JCAT Mock 2

A 27-year-old male comes to the clinic with diarrhea, vomiting, fever, and abdominal cramping. He is a body builder and just began drinking raw eggs for breakfast three days ago. His typical meal consists of seared chicken breast and steamed vegetables. He has not traveled recently and denies any ill contacts. Stool analysis shows motile, oxidase-negative, lactose-negative, H2S-positive, gram-negative rods. Which of the following is the most likely type of diarrhea this patient is experiencing?

A 27-year-old female is brought to the emergency department in a wheelchair due to difficulty walking. Several days ago, she had back pain and a tingling sensation of the toes. Eventually, she had an inability to move her feet and then her legs. Additionally, she reports being constipated for the past week. Three weeks ago, she had the flu, which was treated with over-the-counter medications and resolved on its own. Temperature is 37.0°C (98.6°F), pulse is 92/min, respirations are 13/min, and blood pressure is 125/72 mmHg while sitting. After standing assisted for several minutes, the blood pressure is 104/60 mmHg. Physical examination reveals absent ankle and knee reflexes. Which of the following is the most likely cause of this patient’s symptoms?

A 12-year-old boy comes to the office with his parents because he has started stumbling and tripping lately. He is thinking about quitting his soccer team since he is embarrassed by his frequent falls when his legs sometimes “give out” under him. He was diagnosed with scoliosis by his school nurse last month. During his workup, an ECG shows hypertrophic cardiomyopathy and an ECHO is ordered. Which of the following is the most likely genetic abnormality underlying his condition?

A 21-year-old man presents to the emergency department for evaluation of jaw pain. The pain started two hours ago after yawning, and now he cannot open or close his mouth. Past medical history is unremarkable. Vitals are within normal limits. Physical examination demonstrates tenderness over the bilateral periauricular areas with palpable indentation of the preauricular space. The patient’s mouth is open and fixed. The coronoid process of the mandible is prominent and palpable just below the maxilla. Persistent spasm of which of the following muscles contributes to this patient’s clinical presentation?

A 5-year-old boy is evaluated on inpatient rounds for a retropharyngeal abscess. Temperature is 102 °F, pulse is 122/min, respiratory rate is 20/min. The patient is awake and oriented and appears tired. He is not struggling to breathe and is otherwise resting comfortably. An area of erythematous inflammation is seen in the posterior oropharynx, and the patient has mild submandibular lymphadenopathy. Parenteral antibiotic therapy is initiated with clindamycin and metronidazole. The physician explains to the parents at the bedside that urgent treatment is required due to the potential spread of infection into a region called the “danger space.” Which of the following best describes the boundaries of this space?

A 35-year-old man is brought to the emergency department after being assaulted at a local bar. He sustained facial trauma, including multiple lacerations and multiple punches to the face. He reports right-sided jaw pain and teeth malalignment. Temperature is 37.2°C (98.9°F), pulse is 85/min, respirations are 19/min, and blood pressure is 120/64 mmHg. CT of the facial bones demonstrates a right-sided displaced mandibular fracture. The patient is subsequently taken to the operating room for operative repair by otolaryngology. The anesthetist injects a local anesthetic agent between the coronoid notch and the pterygomandibular raphe of the right mandible. Injection of an anesthetic into this space is likely to anesthetize which of the following nerves?

A 65-year-old woman goes to her primary care physician for an annual wellness examination. She has no acute complaints. Past medical history is notable for type 2 diabetes mellitus and hypertension, for which she is currently taking metformin and lisinopril, respectively. She frequently engages in outdoor exercise and eats a diet rich in protein and vegetables. Laboratory studies show a serum creatinine within normal limits. A dual-energy X-ray absorptiometry test is ordered, and the results show that the patient’s T-score is more than three standard deviations below the mean. Which of the following best explains the pathophysiology of this patient’s condition?

