once. eae o Rad erates eee yeh comet e eeneeent . Sim nossa eine ncs ae ncan a Lea ee ee ee Tee I sad cece een vest ioteyew ects Tin wees re eee ee ee eee * ase einer aay ne anon mia aceon iaens Bic eae Ser a ee ence Cos teigareiy au Saigimt mr mpenr a7 Team paw nm a space 130/84 mig photograph ofthe athe shor. One mom aga, ha emoplbin Aca 78 Which ofthe following Ismosiky 6 conrm he cleans? > ‘Wood lamp examination “Thypoid stalation hormone sion cure ‘Potstu hyonde preparation © Ic (© Arcola annoy eng‘A potssum hyromdepreparaven is conducted om asl scraping ofthe hypeplamened area, Microscopy ofthe pation shows ing ype among cusers of est cls. Based on hese ndings, wih of he along se mosto a es 83 oss Om Ds al “ws question sparta sequence of quests. Answering tis question wl unlock he follow-up questions. Hower, you won't Be bit change ti anewer a soon at You have ewe the follow-up question. 1 21-year-old man comes ro the pysican because of US and 2 BOpIANEATEB on supper boay for Says. Fe ert noted the smpters afar retain fom 2 bus ip tock nthe Sahara, he war tere, he vist ‘coupe of beaches ant wen king wth some coworkers, The rash inal stared as single lesion on his upper back but amce them as extended tia shoulders He has sary of ype | dabtes melts contre than nln pump He wors as an ofee manager dnd fas ne krowa axpsur 0 mlanactowc chemi He as Been sexual aCe WE ‘Qe emale partes over the past ea an uses condoms inconssey. Hets 183 (59 al nd wighs 10g (76Ib) eae 25g me He trperatre 372°C (9, ple 75min an oe pressure 130/88 mm Ho. photograph of th as 5 shown. One month ago, hs hemosTobn Aye was 7.8% Which of he lowing Ismet ky 0 canem he agnosis 2a ‘bermoscopy may be used ancy n pavers wth pris esl, where shows wel-demarcte, wht ares wh fine lath seating cazes te sn Trows I does et com the legs. Demoscoy is aso used io exclude magn Tesions such melanoma ad baal call excnoms, However, nather ofthe to ston causes widespread yeopimeneson, thor would ey spreads apy ad suparaly ‘AWood amp examnanon may reveal a oppery-otange oF yellow orescence at haates pyr versclr but oly n scores, making ita por contreatery test. .Om Ds al <1m> “aasurement of 5 the bes est west r lagnoss hypothyroidism. Hashimoto tyr ithe most common cute of Inypotyrlcsm ands suonly associate wth lig. Vio cen presen wh wel-demarcated hypopigmented maul, bt they are nt pte a sey Ike the sons een hee tionally, hs patient fas no cea feature hyphen, suchas constpation, breeeardla mvedem, fig, col iolrance oF @ hearse ve Sk cu ren el ee cn fdr ape tai ete en ld ae alough skin cultures ae cos-tfeci, the te ine-consuming end can delay adequate eater. nti ester Son clues often reported ta be negative nce Maser labora and hlser fr the pathogens causing pyran ‘esol, ae eeu row under aboratr conditions ‘4 pousium nydronde (KON preparation soul be perormed i this panto cont the ages of py vesicle ‘ohch appears a"mostall” Pound yest cals) and epaphet ong hyphae on HOM proparston. Pats erselor mort “ommonl caused by the ung taseza gloss and Melsszt rf. Palen’ often become are of he dea he 54" ‘spovate Beats he lesions net tan an become moe ale agai he ecenty anne srr si oe ‘sk biopsy an important etn cases suspected skin fection of mallonany. Whi an wecton with Mcozscterum Sead ea seed eae pe eee Teter eee aioe ‘muscle weahnes, poo ejsiht and pales ups onthe fae or eobes would also be expects {Ctaneous Tel mphorn 3 wel my presen th papier ates, but hs arnt pecorinates inchoate, ‘than na21-year 6 man Csi cianeous T-cell ymphoma presents wh ed Scay prune, we demarcated sk plagues {and pataes, ard mushvoom-sapea tuners, ymptadenopaPy and Mepaesplenomecay ae ae stages o Oe sease ‘enopatelageal austin woud show atypia! CDA Teal nthe erm and piers and Putt mroabacesso, Wale {kn biopsy n «pee wh pass vestolor would Show spores and shot hyphae thin he sawn come of Inatopatlogy, ess invanne et is prefered acon the dagronomnes i +40 > Eo cers ol eee If etanercept ee ee ‘Alough skin cultures ae cost-efece, the are time-consuming and can delay aGequte treater. ness ersInor Son cultures oan reported to be negative since Musassen fobs ahd Matasez fr the pathogens Causing PASS Serato, af felt grow under nbrstory condos 8 ‘poasium hose (KOM preparation shoud be performed in this patent con the cagness f pias vesicle, ‘heh appears "meatall” Pound yest cls) and spaphett ong hyphae on KOM preparation. Pans erecta a mort “commonly caused y the ung ateseciaglaboss and Malsset fort Patents often become avare of he dea fe 5" “expotute because te lesions net tan at becore moe lb agat he econ aed surouiing Si ‘skin biopsy san impertane est incase of suspected skin infection o malignancy. Wh an infection with Mobster ‘eprae may sho resent wth Pypnigerted patches the sults, ote mpm of eon sucha ss of senso, ‘muscle weakness, poor eyesight, ané panies: umps on te face or erobes would aso be expects ‘Cutaneous Tel hmpoma as wal may presen wth ypeplmerted tes, buts vara preaomates in chien rae {hana 2 21-year ld man Cele cancout T-cell ymphoa ports th ed sea, prte, wal demas sin plaguet ‘and patches, and mushvoom-shaped tuners, mphadenopety and hepatespleromegly ne ate stages ofthe disease topathelageal uation would show typical CDA~ Ta nthe erm nd epidermis and Pater meroatacesses, Wile {sm biopsy na peben wh IITs verter WOU Show spores and HO hype hin he Satu orMEUM oH nstopataloy, ss vase et sree o cont the dag (A oa loo ae eee eee ere eee ‘avert SLE ypcaly preset with 2 photosensitive malt ash and eyhematous erupts; hyppigmetted sions ae fe less common Aetna th man lick ysemic neveren fhe lunge, Kdney, musculoskeletal system, Blood ‘borers, wich would ase suspen fr SLE. a —Om Ds al <2 +> o | Ta un ipa ac oun a nlc ann pre on, a ‘num mone npaon coc on seo oh samen re oc fe preataon shows Yong pha ariongEusee GF YER Gl Base on res nding, which of he allowing ste st ry Sppropnatepharmaceherapy? ant 2 Fcorazte sed for eectons wih Canal, Cptococas and detmatphytes Inducing Ua versclr Hower, i ‘oconzole ar may yom rie fot is hepato selzuen and getoimtestia ese. Therefor, ie only eed {or Sevete and idespend for fines veto of opis! rey snot suc eect SS Sa which also cause Pypoiamentaton ings commen presents wth Wypopianted eins onthe extremes tat do Not e aye say appearance, as Seen nis paler Wie autre pst can preset wh Mypopigeraion, PRS papules sth ine cls ra ors common ar they tnd 0 occur overs prod of 73 mane ater nan 3 da, seen Noho Datenc here Corcostreds ae wetter nly not eated hey woul actually worsen he Fungal nfcton withthe exoconazaleiseffecve against Canaza Histoplasma and sermatopyss, inCudig tna vest. Howes, ‘etosnazoseEnoun tobe Repsotonc at wall at to caue adroal jr, ad har mule drag itrarons. Therefor he ‘seo fl Ktoconzoles ested to serous dseminatedfaigalfecios ony Topical ketoconazole may, howe beOM Dra shi? + yar “Topica conosteroid suchas oberatol or mometisone are ued in aommune deze ie quae peoriss or Ege, lhc alt eure Hypaigmentation. Viigo commonly protests hypapiraried ess on theaters that do nt e Ihave say apperance, as seen his pai While guitare psoriasis can pase wth hypop;greraion,plnkish papoles vit fine cle re ore common ard they tendo aeut ora prod of 23 maths ater nan 5 da, seen 9 he — Davene here. Cortcostroes are merefre net ony not maleated, hey Would actually worsen he ung mcr With ter Imunosuppresive eect. ‘eroconazaletseffecve against Cana Hsrplasma and cermatopyss,incuding tna wesc. Howe, tare a A remo ome ete poise eile ae a ea ‘seo rl Ketoconazole rested snes dseminated fungal feos on Topi Ketoconazle May, ROWE be eS Se SS {suse for scalp sins as wel as Sborrhetdermatls, heres loon typcal used for shin sions no occuring on the ap elem sulide promotes epermal trove, epoca ofthe arate cote hich the jer nected by Masco rr the cabsatve organism of Urea Versa. tpl teraby als othe seas severe and widespread, ‘oral antungas sun as corazole ae use. By Tea versicolor ‘statins used ro wea lc infectons with Cana which woul Show pseuhyphae and budding yas cls on 2 KOH preperation. Cancel infestans f the ain cause a red fen rah ara not he Rypopgrerted isons cberved in hs patent eis not effec against nalssza rr te cause gan oes Vrs.Ons al <3 +im> 1 12-year-old its bough wo the emergency depart vecause of severe pl and seg ot ht ight ee fr 3 das {ook overthe-coumter naproxen ad phenfephne, Her nase congestion he since proved, but the hesdache pe i Se underwent dental procedure for cares about ten dys ag. She does not recollect any recent inet tes or auras. Her immunzstons ae up-t-date, she appears and rere ecasonal cis er temperstire 5 36.3 (IO pulse £9, min, ad blood pressures 110/70 rm ig. Examination shows propel of theight es, Viton imped in he fect oye. Har ogh uppar anlar seid are eythematou, salen and tender 0 fuch, Cel movement ‘Seer pain Her each s worsened by lesing forward an imprones wen the patents ing on ar bac Which of {he flloning the most ly eaue ofthe pans symptoms? a Suppurave spread of decrees ‘ace nfacon fo spend sinus ral al tomer ‘linen tom malay iusant oss Omns al <2+> Esineltp ter hitomemerinsinntnnsdiinenseminatenstiriginnintion, (i eee } ee ee ee a eee ee ee ar a a na Ginette pnatel teat semen ee ea oo a ee ea eee Hamed Cnc occ ec) etiaiseeiiccnccahere ee ee ee “Ths gf has pated vison ely due to plop propose, eye erythema ad enemas, and exter pn on ‘euar movement which eines of orb celts. 