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A heel pad of dense connective tissue braces the toes and largely supports the weight of the animal. An adaption allowing the efficient support of great weight, the long access of the pelvic girdle is nearly at right angle to the vertebral column comment and the acetabulum faces venterally.

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A 14-year-old girl is brought to the physician by her mother for evaluation of several bruises on her lower extremities. She has had these bruises for about 6 weeks, and the mother is concerned that she might be bullied at school. The patient has had increasing fatigue and paleness over the past several days. She has a history of recurrent generalized tonic-clonic seizures treated with carbamazepine. She appears pale and ill. Her temperature is 37.8°C (100.1°F), pulse is 115/min, and blood pressure is 100/60 mm Hg. The lungs are clear to auscultation. Examination shows a soft, nontender abdomen with no organomegaly. There are several subcutaneous purple spots on her legs bilaterally. Her hemoglobin concentration is 8.4 g/dL, leukocyte count is 2,600/mm3, platelet count is 18,000/mm3, and reticulocyte count is 0.3%. Serum electrolyte concentrations are within normal limits. Which of the following is the most likely underlying cause of this patient's symptoms?

Three days after undergoing an open cholecystectomy, a 73-year-old man has fever and abdominal pain. He has hypertension, type 2 diabetes mellitus, chronic obstructive pulmonary disease, and benign prostatic hyperplasia. He had smoked one pack of cigarettes daily for 40 years but quit 1 year ago. He does not drink alcohol. Prior to admission to the hospital, his medications included lisinopril, metformin, ipratropium, and tamsulosin. He appears acutely ill and lethargic. His temperature is 39.5°C (103.1°F), pulse is 108/min, respirations are 18/min, and blood pressure is 110/84 mm Hg. He is oriented only to person. Examination shows a 10-cm subcostal incision that appears dry and non-erythematous. Scattered expiratory wheezing is heard throughout both lung fields. His abdomen is distended with tenderness to palpation over the lower quadrants. Laboratory studies show:Hemoglobin 10.1 g/dlLeukocyte count 19,000/mm3Serum Glucose 180 mg/dlUrea Nitrogen 25 mg/dlCreatinine 1.2 g/dlLactic acid 2.5 mEq/L (N = 0.5 - 2.2 mEq/L)Urine Protein 1+RBC 1-2/hpfWBC 32-38/hpfWhich of the following is the most likely underlying mechanism of this patient's current condition?

A 2-year-old boy is brought to the physician for evaluation of pallor and increasing lethargy for 2 days. One week ago, he experienced abdominal pain, vomiting, and bloody diarrhea that have since subsided. The patient's father states that they returned early from a 6-week roadtrip in Mexico because of these symptoms. His parents have been giving him oral rehydration solution. His immunizations are up-to-date. He appears pale. His temperature is 38.4°C (101.1°F), pulse is 130/min, respirations are 35/min, and blood pressure is 95/50 mm Hg. Examination shows scleral icterus. The abdomen is soft and nontender; there is no rebound or guarding. Bowel sounds are hyperactive. The remainder of the examination shows no abnormalities. Laboratory studies show:Hemoglobin 8.5 g/dLMean corpuscular volume 94 μm3Leukocyte count 18,000/mm3Platelet count 45,000/mm3Prothrombin time 12 secPartial thromboplastin time 34 secSerum Urea nitrogen 28 mg/dLCreatinine 1.6 mg/dLBilirubin Total 2.5 mg/dLDirect 0.1 mg/dLLactate dehydrogenase 1658 U/LA blood smear shows schistocytes. Which of the following is the most likely diagnosis?

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