A 25-year-old male is brought into the emergency department by emergency medical services. The patient has a history of bipolar disease complicated by polysubstance use. He was found down in his apartment at the bottom of a staircase lying on his left arm. He was last seen several hours earlier by his roommate. He is disoriented and unable to answer any questions, but is breathing on his own. His vitals are HR 55, T 96.5, RR 18, BP 110/75. You decide to obtain an EKG as shown in Figure 1. What is the next best step in the treatment of this patient?

A 50-year-old man presents to the emergency department with chest pain. He states that it began earlier today and worsens with inspiration. It is non-exertional, 7/10 in severity, and sharp in nature. He states that he just returned from China yesterday and has not had any similar symptoms prior to today. He noticed that he has coughed up a small amount of blood-tinged sputum several times as well. He is otherwise healthy, other than having his foot splinted 4 days ago for an Achilles tendon injury he sustained while playing volleyball. His temperature is 97.9°F (36.6°C), blood pressure is 112/68 mm Hg, pulse is 120/min, respirations are 23/min, and oxygen saturation is 92% on room air. Physical exam is notable for an uncomfortable man who is mentating appropriately and moving all his extremities. Inspection of his lower extremities reveals a swollen and tender calf on the leg that is splinted. An ECG is seen in Figure A. The patient is started on IV fluids and oxygen. Which of the following is the next best step in management?

A 67-year-old male presents to your office one day after an injury. Yesterday he tried to play basketball with his grandchildren and he was doing well until he jumped to get the ball and landed awkwardly on his right foot, after which he could not bear weight on his foot. On exam, his right foot is significant for swelling with tenderness to palpation anterior to the Achilles tendon. The patient has no tenderness over his medial or lateral malleoli. Figure A is a radiograph of his right foot with the area of traumatic injury. What is the most likely diagnosis?

A 69-year-old male presents to the emergency room with back pain. He has a history of personality disorder and metastatic prostate cancer and was not a candidate for surgical resection. He began chemotherapy but discontinued due to unremitting nausea. He denies any bowel or bladder incontinence. He has never had pain like this before and is demanding morphine. The nurse administers IV morphine and he feels more comfortable. Vital signs are stable. On physical examination you note tenderness to palpation along the lower spine, weakness in the bilateral lower extremities, left greater than right. Neurological examination is also notable for hyporeflexia in the knee and ankle jerks bilaterally. You conduct a rectal examination, which reveals saddle anesthesia. Regarding this patient, what is the most likely diagnosis and the appropriate next step in management?

A 5-year-old male is brought to the pediatrician by his mother, who relates a primary complaint of a recent history of five independent episodes of vomiting over the last 10 months, most recently 3 weeks ago. Each time, he has awoken early in the morning appearing pale, feverish, lethargic, and complaining of severe nausea. This is followed by 8-12 episodes of non-bilious vomiting over the next 24 hours. Between these episodes he returns to normal activity. He has no significant past medical history and takes no other medications. Review of systems is negative for changes in vision, gait disturbance, or blood in his stool. His family history is significant only for migraine headaches. Vital signs and physical examination are within normal limits. Initial complete blood count, comprehensive metabolic panel, and abdominal radiograph were unremarkable. What is the most likely diagnosis?

A mother brings her 4-year-old son to his pediatrician. Over the last eight months, her son has been exhibiting several "odd" behaviors. Most importantly, he repeatedly says that he is playing games with a friend named "Steven," though she is certain that he does not exist. She has often found him acting out magical scenarios as though someone else is present, when no one is there. What is the most likely diagnosis in this patient?

A mother brings her 10 month-old boy to the pediatrician for a check-up. His birth was without complications and his development to-date has been progressing normally. He currently crawls, pulls himself up to standing, says 'mama' and 'dada' nonspecifically, and responds when called by his name. However, his mother is concerned, as she has noted over the past several weeks that he has periods where he stops breathing when he gets frightened or upset. These episodes last for 20-30 seconds and are accompanied by his lips and face become bluish. His breathing has always resumed normally within 45 seconds after the start of the episode, and he acts normally afterwards. One instance resulted in the child passing out for a 5-10 seconds before a spontaneous recovery. Which of the following is the most appropriate management of this patient's condition?

