DES C_Diagnosis (3) Prepared : CHILLY

A 22-year-old Caucasian female comes to your office complaining of difficulty swallowing. She says that solid food sticks in the middle of her chest, and that's why she prefers liquids. She has lost 10 pounds over the last 3 months. She also complains of recent severe heartburn that does not respond well to over-the-counter antacids. On review of systems, she denies cough, shortness of breath and palpitations. She has noticed occasional swelling and pain in her small finger joints. Her fingers turn blue upon cold exposure, and she always wears gloves to keep them warm. She does not smoke or drink alcohol. She denies illegal drug use. Which of the following is the most likely diagnosis?

A 22-year-old Caucasian female presents to the office with several months history of decreased visual acuity and decreased brightness sensation in the right eye. Slight exophthalmos of the right eye is present on physical examination, and ophthalmoscopy shows pallor of the right optic disk. Several cafe-au-lait spots and intensive axillary freckling are present. Which of the following is the most likely cause of this patient's visual problems?

A 22-year-old college student notices a bulge in his right groin. It is accentuated with coughing, but is easily reducible. Which of the following hernias follows the path of the spermatic cord within the cremaster muscle?

A 22-year-old female is referred to the dermatology clinic. Over the past few years, she has noticed small areas of depigmentation on her arms and legs. Some of these areas are well-circumscribed, as shown in the picture below. She is otherwise well. Her only medication is the oral contraceptive pill. She is currently sexually active with more than one partner. Which of the following diseases is most likely to be associated with her skin condition?

A 22-year-old female presents with a two-day history of inability to close her right eye, a low-grade fever, and a rash on her trunk. There is no burning or itching associated with the rash. She denies headache, confusion, neck stiffness, numbness, and tingling. She went on a camping trip in Vermont four weeks ago but cannot recall any exposure to ticks. She was treated for chlamydia! Urethritis infection in the past. She has been using over-the-counter acetaminophen for fever; she noticed the rash after beginning the acetaminophen. Physical examination reveals several erythematous lesions around her waistline. Neurological examination shows right-sided facial nerve palsy. Based on these findings, what is the most likely diagnosis?

A 22-year-old G1 at 34 weeks is tested for tuberculosis because her father, with whom she lives, was recently diagnosed with tuberculosis. Her skin test is positive and her chest x-ray reveals a granuloma in the upper left lobe. Which of the following is true concerning infants born to mothers with active tuberculosis?

The risk of active disease during the first year of life may approach 90% without prophylaxis

Bacille Calmette-Guérin (BCG) vaccination of the newborn infant without evidence of active disease is not appropriate

Neonatal infection is most likely acquired by aspiration of infected amniotic fluid

Future ability for tuberculin skin testing is lost after BCG administration to the newborn

Congenital infection is common despite therapy

A 22-year-old G1P0 woman who is 10 weeks pregnant with twins presents to the emergency department because of vomiting and dizziness. She has had “morning sickness” for the past month and would vomit once or twice a day. However, over the past week, she has been vomiting multiple times a day, and she has been unsuccessful at “keeping anything down” for the past 2 days. She denies fever or change in her bowel movements; her last bowel movement was that morning and was well formed. She has otherwise been healthy. Physical examination reveals a tired-appearing, pale woman with poor skin turgor; otherwise her examination is unremarkable. Her blood pressure is 110/75 mm Hg lying down and 90/45 mmHg sitting up. Her pulse is 80/min lying down and 115/min sitting up. Her respiratory rate is 24/min, and her temperature is 37.2C (99.0F). Her original blood work results are: WBC count: 14,000/mm3, Platelet count: 350,000/mm3, Na+: 150 mEq/L, K+: 4 mEq/L, Cl-: 88 mEq/L, HCO3-: 26 mEq/L, Hemoglobin: 15 g/dL, Hematocrit: 40%, Aspartate aminotransferase: 80 U/L, Alanine aminotransferase: 85 U/L. What is this woman’s most likely diagnosis?

A 22-year-old healthy African-American woman presents with a recurrent growth on her right thigh. She has a childhood history of a third-degree scald burn to the same area that did not require skin grafting. The growth was completely removed 2 years ago. On physical examination there is a 5 cm × 2 cm, raised, irregularly shaped purple lesion with a smooth top. Which of the following is the most likely diagnosis?

A 22-year-old male presents to you with feelings of general malaise. He is always tired and has noticed that he has frequent headaches. Exam reveals an elevated arm blood pressure with a radial to femoral delay. ECG shows left ventricular hypertrophy and the chest-x ray is shown below. Close examination of the x-ray reveals a "3" sign. What is the most likely diagnosis in this patient?

A 22-year-old male student presents with an acute onset of fever, double vision, and painful swelling around his eyes. He also has significant muscle pain in his neck and jaw muscles. A week earlier, he experienced a period of abdominal pain, nausea, vomiting, and diarrhea, all of which resolved spontaneously. He has a history of intravenous drug abuse but has recently completed of a drug rehabilitation program. He is febrile. Physical examination shows "splinter" hemorrhages, periorbital edema, and chemosis. Chest is clear to auscultation. Cardiac exam reveals no murmur. Abdomen is soft and nontender with no organomegaly. His complete blood count is shown below: Hemoglobin 13.0 g/L, MCV 85 fl, Platelets 228,000/mm3, Leukocyte count 10,500/mm3, Neutrophils 56%, Eosinophils 21%, Lymphocytes 23%. Based on these findings, what is the most likely diagnosis?

A 22-year-old man comes to the physician because of a 2-day history of dark urine. He has had an upper respiratory tract infection for 3 days. His temperature is 37.1° C (98.9°F), blood pressure is 145/90mm Hg, pulse is 80/min, and respirations are 14/min. Examination shows no abnormalities. Laboratory studies show: Urinalysis: Glucose Negative, Protein 1+, Ketones Negative, Leukocyte esterase Negative, Nitrites Negative, WBC 3-6/hpf, RBC 30-50/hpf, Casts RBC. Serum chemistry: Serum Na 138 mEq/L, Serum K 4.5 mEq/L, Bicarbonate 22 mEq/L, BUN 30 mg/dL, Serum creatinine 1.8 mg/dL. Serum complement level is within normal limits. Which of the following is the most likely diagnosis?

Acute interstitial nephritis

Anti-glomerular basement membrane disease

IgA nephropathy

Acute post-infectious glomerulonephritis

Benign recurrent hematuria

A 22-year-old man comes to the urgent care clinic with a one-week history of fever, sore throat, and malaise. He has tried several over-the-counter products with partial relief. His temperature is 38.8°C (102°F), pulse is 110/min, respirations are 18/min, and blood pressure is 130/70 mm Hg. Oropharyngeal examination reveals palatal petechiae with streaky hemorrhages and blotchy, red macules. The tonsils are enlarged and covered with whitish exudate. Mild jaundice is present. Enlarged lymph nodes are palpable posterior to the sternocleidomastoid muscle bilaterally. Axillary lymphadenopathy is also present. Abdominal examination reveals normal bowel sounds and mild hepatosplenomegaly. His complete blood count is shown below: Hemoglobin 14.0 g/L, MCV 88 f l, Platelets 140,000/mm3, Leukocyte count 14,500/mm3, Neutrophils 33%, Lymphocytes 66%, Eosinophils 1%. Which of the following is commonly associated with this patient's condition?

A 22-year-old man develops the insidious onset of low-back pain improved with exercise and worsened by rest. There is no history of diarrhea, conjunctivitis, urethritis, rash, or nail changes. On examination, the patient has loss of mobility with respect to lumbar flexion and extension. He has a kyphotic posture. A plain film of the spine shows sclerosis of the sacroiliac joints. Calcification is noted in the anterior spinal ligament. Which of the following best characterizes this patient’s disease process?

