A 24-year-old woman presents to her doctor complaining of abdominal pain and diarrhea. For the past 6 months she has noticed loose stools associated with diffuse abdominal pain. The diarrhea is non-bloody and not associated with any particular foods. She has had intermittent fevers during the past month and reports a 7 lb. unintentional weight loss, but denies any recent travel. She has a history of anxiety and nephrolithiasis. She is currently taking paroxetine and a combined oral contraceptive. Her temperature is 100.1°F (37.8°C), blood pressure is 110/60 mmHg, pulse is 75/min, and respirations are 14/min. Physical exam reveals a thin young woman with normal heart and lungs sounds. Her abdomen is diffusely tender to light palpation with increased bowel sounds. Multiple shallow ulcers are found on the oral mucosa, and a perianal tag is noted during rectal exam. What is most likely to be found on additional workup for this patient?

A 24-year-old female with no significant PMH presents to the Emergency Department for chest pain that began approximately 1 hour ago. She denies any trauma to the chest and describes the pain as a “pressure-like” sensation affecting the middle of the chest. She has no medical history and takes oral contraceptive pills. A few hours ago she attended a party where she was smoking crack cocaine and subsequently developed this chest pain. BP 176/104 mmHg, HR 108/min, and RR 18/min with pulse ox of 99% on room air. Chest auscultation is unremarkable. An electrocardiogram is obtained (see image below).  Based on these findings, what is the diagnosis for this patient?       

A 26-year-old female with no significant PMH presents to clinic with 1 month of persistent pain in her left breast. She first noticed a small, firm mass in her left breast approximately 1 month ago, and since then, the mass has become tender and has slightly increased in size.  The patient has no personal or family history of breast cancer. T: 97.9°F, BP 118/74 mmHg, HR 72/min, RR 14/min, and pulse ox is 98% on room air. On exam, there is a 2.5 cm firm, mobile mass in the left breast that is mildly tender to palpation.  There is no associated nipple discharge. There are no skin changes and no lymphadenopathy is noted. Ultrasound of the mass is performed, which reveals a round, well-circumscribed fluid-filled mass.  Based on these findings, which of the following statements is correct?

A 32-year-old male presents with a 3-day history of fever with chills and severe weakness.  There are no other complaints.  The patient has a history of unprotected sex with multiple previous partners.  He also reports a history of travel to South America and consumption of food from street vendors while working there one month ago.  He admits to intravenous drug abuse.  The patient denies a history of previous blood transfusion.  Abdominal exam reveals mild hepatomegaly.  Routine laboratory tests are ordered, including CBC, CMP, HIV, and Hepatitis serology panel.  Liver enzymes are elevated and Hepatitis C virus antibody test is positive.  Testing for Hepatitis A and Hepatitis B is negative.  How did this patient most likely acquire Hepatitis C infection?

A 40-year-old male with a past medical history of Hepatitis C presents with a pruritic rash of the flexor aspect of his left wrist. The physical exam is remarkable for violaceous, shiny, and polygonal papules arranged as lines and circles on his wrist. These papules range in size from 1 mm to 1 cm in diameter, and have fine, white lines on them.  Which of the following statements about this clinical finding is true?

A 56-year-old female with PMH significant for hypertension and Type 2 diabetes mellitus presents to her primary care physician with complaints of nausea, vomiting, abdominal pain, and bloating that have increased in severity over the past several months. She reports that she occasionally vomits after eating. She states that the emesis contains undigested food particles. Additionally, the patient states that she often feels full after only a few bites of food at meals. Initial laboratory values are notable only for a hemoglobin A1c of 14%.  Which of the following conditions is the most likely cause of this patient’s symptoms?

A 68-year-old man was brought to the Emergency Department by ambulance with sudden onset of severe chest pain, described as tearing, that radiates down the back for the past 25 minutes. He admits to a long-standing history of hypertension that has not been well controlled for the past 25 years. He states that he feels short of breath, is beginning to feel dizzy, and his legs are becoming weak. His vital signs are as follows: RR 24/min, HR 110/min, BP 208/152 mm Hg (right arm) and 212/156 mm Hg (left arm). He is afebrile.  Which of the following conditions is the most likely diagnosis for this patient?

A 36-year-old software consultant complains of burning sensation in his chest, which has occurred almost daily for the last two weeks.  He has had similar symptoms intermittently for the past 6 months and states that the symptoms are now increasing in frequency and severity. His wife has noticed episodes of regurgitation and coughing at night. There is no dysphagia, weight loss, hematemesis, or melena. He has no other past medical history. He is a nonsmoker and does not drink alcohol. Family history is significant only for HTN in father.  On examination, BP is 120/80 mm Hg, HR 76/min, pulse ox (room air) 98%, height 6’4, weight 242 pounds. Physical examination is unremarkable. What would be the most appropriate treatment for this patient?

A 56-year-old male automotive mechanic presents to your Internal Medicine office for a routine exam and states that “my wife made me come in to see you.”  His last office visit was 6 years ago for a broken toe, and he has had no laboratory testing or other diagnostic evaluation in the past 10 years.  HPI and the review of systems are negative except that he currently smokes cigarettes 1 pack-per-day (40 pack-year history).  The patient reports dyspnea on exertion during the past year, and hears audible wheezing at times.  He denies chest pain or pressure and is without other concerns today.  On exam, you hear faint end-expiratory wheezes in the bilateral lung bases.  The remainder of the examination is negative. Height: 5 feet 10 inches Weight: 210 lbs. BMI: 30 BP: 148/86 HR: 84 RR: 14/min T: 98.0°F O2 sat (room air): 93%   Which of the following screening tests would NOT be indicated at this time?

Patient is a 26-year-old female with no significant PMH who presents to Internal Medicine office with recent onset of sore throat, fever, and malaise that developed 7 days ago. She complains of severe throat pain, more pronounced on the right, and right ear pain. She reports severe pain with swallowing and states that for the past day, she has been unable to open her mouth widely. Patient is noted to have muffled (“hot potato”) voice.On physical exam she is breathing comfortably. Her vital signs are temperature, T: 102.2°F; HR 102/min; BP 110/70 mm Hg; and RR 15/min.  Examination of the oropharynx revealed a markedly enlarged right tonsil with associated swelling of the soft palate uvular deviation to the left. The right tympanic membrane is clear, with good light reflex and no bulging. There is tender anterior cervical lymph nodes bilaterally. The lung exam was normal and no stridor was noted.  Throat culture is obtained.  What is the most likely bacterial pathogen isolated from the oropharyngeal culture performed by the provider?