse.
Howell-Jolly bodies occur in patients with asplenia, since the spleen usually removes these cells from circulation. Many types of hemolytic anemia result in increased reticulocytes in the peripheral blood; this finding is nonspecific.
Spherocytes are nonspecific and may be seen in many types of hemolytic anemia as well as in hereditary spherocytosis. In addition to facilitating the uptake of glucose in skeletal muscle and adipose tissue, insulin promotes the cellular uptake of potassium. Sodium bicarbonate (option E) induces cells to secrete H+ to maintain the normal serum pH; and serum potassium declines as the cells concomitantly take up potassium in order to maintain electroneutrality.
This is a longer-term therapy that is not appropriate for emergency short-term management of hyperkalemia. This patient has Whipple’s disease, caused by Tropheryma whipplei infection of the intestine and other tissues.
Amyloid beta (A?) is formed by the proteolytic cleavage of amyloid precursor protein (APP), which is encoded by a gene found on chromosome 21. This patient presents with symptoms of cinchonism, a syndrome caused by the ingestion of derivatives of cinchona bark such as quinine and quinidine. Aspirin also stimulates the medullary respiratory center and causes tachypnea (rapid breathing) and hyperventilation (deep breathing) which are not present in this patient.
It does not cause tinnitus, however, and it usually only causes hypotension wen administered intravenously. Phenytoin (option D) can cause blurred vision, headache, vomiting, and various dermatological eruptions, but it does not cause tinnitus, and findings of bradycardia and hypotension are rare (and more commonly associated with intravenous administration). This patient demonstrates Beck’s triad of cardiac tamponade, which consists of hypotension, jugular venous distension and muffled heart sounds.
Headaches that do not respond to oxygen may be treated with a subcutaneous dose of a serotonin agonist such as sumatriptan (option C), but the risk of side effects makes 100% oxygen a better first-line choice. Giant cell arteritis is most commonly seen in elderly women and generally presents with a unilateral headache not accompanied by sympathetic symptoms.
Trousseau’s sign is associated with hypocalcemia, which characteristically causes prolongation of the QT interval on ECG (option B). This patient’s presentation suggests syringomyelia, in which a longitudinal cavitary lesion develops in the spinal cord as a late sequela of spinal cord injury or a Chiari malformation. Another hallmark of MS is that lesions occur in multiple locations within the CNS, and typically MS follows a relapsing-remitting course, where new lesions (and symptoms) appear and spontaneously resolve over time.
GBS causes muscle weakness that typically begins in the legs and ascends to involve the arms, the face and oropharynx, and sometimes the respiratory muscles. Conversion disorder is characterized by the presence of neurological symptoms that are incompatible with a recognized neurological or medical condition. There is nothing in the given clinical scenario that indicates willful deception or deliberate falsification of symptoms. ANCA (option B) can be associated with a variety of diseases that cause glomerulonephritis, such as granulomatosis with polyangiitis (Wegener’s) and eosinophilic granulomatosis with polyangiitis (Churg-Strauss). Between the episodes of illness, the child is generally healthy and exhibits normal growth and development. The episodic illness can occur for 5-8 years but generally resolves spontaneously and without sequelae. Aspirin (option B) is the treatment for Kawasaki disease, which causes fever and lymphadenopathy but also rash, conjunctivitis, cracked lips, and strawberry tongue. Listeria monocytogenes is a motile, gram-positive bacillus that may infect humans through contaminated food.
Individuals with less severe ASD may not be recognized until school age (option C), when the demands placed upon them by increased socialization exceed their capabilities.
Non-ergot dopamine agonists such as ropinirole and pramipexole are generally the first-line treatment for patients with moderate or severe restless legs syndrome (RLS).
The funduscopic examination shows a pale retina (due to ischemia) with a “cherry-red spot” at the macula. The entire visual field is generally not obscured, since the portion of the retina that remains attached is still functioning normally. The funduscopic examination typically shows small flecks of yellow extracellular debris called drusen. Acute angle-closure glaucoma (option A) causes acute, monocular vision loss associated with eye pain, conjunctival redness, corneal edema, and a pupil that does not react to light. As of 2008, the USPSTF recommends colon cancer screening using fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy beginning at age 50 and continuing until age 75.
FOBT should be performed by having the patient submit samples from three successive stools, which are then tested for the presence of blood using one of several methods. The question is asking for the proportion of all negative test results that are true negatives, which is called the negative predictive value.