A rheumatoid factor is likely to be positive

A colonoscopy is likely to show Crohn disease

The patient is likely to die from pulmonary fibrosis and extrathoracic restrictive lung disease

The patient has a spondyloarthropathy, most likely ankylosing spondylitis

He is most likely to have acute lumbosacral back strain and requires bed rest

A 22-year-old man is an avid spelunker (cave explorer) and has recently been exploring several caves. A routine CXR taken for a new job reveals hilar adenopathy and two patches of pneumonitis. His physical examination is completely normal. Careful questioning reveals he has just gotten over a cold with mild fever, cough, and malaise. Which of the following is the most likely diagnosis?

A 22-year-old man is brought to the emergency room after he became exceedingly anxious in his college dormitory room, stating that he was sure the college administration was sending a “hit squad” to kill him. He also notes that he can see “visions” of men dressed in black who are carrying guns and stalking him. His thought process is relatively intact, without thought blocking or loose associations. His urine toxicology screen is positive for one of the following drugs. Which drug is the most likely cause of these symptoms?

A 22-year-old man presents to the ED for left eye pain. He was in an altercation yesterday and was punched in the left eye. On examination, his left eye is ecchymotic and the eyelids are swollen shut. He has tenderness over the infraorbital rim but no step-offs. You use an eyelid speculum to examine his eye. His pupils are equal and reactive to light. His visual acuity is normal. On testing extraocular movements, you find he is unable to look upward with his left eye. He also complains of diplopia when looking upward. Funduscopic examination is normal. What is the most likely diagnosis?

A 22-year-old man presents to the ED with a history consistent with an acute MI. His ECG reveals ST elevations and his cardiac biomarkers are positive. He has been smoking half a pack of cigarettes per day for the last 3 months. He drinks alcohol when hanging out with his friends. His grandfather died of a heart attack at 80 years of age. The patient does not have hypertension or diabetes mellitus and takes no prescription medications. A recent cholesterol check revealed normal levels of total cholesterol, low-density lipoprotein (LDL), and high-density lipoprotein (HDL). Which of the following is the most likely explanation for his presentation?

A 22-year-old man who was involved in a motor vehicle accident undergoes intravenous fluid resuscitation with 2 L normal saline over 20 minutes. He is in respiratory distress, with a respiratory rate of 40/min. He receives bilateral chest tubes. Endotracheal intubation is performed and mechanical ventilation is initiated due to progressive respiratory failure. His blood pressure is 92/50 mm Hg and pulse is 121/min. The patient is responsive to painful stimuli only. Pulmonary examination shows coarse breath sounds bilaterally. The chest x-ray is shown below. Which of the following most likely contributed to this patient's progressive respiratory failure?

A 22-year-old nulliparous woman has recently become sexually active. She consults you because of painful coitus, with the pain located at the vaginal introitus. It is accompanied by painful involuntary contraction of the pelvic muscles. Other than confirmation of these findings, the pelvic examination is normal. Which of the following is the most common cause of this condition?

A 22-year-old obese woman presents to the obstetrics-gynecology clinic complaining of mild abdominal pain and vaginal bleeding. The patient states that she is sexually active with her boyfriend and uses condoms “basically all the time.” She states that her last menstrual period was 7 weeks ago and insists that her periods have always been irregular, occurring every 3 to 4 months. She denies any past medical history but states that she used to have a problem with excess facial hair prior to starting low-dose oral contraceptive pills. Which of the following is the best next step in diagnosis?

Measure thyroid-stimulating hormone level

Measure urine β-human chorionic gonadotropin level

Endometrial biopsy

Progesterone challenge

Measure prothrombin time/partial thromboplastin time

A 22-year-old primi-gravida woman is brought to the emergency department during the 33rd week of pregnancy after a tonic-clonic seizure. She has no history of seizure disorder and has not had any complications during her pregnancy. She is given magnesium sulfate and hydralazine. One hour later, she is lethargic and complains of persistent blurry vision and headache. She also complains of muscle pain, sore joints, and inability to move her right arm. Her temperature is 37.2°C (99°F), blood pressure is 182/111 mm Hg, pulse is 112/min, and respirations are 16/min. She holds her right arm adducted and internally rotated. Examination shows no sensory loss but an inability to externally rotate the right arm. Deep tendon reflexes (DTRs) are intact bilaterally, and handgrip is preserved on both sides. Which of the following is the most likely cause of her arm weakness?

A 22-year-old primigravid woman at 10 weeks gestation is brought to the emergency department because of vaginal bleeding and lower abdominal pain. She was cleaning the house when she suddenly started feeling colicky pain in the suprapubic area. The pain did not subside after resting, and a few minutes later a tissue-like substance passed through her vagina along with moderate bleeding. The pain subsequently ceased, but she still has mild discomfort. Her temperature is 37.0 C (98.7 F), blood pressure is 120/70 mmHg, pulse is 90/min and respirations are 16/min. Physical examination shows a closed cervix and blood pooled in the vaginal vault. Ultrasonogram shows a vacant uterine cavity and free adnexae. Which of the following is the most likely diagnosis?

A 22-year-old primigravida woman at 33 weeks gestation is brought to the emergency department after a tonic clonic seizure. On arrival, she also has visual disturbances and a headache. She is given magnesium sulfate and hydralazine. She soon regains consciousness but cannot move her right arm; however, she can move her fingers. Her temperature is 37.2C (99F), blood pressure is 160/100 mm Hg, pulse is 110/min and respirations are 20/min. Examination shows her arm extended along the chest and internally rotated. There is no sensory loss on the arm, but there is an inability to externally rotate the shoulder. Deep tendon reflexes (DTR) are intact. Which of the following is the most likely cause of her inability to move her hand?

Todd's paralysis

Posterior dislocation of shoulder joint

Magnesium toxicity

Anterior dislocation of shoulder joint

Dislocation of acromioclavicular joint

A 22-year-old professional tennis player presents to your office with a 5-month history of amenorrhea. She describes an intense schedule of regular exercise, and says that she eats a balanced diet but avoids fatty foods. She does not smoke or consume alcohol. Her mother suffers from long-standing hypertension. The patient's BMI is 22.5 kg/mm2. Pregnancy test is negative. The patient is at greatest risk for which of the following?

Decreased bone mineral density

Poor glucose tolerance

Decreased thyroid function

Cholesterol precipitation in the gallbladder

Atypical endometrial hyperplasia

A 22-year-old woman complains of palpitations and has a regular heartbeat at a rate of 170/min, with a blood pressure of 110/70 mmHg. The rate abruptly changes to 75/min after applying carotid sinus pressure. Which of the following is the most likely diagnosis?

Sinus tachycardia

Paroxysmal supraventricular tachycardia (PSVT)

Paroxysmal ventricular tachycardia

Paroxysmal atrial fibrillation

Paroxysmal atrial flutter

A 22-year-old woman delivers a 7-lb male infant at 40 weeks without any complications. On day 3 of life, the infant develops respiratory distress, hypotension, tachycardia, listlessness, and oliguria. What is the most likely cause of the infant’s illness?

A 22-year-old woman has just delivered a male infant at 41 weeks of gestation. Her medical history is normal and her pregnancy was uncomplicated. She is an assistant in a veterinary clinic. Examination of the infant reveals jaundice, hepatosplenomegaly, and generalized lymphadenopathy. During the examination, he suddenly begins to have tonic-clonic seizures. The CT scan reveals active inflammatory lesions, hydrocephalus and intracranial calcifications. What is the most likely diagnosis of this patient?

A 22-year-old woman is seen by a psychiatrist in the emergency room after she is found walking in the middle of a busy street with no shoes on. During her interview she is asked to count backwards from 100 by 7’s. Which of the following best describes the cognitive functions being tested by this request?

