A 68-year-old woman comes to the physician for a 1-week history of gradually worsening pain in her right hip. Physical examination shows pain with passive and active range of motion. She has a history of chronic kidney disease managed with dialysis. X-ray of the hip shows a pseudofracture. Which of the following is the most likely explanation for this patient’s presentation?

A) Decreased osteoid
B) Increased bone turnover
C) Osteitis fibrosa cystica
D) Osteomalacia
E) Pathologic reduction of carbonic anhydrase II

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 36-year-old man is evaluated in hospital. Cardiopulmonary auscultation is performed.

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

A) Cocaine use
B) History of 20-30 episodes of left-sided “fleeting” chest pain
C) Murmur that increases with inspiration
D) Myocardial ischemia
E) Myxomatous degeneration

A 69-year-old man is brought to the clinic by his wife due to progressive difficulty walking and frequent falls over the past year. She reports that he often falls backward without warning and has developed increasing stiffness and slowness of movement. Physical examination demonstrates axial rigidity and Parkinsonism. Which of the following is the most likely diagnosis?

A) Amyotrophic lateral sclerosis
B) Lewy body dementia
C) Neuromyelitis optica
D) Progressive supranuclear palsy
E) Wilson disease

A 26-year-old male is brought in by ambulance following a skiing accident in which he sustained bilateral comminuted fractures of the femurs requiring intramedullary rod stabilization. Platelet count is 90,000/μL. A photograph of his axillary region is shown.

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

A) Cryoglobulinemia
B) Immune thrombocytopenic purpura
C) Fat embolism
D) Lichen planus
E) Kaposi sarcoma

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 71-year-old man is brought in by ambulance after an episode of crushing chest pain. He has a history of hypertension and diabetes. Which of the following vessels is most likely occluded in this patient?

A) Left anterior descending artery
B) Left circumflex artery
C) Left main coronary artery
D) Obtuse marginal artery
E) Posterior descending artery

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 3-year-old boy is brought to the pediatrician for a follow-up appointment. He has a history of Staph and Strep infections. He appears notably fairer skinned than his 6-year-old sister.

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

A) Adenosine deaminase deficiency
B) Glucocerebrosidase deficiency
C) Impaired phagolysosomal fusion
D) Leukocyte adhesion disruption
E) Tyrosine kinase deficiency