AF is a 55 yo female forensic chemist who has always taken pride in her healthy lifestyle. She has exercised regularly all her life, and enjoys sports such as tennis, bicycling and strenuous hiking.

BJ is a 58 yo woman how is undergoing the novel method of transesophageal echocardiography in preparation for use in determining the correct placement of a central vein catheter for long-term parenteral nutrition.

GM is a 62-year-old architect who has been diagnosed with stage III ovarian cancer. She underwent surgical ovarian debulking and is now about to begin an aggressive chemotherapeutic regimen.

KK is a 42 yo Brazilian-born executive who works for Ronald Stump, an internationally famous investments mogul and entrepreneur who mentors (and generously rewards) go-getters like KK.

BL is a 71 yo financial advisor on vacation on the gulf coast with his wife of 47 years. It’s been a therapeutic get-away, especially for Mrs. BL who lost her central vision to exudative macular degeneration 18 months ago.

BZ is shows up at the hospital where you work. He is a 30 yo computer jock who works for one of the high tech internet companies. He has no history of any health related problems but today he reports that he has been coming in from playing basketball on the company grounds feeling dizzy and thinking he was going to faint.

FP is a 63 yo physician practicing in a rural, sparsely populated county in northeast Arkansas. While he works two days a week out of a clinic in one of his county’s larger communities, he is on the road the other three days, often driving long distances to see patients who live in the more remote areas.

LM is a 73-year-old man who retired 8 years ago from his job at the downtown public library. Until a few weeks ago, his daily routine consisted of spending the morning with his wife and then taking the bus downtown to his old stomping grounds (he no longer drives an automobile owing to poor eyesight).

NL is an 84 yo female who had to move to a retirement community after losing her husband to prolonged battle with cancer. She desperately misses her home and the life they shared there, and the move was made all the more devastating because of the need to find good homes for their beloved cats.

Your neighbor, GY, is the 67-year-old patriarch of a large and gregarious family with an unfortunate history of cardiovascular disease. GY is 5’10” and weighs 240 pounds. He is a smoker, and spends most of his life relaxing on the deck of his Sarasota, FL beach home.

BB, a 27-year-old, male attorney, was diagnosed with the HIV virus last year and is currently asymptomatic. He is undergoing treatment with zidovudine (100 mg q4h).

BJ is a Las Vegas blackjack dealer. He is a 38-year-old Caucasian man who has mild intermittent asthma treated with inhaled albuterol for occasional exacerbations. He works nights and sleeps during the day.

FP is a 77-year-old recovering alcoholic who has lived and worked for the past few years with the indigent in a depressed area of Los Angeles. He helps run a soup kitchen and homeless shelter, and is involved in the management of a neighborhood “free clinic” to provide basic health care services to this population.

KG is a 73 yo single retired bank executive living in Paris who is in the early stages of Alzheimer’s Disease. She began therapy with tacrine HCl four months ago (Cognex, currently taking 20 mg four times a day) and it seems to be halting the advancement of dementia.

MN is a 52-year-old driven and highly successful entrepreneur from Ohio who, seeking warmer climes for his retirement, plans to establish a sailing business in the U.S. Virgin Islands.

MR is an 87 yo widowed female living in a facility designed for healthy seniors capable of independent care. An unusually cold and harsh winter has curtailed the number of field trips and outings that could be planned, but the Activities Director has engaged the residents in many popular indoor events, such as line-dancing, “chairobics” exercise sessions, board games and musical entertainment.

NW is a 27-year-old male who married his childhood sweetheart 2 years ago and moved to Vermont to open a bed and breakfast. They love each other very much, but are having some difficulties owing to NW's lack of interest in sexual relations.

PQ is a 45 yo mother of 4 healthy young children. He husband died suddenly 6 months ago from a heart attack. PQ’s husband was a patent lawyer and left her and the children in an adequate financial state.

VR, a 45-year-old, white female, finally achieved a life-long desire to visit Africa and go on Safari. A month after she returned to the States, VR complained of anorexia, headache, and fatigue that were followed by paroxysms of fever, chills, and rigor.