This patient has neuroleptic malignant syndrome (NMS), which is characterized by altered mental status, muscle rigidity (leading to hyperthermia and rhabdomyolysis), and autonomic instability (tachycardia and hypertension).
Clinically, serotonin syndrome can be distinguished from NMS by the rapid onset (serotonin syndrome develops over 24 hours while NMS develops over days to weeks) and by the presence of hyperreflexia and clonus, which are characteristic of serotonin syndrome but not NMS. This peripheral blood smear shows spherocytosis, in which the red blood cells (RBCs) become somewhat spherical, losing their normal biconcave shape and central pallor.
The Ham test (option A) is an older test for paroxysmal nocturnal hemoglobinuria, performed by measuring the propensity of RBCs to lyse in an acidic solution. In developing countries, treatment with vitamin A (option E) has been shown to reduce morbidity and mortality in measles patients.
In vitro studies show susceptibility to the antiviral ribavirin, but this has not been studied in clinical trials. This patient has mumps, which is characterized by a prodrome of fever, myalgias, headache, and anorexia, followed by painful swelling of the parotid glands (parotitis) that can last 7-10 days.
Of the viruses listed, only respiratory syncytial virus (option D) is a member of the Paramyxovirus family.
HIV infection (option C) and SLE (option E) are more likely to be associated with the production of warm agglutinins rather than cold agglutinins. Compartment syndrome occurs when an injury causes increased pressure within an enclosed compartment of an extremity, leading to impaired circulation. Clindamycin (option A) might be appropriate treatment for cellulitis, although cellulitis typically causes redness and warmth of the affected limb, as well as fever.
According to 2014 data released by the American Cancer Society, there are an estimated 310,010 cancer deaths among U.S.
This patient is potentially having an anaphylactic reaction to the candy (possibly to peanuts, a common allergen found in many candy bars). Not only does epinephrine reduce mast cell degranulation, but it also reverses or prevents bronchoconstriction, upper airway edema and hemodynamic collapse. It will not, however, treat the oropharyngeal edema which may contribute to dyspnea in these patients. The mammographic feature that is most specific for breast cancer is the presence of a spiculated soft tissue mass. Measuring cotinine in people's blood is the most reliable way to determine exposure to nicotine for both smokers and nonsmokers exposed to environmental tobacco smoke (ETS).
A small drop of blood, obtained by pricking the skin with a lancet, is placed on a disposable test strip that the meter reads and uses to calculate the blood glucose level. Different manufacturers use different technology, but most systems measure an electrical characteristic, and use this to determine the glucose level in the blood.
Diabetics who use insulin (all Type 1 diabetes and many Type 2s) usually test their blood sugar more often (3 to 10 times per day), both to assess the effectiveness of their prior insulin dose and to help determine their next insulin dose.Accuracy of glucose meters is a common topic of clinical concern.
The Clarke Error Grid has been a common way of analyzing and displaying accuracy of readings related to management consequences. It is primarily a disease of children, and often follows a recent upper respiratory infection, especially group A streptococcal infection.
Other prominent features of rheumatic fever include pancarditis, chorea, and painless subcutaneous nodules.
His risk factors include his age, history of tobacco use and known atherosclerotic cardiovascular disease. Pheochromocytomas produce catecholamines such as epinephrine and norepinephrine, leading to episodic hypertension, tachycardia, diaphoresis, and headache.
However, examination of the brain tissue in a patient with vCJD would show abnormally folded prion proteins, not trophozoites. However, these are due to viral infections and would not show trophozoites on examination of the brain. Of note, the tetracycline antibiotic tigecycline is active against MRSA, but it has been associated with increased mortality and is only used when other effective antimicrobials are not available. But the vignette presents no evidence that the hospitalist breached his duty to the patient. Sickling of red cells causes recurrent splenic infarction and autosplenectomy at an early age, rendering these patients susceptible to infections by encapsulated organisms such as S. The illness begins 2-14 days following a tick bite, and may initially include fever, headache, myalgias, arthralgias, nausea, and abdominal pain. Concerns about so-called “gray baby syndrome” due to chloramphenicol are likely unwarranted in this patient.