A 64-year-old woman presents to her primary care physician with complaints of fatigue, a sore mouth, as well as occasional abdominal pain and diarrhea for the past several months. She denies any loss of balance, trouble walking, numbness, pain, or tingling in her hands or feet. She has a past medical history of morbid obesity, depression, rheumatoid arthritis, suicide, anxiety, hypertension, diabetes, and factor V Leiden being managed by her PCP. Her temperature is 99.4°F (37.4°C), blood pressure is 154/94 mmHg, pulse is 87/min, respirations are 18/min, and oxygen saturation is 98% on room air. Physical examination is significant for the finding in Figure A. The patient's creatinine is 2.0 mg/dL at this visit. Which of the following is most likely to be found in this patient?

A 42-year-old man with a history of tuberculosis presents to your office complaining of fatigue for 2 months. Serum laboratory studies reveal the following: WBC 7,000 cells/mm^3, Hb 9.0 g/dL, Hct 25%, MCV 75 fL, Platelet 450,000 cells/mm^3, Vitamin B12 500 pg/mL (200-800), and Folic acid 17 ng/mL (2.5-20). Which of the following is the most appropriate next step in the management of anemia in this patient?

A 46-year-old woman presents to the emergency department with 1 day of painful leg swelling. She is otherwise healthy and takes only oral contraceptive pills. The patient does not regularly follow up with her primary doctor. Her temperature is 98.0°F (36.7°C), blood pressure is 122/78 mm Hg, pulse is 70/min, respirations are 13/min, and oxygen saturation is 99% on room air. Lower extremity examination shows mild calf swelling on her left leg, but otherwise is unremarkable. An ultrasound is performed as seen in Figure A. Which of the following is the most appropriate course of action?

A 79-year-old man presents to the emergency department with abdominal pain. The patient describes the pain as severe, tearing, and radiating to the back. His history is significant for hypertension, hyperlipidemia, intermittent claudication, and a 60 pack-year history of smoking. He also has a previously diagnosed stable abdominal aortic aneurysm followed by ultrasound screening. On exam, the patient's temperature is 98°F (36.7°C), pulse is 183/min, blood pressure is 84/46 mmHg, respirations are 24/min, and oxygen saturation is 99% on room air. The patient is pale and diaphoretic, and becomes confused and obtunded as you examine him. Which of the following is most appropriate in the evaluation and treatment of this patient?

A 55-year-old obese woman with a past medical history of a pulmonary embolism presents with shortness of breath and chest pain. It started this morning, and she can't recall any preceding symptoms. She feels short of breath and has chest pain with deep breaths. Her temperature is 97.6°F (36.4°C), blood pressure is 117/77 mmHg, pulse is 120/min, respirations are 22/min, and oxygen saturation is 92% on room air. A CTA is performed and the patient is subsequently treated with warfarin and admitted to the hospital. On hospital day 2, the patient complains of leg pain and demonstrates the finding in Figure A. Which of the following is the most likely etiology for this patient's presentation?

A 35-year-old woman presents to her family physician with a complaint of painful joints for the past 2 weeks. She reports symmetric bilateral joint pain in her hands, knees, and ankles. She has never had this before, and her past medical history is notable only for asthma. She states the pain is worse in the morning and improves throughout the day. Review of systems is notable for a recent low-grade fever with malaise. She works as a school teacher and is sexually active with men and women. Her temperature is 97.9°F (36.6°C), blood pressure is 120/84 mmHg, pulse is 70/min, respirations are 14/min, and oxygen saturation is 97% on room air. The patient is instructed to take ibuprofen and acetaminophen for her joint pain. She returns 1 month later stating that she has not needed to take the medications as her pain has been absent for the past 3 days. Which of the following is the most likely diagnosis?

An 86-year-old woman is brought to the emergency department from her nursing home facility. She has been more fatigued and less communicative over the past 3 days. The patient's only complaint is generalized weakness. She has had no witnessed falls and no signs of trauma during this time frame. Her past medical history is significant for mild dementia, well-controlled hypertension, and hyperlipidemia. Her medications include hydrochlorothiazide, losartan, and simvastatin. Her temperature is 97.6°F (36.4°C), blood pressure is 133/83 mmHg, pulse is 120/min, respirations are 16/min, and oxygen saturation is 98% on room air. Neurologic exam is unremarkable. There are no signs of trauma upon inspection. An ECG is performed as seen in Figure A. A previous ECG performed 2 weeks ago demonstrated normal sinus rhythm. An initial CBC, troponin, and serum chemistry are within normal limits. A chest radiograph, urinalysis, lumbar puncture, and flu swab are negative for any source of infection. Which of the following is the best next step in management?