A 40-year-old woman, gravida 2 para 2, presents to the clinic because of heavy and painful menstrual bleeding for the past 2 months. The pain starts with the onset of menstrual bleeding and has now become severe in intensity. Her last menstrual period was a week ago. Menarche was at age 11. Her menstrual cycle is regular, with 5-6 days of heavy bleeding. She is sexually active with her male partner and denies any pain during intercourse. Past medical history is significant for diabetes mellitus for 2 years treated with metformin and Neisseria gonorrhoeae cervicitis as a teenager, for which she received appropriate treatment. Family history is unremarkable. Vitals are within normal limits. Bimanual examination shows a uniformly enlarged, mobile, tender and boggy uterus. Urine pregnancy test is negative. Which of the following is the most likely etiology of this patient’s symptoms?

A 12-year-old girl is brought to the primary care office by her father because of swelling, pain, and erythema of her left cheek just in front of her ear and the left side of her jaw for the past week, causing her difficulty when eating. The patient’s medical history shows that she has not had her routine booster immunizations. Physical examination shows that she has a fever of 38.9°C (102°F) and her mouth is extremely dry with no purulence noted. Which of the following is the most likely diagnosis?

A 16-year-old girl comes to the clinic because of worsening fatigue for the past month. She says she has always been the smallest in her class but began puberty at age 14. Her height is now 160 cm (5 ft 3 in). While she keeps up with her class in terms of grades, she feels constantly tired despite having sufficient time for fun and rest. Physical examination shows normal skin color and texture, no periorbital edema, and no visible thyroid on extension of the neck. Her serum thyroxine, thyroid-stimulating hormone, and thyroglobulin are 3 μg/dL, 25 μU/mL, and 3ng/mL respectively. Ultrasound shows no thyroid tissue at the thyroid bed. Computed tomography of the neck and chest shows a hyperdense soft tissue mass located at the retroesophageal superior mediastinum and a normal appearance of the base of the tongue. Which of the following is the most likely diagnosis?

A 40-year-old woman comes to her physician for a routine preventative examination. The patient gets regular exercise and does not consume tobacco, alcohol, or illicit drugs. She states she has been feeling fine for the past year. Her physical examination findings are unremarkable. The patient expresses concern about undergoing colonoscopies because of the procedure’s invasiveness, and she wants to know when it is necessary to have one done. Which of the following risk factors, if present in this patient’s history, would warrant early screening for colorectal cancer?

A 28-year-old man presents to the emergency room with new-onset dyspnea. He reports having had several sexual partners over the past decade, using barrier protection only sparingly during this time. His CD4 count was found to be 120/mm3. He recently emigrated from Uruguay to New York City three months ago and reports no additional travel. Physical examination shows hepatomegaly along with lymphadenopathy and the presence of several purple papules scattered across his face. Bronchial lavage reveals round yeast with multiple buds. Which of the following is the most likely causative agent?

A 15-year-old boy comes to his general practitioner because of generalized right knee pain that has gradually worsened over the past five months. He does not recall any trauma or any inciting event. He says that the pain is accompanied by catching and clicking of the joint and is worsened by physical activity. He works on a farm and enjoys playing soccer with his siblings but has been unable to do so for the past month due to his symptoms. His knee appears swollen and is tender on palpation medial to the patella. Range of motion is limited and the knee clicks as it extends. The McMurray test is negative. Imaging cannot be obtained because the patient is unable to travel to an imaging center. Which of the following is the most likely diagnosis?

An 8-year-old boy comes to the office because of red spots on his eyes and inside of his mouth for 2 months. Medical history includes epistaxis, which has decreased in frequency and severity over the years. His mother also says that if he gets a cut, it seems to bleed for an abnormally long amount of time. Examination shows conjunctival and buccal purpura. Laboratory findings are normal, including platelet count and morphology, prothrombin time (PT), ristocetin, and activated partial thromboplastin time (APTT). Administration of DDAVP (desmopressin) does not improve the patient’s bleeding time. Which of the following is the most likely diagnosis?

A 36-year-old primigravida woman at 17 weeks gestation presents to the obstetrician’s office with a chief complaint of severe acne. The patient states that her symptoms started three weeks ago and have progressively worsened. Her friends and family members have noticed her voice deepening as well. Vital signs are within normal limits. Transabdominal ultrasound reveals a female fetus with head circumference at the 57th percentile and body length at the 46th percentile. On physical examination of the patient, coarse dark hair is present on her face, chest and back. Hormone panel testing demonstrates that the patient’s circulating testosterone levels are >70 times the upper limit of normal. Which of the following is a characteristic clinical finding to be expected in the fetus following parturition?

