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Upon careful physical examination and re-examination of a 6-month-old infant, the left testis is palpable in the scrotal sac while the right testis is not palpable at all. There are prominent rugae on the left side of the scrotum but not on the right. Your initial assessment is:
A 10-year-old presents complaining of a new onset of “tea-colored” urine. Past history per her mother is significant for a throat infection approximately 2 weeks prior to presentation, for which a course of antibiotics was given but not completed. Exam is remarkable for mild hypertension. Labs are remarkable for a positive ASO titer and mild proteinuria. Which of the following is the most likely diagnosis?
A 20 year-old female presents with tea colored urine 3 weeks after having the stomach flu. Blood pressures are noted to be elevated, RBC casts are seen in the urine. What is your diagnosis?
Which of the following is the most common presenting sign of a Wilms tumor?
What organisms cause the formation of struvite kidney stones?
Which of the following findings would be suggestive of nephrotic syndrome in a 45-year-old male with diabetes type 2?
A 75-year-old diabetic male presents with burning on urination and urinary frequency of 2 days duration. He has not had any recent invasive procedures. Urinalysis reveals many organisms/high power field. What organism is the most likely be found on urine culture?
Which of the following signs and symptoms is typically found in patients with acute cystitis?
A 45 year-old male presents with flank pain and hematuria, he was treated and discharged with pain medications and a urine strainer. He brought in his stone and analysis reveals a calcium oxylate stone. Which of the following is effective in lowering urine calcium in idiopathic hypercalciuria to prevent the formation of stones?
A 45 -year-old male presents with small bowel obstruction and he is made NPO, a NGT was placed, antibiotics and IV fluids started. Which of the following Arterial blood gas is most likely to be seen in the patient with continuous nasogastric suction for 4 days?
Normal ranges – CO2 is 35-45, HCO3 is 23-28
A 27 year-old female with generalized anxiety disorder has a panic attack when she sees a mouse run across the floor. What ABG findings would you find in this patient?
Normal ranges – CO2 is 35-45, HCO3 is 23-28
A 65-year-old diabetic male on long term dialysis is noted to be anemic but asymptomatic. What treatment for his anemia do you recommend if you suspect it is due to his chronic renal disease?
A 22-year-old black female who suffers from heroin addiction now has generalized edema and massive proteinuria. Which of the following is the most likely diagnosis?
A 21-year-old male overdoses on aspirin, what renal function changes are expected?
Calculate the anion gap.
Na = 135 , Cl = 95, Hco3 =15, K+=4.0, Ca++= 8.9
An 80-year-old frail woman on diuretic therapy for congestive heart failure develops diarrhea for several days and then has a syncopal episode and lands on the bathroom floor. When the paramedics arrive, they find her apneic and pulseless. She receives a full course of CPR and ACLS, including 2 ampules of sodium bicarbonate. Her ABG on arrival to the emergency department shows pH of 7.67, PCO2 of 62 mm Hg, and PO2 of 212 mm Hg on 100% by way of endotracheal tube. The serum HCO3 on her electrolyte panel is 23. Her acid-base disorder is:
A 75-year-old man with a history of recurrent urinary tract infections complains of dysuria and perineal discomfort. He denies fever, chills, and obstructive symptoms. Urine shows a few leukocytes and some bacteria. Prostate is mildly tender on palpation and minimally enlarged. Testicular examination is normal. A prostatic massage with collection of expressed prostatic secretions demonstrates pus. What is the most likely diagnosis in this patient?
A 72-year-old man comes to the office complaining of leaking urine for 2 months. He has had nocturia and reduced stream for the past year. Which of the following would best diagnose overflow incontinence in this patient?
A 70-year-old man is seen in the office with a 1-month history of involuntary loss of small amounts of urine not associated with position, coughing, or sneezing. The patient also describes a sensation of incomplete bladder emptying and a weak urine stream. Which of the following is appropriate treatment for this patient?
A 15-year-old boy presents to the emergency department with an acute onset of testicular pain while playing soccer. On physical examination, the cremaster reflex is absent. Color Doppler ultrasound shows a normal testicle with diminished Doppler wave pulsation. Which of the following is the most likely diagnosis?
An obese 52-year-old female smoker is complaining of urinary leakage with coughing. She should additionally be evaluated her for:
A 68-year-old female has a history of type two diabetes mellitus for greater than twenty years. She has mild renal insufficiency associated with hyperkalemia and a mild non-anion gap metabolic acidosis. Which of the following is the most likely cause of her acidosis?
A 56-year-old male presents with symptoms of urgency, frequency and nocturia. He denies any significant past medical history, and is on no medications. On examination his blood pressure is 156/92. His prostate feels firm, but rubbery, is moderately enlarged, and the median sulcus is not appreciated. There is no asymmetry, nodules or induration. Urinalysis and prostate specific antigen are normal. Which of the following medications would be most appropriate to manage his symptoms?
A 27-year-old male presents with a history of a lesion on his penis for two days. It is painful and he denies any discharge or urinary sympotms. On examination there is a 1 cm painful ulcer with overlying erythema on the shaft of his penis. His inguinal lymph nodes are enlarged and tender on the left side. Which of the following is the most likely causative organism of this ulcer?
A 50-year-old male who is taking hydrochlorothiazide for hypertension has developed severe diarrhea and vomiting. He began to feel muscle weakness, fatigue and felt palpitations associated with lightheadedness. He proceeded to the emergency room where an ecg was performed, and there were prominent U waves were seen on his ECG. An abnormality of which of the following electrolytes is most likely responsible for his symptoms and ECG findings?
A 45-year-old construction worker is brought to the emergency department following an accident at the construction site. He was pinned under a concrete wall for several hours. He is unresponsive and has a very weak, rapid pulse. His potassium level is 9.9 mEq/L (normal 3.5-5.5 mEq/L). Which of the following findings would most likely be seen on his ECG?
A 59-year-old female has been in chronic renal failure for several years. She is generally compliant with her prescribed diet. Which of the following vitamins is she most likely to be deficient in?
A 42-year-old female with a history of hypertension presents to the emergency room with a complaint of palpitations. She reports that she was started on lisinopril for her hypertension one month ago, but has not been seen in follow up. She reports that she has been experiencing muscle cramps over the past week. On examination, her blood pressure is 130/84, and her pulse rate is 78. Her examination is otherwise normal. Her serum potassium level is 6.2 mEq/L (normal 3.5-5.5mEq/L). An ECG shows peaked T waves and a shortened QT interval. Which of the following is the most appropriate in the immediate management of this patient?
A 68-year-old female is hospitalized for meningitis and is receiving IV ampicillin and gentamycin. On the third day of hospitalization there is an acute decrease in urine output, and an acute rise in her BUN and creatinine levels. Microscopic urinalysis reveals pigmented granular casts and renal tubular epithelial cells. Which of the following is the most likely diagnosis?
An otherwise healthy, athletic, 30-year-old male presents with prostatitis. You will be placing him on a 1-month course of antibiotics. In reviewing possible side effects of the drug you are prescribing, you tell him to report to you any signs indicative of Achilles tendonitis. You are ordering what class of drugs?