Daily Answers

07/16/2026
The Question A 28-year-old woman comes to the office to discuss management of chronic abdominal symptoms. For the past two years, she has experienced crampy lower abdominal pain, bloating, and a sensation of incomplete evacuation. The pain is typically relieved with defecation. Her bowel habits fluctuate between periods of hard, pellet-like stools and loose, watery stools, with each pattern lasting for several weeks at a time. These symptoms occur 3 to 4 days per week and are causing her significant distress. She has not experienced weight loss, rectal bleeding, or... Read more...
07/15/2026
The Question A 78-year-old man at a skilled nursing facility is evaluated for a 3-day history of profuse watery diarrhea and lower abdominal cramping. He has had up to 10 non-bloody stools per day. His medical history is notable for COPD and hypertension. Two weeks ago, he completed a 5-day hospital course of intravenous ceftriaxone and oral azithromycin for community-acquired pneumonia. On examination, his temperature is 38.4°C (101.1°F), heart rate is 105/min, and blood pressure is 110/70 mm Hg. His abdomen is soft and diffusely tender without peritoneal signs. Laboratory... Read more...
07/14/2026
The Question A 28-year-old woman of Greek descent presents for a new patient visit. She feels well overall but reports mild, intermittent fatigue for the past year, which she attributes to a busy work schedule. She has a history of "mild anemia" but has never had a formal workup. She eats a varied diet and has regular menstrual cycles, lasting 4 days with moderate flow. She is not pregnant. On examination, her vital signs are normal. There is no conjunctival pallor, glossitis, or splenomegaly. A complete blood count is obtained,... Read more...
07/13/2026
The Question A 48-year-old man with a history of type 2 diabetes mellitus and social alcohol use presents to the emergency department with one day of severe, constant epigastric pain that radiates to his back. The pain is associated with nausea and several episodes of non-bilious vomiting. His temperature is 37.9°C (100.2°F), heart rate is 118 beats/minute, blood pressure is 112/74 mm Hg, and respiratory rate is 20 breaths/minute. On examination, he is in moderate distress. His abdomen is tender to palpation in the epigastrium without guarding or rebound. Laboratory... Read more...
07/12/2026
The Question A 45-year-old man presents for a new patient visit. He has no specific complaints and feels well. He has not had routine medical care for over a decade. His father was diagnosed with colon cancer at age 52. His mother is healthy. He does not smoke, drinks alcohol socially, and works a desk job. His temperature is 37.0°C (98.6°F), blood pressure is 125/78 mm Hg, pulse is 72/min, and respirations are 14/min. BMI is 26 kg/m². The physical examination is unremarkable. Which of the following is the most... Read more...
07/11/2026
The Question A 48-year-old woman is brought to the emergency department by her husband due to 3 days of worsening confusion, an unsteady gait, and seeing double. Her medical history is notable for obesity, for which she underwent a Roux-en-Y gastric bypass 5 years ago, with an initial weight loss of 90 lbs. For the past week, she has had a viral gastroenteritis with significant nausea, vomiting, and poor oral intake. On examination, she is afebrile with a heart rate of 105/min and blood pressure of 110/68 mm Hg. She... Read more...
07/10/2026
The Question A 68-year-old man is evaluated on postoperative day 7 after a coronary artery bypass grafting procedure. He reports the acute onset of swelling, pain, and redness in his right leg. His medical history is notable for hypertension and hyperlipidemia. Since surgery, he has been receiving prophylactic unfractionated heparin. His temperature is 37.6°C (99.7°F), blood pressure is 140/85 mm Hg, pulse is 92/min, and respirations are 16/min. Examination reveals a warm, erythematous, and swollen right lower extremity with calf tenderness. There are no skin lesions or signs of bleeding.... Read more...
07/09/2026
The Question A 24-year-old man presents to the emergency department with a 5-day history of joint pain. The pain began in his right knee and has since involved his left wrist and right ankle. He also reports pain and swelling along the tendons of his left wrist. He denies any recent trauma. He has felt generally unwell with subjective fevers. He is sexually active with a new partner for the past month and reports inconsistent condom use. He denies any penile discharge, dysuria, or genital lesions. Temperature is 37.9°C (100.2°F),... Read more...
07/08/2026
The Question A 28-year-old man presents to the clinic for evaluation of worsening leg swelling over the past three weeks. He has also noticed puffiness around his eyes in the morning and foamy urine. His medical history is notable for Hodgkin lymphoma, for which he was treated with chemotherapy 5 years ago and has been in complete remission. He takes no medications. On examination, his temperature is 37.0°C (98.6°F), blood pressure is 130/80 mmHg, pulse is 78/min, and respirations are 16/min. There is prominent periorbital edema and 3+ pitting edema... Read more...
07/08/2026
The Question A 28-year-old man presents to the clinic for evaluation of worsening leg swelling over the past three weeks. He has also noticed puffiness around his eyes in the morning and foamy urine. His medical history is notable for Hodgkin lymphoma, for which he was treated with chemotherapy 5 years ago and has been in complete remission. He takes no medications. On examination, his temperature is 37.0°C (98.6°F), blood pressure is 130/80 mmHg, pulse is 78/min, and respirations are 16/min. There is prominent periorbital edema and 3+ pitting edema... Read more...
07/08/2026
The Question A 28-year-old man presents to the clinic for evaluation of worsening leg swelling over the past three weeks. He has also noticed puffiness around his eyes in the morning and foamy urine. His medical history is notable for Hodgkin lymphoma, for which he was treated with chemotherapy 5 years ago and has been in complete remission. He takes no medications. On examination, his temperature is 37.0°C (98.6°F), blood pressure is 130/80 mmHg, pulse is 78/min, and respirations are 16/min. There is prominent periorbital edema and 3+ pitting edema... Read more...
07/07/2026
The Question A 38-year-old woman with a 10-year history of generalized tonic-clonic epilepsy, well-controlled on levetiracetam 1000 mg twice daily, presents for follow-up. She reports two breakthrough tonic-clonic seizures in the past three months, prior to which she had been seizure-free for over five years. She affirms medication adherence, and a levetiracetam level drawn one month ago was in the therapeutic range. Her medical history is also significant for migraine headaches without aura, for which she takes ibuprofen as needed. Her neurologic examination is non-focal. Vitals are stable. She expresses... Read more...