A 42-year-old man comes to the emergency department because of upper abdominal pain, nausea, and vomiting for the past 24 hours. He has a history of heavy alcohol use. Vital signs show temperature is 37.8°C (100.1°F), pulse is 114/min, respirations are 22/min, and blood pressure is 108/68 mm Hg. Physical examination shows upper abdominal tenderness and flank bruising. Which of the following conditions is the most likely cause of his symptoms and signs?

A 62-year-old man comes to clinic because of chest pain and respiratory distress. He says this started 9 hours ago while he was resting in bed and had oppressive chest pain in his retrosternal area radiating to his left arm. He decided not to seek medical attention and took omeprazole for the pain which failed to alleviate symptoms. He quickly starts to feel lightheaded. Current medications are lisinopril, rosuvastatin, and metformin. His past medical history is significant for hypertension, diabetes mellitus type 2, and dyslipidemia. His temperature is 37.2°C (98.96°F), pulse is 65/min, respirations are 28/min, and blood pressure is 80/50 mm Hg. Physical examination shows jugular venous distention, cool extremities, and crackles in both lower lung fields are heard on auscultation. 12 lead ECG shows ST-elevation in leads V1-V6. Which of the following is the most likely diagnosis?

A 36-year-old man comes to the emergency room because of body rash which started at the trunk and then spread to the extremities. Three days ago, he came to the clinic because of fever and headache for two days. Common cold was suspected, and symptomatic treatment was prescribed. His temperature is 39.5°C (101.3°F), pulse is 100/min, respirations are 15/min, and blood pressure is 110/70 mm Hg. Physical examination shows a maculopapular rash that involves all of his body except his palms and soles. He works as a zoologist. Ten days ago, he traveled to Mississippi to study the wildlife of flying squirrel. Which of the following is the most likely diagnosis?

A 22-year-old man comes to the emergency department because of a headache that feels “like a screwdriver” going through his right temple and eye. He says that it has lasted for approximately 1 hour thus far, and rates the pain as a 9 on a 10-point scale. He says this has happened almost every morning this week, but he cannot identify a trigger. He also describes “watering of his eyes” and difficulty seeing during these episodes. Physical examination shows ipsilateral miosis of the right eye, but the remainder of the ophthalmoscopic examination is normal. There is no tenderness of the right temporal region on palpation. Which of the following is the most likely diagnosis?

A seven-year-old boy comes to the clinic because of recurrent axillary and scalp abscesses. Past medical history is significant for multiple episodes of otitis media and three instances of liver abscesses caused by Staphylococcus aureus. Physical examination shows two pyodermic lesions – one behind his left ear and another in his right axilla. Which of the following is the definitive test for the most likely diagnosis?

A 60-year-old man presents to an urgent care clinic for evaluation of an ongoing nose bleed. He has been pinching his nose for approximately three hours, but the bleeding has persisted. Past medical history is notable for hypertension, and he has no known history of trauma or bleeding disorders. Upon arrival, temperature is 98.0°F (36.6°C), blood pressure is 168/85 mmHg, pulse is 75/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination shows significant bleeding from both nostrils and draining to the back of the throat. Which of the following anatomical locations is the most likely etiology of this patient’s symptoms?

A 51-year-old man comes to the emergency department because of decreased strength in both legs for 5 days. He says 2 weeks ago he had a dry cough and fever that resolved after 6 days. Five days ago, he began experiencing frequent cramps in both legs. 2 days ago he had difficulty standing, and now he is unable to move either leg. He denies recent trauma, visual disturbance, or changes in bowel or bladder behavior. Physical examination shows speech is normal, cranial nerves II-XII are normal, pupils are equal and reactive to light, no facial droop, hypotonia in hips, knees, and ankles, lower limb strength is 0/5 bilaterally, positive Beevor’s sign, negative Babinski’s sign, upper limb reflexes are normal, knee and ankle jerk reflexes are absent, sensation is normal along all extremities, and spine is non-tender with no gibbus. Which of the following is the most likely diagnosis?