A 22-year-old woman is taken to the emergency department after she injures her foot. She had been standing on a chair changing a light bulb, when she accidentally stepped off the chair backward. She heard a cracking sound when she fell and developed pain and swelling behind the ankle. Her symptoms worsened when she tried to descend the stairs in her house. Physical examination demonstrates marked swelling behind her ankle, and her pain is exacerbated by plantar flexion and dorsiflexion of the hallus. Which of the following is the most likely diagnosis?

Anterior Achilles tendon bursitis

Fracture of the posterolateral talar tubercle

Calcaneal spur syndrome

Epiphysitis of the calcaneus

Posterior tibial nerve neuralgia

A 22-year-old woman presents to office with a 3-week history of scant vaginal discharge. She has no other complaints. She is sexually active and uses oral contraceptives. She has regular 26-day menstrual cycles and her last menstrual period was ten days ago. She does not smoke or consume alcohol. Her temperature is 36.7C (98 F), blood pressure is 120/80 mmHg, pulse is 80/min, and respirations are 14/min. On examination, the abdomen is non tender. Yellow mucopurulent discharge is seen at the cervical os. Which of the following organisms is the most probable cause of this patient's problem?

A 22-year-old woman presents with a painful fluctuant mass in the midline between the gluteal folds. She denies pain on rectal examination. Which of the following is the most likely diagnosis?

A 22-year-old woman presents with chronic diarrhea. She has no abdominal discomfort, feels well, and reports no weight loss or systemic symptoms. Physical examination reveals a healthy young woman who is 5’7” tall and weighs 150 lb. The complete physical examination is normal. Which of the following is the most likely cause of a secretory diarrhea in this young woman?

A 22-year-old woman presents with mouth sores, sore throat, vaginal discharge, fever, and myalgia. She has no other medical problems. She takes oral contraceptive pills. She is in a monogamous relationship and states that her partner occasionally uses barrier contraception. Physical examination reveals a temperature of 38.3 C (101 F), cervical and inguinal lymphadenopathy, exudative pharyngitis, and multiple ulcers on the oral mucosa, the labia, and cervix. The vaginal discharge is profuse, and Gram stain indicates many neutrophils. Which of the following is the most likely diagnosis?

A 22-year-old woman, gravida 2, para 1, at 39 weeks gestation is admitted to the hospital for delivery. She has had regular and painful uterine contractions occurring every 3 minutes for the past 10 hours. Her pregnancy has been uncomplicated. She had a normal vaginal delivery for her first pregnancy and required an episiotomy. A recent ultrasound at 37 weeks gestation showed a fetus in a cephalic presentation with an estimated fetal weight of 3,400 g (7.5 lb). Examination shows the cervix is soft, 50% effaced and 2 cm dilated. She is given epidural anesthesia per her request. Eight hours later, her cervix has not significantly changed, and uterine contractions are occurring every 5 minutes. Which of the following is the most likely cause of her current condition?

A 22-year-old woman, gravida 4, para 3, at 38 weeks' gestation comes to the labor and delivery ward with a gush of fluid. Sterile speculum examination reveals a pool of fluid that is nitrazine positive and forms ferns when viewed under the microscope. The fetal heart rate is in the 150s and reactive. An ultrasound demonstrates that the fetus is in the breech position. A cesarean delivery is performed. During the operation, the physician, who has received no recent immunizations, is stuck with a needle that had been used on the patient. Which of the following is this physician at greatest risk of contracting?

A 22-year-old, gravida 1, para 0, at 13 weeks gestation is brought to the emergency department because of vaginal discharge and lower abdominal discomfort. She has had no passage of tissue from her vagina. She does not use tobacco, alcohol or drugs. She has no history of trauma. Her temperature is 37.0C (98.7F), blood pressure is 128/80 mmHg, pulse is 76/min and respirations are 14/min. Physical examination shows a closed cervix, a slightly tender uterus with a size consistent with gestational age, free adnexa and scant bright red bleeding from the introitus. Ultrasonogram in the emergency department shows normal fetal heart motion. She is anxious and concerned about her baby. Which of the following is the most likely diagnosis?

A 23-year-old college student comes to the office due to itching all over her body for the past 10 days. She hardly gets to sleep at night because of it. Her roommate has similar complaints. Her vital signs are stable. Physical examination reveals vesicles and pustules arranged in short, gray wavy channels on the finger webs, heels of palms, and in wrist creases. There are papules over the nipples and areola of her breasts. What is the most likely diagnosis?

A 23-year-old female comes to the physician because of a swelling in her vagina. She states that the swelling started about 3 days ago and has been growing larger since. The swelling is not painful, but it is uncomfortable when she jogs. She has asthma for which she uses an albuterol inhaler, but no other medical problems. Examination shows a cystic mass 4 cm in diameter near the hymen by the patient's left labia minora. The mass is nontender and there is no associated erythema. The mass is freely mobile. The rest of the pelvic examination is unremarkable. Which of the following is the most likely diagnosis?

A 23-year-old G1 with a history of a flulike illness, fever, myalgias, and lymphadenopathy during her early third trimester delivers a growth-restricted infant with seizures, intracranial calcifications, hepatosplenomegaly, jaundice, and anemia. What is the most likely causative agent?

A 23-year-old G1P0 woman at 28 weeks’ gestation presents to her obstetrician for a prenatal examination. She has received poor prenatal care up to this point, but is confident about dating the pregnancy. She denies use of alcohol and illicit drugs but has continued to smoke during the pregnancy. The mother has gained only 9 kg (20 lb) during the course of the pregnancy. The mother’s temperature is 36.8C (98.2F), pulse is 94/min, blood pressure is 138/84 mm Hg, and respiratory rate is 12/min. The fundal height is 23 cm above the pubic symphysis. Further examination with ultrasound reveals the fetus is < 10% of the expected weight for the gestational age with symmetric growth anomalies. What is the most likely cause for the intrauterine growth restriction of this fetus?

A 23-year-old G3P1011 at 6 weeks presents for routine prenatal care. She had a cesarean delivery 3 years ago for breech presentation after a failed external cephalic version. Her daughter is Rh-negative. She also had an elective termination of pregnancy 1 year ago. She is Rh-negative and is found to have a positive anti-D titer of 1:8 on routine prenatal labs. Failure to administer RhoGAM at which time is the most likely cause of her sensitization?

Within 3 days of delivering a Rh-negative fetus

At 28 weeks in the pregnancy for which she had a cesarean delivery

At the time of cesarean delivery

At the time of external cephalic version

After elective termination

A 23-year-old male comes to your office with a 10-day history of severe headaches. He states that they are sharp in character and are mostly right-sided involving the frontal area. The headaches interfere with his sleep, and he also complains of double vision, nausea, and malaise. His blood pressure is 120/80 mmHg, pulse is 103/min, respirations are 14/min, and temperature is 38.0°C (100.5°F). Examination reveals bilateral periorbital edema. There is subtle right-sided lateral gaze palsy. Which of the following is the most likely diagnosis?

A 23-year-old male is brought to the emergency department after a motor vehicle accident. He was an unrestrained driver. He was found unresponsive at the scene of the accident, and was intubated by the paramedics. He has received 2L of normal saline over the last 20 minutes. His blood pressure is 80/40 mmHg, and heart rate is 120/min. He responds to strong vocal and tactile stimuli by opening his eyes. His pupils are equal and reactive to light. His neck veins are distended. There are multiple bruises involving the anterior chest and upper abdomen. His chest x-ray shows a small, left-sided pleural effusion and normal cardiac contours. Which of the following is the most likely diagnosis?

A 23-year-old male is brought to the emergency department following a motor vehicle accident (MVA) where he was the unrestrained driver. The patient was found unresponsive at the scene and was intubated by paramedics. He receives 2.5L of normal saline over the 20 minutes before he reaches the ED. His blood pressure there is 70/30 mmHg and his heart rate is 120/min. On physical examination, he responds to strong vocal and tactile stimuli by opening his eyes. His pupils are equal and reactive to light. There are multiple bruises over the anterior chest and upper abdomen. His neck veins are flat, trachea is midline and extremities are cold. Cardiac monitoring shows sinus tachycardia. Which of the following is the most likely cause of this patient's current condition?

