Q_D_Germ_S_V

Germ: A 14-year-old girl awakens with a mild sore throat, low-grade fever, and a diffuse maculopapular rash. During the next 24 hours, she develops tender swelling of her wrists and redness of her eyes. In addition, her physician notes mild tenderness and marked swelling of her posterior cervical and occipital lymph nodes. Four days after the onset of her illness, the rash has vanished. Which of the following is the most likely diagnosis?

A 15-month-old Asian girl is brought to the physician's office because of persistent non-productive cough and skin rash. Other accompanying symptoms are a runny nose, sneezing and intermittent nasal obstruction. She has had these symptoms for the past four days. Her parents report that she seems to have lost interest in her usual activities and is irritable all the time. Her pulse is 130/min, temperature is 38.8C (102F), and respirations are 24/min. Her eyes are red and have a watery discharge; there is congestion that is more marked over the canthi; the inner conjunctiva has bluish white lesions on an erythematous background. Throat examination reveals erythema of the posterior pharyngeal wall and tonsillar pillars, and yellowish exudates on the tonsils. The buccal mucous membranes are red with bluish-white lesions. The face has blanching, erythematous "brick-red" maculopapular rash. No rash is present over the extremities. Cervical lymphadenopathy is noted. The lab results are as follows: Hct 46%, WBC count 3,000/mm3, Platelet 160,000/mm3,Urine Dipstick ++ for proteins. What is the most likely diagnosis?

A 15-year-old girl complains of low-grade fever, malaise, conjunctivitis, runny nose, and cough. After this prodromal phase, a rash of discrete pink macules begins on her face and extends to her hands and feet. She is noted to have small red spots on her palate. What is the most likely cause of her rash?

A 26-year-old woman comes to the physician's office for evaluation of a vulvar ulcer that she noticed two days ago. Initially she had a small painless papule that later became ulcerated. Upon further questioning she reluctantly admits to using sex to obtain drugs. She also reports using oral contraceptives to prevent pregnancy. On vulvar examination there is a 2-cm ulcer with a non-exudative base and a raised, indurated margin. Painless bilateral inguinal lymphadenopathy is present. Which of the following is the most likely diagnosis?

A 3-year-old child presents in clinic with marked erythema of the cheeks, with no prior symptoms. The rash soon involves the arms and has a reticular erythematous maculopapular appearance. The patient has been previously healthy and is not on any medications. He has not been exposed to any other ill individual. Which of the following is the most likely diagnosis?

A 33-year-old woman presents to the physician because of a malodorous vaginal discharge that has been present for the past 3 days. She has no vaginal or vulvar irritation, and has no urinary complaints. Pelvic examination demonstrates a copious, gray discharge with a pH of 5.0. When 1 drop of potassium hydroxide (KOH) is added to a sample of the discharge there is an intense amine odor. A normal saline wet preparation is performed that demonstrates epithelial cells whose borders and nuclei are obscured by the presence of bacteria. Which of the following is the most likely pathogen?

A 4-year-old girl is brought to your office by her mother for recent onset of fever and rash. For the past 4 days, she has had headaches, fever, and sore throat. She was apparently normal 4 days ago, and upon presentation of the symptoms, her mother thought that she was having a simple viral fever which would go away with time; however, she then developed a pale pink maculo-papular rash, first on the face and neck, and then it rapidly spread onto the trunk and limbs. On examination, the child is afebrile and doesn't appear ill, but there are few palpable suboccipital and posterior auricular lymph nodes. What is the most likely cause of this patient's condition?

A 6-year-old girl has a low-grade fever, headache, and nasal congestion. She has a flushed face and has developed a lacy reticular rash on the trunk and extensor surface of her arms and legs. Palms and soles are spared. Her mother has been ill with a low-grade fever and some joint stiffness and pain. Which of the following is the most likely diagnosi

A mother brings her 9-month-old daughter to the pediatrician with complaints of a rash. The mother states that the infant had a high fever [temperature up to 40.0 C (104 F)] for 3 days prior to developing the rash, but is now afebrile. The mother also says that the infant has had a runny nose and a slight cough for the past 3 days. On examination, there is a fine macular rash on the infant's trunk and neck. The examination is otherwise within normal limits, and the infant is playful and smiling. Which of the following is the most likely diagnosis?

An 18-year-old male college student is seen in the student health clinic for urinary frequency, dysuria, and urethral discharge. Which of the following is likely to explain his condition?

An 18-year-old woman visits her physician because of 3 weeks of malaise, 2 weeks of fever, and a sore throat. Physical examination shows pharyngeal infection with enlarged tonsils and a patchy, white exudate; enlarged, palpable anterior and posterior cervical, axillary, and inguinal lymph nodes; tenderness in the right upper quadrant; and minimal splenomegaly. Laboratory data show hemoglobin 14 g/dL; hematocrit 42%; platelets 380,000/mL; WBC 8500/mL, with 35% segmented neutrophils, 1% eosinophils, and 64% lymphocytes, of which 36% were atypical. Which of the following is the most likely diagnosis?

An 8-year-old boy presents with a 2-day history of rash. The rash started on the head and spread downward to his trunk and extremities. He also complains of a fever, cough, and a runny nose for the past 5 days. On physical examination, his temperature is 38.2 C (100.7 F), blood pressure is 88/56 mm Hg, pulse is 76/min, and respirations are 16/min. There is a small, irregular red spot with a central gray color on his buccal mucosa. The rash on his body is erythematous and maculopapular in quality. Which of the following is the most likely diagnosis?

