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A 15-year-old boy attends his GP with a week of cough productive of yellow sputum, fever to 39°C and chest pain on the right side of the chest on coughing. There is no history of foreign travel or unwell contacts. On examination there is reduced air entry in the right lower zone with crepitations and bronchial breathing. You diagnose a right-sided chest infection. What is the most likely causative organism?

A 14-month-old girl is brought to the emergency department with a 12-hour history of fever and rash. Her mother became frightened when it was difficult to arouse the girl after her nap. Findings on physical examination include a temperature of 104°F (40°C), a heart rate of 164 beats/min, a respiratory rate of 42 breaths/min, and a blood pressure of 75/45 mm Hg. There are petechiae and purpura (Item Q156A) on the chest, arms, and legs. As you are establishing intravenous access and drawing blood for initial laboratory evaluations, you request an immediate dose of antibiotics. Of the following, the MOST appropriate therapy is

A 3-year-old boy who has myelomeningocele and a history of recurrent urinary tract infections presents with a 1-day history of a temperature to 102ºF (38.9ºC) and cloudy urine. Laboratory test results include a peripheral white blood cell count of 15x103/mcL (15x109/L), with 60% neutrophils, 30% lymphocytes, and 10% monocytes. Urine obtained by catheterization is cloudy; has a strong odor; and is positive for nitrites, leukocyte esterase, and blood. Microscopic analysis shows too numerous- to-count white blood cells and 50 to 100 red blood cells, and gramnegative bacilli are seen on Gram stain. One day later, the urine culture is positive for Pseudomonas aeruginosa. Of the following, the MOST appropriate antibiotic for treatment of this patient is

A 10-year-old child is brought to your office for evaluation of a 1-day history of fever, vomiting, diarrhea, and abdominal pain. His mother states that he has vomited five times, and the emesis has been clear. He has had four episodes of nonbloody diarrhea. He describes his abdominal pain as crampy but cannot localize it to any specific part of his abdomen. He denies any symptoms of dysuria. On physical examination, the child is in no acute distress, his temperature is 99.2°F (37.3°C), heart rate is 102 beats/min, respiratory rate is 26 breaths/min, and blood pressure is 105/70 mm Hg. Results of examination of the head, neck, chest, and heart are normal. His abdomen is soft, and there is no guarding. There is no rebound tenderness. He complains of mild discomfort on deep palpation of his entire abdomen. He has hyperactive bowel sounds on auscultation, and he has no flank tenderness. Of the following, the MOST appropriate next step in the management of this patient is to

Two days after undergoing posterior exenteration for recurrence of cervical adenocarcinoma a 53-year-old woman develops a tachypnoea, tachycardia of 125 bpm and a fever of 39° Blood cultures have grown methicillin-resistant Staphylococcus aureus (MRSA). She requires intravenous vasopressors. What is the most appropriate diagnosis?

A 42-year-old woman is in her first pregnancy. She conceived with in vitro fertilization (IVF) and has had a straightforward pregnancy so far. At 25 weeks’ gestation she is seen in clinic with a blood pressure of 142/94 mmHg and protein + in her urine. A protein creatinine ratio (PCR) comes back as 19. She says that her blood pressure is often up at the doctor’s. With the information you have to hand what is the most likely diagnosis?

A 28-year-old woman attends accident and emergency unable to walk because she is so faint. She has had heavy vaginal bleeding for 4 hours since she engaged in sexual intercourse with a new partner, which she described as ‘rough and very painful’. She is still bleeding and cannot tolerate vaginal examination due to the pain. A point-of-care haemoglobin estimation is 6.4 g/dL and she is haemodynamically unstable. What is the most appropriate management?

A 10-year-old boy presents with a history of multiple episodes of moderately severe epistaxis that resolve with conservative management. The most recent attack required hospital admission. He also describes multiple episodes of having a ‘stuffy noise’ associated with mild headaches. During these episodes his mother thinks he looks ‘puffy’. There is no history of foreign body inhalation or nasal trauma. He does not suffer from easy bruising. Which one of the following is the most likely diagnosis?

A 6-year-old Asian boy is brought to the paediatric emergency department by his mother. She is worried because the boy is lethargic and has been complaining of right-sided earache all day. There have been no similar attacks in the past. On examination, he looks unwell, and his temperature is 39.0°C, pulse rate is 110beats/min and blood pressure is 90/40 mmHg. There is no cervical lymphadenopathy. Otoscopic examination reveals a bright red right tympanic membrane. You decide to take a microbiology swab. Which one of the following is the most likely pathogen?

An 18-year-old student presents with a 6-month history of a painless lump in her right breast. She is currently mid cycle and does not report any cyclical change in the lump. On examination a 3 cm × 2 cm lump is found in the inner lower quadrant of the right breast as well as a 1 cm × 0.5 cm lump in the upper outer quadrant of the same breast. Both are smooth on palpation and have sharp edges. They slip easily between the examining fingers of the physician. The primary problem is likely to be a?