A 23-year-old man is experiencing a flare of his asthma. He is using his salbutamol inhaler more frequently than usual and despite increasing his inhaled steroids he is still short of breath. Previously his asthma was considered mild with no severe exacerbations requiring oral steroids or hospitalization. With his flare, he has recurrent episodes of bronchial obstruction, fever, malaise, and expectoration of brownish mucous plugs. On examination, there is bilateral wheezing. The heart, abdomen, neurologic, and skin exams are normal. CXR reveals upper lobe pulmonary infiltrates; the eosinophil count is 3000/mL, and serum precipitating antibodies to Aspergillus are positive. Which of the following is the most likely diagnosis?

A 23-year-old man notices a gradual but progressive increase in breathing difficulty. He has a long history of back pain with prolonged morning stiffness. He has also had an episode of iritis in the past. On examination, there is reduced range of motion in the lumbar spine with forward flexion and pain on palpation of the sacroiliac joint and surrounding soft tissue. X-rays of the pelvis show erosions and sclerosis of the sacroiliac joint. Which of the following is the most likely pulmonary complication of this condition?

A 23-year-old man presents to the emergency room complaining of severe abdominal pain. He has also suffered from nausea and vomiting for several hours. His past medical history is insignificant, but his brother has had similar problems. He denies risky sexual behavior and intravenous drug use. On exam, his temperature is 38.8°C (101.8°F), heart rate is 102/min, and respirations are 14/min. There is tenderness in the right upper quadrant exacerbated by deep inspiration. The liver span is 7 cm. His spleen is palpated 2 cm below the left costal margin. There are no peritoneal signs. Which of the following is the most likely diagnosis?

A 23-year-old man presents with coughing up blood and sputum. He gives a history of recurrent pneumonias and a chronic cough productive of foul-smelling purulent sputum. The sputum production is worse when lying down and in the morning. On physical examination, he appears chronically ill with clubbing of the fingers. Wet inspiratory crackles are heard at the lung bases posteriorly. There are no hepatosplenomegaly or any palpable lymph nodes. CXR shows scaring in the right lower lobe, which on chest CT scan is identified as airway dilatation, bronchial wall thickening, and grapelike cysts. Which of the following is sometimes seen in this condition?

A 23-year-old woman comes to the emergency room with the chief complaint that she has been hearing voices for 7 months. Besides the hallucinations, she has the idea that the radio is giving her special messages. When asked the meaning of the proverb “People in glass houses should not throw stones,” the patient replies, “Because the windows would break.” Which of the following mental status findings does this patient display?

A 23-year-old woman comes to the physician because of a 4-week history of a whistling noise during respiration. She underwent a difficult rhinoplasty a few months ago. The noise is getting louder and is annoying. Which of the following is the most likely diagnosis?

A 23-year-old woman comes to the physician because of right-sided foot pain. The pain started 5 weeks ago and is sharp and localized to the forefoot. She recalls no trauma or other inciting event but is an avid runner training for a long-distance race. The pain has been worsening over the past 1 week and prevents her from doing her daily running activities. She takes no medications. She is a vegetarian and does not drink soda. She does not use tobacco, alcohol, or illicit drugs. She is not sexually active, and her last menstrual period was 8 weeks ago. Her temperature is 37°C (98.6°F), blood pressure is 100/60 mm Hg, pulse is 68/min, and respirations are 12/min. Her body mass index is 15 kg/m2. Examination reveals tenderness to palpation along the first four metatarsal bones on the dorsal surface of the right foot, normal range of motion, and no erythema or bruising. Which of the following is the most likely diagnosis?

A 23-year-old woman comes to the psychiatrist because she “cannot get out of the shower.” She tells the psychiatrist that she has been unable to go to her job as a secretary for the past 3 weeks because it takes her at least 4 hours to shower. She describes an elaborate ritual in which she must make sure that each part of her body has been scrubbed three times, in exactly the same order each time. She notes that her hands are raw and bloody from all the scrubbing. She states that she hates what she is doing to herself but becomes unbearably anxious each time she tries to stop. She notes that she has always taken long showers, but the problem has been worsening steadily for the past 5 months. She denies problems with friends or at work, other than the problems that currently are keeping her from going to work. Which of the following is the most likely diagnosis?

Obsessive-compulsive disorder

Separation anxiety disorder

Attention-deficit hyperactivity disorder

Brief psychotic disorder

Obsessive-compulsive personality disorder

A 23-year-old woman complains of breast pain two days after delivering her first child. The delivery was complicated by mild postpartum bleeding. On exam, both breasts are tense, warm, and tender to touch. Her blood pressure is 130/70 mmHg, heart rate is 100/min, and temperature is 99.4 F (37.4 C). What is the most likely diagnosis?

A 23-year-old woman presents to the ED with RLQ pain for the last 1 to 2 days. The pain is associated with nausea, vomiting, diarrhea, anorexia, and a fever of 100.9°F. She also reports dysuria. The patient returned 1 month ago from a trip to Mexico. She is sexually active with one partner but does not use contraception. She denies vaginal bleeding or discharge. Her last menstrual period was approximately 1 month ago. She has a history of pyelonephritis. Based on the principles of emergency medicine, what are the three priority considerations in the diagnosis of this patient?

Ectopic pregnancy, PID, menstrual cramps

Gastroenteritis, amebic dysentery, menstrual cramps

Pelvic inflammatory disease (PID), gastroenteritis, cystitis

Perihepatitis, gastroenteritis, cystitis

Ectopic pregnancy, appendicitis, pyelonephritis

A 23-year-old woman presents to your office with the complaint of a red splotchy rash on her chest that occurs during intercourse. It is nonpuritic and painless. She states that it usually resolves within a few minutes to a few hours after intercourse. Which of the following is the most likely cause of the rash?

Decreased systolic blood pressure during the plateau phase

Increased estrogen during the excitement phase

Allergic reaction to her partner’s pheromones

Vasocongestion during the excitement phase

Vasocongestion during the orgasmic phase

A 23-year-old woman presents with urinary frequency and abnormal uterine bleeding. A careful medical history finds that her abnormal menstrual bleeding is characterized by excessive bleeding at irregular intervals. A pelvic examination finds a single mass in the anterior wall of the uterus, this being confirmed by ultrasonography. Which one of the following clinical terms best describes the abnormal uterine bleeding in this woman?

A 23-year-old woman who is 26 weeks pregnant presents to the emergency department with sudden onset severe shortness of breath and inability to lie flat. She recently emigrated from Eastern Europa. Her medical history is significant for recurrent sore throats requiring tonsillectomy as a child. Presently, her blood pressure is 110/60 mmHg and her heart rate is 120/min. An EKG rhythm strip suggests atrial fibrillation. Which of the following is the most likely diagnosis?

A 23-year-old woman, gravida 2, para 1, at 38 weeks' gestation was admitted to the delivery room for management of labor. On admission 6-hours ago, the patient was in the active phase of labor and the cervix was 4cm dilated. She was then placed under external tocometer and epidural anesthesia. Contractions were regular, occurring 2-3 minutes apart and lasting 40-60 seconds. She progressed well to 7cm. However, she has remained at 7cm the past 4 hours. The fetus is in the Left Occipita Anterior (LOA) position and at +1 station. Internal pelvic assessment shows prominent ischial spines. Electronic fetal heart monitoring shows 140 bpm with normal beat-to-beat and long term variability. Prenatal ultrasound at 37-weeks showed no abnormalities. Which of the following is the most likely cause of this patient's anomaly of labor?