A 22-year-old female presents to her PCP after having unprotected sex with her boyfriend 2 days ago. She has been monogamous with her boyfriend but is very concerned about pregnancy. The patient requests emergency contraception to decrease her likelihood of getting pregnant. A blood hCG test returns negative. The PCP prescribes the patient ethinyl estradiol 100 mcg and levonorgestrel 0.5 mg to be taken 12 hours apart. What is the most likely mechanism of action for this combined prescription?

A 70-year-old male presents to the emergency department with fever and productive cough that has progressed rapidly over the past day. On exam, he is very ill appearing and his vitals demonstrate T: 39 deg C, HR: 95 bpm, BP: 80/40 mmHg, RR: 15, SaO2: 93%. A CBC is obtained which demonstrates a white blood cell count (WBC) of 14,000. A chest radiograph is obtained which is demonstrated in Figure A. The patient is subsequently diagnosed with severe sepsis secondary to pneumonia and is transferred to the ICU after intubation, appropriate antibiotic therapy, and resuscitation measures are initiated. The patient improves steadily over the subsequent days in the ICU with improving vitals and decreasing WBC. However, on hospital day 4 he develops a fever to 41 deg C, and his WBC elevates to 16,000. On exam, he appears to withdraw in pain when his abdomen is palpated. Liver function tests and amylase/lipase are ordered and shown to be within normal limits. An abdominal ultrasound is obtained which is demonstrated in Figure B. What is the most likely cause of this patient's current presentation?

A 66-year-old man presents to his primary care physician endorsing easy bleeding. He reports that roughly 5 days ago, he began noticing excessive bleeding while brushing his teeth. He has not noticed any bleeding since this event and is currently asymptomatic. He is otherwise healthy with a medical history including hypertension treated with amlodipine and depression for which he takes fluoxetine. On examination, he is well appearing. His lower extremities are notable for the finding in Figure A. No active bleeding is seen in his oropharynx and rectal exam is negative for occult blood. Laboratory studies are ordered as seen below. Hemoglobin: 15 g/dL Hematocrit: 44% Leukocyte count: 7,500/mm^3 with normal differential Platelet count: 31,000/mm^3 Which of the following is the most appropriate next step in management?

A 46-year-old woman presents to her family physician for a general wellness checkup with a chief complaint of high levels of anxiety over the past year. Her anxiety has started to affect her performance at work, making her even more anxious and concerned that she will lose her job. She started psychotherapy several months ago and has experienced minimal improvement in her symptoms from this treatment. The patient is vehemently opposed to beginning any pharmacologic treatment for anxiety; however, she is interested in potential herbal remedies and has started taking kava. She also takes vitamin D, a multivitamin, fish oil, protein powder, and drinks goat milk regularly. The patient works as a commercial sex worker and has a history of IV drug abuse and alcohol abuse which she states she has not used in over a year. She has chronic tension headaches for which she self-administers acetaminophen usually multiple times per day. Her last wellness appointment was unremarkable and these problems are new. Laboratory values are ordered as seen below. Hemoglobin: 13 g/dL Hematocrit: 38% Leukocyte count: 6,870/mm^3 with normal differential Platelet count: 227,000/mm^3 Serum: Na+: 138 mEq/L Cl-: 102 mEq/L K+: 4.1 mEq/L HCO3-: 25 mEq/L BUN: 20 mg/dL Glucose: 111 mg/dL Creatinine: 1.0 mg/dL Ca2+: 10.2 mg/dL AST: 82 U/L ALT: 90 U/L Which of the following is the most likely cause of this patient's lab derangements?

A 17-year-old male is brought to the emergency department following a motor vehicle accident. He has suffered several wounds and is minimally responsive. There is a large laceration on his forehead as well as a fracture of his nasal bridge. He appears to be coughing and spitting blood. He is already wearing a soft collar. Vitals are as follows: T 36.4C, BP 102/70 mmHg, HR 126 bpm, and RR 18 rpm, and SpO2 is 88% on RA. He has 2 peripheral IVs and received 2L of IV normal saline on route to the hospital. There is frank blood in the oropharynx. Breath sounds are present bilaterally. Abdomen is distended and tender. Pulses are 1+. Which of the following should be the first step in management?

