Property:Prompt
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A 6-year-old boy is brought to his pediatrician's office for severe headache and nosebleeds over the past six months. The patient complains that his feet become very cold at night for which he has been wearing two pairs of thick socks. At school, he gets occasional cramps in his legs and is easily winded when running in gym class. His blood pressure is 170/95mmHg in the both upper extremities and 100/70 mmHg in both lower extremities, heart rate is 80/min, respiratory rate is 15/min, and temperature is 37 °C (98.6 °F). On physical examination, he has clear breath sounds bilaterally, but a continuous murmur is heard over the inter-scapular area. A chest x-ray demonstrates prominence of the descending aorta compared to the spine. Which of the following findings on chest x-ray is most specific for this patient's condition? +
A 20-year-old woman presents to her primary care physician complaining of dyspnea and malaise, associated with a lingering cough. Her symptoms started one week ago and have been gradually worsening. Nonetheless, she is generally still able to perform her daily activities. She denies abnormal sputum production, chest pain, sore throat, or runny nose. Her past medical history is insignificant. She does not use any medications and has no known allergies. Her blood pressure is 120/70 mmHg, heart rate is 72/min, temperature is 101 °F (38.3 °C), respiratory rate is 22/min, and oxygen saturation is 94% on room air. On physical examination, her cardiac auscultation is unremarkable; but pulmonary auscultation reveals diffuse crackles bilaterally. Which of the following may be the causative agent of this patient's condition? +
A 25-year-old woman presents to her primary care physician with complaints of worsening dyspnea, dry cough, and myalgia for the past 8 days. Her past medical history is significant for migraines, for which she occasionally takes over-the-counter NSAIDs. She denies smoking, drinking alcohol, or illicit drug use. She has no known allergies. Her blood pressure is 116/82 mmHg, heart rate is 72/min, temperature is 101 °F (38.3 °C), and respiratory rate is 24/min. Physical examination is remarkable for diffuse crackles over both lung fields. Chest xray shows bilateral bronchial wall thickening and centrilobular nodules. Which of the following is a characteristic finding of the organism responsible for this patient's symptoms? +
A 27-year-old man presents to his primary care physician with complaints of a stubborn cough, dyspnea, and chills over the past week. Although he reports his symptoms are gradually worsening, he reassures that his condition is "not so bad". His past medical history is significant for an appendectomy when he was 13. He smokes one pack of cigarettes each day for the past 5 years. He denies any allergies or use of daily medications. His blood pressure is 112/82 mmHg, heart rate is 72/min, temperature is 101 °F (38.3 °C), respiratory rate is 24/min, and oxygen saturation is 92% on room air. Physical examination is remarkable for the presence of diffuse crackles over both lung fields. Chest xray reveals diffuse interstitial infiltrates over both lung fields with no focal consolidation. Which of the following is the most appropriate treatment for this patient's condition? +
A 5-year-old boy is brought to his pediatrician by his mother for a 12-day history of worsening dry cough. His blood pressure is 110/78 mmHg, heart rate is 108/min, respiratory rate is 98%, and temperature is 38.7 °C (101.6 °F). During physical examination, the patient experiences paroxysmal coughing spells and is temporarily unable to breathe. Further history reveals the child immigrated from rural India with his family 3 months ago and has not received any medical care before today's visit. Initial lab tests are significant for marked lymphocytosis. Which of the following media could be used to culture the infectious agent of this patient's condition? +
A 69-year-old man is brought to the emergency department by his wife for worsening fever, vomiting, and cough for the past 3 days. The patient's wife explains that they recently returned from a cruise trip on a nearby lake. His past medical history is significant for well-controlled essential hypertension managed by lisinopril. He has smoked one pack of cigarettes daily since the past 40 years. He denies drinking alcohol or any use of illicit drugs. On admission, his blood pressure is 134/88 mmHg, heart rate is 86/min, temperature is 103 °F (39.5 °C), and respiratory rate is 25/min. Initial work-up reveals the following set of electrolytes: Na=129 mEq/L, K=4.5 mEq/L, Cl=108 mEq/L, and HCO3=21 mEq/L. Which of the following media may be used to grow the infectious agent responsible for this patient's condition? +
A 52-year-old homeless man presents to the emergency department after coughing up blood. He has experienced increasing cough over the past 2 weeks after recovering from an upper respiratory tract infection. Upon further questioning, the patient reports he smokes one and a half packs of cigarettes and drinks 8 beers daily for the past 20 years. The patient also states he has unintentionally lost 10 kilograms of weight in the past 6 months. His blood pressure is 138/88 mmHg, heart rate is 98/min, and temperature is 101.5 °F (38.6 °C). Physical examination is remarkable for crackles heard over the right chest. In the ED, a chest xray is ordered; it reveals a right upper lobe opacity. Which of the following media may be used to isolate the organism most likely responsible for this patient's condition? +
A 22-year-old man presents to his primary care physician complaining of dysuria and mucopurulent urethral discharge for the past 3 days. He states that he had an unprotected sexual encounter 2 weeks prior to presentation. Gram stain of the urethral swab reveals gram-negative diplococci. Which of the following media may be used to isolate the organism responsible for this patient's condition? +
