A 59-year-old man is evaluated at a dental clinic prior to undergoing a root canal procedure. His BMI is 45. There is a 2/6 decrescendo holodiastolic murmur auscultated on cardiac examination. Blood pressure is 140/60. Echocardiography confirms the diagnosis. Which of the following is the most appropriate next step in preoperative management?

A) Amoxicillin orally 2 grams
B) Cefoxitin orally
C) No preoperative antibiotics indicated
D) Vancomycin + ceftriaxone
E) Vancomycin + gentamicin

A 54-year-old man comes to the physician for a 3-week history of persistent productive cough, foul-smelling sputum, low-grade fever, and fatigue. For the past 2 days, he now reports night sweats and some sharp chest pain. Past medical history is otherwise unremarkable apart from on-and-off heavy drinking. A chest x-ray and CT are performed.

What is the most appropriate next step in management?

A) Bronchoscopy with transbronchial biopsy
B) CT-guided percutaneous drainage
C) Intravenous clindamycin therapy
D) Lobectomy
E) Sputum cytology for malignant cells

A 22-year-old man comes to the physician for a 3-month history of intermittent abdominal pain and bloody stools. He believes he may have lost around 5 pounds over this time. He reports occasional low-grade fevers and fatigue. He also noticed a painful red bump on his shin that appeared a few weeks ago and has not gone away. Physical examination reveals mild RLQ abdominal tenderness and an erythematous left shin. Hemoglobin is 10 g/dL. MCV is 85 fL. His mother has psoriasis. Which of the following is the most appropriate next step in confirming the diagnosis?

A) Abdominal CT scan
B) Anti-saccharomyces cerevisiae antibody testing
C) Colonoscopy
D) HLA-B27 testing
E) Small bowel capsule endoscopy

A 41-year-old man comes to the physician for a follow-up appointment. He has had a slight yellowish tinge to his eyes the past week. Vitals are normal. Laboratory studies show high total bilirubin and ALP. LDH is not elevated. There is no transaminitis. Pancreatic enzymes are not elevated. There is no history of autoimmune disease in him or his family. An ultrasound is negative. Which of the following is the most appropriate next step in diagnosis?

A) Abdominal x-ray
B) CT of the abdomen
C) Endoscopic retrograde cholangiopancreatography
D) Gastroesophagoduodenoscopy
E) HIDA scan

A 62-year-old man is brought to emergency by his wife several hours after an episode of sudden-onset right arm weakness and difficulty speaking that resolved after 45 minutes. He has a history of hypertension and dyslipidemia but does not take medications consistently. He has a 40-pack-year smoking history. He drinks Scotch. Blood pressure is 160/90. Neurologic exam is unremarkable. A non-contrast CT of the head shows no acute abnormalities. ECG shows sinus rhythm. Which of the following is the most appropriate next diagnostic step to evaluate the cause of this patient’s symptoms?

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A 66-year-old man comes to the physician because of a 2-month history of worsening shortness of breath that now has transitioned to him experiencing difficulty climbing a single flight of stairs. He sleeps propped up on two pillows to avoid waking up gasping for air. He also describes episodes of waking up at night feeling like he cannot breathe, which improve after sitting up for several minutes. He has no symptoms at rest. He denies chest pain. He has a 20-year history of hypertension managed with lisinopril. A resting ECG shows a left bundle branch block. Which of the following is the next best step in management?

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A 45-year-old woman presents to the emergency department with a 3-hour history of severe, colicky right upper quadrant abdominal pain radiating to the back. She also has associated nausea, vomiting, and a low-grade fever. On physical examination, she is tachycardic, with tenderness in the right upper quadrant of the abdomen. Murphy sign is positive. Laboratory findings show: WBCs 14,000/μL, ALP 120 IU/L, bilirubin 1.1 mg/dL. Abdominal ultrasound shows a gallbladder wall thickness of 5mm and pericholecystic fluid. Which of the following is the next best step in management?

A 54-year-old man comes to the physician for a 6-month history of increasing abdominal discomfort, bloating, and alternating diarrhea and constipation, with occasional gross blood. He has lost 10 pounds during this time. He has a long history of smoking and worked in construction for 25 years. Physical examination reveals a mildly distended abdomen with generalized tenderness on deep palpation. Vitals and laboratory studies are normal. CT of the abdomen shows a mass in the cecum with thickened, irregular bowel walls. Which of the following is most likely to be seen in this patient?

A 72-year-old man comes to the physician for a 12-hour history of increasingly severe lower abdominal pain. Physical examination shows a tender suprapubic mass. Vitals are normal. Urinalysis is 1+ for bacteria. Which of the following pharmacologic agents is most likely responsible for this patient’s acute presentation?

A 48-year-old woman is recovering in hospital 48 hours following a total thyroidectomy for papillary thyroid carcinoma. Vitals are normal. Which of the following is most likely to be seen in this patient?