A 77-year-old woman presents with pain and decreased vision in her right eye. She states that it started yesterday and has been rapidly worsening. Her temperature is 99.0°F (37.2°C), blood pressure is 133/81 mmHg, pulse is 88/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Which of the following is most likely to be found in this patient's history?

A 26-year-old woman presents to the emergency department with vaginal discharge. She states she noticed it a few days ago and states it has been gradually worsening. The patient works at a farmer's market selling produce. Her temperature is 98.4°F (36.9°C), blood pressure is 120/74 mmHg, pulse is 83/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Laboratory testing is ordered as seen below. Nucleic acid amplification: Chlamydia: Negative Gonorrhea: Negative Urine: Color: Amber Protein: Negative Red blood cells: Negative hCG: Positive Which of the following is an appropriate treatment for this patient?

A 6-year-old previously healthy boy is brought to the emergency department for right ear pain. His mother states he has been pulling at his ear for the past 2 days and has complained of discomfort. She states he felt warm but has not taken his temperature. His birth history is unremarkable and he has no significant medical history. His temperature is 100.4°F (38.0°C), blood pressure is 94/54 mmHg, pulse is 100/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Which of the following is the most likely etiology of this patient's symptoms?

A 50-year-old man presents to his primary care physician for management of a lung nodule. The nodule was discovered incidentally when a chest radiograph was performed to rule out pneumonia. The nodule is 8.5 mm in size and was confirmed by CT. The patient is otherwise healthy, has never smoked, and exercises regularly. The patient works in a dairy factory. He has had no symptoms during this time. His temperature is 97.6°F (36.4°C), blood pressure is 122/81 mmHg, pulse is 83/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam including auscultation of the lungs is unremarkable. Which of the following is the most appropriate next step in management?

A 21-year-old man presents to the emergency department after sustaining a stab wound to the neck at a local farmer's market. The patient is otherwise healthy and is complaining of pain. The patient is able to offer the history himself. His temperature is 97.6°F (36.4°C), blood pressure is 120/84 mmHg, pulse is 90/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam demonstrates a 3 cm laceration 1 cm inferior to the mastoid process on the right side. The patient's breath sounds are clear and he is protecting his airway. No stridor or difficulty breathing is noted. Which of the following is the most appropriate next step in the management of this patient?

A 21-year-old U.S. born first year medical student with no prior hospital or healthcare work presents to the physician for a routine physical exam. The patient is HIV negative, denies drug use, and denies sick contacts. The physician places a purified protein tuberculin test in the patient's right forearm intradermally. What is the proper time to read the test and induration diameter that would indicate a positive test result?

A 68-year-old woman presents to the emergency department complaining of ear pain. She states it started a few days ago and it has been gradually worsening. She also endorses subjective fevers and neck stiffness. The patient is an adamant swimmer and swims 2-3 times per day. She has a history of diabetes, hypertension, and morbid obesity. Her temperature is 103°F (39.4°C), blood pressure is 177/99 mmHg, pulse is 110/min, respirations are 15/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding in Figure A. Which of the following is the most likely diagnosis?

A 14-year-old boy presents to the emergency department with an intractable nosebleed. Pinching of the nose has failed to stop the bleed. The patient is otherwise healthy and has no history of trauma or hereditary bleeding disorders. His temperature is 98.9°F (37.2°C), blood pressure is 120/64 mmHg, pulse is 85/min, respirations are 12/min, and oxygen saturation is 98% on room air. Physical exam is notable for multiple clots in the nares which, when dislodged, are followed by bleeding. Which of the following location is the most likely etiology of this patient's symptoms?

A 35-year-old woman presents to an outpatient clinic during winter for persistant rhinorrhea. She states it is persistent and seems to be worse when she goes outside. Otherwise, she states she is generally healthy and only has a history of constipation. Her temperature is 98.7°F (37.1°C), blood pressure is 144/91 mmHg, pulse is 82/min, respirations are 14/min, and oxygen saturation is 98% on room air. Nasal sputum cytology reveals eosinophilia and boggy turbinates. Which of the following is the most likely diagnosis?

An 8-year-old girl presents to the emergency department for a cough, fever, and a runny nose. The patient is an immigrant from Lebanon and has never seen a doctor before. She has been given antibiotics for infections every few months for similar symptoms in the past. She has seasonal allergies and has always been sick since she was a child. Her temperature is 101°F (38.3°C), blood pressure is 100/64 mmHg, pulse is 89/min, respirations are 18/min, and oxygen saturation is 96% on room air. Physical exam is notable for bilateral coarse breath sounds. She appears well otherwise. A chest radiograph is performed as seen in Figure A. Which of the following is the most likely diagnosis?

A 5-year-old boy is brought in by his parents for recurrent abdominal pain. The child has been taken out of class 5 times this past week for abdominal pain that resulted in him being sent home. The mother reports that her son's stools have remained unchanged during this time and are brown in color, without blood, and with normal consistency and scent. She also notes that while at home he seems to be his usual self and does not complain of any symptoms. Of note she presents to you that she has been preparing her son's lunches which consist of couscous, vegetables, fried rice, and chicken. The patient denies difficulty with producing stool and does not complain of any functional pain. The child's vitals and labs including BMP and CBC are unremarkable and within normal limits. An abdominal exam is performed and there is no tenderness upon palpation, and the abdomen is soft and non-distended. After a conversation with the child exploring his symptoms, which of the following is the next step in management for this child?

