A 7-year-old boy is brought in by his mother after he developed a rash, shown in Figure A. On interview, you learn that four days ago your patient had a fever of 100F, headache, coryza, and diarrhea. Besides the rash, the patient has no other complaints. It is recorded that his vaccinations are up-to-date. With regards to the rash, which of the following is the best treatment?

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A 15-year-old girl is brought into her pediatrician's office by her mother because the mother thinks her daughter has attention issues. The mother explains that her daughter started high school four months ago and had lackluster grades in a recent progress report despite having earned consistent top marks in middle school. The mother complains that her daughter never talks to her at home anymore. The patient yells at her mother in the exam room, and the mother is escorted out of the room. The patient scoffs that her mother is so overbeaing, ruining her good days with criticism. She begins to chew gum and states that she hates hanging out with the girls on the cheerleading squad. She denies experiencing physical abuse from anyone or having a sexual partner. She has seen kids smoke marijuana underneath the football field bleachers, but does not go near them and denies smoking cigarettes. She denies any intention to harm herself or others, thinks her grades went down because her teachers are not as good as her middle school teachers, and states she thinks she learns best by watching explanations through online videos. What is the most likely diagnosis?

A 22-year-old woman presents to the emergency department for abdominal pain. The patient has been trying to get pregnant and was successful recently, but now she is experiencing abdominal pain, contractions, and a bloody vaginal discharge. According to her last appointment with her primary care provider, she is 10 weeks pregnant. The patient has a medical history of constipation, anxiety, and substance abuse. She is not currently taking any medications. Her temperature is 99.5°F (37.5°C), blood pressure is 107/58 mmHg, pulse is 90/min, respirations are 17/min, and oxygen saturation is 98% on room air. Physical exam is notable for a bloody vaginal discharge and an open cervix. The patient is initially extremely grateful for the care she is receiving and thanks the doctor and the nursing staff for saving her baby. Upon hearing the news that she is having a spontaneous abortion, the patient becomes angry and aggressive and states that her physician and the medical staff are incompetent, evil, and she is going to sue all of them. The patient is left to grieve but upon entering the room again you notice that the patient has new lacerations over her wrists and that some of the medical equipment in the room is broken. Which of the following is the most likely diagnosis?

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A 22-year-old man presents to his primary care physician with itchy eyes. The patient recently moved to the northern US and states that he has experienced bilateral itching and watering of his eyes. He states that it is very distracting and is making it hard for him to work. The patient denies any recent sick contacts and lives alone. He works as a machinist and is currently struggling with his finances. The patient has a past medical history of asthma, and his current medications include albuterol, fluticasone, fish oil, and whey protein supplements. His temperature is 99.5°F (37.5°C), blood pressure is 100/65 mmHg, pulse is 60/min, respirations are 15/min, and oxygen saturation is 99% on room air. Cardiopulmonary exam is within normal limits. You notice the bilateral findings seen in Figure A. Otoscopy reveals bilateral clear tympanic membranes. The rest of the patient's physical exam is within normal limits. Which of the following is the most likely diagnosis?

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A 26-year-old man presents to his primary care physician for a routine physical exam. He is concerned about a burning sensation that he feels in his throat whenever he eats large meals and is concerned he may have esophageal cancer like his uncle. The patient has a medical history of irritable bowel syndrome and constipation. His current medications include whey protein supplements, fish oil, a multivitamin, and sodium docusate. The patient is concerned about his performance in school and fears he may fail out. He recently did poorly on an exam and it has caused him significant stress. He also is worried that his girlfriend is going to leave him. The patient claims that he thought he was going to be an incredible doctor some day, but now he feels like a terrible person. The patient also states that he feels guilty about his grandfather's death which occurred 1 year ago and he often reexperiences the funeral in his mind. He regularly has trouble sleeping for which he takes melatonin. The patient has been praying every 4 hours with the hopes that this will make things go better for him. Which of the following is the most likely diagnosis?

