Exam Irregularities

This patient has the subjective symptoms of weight loss, decreased appetite, shortness of breath, and cough. Abnormal laboratory values include elevated temperature, decreased hemoglobin and hematocrit, and decreased CD4 count. Chest x-ray shows diffuse interstitial infiltrates bilaterally. Physical exam reveals thrush. The assessment is possible AIDS with CD4 count of 150 cells/mm3, thrush, a respiratory illness (possibly Pneumocystis jiroveci pneumonia), and anemia of chronic disease. He also has a history of hepatitis B, hypertension, and GERD (on famotidine), poor adherence to his anti hypertensive medications, and likely has an irregular daily regimen due to his occupation as a truck driver. 

Get a copy of this announcement. Often your public library will have a copy, or you can get one directly from the fire department, city human resources department, or from the Internet. If exams are held irregularly, the fire or personnel department may maintain a mailing list so that you can receive an exam announcement the next time an exam is scheduled. If exams are held frequently, you will sometimes be told to simply show up at the exam site on a given day of the week or month. In those cases you usually get more information about the job and the selection process if you pass the written exam. Study the exam announcement, as well as any other material, such as brochures, that the department sends you. You need to be prepared for the whole selection process to be successful. 

A 41-year-old female presented to her primary medical doctor with a chief complaint of insomnia and nervousness worsening over the past several months. Since her last gynocologic exam, which was normal, she has experienced irregular menstrual cycles. She described her job as stressful and attributed some of the nervousness to her job. 

The esophagus is a hollow organ and may appear collapsed on routine CT. Its non-distended wall, even if normal, may appear thickened, nodular and irregular, thus simulating a tumor. Furthermore, it is difficult to judge the superior and inferior extent of esophageal tumors on standard CT exams (Lyang and Chan 1996). 

---