36-year-old man comes to the physician with a 1-month history of diarrhea


36-year-old man comes to the physician with a 1-month history of diarrhea, abdominal distension, and flatulence. Over this period, he has lost

6.8 kg (15 lb) and developed night sweats and occasional arthralgias. There is no history of recent travel. On physical examination, his

temperature is 37.5 C (99.5 F), blood pressure is 112/74 mm Hg, pulse is 104/min, and respirations are 16/min. Physical examination shows

enlarged, nontender cervical and inguinal lymph nodes. A small ulcer is seen on the buccal mucosa. He has no skin rashes or joint effusions.

The abdomen is soft and nontender. Which of the following is the most appropriate next step in the immediate management of this patient?

  • QA Antinuclear antibody screen
  • 0 B. Colonoscopy with biopsies
  • 0 C . HIV testing
  • 0 D. Thyroid function tests
  • 0 E. Tissue transglutaminase antibodies

0 voters

3-year-old boy is brought to the emergency department due to loss of consciousness while playing at a park The boy was short of

breath from running when he appeared blue and went limp for approximately 10 seconds. His mother caught his fall and says that he

regained consciousness quickly. He did not hit his head or experience any trauma. However, the patient has previously lost

consciousness during excess crying and temper tantrums. The events are brief and accompanied by blue discoloration of his lips

The patient was born full term via normal vaginal delivery, and there was no known history of cyanosis or jaundice in the neonatal

period He has met all developmental milestones. The patient’s father has hypertension and hyperlipidemia, and his paternal uncle

has a seizure disorder. Temperature is 37.5 C (99.5 F), pulse is 110/min, and respirations are 45/min. Physical examination shows an

alert and mildly cyanotic boy with a systolic ejection murmur along the mid to upper left sternal border. When the child squats, the

murmur becomes louder and the cyanosis improves The abdomen is soft, nontender, and nondistended. No organomegaly is

present Femoral and brachia! pulses are equal and 2+. Deep tendon reflexes are 2+. Which of the following is the most likely

diagnosis in this patient?

  • QA Absence epilepsy
  • 0 B. Breath-holding spell
  • 0 C. Generalized seizure
  • 0 D. Hypertrophic cardiomyopathy
  • 0 E. Isolated atrial septal defect
  • 0 F Tetralogy of Fallo!
  • 0 G. Vasovagal syncope

0 voters