Valentines
Who is Valentine's Day named after?
St. Valentines
A 26-year-old woman is evaluated in the emergency department for acute flank pain and gross hematuria.
On physical examination, the patient is afebrile. Pulse rate is 102/min; other vital signs are normal. Costovertebral angle tenderness is noted. The abdomen is soft and nontender.
Urinalysis shows 3+ blood, trace protein, no nitrites or leukocyte esterase, 2-3 leukocytes/hpf, and too numerous to count erythrocytes. Pregnancy test is positive.
What diagnostic test should you perform next?
Renal ultrasound
Who was the lead producer for the film Barbie?
Margot Robbie
A 50-year-old woman is evaluated for a 6-month history of pain and swelling in the hands, knees, and feet. She reports 1 hour of joint stiffness in the morning.
On physical examination, vital signs are normal. The thumb and second and third fingers on the right hand are diffusely swollen, with tenderness and swelling at the metacarpophalangeal and proximal and distal interphalangeal joints. There are similar findings on the thumb and second finger on the left hand. Several of the affected proximal interphalangeal joints have a slight purple discoloration. There is a right knee effusion. The second and fourth toes on the right foot are diffusely swollen, as are the first and third toes on the left foot. Two small psoriatic plaques—one in the umbilicus and one on the scalp—are noted.
Laboratory evaluation reveals a negative rheumatoid factor result.
What is the diagnosis?
Psoriatic arthritis
Who won the first season of American Idol?
Kelly Clarkson
What popular TV sitcom popularized the concept of celebrating Galentine's Day?
Parks and Rec
A 28-year-old man is evaluated for hematuria that he noted on awakening and a 3-day history of fever, runny nose, and cough. One year ago, he had an episode of gross hematuria after running a half marathon. Evaluation at that time resulted in a biopsy diagnosis of IgA nephropathy. He has no other medical problems and takes no medications.
On physical examination, temperature is 37.9 °C (100.2 °F), and blood pressure is 110/70 mm Hg; other vital signs are normal. The nasal mucosa is edematous, with serous discharge. Examination of the oropharynx reveals erythema without exudate. There is no lymphadenopathy. Lungs are clear to auscultation. The remainder of the examination is unremarkable.
Laboratory studies show a serum creatinine level of 0.9 mg/dL (79.6 µmol/L); urinalysis shows 3+ blood, trace protein, too numerous to count erythrocytes, and no casts. Streptococcal rapid antigen test is negative.
What is the next step in management?
Clinical observation
Who directed the 2017 film Get Out?
Jordan Peele
A 36-year-old woman is evaluated for abdominal pain and diarrhea. She has a 3-year history of ankylosing spondylitis. For the past 6 months, she has had four or five bowel movements daily and over the past month she has experienced unintentional weight loss of 3 kg (6.6 lb). The abdominal pain is poorly localized and unrelated to defecation. Stools are loose but not greasy, mucoid, or bloody. She has been taking naproxen twice daily, with good control of her ankylosing spondylitis. She reports no recent travel or antibiotic therapy. She has no other medical problems and takes no additional medications.
On physical examination, vital signs are normal. There is mild nonlocalizing abdominal tenderness. Range of motion of cervical and lumbar spine is normal. Sacroiliac joints are not tender.
What is the likely diagnosis?
IBD
A 28-year-old woman is seen for pregnancy planning. She underwent mitral valve replacement with a mechanical prosthesis 4 years ago for congenital mitral valve stenosis. She is asymptomatic. Medications are warfarin, 4 mg/d, and low-dose aspirin. Her INR measurements have been within the therapeutic range for the past 18 months, including her most recent INR measurement of 3.0.
Other than a mechanical-sounding S1, vital signs and all physical examination findings are normal.
Echocardiography shows a normally functioning mitral valve prosthesis and normal left ventricular function and estimated pulmonary artery pressure.
The patient would like to attempt pregnancy as soon as possible. During this time, aspirin will be continued.
What is the most appropriate anticoagulation strategy during the first trimester?
Continue warfarin
Cupid has what name in Greek mythology?
Eros
A 28-year-old woman seeks preconception counseling. She has a 3-year history of primary hypertension. Medical history is otherwise unremarkable, and her only medication is ramipril.
