Figure 1 
A five-year-old male with a four-day history of fever presents with a new erythematous rash. His mother says he has been coughing and sneezing for the past few days. Examination reveals conjunctivitis, grayish elevations on the buccal mucosa opposite his molar teeth, and a maculopapular rash on his trunk and extremities. Which of the following is a long-term complication of this patient’s condition?
A. Mitral valve disease
B. Subacute sclerosing panencephalitis
C. Cataracts
D. Infertility
A 24-year-old sexually active female presents with a three-day history of severe right upper quadrant pain that worsens on inhalation. She has a history of multiple sexual partners and does not use contraception. Examination reveals marked tenderness in the right upper quadrant and laparoscopy demonstrates the findings seen here. Based on this patient’s diagnosis, what treatment would address the most likely underlying infection?
A 62-year-old female, G3P3, presents to her gynecologist with a year-long history of worsening stress urinary incontinence. During the course of her investigation, a pelvic MRI is performed, and reveals the findings seen here. Which of the following histories is most consistent with these findings?
A three-year-old African American boy is brought to his new pediatrician over concerns of poor growth, fatigue, and irritability. On examination, he has a large head and generalized muscular hypotonia. His left wrist demonstrates the findings seen here. What next step is most appropriate?
A 28-year-old female presents to the emergency department with an occipital headache and neck pain. She mentions her symptoms appeared after hyperextending her neck while playing tennis the day before. Examination reveals dysdiadochokinesia and decreased lateral vision. A contrast head and neck CT demonstrate the findings seen here. Based on this patient’s probable diagnosis, which of the following treatments is most appropriate?
A 65-year-old male presents to his family physician with complaints of increasing fatigue, dyspnea on exertion, and unintentional weight loss within the last six months. On examination, he is noted to have macroglossia and peripheral edema. Crackles are audible bilaterally on chest auscultation. Which of the following tests will help to confirm this patient’s most likely diagnosis?
An 80-year-old female with a history of diabetes and chronic constipation presents to the emergency department with a purple urine bag. She is currently bedridden and uses an indwelling catheter. On examination, she is hypotensive and confused. Blood cultures are positive for Proteus vulgaris. Based on this patient’s presentation, which of the following antibiotics should be commenced?
A 76-year-old male presents with a progressive headache, dizziness, and confusion after falling from his bed the night before. He currently takes warfarin following a mechanical valve replacement 11 years ago, and has been recently diagnosed with depression. A CT scan reveals a subdural hematoma and the patient’s INR measures 7.5. Which of the following is most likely to increase the anticoagulant effect of warfarin?
A 75-year-old female presents with a two-year history of a persistent cough and fatigue. The cough is occasionally productive of purulent sputum. She was treated for a community-acquired pneumonia two years earlier and underwent an anterior cervical discectomy and fusion previously, but is otherwise well. On examination, she appears well-groomed, polite, and thin. Chest auscultation reveals wheezing in the mid zones bilaterally and a later chest X-ray and CT scan demonstrate the findings seen here.
A 70-year-old male is brought to the emergency department with subacute shortness of breath and fatigue. Upon searching her father’s home, his daughter reports she found his medication — a nearly empty bottle of metoprolol, 100 mg bid. She believes her father has coronary artery disease. On examination, the patient is confused. His blood pressure is 69/49 mmHg and he has a heart rate of 48 bpm. An ECG reveals the findings seen here. After initiating oxygen and atropine, which of the following is the best treatment for this patient’s presentation?
A 70-year-old female with psoriasis presents with a four-month history of worsening arthralgia. She mentions she has pain and stiffness in her big toes and most of her fingers. On examination, a telescoping finger deformity is seen on her right second digit.
A 32-year-old female presents with a headache and a rash on her trunk and extremities. She has had unprotected sex with multiple partners over the last two months, but denies any history of sexually transmitted infections. Examination reveals generalized non-tender lymphadenopathy, a diffuse macular rash on her chest and arms, and patchy hair loss. Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody-absorption (FTA-ABS) tests are both positive, and she is given a single dose of penicillin G benzathine intramuscularly. She returns within a few hours with a worsening rash (seen here), myalgia, and a fever.
A 19-year-old female exchange student presents to the emergency department with severe abdominal pain and a swollen right knee. She has had recurrent episodes of abdominal pain for the past 5 years which last 2-3 days before resolving spontaneously. Previous investigations have all failed to identify a cause. She mentions that several family members back home in Turkey have similar symptoms. On examination, she has a temperature of 39.4°C and a heart rate of 125. Her abdomen is diffusely tender with rebound tenderness. A right knee effusion is present, and a raised, tender erythematous lesion on her left lower leg is noted. Laboratory testing reveals an elevated white cell count with a neutrophilic predominance, as well as elevated ESR, CRP, and SAA protein.
A 66-year-old male with a history of hypertension presents to the emergency department with dyspnea and sharp abdominal pain radiating to his back. On examination, his blood pressure is 180/120 mm Hg. A CT scan demonstrates the findings seen here and laboratory testing indicates that his renal function is preserved. Which of the following is the most appropriate next step given this patient’s likely diagnosis?
25-year-old male presents to the emergency department with headache, retro-orbital pain, and diplopia when gazing to the right. He had visited an urgent care clinic with right ear pain two weeks earlier and had received a short course of antibiotics. After some initial improvement, he became increasingly unwell before presenting today. Otoscopy reveals purulent discharge in the right ear canal and a CT scan demonstrates the findings seen here. Which organism is most commonly responsible for this patient’s likely diagnosis?
A 9-year-old girl is brought to a new pediatrician by her mother over concerns regarding her weight. She has a history of developmental delay, and her mother mentions that she is noticeably shorter than her peers. She is noted to have a round face and bilaterally shortened fourth metacarpals on examination. She is in the 96th percentile for weight and below the 3rd percentile for height for her age. Laboratory testing reveals hypocalcemia. Which additional laboratory findings are associated with this patient’s most likely diagnosis?
A 37-year-old female presents to her family physician with recurring abdominal and flank pain. She mentions her mother suffered from kidney problems but doesn’t know many details. Examination reveals a blood pressure of 170/110 mmHg and proteinuria is present on dipstick. Laboratory tests show an elevated hematocrit, microalbuminuria, and microscopic hematuria. A CT scan later reveals the findings seen here.Which of the following conditions is most commonly associated with this patient’s likely diagnosis?
A 14-year-old boy is brought to the pediatrician by his mother over concerns of difficulty walking and worsening clumsiness. He reports a gradual loss of night vision, and a long history of chronic diarrhea which is pale and foul-smelling. Examination reveals an ataxic gait, and loss of deep tendon reflexes. Bilateral retinitis pigmentosa is noted on fundoscopy and a peripheral blood smear reveals the findings seen here. Which additional laboratory finding is most likely?