You are moonlighting at a local hospital inpatient pharmacy when JB, a 37-year-old nightclub owner, is rushed in to the emergency room (ER), unconscious, unresponsive, and breathing shallowly. JB is a locally well-known wheeler-dealer who lives in the fast lane of life, drinks heavily, and has even been arrested once for distributing cocaine and heroin to his cronies in the back room of his club.

You often eat lunch with your favorite grandma who is 85 years old and generally in good health except for infrequent bouts of gout. Over the last couple of years when you meet with her you have noticed that she has been gaining weight around her middle and that her legs and ankles seem to be puffy.

BB is a 78 yo holy man living on the Apache reservation in western Arizona. Like too many of his heritage, he is diabetic, and the limited formulary at the reservation’s health center provides him with tolbutamide to control his blood sugar levels.

Dr. IG is an endocrinologist with a 27-year-old, female patient who has just become pregnant. The patient was diagnosed with Grave disease about 6 months ago and is currently undergoing antithyroid therapy with methimazole (drug 1).

FC is a 28-year-old woman with a history of anorexia and bulimia. She was in therapy for these serious eating disorders until she finished high school and was then a member of a bulimia support group during college, but she has not seen a counselor for almost 6 years.

GB is a bright 76-year-old female who complains to her doctor that recently her bones ache terribly, especially in the morning. She states that she has always had “good bones” and has faithfully taken calcium supplements in the form of chocolate chews (calcium carbonate).

JM is a 56-year-old female who works the counter at a neighborhood diner that specializes in really good cheeseburgers, fries, malts, and homemade pies. Moderately obese, JM knows she shouldn't eat lunch at the diner every day, but she just can't seem to help herself.

PB is your favorite grandma and you are her favorite grandchild. She is 78 yo this weekend and you are visiting her at the nursing home where they are celebrating her birthday with a small party.

ST is a 68 yo female who traded in her stressful job as an academic administrator at a major academic health center for the relaxed life of Southern California. Heading to “wine country” with her cats, retirement funds and a few family heirlooms, she purposefully sought a new life, making new friends and doing the things she loves most.

WH.-L is a 62 yo Beijing-born scientist attending an international scientific meeting in your hometown. While delivering his groundbreaking paper on the neuroprotective action of some unique bicyclic molecules he has synthesized, he experienced a very rapid and irregular heart rate followed by a tight, gripping pain in his chest.

Your 92-year-old great uncle, BC, was just diagnosed with early stages of Alzheimer’s disease. Yesterday, you started him on donepezil (Aricept, 1) as prescribed by the gerontologist.

JG is a 48-year-old, itinerant farm worker. Ten years ago he was diagnosed with Type 2 DM and until recently, his blood glucose has been controlled with the rarely prescribed, acetohexamide (Compound 1).

KG is a 5-year-old boy who was recently diagnosed with juvenile arthritis. His physician placed him on tolmetin sodium (15 mg/kg/day in three divided doses) 4 weeks ago, which he is tolerating well, and is now planning to add a disease-modifying antirheumatic agent to the regimen.

OP is a 72-year-old, white female who is recovering from a hip fracture sustained during a square dance lesson at the assisted-living facility where you are the consultant pharmacist.

RK is a 26-year-old female who works at a popular roadside restaurant in Kualapuu, Molokai (Hawaii). She spent her childhood and young adulthood in the Kalaupapa leper colony located on the island with her father, who was a missionary in service of the Methodist church.

A young male patient, BO, will undergo surgery to repair torn ligaments in his left knee. The knee injury was the result of a rough game of intramural “touch football” as part of the fraternity competition at his university.

BK is a 25-year-old white female who is trying to make it in the world of stand-up comedy. She's been playing comedy clubs up and down the East Coast for a couple of years and has found the crowds to be somewhat ruthless when they think she's not sufficiently funny.

GM is a 38-year-old mildly obese black, diabetic male who is the CEO of a new and rapidly growing internet-based marketing firm. His hyperglycemia is being controlled moderately well with glipizide, although he has experienced a few hyperglycemic episodes over the past year.