4a « SS ‘passing trough the sinus. These trutresncue al ran nerves responsible for eye mavemant (cule mor, CNH ‘Moca, CWI abauces, CN Ub and te opal and maxillary branches of e ued neve, cN Vand the “ompromiz asst ophthalmoplegia a los of rareton tthe upper soe te fhe face. Since tl patent Joe Rt Ihave any lanl ere symptoms, cavernous Sus vombosis nla Paver ith dental abscess preset wth toothache pa and ueling nthe area of the acess More stems mets, ‘sucha eer, nasea vomiting, and cay salou or speaking, can ao ECU Tis pan recent underwent etl ‘rocedue and dea abscesee can speaa wo th ob ad cause oral cella, Monee, he patent haemo syrptonsOUD s al <2 > ‘tans oat ut tenons of the nsolcimal act lasso bacterial elonzaton and dacyoeystt. Symptoms of severe infanmaton, swing aly ad edness ar WoL Sistem symtoms such s fever, malas, an loalzed ‘yah nae sating may ae occur ace patogars om telacerl sca heh Spread to adage areas, cus ‘lds. Mower, te patent hat no ior of sympioms consistent wth eyes ‘acral infection ofthe sphenid snus can presen wth symptoms such a fee, hil and headache, he areas present {nth patent hl the patent sky had sista, the pheno sinuses ate aed inthe aphenoid bans eat the ote ‘ere and pray ganz Therefre,bacerlspead tothe obama spend SnUs woul be ess ey tan seread om rus tas closer toe orbs. ‘Patents th orl wall amor usually present th gradual onset of symptoms such a5 pops, diplopia pared vison, ‘nemangiomas and mphanalomas in acts aswel as children, are benign, As an oral wall tumor snot an infecous ‘asease, would nt preset th th abet’ Syrions of cue onset fee and Signs of ells ‘teal macomycost may ecu du ofa spread patents wth thal or asia fangal sus Fates wth fungal smusis picay Nave eter poorly controled abeesmelius, HF ahisey of longete Steroid therapy, a ate ali ecg cae pense pera oe patel tcl ced eer beta ‘Signs and symptoms of musts, ine ts pater s young, heathy, and rot MIMUNECOMBYOMSEG,& fungal source ot© BU se sh <3 yD ‘hemangiomas and mphanglomasn acts aswell as chien, are benign, Asan orbital wal tari not an nectous ‘isease, c would noc preset wit his patente’ symoroms of acute onset of fever and signs of elas. ‘real mcormycont may acu ofa prea patents wth thal or avila fungal ruse Fates wh fungal shusits typical have eter poorly cntoted abees liu, HV Fahey of logete Steroid therapy, 2 ae ‘ually imminocorpromiad These putes ould present wth palatal or nat maronal ueeration aston tthe other Sian and symptoms of snus since is paent: youn, Rea, ands nt immunocompromised fungal source of Intecion is untaly ‘oral eis s mos commonly cused by bacerlSpreed from eral or maxilary rusts 25 hese muses ate most ‘prokmal tothe orbs Tha patents toy of recent nuns, terre, rakes spread om the emits he most ey cause of er soto 9 “This pave nay have nily had vial sins, Howse the prsisence oF his pate’ yon for so wees males ‘motte tht she no has bacterin In aden, oa celui sypealy duet acer rather tania pathogens.Ons al 1.35-yurol man comes tthe pcan beans of ae, long, aed, ad vont fore a2 ye x describes his stocl as soft, frothy, and greasy. He denies sesing blood in stool. The patient went on a hiking trip last wack a Sn rank esha ote Sam. Tes month sp, ewes on vacate wih ray for west nd we tas no Wao of eras nese ats no meastons The ate apes eae, steer 37 (Gey blows pasue 100 mm pulses 60a rspraton ae 12 xamiaton sows ry mucous ‘porn net sepn manager ge 8 ont 2a () crontoxacin erapy ‘ceo therapy (©) Mewondszoe therapy (©) | terwtionrn-cltetnatch eapy (©) Veco tery (F) Supporve weatment onyoats Omns al <1 +> Pear ee anes terre ene ay ere eer rea eee ae oa teres taal SS a | es Toray ennai hetried many wadiona dahes He alsa ed watery lB and stomach cramping ot 3 cay during hs vs thre He has no stor of serious hes. He takes no means. The psbent appears Gehyraed His temperature 37 (98.5, lees pressures 100/60 mm Ha, pulses 60/min, and espratons ae 12 min Gvamnaton shows ay mucous ‘mambrant and aifareandominal tendenar,Miericony of the sto eee SJ Which ofthe fallowing the most Soproprate next step nmanageren? “The patent’ acer king wp rng which me he rank fom 2 steam, andthe detection of ess in his tol make (para the most ely dngnons The fection impars absorption hic leas to geay an Wahy caren 2a « ‘iprioxacin canbe used 10 eat wavele’s area caused by emeorougenic Escherichia col endemic n many wopic ‘counties Tha part ved as! 2 months age and might Have contracted Waele’ rhe watery care) during the ‘ames Which reseed wine further Weave. Ame, Ree, the PAPE MoS" Kel has ees, WHEN Cipoioxach tent etecveagenst ‘Getrctide weed ta ratirs sympa: paces weh cca emo, ic classe prevent th dares, eta ‘shin, 2nd asthmecike attacks. Tis patient does na compan of any fusing or Syspes. ‘lara sth most common prasi caus of cares th US. caused by Gara mba rch can be acqured from ‘inking urreied water natural epings, teams, Mercigazla an arto ats eflecve aga anseobes and Fens shuld be adisea not to conse lool wie tng menidazole because ca at a iuranthe eatOU Da al < +> ‘Cercle uted flrs sympa: paces wth comet moe ich lately preven nth dane, taneous ‘shin, 2nd asthmecibeatacks. THs patient does no compan of any fushing or dyspes. ‘lard the most common prasi caus of aares in th US, caused by Gara lamba ch can be acqures from ‘ining unetes water (ava sprigs, steams. Neonat an afb. ats eMecne aguas anzeobes and Potores andr cormanty uted eater! for lati Sde effect inclu rauea ands metal ate nthe out Fens shuld be adised not to conse lool hie teing meoniazole because I can ad a isulfivam-the reaction “Te-Stks used for matnanceteapy in Whipple's ease, Whi may alo present wth malabsorption and greasy sels. However tar are vualy ag extrarenal syotons such e marry arth, Nphadeopaty, andr neuogie eta Moreover, hips sree would no preant th cyte stool sample TMP-SNE spt effects agaist ondiass. ‘ra vancomyen ithe fst therapy for Cesium acl ifecon, which may presen wh watery, ater han Froth {ind greasy area, Moreover, ace many cases actor neldey pate (> 65 years] who have received veament “ivan arb a cindamyei or ceplespann. The patent has no htoy of por ntti estmané ad ox ly tas gars, which vancomycin ino effective against “Support eaten is importn i the cantet of hahes a repice Md andere losses, However, th pa ‘hares caused by a paras an heer lo demands casstve eames.oats & om Ds al ‘56-year-old woman i trought te emergency depart because of eet, ci ight Sweats, and progressive ‘hones of rea for} weak. She se ers guested fate arc eee, Sha ha tye 2 bees ellis sd Fhmothoiism. cure medcaons incu metormin, agin, ahd leotivonne She appa He temperature D7 (1O1-7P, plac 104/mn, and ood pressure 160/30 mn Hi Exaranation shows pel conjunctive aed snl rnontencr hemrrhale macaes oe” hr pals and sls, races ae heard st both ung oases. A ade 276 ‘i aastoic murmurs hers besa the Ole tect space an is acemuated BY lang Yorwad. The spleen emoaloon ros aia niece sedimentation ate mm/h eed 2 face 20-20)" sn echocatiography sows multiple vegetations onthe sort ae, ood culures gow S gellohticesShe is ented with fmpcn ane gentamicin for ese an her symptoms rere, Aregest eneetracaraphy at week sows ma soie ‘eguratation wh na vegetations Wht of he allowing i the mast appropiate next Sep M manageen? iN ee © Wastin nerpy hrfoxacin propa implant deioator ' |@lO@G ‘Sopnaposisvoavodenosconyoats Omns al ‘56-year-old woman i trought te emergency depart because of eet, ci ight Sweats, and progressive i ‘hones of rea for} weak. She se ers guested fate arc eee, Sha ha tye 2 bees ellis sd Fhpothoidsm. Curent mescaon inca metormin, agin, an levothyroxine She appears He enperaue D7 (1O1-7P, plac 104/mn, and ood pressure 160/30 mn Hi Exaranation shows pel conjunctive aed snl hnottensehemarnai maces oer her pals and sles, cracls ae heart st bth ung sees. A aage 2/6 ‘i aastoic murmurs hers besa the Ole tect space an is acemuated BY lang Yorwad. The spleen Papa 1-2 em Solow he lef otal