What is your understanding of the live, attenuated vaccine regimens and the myths that may prevent widescale uptake of vaccines with proven efficacy at preventing disease?

What condition is most likely present when a normal p wave is negatively deflected?

A24-year-old g4p2 woman at 34 weeks gestation complains of a cough and whitish sputum for the last three days. she reports that everyone in the family has been sick. she reports a high fever last night up to 102°f (38.9°c). she denies chest pain. she has a history of asthma with no previous intubations. she uses an albuterol inhaler, although she has not used it this week. vital signs are: temperature 98.6°f (37°c); respiratory rate 16/minute; pulse 94 beats/minute; blood pressure 114/78; peak expiratory flow rate 430 l/min (baseline documented in the outpatient chart = 425 l/min). on physical examination, pharyngeal mucosa is erythematous and injected. lungs are clear to auscultation. white blood cell count 8,700 mcl; arterial blood gases on room air (normal ranges in parentheses): ph 7.44 (7.36–7.44); po2 103 mm hg (> 100); pco2 26 mm hg (28–32); hco3 19 mm hg (22–26). chest x-ray is normal. what is the correct interpretation of this arterial blood gas?

A92-year-old man with a 45-year history of chronic obstructive pulmonary disease is intubated in the icu because of a bout of viral pneumonia that fails to improve after 72 hours of antibiotics. although the inspired fraction of oxygen is 100%, the patient's po2 remains at 57 mmhg. positive-end expiratory pressure (peep) is added to allow the inspired fraction of oxygen. twelve hours after the introduction of peep the patient suddenly become hypotensive. at the same time, his oxygen saturation drops from 92% to 61%. on physical examination, his bp is 80/50 mmhg and his pulse is 124/min. he has distended neck veins and distant heart sounds. which of the following would also most likely be seen on this patient's physical examination? - absence of breath sounds in the right hemithorax- high amplitude carotid artery upstroke- a pleural friction rub- pulsus alternans- splenomegaly