Although the history given is insufficient to make a formal diagnosis of MS, the presence of oligoclonal bands supports the diagnosis. The findings can include vertigo, nystagmus, hoarse voice, dysphagia, loss of pain and temperature sensation in the contralateral trunk and limbs, loss of pain and temperature sensation in the ipsilateral face, limb ataxia, and sometimes ipsilateral Horner syndrome. G6PD is an enzyme that is required to regenerate NADPH in order to neutralize reactive oxygen species. Intravenous administration of insulin begins to lower serum potassium levels within 10-20 minutes. IV calcium stabilizes myocardial cell membranes and protects against life-threatening arrhythmias such as AV block, ventricular fibrillation, and asystole. This process takes at least 1-2 hours, and may only be beneficial in patients with underlying metabolic acidosis.
The disease predominantly affects middle-aged Caucasian men and causes malabsorption, weight loss, diarrhea, and abdominal pain.
The key features of cinchonism include tinnitus (and often hearing loss), blurred vision, headache, vomiting, and diarrhea.
Other signs of cardiac tamponade can include tachycardia (which is present in this patient) and pulsus paradoxus (which is not described).


Morphine (option B) and nitroglycerin (option E) might be appropriate treatments for myocardial infarction, but either treatment would need to be used with extreme caution in a patient with such significant hypotension.
Tall, peaked T waves (option D) are classically seen in hyperkalemia, and may sometimes be seen in hypomagnesemia. Syringomyelia is most commonly found in the cervical cord and therefore affects the upper extremities. Antistreptolysin O antibodies (option C) are found in individuals with recent group A streptococcal infection, and would thus be more likely to be positive in a patient with poststreptococcal glomerulonephritis. Valacyclovir (option D) would be appropriate for treating an oral herpes simplex virus infection, which can cause fever and pharyngitis, but oral herpes lesions are grouped vesicles on an inflamed, erythematous base. Listeriosis can affect immunocompromised individuals and pregnant women, especially in the third trimester. RLS causes an uncomfortable urge to move the legs when at rest, especially late in the day. This is an ophthalmologic emergency, as it may result in irreversible ischemic damage and permanent vision loss.
The preferred frequency of screening varies with each screening modality: FOBT is performed annually, sigmoidoscopy is performed every 5 years, and colonoscopy is performed every 10 years. The drugs associated with the highest risk of NMS are the high-potency traditional neuroleptics such as fluphenazine (option C). Low ferritin (option C) is associated with iron deficiency anemia, which causes a hypochromic, microcytic anemia. Measles infection has an incubation period of 8-10 days, followed by a prodromal illness that typically lasts 2-3 days. The World Health Organization (WHO) recommends administration of vitamin A to all children with measles in developing countries.
Acyclovir (option A) and amantadine (option B) are antivirals used for herpes virus and influenza virus, respectively.
Complications may include aseptic meningitis and orchitis (inflammation of the testes), with infertility as a potential sequela. Influenza virus (option C) is also a negative-sense ssRNA virus but is a member of the Orthomyxovirus family. Of the disorders listed, Mycoplasma pneumoniae infection (option D) is most closely associated with cold agglutinins. SLE may also cause anemia of chronic disease, which is associated with a low (rather than high) reticulocyte count.
It classically causes pain, paresthesias, pallor, poikilothermia, diminished pulses and occasionally paralysis.
Heparin (option C) would be appropriate treatment for a deep venous thrombosis, which does not cause diminished arterial pulses or severe pain. This patient’s presentation suggests acute bacterial prostatitis, which typically causes symptoms of urinary tract irritation (frequency, urgency, incontinence), dysuria, fever, and sometime perineal pain.
Anaphylaxis occurs when antigens bind to allergen-specific IgE on the surface of mast cells and basophils, resulting in the rapid release of mediators such as histamine, leukotrienes and cytokines. Named after a type of spear used by Roman soldiers, a spicule is a thin, needlelike projection on the surface of the mass.
The A1C complex is formed when the glucose in the blood binds irreversibly to hemoglobin (glycates).
Blood glucose meters must meet accuracy standards set by the International Organization for Standardization (ISO). More recently an improved version of the Clarke Error Grid has come into use: It is known as the Consensus Error Grid. It is usually a benign, self-limited disease that does not require any treatment beyond supportive care.
The second most common cause is thought to be ectopic production of adrenocorticotropic hormone (ACTH) from a non-pituitary site, most notably small cell lung cancer (option D). The most common type of functioning pituitary adenoma is a lactotroph adenoma (option A), which produces prolactin, not ACTH. Osteomyelitis often presents with signs and symptoms of infection such as fevers and chills.
Septic shock is circulatory collapse resulting from peripheral vasodilation that comes about in response to infection.