A 23-year-old woman who is an elementary school teacher is brought to the ED after syncopizing in her classroom while teaching. Prior to passing out, she describes feeling light-headed and dizzy and next remembers being in the ambulance. There was no evidence of seizure activity. She has no medical problems and does not take any medications. Her father died of a “heart problem” at 32 years of age. She does not smoke or use drugs. BP is 120/70 mmHg, pulse rate is 71 beats per minute, RR is 14 breaths per minute, and oxygen saturation is 100% on room air. Her physical examination and laboratory results are all normal. A rhythm strip is seen below. Which of the following is the most likely diagnosis?

A 23-year-old woman, gravida 2, para 1, underwent first-trimester sonography at 10 weeks to rule out twins. A 6-cm, unilateral,fluid-filled, smoothwalled, unilocular pelvic mass was found. The mass is separate from the uterus and is essentially unchanged on serial sonograms. However, it is variable in location, being noted anterior, posterior, and lateral to the uterus. Which of the following is the most likely diagnosis?

A 24-year-old African American woman presents with mild dyspnea on exertion, fever, and a rash on her legs. Her symptoms have come on gradually and she reports no pleuritic chest pain, hemoptysis or sputum production. She has no significant past medical history, smokes 10 cigarettes/day and is not taking any medications. Physical examination reveals generalized lymphadenopathy and tender erythematous nodules on her legs. CXR shows bilateral symmetric hilar adenopathy and reticulonodular changes in both lungs. She has a restrictive lung disease pattern on pulmonary function testing. Which of the following is the most likely diagnosis?

A 24-year-old Caucasian female comes to the outpatient clinic and complains of heat intolerance and increased appetite. Her past medical history is insignificant. She denies use of over-the-counter medications. Her pulse is 110/min and regular, temperature is 37.2°C (99°F), and respirations are 14/min. Swelling is noted in the front of her neck, which moves with deglutition. Lab studies show: Total T4 Increased, Free T4 Increased, TSH Decreased. Radioactive iodine uptake is decreased. The thyroid scan shows very low uptake of radioiodine. What is the most likely diagnosis?

A 24-year-old Caucasian female complains of recurrent painful ulcers in her mouth and occasional abdominal pain. She has also unintentionally lost 5 pounds over the last six months. She is not sexually active, and denies use of tobacco, alcohol, or drugs. Past medical history is noncontributory and she takes no regular medications. Her mother suffers from asthma and her father has prostate cancer. She is afebrile with a blood pressure of 118/69 mmHg and pulse of 71/min. Physical examination reveals mild abdominal tenderness primarily in the lower abdomen without guarding or rebound. Several shallow ulcers are seen on the buccal mucosa. A biopsy of one of the ulcers demonstrates granulomatous inflammation. Her hematocrit is 42%. Which of the following is the most likely cause of this patient's complaints?

A 24-year-old female and her husband come to the physician's office for evaluation of infertility. They have not been able to conceive after 12 months of frequent intercourse without contraception. She has no other medical problems and takes no medication. Physical examination shows an obese woman with excess thick hair over her chin and along the linea alba of the lower abdomen. There is no increase in muscles mass. When asked about the excess hair, she states that she has had it for a long time. Serum testosterone levels are elevated. Which of the following is the most likely cause of her infertility?

A 24-year-old G0 presents to your office complaining of vulvar discomfort. More specifically, she has been experiencing intense burning and pain with intercourse. The discomfort occurs at the vaginal introitus primarily with penile insertion into the vagina. The patient also experiences the same pain with tampon insertion and when the speculum is inserted during a gynecologic examination. The problem has become so severe that she can no longer have sex, which is causing problems in her marriage. She is otherwise healthy and denies any medical problems. She is experiencing regular menses and denies any dysmenorrhea. On physical examination, the region of the vulva around the vaginal vestibule has several punctate, erythematous areas of epithelium measuring 3 to 8 mm in diameter. Most of the lesions are located on the skin between the two Bartholin glands. Each inflamed lesion is tender to touch with a cotton swab. Which of the following is the most likely diagnosis? Obstetric gynecology pretest 12th 319?

A 24-year-old G2P2 woman presents to the emergency department complaining of vaginal bleeding and abdominal cramping. She is sexually active in a monogamous relationship with her husband. Her last menstrual period was 6 weeks ago. The patient is afebrile, and vital signs are within normal limits. Pelvic examination is notable for a dilated cervix, fetal tissue in the vaginal vault, and no cervical motion tenderness. Which of the following is the most likely cause of this patient’s abortion?

A 24-year-old gravida 2, para 1, African American woman at 12 weeks gestation comes for her first prenatal visit. Except for early morning mild headaches and nausea she has no other symptoms. Physical examination shows mild bilateral ankle edema. Blood pressure is measured twice 15 minutes apart and is 150/96 mmHg on both occasions. Blood is drawn for laboratory tests and the patient is sent home with a follow-up appointment 3 days later. She returns 3 days later and repeat blood pressure is the same. Laboratory studies show: Urinalysis: Protein: negative, Blood: negative, Glucose: trace, Ketones: negative, Leukocyte esterase: negative, Nitrites: negative, WBC: 1-2/hpf, RBC: 1-2/hpf. Chemistry panel: Serum sodium: 150 mEq/L, Serum potassium: 2.5 mEq/L, Chloride: 100 mEq/L, Bicarbonate: 23 mEq/L, Blood urea nitrogen (BUN): 14 mg/dL, Serum creatinine: 0.8 mg/dL. Ultrasonogram reveals intrauterine gestation consistent with dates; no abnormalities noted. Which of the following is the most likely diagnosis?

A 24-year-old gravida 2, para 1, African American woman at 12 weeks gestation comes for her first prenatal visit. Except for early morning mild headaches and nausea she has no other symptoms. Physical examination shows mild bilateral ankle edema. Blood pressure is measured twice 15 minutes apart and is 150/96 mmHg on both occasions. Blood is drawn for laboratory tests and the patient is sent home with a follow-up appointment 3 days later. She returns 3 days later and repeat blood pressure is the same. Laboratory studies show: Urinalysis: Protein: negative; Blood: negative; Glucose: negative; Ketones: negative; Leukocyte esterase: negative; Nitrites: negative; WBC:1-2/hpf; RBC: 1-2/hpf. Chemistry panel: Serum sodium: 150 mEq/L; Serum potassium: 2.5 mEq/L; Chloride: 100 mEq/L; Bicarbonate: 23 mEq/L; Blood urea nitrogen (BUN): 14 mg/dL; Serum creatinine: 0.8 mg/dL. Ultrasonogram reveals intrauterine gestation consistent with dates; no abnormalities noted. Which of the following is the most likely diagnosis?

A 24-year-old man comes to the physician 24 hours after sustaining an injury to the right knee while playing soccer. He can walk, but he limps on the right side. He reports that he was hit by another player on the lateral side of his right knee, but did not feel a snap or pop at the time of the accident. On examination, the right knee appears normal, but palpation elicits tenderness along the medial aspect of the joint line. Increased laxity is observed when a valgus stress is applied to the knee flexed at 30 degrees, but not when the knee is in full extension. Lachman's test and posterior drawer tests are negative. Which of the following is the most likely diagnosis?

Sprain of the lateral collateral ligament

Tear of the anterior cruciate ligament

Meniscus injury

Tear of the posterior cruciate ligament

Sprain of the medial collateral ligament

A 24-year-old man comes to the physician because of 1 week of abdominal pain. It is localized in the right lower quadrant and somewhat exacerbated by motion. Over the past 2 days, it has radiated to the back. He initially had two episodes of vomiting but now just has decreased appetite. He had one episode of diarrhea 1 day ago. He denies urinary frequency. His other medical problems include mild intermittent asthma and gastroesophageal reflux disease. He traveled to Mexico for 5 days 1 month ago and did not have any gastrointestinal symptoms during his stay there. His mother was diagnosed with colon cancer at the age of 49 years. His temperature is 38.2°C (100.8°F), blood pressure is 122/77 mm Hg, and pulse is 109/min and regular. Physical examination reveals prominent tenderness in the right lower quadrant, without rebound. Flexion of the right hip against resistance elicits significant abdominal pain. Laboratory results show:WBC count 16,000/mmHemoglobin 14.2 g/dlPlatelet count 620,000/mmPotassium 4.5 mEq/LCreatinine 1.0 mg/dlWhich of the following is the most likely diagnosis?

