A 39-year-old woman presents to the emergency room with a 2-week history of increasing fatigue and jaundice. She has also noticed that her urine has become dark-colored like tea during this period. She currently works as a hospital cleaner and reluctantly admits to an unreported needlestick injury from a patient with known hepatitis B about 3 weeks prior. On examination, there is hepatomegaly with hepatic punch tenderness. What laboratory investigation would be most appropriate in the diagnosis of this patient?
A Anti-HBc IgM
B Anti-HBe IgM
C Anti-HBs IgM
D HBV DNA
E HBV RNA
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A 29-year-old man presents to a community health clinic with a week-long history of painful swallowing. The pain is located retrosternally and occasionally radiates into the oropharynx. He denies weight loss, hematemesis, or change in stool color. He has a known history of human immunodeficiency virus (HIV) infection and his last CD4 count was 48 cells/mm3. A barium swallow is performed and demonstrates multiple large, deep linear ulcers. Endoscopy is performed with brushings and biopsy. Histopathology reveals a paucity of cells with enlarged and smudged nuclei that are intensely eosinophilic. What is the most likely cause of this patient's symptoms?
A Candida albicans
B Cytomegalovirus (CMV)
C Eosinophilic esophagitis
D Gastroesophageal reflux disease (GERD)
E Herpes simplex virus (HSV)
A 45-year-old man is brought to the emergency room with fever, rigors, and depressed consciousness. The day previously, he had eaten imported raw oysters and shortly thereafter, began to complain of myalgias. He became febrile and had exquisite pain in his lower extremities. He was previously well and does not have any known allergies. Accompanying family members specifically deny any food allergies and state he has eaten raw oysters many times previously without incident. On arrival, his blood pressure is 90/60 mm Hg; pulse, 115 beats/minute; temperature, 39.7°C (103.4°F); and respirations, 22 breaths/minute. There are multiple hemorrhagic bullae and ecchymoses over the lower torso and lower extremities. What is the most likely diagnosis?
A Anaphylaxis
B Enterohemorrhagic Escherichia coli (EHEC) infection
C Staphylococcus aureus infection
D Vibrio parahaemolyticus infection
E Vibrio vulnificus infection
A 32-year-old woman complains of monthly pelvic pain, especially on the right side for the last 2 years. The pain is noted only during her menses and during the days just before her menstruation. She does not have any vaginal discharge. Which one of the following is most likely producing these symptoms?
A Chronic appendicitis
B Endometriosis
C Ovarian cysts
D Ovarian neoplasm
E Pelvic inflammatory disease
A 75-year-old woman comes to the physician because of abdominal fullness. She states that she always feels bloated and that she becomes full quickly when eating. She has hypertension, for which she takes an angiotensin-converting enzyme inhibitor, and no other medical problems. Examination shows abdominal distention and a positive fluid wave. Pelvic examination reveals a large, nontender right adnexal mass. Abdominal computed tomography demonstrates masses on both ovaries and ascites. The CA-125 level is significantly elevated. Serum alpha-fetoprotein and human chorionic gonadotropin are negative. Which of the following is the most likely diagnosis?
A Cervical cancer
C Epithelial ovarian cancer
D Ovarian torsion
The mother of a 4-year-old boy calls the office for advice regarding an outbreak of diarrhea at her child's daycare center. The boy is currently asymptomatic and has no significant past medical history. Of the center's 30 children, 5 are ill with mild fevers and copious watery diarrhea. The mother also has a 6-month-old girl at home. What is the most appropriate advice to the mother regarding management of the child's infectious status?
A Elective vaccination of all family members is a reasonable precaution in this situation
B The likely causative agent of the daycare center diarrhea outbreak presents no significant risk to the 4-year-old
C There are no medical measures that reduce the risk of transmission of the likely agent responsible for the diarrhea outbreak
D Vaccination for the likely causative agent is no longer available due to associated risk of intussusception
E Withholding the 4-year-old from attendance at the daycare center is sufficient to prevent transmission of the disease to the child's family members
A 20-year-old woman presents to the university health clinic, complaining of intermittent abdominal pain and associated diarrhea over the last 6 months. The abdominal pain is crampy, diffusely located, and begins shortly before the onset of diarrhea. Her diarrhea is watery in nature, and she specifically denies seeing blood or mucous in the bowl. She states that her symptoms begin 1 to 2 hours after drinking milk or eating foods that contain dairy products. She has been otherwise well, and her only regular medication is the oral contraceptive pill. Physical examination is within normal limits. What is the most appropriate next step in the diagnosis of this patient?
A D-xylose test
B Hydrogen breath test
C Lactose-tolerance test
D Stool osmotic gap
A 40-year-old man is on an extended course of intravenous antibiotics for a lung abscess. At 4:00 AM, you are called to see the patient, who is showing signs of acute dehydration. On arrival you discover the patient has been having almost constant, profuse, watery diarrhea throughout the day. His temperature is 38.0°C (100.4°F), and his abdomen is diffusely tender. Which of the following medications should you order to treat the most likely cause of this condition?
A Ceftriaxone
B Ciprofloxacin
C Metronidazole
D Prednisone
E Vancomycin
A 30-year-old multiparous woman visits her primary care physician complaining of early satiety, nausea, and vomiting. Her current use of birth control pills, physical examination findings, and results of laboratory studies trigger an investigative pathway that concludes with a single-photon emission CT study that is most consistent with a peripherally located, 11-cm, solitary hepatic hemangioma. Which of the following is the most appropriate next step in management?
A Initial pharmacological management to reduce the size of the lesion
B Percutaneous biopsy
C Radiation therapy
D Stop birth control pills and reevaluate with ultrasound for every six months
E Surgical resection
A 38-year-old man presents for physical examination and is found to be healthy. He reports a family history of colorectal cancer (CRC) in his father and grandfather. Which of the following recommendations for colorectal cancer screening is most appropriate?
A Annual fecal occult blood testing with guaiac or immunochemical test beginning at age 50 years
B Both annual fecal occult blood testing and flexible sigmoidoscopy every 5 years, starting at age 50 years
C Fecal occult blood annually, and flexible endoscopy every 5 years, starting at age 40 years
D Flexible sigmoidoscopy every 5 years, starting at age 50 years
E Twice yearly colonoscopy