margin Labor sade show emoaloon ros aia Levy count nro sedimentation te eed 2 face 20-20)" 4 neces i REACH HGH Sew ne wn re eee een eet eee en aE sores pees ye ae a me oer se eee | 5 “The inal estues and urna tndings above dive te major and minor Ouke cine fora demeve agnosis of (nfecieendocarct epsthogn uted essceted wth athe ife-thestening arate 2a Inacaons or orc valve replacement in intacve endocardial severe destucton of he valve, leading wo coc tegeraton and corgasve he fate, parser fection despa appropri woe teaver aed fects wth \Watarn isa vitamin Kanagonist used or anuhrmbod theta, which rot equred fr neve endcaris Despite Inseaons for antoagustio e, pottatie hea aver, tl Railten, venous thomboemtaim) often co-occurring te, ch nccaons represen nhs patent Pavan ith aso of endracts shoul ecene antici propyl when undergoing procedures mith an increased rk ‘of bacteremia, career aerta procedures, Antbotes recommended for poptvans nce amaxiin, amp. “cwrtworjcn and e2thoman. ciprtonacln& more commonly ued fo Wea ceil gastoantets and unary Wack, plntableSefiblator ar wet revert posible suds cardiac death n patents with at inceabed ik of ventclar ‘anon (and/or verculr tence VD, The mos comin macetonsincuce 2 Mtry of VF/VT severe congestne ‘eat lure a yperuopnic cadlanyopaty, eC can occur ae potable complication of inaciveeadocrdne te patent hows na cme gn ofhon fale, _Srarococus gales can be ound in th noir bowel fra of hea homans. ink batween 5 gals bacteremia, ‘arta in ecards, and colorectal cnc hasbeen wl esablahed. However, remains unl whether& gels 15 par ofthe elony of colorectal malgrarls ora consequence f te csese colonoscopy sled nl patent wh ‘5 galeycas on boos cau. BB ttecve endocarans ‘The fading ofS. galohcas bacteremia associated with clonic makgnancies. CT scan ofthe abdomen apes an be helpful in the detection an staging of clon cancer However, a tanta witha connderable amu of aio, anoter fst that ao allows for stone samotng and he cetcvon of earer stages of cancer shouldbe performed HtOU Ds al <: a> anes wit ahistory of ndocadns should vcave able prophyans when undargong procadurs wth an cent risk of bacteremia, gral deta procedures. ambos recommended for pophyans nde amoxiin, ampicin, Infections es, terefre ot masta im ths pave Inparable efbilrs ae weed o preven posabezudcen cardiac ath n patente with an teased ek of verte ‘brieon (and/or vertical tachycardia VT, THe mos comin dicen incu 2 istry of VT, severe congestne Ae fares eat Wak CHI cae atc err nt nel ta ‘tent shows no cal ns of ear Tare, “Sreprococeus locus an be Yun nse normal Bows or of heslay hum, A ink between 5. gelorcuswacerem a arturo endocardial olor ane has ben wl etblched. Hower trent ances ati &: gles Is parc of the elogy of colorectal maligrancs or = consequence f the ciease colonoscopy sated in stent with 5 gelayecuson bod etre By etectv entocaniis “Te tang ofS gaohcesbacarema associated wih caloric makgnances A CT scan of he abdomen apes ate ‘another tt that als allows for hstlogie sampling and the detection of eae stages of cancer should be performed fst. “An esophagogstoduodenoscoy canbe used to detec maignances ad ther esses inthe upper gatrintstinal ck. ‘The hang of 5. gates baceremla, Hower asocated wih mallgnancls nthe lowe Iesones‘422-yer-od woman comes tothe ghskgn because of mom story of aight greenish, miky charge tom Both raat Thar no maragt Shea ypothyrcem and migraine headaches er ater ha reat arctan carreny undergoing chemothelay. Manse ocr at egular 2-day tervals wth madera lowe lt mens Pid was | week ago. trent mediation ude lthyroxne an propanco She appears amicus. Mer empersure Irar.ve jerah, pate 62 mn ang logs pressure fe 116/72 mm Na The lungs are ent uecuraton reset uaminaion urvemarable etic amination shows 2 normal yagng and cv elu tudes stow “Tyrad-simulaing hormone 2.5 um Progesterone 0.7 name (ocular phase:N <3) Protctn Veegim Folilestimolting hormone 20 mU/L ‘urine pregnancy tat negate, Whi fhe flung the mot appropiate nee stp in management > Fesdback « 2a @ caersrpy ofboth bee (©) Menmogar cf eth beat (©) waver meneas © me dene cron ©) Uresoun oth eee ©) erence cece meres of pga rates B sow anorOmns al <5 +> a woman comes to he gsician because of Tere sno masta She has hypothesis aod er moter has emt ance on : Carreny undergoing chemother he lst menstrual Ira7.ve jerah, pate 62 mn an lees pressure fe 116/72:m Aa The lungs are est ecuraton reset ‘haminazon i urvemarable. uc examination shows 8 normal vagina and ceri. eum tudes how: “Tyraid-simulaing hormone 35 mt Progesterone 0.7 name (oelarphase:N <3) ‘urine pragnaney ets negate, Which of the fllouing the most appropiate next sep in manapement? ese, batera() dachage hyena! aserarae. 22-year-old women without anyother abnormal fangs highly suggestive of = alactoraphy sical fr the evaluation of ipl dacheige associated wth ducal anomalies (eg. tract papi ‘which ae gereray assocated wth unter scar. This patents lateral ngple scare suggests a system or prstlopca etolgy fr which galcography i ot unable ‘Amamevogam indicated inpatient > 30 yess od with teal ipl charge for evaluation of posible re sons, Despite er omy ator, hs patents under 30 yeas ol pd aisha tral mppedacarge, which sugges «dierent ‘eoloay. Bg?Om Ds al ‘Amamevogam indicated inpatient > 30 yess od with teal ipl charge for evaluation of posible re sons, Despite er omy ator, hs patents under 30 yeas ol pd aisha tral mppedacarge, which sugges «dierent ‘eoloay. ‘uni of behead can be used lags putary adenomas, ning prclacanomas, tough hese mers cou ead 1 Insta ppl arhran, pater wth prolecioras wuld hav raed proliant lvl aig fo ingulr menses. tonal, hough rat, sme cases of ager prlainomas Causing ass effec may ead to headaches Alough yelogy may enuy magna in some patents with pple Scharge, MS Nox acOs-tTecive nerenton fo the evatston of nipsle decharge aa i thrfore ot oui recommended Adana he pasent hae lateral pple schage which suggests nonratignan tology. Uteesound isa in patents 30 years od with nist ipl dockage forthe evaluation of possible bre ‘eg, ductal aseas Despre ner ge, ths patent has blseral mpl share, rich suggests ferent tly. “chen this pate prerenttion ac normal pela, she mos aly has physiol ripple charge cet mgple Stimulation, athe! common condiion a women of eprdctive age. The eicharge is normally mifky Bu can appear (greens or yl, Ressurance and hang the patent ved sige tnuation woudl the commended interventionConsider various drugs as {esses onael ond cbs of ee unset ay te ceca pect YT coe ‘app satan) Inboard rapasion) one-sided or rons discharge Patenthistoy Galactorhes gia | SsubareolatUtra80UNd to ainoogy—- Measure prolactin fete Nopainoogy--» Measure prolati mammography ct grancy em ——L ova Sere af ty Measure: HCG, __Nootar poste. ‘TH,creatinne "perenne ares Y Y MRI of pituitary Pregnancy ontOns al <7 -im> . ‘A press mealty 10-a)-ld nar brought the emergency deparomen by hs maherbecauce opcodes of has no had fever, cough, lathes or vomiting, He was bmn a 39 wees gestation via uncomplicated vaginal devery a Shes wormed is symotoms may e om Some rau hone is ler ster mayoe madvetety es hm 5 days a. He Sppeus ble Hs temperatures 27.1 (96.87). amination shons geresal2ed muscle sthess ard ewhes. HS key aul organan? es a con £3 @ eestor seaman 2 © ews ea 8 | © mesma rans aaOmns al <7 +> o m ‘pesosy nat YOR is rouge oh emegecy Sear bys oe acu of pads ot = Oreien sree a spe rth pet tor ce sre ta be hws bd hy ding ed ek i as ot had eer, 00h, area orvomkng ewe bom at 38 wee gettin via unconplcted gia liegt a Paes ee eee wl aus rable as ampere 37.1 98.8. amas tow ite Ia cul organo aa hie esas cases muscle Spasms medion, and a weak suc? 2 a 2a sis a hs Bruin aces «moxie cee fae Bose yom tha presen wh sakes, oot ecg and realty. tis antocated wih the ngenon ot Roney proauct cantarinted uth Sulu shoo “herauone ht he nfanepeebiy gees may hve eens potent sure one sas, bu ne fr reset nth mus sures instead of ypotony, wen Isnt Constant wih boul i eewrtene lot ttanproduces an exotoxin tancrpasmin hat nhs neurtanemision, autng tana Me-thratning ‘ondion caracarzed by musce spams, nyaclons, ably, and por fading. The Gast acquire i nnineumized Indduls ater spores of the pathogen emer he body though boken sk. nthe cae of neonates, fection prima occurs Ife uma cor severe or aressed wh conammated mens, which mainly hapoersnaevloina counties oF tome Dens wan ustnie sting, The vaccine agaist fetes aaminsereatoume to pregnant woman, which allows protection of matali tht ea rst placenta and protect the by unl te ch recast opt tt ‘acin (t2 monte of age, infats Borne nrimnized woman re spall igh sk of developing ths ness, 9 SsOmns al <7 (> g 8 ‘last tezan produces an exotoxin Getanespami ha mvs neurtranemsson, causing tetanus, a e-teatning ond charaterze by musce spasm, melon, tly, and por fssing. The saat argued iy honest Inada ater pores ofthe patiogen ene the boty trough broken skin the ase of neonates, nection primary curs births an unstnie sting The vaccine aganst Ceca aominsterearoutme to pregnant women which allows prosucun of matralatboies tat can ss the placenta ans protect he baby un he hd veces the egla Cts ‘ei (t2 mono age tfts nts animated women re espacial t hgh sk of avcopng te ness essen mevingitsisagam-negtve iplocccis hat causes bacterial mening pray i ler chen ar ads ‘salsa possible cause of reonatlbateal menngts, Bu other rcearganisms Such as ou & Septococas an E clk {remote common Neoatal mengiis presets wi tally, pot feeding eve, and a ling foranais However, TS fot be expected SS ra oor een, fever, and bulging Tomales. However tis ate presets wth a sof and Nt font an has rot had a Tevet. usta also doesnot cause muscle spasms an sess, making an unitey dag ‘ich os a gram-negative tod tha an caus onal mening, which ypc presen wh rail, poor coals does not cause muscle spasms ana stress, making an ul cagnos.oats & Omns al <5 > ‘24-year-old woman wh 53% some comes tthe pysian becuse of rhea oF 4 mons. She ao repos ‘bzen unable to de her norma chores. Se went on a backpacking ip across Southeast sia around 7 months ago. Shes stem (48 9in tal andveigh 40 bg (65), i 19g Her ond pressure 110/60 mr ig inthe upper cemines an 20 40 mm ha nh over eters examination shows pale conuncta and agile Romar ‘Abdominal examation ie nrmal Laboratory studies show Levert count Si00 mm? Pate court 200,000 mn? c 7 meat & os meg Creatine hamgidt Ighristue ransinaminrsantbosy peste Undergo the procedare, Which ofthe fllning isthe max appropriate nex sep management of his pten’s Gentes eaten NK a > 0 BO © (©) Mevonasaoe meray (© sateaasie heaoy ‘old mk products2a BD) Proton therapy (©) Teraji erapy © mewonidasoe therapy (© suteslacrne terany (©) Ave mil produce ©) nemencusimmunegiabuln heey (©) Cuteness (B) Twmetnopin-suifamethaxazle therapy B snow enner Feeback eOmns al a am 4.2-yr-o woma nm ASHP aes rca ease often mors se aoreprs ES ‘bzen unable to de her norma chores. Se went on a backpacking ip across Southeast sia around 7 months ago. Shes _ stem (48 9in tal andveigh 40 bg (65), i 19g Her ond pressure 110/60 mr ig inthe upper a ‘exremes and 60/40 mm Ho he lower exremites, Examination shows bale conuncmae and angular soma ‘Abdominal examation ie nrmal Laboratory studies show ee —_ 4 Frac coe eao00 mn? = 126 meait © armen 2 & Josmegit ee esine 4 mgiat Unde the prcedue. Which of the flung she mos appropriate nex sep management of his patlen’s Gentes eaten fecmet ‘Thus woman he ares, abdorsral osing, in of kon decency anema fatigue pale conpnet, ag stomatrs anda post 9d tissue anslutamnaseantbed, nating cela esese she als as Tre sya, 2a ‘tscomfor, t's nt associated wth a postive IgA TGA or Turner symdrome, and would nok cause ron deficiency anemia. “ewacyines ate utd o west opel sue, whch an presen vty smaty 0 Calle deat, yptealy Segrnng with =n ‘ase stack before setting no a von phase However, de pater sk actors ana posiv ga TA make sotier ‘agnosis more likely A bopsy would canal eau pial pr, bul the patent ha fated under oe ‘Meroncazl smciested for garcia, which tpl manfests wth symptoms Smart the oes seen n this patent and ‘common in Southeast AS However, he incubaton pedi 7-18 das, meaning her symptoms should Mave begun soon ae, erp. ako would no expan te patents poe IgA TER “Sufsalarnes are fst heap or flammetory bowel dase (6D), However, his patent doesnt have he ssc symptoms asceated wih ether rons disease abdominal pan due to perianal abscesses fits or uceranve cats (@lody sid, Uv, aris, and skin mantsations suc as pyoderma ganrenesu, ae comman i both uct cols Syedome Yt products can cause gunttitestin ymptoms uns wth actovenolerance which woul be wey a woman went aistory ndczna latse lerance at an eater ae. Addionaly acs molerance I not ssoote wth & postive TTGA or Tuma syaome, and weuld very trey cause Won decency anemia in ad IMG therapy is used to west common vaibe immunodeficiency (VI). CD ess in vecurem infections duet markety ‘eced Gg andor igh level The pets ator i ot comister with CIO Morever, ost TIGA would be ‘er unthaly ma cease characterized y ecuce abo eeOme al <3 -i9> sSlraidaains are a st-ine merpy or ammeter vowel ease Ua). However, is patent oes nx nave we case symptom sicelaed wih ether ions dear abdominal pain dus to pera abscesses) o ata cal ‘Goody sto), Uv, avis, and shin manifestations Such a pyoderma gangrenosum,arecommen i bath ulate cols a produ can cause gasuciestinal symptoms acuas wih cose molerance, wc woud e way i a woman sathout a hat ndesting actos intolerance at eater ae. Asda Iacor laren not atone th 2 postive gt TTGA or Tamer syndome, an woul vey ar cause Won decency anerain adult {wie therapy used 0 treat common vnblemmunedeitecy (CMD). CMD resus recurrent nfetons due fomarkeol ‘reaucea 198, andor gl ess. The puters toy sro constant wit CMI. Mveovt, a postive loa TTGA would Be ‘rey colny ra lenesCharscrze by redeced ated lov ‘Aielong genie ats he wearin of choice fr clic disease Neral, the nest apn agnosis would be a Biopsy Theme ie ae esd pe fare epee ena er rear ins eed eto ten cae ‘alo gluten-free lt would be te mas appropiate next Step The patent’ response wi then Melb © eer confirm or eect me days of eae asease. By conse sense ‘TMP-StKis used 10 eat Whipp’ dase, which has «highly variable presentation but common manfests wh dares od gasvantesinal symptoms, Whips ceese, however, pes iavesenttaitstinl symptoms sucha art and not assoited wh postive ATTA,Omns al a a ‘46-year-old woman comes othe hyscan because orseere muscle and Jor pat for mons. The gn vases in 5 Oreniow Incas ad mn, Sh has oes in rer shennan of tia negli nyo nce’ A the fag oor steeping wal Sh repre angling serston in a lowe Imbs er bowel habs are Unchanged Bt a Consume leahol Her meccatons incu prooranll and sumatptn. She appears realy. examination shows Syeneui muscular tendeess ate base ote eck, ov! te Should, andi he umbosactal area, tenth and emoaloon rere an ean corpuscular volume 85 un? [yey sedimentation ate 12 mh Chuooe 22mg. oats ai aes ‘nny is thin normal ims. which ofthe followings te most appropte therapy fortis patient Za @ srepen S Temszensn Q\O@|© arinpoine ©) weonenneont me Omns al 46-year-old woman comes othe physcan because or severe for S months. The pin arise leeanon and any sha Rat ot sess m te moring. sha complains of fague throughout th day and tuts the fate vot steeping wal she epee inglin erseon ne owe ibs. Her bowel has ete Unchanged Bt Consume leahol Her mecicatons Include pooranil and sunatnstn, She appears rely. Examinaten shows Syne muscles ate base ote neck ov! te Shoudes, andi he urbosactal area tenth and emoaloon rere Levey count 200i? ean corpuscular volume 85 un? [yey sedimentation ate 12 mh Chuooe 22mg. ‘nny is thin normal ims. which ofthe followings te most appropte therapy fortis patient gana Bo 2a upropion san atic aniceprexsat use forthe weniment of malo sepressve sore. THe aera 0 presente wth Taigue and uretesig ep, butte paver lack oer conmron findings suchas aula Gennished router anedora (ae of plstirenpretouthy enjoyable ace), concentration aia, and sil hough enrocarepins such a temazepam ar ued fr the treatment of sornis which would be inne wth th patentsom eat io se enrosiarepines such a temazepam ar ed fr the treatment of orn which would be inne wth thi patents ‘nsatstacor see. However, she does not met theater slagnestc entra Suh 5 cfu ing or martning sleep. Moreover feces sucha con jon end usc pain morning sites, blosing, and paresthesia telnet bbe ae ‘Yamin Bg used forthe weave of pernicious anemia, wich can ao presen with muscular pan fate, esting, cae erg el aren eee tr as altri tial aie Seni eee ‘causes numerous neurological manfestavons sun as unsteady gk, Impaled preerocepton and/or gneve Moai mene ‘Moreover, 2 patent wth penicous anemia woul have an neases HCV. Prednsoneis used the weatment of aucimmune disease sucha systemic ypu evythematess Lf SLE afects women fore often than men and preset th symptoms also exited hs patent, scusing fatigue and malas. However the ‘atent aks ether common rings n SL suchas sm volvement (ge plea “outer rst eer, and WeDo. Low-dose yee antidepressants, such as Amite fe ues forte Ueauret of NbromalQa TS come asorder “Stes mouth ween brome the hed wed ath daa of ess charcaroed by ont escapee fe, {axgue, and umeteshin leo Sever! tender points maybe denied wich ae usualy located ine