Environmental and Nutritional DiseasesCase 1A 22-year-old man presents with a 2-week history of malaise, headaches, nausea, and crampingabdominal pain. His relatives noted that he has been lethargic for one week. He had been workingas painter in a condominium construction for the last six months. On physical examination, he wasnoted to be pale and exhibited no neurological and intellectual impairment. Laboratoryexaminations were requested.Complete Blood Count:Reference Range Result Unit4.2 – 5.4 RBC count 4.0 X1012/L120 – 160 Hemoglobin 96 G/L0.36 – 0.47 Hematocrit .32 Vol%80.0 – 96.0 MCV 85.7 fL27.0 – 31.0 MCH 28.5 pg32.0 – 36.0 MCHC 31.4 %11.6 – 14.6 RDW 17.0150-450 Platelet count 300 X109/L5.0 – 10.0 WBC 6.0 X109/LDifferential count0.50 – 0.70 Neutrophil 0.670.2 – 0.5 Lymphocytes 0.230.0 – 0.06 Eosinophil 0.030.02 – 0.09 Monocytes 0.060.0 – 0.02 Basophil 0.01Stab cellsNRBC 2 /100WBC291. What are the possible differential diagnoses of this patient based on history, clinicalpresentation, and laboratory results? Give at least three and explain the possibility of each.2. Among the differentials you have given, what is the most likely diagnosis?3. What tests will you request to confirm your diagnosis?4. What is the pathophysiology of your final diagnosis?5. What are the possible morphologic changes in the organs of this patient?

Sodium 136 mEq/LPotassium 2.6 mEq/LChloride 93 mEq/LBicarbonate 34 mEq/LBlood urea nitrogen 9 mg/dLCreatinine 0.8 mg/dLGlucose 150 mg/dL (non-fasting)Magnesium 0.6 mEq/L Arterial blood gas  pH 7.50  PaO2 95 mmHg  PaCO2 48 mmHg Urine studies show high levels of potassium and chloride, and low levels of calcium. Which of the following conditions would produce similar findings to this patient's disease?

A 21-year-old female from Southeast Asia has been staying with family members in the United States for the last 3 months presents to the emergency department of a local hospital. She reports feeling very tired for the last month, has a poor appetite, and has lost weight. The patient has been feeling somewhat better lately except for a cough that produces a greenish sputum, sometimes specked with blood. With the exception of rales in the left upper lobe, the physical examination is unremarkable and she does not seem to be acutely ill. Laboratory values show a white blood count of 12,000/μL and a hematocrit of 33%. Chest x-ray film reveals an infiltrate in the left upper lobe with a possible cavity. A Gram-stained smear of the sputum shows mixed flora with no dominance. An acid-fast stain reveals many thin rods of pinkish hue. A preliminary diagnosis is made of pulmonary tuberculosis. Sputum is sent to the laboratory for culture. Which drug regimen should be initiated in this patient when treatment is started?Group of answer choicesAmikacin, isoniazid, pyrazinamide, streptomycinCiprofloxacin, isoniazid, linezolid, pretomanidIsoniazid, moxifloxacin, pyrazinamide , rifapentinePyrazinamide, isoniazid, rifampin, streptomycinPyridoxine, pyrazinamide, rifabutin, streptomycin

A 45-year-old Caucasian man is referred for further workup of chronic abdominal pain and diarrhea. These symptoms have been present for 2 months, and he has lost 10 kg of weight over this time. He also reports that he has developed pain in multiple joints that comes and goes and seems to spread from one joint to the next. He denies fevers, chills, chest pain, shortness of breath, vomiting, episodes of constipation, or hematochezia. He is married and works as a farmer, with no recent sick contacts or travel. His vitals are within normal limits, and his examination is unremarkable. A complete laboratory workup is unremarkable. He undergoes a colonoscopy, which is normal, and then undergoes an upper endoscopy. Biopsy of the small intestine shows many macrophages within the lamina propria that stain positive with periodic acid-Schiff (PAS). Which of the following is likely to cure this patient of his chronic diarrhea?Ask StudybuddyGroup of answer choicesCorticosteroidsAntibioticsRadioiodineDietary changesAntiretrovirals

A 49-year-old man presents for routine physical examination. The patient has no active complaints today other than occasional constipation and increased frequency of urination. The patient reports that he has a diagnosis of “pre-diabetes” given to him by his previous physician in another city. His family history is significant for hypertension. The patient denies alcohol or drug use and works as a long-distance truck driver. Physical examination is unremarkable except for a body mass index of 31 kg/m2. The patient's fasting laboratory values reveal the following.Hemoglobin A1c 7.9%Serum glucose 170 mg/dLTotal cholesterol 220 mg/dLLow-density lipoprotein (LDL) 145 mg/dLTriglycerides 130 mg/dLHigh-density lipoprotein 38 mg/dL Which of the following is the best next step in the management of this patient?Ask StudybuddyGroup of answer choicesSulfonylureaLifestyle modificationNiacin, fish oil, and lifestyle modificationAtorvastatin and lifestyle modification

A 48-year-old man felt drowsy. He was alone at home on a warm Australia Day long weekend. He collapsed in the backyard and was fortunately discovered by his son later. He was sent to the Emergency department. His blood biochemical results are:Analyte (SERUM)ResultReference intervalSodium158135 – 145 mmol/LPotassium5.53.5 – 5.5 mmol/LChloride11895 – 110 mmol/LBicarbonate2922 – 32 mmol/LFasting glucose3.83.6 – 5.5 mmol/L* Note: Urine osmolality is normalWhat is the likely reason explaining his high sodium result?Group of answer choicesExcessive loss of body fluidDiabetes insipidusOsmotic diuresis due to diabetes mellitusAddison’s disease