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A 30-year-old G4P3 woman at 38 weeks gestation is admitted to the labor and delivery unit complaining of contractions every 5 minutes for the past hour. Her previous births have been via uncomplicated caesarean sections, but she wishes to attempt vaginal delivery this time. Her prenatal care is notable for gestational diabetes controlled with diet and exercise. The delivery is prolonged, but the patient's pain is controlled with epidural analgesia. She delivers a male infant with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Fundal massage is performed, but the placenta does not pass. The obstetrician manually removes the placenta, but a red mass protrudes through the vagina attached to the placenta. The patient loses 500 mL of blood over the next minute, during which her blood pressure decreases from 120/80 mmHg to 90/65 mmHg. What is the best next step in management?

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A 22-year-old G4P2 at 35 weeks gestation presents to the hospital after she noticed that "her water broke." Her prenatal course is unremarkable, but her obstetric history includes postpartum hemorrhage after her third pregnancy, attributed to a retained placenta. The patient undergoes augmentation of labor with oxytocin and within four hours delivers a male infant with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Three minutes later, the placenta passes the vagina, but a smooth mass attached to the placenta continues to follow. Her temperature is 98.6°F (37°C), blood pressure is 110/70 mmHg, pulse is 90/min, and respirations are 20/min. What is the most likely complication in the absence of intervention?

A 59-year-old man presents to the emergency department with chest pain. He felt a strange sensation in his chest which started after he ate dinner. The patient has a medical history of obesity, diabetes, and alcoholism. His current medications include atorvastatin, lisinopril, metformin, and insulin. His temperature is 99.5°F (37.5°C), blood pressure is 90/58 mmHg, pulse is 120/min, respirations are 17/min, and oxygen saturation is 98% on room air. On physical exam, the patient appears comfortable. Cardiac exam reveals tachycardia. Pulmonary and abdominal exams are within normal limits. An ECG is performed as seen in Figure A. An initial set of cardiac troponins are negative. Which of the following is associated with the most appropriate next step in management?

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A 21-year-old woman presents to her obstetrician because she has stopped getting her period, after being irregular for the last 3 months. Upon further questioning, the patient reveals that she has had a 17 lb unintended weight loss, chronic diarrhea, abdominal pain, and constipation that waxes and wanes. Family history is notable only for an older brother with type 1 diabetes. She is healthy and is eager to gain back some weight. Her gynecologist refers her to a gastroenterologist, but first sends serology laboratory studies for IgA anti-tissue transglutaminase antibodies (IgA-tTG). These results come back positive at > 10x the upper limit of normal. Which of the following is the gastroenterologist likely to find on endoscopy and duodenal biopsy?

A 40-year-old woman presents to the clinic for malaise. She has been in her usual state of health until 2 weeks ago, when she noticed weakness and dyspnea upon exertion. She denies any orthopnea, paroxymal noctural dyspnea, or weight loss. She endorses occasional fevers but has not checked her temperature at home. She also reports worsening pain in her eyes that occasionally causes headaches and occasional joint pain. Her temperature is 98.6°F (37°C), blood pressure is 120/70 mmHg, pulse is 70/min, and respirations are 15/min. Physical exam shows injected sclera bilaterally. She denies pain with eye movement. Her lungs are clear to auscultation bilaterally. Cardiac auscultation reveals an S3 with an occasionally split S2. A chest radiograph is obtained and shown in Figure A. Her lower extremities reveal skin findings shown in Figure B. Which of the following is the most likely diagnosis?

A 30-year-old woman presents to the clinic for evaluation of chronic dry cough of 3-months duration. She denies shortness of breath, hemoptysis, night sweats, or weight loss but does endorse occasional subjective fevers, joint discomfort, and recurrent crops of painful nodules on her legs. Her temperature is 99.2°F (37.3°C), pulse is 60/min, blood pressure is 112/74 mmHg, respirations are 14/min, and oxygen saturation is 98% on room air. Her laboratory test results are shown below: Leukocyte count: 7,200/mm^3 Hemoglobin: 12.1 g/dL Platelet count: 400,000/mm^3 Serum: Na+: 135 mEq/L K+: 5 mEq/L Cl-: 100 mEq/L HCO3-: 24 mEq/L BUN: 20 mg/dL Creatinine: 1.1 mg/dL Glucose: 105 mg/dL Ca2+: 11.5 mg/dL Mg2+: 2.0 mg/dL Phosphorus (inorganic): 3.2 mg/dL Which of the following chest radiographs would most likely be present in this patient?