HL is a 55-year-old plumber who has been diagnosed with advanced intermediate-grade non-Hodgkin lymphoma. He had recently recovered from a prolonged and severe viral infection, which may have been a factor in the development of this neoplastic disease.

HT, a white, 59-year-old male was diagnosed with idiopathic Parkinsonism 6 months ago. He complains to you that his medicine (Laradopa; L-dopa, Compound 1) no longer controls the tremor in his left hand.

LV, a 65-year-old male, ingested what was described as a large quantity of d-CON Mouse Prufe II rodenticide (0.005% brodifacoum) in a suicidal gesture. He told his wife of the ingestion 6 hr later, and she immediately called 911.

Ms. PU comes to the prescription counter and asks to speak to the pharmacist. She is carrying her 2-year-old son in her arms and appears to be mildly distressed.

ST is a 36-year-old female with a history of depression. ST’s life has never been stable (she even spent a few years on the streets), but she has been living with her brother and his family for the past three years.

YH, a 29 yo white prostitute who works the downtown district, visits the free clinic where you volunteer time. YH is new to town and very nervous about coming to the clinic, as she does not yet know whom she can trust.

ZF, a 57-year-old, semi-retired male librarian, has been suffering with recurrent herpes simplex keratitis in his left eye for several years. Until recently, the epithelial eruptions have been controlled by topical application of vidarabine into the lower conjunctival sac 5 times/day at 3-hour intervals.

AF is a 64-year-old retired schoolteacher who has been battling debilitating rheumatoid arthritis (RA) for several years. Unfortunately, she has been nonresponsive to several different nonsteroidal anti-inflammatory drug s (NSAIDs), including the cyclooxygenase 2 (COX-2) selective ones.

BK is a 29-year-old, female weight lifter who is in training for a regional competition that will take place in 4 months. A patient at your full-service pharmacy for several years, she is healthy and usually is in only to stock up on herbal products, vitamins, nutritional supplements, and to get her Rx oral contraceptives (Demulen which contains 35 µg ethinyl estradiol and 1 mg ethynodiol diacetate).

DL is a 43-year-old recovering drug addict who, until recently, was living on the streets of New York. He came from a loving and religious home, however, and responded to the call of a socially conscious church coalition to enter rehabilitation.

GK is a 32-year-old Japanese-American mother of three children under the age of 7. She holds down a part-time job as a filing clerk at a busy law office but is always home to meet her children after school.

JB, the notorious high-living nightclub owner from the Case Study 1, has recovered from his heroin overdose, thanks to your sound application of opioid SAR to rescue him from himself. Unfortunately, he has not followed your advice and has continued to drink and abuse heroin.

JR, a 7-year-old Hispanic boy with a history of two episodes of bronchiolitis as an infant, is having trouble keeping up with his playmates at the playground at school. His teachers say he tires easily and seems to run out of breath much sooner than his friends.

LR is a 33 years old Wall Street stockbroker who works the floor from the moment the market opens until it closes. When not shouting and jockeying with his fellow brokers, LR puts in time in his Manhattan office, studying financial projections for stocks and talking to his firm's analysts.

PJ, a drug abuser, arrives at the emergency room where you are doing your rotation. He is complaining of chest pains, light headedness, and a sense of panic and he demonstrates profuse sweating.

Two days ago HW, a 64-year-old white male postal worker, was brought unconscious to the emergency room (ER) of the hospital where you work. His wife told the ER physician that they were spending their usual Wednesday night at home watching Law & Order on television when HW, who had been complaining of a bad headache and stiff neck ever since he got home, suddenly passed out.

You are one of the lucky few students to draw the police forensic laboratory as one of your elective rotations. On your second day there, you get into a discussion about “designer drugs” with one of the analytical chemists.

GB is a 75-year-old male, who sustained a severe hip injury while bone-fish fishing off the Florida Keys. He is presently in the hospital where you are the chief pharmacist and will be undergoing hip repair surgery requiring general anesthesia.

GG shows up at the diabetes clinic where you work. She is a 68-year-old Native American and her patient profile indicates that she has had Type 2 DM since the age of 45.

