Daily Answers

07/06/2026
The Question A 48-year-old woman with a history of Roux-en-Y gastric bypass 5 years ago presents to the emergency department with 3 weeks of progressive gait instability and confusion. Her husband reports that she has become increasingly apathetic and forgetful. For the past two months, she has had nausea and poor oral intake, and has been inconsistent with her prescribed nutritional supplements. On examination, she is lethargic and oriented only to person. Temperature is 37.1°C (98.8°F), blood pressure is 118/76 mmHg, heart rate is 88/min, and respirations are 16/min. Neurologic... Read more...
07/05/2026
The Question A 38-year-old woman presents with an 8-month history of crampy lower abdominal pain and changes in bowel habits. She reports abdominal pain that is relieved by defecation and associated with 3–5 loose, nonbloody stools per day; symptoms began gradually and have been intermittent but persistent. She has no fever, weight loss, nocturnal diarrhea, family history of inflammatory bowel disease or colorectal cancer, or rectal bleeding. Vital signs are normal. Physical exam is unremarkable without abdominal tenderness or perianal disease. Laboratory studies show hemoglobin 13.2 g/dL, WBC 6.4 x10^9/L,... Read more...
07/04/2026
The Question A 62-year-old man presents 7 days after elective total knee arthroplasty with acute left calf pain and swelling. His postoperative course included low-molecular-weight heparin prophylaxis. He is afebrile, HR 88 bpm, BP 132/78 mmHg, RR 16. Exam shows a tender swollen left calf with erythema. Laboratory data: platelet count was 250,000/µL preoperatively and is now 95,000/µL, hemoglobin 13.2 g/dL, creatinine 0.9 mg/dL; PT and aPTT are within reference range. Duplex ultrasound shows an occlusive left popliteal vein deep venous thrombosis. Peripheral smear demonstrates reduced platelets without schistocytes. He... Read more...
07/03/2026
The Question A 62-year-old man with a 50 pack-year smoking history, who quit 5 years ago, presents with progressive cough. Chest CT reveals a 3.1 cm spiculated peripheral right upper lobe mass. FDG-PET shows intense uptake in the mass (SUV 10) but no FDG-avid mediastinal or hilar lymph nodes. Pulmonary function testing shows FEV1 48% predicted and DLCO 50% predicted; he has coronary artery disease but preserved left ventricular function. Thoracic surgery considers him borderline for lobectomy because of reduced pulmonary reserve. Which of the following is the most appropriate... Read more...
07/02/2026
The Question A 68-year-old man presents with 9 months of progressive exertional dyspnea and a dry cough. He is a former smoker (40 pack-year, quit 5 years ago). On exam he has resting oxygen saturation 95% on room air, bibasilar fine inspiratory crackles and digital clubbing. Pulmonary function testing shows FVC 65% predicted, FEV1/FVC ratio normal, and DLCO 45% predicted. Autoimmune serologies including ANA, rheumatoid factor, and anti-CCP are negative. High-resolution chest CT demonstrates basal predominant subpleural reticulation with honeycombing and traction bronchiectasis, no significant ground-glass opacities, no mosaic attenuation,... Read more...
06/30/2026
The Question A 62-year-old man with type 2 diabetes and longstanding chronic hepatitis C is evaluated for antiviral therapy. He reports mild fatigue but no jaundice, ascites, or encephalopathy. Vitals are stable. Exam shows small non-tender hepatomegaly and no stigmata of chronic liver disease. Labs: ALT 85 U/L, AST 110 U/L, total bilirubin 0.9 mg/dL, albumin 3.8 g/dL, INR 1.1, platelets 130,000/microL, serum creatinine 2.2 mg/dL (eGFR ~25 mL/min/1.73 m2). HCV RNA 3.2 million IU/mL, genotype 1a. Hepatitis B surface antigen negative, HIV antibody negative. Abdominal ultrasound shows a nodular... Read more...
07/01/2026
The Question A 28-year-old man who has sex with men presents with 7 days of rectal pain, mucous discharge, and tenesmus after receptive anal intercourse with a new partner. He has no fever, denies urethral discharge, and reports intermittent adherence to condoms. Vitals: T 36.8°C, HR 78 bpm, BP 122/74 mmHg. On rectal exam there is mucopurulent discharge and mild erythema; anoscopy confirms mucosal inflammation. A rectal nucleic acid amplification test (NAAT) returns positive for Chlamydia trachomatis and negative for Neisseria gonorrhoeae; HIV fourth-generation test is negative. Which of the... Read more...