A 62-year-old woman comes to her outpatient provider for a routine visit. The patient has no acute complaints. Past medical history is notable for hypertension, for which she is currently taking propranolol. She consumes 3-4 glasses of wine per week and smokes half-a-pack of cigarettes per day. The patient’s brother passed away from multiple myeloma 4 years ago. Temperature is 37.1°C (98.8°F), blood pressure is 138/75 mmHg, and BMI is 19 kg/m2. The physician is concerned that the patient may have osteoporosis. Which of the following laboratory findings will most likely confirm this diagnosis?

A 3-year-old boy is brought to the office for evaluation. He has had recurrent episodes of otitis media and respiratory infections that have required antibiotic treatment. His fine motor skills are within normal limits. He appears unsteady when asked to stand still, but can walk quickly while he plays. He displays nystagmus during finger tracking. Which of the following findings is most likely present in this patient?

A 68-year-old right-handed man is brought to the emergency department for evaluation of right-sided weakness and numbness. The patient woke up with right hand clumsiness that rapidly progressed to right-sided weakness, affecting the left arm more than the left leg. Past medical history includes hypertension, atrial fibrillation, and type 2 diabetes mellitus. The patient has a 20-pack/year smoking history. Temperature is 37.2°C (99.0°F), pulse is 138/min, respirations are 14/min, and blood pressure is 146/86 mm Hg. The patient speaks clearly, but his sentences are incomprehensible. Neurological examination demonstrates impaired two-point discrimination to light touch in the right arm, right facial weakness sparing the forehead, 2/5 muscle strength in the right upper extremity, and 4/5 muscle strength in the right lower extremity. Left-sided strength is preserved, and visual fields are within normal limits. The etiology of this patient’s symptoms likely occurred secondary to ischemia of an artery supplying which of the following anatomic regions?

A 36-year-old man comes to the emergency department because of fever, chills, and breathing issues. He recently suffered from strep throat, for which he was prescribed 10 days of antibiotics. He is coughing with significant sputum that looks like red currant jelly. Which of the following is the most likely diagnosis?

A 25-year-old woman comes to the emergency department because of worsening fatigue, lightheadedness, shortness of breath, and chest pain for the past 3 days. She reports seeing her family doctor 2 weeks ago for a fever and rash. She was prescribed antibiotics but stopped the course 1 week early after symptoms subsided. Physical examination shows mild left knee edema and a 6 cm blue-red circular rash with 1 cm of central clearing on the right posterior thigh and lower-left abdomen. Which of the following findings is most expected with this presentation?

A 25-year-old primigravida woman at 20 weeks of gestation comes to the obstetrician for a routine prenatal evaluation. The pregnancy has been uncomplicated, and she has been compliant with prenatal care. She takes vitamins as needed. Family and medical history are unremarkable. She did not have any prior abortions or miscarriages. Ultrasound reveals numerous cysts and no identifiable renal tissue at the location of the fetus’s right kidney. The fetus’s left kidney appears normal. Amniotic fluid index is normal. These ultrasound findings are most likely caused by which of the following?

A 29-year-old primigravid woman at 34 weeks gestation comes to the clinic for a routine prenatal examination. She has noticed regular fetal movements and does not have complaints of vaginal bleeding, leaking or abdominal pain. She had an upper respiratory infection and hyperemesis in the first trimester that have since resolved. The patient uses illicit drugs including heroin, cocaine and marijuana. She does not use tobacco. Prior to conceiving, she would consume alcohol with her friends on the weekends. Temperature is 98°F (36.6°C), pulse is 110 bpm, blood pressure is 100/70 mmHg. Ultrasound reveals a biparietal diameter of 32 weeks and abdominal circumference of 28 weeks. Which of the following complications should be anticipated at the time of delivery?

A 31-year-old man comes to the office for a fertility evaluation. He and his wife have been trying to conceive for the past year without success. He has also noticed a dull aching pain in his scrotum that is exacerbated when he stands. Examination shows a left-sided scrotal enlargement that decreases in size when the patient is placed in a recumbent position. Based on the patient’s symptoms, which of the following veins is most likely to be occluded?