JB has recovered from the injuries sustained in his car accident and is about to enter a court-ordered rehabilitation program. He is willing to try recovery but fearful of relapse because his addiction is of long standing and he doesn't quite know how he'll function without access to heroin.

Dr. B. B. Orbius calls your pharmacy and requests your help in choosing a cholinesterase inhibitor. His patient, KR, is an 80-year-old handicapped female residing in an assisted-living facility.

HB is a hypertensive female music professor who plays first oboe in the “Town & Gown” orchestra at her university. A smoker for 39 of her 53 years, she is starting to have trouble with breath control when playing, and finds herself increasingly out of breath when climbing stairs or engaging in strenuous physical activity.

JM is a 56-year-old hairdresser who suffers from rheumatoid arthritis (RA). Early in the course of her disease, her symptoms were well controlled with aspirin; but lately she has been experiencing salicylate-resistant stiffness, swelling, and pain.

KB is a 71-year-old patriarch of a family that farms in central Iowa. He was recently diagnosed with carcinoma in situ (CIS) of the bladder, and his physician has placed him on the cisplatin, methotrexate, vincristine (CMV) regimen.

TLH is a 35-year-old, full-blooded, female member of the Navajo tribe. An artisan, she lives and works outside of Taos, New Mexico, and spends her days making and selling jewelry in a silver and turquoise shop.

VL, a 52-year-old, black, female TV news anchorwoman has developed early signs of Parkinsonism. They include infrequent blinking, poverty of movement, a slight shuffling gait but most disturbing for her career are her loss of voice volume and diminished facial expression.

Your neighbor, a physician who regularly contributes his time and expertise to the humanitarian medical group Doctors Without Borders is having dinner at your home. He is telling about his experience treating patients affected by the civil conflict in Iraq and challenges you to solve a therapeutic problem he had faced.

KT is a 31-year-old nurse who works in the pediatric intensive care unit of the hospital where you are chief pharmacist. The nursing staff is extremely short handed; and despite recovering from a rather bad cold, KT has been working double shifts to care for the heavy patient load.

Mrs. VG, an octogenarian widow who frequents the pharmacy where you intern, tells you that some of her neighbors have got the grippe, and she's starting to feel a little achy herself.

SN is a 23-year-old female who is in her dermatologist's office to have four rather deep plantar warts removed from the heel of her right foot. The procedure is painful, and the area must be numbed by an injection of a local anesthetic before wart removal can begin.

CW is a 38 year old hot-head who's currently doing a 7–10 year stretch at the Texas State Penitentiary for viciously assaulting his brother-in-law with a frozen tuna after an oil field development deal turned sour.

MD is a 45-year-old white female who will be undergoing a lumpectomy to remove a malignancy in her right breast. MD has a history of reconstructive knee surgeries, which have left her with one kidney as a result of the large doses of cephalosporins she was administered to control postoperative infections.

RP is a 45 yo Caucasian male whose increasingly impulsive, agitated and antisocial behaviors have culminated in a diagnosis of schizophrenia. This is a particularly difficult situation given that, for the past several years, he has been exhibiting symptoms of Parkinson’s Disease, with gait and balance being his most adversely affected abilities.

You are a 25-year-old, 2nd-year pharmacy student working two jobs trying to put yourself through school. Last weekend you strained a muscle in your lower back unloading a truck of stock for the pharmacy at which you work as an intern.

BB is a 58 yo divorced woman who owns her own travel agency. She has a family history of alcoholism and that coupled with the social nature and constant pressures of her job led BB to become an alcoholic.

CB is a 57 yo female independent real estate agent with mild persistent asthma who has recently moved to your community after a traumatic break-up of her 25 year marriage and the death of her beloved mother.

PB, the 36-year-old wife of recovering heroin addict JB, is about to deliver their baby. This will be their first child because PB and JB have had trouble conceiving and PB suffered two early miscarriages during previous pregnancies.

RO, a 24-year-old accountant, has joined his neighborhood gym to enhance his fitness level and lower his stress. His routine is to swim 30 laps; then take an aerobics class; and if a partner is available, play a little fast-action racquetball.

