An 18-year-old female presents to your clinic complaining of progressive dyspnea. She denies chest pain and recent history of infectious disorders. Her blood pressure is 160/110 mm Hg in both arms and 110/70 in both thighs. Physical examination reveals that she has a short stature, a webbed neck, a shield chest with wide-set nipples, and significantly weak femoral pulses bilaterally. Auscultation reveals continuous murmur loudest at the left infrascapular region. Chest x-ray reveals notching of the ribs. Echocardiogram revealed a bicuspid aortic valve. Which of the following is the most likely diagnosis in this patient?
A 27-year-old man presents to the emergency department with complaints of chest pain and hemoptysis. He reports a history of chronic sinusitis and recurrent pneumonias, which have required multiple hospitalizations. He also notes a history of infertility, mentioning that he and his wife have been unable to conceive despite trying for several years. During the physical examination, heart sounds are auscultated on the right side of the chest, and the patient confirms that he has situs inversus. Pulmonary function tests (PFTs) reveal a decreased FEV1/FVC ratio, consistent with obstructive lung disease. A CT scan shows dilated bronchioles with a signet-ring appearance and situs inversus. What is the most likely cause of this patient’s infertility?
A 27-year-old man presents to the emergency department with chest pain and hemoptysis. His past medical history is significant for chronic sinusitis and several bouts of pneumonia that have required hospitalizations. In family history, you discover that he and his wife have not been able to have kids because of his infertility. In the physical examination, you were surprised to hear heart sounds on the right side of the chest. Later he informs you that his heart is on the right side. Pulmonary function tests (PFTs) reveal a decreased FEV1/FVC ratio. CT scan reveals dilated bronchioles with signet-ring appearance and situs inversus. Of the following, which is the most likely diagnosis in this patient?
A 24-year-old woman presents to your office for a refill of her combination oral contraceptive medication. She reports that four months ago, her hemoglobin A1c was 6.1%, and her endocrinologist advised her to take precautions for her prediabetes. Two months ago, she was diagnosed with a hepatoma. She smokes one pack of cigarettes per day. Her blood pressure today is 130/85 mm Hg, and physical examination is otherwise unremarkable. What is the next step in the management of this patient?
Migratory, recurrent superficial thrombophlebitis is most commonly associated with which of the following diseases?
A 44 year-old obese female reports pain in the right lower leg and thigh for the last few days. She reports a dull pain on the medial side of her right thigh (figure 1) and along the lateral surface of her right knee joint (figure 2). She has a history of varicose veins in both lower extremities. Her temperature is 99 °F (37.2 °C), heart rate is 78 beats/min, blood pressure is 140/92 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 97% on room air. On examination, she is an obese woman. Physical examination is significant for induration, redness, and tenderness along the course of the local veins. The veins are erythematous, close to the surface, and palpable. There is erythema of the surrounding skin. Duplex ultrasound of the involved extremity reveals no deep venous thrombosis (figure 3). Figure 1 Which of the following is a true statement regarding this disorder?
Which of the following scores is used to determine pretest probability when deep vein thrombosis (DVT) is suspected?
A 32-year-old woman presents to the emergency room with chest pain localized under her right breast for the past two days. She also reports severe pain in her right lower leg, a constant headache, and blurry vision lasting over 12 hours. She denies fever, nausea, vomiting, or diarrhea. Her medications include a combination oral contraceptive for birth control and acetaminophen for headaches. Which of the following is a warning sign associated with her use of a combination oral contraceptive?
You are treating a 44-year-old woman admitted to the hospital for deep vein thrombosis (DVT). As she is being discharged, you recommend treatment with warfarin. However, the patient refuses, citing concerns about frequent blood tests required for monitoring warfarin therapy. She mentions seeing a television commercial about a newer medication that does not require frequent blood monitoring. Using her phone, she finds information about a drug that works by directly inhibiting factor Xa. Which of the following medications fits her description and is appropriate for treating DVT?
