A 55-year-old patient has received instructions on a heart-healthy diet based on the American Heart Association guidelines. Which statement made by the patient would indicate the patient needs further teaching?

A patient with chronic kidney disease is receiving peritoneal dialysis with 2-liter inflows. Which information should the nurse report promptly to the health care providers?

A 65-year-old male presents to the emergency department with low back pain. The pain started 6 hours ago when he was gardening and carrying a heavy bag. The pain is rated as 10/10 in severity and radiates down the posterior aspect of the right thigh. He reports no fevers or chills. His only medical problem is hypertension for which he takes amlodipine. The patient is a non-smoker, uses alcohol infrequently, and has never used illicit drugs. Initial vital signs: T 99.6°F, BP 140/70 mmHg, HR 90/min, and RR 20/min. Physical examination reveals 3/5 strength to hip extension, knee flexion and extension, and plantar flexion bilaterally. Sensation to pinprick is diminished over the posterolateral legs and lateral aspects of both feet. Ankle and knee reflexes are absent bilaterally. The patient’s underwear is wet and a bladder scan reveals 800 mL of urine. Which of the following is the most likely underlying diagnosis?

As a PA student on your Internal Medicine Rotation, you are evaluating a 28-year-old female patient who complains of “double vision” and has several abnormal findings on exam. While performing a cranial nerve exam, you notice that the patient has left-sided ptosis which seems to become more pronounced when she makes an effort to keep her eyes wide open during the exam. You also notice that her voice is becoming weaker with prolonged speaking, and she seems to have difficulty swallowing. The patient reports recent “choking” spells when eating. Which of the following conditions is the most likely diagnosis for this patient?

A 32-year-old female who was previously healthy is brought to the emergency department by her concerned fiance who states that she is acting very abnormally. He states that over the past day she has developed a fever, become progressively more confused, and is “just not acting like herself.” On exam, she exhibits altered mental status. Initial vital signs: T: 102.2F, HR: 102 bpm, BP: 130/90 mmHg, RR: 12/min, and pulse ox (room air): 100%. The emergency physician obtains a lumbar puncture which demonstrates the following CSF analysis: normal opening pressure, elevated lymphocyte count, elevated protein, elevated RBCs, and normal glucose. An MRI is obtained to confirm the diagnosis and is illustrated (see image). Which of the following organisms is most likely responsible for this patient’s presentation?

Bonus Question: A 72-year-old male has a past medical history that is significant for severe and uncontrolled hypertension; he is brought into the emergency room by his family due to a 30-minute history of change of mental status. The patient had just climbed stairs when he first developed a headache that has become progressive; it is associated with nausea, non-bilious vomiting, and unilateral upper and lower extremity numbness. His physical exam reveals an alert patient who is not oriented to time, place, or person. He is afebrile, with a blood pressure of 185/108 mm Hg, and there is nuchal rigidity present. His neurological exam notes contralateral sensory loss, contralateral hemiparesis, gaze paresis, homonymous hemianopia, and miosis. A CT scan without contrast was performed, and it is shown in the image below.  Your preceptor asks you to calculate the patient’s current mean arterial pressure (MAP).  MAP = / 3

A 46-year-old G0P0 female presents to her primary care provider with insomnia. Over the past 3 months, she has experienced insomnia nearly every night, which is affecting her workplace performance. When she tries to sleep, she reports feels a “crawling” sensation deep inside her calves. She feels better when she repositions her legs, but the sensation always returns. She has no known medical problems and denies any current prescription or over the counter medications. Her menstrual cycles are described as “regular, heavy, and stable” over the past 5 years. Her last menstrual period was 3 weeks ago. She does not smoke or drink alcohol. Vital signs: T 99.6°F, BP 120/70 mmHg, HR 80/min, and RR 18/min. On physical exam, her calves are non-tender to palpation. Sensation is intact to light touch in both feet. Ankle reflexes are 2+.   Based on the suspected diagnosis, measurement of which of the following would be most appropriate to obtain in this patient?

Huntington’s disease is a degenerative neurologic condition due to a mutation in a gene on the fourth chromosome. Based on your knowledge of the type of genetic inheritance associated with this condition, what is the likelihood that a child of a parent with Huntington’s disease will inherit the abnormal copy of the gene from that parent?

A 76-year-old female presents to the emergency department after a ground-level fall. Over the past 6 months, she has experienced progressive experienced difficulty ambulating and has trouble focusing. Two months ago, her daughter discovered that the patient had urinated on herself, after which the patient began wearing diapers. She has a history of hypertension for which she takes amlodipine. She has never smoked cigarettes and does not drink alcohol. Vital signs: T 98.6°F, BP 112/70 mmHg, HR 90/min, and RR 18/min. Physical examination reveals an elderly female with a strong urine odor. There is no papilledema on fundoscopy. Cardiac and pulmonary exam reveals no murmurs, rubs, or gallops. She has a wide-based gait and takes small, slow steps. Which of the following findings on Brain MRI is expected?

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