HP is a 23-year-old woman who works as a toll taker at the Bay Bridge tunnel. She complains of constant thirst, frequent urination, and the loss of almost 30 lb in the last month in spite of her continued good appetite.

You are working the late shift on Saturday night at your local supermarket pharmacy. JG, the pharmacology lab technician from your school, asks you about the relative merits of OTC eye drops for his congested and red eyes.

Theophylline has an average clearance of 2.8 L/hr and volume of distribution of 35 L. The therapeutic window is known to be between 10 mg/L and 20 mg/L. Theophylline can be administered as a constant rate infusion.

A drug (400 mg) is given as a multiple-dose oral treatment. The drug is completely absorbed. The clearance is 20 L/hr and the volume of distribution is 50 L. The absorption rate constant is 2.5 hr-1.

Compare the following two pharmacokinetic profiles: Case A: A hepatically cleared high-extraction drug (400 mg) is given as an oral tablet. The absorption is very rapid and approximates a bolus input.

Phenytoin is a drug with nonlinear pharmacokinetics which can be described using Michaelis-Mentin kinetics. Assume the following pharmacokinetic parameters for phenytoin after oral administration: V = 45 L, Km = 4 mg/L, Vm = 20 mg/hr, ka = 1 hr-1, F = 1

A drug that follows a two-compartment model has the following pharmacokinetic microconstants: k10 = 0.5 hr-1, k12 = 1 hr-1, k21 = 2 hr-1, V1 = 25 L.

Compare the pharmacokinetic profiles of two drugs after intravenous bolus injection and after constant rate infusion. Both drugs have a clearance of 20 L/hr, and volumes of distribution of V1 = 50 L and V2 = 100 L.

A drug that follows a two-compartment model (CL = 80 L/hr, V1 = 50 L, V2 = 200 L, k21 = 0.6 hr-1) is given orally at a dose of 400 mg in to different dosage forms. Tablet A has a rapid drug release and absorption (ka = 3 hr-1).

(1) Compare the concentration-effect relationships for two drugs with Hill factors of ?=1 and C50 values of 10 and 100 mg/L. (2) Compare the concentration-effect relationship for two drugs with the same C50 value (10 mg/L) and Hill factors of ?=1 and ?=2.

A drug (400 mg) is given as an intravenous bolus. The clearance is 10 L/hr and the volume of distribution is 50 L. Assume a one-compartment body model.

A hepatically eliminated drug (400 mg) is given as an intravenous bolus. The intrinsic clearance (CLint) is 200 L/hr. Liver blood flow is 90 L/hr, and plasma and tissue water volumes are 3 L and 39 L, respectively. Both plasma protein binding and tissue binding are 90%.

A hepatically cleared high-extraction drug (800 mg) is given as an intravenous bolus. The intrinsic clearance is 4000 L/hr and the protein binding in plasma and tissues is 80%. Assume blood and tissue water volumes of 5 and 39 L and a liver blood flow of 90 L/hr.

A drug (400 mg) is given as an oral tablet. The drug is completely absorbed. The clearance is 15 L/hr and the volume of distribution is 40 L. The absorption rate constant is 2.5 hr-1.

A hepatically cleared high-extraction drug (400 mg) is given as an oral tablet. The absorption is very rapid and approximates a bolus input. The intrinsic clearance is 5000 L/hr and the plasma protein and tissue binding are 80% and 98%, respectively. Assume blood and tissue water volumes of 5 and 39 L and a liver blood flow of 90 L/hr.

A drug with CL = 20 L/hr and V = 50 L is given orally to two different patients A and B. The dose of 400 mg is completely absorbed, however A takes the tablet with a meal (ka = 0.1 hr-1) whereas B takes it on an empty stomach (ka = 0.5 hr-1). Furthermore, A is more sensitive to the drug (C50 of 5 mg/L vs. 10 mg/L for B).

Theophylline has an average clearance of 2.8 L/hr and volume of distribution of 35 L. The therapeutic window is known to be between 10 mg/L and 20 mg/L. Immediate release oral theophylline products have a rapid absorption (ka = 3 hr-1).