A 67-year-old man comes to the physician’s office due to weight loss and chronic cough for the past 2 months. He also noted streaks of blood mixed in with the sputum. His medical history is significant for smoking 1.5 packs of cigarettes daily for 40 years. The patient’s records show that 1 year ago his BMI was 24 kg/m2, and now it is 18 kg/m2. He denies any changes in his diet but reports a decreased appetite. Chest radiograph shows a central nodule in the right lung field. Biopsy of the suspected lesions is performed and histopathology shows small dark cells that stain positive for chromogranin A. Which of the following is most likely to be responsible for the patient’s weight loss?

A 32-year-old man comes to the office due to 2 days of chest pain and worsening dyspnea. The patient mentions that he is HIV positive and that he is currently taking a triple-drug HIV therapy (lamivudine, zidovudine, and raltegravir). His medical history is also relevant for a concomitant hepatitis C infection. Physical exam shows multiple injection marks on his right forearm, pulsing hepatomegaly, pitting edema, shifting dullness in the abdomen, and c-waves in the venous jugular pulse. Auscultatory findings reveal a pansystolic murmur located in the left parasternal border, with increased intensity on inspiration. His temperature is 37.5°C (99.5°F), pulse is 109/min, respirations are 20/min, blood pressure is 110/60 mm Hg, and pulse oximetry on room air shows an oxygen saturation of 92%. This patient most likely has which of the following conditions?

A 70-year-old Caucasian man comes to the office for a routine medical check-up. He has not seen a physician for many years because he considers himself to be in good health. His pulse is 74/minute and his blood pressure is 170/100 mm Hg. At this point, the patient is diagnosed with hypertension and is started on antihypertensive medication. During a follow-up visit to the office, a few months after, the patient’s blood pressure is 135/80 mm Hg. However, the physical examination is remarkable for bilateral, symmetrical pitting edema. Which of the following drugs was mostly likely prescribed and caused the edema in this patient?

A 33-year-old man presents to his primary care physician to evaluate low back pain. The patient was helping his sibling lift furniture yesterday when he experienced acute onset low back pain, requiring him to lay in bed the remainder of the day. The patient is otherwise healthy and does not take any medications. The patient has tenderness to palpation over the lumbar spine on physical examination. Strength is 5/5 with foot dorsiflexion, toe extension, and foot inversion and eversion in the right lower extremity, while 4/5 in the left lower extremity. Sensation is also diminished on the lateral aspect of the left lower extremity compared to that of the right side. Which of the following is the most likely affected nerve root responsible for this patient’s clinical findings?

A 55-year-old man comes to the clinic due to the recent onset of throat pain, fever, and substernal burning pain. Medical history is notable for hypertension, hyperlipidemia and end-stage renal disease, for which he received an allograft renal transplantation from a deceased donor 6 months ago. Medications include azathioprine and TMP-SMX. Temperature is 38.4°C (101.1°F), pulse is 80/min, and blood pressure is 145/85 mmHg. Cardiopulmonary examination is within normal limits. Examination of the oropharynx is normal without exudate or erythema. The abdomen is soft with mild epigastric tenderness. Leukocyte count is 5000/mm3. An endoscopy is obtained and reveals multiple shallow linear ulcers in the distal esophagus. Which of the following best characterizes the organism responsible for this patient’s findings?

A 56-year-old man comes to the emergency department because he burned his left hand two days ago. He has now noticed that the wound is producing a blue green pus. His temperature is 39℃ (102.2℉), pulse is 90/min, respiratory rate is 16/min, and blood pressure is 126/82 mm Hg. Culture of the bacteria shows a gram negative, oxidase positive bacteria that does not ferment lactose on MacConkey agar. The man gives a history of consuming mostly raw, uncooked vegetables in the last few days. Which of the following best describes the associated virulence factor?