ates whee muss ach athe bones. This iaeane doe ot cae aneial inflaratoy biomarker such aba eleseted ESR ecarn {nanan wlammatory seas such a heumatod aris. BoOM Crt <9 09> ‘Yamin Bes used forthe weatren of prmcous anemia, wich can ao presen with muscular pan fangu, Heating, ere er ee teens Une ed elitr seca feet emi ee ‘causes numerous nesrologicl manfestavons sun as unsteady gk, Impaled preerocepCon and/or gneve Moai MeN oveover, patie ith prncus anemia wouls have an creases MC. Prednsoneis used i the weatment of aucune disease sucha systemic ups erythematosus GLE SLE afects women yore fen tan men and present th symptoms also exited hs pate, cusing fatigue and myalgias However the alr lacks other common findings in LE Such as sknirlerent eas te tpl bury as fever, ad Weg Is Low-dose yee anaidepessars, such as Amite, te ue forthe ueauretofHbromalga Ts chon dsorder ‘tec mouth ween beter the hed ath dead of ess ured by hme ence p, rneng fien, {axigue, and umeteshing le Sever! tender pots maybe denied wich are usually located ne ates hee muscles sacha the bones The disease doesnt cause abot! nflermatar biomarkers ach ab a elevated Ga comenan Arana in wlamatory eases such a heumatod arth. Bo ‘resent with aque, sell pan, and orrng sass fle most the lager Jobs Homer, normal ER would be ‘ery untalyn Furthermore, he pin n RA sual spares the ail leon and tenet fet prea it it whereas ts patent nas mosty muscular pain nthe sould ale and lumbosacral rea.& Ons al < ur > ‘17-year-old boy comes tte physica because of eve, Tague, and a sore tWoat or 12 dys He mas prescribed has map sonal pares and ses condoms consistent Me apes’ large ad thin MS BM 5 TS. Kg HS temperate 2 36-(101-'P, pulse 94min, aod pressure 105 72mm hig. Examination shows « mrt rash fer hs extremes, Oropharyngeal examination sows tonsil enlargement ara entema wth enudates. Tender eral {nd ingua rphadenopaty present, abdominal examnaton shows mie penamepay aborson suds show Leokoete count 15.200 mn? Pace court 160,000) mn Which of te flowing isthe neat best tp in management? a BO ai-cm gh LA for eteophe applnmaton es Fou eyomeryOmns al <0 > ‘17-year-old ny comes tte physica because of RTAIGUE ANG NSOTETWSRTERINUR. He was prescnbea has mukpie soul pares and ses condoms mconsstenty He apes’ lta ad thin MS BM S18. Kg HS temperate 26-1 (101. plse 94min ood presaur 10572 mm hg. Examination shows 2 rer hs extremes. Orpharynaeal examination so¥ if present Abdominal marunation shows mic borat studies show Levee count 13,200/m? Pace court 160,000) mn Which of te flowing isthe neat best tp in management? aan cee ee 2a ‘Achat sua culture indcted or suepococal pharyagit hough the symptoms of eer, sre host, and cena Imahadenopathy may suggest pharyngitis du to Stepocorcx the maclopaplr rash andalenoregaly ake th “The presence of ani-cMY gl would nat an acute cytomeglovs infection, which an aso present wth fer, fatigue, nd soar thas: mphadencpathy and oplesoregal repose but ae Tha conten af ype me likely he result of another iagnoss, mening a ferent tp Is makated a is te. However, tet ep Shows negate resus, ‘measuring eum ai-cMV iM levels would bende, “Th anyms-Inkedmmunosorbent fay EUSA i technique uted forthe sraning of everal cecae, cluding HW. The patent has some signs of primary HV infection eve, sre thot tigi, hmphaseropaty rash) and isk far for Iransmission multiple sexual pater, inconistent andor del, Bt splenomegaly, oir exudes, lack of aren make anther iagnos's more Ike, Fever, s1e throat, mphacenopaty,splenomegay and lautorytonl a al cstv of ifctows mononucleosis (m=), hich s eused by a Epstein vis nection postive etetophie agglutination test Monospot es confers the [iagosin though mona asides aot uly case arash 2 moro rah corenony occurs impatient wth mono Wo ‘are mistakenly aominserea an amnopereiin wh te inant of retin a acer Wfacon ey Stestoocel Per ach als presents th ever, sore oat, an cervical Nmahadenopaay Bo Flow ytmaty i technique employed for easton of patente wth phy, ncludng those suspected of euera ‘or lymph, athough blood cancers often presen ih mphadenopa, splenomegaly, mphocyoss, ad ox body steigh eg BM of 19, the suaen onset of eer are haat, eter Hrmphadenopay nd tnsilar exudates nth pint Imeres an act nfcvon Aon, & morbifrm rash oloutngamxiciin tal wou ot be expectedOns al ‘souar-oldman ames othe pcan becase of 3-moem sty of anon sh Wes Deen eetag mere (i tempat is 325 (8.7, pale 36 respira ae 16min, nd lad presse 1307 Pry ‘caninan shorn ulcerations, prpr paples ois unk and exerted ot ach when bree. The ema’ oe xarraton sho no sonra, The pater Perea g/t evaee court {S300 mn ara pte cours 2500 mm rasan ves unten ess re tn at, ‘lecophorsis nd mutation shows ceed grnagbule wih pronounced pon andi bad os fon he mos sproprate nev te m maageene™ ap plasma agin cat FoR or gonothes = |e ‘in 008) ANCA assay ‘sence Jones pron test 4 lOcoats Omns al <> 1 s2-year-old man comes tothe pysican because of 2 2-monh history ofa nopeuic ash. Hehas ben Teelngrmere (ed cha cua and occtnalyexpenencs pain ies and anes. He doce no smoke or drink aah. nit temperate ts 57.5 (68.70), pulse 98min, espravors ate 18/min and bhood pressure 130/75 mm Ho. Pye Seniesa ge, cytes AUR ir oe ners nt anc er essed The remainder of te examiraton shows no aonormaltes The patents Pemoalebn 14 g/l. leuko count '5,s00jmum ard pate oun 23,000/mm. Ui ar ive func est te wih nema ont Te sf "ecophoresi ana inmunofxation shows incest gamagloulns wth pronounced following te most appropnate nee sep Im management Suggest of ined Gyogaoulinema lke Wpe 1 ayogiobupema, in whieh a cydlebnprecpatin st becomes “pont thin 2¢ hous th croprcptatn tet becomes posthe only afer rama prod of 72 House ake ‘of mixed cogltutinemia, Pats wth mixed yogiobulnemi canbe postive for because the lM in mixes yogiblinemi asthe act of cheumatord air (RP The Rie att f gM ao eases decreared complet levels cause the gh tnd othe Fe poruon of and cause complement actaton. 2a ‘ “The ap pasa engin GPR Lessa crening testo sips, Secondary Syphils mantest wih fue, noapani skin lesen vere unk and exami, poh, nd fale posive RE. However, secondary sys eon ih ‘ter Symptons such as fever ard gereaaeshmphadenopshy, nd the skin lesions Would ppea 5 redahnovown papules tater than the purpia een th poten la this patent dors not havea past hatry af pales ohesing ee on ‘ental (prmary char) to Suggest tat ths aber Is tk fo evlepng Secondary ph = ee ee Dieeminated gonocecal fection car cave potatralge andor sin sions ove the Munk and eaTemies. However, he purpura seen in his paint Moreover, this patent doesnot havea history of unprotected Sex ora past story of wets toOm Ds al Disseminated gonococa fectin an case potatoe andor si sions ove the Munk ana extremes. Howeves he so leone would be maalopapalr, vex, ardor pstlr with 2 nerd a emathage cana ater han the palpsble purpura sen nhs pve Monson, this patine does not have ston of unprotected x or 4 pst Matry of ures 1 a avert wth eyoglbulinemi, «bone maw biopsy would be performed i te underhing caus of cyeleblinena is opeced tate crete hmpheyie ukemi (1 Homever, CU ype resus type 1 eryoglbalinens, wich uly presents wrth a cvoprecprtte est that poste wthin 24 hours, monoctona fl bardson Seu ore elecwophors, nd fetes o a hypecoey sya eg atrial thrombosis, Raynaud phenomenon, Meade, pans) stead of {haga sn papabe purpura Moreover th ptr dos at haa lmphadenopahy or leauosyone on 2 CBC 1 sgn? Abou 08 of cases of mised cryoplbulnemi af atccated th epi C infection Its thought tha the man easton to HCY causes ne formation ef mune complexes with HCV aragen, when subsequent snae” Complement action 3 Irtaramaton of beed vessels, result npapabe purpura ue to cradle asc) immune complex mediates ‘damage also responbl fr pjartralg. sce mined erelebieracan be the inal manfartaten of an ofheruise ‘symptomatic HE infection, is portant oes al patients with mixes ciylebuliemia er hepa Coarse that ety BB vases§OD ae al <1 148 > Abou 08 of cases of mised cryoplbulnemi af atccated th epi C infection Its thought tha the man easton to HCY causes ne formation ef mune complexes with HCV aragen, when subsequent snae” Complement action 3 Irtaramaton of beed vessels, result npapabe purpura ue to cradle asc) immune complex mediates ‘damage also responbl fr pjartralg. sce mined erelebieracan be the inal manfartaten of an ofheruise ‘symptomatic HE infection, is portant oes al patients with mixes ciylebuliemia er hepa Coarse that ety BB vases te apater wh papabe purpura, a san biopsy wou be performed to danty se cause of smal vessel vasa ohe ‘lgpocs ent endo Mtry, piysea earenston and/or bortery sts ts pte, the ein of papa uporais every yen abun vscults,alocly