PIC: USLME-BASIC

A 2-year-old child in shock has multiple nonblanching purple lesions of various sizes scattered about on the trunk and extremities; petechiae are noted, and oozing from the venipuncture site has been observed. The child’s peripheral blood smear is shown below. Clotting studies are likely to show which of the following?

A 23-year-old, HIV-infected female presents with a five-day history of fever and productive cough. She is on antiretroviral therapy, and her CD4 count is 300/mm3. Her temperature is 39.0°C (102.5°F), pulse is 95/min, respirations are 22/min, and blood pressure is 115/76 mm Hg. Physical exam reveals dullness to percussion and bronchial breath sounds in the right lung base. Chest x-ray is shown below. What is the most likely cause of this patient's symptoms?

A 24-year-old woman comes to the physician complaining of a skin rash and pain in her wrists, ankles and elbows over the past 4 days. She has also had a fever and sweats, but denies headache, nausea or vomiting. She has no significant past medical history and does not take any medications. She recently took a vacation with her new boyfriend. She denies any previous sexually transmitted diseases but acknowledges having unprotected sex with her new boyfriend. She does not use tobacco, alcohol or illicit drugs. Her temperature is 38.5°C (101.3°F) and her pulse is 98/min. Her oropharynx is clear and there is no thrush or lymphadenopathy. Her abdomen is benign and the pelvic examination is within normal limits. She has pain along the tendon sheaths with active and passive hand movement. A photo of her skin rash is shown below. Which of the following is the most likely cause of her symptoms?

A 25-year-old man is recovering in the hospital from an open repair of his broken femur, which he suffered during an automobile accident. On postoperative day 3 he develops sudden onset shortness of breath and vague chest discomfort. His temperature is 37.6°C (99.6°F), heart rate is 108/min, blood pressure is 95/62 mm Hg, respiratory rate is 42/min, and oxygen saturation is 89% on room air. Physical examination is significant for jugular venous distention to 9 cm and an accentuated pulmonic component of S2. A pulmonary angiogram is shown in the image. Which of the following is most likely to be decreased?

A 3-year-old boy is brought to the pediatrician because his mother noticed a reddish-purple rash on his buttocks and thighs (see image). She notes that he has not seemed well since he had a mild cold 2 weeks earlier; he has been complaining of aches and pains in his legs and a stomach ache. Urinalysis shows 10–20 RBCs/ mm³ and 2+proteinuria. Which of the following is associated with this patient’s disease process?

A 32-year-old homosexual male with HIV infection presented to his physician with skin lesions. He first noted these lesions last month, and has since observed a change in color from pink to violet. There is no associated pain, itching, or burning. He was diagnosed with HIV infection three years ago and has been noncompliant with his medications. His pulse is 80/min, blood pressure is 115/70 mm Hg, respirations are 14/min, and temperature is 37.1° C (98.8°F). The appearance of his lesions is illustrated below. His CD4 count is 30/microl, and viral load is 300,000copies/ml. Which of the following is the most likely cause of his current condition?

A 38-year -old male is brought to the emergency room with high-grade fever, shaking chills, productive cough and shortness of breath that started two days ago. His medical history is significant for two hospital admissions for alcohol withdrawal seizures. He continues to drink alcohol every day. He has no other medical problems and does not take any medications. On admission, his temperature is 39.7°C (103.5°F), pulse is 110/min, blood pressure is 100/70 mmHg, and respirations are 20/min. His skin and mucous membranes are dry. Physical examination reveals crackles and bronchial breath sounds in the right lower lobe. Chest x-ray demonstrates right lower lobe consolidation. He is started on ceftriaxone, azithromycin and intravenous normal saline at 200 ml/hr. Six hours later the nurse calls you because he is breathing at 38/min and requiring 100% oxygen. Emergent intubation is performed. A repeat chest x-ray is shown below. Which of the following is now most likely to be present in this patient?

A 45-year-old HIV-positive woman comes to her primary care physician complaining of a 2-day history of bloody diarrhea. She states that she has been feeling well until 2 days ago, when she developed abdominal pain. She denies fevers, chills, night sweats, nausea, or vomiting. She admits to feeling tired over the last couple of weeks and has had a 2.3-kg (5-lb) weight loss over the past 2 weeks. Her stool sample shows WBCs and RBCs. Her Gram stain is shown in the image. Her CD4+ cell count is 201/mm³. Which of the following is the most likely cause of this woman’s symptoms?