A 16-year-old boy arrives in a Texas hospital emergency room in a semiconscious state. He was transported there after collapsing during football practice.

A previously healthy 30-year-old man notices difficulty completing his usual exercise routine over the last 2 weeks because of excessive fatigue during the workout.

An 18-month-old boy, with a high fever and cough and with a history of frequent infections, is brought to the emergency department by his father. A blood examination shows elevated numbers of neutrophils but no other defects.

A 15-year-old girl sees her family physician for a routine school athletic physical. Upon routine examination, her physician detects a reasonably loud systolic murmur when placing her stethoscope parasternally around the second and third intercostal spaces, but her physical exam is otherwise unremarkable.

An 8-year-old girl was diagnosed with type 1 diabetes. Nausea and vomiting, symptoms of ketoacidosis, which is not uncommon, were accompanied by polyuria, polydipsia, polyphagia, weight loss, and blurred vision.

Recovering from a heart attack and fighting pneumonia, a 65-year-old Vietnam veteran was transferred from the VA hospital to the university hospital to be evaluated for surgery to repair his blocked arteries.

A 6-year-old boy is brought to the pediatrician by his mother because of a puffy face and lethargy. A few weeks before, he had an upper respiratory tract infection, probably caused by a virus.

A previously healthy girl presented at age 10 years with anorexia, abdominal distention, abdominal pain, vomiting, and severe constipation that failed to respond to large doses of laxatives.

It was mid-August in San Antonio, another week of consecutive greater than 90°F days with high humidity.

A 20-year-old male patient presented with lack of sexual development. On examination, he was eunuchoidal and hypogonadal, and olfactory function testing showed he was anosmic.

Al Martini, a 44-year-old male who has been an alcoholic for the past 5 years, has a markedly diminished appetite for food.

Amanda Tin (amanitin) picked mushrooms in a wooded area near her home. A few hours after eating one small mushroom, she experienced mild nausea and diarrhea.

Amy Biasis (“amoebiasis”), a 23-year-old missionary, was brought to the hospital emergency room complaining of the abrupt onset of fever, chills, and severe pain in the right upper quadrant of her abdomen.

Amy Lloyd (“amyloid”) is a 62-year-old woman who presents with weakness, fatigue, an enlarged tongue (macroglossia), and edema.

Anne Jeina is a 54-year-old woman who arrived in the hospital 4 days ago, approximately 5 hours after she began to feel chest pain.

Ann O’Rexia is a 23-year-old buyer for a woman’s clothing store. Despite the fact that she is 5 feet 7 inches tall and weighs 99 lb, she is convinced she is overweight.

Ann Sulin returned to her physician for her monthly office visit. She has been seeing her physician for over a year due to obesity and elevated blood glucose levels.

Anne Niemick is a 4-year-old girl of Mediterranean ancestry whose height and body weight are below the 20th percentile for girls of her age.

Arlyn Foma, a 68-year old male, complained of fatigue, loss of appetite, and a low grade fever. An open biopsy of a lymph node revealed the presence of non-Hodgkin’s lymphoma, follicular type

Bea Selmass is a 46-year-old woman who 6 months earlier began noting episodes of fatigue and confusion as she finished her daily pre-breakfast jog.

Bea Twelvlow, a 75 year old female, went to see her physician due to a numbness and tingling in her arms and legs. A dietary history indicated a normal and healthy diet but Bea was not taking any supplemental vitamin pills.

Cal Kulis is an 18-year-old male who was brought to the hospital by his mother because of the sudden onset of severe pain in the left flank radiating around his left side toward his pubic area.

Candice Sucher is an 18-year-old female who presented to her physician for a precollege physical examination. While taking her medical history, the doctor learned that she carefully avoided eating all fruits and any foods that contained table sugar.

Carrie Sichel, Will Sichel’s 19-year-old sister, is considering marriage. Her growth and development have been normal and she is free of symptoms of sickle cell anemia.

Colin Tuma had two intestinal polyps at age 50, which were removed via a colonoscope. However, he did not return for a five year colonoscopic examination as instructed.