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A 37-year-old African American man is brought to the emergency department by police. The patient refused to leave a petting zoo after closing. He states that he has unique ideas to revolutionize the petting zoo experience. The patient has a past medical history of multiple suicide attempts. His temperature is 99.5°F (37.5°C), blood pressure is 130/85 mmHg, pulse is 100/min, respirations are 16/min, and oxygen saturation is 99% on room air. The patient's cardiac and pulmonary exams are within normal limits. He denies any nausea, vomiting, shortness of breath, or systemic symptoms. The patient struggles to answer questions, as he is constantly changing the subject and speaking at a very rapid rate. The patient is kept in the emergency department overnight and is observed to not sleep and is very talkative with the nurses. Which of the following is the best long-term therapy for this patient?

A 24-year-old female presents to her primary care physician with right knee pain for the last week. She states that she first noticed it after a long flight on her way back to the United States from Russia, where she had run a marathon along a mountain trail. The patient describes the pain as dull, aching, and localized to the front of her kneecap, and it worsens with sitting but improves with standing. Aspirin has not provided significant relief. The patient has a history of a torn anterior cruciate ligament (ACL) on the right side from a soccer injury three years ago. In addition, she was treated for gonorrhea last month after having intercourse with a new partner. At this visit, the patient’s temperature is 98.5°F (36.9°C), blood pressure is 112/63 mmHg, pulse is 75/min, and respirations are 14/min. Which of the following is most likely to establish the diagnosis?

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A 44-year-old woman presents to her primary care physician’s office with episodes of pain in her right hand. The pain is most significant at night and awakens her from sleep numerous times. When she experiences this pain, she immediately puts her hand under warm running water or shakes her hand. She has also experienced episodes of numbness in the affected hand. Driving and extending the right arm also provoke her symptoms. She denies any trauma to the hand or associated weakness. Medical history is notable for hypothyroidism treated with levothyroxine. She works as a secretary for a law firm. Her temperature is 98.6°F (37°C), blood pressure is 115/73 mmHg, pulse is 72/min, respirations are 12/min, and oxygen saturation is 99% on room air. On physical exam, when the patient hyperflexes her wrist, pain and paresthesia affect the first 3 digits of the right hand. Which of the following is the confirmatory diagnostic test for this patient?

A 45-year-old male presents to the emergency room complaining that he has been coughing up blood-tinged sputum. Since this morning, the patient reports he has coughed up around 1/4 cup of "phlegm" mixed with blood. A review of systems is also notable for fatigue and night sweats that began two nights ago, but he denies any recent changes in weight. His past medical history is significant for hypertension, chronic sinusitis, and childhood asthma. His current medications include metoprolol and amlodipine. He is a smoker with a 20 pack-year history. The patient’s temperature is 99°F (37.2°C), blood pressure is 126/76 mmHg, pulse is 72/min, and respirations are 14/min with an oxygen saturation of 98% O2 on room air. A physical exam is notable for oral ulcers. A chest radiograph is performed and is shown in Figure A. Labs are drawn and are listed below: Serum: Na+: 144 mEq/L Cl-: 109 mEq/L K+: 4.3 mEq/L HCO3-: 23 mEq/L Urea nitrogen: 46 mg/dL Glucose: 100 mg/dL Creatinine: 3.0 mg/dL Leukocyte count and differential: Leukocyte count: 12,000/mm^3 Segmented neutrophils: 60% Bands: 3% Eosinophils: 3% Basophils: < 1% Lymphocytes: 28% Monocytes: 5% Hemoglobin: 13.0 g/dL Hematocrit: 50% Platelets: 200,000/mm^3 Urine: Epithelial cells: 5/hpf Glucose: negative Proteins: 25 mg/dL RBC: 15/hpf Red cell casts: 7/hpf WBC: 1/hpf Leukocyte esterases: negative Nitrites: negative Bacteria: none Based on the information above, which of the following is most likely to be abnormal?

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