A 42-year-old woman comes to the emergency department seeking evaluation for abdominal pain which began 12 hours ago. The pain is localized in the right upper quadrant and is rated as 7 out of 10 in severity. In addition, she has had two episodes of non-bloody vomiting. Past medical history is notable for hypertension and type 2 diabetes mellitus. Her temperature is 37.2°C (99.0°F), blood pressure is 152/88 mmHg, and pulse is 76/min. Physical examination shows jaundice, and pain is elicited on palpation of the right upper quadrant. Laboratory testing reveals a total serum bilirubin of 6.7 mg/dL. Ultrasound reveals obstruction in a portion of the common bile duct. No obstruction or dilation of the pancreatic duct or hepatopancreatic duct is observed. Which of the following additional findings will be most likely present in this patient?

17-year-old girl comes to the clinic for evaluation of a worsening productive cough. The symptoms have been worsening over the past week, and she has noticed increased production of foul-smelling, blood-tinged sputum. She has had multiple similar episodes in the past that mildly improved with antibiotics, but the cough has always persisted. The patient does not smoke cigarettes or use illicit substances. She takes pancreatic enzyme supplements for chronic diarrhea. Temperature is 39.0°C (102.2°F), pulse is 104/min, respirations are 22/min, and blood pressure is 124/75 mmHg. Physical examination reveals digital clubbing. Lung auscultation demonstrates diffuse wheezes and crackles. Which of the following findings will most likely be present in this patient?

A 20-year-old man is brought to the emergency department due to altered mental status and headaches for the past day. His roommate states that he was in his usual state until yesterday, when he started complaining of headaches, fever, and abnormal behavior. Temperature is 38.5°C (101.3°F), pulse is 100/min, and blood pressure is 124/80 mmHg. On physical examination, the patient is lethargic but arousable. The neck is supple with full range of motion. The patient responds to questions, but the speech is incomprehensible. Hyperreflexia is present. MRI of the head shows edema and hyperintensities in the temporal lobes. Which of the following is the most likely explanation for these findings?

A 60-year old man is brought to the emergency department for evaluation of new onset confusion. His partner reports he has been suffering from “hay fever” throughout the week, but today she noticed he was not acting like himself. His partner states, “I went to check on him today, and he did not know where he was; he is usually totally with it.” The patient has no other medical conditions and does not take any other medications. He does not smoke tobacco or use illicit drugs. Temperature is 38.8C (104.84F), respirations are 18/minute, pulse is 120/minute, and blood pressure is 140/90 mmHg. On physical examination, the patient appears agitated and disoriented; he is oriented to person only. The patient’s skin is dry and flushed, the pupils are mydriatic and poorly reactive to light, and bowel sounds are decreased. Which of the following best describes the underlying mechanism responsible for this patient’s clinical condition?

A 58-year-old man is brought to the clinic due to progressive paranoia and personality changes for the past 2 months. The patient’s partner reports that he started acting oddly 2 months ago. He blamed her for infidelity multiple times without any reason. The patient’s partner also noted that he hasn’t been sleeping well lately. The patient has been a lawyer for many years and recently has been receiving bad reviews regarding his performance. There is no family history of any significant medical conditions. Vitals are within normal limits. On physical examination, the patient appears anxious and suspicious. Nystagmus is present bilaterally. The patient occasionally kicks the table involuntarily. When the doctor claps his hands, the patient is startled and jumps in his seat. Which of the following is the most likely diagnosis in this patient?

A 1-week-old male infant who was born at term is brought to the clinic by his mother for consultation about lactation. During the physical examination, abnormal ridges can be felt at the sagittal suture during palpation of the baby’s head. The length of the head is 5 cm longer and the width is 2 cm shorter than expected for his age. During the exam, he displays a normal flexed posture and expected strength, good activity and responsiveness. Which of the following is the most likely diagnosis?

A 67-year-old woman comes to the office because of shortness of breath for the past 4 months. She is very concerned because she used to be quite active and would walk her dog a mile each day. However, recently, she has noticed that she gets “winded” while walking her dog and has to rest. She also has a cough at night. She grew up in Russia and her medical history is non-contributory. Her lungs are clear bilaterally on auscultation. There is jugular venous distension as well as a low-pitched diastolic murmur heard best over the apex. An ECG shows normal rate, rhythm, and axis. The QRS-complexes are of normal duration. There is a dominant R-wave in V1>7 mm tall and a dominant S-wave in both V5 and V6 that is >7 mm tall. Which of the following best describes the patient’s condition?