A 3-year boy with a history of atopic dermatitis is brought to his pediatrician for onset of a new facial rash. His skin exam (Figure A) is notable for erythematous erosions on his cheeks and surrounding his nares, some with an overlying honey-colored crust. What is the optimal first-line treatment for these lesions?

A 69-year-old man presents with granulomatosis with polyangiitis diagnosed about 8 months ago. He was treated appropriately and states that his symptoms are well controlled. He is presenting today for a general follow up visit. His temperature is 99.0°F (37.2°C), blood pressure is 184/104 mmHg, pulse is 88/min, respirations are 12/min, and oxygen saturation is 98% on room air. His physical examination is notable for the findings in Figures A and B. Which of the following would be found in this patient on serum laboratory studies?

A 55-year-old woman is found to have an abnormal mass on routine mammography. The mass is biopsied, and cytology results are diagnostic for invasive ductal adenocarcinoma that is estrogen receptor positive. The patient is started on chemotherapy and ultimately has the mass resected. She is taking tamoxifen and has regular outpatient follow-up appointments to monitor for any recurrence of cancer. The patient has a past medical history of asthma, obesity, and a large uterine leimyoma which was treated with a hysterectomy last year. Her last menstrual period was at the age of 47. The patient's vital signs and exam are unremarkable. Which of the following is a potential complication that could occur in this patient?

A 71-year-old woman presents with a transient episode of right arm and hand weakness that resolved in approximately one hour. Her symptoms started while she was gardening. Her past medical history is notable for hypertension, diabetes, anxiety, and dyslipidemia. Her current medications include insulin, metformin, and fluoxetine. Examination reveals a left carotid bruit. Ultrasound duplex of her carotid arteries demonstrates right and left carotid stenosis of 35% and 50%, respectively. Which of the following is the best next step in management?

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A 68-year-old man presents with a 6-month history of worsening fatigue and weight loss. He is especially concerned about a recent episode in which he noticed a blurring of his vision and headache; he also notes that his “memory is not as good as it used to be,” which his wife confirms. Physical exam is notable only for pallor and general weakness. Laboratory studies reveal anemia as well as an elevated erythrocyte sedimentation rate. Serum protein electrophoresis (SPEP) reveals a sharp, narrow spike of monoclonal IgM; serum IgM concentration is 6.3 g/dL. What is the most likely diagnosis in this case?

An 18-year-old female college student is brought to the emergency department by ambulance for a headache and altered mental status. The patient lives with her boyfriend who is with her currently. He states she had not been feeling well for the past day and has vomited several times in the past 12 hours. Lumbar puncture is performed in the emergency room and demonstrates an increased cell count with a neutrophil predominance and gram-negative diplococci on Gram stain. The patient is started on vancomycin and ceftriaxone. Which of the following is the best next step in management?

A 36-year-old female presents to her gynecologist for a check-up. She has had normal Pap smears as recommended every 3 years since she turned 30 years old. The physician conducts a pelvic examination that is without abnormality and obtains a cervical Pap smear. The results of the patient's Pap smear from the visit return as high grade squamous intraepithelial lesion (HGSIL). Which of the following is the best next step in the management of this patient?

A 31-year-old female presents to her gynecologist for a routine Pap smear. Her last Pap smear was three years ago and was normal. On the current Pap smear, she is found to have atypical squamous cells of unknown significance (ASCUS). Reflex HPV testing is positive. What is the best next step?

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A 27-year-old female presents to her OB/GYN for a check-up. During her visit, a pelvic exam and Pap smear are performed. The patient does not have any past medical issues and has had routine gynecologic care with normal pap smears every 3 years since age 21. The results of the Pap smear demonstrate atypical squamous cells of undetermined significance (ASCUS). Which of the following is the next best step in the management of this patient?

A 45-year-old male presents to your clinic with complaints of heartburn and progressive difficulty swallowing both liquids and solids over the past two years. He has been taking an over-the-counter proton pump inhibitor for the past 6 months without resolution of his symptoms. He is otherwise healthy and has no personal or family history of cancer. He is a nonsmoker. You order a barium swallow study, the results of which are shown in Figure A. What would you expect to see on manometry in this patient?

A mother brings her 3-year-old son to the doctor because she is worried that he might be harming himself by constantly banging his head on the wall. He has been exhibiting this behavior for a few months. She is also worried because he has started to speak less than he used to and does not respond when his name is called. He seems aloof during playtime with other children and seems to have lost interest in most of his toys. What is the most likely diagnosis?

