A 49-year-old male reports a 4-month history of pain and swelling in the hands and wrists, hand stiffness that lasts up to 2 hours each morning, swelling and stiffness in the elbows and knees, and fatigue. He also describes being awakened at night by numbness and paresthesias in both hands, primarily in the thumbs and in the second and third digits. He has no rash, no previous history of pain or swelling in any joints, and no significant alcohol intake. He works as an automobile mechanic and notes that his grip has become weak. He has taken over the counter naproxen without much relief. His current vital signs are unremarkable. Diagnostics include a normal CBC and a positive rheumatoid factor (RF). Which of the following physical examination findings is most likely to be present in this patient?

What is one function of positive thoughts in cognitive psychology?

A 62-year-old woman is brought to the emergency department with altered mental status after her husband found her difficult to awaken. She is lethargic and cannot provide a history but keeps saying her belly hurts. Her husband says that she was discharged from the hospital 3 weeks ago after an episode of hepatic encephalopathy and that she has a history of decompensated cirrhosis secondary to nonalcoholic steatohepatitis, ascites, type 2 diabetes which requires insulin therapy, and hyperlipidemia. He mentions that she seemed to choke last night when she was drinking her Ensure. Allergies include anaphylaxis to ampicillin Vitals: Heart rate 105 bpm, blood pressure of 84/48 mmHg, temp 101.0*F, respiratory rate 24 breaths per minute, oxygen saturation of 92% on 2L nasal cannula (does not usually require supplemental oxygen). Physical exam: Difficulty maintaining alertness, evidence of asterixis, remaining limited neuro exam is normal. Rhonchi over right posterior and anterior lung fields. Mild diffuse abdominal tenderness with abdominal fluid wave. Slight erythema to sacrum but no ulcers or skin tenderness. Laboratory testing: Elevated WBC, chronic anemia and thrombocytopenia without change from baseline, stable elevations in total bilirubin, PT and INR. Elevated lactic acid. Urinalysis demonstrates 1+ bacteria, 2+ squamous epithelial cells. Chest xray reveals opacity in right lower lung field. Blood cultures are drawn and sputum and urine cultures are ordered. The patient is started on IV crystalloids in the resuscitation of her sepsis. Plans are made to perform a diagnostic paracentesis and administer albumin. What is the most appropriate initial antibiotic regimen for this patient?

Sensory memory includes visual (iconic) and auditory (echoic) types.

The alliance system before World War I included the Triple Entente and the __________.

Which parasite was observed to cluster near Peyer’s patches in the manatee small intestine?

Telemetry tags are used to track manatee movements after release.

Marine fungal pathogens like phaeohyphomycosis can become angioinvasive.

Which of the following best defines foreign policy?

Which international organization was formed after World War I to prevent future conflicts?