A 56-year-old woman comes to her primary care physician for evaluation of acid-reflux that began four months ago. The patient has tried ranitidine and pantoprazole; however, her symptoms have remained poorly controlled. Past medical history is notable for asthma, for which she is currently using an albuterol inhaler. Her temperature is 37.5°C (99.5°F) and blood pressure is 118/67 mmHg. Physical examination is notable for skin tightening over the face, hands, and forearms. Several ulcers are observed at the fingertips. Which of the following is the most likely explanation of the patient’s presentation?

A 70-year-old woman is brought to the emergency department from a skilled nursing facility for abdominal pain that has been worsening for the past six hours. She is diagnosed with kidney stones, and the causal organism is determined to be Proteus vulgaris. Which of the following chemical reactions conducted by this organism encouraged the formation of this patient’s kidney stones?

A 75-year-old man comes to the emergency room because of jaundice, light-colored stools, and unintentional weight loss. He denies abdominal pain or irregularity of bowel function, but has felt a bulging lump in his right upper quadrant (RUQ). A RUQ ultrasound does not show any abnormalities but a non-contrast abdominal CT shows dilated biliary ducts throughout the liver parenchyma. The hepatic ducts, gallbladder, cystic duct, and common biliary duct all appear normal. Which of the following is the most likely diagnosis?

A 10-day-old boy is brought to his primary pediatrician for his first newborn evaluation. Since birth, he has had persistent swelling of his scrotum. He was born at 39 weeks gestation following an uncomplicated vaginal delivery. He has been breastfeeding multiple times throughout the day and is making 8-9 wet diapers a day with normal stooling. Vitals are within normal limits. Physical examination reveals bilateral descended testicles that are palpable in the scrotum. There is a visibly enlarged, fluctuant left hemiscrotum. A penlight is held behind the left hemiscrotum, which demonstrates transillumination. Which of the following best describes the underlying etiology of this patient’s condition?

A 33-year-old man comes to the clinic because of fever, chills, and muscle aches that began two days ago. He reports a non-productive cough with nausea and diarrhea. Two weeks ago, he returned from a kayaking trip to Hawaii. None of his travel companions have been ill. The patient appears lethargic. His temperature is 38.1°C (100.6°F), pulse is 80/min, respirations are 22/min, and blood pressure is 135/80 mm Hg. Physical examination shows scleral icterus with bilateral conjunctival suffusions. His spleen can be palpated. Which of the following is the most likely diagnosis?

A 68-year-old man comes to his primary care provider for evaluation of “fullness in the groin,” which started 3 weeks ago. The discomfort is present in both testicles and has not improved with over-the-counter ibuprofen. On review of systems, the patient endorses a decreased appetite, 7-kg (15-lb) weight loss over the past 2 months, and occasionally wakes up at night drenched in sweat. Past medical history is notable for hypertension, peripheral vascular disease, and chronic venous insufficiency. Temperature is 37.2°C (99.0°F), pulse is 71/min and blood pressure is 147/82 mmHg. Physical examination reveals a thin man with diffuse muscle wasting. Bilateral testicular enlargement is present. The masses do not decrease in size when the patient lies flat. The testes are nontender to palpation. No erythema or rashes are noted over the scrotum. Which of the following best describes the pathophysiology of this patient’s testicular findings?

A 35-year-old woman presents to the office because of perianal discomfort and foul-smelling discharge around the anus for the past 2 months. She also reports intermittent abdominal pain and watery diarrhea for the last few years for which she did not seek medical attention. She has no other significant past medical history and has not traveled outside of the country recently. Temperature is 37.2°C (99.0°F), pulse is 102/min, respirations are 20/min, and blood pressure is 110/65 mmHg. Physical examination shows canker sores on the oral mucosa. There is mild tenderness in the right lower quadrant of abdomen and an anterolateral anal fistula draining foul-smelling purulent discharge. Stool microscopy shows 1-2 cell/hpf leukocytes. Colonoscopy shows skip lesions and cobblestone appearance of the descending colon with rectal sparing. Which of the following findings will be seen on light microscopy of the involved tissue sample?