69-year-old man with no significant past medical history except for hypertension receives an X-ray of his skull (Figure A) after his car was rear-ended in a parking lot resulting in neck soreness. No fracture but what is the likely diagnosis of this incidental finding?

A 32-year-old G2P1 at 32 weeks gestation presents to the emergency department with complaints of severe abdominal pain, fatigue, and nausea. Physical examination is significant for profound jaundice and tenderness to palpation of the right upper quadrant of the abdomen. The patient returned 2 weeks ago from a 1 month-long trip to India. She received sporadic pre-natal care while traveling and reports no known complications in her current pregnancy to date. She denies any past medical problems and states that her prior pregnancy proceeded as a normal vaginal birth without any complications. Infection with which of the following organisms would portend the worst prognosis with the highest mortality rate for this patient?

A 24-year-old male is brought in by fire rescue after being the restrained driver in a motor vehicle accident. There was a prolonged extraction. At the scene, the patient was GCS 13. The patient was boarded and transported. In the trauma bay, vitals are T 97.2 F, HR 132 bpm, BP 145/90 mmHG, RR 22 rpm, and O2 Sat 100%. ABCs are intact with a GCS of 15, and on secondary survey you note the following (Figure F). FAST exam is positive at Morrison's pouch. Abdominal exam shows exquisite tenderness to palpation with rebound and guarding. Which of the following radiographs is most likely to be present in this patient?

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 16-year-old boy presents to his pediatrician for evaluation of sore throat. He states he has had a sore throat for the past 4 days, with associated fever, chills, and fatigue. He states the fatigue has been especially bothersome and he has repeatedly fallen asleep in class. His temperature is 102.2°F (39.0°C), blood pressure is 120/70 mmHg, pulse is 100/min, respirations are 20/min, and oxygen saturation is 99% on room air. Exam is significant for splenomegaly, tonsillar exudate, and several large, tender lymph nodes in the anterior and posterior cervical chains. The tonsils are not notably enlarged. Laboratory studies show an elevated lymphocyte count, atypical lymphocytes on peripheral blood smear, and a positive heterophile antibody test. Which of the following is the best next step in management of this patient's condition?

A 32-year-old woman presents to the emergency department with abdominal pain. She states that she has had occasional pain over the last two weeks, but her pain became more constant and intense over the last day. She has no significant past medical history and takes no medications. She is sexually active with one partner. 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. Exam reveals a generally well-appearing female of stated age in no acute distress. The abdomen is soft, non-tender to palpation and non-distended. Pelvic exam is performed and is unremarkable. Initial laboratory tests are obtained as shown below. Urine: Color: Yellow Protein: Negative Red blood cells: Negative ß-hCG: Positive Serum ß-hCG is 2,000 mIU/mL. A transvaginal ultrasound is obtained and does not demonstrate a gestational sac within the uterus. Which of the following is the best next step in management?

A 56-year-old previously healthy woman with no other past medical history is post-operative day one from an open reduction and internal fixation of a fractured right radius and ulna after a motor vehicle accident. What is one of the primary ways of preventing postoperative pneumonia in this patient?

A 28-year-old female presents to her primary care physician because of pain on her right foot. She says that the pain began 2 weeks ago and gets worse with weight bearing. She has been training for a marathon, and this pain has limited her training. On exam, there are no signs of inflammation or deformities on her foot. Compression of the forefoot with concomitant pressure on the interdigital space reproduces the pain on the plantar surface between the third and fourth toes and produces an audible click. What is the cause of this patient's condition?

A 60-year-old patient comes into your clinic with a new concern. He states that about 20 years ago, he was shot in his right quadriceps while serving in the military. Since then, he has had a wound that partially heals, but has never closed completely. Now, the patient describes the wound as somewhat different. He states it is ulcerated with elevated edges and has been bleeding. You perform a full thickness biopsy of the lesion as shown in Figure A. What is the most likely diagnosis?

A 2-year-old boy is brought to the pediatrician by his parents for routine care. The patient was born at 38 weeks via spontaneous vaginal delivery. The pregnancy course was notable for preeclampsia managed with labetalol and asymptomatic bacteriuria which was treated. The patient had an uneventful course since birth and has done well with breastfeeding. He has no significant medical history other than routine childhood infections and is up to date on his vaccinations. He has a family history of anemia, so a hemoglobin electrophoresis test is performed. The results of the child's test can be seen in column 4 in Figure A. This patient is likely better able to tolerate infection with which of the following organisms compared with normal children?