mae procedure sch ab sin bopsy is terefore not cea Ns dra eet Se ele mecca poe el ae syrome, bot of when can present wth palpable purpura ana arvalga. However, cates Nt MITOSCODI Boers would have enance of glomerloneprcs on unas e..procenura, emai and pate wi Churg-Stuss Brier sree vty ered tec Ina pater wh creglotulimema urna fo ance Jone protests would be performed the undying ese af ‘ryoglouinema ws suspected tobe mule myeloma or Waldnsvon's macroloulinemla, oth of which would es Irceased ganna gleblit on seu pret elecroptoress Haneet, morocoral gh (nWaldetens macslebulea) ‘er monoclonal ig (mn muhps myeloma) woul be etn cyolobulrem not polorl bands. erect, both f these ondivons rest n ype 1 cyealobulinema, which usually presents wih a ayoprectate est thats postive within 28 Rous td features of ypentacasyayedrors (atta tambon, Rameu?s phenomene) send of antag and pepea oats Oma s wl <2 a> “Ten cays ae every 21500-9 2.210) newborns esing poo He was bon at 32 Weak’ estat, He as had frequen eptader of voting for ha pat 2 days He het no eer, ates, or homes He apes letarle i dient 0 eouse Tempetatres 37 (8.57) pulses 135/min, respons are 65m, snd blows pressures ‘responsi ony to pain stm is nemonieincaneartraton 30 a ledkeet count 9.900 mm, a ale court 90,000 mn? arti ood ga aay on oom ar hows Feat sommta oe comms 2a ®| ‘porary eparctrmy _Aéminsration of ampicin, abramyel, and mevoniazae only suppor ae onty O@ @|©) BO 4 aoats Ome al < 20 > Aiea 0 aouse. Tempetatres 37 (8.57) pulses 135/min, respons ar 65m, end blows pressures responsive oly to pau stimu Hs nemogieginconcarraten 1309/0 ale court 90,000 mn? arti ood ga aay on oom ar hows a a Feat sommta Poe comms Gpestrston O88 uhoeye COURS 1,900/rm and “Ths pretem fan presen wth poor fang, woming, emargy, pert on exam, omboqopena and metaote ‘eval wach ae conten th capo af meron entero (NEEL An tray semi babies of ‘in che wale he esti pneumatosis iestinais)conimns the diagnos. 2a azopasic tube gut decomprerson to decrease detrion of me bone! supporuve measure used forte muacl tranajement of HEC Ths paar severly with partite on exam aed mtabehe soe Wile he means may OkE "otonsterporary, his wcereton sone would noc adresse undehing cau ftps condon .Om As al <> ‘nesopazrc ue gut compression vo dcease dteron oe Dowel & supportive measue Used forthe medica rranagement of NEC Th potent several ith pentose on exam and metabo aids While the mearre my eeleve "otonsterporary, his wcereton sone would noc adresse undehing cau ftps condon “Thi patent exhbts many ofthe cea festres of ecrotzingenterocoitis NEC Surgical intervention for NEC is wareted hen er enence of sertonts(oncerning for gangrenous bow, perforation (pneumopertaneur on X-ray metable ‘tot, leaed lactate andr portal venous gis on xray The see ofthis patin’s symptoms warans emergent ‘iploratorylpaatomy asthe exe step in management zh wl lay Include emo! f necro porns ofthe Bow By. Necrotizing eterocaiis ous specram arincioialegrers such asamp, obama, and meuonicazl af prof ie management of ‘pected or coftmed HE. Whale sates would be nuded inthe mart of ts pata, the presen of metabo ‘tosis end pron suggest a the paens Dowel may aeady be necrotic and that arts alone would be an ‘suppor cre which may nde bowel rest ttl parenteral ruttor fd replacement, ang carlvasculresprtory Support iste itl sep the mecca management of NEC. However, for a pate wth « metabolic aode65, pont, {ns dtrraing acl sacs sapere ete lane would be appropiate The pent top management sul aes ‘he cause of he patent’ Hess and provide the mos therapeutic BeetOm As al <> ‘nesopazrc ue gut compression vo dcease dteron oe Dowel & supportive measue Used forthe medica rranagement of NEC Th potent several ith pentose on exam and metabo aids While the mearre my eeleve "otonsterporary, his wcereton sone would noc adresse undehing cau ftps condon ‘Thi patent exhbts may of theca features of erotzingenterocoitis NEC Surgical intervention for NEC's wareted hen sere enence of sertonts Concerning fr gararenovs bow, peforaten (pneumopertoneum on X-ray metable ‘tet, leaed lactate andr portal venous gas on xray The see ofthis pau’ symptoms warans emergent {eploratorylpaotomy asthe neue top in management 2 wl aly Include emo! f rere porns fhe Bowe By. Necrotizing eterocaiis ous specram arincioialegrers such asamp, obama, and meuonicazl af prof ie management of ‘pected or coftmed HE. Whale sates would be nuded inthe mart of ts pata, the presen of metabo ‘tosis end pron suggest a the paens Dowel may aeady be necrotic and that arts alone would be an ‘suppor cre which may nde bowel rest ttl parenteral ruttor fd replacement, ang carlvasculresprtory Support iste itl sep the mecca management of NEC. However, for a pate wth « metabolic aode65, pont, {ns dtrraing acl sacs sapere ete lane would be appropiate The pent top management sul aes ‘he cause of he patent’ Hess and provide the mos therapeutic BeetPee) enterocolitisce necrotizing enterocolitisomnes a < 20> “Th pent exes many ofthe cia features ofnerotzingentroclte (NEC) Surgical trenton for NEC is waramted hen ser euence of peronis (oncening fr gangrenous bows, getfration(preumopertaneum on xray), metalic ‘don elevated atte, and ptal venous ges on xray. The seen ofthis pain’ symptorswarants emergent ‘exploratory leparetomy as te next te management 2nd wil key Indie remota! of rere porns fe Bowel By terotiing ener Scud-spectram antimcrtalegimens ach ab ampli, obramyein and merida ate part of he management of suspected or confemed NEC Whleartbotes woul bemused Inthe Management ths peer, the presence f metabo ‘ladon and pertoninssuggest at the pavens bowel may aeaoy be necrouc and Ma arGeOUs alone Would be an “Supportive cre which may ince bowel est total parenteral raion fi eplacemant, and cavloasclespatory supports the si stp in the adie management f NEC However, fora patient ith tabi acdons, pertont, {nds detrracng incl stats, suporov care lone woud be aporeprte. Te nxt tap management Should acess ‘he cause of pants ness anc prone se mos therapeu Deel ari amas no sed nthe acute management of NEC. The agnosis Nes already ban exablsed based on xray {inaings ths pen and farther hagostin woul! only ly tet Furhemore,exosute a batar may cau eh mor damage ro he gastointstnal rat ns pate esuing In posse perforation and barium pertge 8 Ons al < ‘A preusty meaty S-yar-old toys rough othe pcan witha rcuing eve and malas for 2 weeks. He has also the time, he was given a prescron for amoniclin-awlanat, He ceies ore throat r myalgias, eis home-schaled Soluntsers semper i 8.9% (101.27 Phys examination shows a |-em pap son onthe bck of he waht nae iso hae tander, bulky hmphadsnopaty of ne ella and rot Which the fllowing le nex Dest te Doxevcne ere ‘yeti therapy “ c ©) ‘aitrormcin apy ‘reptomycinherepy Ic 4 BOOmns al <> Aeon ety se-ltboy twa oe han wh eur tana fr wets asa ‘he time, he was given 4 prescription for amoxicilin-clavulanate, He denies sore throat or myalgias, He is home-schooled - a ‘Sons pees 01. Pye exaonton hon a ‘ons Super DANA vn oe ohownge ern Dc Sap 3 heen non ont pa ad bly hppa cambned wah bs yo apr, ud oe DrSiesspon tor ecscuth diese ue sores 2 si Chapin sinensis come nines tat coped ar me @ ‘eo cp ccliceaa Ts ands ah y ere oneness Sg See {eo nantes permanent tom sheen : fecmet -yrimenaine sa amiprotezeal ug use inthe West of toxoplasmosis, extrem rare in mmunoconpeent ous f symptoms out, shay ae usally lid o pales, cenial ymphadanopaty, as oppoted tthe fangs inthe pater apa on he han, ase lmprasenopaty traconszoe cn be used for res sproenchoss cused bythe fungus Soorthnx Schenck whichis usualy Wansmted "thougn smal sn lesone when handing sol or mos, Themes common preeration sa papal tat may eat, shally Symptoms, bu this almost only oars imunocompromised patient.