A 52-year-old patient visits the clinic with a chronic cough, shortness of breath, and weight loss for 3 months. There are intermittent fevers and night sweats. A painful ulcerated lesion on the right leg has been growing. There is no recent travel outside of Michigan. On exam, there is an ulcerated erythematous lesion on the right shin, and crackles are heard in the left lower lung field. What additional finding will most strongly support the most likely fungal infection?

A 61-year-old female presents to her primary care physician complaining of fatigue and feeling sad. She reports that ever since her husband passed away 3 months ago, she has noticed a decrease in her energy level and reports frequently awaking at 2 in the morning and cannot fall back asleep. She sometimes wakes up and hears her husband’s voice, constantly thinks about how much she misses him, and has recently thought about ways to kill herself including driving through a red light. She used to be an active member of her neighborhood’s bridge club but has stopped playing. She has lost 15 pounds and rarely feels hungry. Which of the following is the most likely diagnosis in this patient?

A 6-year-old boy is brought to the pediatrician complaining of itchy eyes. The mother states that she has noted that his eyes have been tearing and that both of his eyes have been red for the past 4 days. The patient denies any pain but has had a runny nose for the past week. The mother states that he has not had any sick contacts, and he has been home from school for summer vacation. She notices that his symptoms seem to improve in the evening after he showers. His temperature is 97.0°F (36.1°C), blood pressure is 100/66 mmHg, pulse is 90/min, respirations are 22/min, and oxygen saturation is 98% on room air. Physical exam is notable for the finding shown (see image). Which of the following is the most likely diagnosis?         

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 12-year-old boy is brought in by his parents as they are concerned about his behavior. He is constantly arguing with his parents and blatantly defying their every request. In school, he is known for being intentionally tardy and for defying his teachers. Upon further questioning of the patient you learn about some of his recent behaviors such as beginning smoking to bother his parents. You also notice that he is disrespectful towards you. You then learn that he has also gotten into weekly fights with his peers at school with no apparent cause. In addition, last week he was seen hitting one of the local neighborhood cats with a baseball bat trying to kill it. The patient lives at home with his two parents in a pre-World War II house that was recently renovated. Physical exam is unremarkable. Laboratory values are as follows: Na: 140 mmol/LK: 4.5 mmol/LCl: 100 mmol/LGlucose: 80 mg/dLCa: 10 mmol/LMg: 3 mEq/LCr: 0.8 mg/dLBUN: 10 mg/dLSerum lead: < .01 µg/dLHb: 15 g/dLHct: 45%MCV: 95Urine toxicology: negative As the patient leaves the office you notice him taking all of the candy from the office candy bowl. The patient seems unconcerned about his behavior overall. Which of the following statements is most likely to be true in this patient?

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?

A 50-year-old man with a history of DM and CKD presents to your office for a follow-up   appointment for his hypertension. He reports some non-specific muscle weakness, so you decide to perform an ECG. The ECG demonstrates peaked T waves in several leads without any other abnormality. His labs reveal BUN 12, CO2 22, creatinine 1.0, Glucose 97, K 7.2, Cl 101, and Na 137. What medication is most likely to cause this ECG finding?

A 58-year-old man presents with a recent episode of rectal bleeding. A brief history reveals that his bowel patterns have been increasingly erratic over the past 6 weeks. He reports periods of 2-6 days without bowel movements followed by copious production of thin coils of stool. He has lost 10 lb over the last month. His family history is significant for the death of his cousin from colon cancer. Physical exam reveals the patient is pale and febrile (temperature 101°F); the rectal exam is heme-positive with scant stool, and his prostate is soft and moderately enlarged.What is the most appropriate evaluation method in the diagnosis of colorectal cancer?

A 56-year-old man presents with a 1-week history of palpitations and shortness of breath. He has a longstanding history of poorly controlled hypertension. Physical examination reveals an elevated blood pressure of 190/98 mm Hg, elevated jugular venous pressure, mild hepatomegaly, bilateral pedal edema, and rales at the lung bases. Echocardiogram reveals concentric left ventricular hypertrophy without significant valvular abnormalities. What drug is beneficial in the treatment of the patient’s condition by causing afterload and preload reduction?