An 83-year-old man is admitted to the hospital with fever, weakness, and decreased responsiveness. He is diagnosed with urosepsis based on urinalysis and culture and started on ceftriaxone and intravenous fluids. By hospital day 3, he is clinically improving. During the evening, the patient becomes irritable. He is talking to someone despite nobody being present in the room. He is easily agitated and attempts to strike a nurse with a remote control to his TV. Subsequently, the patient keeps getting out of bed and trying to walk away despite being a fall risk. Which of the following is the most appropriate next step in management?

A 77-year-old man with a history of hypertension and a 46 pack-year smoking history presents to the emergency department from an extended care facility with acute onset of headache, nausea, vomiting, and neck pain which started 4 hours ago and has persisted since. His temperature is 99.0°F (37.2°C), blood pressure is 164/94 mmHg, pulse is 90/min, respirations are 16/min, and oxygen saturation is 98% on room air. The patient's neurological exam is unremarkable with cranial nerves II-XII grossly intact and with stable gait with a walker. He is immediately sent for a head CT, which is unremarkable. His initial lab work all returns without acute abnormalities. Which of the following is the most appropriate management?

A 5-year-old girl with no significant medical history is brought to her pediatrician because her mother is concerned about her axillary hair development. She first noticed the hair growth a day prior as she was assisting her daughter in getting dressed. The girl has no physical complaints, and her mother has not noticed a change in her behavior. On physical exam, the girl has scant bilateral axillary hair, no breast development, and no pubic hair. The exam is otherwise unremarkable. Activation of which of the following is responsible for this girl's presentation?

A 28-year-old G2P1 female with a history of hypertension presents to the emergency room at 33 weeks with headache and blurry vision. On exam, her vitals include BP 186/102 mmHg, HR 102 beats per minute, RR 15 breaths per minute, and T 98.9 degrees Fahrenheit. She undergoes an immediate Caesarian section, and although she is noted to have large-volume blood loss during the procedure, the remainder of her hospital course is without complications. Four weeks later, the patient returns to her physician and notes that she has had blurry vision and has not been able to lactate. A prolactin level is found to be 10 ng/mL (normal: 100 ng/mL). Which of the following is the most appropriate next step?

A 32-year-old male presents to his primary care physician because of a one month history of generalized itching, fatigue, and a recent 5 lb unintended weight loss. He is a tax accountant, with no occupational exposures, drinks alcohol occasionally on weekends, and has never smoked. His past medical history is notable for ulcerative colitis, for which he is on mesalamine therapy. On physical exam, vital signs are within normal limits. The patient is tired appearing, with no notable abnormalities; abdominal exam elicits mild tenderness to palpation in the right upper quadrant, Murphy's sign is not present. Laboratory studies show an elevated alkaline phosphatase, gamma-glutamyl-transpeptidase (GGT), and mild transaminitis. The patient is referred for endoscopic retrograde cholangiopancreatography (ERCP), which is shown in Figure A. Which of the following findings are likely present in this patient?

A 64-year-old male presents to his primary care physician with a complaint of bilateral knee pain that has been present for the past several years but has worsened recently. He reports pain with climbing stairs and with extended walks of greater than 100 yards. The pain worsens with activity throughout the day and is alleviated by periods of rest. He states that he has minimal morning stiffness, lasting approximately 5-10 minutes after waking up most days. Physical examination reveals tenderness to palpation of the bony structures on the medial aspect of the bilateral knees as well as crepitus and a decreased range of motion, limited at the extremes of flexion and extension. Both knee joints are cool to touch and exhibit bony enlargement upon palpation of the medial joint line. Which of the following studies would be indicated for further work-up of this patient's presenting condition?

A 7-year-old child is brought to the emergency room by his parents in severe pain. They state that he fell on his outstretched right arm while playing with his friends. He is unable to move his right arm which is being supported by his left. On exam, his vitals are normal. His right extremity reveals normal pulses without swelling in any compartments, but there is crepitus above the elbow upon movement. The child is able to flex and extend his wrist, but this is limited by pain. The child has decreased sensation along his thumb and is unable to make the "OK" sign with his thumb and index finger. What is the most likely diagnosis?