A 17-year-old man presents with new symptoms of fatigue, malaise, fever, and a sore throat. He has no significant past medical history and is not on any medications. Physical examination is entirely normal except for enlarged, palpable cervical, lymph nodes. He reports no weight loss or night sweats. Laboratory investigations include a normal chest x-ray, negative throat swab, but abnormal blood film with atypical lymphocytes. The hemoglobin is 15.5 g/dL; hematocrit 42%; platelets 290,000/mL; WBC 10500/mL, with 45% segmented neutrophils, 1% eosinophils, and 54% lymphocytes, of which 36% were atypical. Which of the following is the most appropriate initial diagnostic test?

A 4-year-old child manifests symptoms of fever, sore throat, and swollen lymph nodes. The spleen tip is palpable. Throat culture and rapid slide (Monospot) test results are negative. The next logical diagnostic procedure would involve which of the following?

A 43-year-old male presents to a physician with an ulcer on the shaft of his penis. The ulcer is non-tender, with a raised border and a smooth base. There is bilateral inguinal adenopathy. The rest of the examination is unremarkable. Dark field microscopy of a specimen from the ulcer base reveals spirochetes. Which of the following additional screening studies should be performed on this patient?

A 7-year-old is brought to the office with sore throat, poor appetite, and malaise over the last 2 days. He has no cough, rhinorrhea, or nasal congestion. The boy takes no medications, has no known allergies, and his immunization are up to date. Temperature is 38.9 C, BP is 110/70 mmHg, pulse is 130/min, and respitations are 16/min. On examination, his tonsils are swollen and covered with thin, with exudates. Small, tender anterior cervical lymph nodes are palpated. What is the most appropriate next step in management of this patient?

An 11-month-old girl is brought by her mother to the office due to fever, fussiness, and irritability. The girl has a tendency to hold and pull on her left ear. For the past few days, she has had rhinorrhea and nasal congestion. Her medical history reveals nothing particular. Her temperature is 38.9C (102F). Otoscopic examination reveals a bulging, erythematous tympanic membrane with decreased mobility on air compression. What is the most likely organism responsible for the patient's condition?

A 19-year-old HIV-positive man is admitted with headache, confusion and disorientation. He is mildly pyrexial. A CT brain reveals multiple hypodensities, particularly in the brainstem and in the periventricular white matter. There is some ependymal enhancement postcontrast. What is the most likely cause for these findings?

A 32-year-old man presents to his GP with increasing pain on swallowing solids and liquids. He has lost 15 kg in weight over the preceding 2 months. After a full history and examination, he is found to be HIV positive with a very low CD4 count. The GP refers him for a barium swallow examination and this demonstrates a single ulcer in the mid-oesophagus. The ulcer has a smooth margin, measures 4 cm in length and is oval in shape. There is no stricture identified. Which diagnosis is most likely?

A 6-year-old girl has a low-grade fever, headache, and nasal congestion. She has a flushed face and has developed a lacy reticular rash on the trunk and extensor surface of her arms and legs. Palms and soles are spared. Her mother has been ill with a low-grade fever and some joint stiffness and pain. Which of the following is the most likely diagnosis?

A 6-year-old girl with acute lymphocytic leukemia (ALL) is admitted to the hospital with a generalized vesicular rash and high fever. She has no previous history of chickenpox and has never received immunization for varicella. Her 4-year-old sister recently recovered from chickenpox that started about 10 days ago. On admission, her temperature is 38.4 C (101.1 F), blood pressure is 94/58 mm Hg, pulse is 80/min, and respirations are 20/min. Which of the following is the most serious complication of varicella that might occur in this patient?

A 34-year-old G2 at 36 weeks delivers a growth-restricted infant with cataracts, anemia, patent ductus arteriosus, and sensorineural deafness. She has a history of chronic hypertension, which was well controlled with methyldopa during pregnancy. She had a viral syndrome with rash in early pregnancy. What is the most likely causative agent?

Number: A severely traumatized woman is seen in the emergency room (ER) with decreased mental status. Prior to intubation, she does not open her eyes, withdraws with all of her extremities, and makes incomprehensible sounds. What is her Glasgow coma scale score?

7) A 10-year-old child arrives with the complaint of new-onset bed-wetting. He has had no fever, his urine culture is negative, and he has had no new stresses in his life. He is well above the 95th percentile for weight as is much of his family. Which of the following is most helpful in making a diagnosis?

29) A 15-year-old girl is being evaluated for primary amenorrhea. Her previous medical history is unremarkable and she denies taking any medications. Examination reveals absent breasts as well as pubic and axillary hair. Vaginal examination could not be performed. Olfactory exam reveals an inability to identify different odors. Ultrasound shows a uterus and two ovaries; serum FSH level is 2 U/L (Normal is 4-30). Which of the following is the most likely karyotype to be found in this patient?

615) A 73-year-old female presents to your office with lower abdominal discomfort. Physical examination reveals an adnexal mass on the right side. This patient is most likely to have elevated levels of which of the following?

670) A patient with severe neurological devastation after head trauma has a prolonged course in the intensive care unit. He has been mechanically ventilated for his entire hospital stay. Which of the following clinical findings is diagnostic of a ventilator-associated pneumonia?

714) As you are walking across the hospital lobby, you stumble upon the arterial blood gas (ABG) results of a patient. The ABG (on room air) results are shown below: Blood pH 7.43, PaO2 100 mm Hg, PaCO2 25 mm Hg, HCO3- 16 mEq/L. Which of the following patients is most likely to have these laboratory values?

722) Following surgery a patient develops oliguria. You believe the oliguria is due to hypovolemia, but you seek corroborative data before increasing intravenous fluids. Which of the following values supports the diagnosis of hypovolemia?