A 41-year-old woman comes to the physician for a 4-month history of increasing fatigue. She is an avid traveler and visited Honduras 6 months ago. Serum laboratory studies show:

Sodium                                             137 mEq/L
Potassium                                       5.6 mEq/L
Bicarbonate                                   22 mEq/L
Leukocytes                                     8,000/μL
Eosinophils                                    26%

Which of the following is the next best step in diagnosis?

A) ACTH stimulation test
B) Dexamethasone suppression test
C) Measure serum iron and ferritin
D) Stool nematode toxin test
E) Stool smear for ova and parasites

A 43-year-old woman comes to the physician for a follow-up appointment.

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

A) Anti-Smith antibodies
B) Eburnation
C) Family history of type II diabetes
D) IgG antibody against the Fc region of IgM
E) Pannus

A 33-year-old woman is evaluated in hospital. Her x-ray is shown.

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

A) Crohn disease
B) Ethylene glycol
C) Hyperparathyroidism
D) Hyperuricemia
E) Proteus mirabilis

A 46-year-old man is evaluated in hospital. He has a history of COPD. A chest x-ray is shown.

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

A) Adenovirus
B) Haemophilus influenzae type B
C) Mycoplasma pneumoniae
D) Staphylococcus aureus
E) Streptococcus pneumonia

A 28-year-old woman comes to the physician for a 3-day history of increasingly worse vaginal discharge and discomfort. She has recently been sexually active with a new partner. Vitals are: temperature 99 F, HR 100, RR 20, BP 120/80. Laboratory results are pending. Physical examination shows left adnexal tenderness and a yellow-green vaginal discharge. Which of the following is the most appropriate next step in management?

A) Admit to hospital and give IV antibiotics
B) Doxycycline (oral) + ceftriaxone (intramuscular)
C) Doxycyline (oral) + azithromycin (oral) + ceftriaxone (intramuscular)
D) Metronidazole (oral) for patient and partner
E) Metronidazole (oral) for patient only

A 63-year-old woman comes to the physician for a follow-up appointment. Her serum protein electrophoresis is shown.

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

A) Blurry vision
B) Hypocalcemia
C) Low mean corpuscular volume
D) Nephrotic syndrome
E) Systolic dysfunction

A 51-year-old woman is evaluated in hospital. She takes a daily multivitamin. Her mom had a history of osteoporosis. Vitals are normal. Serum studies are shown.

Chloride                                         104 mEq/L
Bicarbonate                                 20 mEq/L
Sodium                                            135 mEq/L

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

A) Aspirin toxicity
B) Diabetic ketoacidosis
C) Lactic acidosis
D) Renal insufficiency
E) Renal tubular acidosis

A 42-year-old man is evaluated in hospital.

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

A) Antibodies against post-synaptic nicotinic receptors
B) Hepatic vein thrombosis
C) Hypothyroid state
D) Increased serum sodium
E) Reactive arthritis

A 49-year-old woman comes to the physician for a 2-month history of gradually worsening left hip pain. She has a history of dermatomyositis managed with prednisone. Physical examination shows duskiness of the eyelids bilaterally, violaceous papules on the knuckles, and rough-surfaced hands. Vitals are normal.

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

A) Necrosis
B) Osteomalacia
C) Osteoporosis
D) Synovitis
E) Vasculitis

A 31-year-old woman comes to the physician for a 3-day history of mildly productive cough and fever. Physical examination shows a right lower lobe consolidation with dullness to percussion. She has lymphadenopathy of the head and neck. A peripheral smear is shown.

Which of the following is the most likely explanation for these findings?

A) Chronic lymphocytic leukemia
B) Chronic myelogenous leukemia
C) Cyanocobalamin deficiency
D) Jarisch-Herxheimer reaction
E) Leukemoid reaction