Which blood vessel begins at the lateral border of the first rib and terminates as it passes by the tendon of the teres major muscle?

INSTRUCTIONS: Complete each sentence with the correct form of a word from the box. Ex: They visit us once a week.   have             visit             need            come            like            speak I want to ____________________ French too.

A 54-year-old male presents with 1 month of low back pain, feeling tired easily, and constipation. He denies any fever, night sweats, cough, trauma, or tingling/weakness in the limbs. On examination, the vital signs are normal. Physical examination reveals tenderness along the L4/L5 area. Abdominal and chest exams are normal. X-ray of the lumbar spine shows lytic bone lesions. Laboratory results are a hemoglobin level of 9 g/dL, a serum calcium level of 12.5 mg/dL, and increased urea nitrogen and creatinine. Urine electrophoresis reveals Bence Jones protein. Which of the following is most likely present in the peripheral blood smear?

A 61-year-old woman presents to your office complaining of mild fatigue and weight loss over the past 6 months. She states she has felt generally unwell and has had decreased appetite during this time frame. Her temperature is 98.1°F (36.7°C), blood pressure is 122/80 mmHg, pulse is 88/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical exam reveals splenomegaly and a nontender abdomen. A complete blood count with differential shows the following:Hemoglobin: 10 g/dLHematocrit: 30%Leukocyte count: 166,500Diff: WBC precursors at all stages of maturationPlatelet count: 92,000A bone marrow biopsy is performed. Which of the following translocations is likely to be seen in this patient?

A 34-year-old African-American woman presents to the emergency department with sudden-onset dark urine and pallor. She also complains of back pain and fatigue. She has a history of celiac disease. Due to inconsistent adherence to a gluten-free diet, the patient has recently developed dermatitis herpetiformis. She was started on dapsone 2 days ago. Labs are drawn, as shown below:Leukocyte count: 11,000Hemoglobin: 8.0 g/dLPlatelets: 200,000 PT/PTT: normalSerum:Aspartate aminotransferase (AST, GOT): 15 U/LAlanine aminotransferase (ALT, GPT): 12 U/LTotal bilirubin: 3.8 mg/dLDirect bilirubin: 0.2 mg/dLHaptoglobin: 36 g/dL (normal range: 50-200 g/dL)Lactate dehydrogenase (LDH): 125 U/LGlucose-6-phosphate dehydrogenase (G6PD): 8.5 U/g (normal range: 5.5 to 20.5 U/g)A peripheral smear shows red blood cells with semicircular portions removed from the cells’ periphery. Inclusion bodies are seen with methylene blue staining. Which of the following is the most likely diagnosis?

A 42-year-old woman presents to the emergency department with complaints of recurrent shortness of breath for the past 2 weeks. She reports shortness of breath whenever she goes on her morning run. The symptoms last for approximately 5-10 minutes and improve with rest. She denies chest pain, syncope, nausea, or abdominal pain during these episodes. Her medical history is significant for rheumatoid arthritis which is treated with hydroxychloroquine. She denies any recent surgeries, oral contraceptive/estrogen use, malignancy, or personal history of deep vein thrombosis (DVT) or pulmonary embolism (PE). She endorses some rhinorrhea and sore throat that has since resolved. Physical examination demonstrates some joint swelling at the proximal interphalangeal joints bilaterally but is otherwise unremarkable. Laboratory studies are shown below:Leukocyte count and differential: 9,800 with normal differentialHemoglobin: 9.8 g/dLPlatelet count: 180,000Mean corpuscular volume (MCV): 83Reticulocyte count: 0.2%Ferritin: 268 ng/mL (Normal: 12-150 ng/mL)Serum iron: 38 mcg/dL (Normal: 60-170 mcg/dL)Total iron binding capacity (TIBC): 240 mcg/dL (Normal: 240-450 mcg/dL) CXR was obtained and reveals clear costophrenic angles and no signs of consolidation or interstitial infiltrate. Cardiac silhouette is clear, and there are no signs of cardiomegaly. What is the most likely explanation for this patient’s symptoms?

In a patient diagnosed with essential thrombocythemia and a high risk of thrombosis, which of the following is the most appropriate treatment?

A 55-year-old male presents to his primary care physician for fatigue. He states he has not felt like himself recently and had to take a few days off of work secondary to fatigue. He has lost 10 pounds over the past month. Vital signs: T: 99.0°F (37.2°C), BP:128/65 mmHg, HR: 100/min, RR: 12/min, and oxygen saturation is 98% on room air. Laboratory values are ordered as seen below.Hemoglobin: 9 g/dLHematocrit: 27%Leukocyte count: 2,500 with normal differentialPlatelet count: 93,000A biopsy of the bone marrow is performed which demonstrates hypocellular and fibrotic bone marrow and a peripheral smear is performed (see image). Which of the following is the most likely diagnosis?

During your Emergency Medicine rotation, you are asked to evaluate a 5-year-old male child who presents after falling off a scooter.  The patient reports that he fell sideways off the scooter as he rounded a curve in the road, and he describes dull, aching pain along his left side where he hit the ground. The patient’s parents report that he has never had any previous serious injury, but the mother recalls that he had increased bleeding following circumcision during infancy.  There is no other history of surgery or trauma.  On physical exam, the patient has extensive bruising of the lateral left thigh and tenderness to palpation. Initial CBC is performed and reveals normal WBC, Hgb, and HCT. Additional laboratory results are as follows: (Normal ranges in parentheses; abnormal results are in bold type)   Initial Test Results PT 12.6 sec (11.0-13.5) PTT 50.0 sec (25.0-35.0) Plt 250,000 (150,000-400,000) Based on these findings, what clotting factor deficiency is most likely in this patient?

A 76-year-old male with a medical history significant for heart failure with reduced ejection fraction (HFrEF) of 30% to 35%, COPD, and iron deficiency anemia is admitted for acute dyspnea on exertion with wheezing. CBC reveals a hemoglobin of 6.2 g/dL and hematocrit of 20%. A packed red blood cell transfusion is initiated. Seven hours later, the patient developed worsening dyspnea with an oxygen saturation of 72% on room air. The temperature is 99.2 °F (37.3 °C). Lung sounds show rales bilaterally. The neck veins are distended, and the patient develops hypertension. CBC shows a WBC of 10,100 and a platelet count of 237,000. What is the most likely diagnosis?