After 3-5 days, the macular rash develops on the wrists and ankles, eventually spreading to the trunk as described. Gray baby syndrome may rarely be seen when chloramphenicol is given to premature infants and neonates, not when it is given to pregnant women.  Chloramphenicol given during pregnancy has not been associated with an increased risk of teratogenesis.
Photoreceptor cells (option D) such as rods and cones are found in the retina but not in the optic nerve, and are not affected in optic neuritis. G6PD-deficient individuals develop hemolytic anemia after ingesting drugs and foods (such as fava beans) that induce oxidative damage. It has been hypothesized that degmacytes are formed when splenic macrophages remove the Heinz bodies (and part of the RBC’s cytoplasm) from the damaged RBCs. 65-70% of patients present with migratory arthralgias and polyarthritis which begin several years before the gastrointestinal symptoms. Because individuals with trisomy 21 have an extra copy of this chromosome and this gene, there is a high prevalence of Alzheimer disease in this population.
The diagnosis of tamponade might be confirmed by echocardiography, but because this patient is in cardiogenic shock the most appropriate intervention is to perform pericardiocentesis to remove the blood that has accumulated within the pericardial space. Emergency needle thoracostomy (option C) would be appropriate management for a suspected tension pneumothorax, which could also present with dyspnea, chest pain and distended neck veins.
Widening of the QRS complex (option E) may be seen in hyper- or hypokalemia and hyper- or hypomagnesemia. As the syrinx cavity enlarges it disrupts the fibers of the spinothalamic tract in the anterior white commissure, leading to loss of pain and temperature sensation in the upper extremities. Likewise, MG is caused by autoantibodies against the acetylcholine receptors at the neuromuscular junction, which leads to fluctuating muscle weakness without sensory deficits. Conversion disorder may or may not be associated with a specific psychological stressor, such as this patient’s witnessing the death of her boyfriend. Hepatitis B infection (option E) is associated with both membranous nephropathy and membranoproliferative glomerulonephritis (MPGN). Vitamin A (option E) might be used to treat measles (rubeola) infection, which causes fever and oral lesions called Koplik spots and may cause pharyngitis and lymphadenopathy. Neonatal meningitis in the first week of life is most commonly due to transmission from mother to child during delivery. This discomfort is quickly relieved by walking or stretching the legs, but it usually recurs quickly once the legs are again at rest. Spherocytes are prone to hemolysis in the spleen, resulting in anemia, jaundice and splenomegaly. Likewise, lead toxicity (option D) causes hypochromic, microcytic anemia, and the RBCs may show basophilic stippling. The prodrome begins with fever, anorexia and malaise, followed by cough, conjunctivitis and nasal mucosal inflammation (“coryza”). Aspirin (option D) is generally not given to children because of concerns about causing Reye syndrome. The patient has acrocyanosis of the fingers that develops following exposure to the cold and improves with warming. Naproxen (option D) and rest, ice, compression and elevation (option E) would be appropriate for a sprain or other mild musculoskeletal injury but are not indicated for treatment of compartment syndrome.
Nearly 87,000 of these deaths are caused by lung cancer, making it the #1 cause of cancer death among U.S. This patient, however, is described as having global abnormal hair growth, which suggests hypertrichosis rather than true hirsutism. These mediators cause increased vascular permeability, vasodilation and bronchoconstriction, which may lead to cardiovascular collapse and respiratory failure. The triad of claudication, diminished femoral pulses and erectile dysfunction is known as Leriche syndrome.
Caution is recommended when using chloramphenicol in a pregnant patient near term or during labor, but the CDC affirms that chloramphenicol may be used for the treatment of RMSF in pregnant women.
Another hypothesis is that the bite-like deformities are hemoglobin-free areas of the RBC that do not stain. Neurological manifestations may include cognitive dysfunction, cerebellar ataxia, and disorders of the extraocular muscles. Quinidine toxicity will also cause bradycardia and hypotension, and a lichenoid photosensitivity reaction is possible. The fact that this patient has normal bilateral breath sounds argues strongly against a diagnosis of tension pneumothorax.
This is often described as a “cape-like” distribution of sensory loss over the shoulders, arms and hands. But the prodrome of measles causes cough, coryza, and conjunctivitis followed by a prominent rash, none of which are present in this patient. Dantrolene (option B) is a drug that reduces skeletal muscle contraction by blocking the release of calcium from the sarcoplasmic reticulum.
