A 26-year-old student with no significant PMH arrives at student health services for persistent diarrhea. She states that for the past 2 months, she has had foul-smelling diarrhea and abdominal cramping. She also reports increased bloating, flatulence, and an unintentional 4 lb weight loss. Prior to 2 months ago, she had never felt these symptoms before. She denies other extra-gastrointestinal symptoms. The patient is an avid hiker and says her symptoms have caused her to miss recent camping trips. The patient has tried to add more fiber to her diet without relief. She feels her symptoms worsen with milk or cheese. The patient currently takes no prescription or OTC medications. She drinks alcohol socially and denies smoking tobacco or using any illicit drugs. She is sexually active with her boyfriend of 2 years. Her last multi-day backpacking trek was about 3 months ago in Vermont. Her temperature is 98.6°F (37°C), blood pressure is 110/70 mmHg, pulse is 76/min, and respirations are 15/min. Physical examination is unremarkable. A stool sample is negative for fecal occult blood. Which of the following is an associated adverse effect of the most appropriate treatment for this patient’s symptoms?

This type of atypical mycobacterium is fast-growing, and is a common cause of nosocomial catheter-related infections.

An 84-year-old female is brought to the Emergency Department by ambulance for intermittent fevers over the last two days. A caretaker at her nursing home reports that the patient has had new-onset incontinence and foul-smelling urine during the past week. They also state that the patient has been more confused than usual during this time. She has a medical history significant for Alzheimer dementia, hypertension, diabetes mellitus, and hyperlipidemia. Her temperature is 98.6°F (37°0F), pulse is 96, blood pressure is 90/60 mmHg, respirations are 24/min. Laboratory studies are obtained and demonstrate a leukocyte count of 11,500. Which of the following aspects of this patient’s presentation meets criteria for the systemic inflammatory response syndrome (SIRS)?

The patient is a 30-year-old male who presents to the Emergency Department with a recent travel history to Africa where he spent 6 months as a Peace Corps Volunteer in Uganda. His chief complaint is fevers, headache, myalgias, and shaking chills. T 39.6°C (103.3°F). The patient was admitted for observation and further work-up. The patient had documented episodes of fever and chills approximately 3 times a day. Based on this information, which of the following laboratory tests would confirm your diagnostic suspicion?

This type of atypical mycobacterium is found in fresh water or salt water; infection occurs following exposure of a skin or soft tissue injury to the organism, often in a fish tank or other marine animal setting, and typically results in granuloma formation.

Which of the following statements pertaining to rabies is TRUE?

A woman presents to your office after a 6-month sabbatical during which she worked in caves in the eastern part of South America. The patient reports fever, chills, productive cough, and joint stiffness that started 1 month before her return. Physical exam reveals 3 ulcerated lesions on her inner cheek. Which of the following is the most appropriate treatment for this patient?

Primary infection with this organism in immunocompetent persons typically follows ingestion of raw or undercooked meat. Although most acute infections are asymptomatic, some patients present with a mild febrile illness resembling infectious mononucleosis. What is the most likely causative pathogen for this illness?

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 3-year-old boy is admitted to the Emergency Department in acute respiratory distress. The patient has T: 40°C (104°F), RR: 70/min, and HR:130/min. Auscultation of the lungs is unremarkable. An examination of the throat reveals an exudate in the posterior pharynx that is yellowish and membranous. Bleeding occurs when it is scraped and removed. The parents of the child reveal that the child has received no prior immunizations. A throat culture was ordered and worked up specifically for an organism that selectively grows on cystine tellurite agar. What organism is causing this child’s disease?