A 28-year-old female is brought to the ER by her husband because of bizarre behavior 4 days after the uncomplicated delivery of a full-term healthy boy. Her personal and family history of mental illness is negative. The second day after delivery, she accused her husband of poisoning her food. She has problems falling asleep, generally sleeping only 2-3 hours nightly and complaining of unpleasant smells waking her up. She started arranging toys and the newborn’s things in a specific symmetrical order and became aggressive when someone moved them. She would stop the ongoing activity from time to time with a blank expression and was found several times staring at the wall and silently counting. Even simple tasks require the help of others, and she often forgets what she started doing. This makes her irritable and sometimes tearful. She feels guilty about being a terrible mother and states that she did not deserve to have a baby. The morning when her husband asked for your advice, she told him that she hears voices telling her to take her son and jump out the window. What is the most likely diagnosis?

A 26-year-old male presents to the urology clinic for evaluation of a painless mass in his left testicle. He said he noticed it the other day when he was performing testicular self-examination. You palpate his scrotum and note a ‘bag of worms’ consistency in his left hemiscrotum. Which of the following conditions is the most likely diagnosis for this patient?

You are asked to evaluate a 32-year-old woman who presents complaining of “worsening stress.”  On further questioning, the patient admits that she is developing a severe fear of public places and open areas, and this has started to affect her ability to function.  She left her previous job due to this escalating discomfort, and now rarely leaves her home.  She realizes that her fears are seriously affecting her ability to function, and, despite considerable anxiety, has come to the office today to get help.  Based on this information, which of the following conditions is the most likely diagnosis for this patient?

A 36-year-old male patient presents for initial psychiatric evaluation and is accompanied by his wife.  She explains that her husband’s behavior is negatively affecting their personal relationship and his interactions with co-workers at the office.  She describes her husband’s overwhelming need for order, strong sense of “how things should be done,” perfectionism that interferes with completing tasks, and rigidity about following rules.  Which of the following conditions is the most likely diagnosis for this patient? 

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. A common complication of this disease is:

A pregnant woman at 30 weeks gestation reported a flu-like illness to her provider. Suspecting Cytomegalovirus infection, laboratory testing was completed. The results showed positive CMV IgM antibodies with high avidity CMV IgG antibodies. Which of the following statements is true concerning this fetus after delivery?

During your Psychiatry rotation, you are asked to evaluate a 34-year-old male patient with signs and symptoms suggestive of Bipolar I disorder.  The patient is started on lithium and your preceptor asks you to review with the patient the possible common side effects associated with this medication.  Which of the following potential side effects should be included in your discussion with the patient? 

Which of the following statements about systemic sclerosis (scleroderma) is true?

A 26-year-old full-term pregnant woman presents with sudden onset of painless vaginal bleeding. She has no other relevant medical history. Her obstetric score is G2, P1, A0, and L1. Her first born is a 2-year-old healthy male child. On pelvic examination, there is active bleeding though the bleeding is moderate, and a 4.5 cm dilated cervix. She is found to have marginal placenta previa. Her pulse is 90/min, BP 100/60 mmHg and RR 20/min. Based on this information, which of the following interventions is the most appropriate management for this patient?

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?