A 40-year-old man presents to the clinic with a 1-week history of progressively worsening visual acuity in his left eye. He has not had blood work performed in many years. He is enrolled in a methadone program.

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

A) Blood glucose of 440 mg/dL
B) Blood pressure of 200/100
C) Bone-spicule pigmentation
D) Cowdry bodies
E) Owl eyes

A 2-day-old newborn is evaluated for poor feeding and abnormal eye findings. Physical exam shows bilateral cloudy lenses, a pan-systolic pan-diastolic murmur, and numerous purplish-red skin lesions on the trunk and extremities. The infant fails the newborn hearing screening. Which of the following is most likely to have been seen in the mother during pregnancy?

A) Arthritis
B) Chancre
C) Cowdry bodies
D) Owl-eye inclusions
E) Working in a pet store

A 40-year-old man comes to the physician for a follow-up appointment. His brother has rheumatoid arthritis. Laboratory findings are shown:

Sodium                                          138 mEq/L
Potassium                                    6.0 mEq/L
Calcium                                         8.8 mg/dL
Phosphate                                   4.1 mEq/L
Bicarbonate                               20 mEq/L

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

A) Decreased parathyroid hormone
B) Decreased urinary calcium
C) Increased adrenocorticotropic hormone
D) Kaliuresis
E) Zona glomerulosa adenoma

A 53-year-old man is evaluated in hospital. Scattered petechiae and ecchymoses are noted on his forearms. There is mild bilateral pedal edema. A renal biopsy is shown.

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

A) BUN/Cr of 22
B) 1+ blood on urine dipstick + 0-1 RBCs/hpf
C) 1+ blood on urine dipstick + 20 RBCs/hpf
D) Insulin resistance
E) Platelet count of 50,000/μL

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

A 45-year-old man comes to the physician for a follow-up appointment.

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

A) APC gene mutation
B) C-MYC gene mutation
C) Hashimoto thyroiditis
D) High-grade hepatocellular carcinoma
E) Polycystic kidneys

A) Conjugated hyperbilirubinemia
B) Hematuria + flank mass
C) Hematuria + no flank mass
D) Intercellular bridges
E) Serum sodium of 125 mEq/L

A 54-year-old woman is evaluated in hospital. She has a long smoking history. A biopsy specimen is shown.

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

A) Direct hyperbilirubinemia
B) Hematuria without flank mass
C) High serum calcium
D) Low serum sodium
E) Painful flank mass

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