Colleen Lakker was born 6 weeks prematurely. She appeared normal until about 30 minutes after delivery, when her respirations became rapid at 64 per minute with audible respiratory grunting.

Cora Nari is a 64-year-old woman who had a myocardial infarction (MI, often referred to as a “coronary”) 8 months ago and had a significant loss of functional heart muscle.

Dennis “the Menace” Veere, age 3, was brought to the emergency department by his grandfather, Percy Veere. While Dennis was visiting his grandfather, he climbed up on a chair and took a half-full 500-tablet bottle of 325 mg aspirin (acetylsalicylic acid) tablets from the kitchen counter.

Deria Voider is a 20-year-old exchange student from Nigeria who has noted gastrointestinal bloating, abdominal cramps, and intermittent diarrhea ever since arriving in the United States 6 months earlier.

Dianne (Di) Abietes is a 26-year-old woman who was diagnosed with type 1 diabetes mellitus at the age of 12. She has an absolute insulin deficiency resulting from autoimmune destruction of the ß-cells of her pancreas.

Emma Wheezer presented to the emergency room 3 days after discharge from the hospital following a 10-day admission for severe refractory bronchial asthma. She required high dose intravenous methylprednisolone (a synthetic anti-inflammatory glucocorticoid) for the first 8 days of her stay.

Erin Galway is a 3-week-old female infant who began vomiting 3 days after birth, usually within 30 minutes after breastfeeding. Her abdomen became distended at these times and she became irritable and cried frequently.

Erna Nemdy (“earn an M.D.”), a 25-year-old junior medical student brings her healthy 4-month-old daughter, Beverly, to the pediatrician for her second diphtheria, pertussis, tetanus (DTaP,acellular pertussis) immunization, which she received along with the pneumococcal, inactivated polio, haemophilus influenza and rotavirus vaccines.

Ivan Applebod’s brother, Evan Applebod, was six feet tall and weighed 425 pounds (BMI = 57.6 kg/m2). He had only been successful in losing weight once in his life, in 1977 when he lost 30 lbs through a combination of diet and exercise with the support of a registered dietitian, but quickly regained this weight back.

A newborn baby girl, Getta Carbo, was born after a 38-week gestation. Her mother, a 36-year-old woman, developed a significant viral infection that resulted in a severe loss of appetite and recurrent vomiting in the month preceding delivery.

Homer Sistine, a 14-year-old male, had a sudden grand mal seizure (with jerking movements of the torso and head) in his eighth grade classroom. The school physician noted mild weakness of the muscles of the left side of Homer’s face and of his left arm and leg.

Ivan Applebod is a 56-year-old accountant who has been morbidly obese for a number of years. He exhibits a pattern of central obesity, called an?apple shape, which is caused by excess adipose tissue deposited in the abdominal area.

Ivy Sharer is a 26-year-old intravenous (IV) drug user who has shared needles with another addict for several years. Five months before presenting to the emergency department with soaking night sweats, she experienced a 3-week course of a flu-like syndrome with fever, malaise, and muscle aches.

Jay Sakz is a 9-month-old male infant of Ashkenazi Jewish parentage. His growth and development were normal until age 5 months when he began to exhibit mild, generalized muscle weakness.

Jean Ann Tonich, a 46-year-old commercial artist, recently lost her job because of absenteeism. Her husband of 24 years had left her 10 months earlier.

Jim Bodie, a 19-year-old body builder, was rushed to the hospital emergency room in a coma. One-half hour earlier, his mother had heard a loud crashing sound in the basement where Jim had been lifting weights and completing his daily workout on the treadmill.

Katie Colamin, a 34-year-old dress designer, developed alarming palpitations of her heart while bending forward to pick up her cat. She also developed a pounding headache and sweated profusely.

Katta Bolic, a 62-year-old homeless woman, was found by a neighborhood child who heard Katta’s moans coming from an abandoned building. The child’s mother called the police, who took Katta to the hospital emergency room.

Two years ago, Les Dopaman, a 62-year-old male, noted an increasing tremor of his right hand when sitting quietly (resting tremor). The tremor disappeared if he actively used this hand to do purposeful movement.

