A 30-year-old woman presents with a 4-day history of extreme…

A 30-year-old woman presents with a 4-day history of extreme vulvar pruritus and vaginal discharge. The discharge is thick and white, moderate in amount, without associated foul odor. Her PMH is significant for poorly controlled diabetes for 2 years. On external exam, the vulva is erythematous with excoriations and presence of white plaques on the vaginal walls. The diagnosis was confirmed by examination of the wet-mount preparation of the discharge. Which of the following interventions is the most appropriate treatment for this patient?

A 4-year-old boy develops fever and an upper respiratory inf…

A 4-year-old boy develops fever and an upper respiratory infection in late December. On physical examination, the pediatrician notes whitish spots in his mouth near his second molars (see image below). A day later the boy develops a rash on his face. The rash consists of reddened macules and papules. Within the next several days, the rash becomes confluent and moves downward over his whole body. Which of the following interventions would be most helpful in confirming the diagnosis of this condition? 

A 12-month-old boy presents with a rash that followed a 2-da…

A 12-month-old boy presents with a rash that followed a 2-day fever of 102°F. His mother states that she saw a pink, raised rash on the child’s trunk as the fever went away. “The rash looks like pink or red spots that turn white when I touch them.” On physical exam, the child is currently afebrile, and there is a diffuse, maculopapular rash on the chest, abdomen, and thighs. The rash spares the face, palms, and soles. The child has no symptoms of upper respiratory infection, and the physical examination is otherwise normal. Which of the following conditions is the most likely diagnosis for this patient?

A 22-year-old man presents to the emergency department with…

A 22-year-old man presents to the emergency department with a burning cut on his left arm. The patient states that he noticed a few cuts along his arm which have become more swollen and are associated with bumps. He now feels fatigued and has a fever. The patient is otherwise healthy and is not currently taking any medications. The patient lives alone, is a student, and owns a new cat. His temperature is 101°F (38.3°C), blood pressure is 120/88 mmHg, pulse is 97/min, respirations are 14/min, and oxygen saturation is 99% on room air. Physical exam is notable for the finding in the image (see below). There is notable tender lymphadenopathy in the ipsilateral antecubital fossa and axilla. Which of the following is the most likely infectious etiology of this patient’s symptoms? 

A 43-year-old female is admitted for evaluation of nausea, e…

A 43-year-old female is admitted for evaluation of nausea, emesis, ataxia, and dizziness. Previous medical history reveals HIV (+) status for 4 years with the most recent CD4 count of 100/mm3. Vital signs and neurologic examination are normal. MRI shows 2 ring-enhancing lesions of the basal ganglia, each approximately 1 cm in diameter. The patient is treated with sulfadiazine plus pyrimethamine and she is discharged following rehydration. Within 1 week, the patient’s symptoms improve and a second MRI 4 weeks later shows a significant reduction in the size of the lesions. Which of the following conditions is the most likely diagnosis for this patient?

A 36-year-old male presents with a 3-month history of a prod…

A 36-year-old male presents with a 3-month history of a productive cough and reports that the cough produces a scant amount of yellow sputum, which is occasionally blood-streaked. He has also had an evening temperature rise (101° F) for the past 3 months. He has lost a significant amount of weight during this period. Patient is a non-smoker. He emigrated from India 5 years ago, and his medical records are not available. Coarse upper lobe crackles and rhonchi are heard bilaterally. CXR reveals multiple bilateral upper lobe cavities with surrounding infiltrate. Which of the following clinical findings would confirm your diagnostic suspicion?