A 54-year-old female with a long history of hypertension and a recent hospitalization for atrial fibrillation with rapid ventricular response now returns to the hospital complaining of skin changes. Her medications include warfarin, hydrochlorothiazide and metoprolol. On physical examination, her temperature is 36.7°C (98°F), blood pressure is 130/80 mm Hg, pulse is 80/min and irregular, and respirations are 16/min. You observe the skin changes pictured below. Her exam is otherwise unremarkable. Which of the following is the primary cause of her condition?

A 6-year-old boy is brought to his pediatrician for a routine check-up. He has not been seen by a physician for the past 3 years. Recently, he has developed some patchy areas of hair loss on his scalp. The mother also notes he has had many colds over the past year. She says he has developed normally, although he started walking later than her other two children. On physical examination his wrists appear enlarged, and he has bowing of the forearms and legs. X-ray of the boy’s legs is shown in the image. Laboratory tests show a calcium level of 7.1 mg/dL, phosphate of 1.8 mg/dL, and intact parathyroid hormone of 130 pg/mL (normal: 10–65 pg/mL). Vitamin D level is normal. Treatment with vitamin D does not correct the patient’s hypocalcemia. Which of the following disorders best explains this patient’s findings?

A 65-year-old female presents with 6 months of worsening dyspnea and dry cough. Whereas she had previously enjoyed an active lifestyle, she now becomes breathless after walking just a few steps. The patient denies fever or chest pain and does not use tobacco, alcohol or illicit drugs. Her only medicine is hydrochlorothiazide for hypertension. She is retired and lives with her husband. She has never travelled abroad and denies any history of exposure to pets. On physical examination, her temperature is 37.2°C (98.9°F), blood pressure is 140/86 mm Hg, pulse is 84/min and respirations are 18/min. Examination shows dry, late inspiratory crackles and finger clubbing. Her chest x-ray is shown below. Which of the following abnormalities is most likely to be present in this patient?

A 70-year-old Caucasian man comes to the emergency department because of the sudden onset of nausea, vomiting, diaphoresis, and chest pain. His other medical problems include hypertension, diabetes mellitus-type 2, and aortic stenosis. He has smoked one-and-a-half packs of cigarettes daily for 30 years and drinks 4 ounces of alcohol daily. His temperature is 37.2°C (99°F), blood pressure is 100/60 mmHg, pulse is 60/min, and respirations are 18/min. The patient's pulse oximetry showed 98% at room air. Examination shows normal first and second he sounds. Lungs are clear to auscultation. His EKG is shown below. Which of the following is the most likely mechanism of this patient's condition?

A 74-year-old Caucasian woman is brought to the emergency department after a fall. Her husband is concerned since she is on "blood thinners." Her other medical problems include hypertension, hearing loss, congestive heart failure, coronary artery bypass graft, transient ischemic attack, and atrial fibrillation. She does not use tobacco, alcohol, or drugs. Her medications include aspirin, metoprolol, digoxin, furosemide, and warfarin. Her temperature is 37.2°C (99°F), blood pressure is 140/90 mmHg, pulse is 72/min, and respirations are 14/min. CT scan of the head without contrast is shown below. Which of the following is the most likely cause of her condition?

A previously healthy 5-year-old boy has a 1-day history of low-grade fever, colicky abdominal pain, and a rash. He is well-appearing and alert. His vital signs, other than a temperature of 38°C (100.5°F) are completely normal. A diffuse, erythematous, maculopapular, and petechial rash is present on his buttocks and lower extremities, as shown in the photograph. He has no localized abdominal tenderness or rebound; bowel sounds are active. Laboratory data demonstrate Urinalysis: 30 red blood cells (RBCs) per high-powered field, 2+ protein. Stool: Guaiac positive Platelet count: 135,000/μL. These findings are most consistent with which of the following?

You see the newborn baby shown below for the first time in the nursery. You consult plastic and reconstructive surgeon as well as the hospital’s speech therapist. Understandably, the parents have many questions. Which of the following statements is appropriate anticipatory guidance for this family?