On physical examination, blood pressure is 138/78 mm Hg. Average blood pressure with home blood pressure monitoring is 136/72 mm Hg. Other vital signs are normal. BMI is 30. The remainder of the examination is normal.
Previous evaluation revealed no evidence of retinopathy, left ventricular hypertrophy, or kidney disease.
What is the next step in management?
Discontinue ramipril, start labetalol
What is the name of the serial killer in the film The Silence of The Lambs?
Buffalo Bill
A 43-year-old woman is evaluated for fibromyalgia. She continues to be symptomatic with poor sleep quality and diffuse stiffness despite her participation in cognitive behavioral therapy, land and aquatic therapy, and tai chi. She also has depression, treated with escitalopram.
On physical examination, vital signs are normal. There is tenderness at multiple soft-tissue sites with soft palpation. All other findings are normal.
What medication would you want to prescribe next?
Pregabalin
A 54-year-old man is evaluated for an 8-week history of postprandial, gnawing, epigastric abdominal pain after every meal. Pain begins 30 minutes after eating, persists for 1 hour, and gradually resolves. He has had an associated 4.5-kg (9.9-lb) weight loss. He has hypertension, coronary artery disease, and peripheral vascular disease. Current medications are aspirin, atorvastatin, lisinopril, and metoprolol.
Vital signs are normal. BMI is 24. Physical examination reveals epigastric tenderness and an abdominal bruit.
Upper endoscopy findings are normal.
What is the most appropriate diagnostic test to perform next?
CT mesenteric angiography
After candy, what's the most popular gift consumers give on Valentine's Day?
Greeting cards
A 74-year-old woman is evaluated during a follow-up visit for hypertension and slowly progressive chronic kidney disease. She reports that she feels well and has no symptoms. Medications are atenolol, cholecalciferol, hydralazine, nifedipine, simvastatin, and sodium bicarbonate.
On physical examination, blood pressure is 130/70 mm Hg; other vital signs are normal. The remainder of the examination is unremarkable.
Laboratory studies show an estimated glomerular filtration rate of 28 mL/min/1.73 m2.
What is the next step in management?
Renal replacement therapy education
Which of these Disney movies was released first: Pocahontas, Mulan, The Lion King, or Toy Story?
The Lion King
A 32-year-old man is evaluated for low back pain of 6 months' duration. He experiences back pain at night and back pain and stiffness in the morning for more than 30 minutes. He feels less back pain when he exercises. He had an episode of left Achilles tendinitis 4 months ago and continues to have some pain and swelling at the Achilles insertion.
On physical examination, vital signs are normal. Peripheral joints are normal. Lumbar spine flexion is limited, and hip flexion, abduction, and external rotation cause discomfort in the buttocks bilaterally.
Laboratory evaluation reveals normal erythrocyte sedimentation rate and blood C-reactive protein level.
Anteroposterior pelvic radiograph shows no evidence of sacroiliitis.
What is the most appropriate diagnostic test to perform next?
Before he was the frontman for Foo Fighters, Dave Grohl was the drummer for which band?
Nirvana
From where was the oldest-known Valentine's Day message sent?
Prison
A 38-year-old woman seeks treatment for polyuria and nocturia that began 6 weeks ago after starting lithium for bipolar disorder. Medical history is otherwise unremarkable. Her only other medication is olanzapine.
Physical examination findings, including vital signs, are normal.
Laboratory studies show a serum sodium level of 145 mEq/L (145 mmol/L) and a urine osmolality of 200 mOsm/kg H2O.
What is the next step in management?
Add amiloride
Phil, Stu, and Alan spend all of The Hangover looking for their friend Doug. Where do they eventually find him?
On the roof
A 23-year-old man is evaluated for fever, abdominal pain, rash, and arthritis of the right knee of 3 days' duration that resolved 1 week ago. He has had more than 20 similar episodes, the last three occurring in the past year. The first episode occurred at age 5 years and presented as abdominal pain; the patient underwent appendectomy but no appendicitis was found. His paternal grandfather and maternal grandmother had a similar syndrome.
Physical examination findings, including vital signs, are normal.
Laboratory evaluation shows an erythrocyte sedimentation rate of 23 mm/h, a normal serum creatinine level, and 1+ protein on urinalysis.
What is the most appropriate treatment?
Colchicine
What is Rihanna’s real name?
Robin Fenty