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A 14-year-old boy reports a 2-month history of low back pain…

A 14-year-old boy reports a 2-month history of low back pain with no known trauma. The pain is worse with activity and relieved by rest, although he does report difficulty with prolonged sitting in school. He reports no history of radicular pain and denies any numbness, tingling, or weakness in his legs. On exam, he has slight tenderness to palpation over the lower back, 5 out of 5 strength in the lower extremities, and a negative straight leg raise test. The lumbar spine demonstrates full range of motion but he reports pain with back extension. Initial AP and lateral radiographs of the spine are negative. Which of the following should be ordered next to determine the patient’s diagnosis?

A 32-year-old man presents with a cough productive of sandy…

A 32-year-old man presents with a cough productive of sandy sputum, malaise, and intermittent fever. He was seen 4 weeks ago for the same cough and completed a course of oral antibiotics without notable improvement. He has no significant past medical history, does not take any medication, does not smoke, and works as a farmer in the Ohio River Valley. Vital signs and physical examination are unremarkable. A chest x-ray shows bilateral, enlarged, calcified hilar and mediastinal lymphadenopathy. What is the most likely diagnosis?

A 3-year-old previously healthy female is brought to your of…

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?