Ananya, a 10-year-old girl, presents with a 3-week history of persistent diarrhea, abdominal cramps, and weight loss. Her mother describes the stools as greasy and foul-smelling. Ananya recently attended a summer camp where she drank untreated water from a nearby stream. On physical examination, Ananya appears mildly dehydrated and underweight. Laboratory stool analysis reveals Giardia trophozoites. Which of the following best describes the histological features of the small intestine in Giardiasis-induced malabsorption?
Michael, a 34-year-old man backpacker presents to the clinic with a 2-week history of watery diarrhea. On physical examination, he appears mildly dehydrated but otherwise stable. Stool analysis shows no fecal leukocytes. Fecal leukocytes are usually absent in which of the following infectious diarrhea?
James M., a 62-year-old male, presents with a 3-month history of intermittent blood in his stool, fatigue, and unintentional weight loss of 8 kg. He also reports changes in bowel habits, including alternating diarrhea and constipation. James denies abdominal pain, fever, or vomiting. He has a significant smoking history (20 pack-years), a diet high in processed meats, and a sedentary lifestyle. He has never undergone colorectal cancer screening, and there is no family history of colorectal cancer or other malignancies. On physical examination, James’s vitals are stable. Abdominal examination reveals mild tenderness in the lower abdomen without palpable masses. Rectal examination shows blood in the stool, but no obvious masses are felt. A colonoscopy is performed, revealing an ulcerating mass in the sigmoid colon. Biopsy of the lesion confirms moderately differentiated adenocarcinoma. Laboratory testing of the biopsy specimen reveals nuclear beta-catenin accumulation, suggesting dysregulation of the Wnt signaling pathway. Further genetic testing identifies a mutation in the APC gene, leading to beta-catenin stabilization and activation of oncogenic transcription. A CT scan of the abdomen and pelvis shows that the tumor is localized to the sigmoid colon without evidence of distant metastasis. How can nuclear beta-catenin localization in colorectal cancer be detected clinically?
A 52-year-old woman comes to the emergency room complaining of tremor, sweating, anxiety, and palpitations. She reports feeling weak and has difficulty speaking and walking. A fingerstick blood glucose test reveals a glucose level of 42 mg/dL (2.3 mmol/L). Her medical history includes diabetes, hypertension, a recent urinary tract infection, and a protozoal infection. Her current medications are metoprolol, levofloxacin, lisinopril, insulin, and pentamidine. Upon further evaluation, it is determined that her hypoglycemia is drug-induced. Which of the following medications can cause hypoglycemia?
Which of the following medications is recommended for a high-risk 6-month-old with Tetralogy of Fallot during the fall and winter season to prevent severe respiratory syncytial virus (RSV) infection?
A mother brought her 8 month-old baby to the emergency room because the baby appears to be having trouble breathing. He is also not gaining weight as he should, gets frequent respiratory infections, gets short of breath and becomes sweaty when crying or playing. Upon further enquiry, the mother reports that she took some medications during her pregnancy with this child, ‘a vitamin pill’ ‘an energy pill’ and ‘some other pill’ her father-in-law gave her, which helped him a lot. She is not able to recollect its name. On physical examination of the baby, a continuous “machinelike” murmur is heard and you note signs of pulmonary congestion. Of the following, this mother probably took which medication, that caused a congenital heart disorder in this baby?
You’re overseeing the discharge of a 26-year-old woman from the hospital after she had stayed in the hospital for 3 days for pulmonary embolism. As you prepared her discharge instructions, the floor nurse came and informed you that the patient developed a severe headache, sudden trouble seeing in one eye, dizziness, loss of balance and right sided weakness. Patient reports that her symptoms started suddenly while she was straining at the stool during a bowel movement. You suspected a stroke in this patient and wondered how such a young woman all of a sudden could get a stroke. You glanced over her medical record. She has no history of hypertension, diabetes or prior stroke or transient ischemic attacks. She does not smoke but drinks occasionally. She is sexually active. She works as a bank executive and four days ago, she returned home taking a 17-hour long transcontinental flight after attending a financial conference in Singapore. She developed chest pains 3 days ago, came to the emergency department, eventually diagnosed with pulmonary embolism, admitted and treated for it. Her current medications include a combination pill for contraception, colace for constipation, and a low-molecular weight heparin for the treatment of pulmonary embolism. On physical examination, you notice right sided weakness and normal heart examination. Which of the following is the most likely cause of her stroke?
A 48-year-old woman with a history of hypertension, hypothyroidism, diabetes, and dyslipidemia presents to establish care. Her current medications include hydrochlorothiazide, levothyroxine, metformin, and colesevelam, which was prescribed after atorvastatin caused severe myalgias. Before starting colesevelam, which precaution is most important to discuss with this patient?
