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A 3-year-old previously healthy female is brought to your office by her mother. The mother reports the child has been crying and pulling at her right ear over the past 2 days, and reports the patient has been febrile the past 24 hours. The patient’s past medical history is unremarkable, although the mother reports the patient had a “common cold” a week ago which resolved without intervention. Her temperature is 101.6 deg F (38.7 deg C), blood pressure is 100/70 mmHg, pulse is 120/min, and respirations are 22/min. Otoscopic exam is performed (see image). What is the most likely diagnosis?

A 68-year-old male patient with PMH significant for HTN, stroke, vascular dementia, and atrial fibrillation, presents with a two-month history of generalized weakness and dizziness.  His symptoms began gradually, and have been progressing over the past few weeks, now affecting his ability to perform activities of daily living.  The patient reports an estimated unintentional weight loss of 20 pounds over the past two months, and his appetite has diminished.  The patient denies any fever, night sweats, headache, cough, hemoptysis, or dyspnea.  He denies abdominal pain, change in bowel habits, nausea, vomiting, or urinary symptoms.  Six weeks prior, the patient was initially evaluated in the ER and received IV fluids and electrolyte supplements for dehydration.  Physical examination reveals patchy hyperpigmentation of the elbows, knees, neck, and palmar creases.   Based on this information, which of the following conditions is the most likely diagnosis for this patient?  

A 70-year-old woman is brought to the emergency department by ambulance. She was found on the floor of her apartment after her neighbor called 911. She is confused and is unable to provide any history, but complains of generalized pain. Her temperature is 99.2°F (37.3°C), blood pressure is 129/64 mmHg, pulse is 63/min, respirations are 13/min, and oxygen saturation is 99% on room air. Physical exam reveals, a confused, ill-appearing woman. Lungs are clear to auscultation bilaterally. An electrocardiogram is obtained (see image). Dipstick urinalysis is notable for 4+ blood and dark colored urine. Which of the following is the most appropriate next step in management?

You are asked to evaluate a 62-year-old male patient who presents for a yearly physical, and is without new complaints.  PMH is significant only for mild HTN, controlled with HCTZ. On examination, you note palpable lymphadenopathy in the cervical and axillary regions bilaterally. The patient denies recent acute illness, fever, night sweats, weight loss, fatigue, or other associated symptoms. The CBC results for this patient are as follows: WBC: 60,000, Hgb: 13.5, HCT 41% , Plt 168,000 Differential: 20% segs, 2% bands, 68% lymphs, 5% monos, 3% eos, 2% basos. Peripheral Blood Smear: Increased number of mature appearing lymphocytes; smudge cells noted; RBCs appear essentially unremarkable.  Based on this information, which of the following conditions is the most likely diagnosis for this patient?

A 36-year-old patient has had 1 month of fever, chills, productive cough, fatigue, and joint stiffness that began before their return from a 6-month sabbatical working in bat-infested caves in eastern South America. There is unintentional weight loss and mouth pain. Physical examination reveals three painful ulcerated lesions on the buccal mucosa and scattered bilateral crackles on lung auscultation. Chest x-ray shows bilateral patchy infiltrates. The patient is HIV-negative and has otherwise has intact immunity. What is the most appropriate treatment recommendation for this patient?

A 62-year-old male with a 40-year history of poorly controlled hypertension and Type 2 diabetes presents with fatigue, peripheral edema, and nocturia. His physical exam reveals bilateral lower extremity pitting edema. Lab results show a serum creatinine level of 3.5 mg/dL and a GFR of 22 mL/min/1.73 m². Urinalysis shows proteinuria. Which of the following is the most likely initial finding on a renal ultrasound? 

A 36-year-old female presents with a history of gradual onset of nervousness and fatigue. She has lost 15 pounds in the past year despite an increase in appetite.  She reports that she is not sleeping well, because she feels anxious all of the time. Her menses have become scant with frequent intermenstrual spotting, and she feels that she constantly prefers a cooler environment than those around her. On physical examination, she has a heart rate of 100/min with normal blood pressure, and a fine tremor of the fingers is noted. The skin is warm, moist, and has a smooth texture. The thyroid is diffusely enlarged to palpation. A lid-lag sign is easily demonstrable. Which of the following is a common complication of this disease?

A 30-year-old woman presents with episodes of dizziness. She is G1P1 and 8 hours postpartum. Her delivery was complicated by hemorrhage and she received multiple units of blood. She says that she is unable to feed her baby. Her vital signs are heart rate 95 bpm, blood pressure 100/62 mm Hg, respiratory rate 16 breaths/min, and temperature 98.6 °F (37 °C). Her physical examination findings are unremarkable. Laboratory tests show multiple low blood glucose readings during the last 18 hours. Her hemoglobin is 11.0 g/dL, hematocrit 35%, WBC count 5000/μL, platelets 275,000/μL, sodium 130 mEq/L, potassium 4.5 mEq/L , creatinine 0.8 mg/dL, and blood glucose level 60 mg/dL. What is the underlying pathophysiology of this patient’s disorder?

A 63-year-old man undergoes uncomplicated laparascopic cholecystectomy for acute cholecystitis and is admitted to the surgical ward for postoperative management. On postoperative day 1, routine laboratory studies reveal an increase in serum creatinine to 1.46 mg/dL from 0.98 mg/dL before the operation; BUN is 37 mg/dL, increased from 18 mg/dL on prior measurement; K is 4.8 mEq/L and CO2 is 19 mEq/L. The patient has an indwelling urinary catheter in place, draining minimal urine over the last few hours. After ruling out urinary catheter obstruction, which of the following is the most appropriate next step in management?

A 21-year-old woman presents with urinary frequency. Her BMI is 41. A urinalysis is positive for glucose. Her random blood sugar is 257 mg/dL, hemoglobin A1c is 8.5%, and C-peptide is 1.5 ng/mL. She is diagnosed with type 2 diabetes; diet and exercise are recommended.What is the drug of choice for managing her diabetes?