Lofata Burne is a 16-year-old female. Since age 14 months she has experienced recurrent episodes of profound fatigue associated with vomiting and increased perspiration, which required hospitalization.

Lopa Fusor is a 68-year-old woman who is admitted to the hospital emergency room with very low blood pressure (80/40 mm Hg) caused by an acute hemorrhage from a previously diagnosed ulcer of the stomach.

Lotta Topaigne is a 54 year-old woman who came to the physician’s office complaining of a severe throbbing pain in the right great toe that began 8 hours earlier. The toe has suffered no trauma but appears red and swollen.

Mannie Weitzels is a 56-year-old male who complains of headaches, weight loss related to a declining appetite for food, and a decreasing tolerance for exercise. He notes discomfort and fullness in the left upper quadrant of his abdomen.

Melvin (Mel) Anoma is a 46-year old male who noted a superficial, brownish-black, 5-mm nodule with irregular borders in the skin on his chest. He was scheduled for outpatient surgery, at which time a wide excision biopsy was performed (in an excision biopsy the complete mole is removed and biopsied).

Mya Sthenia is a 37 year-old female who complains of increasing muscle fatigue in her lower extremities with walking. If she rests for five to ten minutes, her leg strength returns to normal.

Newman Itis complains to his physician of a fever and cough. His cough is productive of thick yellow-brown sputum. He is empirically started on azithromycin for community acquired pneumonia.

Nick O’Tyne is a 62-year-old electrician who has smoked two packs of cigarettes a day for 40 years. He recently noted that his chronic cough had gotten worse.

Nona Melos is a 7-month-old baby girl, the second child born to unrelated parents. Her mother had a healthy, full-term pregnancy, and Nona’s birth weight was normal.

Otto Shape is a 25-year-old medical student who was very athletic during high school and college, and is now “out-of-shape”. Since he started medical school, he has been gaining weight.

Percy Veere is a 59-year-old schoolteacher who was in good health until his wife died suddenly. Since that time he has experienced an increasing degree of fatigue and has lost interest in many of the activities he previously enjoyed.

Piquet Yuria, a 4-month-old female infant, emigrated from the Soviet Union with her French mother and Russian father 1 month ago. She was normal at birth but in the last several weeks was less than normally attentive to her surroundings.

Rena Felya, a 9-year-old girl, complained of a severe pain in her throat and difficulty in swallowing. She had chills, sweats, headache, and a fever of 102.4° F. J1255

Sam Atotrope, a 42-year-old jeweler, noted increasingly severe headaches behind his eyes sometimes associated with a “flash of light” in his visual fields. At times his vision seemed blurred, making it difficult to perform some of the intricate work required of a jeweler.

Sis Lupus, a 28-year-old computer programmer, notes increasing fatigue, pleuritic chest pain, and a nonproductive cough. In addition, she complains of joint pains, especially in her hands.

Sissy Fibrosa is a 3-year-old Caucasian female who has been diagnosed with cystic fibrosis (CF). Cystic fibrosis is a disease caused by an inherited deficiency in the CFTR (cystic fibrosis transmembrane conductance regulator) protein, which is a chloride channel.

Sloe Klotter, a 6-month-old male infant, was brought to his pediatrician’s office with a painful, expanding mass in his right upper thigh which was first noted just hours after he fell down three uncarpeted steps in his home.

Spiro Site is a 21-year-old college student who complains of feeling tired all the time. Two years previously he had had gallstones removed, which consisted mostly of bilirubin.

Vera Leizd is a 34-year-old woman in whom pubertal changes began at age 12, leading to the development of normal secondary sexual characteristics and the onset of menses at age 13.

Victoria Tim was a 21-year-old woman who was the victim of a rape and murder. Her parents told police that she had left her home and drove to the local convenience store.

Will Sichel is a 17-year-old male who presented to the hospital emergency room with severe pain in his lower back, abdomen, and legs, which began after a 2-day history of nausea and vomiting caused by gastroenteritis.

X.S. Teefore is a 26-year-old male who noted heat intolerance with heavy sweating, heart palpitations, and tremulousness. Over the past 4 months he has lost weight in spite of a good appetite.