A 28 year-old female is brought to your office for evaluation by her husband. A week ago she gave birth to a baby in a local hospital. Suddenly three days ago, one afternoon, she started to state that she is being followed by a foreign spy agency which is planning to take away her baby. Their home is near an airport and every time a plane flies over their house, she runs into a dark room to ‘protect herself from all scanning devices planted on the plane’. She insists that she can feel the x-rays penetrating her body when the scanners fly over. She can even hear the pilots’ talking about her and her baby. She stopped using her mobile phone in order to stop sharing her location. She talks very little to the family members. She believes her thoughts can be read by the flying scanners. She gets easily frustrated with him and other family members. Her husband reports that the patient had no history of mental health problems before, ‘not even anxiety or stress’. However, during her delivery process, she had some painful experiences with anesthesia not giving her full relief from pain of parturition. Which of the following is the most likely diagnosis in this patient?
Dr.John had an argument with his wife before he left home. ‘I want answers, John, I want answers’: her angry words echoed in his ears as he went to see his first patient, Isha. At the end of their visit, Isha looked at Dr.John and said, ‘I want an answer, Dr.John, I want your answer’. Dr.John just stood there looking at Isha. For a moment, it felt like his own wife standing there and demanding an answer from him. This unconscious phenomenon in Dr.John’s mind is known as which of the following?
Of the following, which is the most common emergency associated with treatment of hematologic cancers?
A 34 year-old female presents to the emergency room with nausea, vomiting, loss of appetite, extreme weakness, decreased urine output, tingling around her lips, chest pain, palpitations and depressive mood. She was recently diagnosed with Burkitt’s lymphoma and was started on an aggressive rituximab therapy a few days ago. Her past medical history is significant for glucose-6-phosphate dehydrogenase deficiency. She is breast feeding her one-year old baby boy. In physical examination, you notice an anxious individual having some difficulty in breathing, tachycardia and decreased muscle strength. When you tap over the facial nerve in front of the ear you notice ipsilateral contraction of the facial muscles. Laboratory results are given below: Test Result Reference range Potassium (K⁺) 7.7 mEq/L 3.5 – 5.0 mEq/L Calcium 5.6 mg/dL 8.4 – 10.2 mg/dL Uric acid 10.7 mg/dL 3.0 – 8.2 mg/dL Phosphorus 5.2 mg/dL 3.0 – 4.5 mg/dL Creatinine 4.6 mg/dL 0.6 – 1.2 mg/dL Urea nitrogen 27 mg/dL 7 – 18 mg/dL Lactate dehydrogenase 743 U/L 45 – 200 U/L EKG showed QRS prolongation with peaked T waves. Which of the following medications could have a prominent role in the prevention of tumor lysis syndrome in this patient?
A 32 year-old female presents to the emergency room with nausea, vomiting, loss of appetite, extreme weakness, decreased urine output, tingling around her lips, chest pain, palpitations and depressive mood. She was recently diagnosed with Burkitt’s lymphoma and was started on an aggressive rituximab therapy a few days ago. Her past medical history is significant for glucose-6-phosphate dehydrogenase deficiency. She is breast feeding her one-year old baby boy. In physical examination, you notice an anxious individual having some difficulty in breathing, tachycardia and decreased muscle strength. When you tap over the facial nerve in front of the ear you notice ipsilateral contraction of the facial muscles. Laboratory results are given below: Test Result Reference range Potassium (K⁺) 7.7 mEq/L 3.5 – 5.0 mEq/L Calcium 5.6 mg/dL 8.4 – 10.2 mg/dL Uric acid 10.7 mg/dL 3.0 – 8.2 mg/dL Phosphorus 5.2 mg/dL 3.0 – 4.5 mg/dL Creatinine 4.6 mg/dL 0.6 – 1.2 mg/dL Urea nitrogen 27 mg/dL 7 – 18 mg/dL Lactate dehydrogenase 743 U/L 45 – 200 U/L EKG showed QRS prolongation with peaked T waves. Of the following, which is the most likely diagnosis in this patient?
A 27 year-old female comes to your office and reports a ‘migraine attack’, sore throat and dark urine color. She is 2 months pregnant. She takes acetaminophen 500 mg twice daily as needed for pain in her back. She has not been taking folate or any other vitamin supplements. She takes propylthiouracil for hyperthyroidism. On further questioning, she reveals she also has abdominal pain and swelling of the legs. On physical examination, you notice yellow eyes and skin along with abdominal tenderness in the right upper quadrant. Her temperature is 101 °F (38.3 °C), heart rate is 108 beats/min, blood pressure is 100/70 mm Hg, respirations are 19 breaths/min, and oxygen saturation is 98% on room air. What is the next best step in the management of this patient?
A patient came to your office for a ‘medical clearance’ exam before his surgery. She is scheduled to have an elective splenectomy for the treatment of hereditary spherocytosis. Which of the following advice is the most important advice to give to this patient?
A 34-year-old female presents with recurrent bruising, petechiae, and intermittent epistaxis. Laboratory workup reveals severe thrombocytopenia with a platelet count of 18,000/μL. She has a history of immune thrombocytopenia (ITP) refractory to corticosteroids and intravenous immunoglobulin (IVIG). After failed medical management, the patient undergoes a laparoscopic splenectomy. Postoperative recovery is uneventful, and her platelet count stabilizes within the normal range. Which of the following is the most feared complication after splenectomy?
A 54 year-old overweight male was brought to the emergency room after a serious motor vehicular injury. His medical history is significant for being overweight and smoking. He had to undergo a splenectomy for blunt abdominal trauma. Which of the following is the most important thing to do for this patient as you prepare his discharge plan?