A 24-year-old man from Long Island, New York, presents with fever, drenching sweats, and malaise for the past week. For the last few days, he has noted jaundice and dark-colored urine. He recalls being bitten by a tick two weeks ago. His surgical history includes splenectomy after a car accident 10 years ago. He does not use tobacco, alcohol, or illicit drugs. His temperature is 39.5°C (103°F), pulse is 106/min, and blood pressure is 110/70 mm Hg. Systemic examination is unremarkable, except for jaundice. Based on these findings, what is the most likely diagnosis?

A 24-year-old military recruit is brought to the emergency room after suddenly collapsing while at training camp. Witnesses say he lost consciousness, and in the ER he appears confused. He had apparently been in his usual state of good health until this incident. His medical history includes allergic rhinitis for which he takes chlorpheniramine. On physical examination, his temperature is 4 1°C (106°F), blood pressure is 90/60 mmHg, respiratory rate is 22/min, and pulse is 130/min and regular. He appears restless. His pupils are 4mm in size, symmetric, and reactive to light. Lung exam reveals a few rales at both lung bases. His abdomen is soft, non-tender and bowel sounds are present. There is no neck stiffness. His skin is dry and hot. He has 2+ symmetric reflexes in the upper and lower extremities. Muscle tone and bulk are normal. Initial laboratory studies show: Hemoglobin 16.0 g/L, Platelets 120,000/mm3, Leukocyte count 18,500/mm3, Blood urea nitrogen (BUN) 40 mg/dL, Prothrombin time 17 sec, Partial thromboplastin time 40 sec. Which of the following is the most likely cause of his current condition?

A 24-year-old nullipara is being evaluated for infertility. On pelvic examination, she has a single cervix. A diagnostic laparoscopy shows a double uterine fundus. Which of the following is the most likely diagnosis of her uterine anomaly?

A 24-year-old patient with known neurofibromatosis type 2 undergoes an MRI for ringing in his ears. The MRI demonstrates lesions in bilateral auditory canals. Which of the following is the most likely diagnosis?

A 24-year-old primigravid woman, who is intent on breast-feeding, decides on a home delivery. Immediately after the birth of a 4.1-kg (9-lb) infant, the patient bleeds massively from extensive vaginal and cervical lacerations. She is brought to the nearest hospital in shock. Over 2 hours, 9 units of blood are transfused, and the patient’s blood pressure returns to a reasonable level. A hemoglobin value the next day is 7.5 g/dL, and 3 units of packed red blood cells are given. The most likely late sequela to consider in this woman is which of the following?

A 24-year-old white male presents with a persistent headache for the past few months. The headache has been gradually worsening and not responding to over-the-counter medicines. He reports trouble with his peripheral vision which he noticed while driving. He takes no medications. He denies illicit drug use but has smoked one pack of cigarettes per day since the age of 18. Past history is significant for an episode of kidney stones last year. He tells you no treatment was needed as he passed the stones, and he was told to increase his fluid intake. Family history is positive for diabetes in his mother and a brother (age 20) who has had kidney stones from too much calcium and a “low sugar problem.” His father died of some type of tumor at age 40. Physical examination reveals a deficit in temporal fields of vision and a few subcutaneous lipomas. Laboratory results are as follows: Calcium: 11.8 mg/dL (normal 8.5-10.5), Cr: 1.1 mg/dL, Bun: 17 mg/dL, Glucose: 70 mg/dL, Prolactin: 220 μg/L (normal 0-20), Intact parathormone: 90 pg/mL (normal 8-51). You suspect a pituitary tumor and order an MRI which reveals a 0.7 cm pituitary mass. Based on this patient’s presentation, which of the following is the most probable diagnosis?

A 24-year-old woman arrives in the emergency center in active labor. She is at term, but received no prenatal care after 16 weeks of gestation when she lost her insurance coverage. The mother has an uncomplicated vaginal delivery. You are paged shortly after birth when the baby is noted to have respiratory distress. The infant has diminished breath sounds on the left, and the PMI is shifted toward the right. A chest radiograph is shown. The NG tube you placed earlier reveals the stomach to be below the diaphragm. Which of the following is the most likely diagnosis at this point?

A 24-year-old woman comes to the emergency room with the chief complaint that “my stomach is rotting out from the inside.” She states that for the last 6 months she has been crying on a daily basis and that she has decreased concentration, energy, and interest in her usual hobbies. She has lost 25 lb during that time. She cannot get to sleep, and when she does, she wakes up early in the morning. For the past 3 weeks, she has become convinced that she is dying of cancer and is rotting on the inside of her body. Also, in the past 2 weeks she has been hearing a voice calling her name when no one is around. Which of the following is the most likely diagnosis?

A 24-year-old woman comes to the physician because of a one-week history of increasing pain in the right leg. She is an active dancer and practices 4-5 hours a day. One week ago, she felt a dull aching pain in the right middle leg; the pain has been increasing since and is particularly bad when she dances. The pain is interfering with her dancing sessions. She is afebrile and her other vital signs are within normal limits. Examination shows point tenderness over the midpoint of the right leg; there are no abnormalities of the skin overlying the tender point. Knee and ankle examinations show no abnormalities. An x-ray of the lower leg shows no abnormalities. ESR is within normal limits. Which of the following is the most likely cause of her pain?

A 24-year-old woman comes to the physician because of right lower quadrant abdominal pain. She has had the pain off and on for the past month, but it is now increasing. She has no other symptoms and no medical problems. Examination reveals a mildly tender, right adnexal mass. Pelvic ultrasound shows a 7 cm right adnexal complex cyst. Urine hCG is negative. The patient is taken to the operating room for laparotomy and right ovarian cystectomy. Microscopically the cyst has cartilage, adipose tissue, intestinal glands, hair, and a calcification that appears to be a tooth. There is also a large amount of thyroid tissue. Which of the following is the most likely diagnosis?

A 24-year-old woman comes to the physician for an initial prenatal visit. Her last menstrual period was 7 weeks ago and a home urine pregnancy test was positive. She has had no bleeding or abdominal pain. She does complain of increased fatigue lately and some mild nausea and vomiting. Examination is significant for both a systolic and a diastolic cardiac murmur. The uterus is 8 weeks' sized and nontender. Which of the following findings is most suggestive of structural heart disease in this woman?

A 24-year-old woman comes to the physician for her third prenatal check-up at 12 weeks gestation. She has been feeling well for the last 4 weeks because she no longer has nausea and vomiting. She had a small dark brown discharge 4 weeks ago, but it stopped spontaneously. Physical examination shows the cervix is closed and fetal heart tones are not heard. Real-time ultrasonogram shows a collapsed gestational sac with absent fetal heart motion. Urine pregnancy test is positive. Which of the following is the most likely diagnosis?

A 24-year-old woman delivered a healthy baby by vaginal delivery at 36 weeks gestation. She had a prolonged premature rupture of the membranes, and mid forceps application was required during delivery. On the second postpartum day she complained of fever and chills. She cannot breast-feed because her "nipples are tender". Her temperature is 38.5C (101.3F), blood pressure is 120/55 mmHg and pulse is 92/min. Bimanual examination shows tender uterus and foul-smelling lochia. Her nipples are cracked but without surrounding erythema or warmth. Physical examination otherwise shows no abnormalities. Which of the following is the most likely diagnosis?

