A 30-year-old man is evaluated in hospital. A urinalysis and his hand are shown.

Which of the following is most likely to be seen in this patient?

A) Conjunctivitis
B) Deficiency of complement protein C1q
C) Infection with obligate intracellular organism
D) Tenosynovitis
E) Treatment with azithromycin or doxycycline

A 51-year-old man is evaluated in hospital. His point of maximal impulse is palpated in the subxiphoid space. A chest x-ray is shown.

Which of the following is most likely to be seen in this patient?

A) Cystic medial necrosis
B) Loud P2
C) Increased FEV1/FVC
D) Mid-systolic murmur
E) Usual interstitial pneumonitis

A 49-year-old man comes to the physician for a follow-up appointment. Stool is positive for staining with Oil Red O and Sudan Black. Laboratory studies show direct bilirubin, ALP, amylase, and lipase within the normal range.

Which of the following is the most likely explanation for this patient’s findings?

A) Acute cholecystitis
B) Chronic cholecystitis
C) Acute pancreatitis
D) Chronic pancreatitis
E) Porcelain gallbladder

A 43-year-old man comes to the physician for a follow-up appointment. He has a 4-month history of occasional regurgitation of undigested food.  Physical examination shows tightening of the skin of the fingers, with small calcium deposits in the pulps of some of the fingers. Which of the following is most likely to be seen in this patient?

A) Bird’s beak appearance
B) Cricopharyngeal muscle spasm
C) Esophageal fibrosis
D) Loss of NO- and VIP-secreting neurons
E) Schatzki ring

An 80-year-old woman is brought in by ambulance in the summer after being found in her home by her husband dazed and confused. Body temperature is 106 F.

Which of the following is the most likely explanation for this patient’s hematologic findings?

A) Asplenia
B) Coombs test-positive hemolytic anemia
C) Liver failure
D) Microangiopathic hemolytic anemia
E) Sepsis

A 16-year-old boy is brought to the physician for a follow-up appointment.

Which of the following is most likely to be seen in this patient?

A) Abnormal endoderm of foramen cecum
B) Decreased serum sodium
C) Galactorrhea
D) Remnant of primitive oral cavity
E) Upward gaze palsy

A 31-year-old woman comes to the physician for a health maintenance examination. She had a prior imaging modality performed, the results of which are shown below. “A” represents a healthy control individual; “B” is the patient’s imaging results.

Which of the following is most likely to be seen in this patient?

A) Anti-microsomal antibodies
B) Anti-thyrotropin receptor antibodies
C) Calcium of 7.9 mg/dL
D) Calcium of 11.0 mg/dL
E) Post-viral illness state

A 47-year-old man is evaluated in hospital following a 2-week history of darkening of his urine. He reports no recent illnesses.

Which of the following is most likely to be seen in this patient?

A) Anti-Hu antibodies
B) Insulin resistance
C) Serum calcium of 12 mg/dL
D) Serum sodium of 125 mEq/L
E) Urinary specific gravity of 1.030

A 31-year-old woman comes to the physician for a follow-up appointment. She has a history of recurrent flares of joint pain and low platelets. Today she presents with two small mouth ulcers. Her prior HLA-B27 screening was negative. Serum creatinine and BUN are mildly elevated. Which of the following is most likely to be seen in this patient?

A) Anti-cyclic citrullinated peptide antibodies
B) Anti-microsomal antibodies
C) Decreased serum C3
D) IgM targeting the Fc region of IgG
E) Type II hypersensitivity

A 9-year-old girl is brought to the physician by her mother for a 1-month history of skin changes to the right forehead and periorbital region. She has acute lymphoblastic leukemia in remission and received her last dose of chemotherapy 4 months ago. Which of the following is the most likely explanation for this patient’s findings?

A) Bacterium
B) DNA virus
C) Stevens-Johnson syndrome
D) RNA virus
E) Toxic epidermal necrolysis