A 24-year-old woman presents to the emergency department with a severe headache. She states it is 10/10 in intensity and states that it is associated with chewing. She describes it as a dull pain over the sides of her head. The patient is otherwise healthy and is not currently taking any medications. Her temperature is 97.0°F (36.4°C), blood pressure is 111/74 mmHg, pulse is 83/min, respirations are 13/min, and oxygen saturation is 98% on room air. Physical exam is notable for pain and tenderness over the mandibular and temporal region that is worsened when the patient opens and closes their mouth. Which of the following is the most likely diagnosis?

A 23-year-old man presents to his primary care physician with complaints of fatigue and cheek pain that started a day ago. He notes that he has nasal discharge that is yellow/green as well. Otherwise, he feels well and is generally healthy. The patient has a past medical history of type I diabetes mellitus and occasionally uses IV drugs. His temperature is 99.0°F (37.2°C), blood pressure is 120/84 mmHg, pulse is 70/min, respirations are 16/min, and oxygen saturation is 98% on room air. There is pain to palpation of the left and right maxilla. Pain is worsened when the patient bends over. Which of the following is the most appropriate initial step in management?

A 56-year-old woman presents to the emergency department with several episodes in which she felt "dizzy." She has had these symptoms on and off for the past year and can recall no clear exacerbating factor or time of day when her symptoms occur. She has a perpetual sensation of fullness in her ear but otherwise has no symptoms currently. Her temperature is 97.6°F (36.4°C), blood pressure is 122/77 mmHg, pulse is 85/min, respirations are 13/min, and oxygen saturation is 98% on room air. Cardiopulmonary exam is unremarkable. The patient's gait is stable. Which of the following is also likely to be found in this patient?

A 16-year-old boy presents to the emergency department due to right-sided hearing loss, headache, and nasal bleeding. He reports that for the past few months, he has found it difficult to breathe through his nose and has had nasal drainage. He also states that he has not been able to stop his nose from bleeding for the last few hours. His right-sided hearing loss began around the same time as his difficulty with nasal breathing. He denies any history of trauma to the nose, uncontrollable bleeding, and easy bruising. His family history is unremarkable. His temperature is 99°F (37.2°C), blood pressure is 112/67 mmHg, pulse is 95/min, and respirations are 20/min with an oxygen saturation of 99%. On physical examination, the patient appears anxious. There is an amber fluid collection in the right ear appreciated on otoscopy. Physical exam is notable for the finding in Figure A which does not remove with irrigation or the patient blowing their nose. Which of the following is the most appropriate next step in management?

A 32-year-old woman presents to the emergency department with abdominal pain. She states it started last night and has been getting worse during this time frame. She states she is otherwise healthy, does not use drugs, and has never had sexual intercourse. Her temperature is 99.0°F (37.2°C), blood pressure is 120/83 mmHg, pulse is 85/min, respirations are 12/min, and oxygen saturation is 98% on room air. A rectal exam is performed and the patient is subsequently disimpacted. Five kilograms of stool are removed from the patient and she subsequently states her symptoms have resolved. Initial laboratory tests are ordered as seen below. Urine: Color: Yellow Protein: Negative Red blood cells: Negative hCG: Positive A serum hCG is 1,000 mIU/mL. A transvaginal ultrasound does not demonstrate a gestational sac within the uterus. Which of the following is the best next step in management?

A 29-year-old G2P1001 woman at 39 weeks gestation presents to labor and delivery triage with intermittent lower abdominal pain. Her pregnancy has been followed and she is currently taking folate and a multivitamin. Her temperature is 98.0°F (36.7°C), blood pressure is 129/82 mmHg, pulse is 110/min, respirations are 22/min, and oxygen saturation is 98% on room air. The fetal heart rate monitoring strip depicted in Figure A is obtained. Which of the following best explains this fetal heart rate tracing?

A 65-year-old obese man presents to his primary care clinic feeling weak. He was in the military and stationed in Vietnam in his youth. His current weakness gradually worsened to the point that he had to call his son to help him stand to get on the ambulance. He smokes a pack of cigarettes every day and drinks a bottle of vodka a week. He has been admitted for alcohol withdrawal multiple times and has been occasionally taking thiamine, folic acid, and naltrexone. He denies taking steroids. His temperature is 98°F (36.7°C), blood pressure is 170/90 mmHg, pulse is 75/min, and respirations are 20/min. He is obese with a significant pannus. Hepatomegaly is not appreciable. Abdominal striae are present. His workup is notable for the following: Serum: Na+: 142 mEq/L Cl-: 102 mEq/L K+: 3.9 mEq/L HCO3-: 25 mEq/L BUN: 24 mg/dL Glucose: 292 mg/dL Creatinine: 1.5 mg/dL Ca2+: 10.1 mg/dL AST: 7 U/L ALT: 14 U/L 24-hour urinary cortisol: 400 µg (reference range < 300 µg) Serum cortisol: 45 pg/mL (reference range < 15 pg/mL) A 48-hour high dose dexamethasone suppression trial shows that his serum cortisol levels partially decrease to 25 pg/mL and his adrenocorticotropin-releasing hormone (ACTH) level decreases from 10 to 6 pg/mL (reference range > 5 pg/mL). What is the best next step in management?

A 72-year-old man presents to the primary care clinic for ev...

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