A 24-year-old woman delivers a normal 8-lb baby boy at 40 weeks of gestation. She has no history of drug abuse, and her pregnancy was unre-markable. Examination had revealed the placenta to be located normally, but following delivery the woman fails to deliver the placenta and subsequently develops massive postpartum hemorrhage and shock. Emergency surgery is performed to stop the bleeding. Which of the following is the most likely cause of her postpartum bleeding?

A 24-year-old woman develops moderate, generalized abdominal pain of sudden onset and shortly thereafter faints. At the time of evaluation in the emergency department, she has regained consciousness, is pale, and has a blood pressure of 95/70 mm Hg and a faint pulse rate of 90/min. The abdomen is mildly distended and tender, with normal bowel sounds. Her hemoglobin is 7 g/dL. There is no history of trauma, but it is suspected that she might be bleeding into her abdomen, and a diagnostic peritoneal lavage is performed. The study shows that there is free blood in the peritoneal cavity. She denies the possibility of pregnancy because she has been on birth control pills since the age of 14 and has never missed taking them. Pelvic examination is normal, and a pregnancy test is negative. At laparotomy, the surgeons are likely to find which of the following?

A 24-year-old woman has a MSAFP of 0.5 MOM (multiples of the median) at 17 weeks’ gestation. Which of the following fetal abnormalities is most likely to occur with this MSAFP?

A 24-year-old woman presents to her primary care provider because of bloody diarrhea for several months and uveitis. Complete blood cell count shows mild anemia but a normal WBC count. The erythrocyte sedimentation rate and the C-reactive protein level are not elevated. Which of the following is the most likely diagnosis?

A 24-year-old woman, 5 days after delivery of a normal, full-term infant, is brought to the obstetrician because she is so tearful. She states that her mood is quite labile, often changing within minutes. She has trouble sleeping, both falling asleep and awakening early. She notes anhedonia, stating she doesn’t enjoy “much of anything” right now. Which of this patient’s symptoms point preferentially to a postpartum depression?

A 24-year-old woman, gravida 2, para 1, at 36 weeks' gestation is brought to the emergency department after passing out. She is drowsy and moaning, complaining of abdominal pain. Her husband accompanies her. He states that she has not experienced any trauma, but that she experienced the sudden onset of severe abdominal pain before she passed out. She has no significant past medical history. Her pregnancy has been uncomplicated thus far. She does not use tobacco, alcohol, or drugs. She takes supplemental vitamins, but no other medications. Her temperature is 36.9 C (98.4F), blood pressure is 90/60 mm of Hg, and pulse is 130/min. Physical examination shows a cold and diaphoretic female. Examination shows a uterus consistent in size with a 36-week gestation; the cervical os is closed and no vaginal bleeding is noted. Which of the following is the most likely diagnosis?

A 25-year-old African American male comes to the office with sudden-onset back pain, dark urine and an one day history of fatigue. Two days ago, he was started on trimethoprim-sulfamethoxazole for his sinusitis. Otherwise, his past medical history is unremarkable. Physical examination reveals significant pallor. His laboratory report shows: Hb 7.5 g/dl, Total bilirubin 3.5 mg/dl, Direct bilirubin 0.8 mg/dl, Haptoglobin decreased, LDH increased. The peripheral smear shows bite cells. His G6PD level is normal. Which of the following is the most likely cause of his hemolysis?

A 25-year-old African American man presents to your office complaining of nocturia over the past several months. He reports having to wake to urinate 2 to 3 times per night despite restricting his fluid intake. He denies any back pain, fever, dysuria, or urinary urgency. His past medical history is significant for recurrent otitis media in childhood and hepatitis A infection two years ago. He is sexually active with one partner and does not use condoms. His brother died of a "blood disease" at age 10. The man's hematocrit is 49%. Urinalysis reveals no proteinuria or sediment abnormalities. His nocturia is most likely related to:

A 25-year-old female in her first pregnancy delivers a 6-lb male infant at 38 weeks. The infant develops fever, vesicular rash, poor feeding, and listlessness at 1 week of age. What is the most likely cause of the infant’s signs and symptoms?

A 25-year-old female presents to the physician's office for evaluation of infertility. Her menstrual periods are regular. She has mild chronic pelvic pain. Her husband's semen analysis is within normal limits. She has no history of sexually transmitted diseases in the past. Her temperature is 37.2 C (98.9 F), and her blood pressure is 120/72 mmHg. Physical examination shows a normal sized uterus and enlarged left adnexae. Ultrasonography shows a homogeneous mass on the left ovary, but is otherwise normal. Which of the following is the most likely diagnosis?

A 25-year-old G1 at 37 weeks presents to labor and delivery with gross rupture of membranes. The fluid is noted to be clear and the patient is noted to have regular painful contractions every 2 to 3 minutes lasting for 60 seconds each. The fetal heart rate tracing is reactive. On cervical examination she is noted to be 4 cm dilated, 90% effaced with the presenting part a −3 station. The presenting part is soft and felt to be the fetal buttock. A quick bedside ultrasound reveals a breech presentation with both hips flexed and knees extended. What type of breech presentation is described?

A 25-year-old G1P1 comes to see you 6 weeks after an uncomplicated vaginal delivery for a routine postpartum examination. She denies any problems and has been breast-feeding her newborn without any difficulties since leaving the hospital. During the bimanual examination, you note that her uterus is irregular, firm, nontender, and about a 15-week size. Which of the following is the most likely etiology for this enlarged uterus?

A 25-year-old G3 at 39 weeks delivers a small-for-gestational-age infant with chorioretinitis, intracranial calcifications, jaundice, hepatosplenomegaly, and anemia. The infant displays poor feeding and tone in the nursery. The patient denies eating any raw or undercooked meat and does not have any cats living at home with her. She works as a nurse in the pediatric intensive care unit at the local hospital. What is the most likely causative agent?

A 25-year-old immigrant from Eastern Europe is being evaluated for right shoulder pain and swelling. He also complains of heel pain while walking. Palpation over the heels, iliac crests and tibial tuberosities elicits tenderness. Which of the following additional findings is most likely in this patient?

A 25-year-old male comes to the office due to severe itching and burning of the skin lesions on his knees, elbows and back of his neck. He gives a history of loose stools, flatulence, weight loss of more than 10 lbs, and fatigue for the past 6 months. His vital signs are stable. On examination, there are papules and vesicles over the extensor aspect of his elbows, knees, posterior neck and scalp. The laboratory studies reveal the presence of anti-endomysial antibodies. Which of the following is the most likely diagnosis?

A 25-year-old male is brought to the emergency department following a motor vehicle accident in which he was the unrestrained driver. The emergency response team's reports indicate that his breath smelled of alcohol at the scene. En route to the hospital, the patient receives 2 liters of intravenous normal saline, and in the ED his blood pressure is 100/60 mmHg, heart rate is 120/min, and respiratory rate is 34/min. His neck veins are flat. You note multiple bruises overlying his anterior chest wall and upper abdomen. On inspiration, there is inward motion of the right side of his chest wall. His abdomen is soft and non-distended. He is put on positive pressure mechanical ventilation and his chest movements become symmetric. Which of the following is the most likely diagnosis?

A 25-year-old male presents to his physician with dyspnea and fatigue for the last few weeks. He is a non-smoker. He denies any family history of asthma or blood disorders. He does not take any medications. Examination shows pallor, scleral icterus and splenomegaly. Lab tests show the following: Hematocrit 20%, WBC count 10,000/micro-L, Platelet count 180,000/miro-L, Total Bilirubin 7 mg/dl, Direct bilirubin 1.4 mg/dl, BUN 10 mg/dl, Serum creatinine 0.7 mg/dl, Serum LDH 400 U/L (normal value is 80-280 U/L), Serum haptoglobin 160mg/dl (normal value is 30-220 mg/dl ), Reticulocyte count 8 %. Peripheral blood smear shows spherocytes with central pallor. Osmotic fragility and direct Coombs' tests are positive Based on these findings, what is the most likely diagnosis?