Spherocytosis may result from several disorders, including hereditary spherocytosis, autoimmune hemolytic anemia (AIHA), and glucose-6-phosphate dehydrogenase (G6PD) deficiency. The exanthem seen on the oral mucosa is consistent with Koplik spots, which are pathognomonic for measles infection. This should be distinguished from Raynaud phenomenon, which is characterized by sharply demarcated pallor followed by cyanosis and then erythema as perfusion is restored. The limb pain is typically worsened by external compression of the affected compartment or by passive stretching of the muscles within the compartment. Chlamydia trachomatis (option A) and Neisseria gonorrhoeae (option D) may cause prostatitis in addition to urethritis and epididymitis, but these are usually seen in patients with STI risk factors and are classically suspected in younger patients.
Drugs that cause hypertrichosis include cyclosporine, minoxidil, penicillamine, and phenytoin (option E). 90% of anaphylaxis patients will have cutaneous manifestations such as pruritus, flushing and generalized hives. Laboratory markers of inflammation such as leukocyte count, ESR and CRP are frequently elevated. For a valid malpractice claim, the plaintiff would need to demonstrate that the hospitalist was negligent in his delivery of care, and that this breach of duty caused the patient’s infection and subsequent death. This “crosslinking” of multiple platelets with fibrinogen causes the platelets to aggregate and form a platelet plug, which is the first step in hemostasis. Laboratory studies are often unremarkable, although thrombocytopenia may eventually develop as the illness progresses, and CSF protein may be moderately elevated. Koplik spots usually precede the characteristic maculopapular rash of measles by about 2 days.
EBV causes a variety of clinical illnesses including infectious mononucleosis, which presents with fever, fatigue, pharyngitis, tonsillitis, and cervical lymphadenopathy. The cold agglutinins associated with Mycoplasma infection may be found about two weeks after the onset of infection and usually resolve within 3-4 months. The diagnosis of compartment syndrome can be confirmed by needle manometry, which demonstrates elevated pressure within the affected compartment(s).
Prostate cancer (option G) is the most common cancer among men overall, with an estimated 233,000 cases diagnosed each year, but it is the second most common cause of cancer death, causing 29,480 deaths annually. Danazol (option A) is a drug that suppresses pituitary FSH and LH production and is used to treat endometriosis. Food allergies typically cause gastrointestinal symptoms such as vomiting, crampy abdominal pain, and eventually diarrhea. Clopidogrel acts early in this process by inhibiting the P2Y12 receptors and preventing platelet aggregation. Although Listeria accounts for a small percentage (< 5%) of all cases of neonatal meningitis, it is a classic pathogen in this age group. Hemolytic episodes in G6PD deficiency are associated with Heinz bodies and degmacytes (bite cells) on the peripheral smear.
Lymphadenopathy, which is usually absent during the prodrome, commonly develops with the exanthem. Colon cancer (option A) kills an estimated 26,270 men annually, and pancreatic cancer (option F) kills 20,170.  Of note, basal cell skin cancers (option B) are not reported in cancer registries, and while they are very common they rarely cause death.
Likewise, coagulase-negative staphylococcus (option C) and Enterococcus species (option D) are infrequent causes of meningitis in neonates.
The combined measles-mumps-rubella (MMR) vaccine is given to reduce the number of injections needed, not because of structural similarity of the viruses. Finasteride (option B) is an inhibitor of 5?-reductase, the enzyme that converts testosterone to the more potent androgen dihydrotestosterone. Finasteride is used to treat conditions in which high testosterone levels are problematic, including benign prostatic hyperplasia and male-pattern hair loss. Vancomycin works by inhibiting bacterial cell wall biosynthesis by binding to D-alanine-D-alanine precursor thereby blocking peptidoglycan polymerization. Haemophilus influenzae (option B) is an uncommon cause of osteomyelitis, due to the effectiveness of the Hib vaccine.
Flutamide (option C) is a drug that directly antagonizes testosterone receptors and is used to treat prostate cancer.
Staphylococcus aureus (option E) accounts for one-half to two-thirds of cases of osteomyelitis in individuals without SCD in the US and Europe, but only one-fourth of cases of osteomyelitis in individuals with SCD.  In sub-Saharan Africa and the Middle East, however, S. Side effects may include decreased libido and sexual dysfunction but not increased hair growth.




How does blood sugar get too low 524
24 hour blood sugar chart template
Reasons for high blood sugar not diabetes


Comments

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    Author: itirilmish_sevgi
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    Author: INKOGNITO
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