A 6-year-old African American boy is brought to the emergency department for severe abdominal pain. He reports his abdomen is stiff and bloated with diffuse pain that is most severe in the left upper quadrant. The patient has had a previous similar episode in the past. His past medical history is also significant for dactylitis at the age of 18 months. Further questioning reveals that his older sister suffers from similar painful episodes that also require hospitalizations. After supportive measures, this patient is requested to receive a vaccine for an encapsulated, catalase-positive, gram-negative rod. What moiety is used in this vaccine? +
A microbiologist has been given a number of unknown clinical samples and is attempting to visualize the organisms by gram stain. Samples from which patient population will he be unable to visualize with this method? +
A 5-year-old boy is brought to the emergency department by his father for low-grade fever. He has recently immigrated from rural Africa. In the ED, the patient appears sick-looking, leaning forward with his neck extended, and drooling. His blood pressure is 110/70 mmHg, heart rate is 110/min, and temperature is 100.7 ºF (38.2 ºC). Physical exam reveals marked cervical lymphadenopathy, and pseudomembranes in the throat. What is the mechanism of action of the toxin produced responsible for this patient's condition? +
A 32-year-old male soldier suffers from an open leg wound following an explosion. He is immediately stabilized upon returning to the military base and is admitted for emergent surgery. Two days later, the patient develops high-grade fever with painful swelling and blisters at the wound site. CT scan of the involved leg is remarkable for gas formation in nearby muscles and subcutaneous tissue. What is the mechanism of action of the toxin responsible for this patient's complication? +
A 39-year-old woman presents to her primary care physician complaining of fever, muscle soreness, headache, and severe malaise one week after returning from a summer vacation on Cape Cod. Physical examination is remarkable for a red rash on her left leg with an inner ring clearing resembling a bullseye. What is the most likely causal organism? +
A 27-year-old woman presents to her primary care physician complaining of fever, flu-like symptoms, and a rash. She recently returned from a camping trip in Boston. Physical examination is remarkable for erythema chronicum migrans. What is the optimal treatment for this patient? +
A 34-year-old woman presents to her physician's office complaining of a rash that started on her palms and soles but has begun spreading to her wrists and ankles. She has recently also been experiencing new-onset headaches, malaise, and progressive fever. Her past medical history is unremarkable. She has no known allergies to food or medications. She does not drink alcohol or smoke, but is sexually active. She reports no history of international travel, but recently returned from a vacation in Boston. What is the optimal treatment for this patient's condition? +
A 29-year-old sexually active woman presents to the emergency department (ED) with an acute onset of left lower quadrant abdominal pain and chills. She describes the pain as constant and is exacerbated by movement. Her last menstrual period was 8 weeks ago. Her past medical history is significant for tension-type headaches and GERD. Her medications include PRN acetaminophen and daily omeprazole. She denies use of alcohol, illicit drugs, or smoking. Her blood pressure is 118/84 mmHg, heart rate is 92/min, and temperature is 99.7°F (36.7°C). Physical examination is remarkable for left lower quadrant abdominal tenderness with no guarding or rebound tenderness. An initial blood test is immediately sent for analysis; and results are pending. Ultrasound in the ED demonstrates a left adnexal mass. Which of the following organisms most likely predisposed this patient to her current presentation? +
A 28-year-old man began experiencing numbness in his toes which progressed to symmetrical distal muscle weakness of his lower limbs and currently includes the entire lower limbs and the distal upper limbs. A lumbar puncture is performed and CSF findings demonstrate increased proteins with a normal cell count. The patient is started on intravenous immunoglobulin (IVIg). Which of the following describes the organism most likely to have infected this patient prior to his developing this condition? +
A 3-year-old boy is brought to the pediatrician's office after his mother noticed that he has had several episodes of watery diarrhea for the past 2 days. The mother reports that several of her son's playmates from daycare have had similar symptoms as well. Which of the following best describes the most likely infectious agent of this patient's condition? +
A 32-year-old woman is contacted regarding an abnormal pap smear on her most recent annual screening exam. The smear shows dysplasia of squamous cells from the surface of the cervix. The degree of dysplasia is then deemed cervical intraepithelial neoplasia grade-1 (CIN-I). The molecular mechanism of oncogenesis of the causal organism is similar to the defect underlying which disease? +
A 49-year-old male factory worker presents to the emergency department with complaints of weakness, abdominal cramps, vomiting, and passage of loose "rice-water" stools. Physical examination reveals an abnormal cardiac rhythm, and peripheral motor and sensory neuropathy. Skin examination reveals hyperkeratosis of the palms and soles. The physician notes the patient's breath has a strong “garlic” odor. Which of the following is most likely responsible for this patient’s condition? +