A 25-year-old man complains of left precordial chest pain that radiates to the left shoulder but not down the left arm. The pain is accentuated by inspiration and relieved by sitting up. The pain is accompanied by fever and chills. His blood pressure is 105/75 mmHg, pulse 110/min and regular, and temperature 37.5°C. Aside from the tachycardia, there are no abnormal physical findings in the heart or lungs. The ECG shows STsegment elevation in all leads except aVR and VI. On the third hospital day, the patient’s blood pressure falls, JVP rises, and he goes into CHF. Which of the following is the most likely diagnosis?

A 25-year-old man is admitted with fever and rust-colored sputum. He looks unwell, temperature 38.4°C, pulse 100/min, and blood pressure 115/80 mm Hg. On auscultation, there are bronchial breath sounds in the right axilla and inspiratory crackles. The CXR is shown in Fig. Which of the following is the most likely diagnosis?

A 25-year-old man is brought to the physician after complaining about a visual hallucination of a transparent phantom of his own body. Which of the following specific syndromes is this patient most likely to be displaying?

A 25-year-old man is referred to you because of hematuria. He noticed brief reddening of the urine with a recent respiratory infection. The gross hematuria resolved, but his physician found microscopic hematuria on two subsequent first-voided morning urine specimens. The patient is otherwise healthy; he does not smoke. His blood pressure is 114/72 mm Hg and the physical examination is normal. The urinalysis shows 2+ protein and 10 to 15 RBC/hpf, with some dysmorphic erythrocytes. No WBC or casts are seen. What is the most likely cause of his hematuria?

A 25-year-old man presents to the emergency room with shortness of breath and cough productive of blood tinged sputum for the past few days. He denies associated fever, arthralgias or weight loss. He has never had these symptoms before, and is extremely concerned. He has no history of recent travel or sick contacts. He smokes half a pack of cigarettes daily, and has had two sexual partners in the past six months. On physical examination, his temperature is 37.2°C (98.9°F), blood pressure is 120/70 mm Hg, pulse is 102/min, and respirations are 22/min. Lung auscultation reveals patchy bilateral rales. Chest x-ray demonstrates bilateral pulmonary infiltrates. His serum creatinine is 2.6 mg/dl and urinalysis shows dysmorphic red cells. Which of the following is the most likely cause of his current condition?

A 25-year-old man was admitted to the ICU with severe head injury with a basal skull fracture. Eighteen hours after the injury, he developed polyuria. Urine osmolality was 150 mOsm/Land serum osmolality was 350 mOsm/L. IV fluids were stopped, and 1 hour later urine output and urine osmolality remained unchanged. Five units of vasopressin were administered intravenously, and urine osmolality increased to 300mOsm/L. Select the most likely diagnosis of the patients with polyuria?

A 25-year-old motorcyclist is brought to the emergency department after being involved in a collision with an automobile. On arrival he is in obvious pain. He expresses an urge to void, but is unable to do so. Genital examination shows blood at the urethral meatus and a scrotal hematoma. Rectal examination reveals a high riding prostate. Abdominal examination is suggestive of a distended bladder. Which of the following is the most likely diagnosis?

A 25-year-old previously healthy man experiences fatigue and malaise. One week ago he had a “viral” type illness consisting of a sore throat, fever, and myalgias. He now appears jaundiced, but the rest of the physical examination is normal. His investigations reveal a total bilirubin of 4 mg/dL (0.1–1.0 mg/dL) and a direct bilirubin of 0.3 mg/dL (0.0–0.3 mg/dL). Which of the following is the most likely diagnosis?

A 25-year-old previously healthy man is scheduled for elective inguinal hernia repair under general anesthesia. After induction of anesthesia and initial inguinal incision, the patient develops tachycardia, muscle rigidity, fever of 38.5°C, and elevated end-tidal carbon dioxide. Which of the following is the most likely diagnosis?

A 25-year-old white female presents to the clinic with persisting pain in her wrists and ankles for the last 3 months. The pain is 3/10 in intensity, and partially relieved by ibuprofen. She also has a rash on her face. She denies smoking, and drinks alcohol occasionally. Her temperature is 37.3°C (99.2°F), blood pressure is 120/80 mm Hg, pulse is 79/min, and respirations are 18/min. Physical examination reveals swollen joints of the hands and ankle, as well as erythema over the bridge of the nose and the upper cheeks. There is no muscle weakness. Labs show: Hemoglobin 11.0 g/dL, Hematocrit 33%, Platelets 240,000/mm3, WBC 13,600/mm3. Leukocyte distribution:Segmented neutrophils 76%, Lymphocytes 20%, Bands 2%, Monocytes 2%. RF, ANA, and antibodies to double stranded-DNA are positive in high titers. What is the most likely diagnosis?

A 25-year-old white female presents with a 5-day history of sore throat, extreme fatigue, and headaches. She has just returned from a spring break in Jamaica where she had "the time of her life." She smokes 2-3 cigarettes daily and occasionally drinks alcohol. Her vital signs are stable. She is afebrile. Physical examination reveals posterior cervical lymphadenopathy, mild splenomegaly, and exudative pharyngitis. Palatal petechiae are present. CBC shows: WBC 16,000/cmm with 55% lymphocytes, Hemoglobin 13.5gm/dl, Hematocrit 41%, Platelets 216,000/cmm. Many variant forms of lymphocytes are seen, including cells with convoluted nuclei and highly vacuolated cytoplasm. Rapid streptococcal throat test, urinalysis, and heterophilic antibody test are all negative. What is the most likely diagnosis?

A 25-year-old woman brings her 5-day-old infant to the emergency room after noticing that he bruises very easily. Her pregnancy was normal, and the baby was born at term via vaginal delivery at home. This is the child's first visit to the doctor. He is exclusively breast-fed, and there is no family history of bleeding disorders. On physical examination, his vital signs are within normal limits. You note several ecchymotic skin lesions, but his exam is otherwise normal. Laboratory studies show the following: Prothrombin time 20 sec, Partial thromboplastin time 37 sec, Platelets 200,000/mm3. Which of the following is the most likely cause of his current condition?

Excessive destruction of platelets

Vitamin K deficiency

Consumption of coagulation factors

Impaired synthesis of von Willebrand factor

Factor VIII deficiency

A 25-year-old woman comes to the office and complains of intermittent dizziness and an unsteady gait for the last few days. Her symptoms worsen with exercise. Her past medical history is significant for tingling and numbness of her right foot that lasted 3-4 days (1 year ago), and visual loss in her right eye which spontaneously resolved (3 years ago). She is currently nursing her 2-month-old baby. Her obstetrical history was uncomplicated. Her neurological examination shows right hyperactive deep tendon reflexes. On attempted left gaze, her left eye abducts and exhibits horizontal jerk nystagmus, but her right eye remains stationary. When she attempts to look to the right, her right eye abducts and exhibits horizontal jerk nystagmus, but her left eye remains stationary. The patient is able to converge both eyes together, without any associated nystagmus. The facial muscles show no signs of weakness. Where is the most likely site of this patient's lesion?

{"name":"DES C_Diagnosis (3) Prepared : CHILLY", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"A 22-year-old Caucasian female comes to your office complaining of difficulty swallowing. She says that solid food sticks in the middle of her chest, and that's why she prefers liquids. She has lost 10 pounds over the last 3 months. She also complains of recent severe heartburn that does not respond well to over-the-counter antacids. On review of systems, she denies cough, shortness of breath and palpitations. She has noticed occasional swelling and pain in her small finger joints. Her fingers turn blue upon cold exposure, and she always wears gloves to keep them warm. She does not smoke or drink alcohol. She denies illegal drug use. Which of the following is the most likely diagnosis?","img":"https://cdn.poll-maker.com/18-735785/image.jpeg?sz=1200"}