& omns a < 2-10 > ‘Promecoamia an aroprowzoa aru usa is he uaitmen tnopismeds, Ks een rae n momunocompetet oss fsyptoms cea, thay ae usual mn to pales, ental lymphadenopathy, as opposed tthe fangs inthe pater apa on he hen, ase lmpraseropaty traconszoe can be used fr tren sporoenchoss cused bythe fungus Soorthnx Schenck wich is usualy wansmted ‘througn smal si esone when handing color mote, Themes common preeraton la papul tat may leat, shally Symptoms, bu this almost only occurs in mmunocompromised patients. Ihmonadenopatny fom uncompleted eat-serateh asase. infection with saroneePensece the bacea responsible for cat Stat dese, gereaty resus na St-mtes, ld course ans dows Ao pall requ aC Cera. HOWE, ntiremyen has buen shown o decreas lymphadenopathy and dear ration of [B)cotleton of demetteiel rdert Streptomycin san amingheoside elec agains ers pesis, which spread through le bites ad causes he plague. “The ost conmon subtype Is bubonic plague, whch also peesnts it fever nd wenkess,folonee By tender Inmonadenoosny, mphaceropaty cease th fection has spread fom the tal ety pa on he had ‘hroughout the body. nthe eat of plague, the presanc of mphadcropahy would neat x avre asst couse, ‘often with gasvoimtesinal symptoms fe, darth, vomiting), fone by shock and multiple organ fale, Most cases ofcat-sratch ease niemunocomten patient re e-lnted and dono rege anaic Heament, ‘Supporeve cre alone woud not be nated nts patent wth recurent fever ana buy ImpRaGenepathy.ge 8 Ons al ‘ presiousty meaty 18-yer-oa woman comes tothe emergency department because of dares and sbdomina ramos he ecole eating ut? ays ago. Se as bnen ona eg it for 8 months Se akes no medications and as not treed ampere recent her temperature 36.8198 27), pulse i 72min and bled pense ie 110/70 Examinction stows ry mucous memorans,Abcomina examination unremarkable, Which ofthe following Is he mest Tike caus organ? Za (©) rere eneracotne shige enrerce Staphylococcus aureus BO erie vlc GE) sce cereue «Omns al <> ooo ey eye wean aes he gt depute tauren id emia cargs fats pevun eng sh bs ad wound pce, Setannamesdtarvommeine | She ects ent # es ag Sts ben no for mor Ste ates no meats aah i peer eey ertmpeaes 688 7 pe 2m and pre 107m a Exemnon ios mucus mena acorn earenatonvreanae Wh teens eM a wy cru . aaa ae on 2 si "ers enerocoluca causes yesiness hen contareated uk and pk ae ingested and may ao present wih nausea anc lathes sar a cabation prog of 2-8 aye oueer, yrs peal erures toady ane, fever sha abdominal = ‘tenderness nthe igh lower quadrant wich may mini appends. 5, ts pan vegan which means she does not ‘onmumeatia! product), making a fection wth Yersnsenterocates wie & “Shige rsemeraecauses geo, whieh ma lo present with area 1-3 das afer ngesion of commie fod 9 fecmet tates. Howe, hgeosseypaly leads were atarmation, cos Gamage, and uc Moody res, Pent aso Staphylococcus sures 2 common ageism causing fond posing due to ingeston of peformad ectonns hat aureus provces in contaminated fod te. canned meats, mayonnaise. Hower, 5. aureus type cases & ap nse of Masea {ind vorting 1-9 Rove ar ngstion. Tis patent predominant preset wit rhea and Me symptoms have oly staredouts w ‘Wile revs gastoecerts may also present with vomiting, cates, and mae after a Incubation prod of 1-3 day ‘sanulyssccuted wth ever mre severe naar thee 10 watery stot wha 24 hos) and dehyration Moree, Is much more common m fats and chien cours tat have no adopted Unersa seo tes aces. Enerotongen co (TEC the moet common saute of rales dates, whieh can be aque when tang to “counties or ragions wth poor water ad oad Wygene, White ETE may iso prasen with watery cara, abdominal caging, aurea and posi vomting ater ansnebaton prod of © hours to days the gett des at meon recente Saimonea ener can invade te testinal mucosa n mfeces nals and cause simondioss which may ao present. te watery Sols, nausea ana orig afer an seubatonpaiod a about 4 hours. Howeve,samonelss Is usually {stotted wth high-grade evr and flammatory vasry-blody are, whch re ssng tpn. Because “sional seers pial tansried by he ingetion of pou, poly pasteurized gs and rik infection is ‘nie intha vegan potent ute dors nt conse aural prods “This patent presets wt gastcemes caused by nxoutus, whi usualy MANTESK Wah nausea, acute-onset voming, vise an-blady ahes and abdominal carp fallout an newton pad of 12-48 hous becane ero "ansmitedfcaraly te women might have convacted the ines from ing contaminate 00d or wae or cota wth {contaminate surfaces: Traramisnion through pesonto person contact aso ope = lo possible, Secauve the ts Is very ult nfecte indual are ha contagious cringe acute Pras and up 0 72 ou lla one of septs. Bo ito lace can be wanemited though ingettion of unsercocked seafood eg, contaminated opts) and may aa causeOm Ds al _Samonefa seers can vad the testinal maces i fete nda and cause selmerois, whch may ao present ‘uth eatery sols, nau, and orig afer an cubation pated of about <8 hours. However, salmon e sually {ssociate wh high-grade eves and iniarimatry vate =biod Bares, which are missing ths pain. Because Sect ene ey ered pete eer pray peel cop ee ein cr ‘nln ts vegan peter whe doesn consume anal products, “Thi patent presets wth gastcemerie caused by norco, whieh usually manfests wah nausea, acute-one omg, tse, non-Dioody dares and abdominal camps allowing an ncbaton prod of 12-48 hours Because oro Ituraitiedfcabraly, the women mgt hve contacod the Aes ror eating contaminated food or water or cota with contaminates surfaces Transmssion through personso-eSon contact or aoore Copies sso possibe, Because the WKS ie very vuln, necte indus re gh contagious during te acute phate and up 0 72 our allowing onset of symptom Bo ‘iio lias can be wansmited tough ingestion of undercooked seafood fe, contaminated oysters) and may ao cause ‘omting an artes, However, tha paint epan hich means She dees net consume animal roduc) suggesting 2 Infecwon wen aaferenc orgs. “scl corse 2 common seus of food potoning aftr ingestion of rsheatd nes. & caver produssenerotou which leas omauss and wring ~ 30 minutes wo & hou after ingestion iGo produces eertonn which ads to watery erica 615 Powrs er eget The re re of bth te dc et corel te pct pore ich ‘eveopea 28 ours ater estou. Furthermore the patent Ses ot report eating ahested Wo eFeTted 03 eyge 8 Ons al ‘year-old boy ie brought the psi by hie me because fash on shan an eet or he pst = tests etrcly puri, epecay night He sot hd ever Reda, or artes His mother Rae 2 tony of ‘crema, The child was du or a appoicnet late in the weak follow up on ay porealy missing vechaions is tempertare 3751 (100. Examination shows a maclopaplar rsh with ear patra tfecng the rd "paces of the ges ans tes. he remainder ote examination shows na sbronrales, We fe fling eRe ‘moet eecveitrverion for patente lesion? Za ©) oat ercove Suppor cre ra aphenydraing ‘Tope permetina (© Torcal clarimesse 4Omas a < 51/0 > ‘.4-yea-oa noi bough wt pyc by ets Becaue ra on hands eo hepato aie = hos rot ta hea antes We mater has eect eczema, The ils wes de or an appointee in the weak folow up on ay potently missing vaca tempertie 2 37.51 (100) Examination shows a SEES fe tigers na tes. The emainer of he examination sNws no abrormales. WHR of he following se ‘moet eecveicrverion for tl patente lesion? ‘Ayow sa anvil mekcaton commonly used Tr herpes Simplex and Mepes2ose eectons, 2, cMckengoK. THe ‘harcore chelanpox ath ha tious sage at once ineling eile), begs on he face and nana eprc he Pls and sls, none of which ae present in his pte ‘Supporti terapy alone ean ancprutc agen & mest commany employed for e-imang esses Uke vial xantem. ‘Thi ld mnfered wer mnat 2d, whl suppers therapy maybe ued as an anc reaert, wl not adress the source of infection.Pathogen vaccine Further symptomsOoms wl <1 > ‘Stpporove therapy alone en ancprrie agen mast commonly employed fo Seirtingilesss ike rel exantem “his eile nfected wth tesa, whl supportive therapy may be ued san adjunct tester, wl not adress the seurce of intron. iphenydomin is wed fr ching allergy and nausea. Wl dipheniqdramine may alla the chs poms, wl not ueathe undering elegy ofthe infection. Tetfore ts onan adjunct and ot te most effect ntervenion in his ‘hid isonlly,dphenhyamane shouldbe evoied in chien ander 6 year of age anpwey “Topica permetnrins a pyretvlé ands used a5 2 fst-me treatment for sabes adie The patent has cass presentation of sabes a macula 6s with heat paters atypically aes the eal spaces an i itesely Prot, especialy aight. Thrash develop rom superela butroning of sarcapee scabies ales fo pin Ili opel ramon, uf cramer, ne, ad ofl vetmetin although he st wo rugs cannot be ued in hares younger than 8 Bo ‘lowimazoeis indicted for ne, hich ypc present sam cy ing rash with rad ried acl occ and ‘eral dering. However, nen ds ot ora simulans onal the webbed spaces of the igs and the ching hes no {elaonship ote tme of hea. ESS age 8 Ons al < 1 22-year-old woman comes othe physician because of 2-yaristoy of termine epsodes of pain in aller Nagers ‘severely painful and num once chey mar up, She has started wearin gloves a all mes to preven these episodes. she seme any te eee es cpt meee: Crd cates ec creer {na fosetn, sh appear nso Her teparstre e972 (991 ple 92 rm nd lod pes e 116/72 mig, Examination ofboth hands shows no sbnoralis, lens esis negave, Her hemoglobin cncerraion e142 ga, lukas counts 800mm, ad platelet cous 150,009 mn Seam acre concentration ate ‘chin norma! ts, Nalol capil micoscopy formal Which ofthe olouing isthe mos appropriate pharmacotherapy? a BO 2 2 i i e Ic Fone mirogcein ra edie =) |E (ra epoprestenot (oat hsatanneOmns al <5 > 1522-year-old woman comes ote yaa because ot 2-yar stony res ‘severely painful and numb once chey nar up, She has started wearing gloves a all mes to preven these episodes. she has generalized amity order Her mother ha stem pes erthematons.Ctrent meats ede lraepart and fvortn, She appea's ansous er temperatures 37.3 (99.1, pls 92 rm an bled pressures 116/72 mig, Examination ofboth hands shows no sbnoralis, lens esis negave, Her hemoglobin cncerraion e142 ga, lukas counts 800mm, ad platelet cous 150,009 mn Seam acre concentration ate ‘chin norma! ts, Nalol capil micoscopy formal Which ofthe olouing isthe mos appropriate pharmacotherapy? “Ths patient presents wth gos of Rayrauts phenomenon finger that turn whe when expored tocol and Become AY eta rant on eure. ails ata merozcp's ora when ues primary Rau Penemenen 4a « ‘bat blockers eg propanol are contracted inpatients with Raynaucs phenomenon because hey last further ‘vasoconstncven of te arenes ab worsn he vasospasm caused by the cnaioon ‘spin may be administered or eyovomeagia im pocthemia vera OV. altough eythvomlag on minis Rayna ‘ieee ne oe RA apes cone Freee eens lees) InicrovacularOvomboss duet mperdscosiy This patent dos ot preset with Sgn OFF e, cOnsuOal SymptOMS, Plethora. prs) and her Bood cll counts arena eee, hic exeae V “Topica mitogen sony usedin sere courses of nerapy-restant scordary Raynaud's phenomenon ea. necro Ainge tip ot fst. teste pool tlre or contrainteOm Ds al < sri > “Topica niveghcarin soy usedin sere courses of hrapyrestant scondary Raynaud's phenomenon e.g necro of Anger tipo fst-ie testment poorly tolerated conrad ‘elem cane! Blockers parca medi) re the iste vesiment for primary Ramauds phenomenon bow TSX of tent ith primary Raynaud's phenomenon expand mesipine. [Reynaud phenomenon popostenol maybe administered for pulmonary hypertension ane case of Seve and tesistunt aynauds phenomene Ci ‘play stmintresnraanculy. The patent the ignete doe ot hae any signe severe aca og les) an ha rot reeived ey rsline ages yt Which ears tha epopresteal snot ncte. ysralzine's und in the testent of igh lod pressure, particularly npregnant women. is ptindcte or ‘wezemet of pens wt Rayna phenomenon. ‘ra prez maybe uted to wet patents wath secondaty Raynatcs phenomenon dost an uneryng coon ‘es, vaxculides, conactne tissue seats) Unlike in th Cate, pats wth secondary Rayauds phenomenon tpl ave ater changes inthe fingers andor tes that lea to vaoapat and thas Have abpaal Figs oh el apary rmeroscopy. Ths patent aso has no Signs fsstemic esese.‘12-year-old no s bought othe pyscan Because offer, malas, and a pal, Key tas on eight shoul! or 2 es. The patents mother says the boys canton har worsened ove the at ¢ days te has ned th he athe at Set publc hss since she separated om ns pyslealy abuse father 2 ors ago, His imunizavons ae Upsto-eate. Theres cereal lphadenopathy, Laboratory sts show no abhoralte. A photograph of he ath it Shown Frter evaluation 1 most key to eval whch oF he llewing? Feedback 20 « @ sng wth bed ages (©) Honey clr sts woe perl eion (© Feces pe esate necton {© Pusan ys ive the eval sues (ley eee ee ee (©) evn he interdig fle (© wecanc nzose w enchengox B snow anmerompe al el hers a oO sta eoisny bough oe psc cas cawenmsouser (iS RS eee ee eee pid eae ee aed eee eee ee ee eerie eee eee ee a ‘hon ute ealuson mat ae reves wien ening? ae = so ‘A stling wn bed bug bes would ras ugpcon for bed bug In ths paem. Although cred, unsanitary Wing cnions & becomes thy and resolves spontaneous within awed typically occurs on kin that was exposed ding Seeing, oney-clored crusts nthe pnrl region are a si finding in nonbulleus peta Rashes usualy progres fom papules to smallvescessutounded by eee, lowed by pustules that rupture Hower, ronbulous impetiga pray occ ‘Younger chen 2-8 yea) ganas not pal ap rae ores th eer and alae Therfre another ashe ‘option would be mre tly.ome al “recent upp tespiatory infection special wl aycoplasma at bee ncting Tot or Stevers-Johason syarome. THe rash inthe pst papular in nts util te staring ath obeted in staveneJobneon syndrome, Moreover, pnt Suffering rom his conan te often vey and require hosptaztion, “The patents symptoms ane rathndete eczema hopes, a ctaneous manifestation of hepe infection sly svar orH5\-2) Tis condo associated wit preeisting shin condos; most fen wth tpi erat PUTTS ard {ry sin invong the feral surfaces af or jmploms of tpi ecmatinan ae th, ey kal abe preset th pater. czema hepetcum scnsierd a dermatoogal emerge and he ash onthe pater’ Shoulder can asemate Fepiy Teearent with ora oe W aco shou be nated as S00 as possible By. Herpes sme vrs teen ‘Aniston of tenant wih ystame glacocoricods dicts probable mmunosupeestion, which subsequealyerenes the tisk of shingles The rash associated wth singles has a dermatomalistabuton, eal tfecting 1-3 dermarones on ne Side ofthe ody Mou patient ear severe baring or trang pan that flamed by araoh The rash tally Imaclopapult onan erematus base and qu rogresss toa vesicular rash, crusting an invluten ply occur {te 7-10 das. Ths patents immunizations ate up-to-date and shou ircuce chichenipox saci, auch makes ESOURS a £770 > ok of hinges. The ash assocaed wih singles has a dermatomalitbuton, pally affecting 1-9 dermatones on one Side ofthe ody Mon pint er seere burning or trang pan tat flawed by arash The fash nally Iraclopspulr onan enematos ee and qu poaresres toa vest rach. cruing an nvoluren type) cor ter 71: pleats mmutatos we up-e-ane at hs ece arxac WN Maes es urows i te tral Ts ae nate of cables. Scales pay aes he wis, aes, 2b nega lds and Paton cascaly compas of ane prs that neo tight though cowed, urea ning conden are 2k {cor for be bg infestations the ash associated th scabs no pail, ad eer, malaise, ad mphadropshy would ‘Cickanpox highly contagious wal les that yea pasens wha widespread prune rash thar mly moh he ‘uunk ana quichiy spreads ote fac, scalp, and exvertes. This pets undevng kin conan pts hit an irceasad tat of developing a severe form of eckenpon and complications tach sbateral superinfection ana seating However, hs patent’ immunizations ae up-to-date and should elude chickenpox vaccine mong this apne ver Unleya ge 8 oats Oma s wl ‘A presusty meaty 22-yer-a male comes tothe emergency department Because ofa high-grade fever ani mals or lh iss ee a et ad cre inn icp ean bere ab being is eps. He etumed rom a upc TawanT wack ago. Hes sexual ate ard Ses condoms consistent HS temperate 35.716 (101-7, pulse 2 102/ma, and ood pressure 100/70 men Hy Examination shows ntence ngumal mpkaderopathy. Ther sa maclepapular rsh ove the Wunk and extremities wi some sparing ofthe Sin ‘vere backand gon. abdominal examination shows no abnormaltes.abortory studs show Levionte count 3 200/me* Ne 136 neat to meat e s2 meat hace noses ‘iania rect on marae aie phosphatase $0 U/L nny is noemal An EUSA test for Hs negate hich ofthe fllowing measures 5 mst yf have prevented his patent's conan 4a (st ser actos ssa epee © phn wen dospeyeine (Ohne ®Omns al <> ‘A preusty meaty 22-year mle comes tothe emergency department because of ahigh-arade ever ana malase or (Sy lap cenres eee aa esc o setaminophen He a0 hat 3 He tuned fom apo Tala 1 week agp He Sexually ative and uss condoms inconsistent Hs tempera 35.71 (101-7, pulse 2 102m, and Bead pressure 100/70 me Hy Examination shows nen Inguinal mpkadenopsthy. Ther s = EUBBABUTaSH ove the Wank nd extremist some sparing ofthe Sin ‘over backand gon. abdonina examination shows no abnormal. abortoy ste show Ne 136 meait oa meat e s2 meat Ureanivogen 1S mga on marae nny is noemal An EUSA test for Hs negate hich ofthe fllowing measures 5 mst yf have prevented his patent's conan ee 2a “ ‘altough inconsistent condom ase Wreases te rk of senuallyWansrited Aeass (STO), MS pant des not presen ayog gs a ‘altough inconsistent condom ase Wreases te rk of senuallyWansrited Aeass (STO), MS pant des not presen ay “The ue of manque repellent san ffechue mesure for preventing be am Aedes apy an thus dengue ius fection ero par, fever malas, and mii are yall aes by pavents who have contacted dengue and are ‘companied by exam ar ynphadenopth, Adgioaly te ocuece ot plea ematlogi ndings suche teokopeta aed ironceyiopets to x atent wns Hs tena os eco ne bgtyseppest of Bo Doxyeyin ione of he drugs that may be given 1 patients who mae th nea for eching maar chemoprophylass Abhough ths patent he ome ofthe hcl festares of alia ouch a fever, ale and myalgia he sat eles 0 lan aregin whch the ascasesendem. Therefor, mala Is ery UME sa agne5. “Toe COC ecommerce bpatts Accra fo meet iniratonal ravers beau of to sd of contacting hapa A ‘vough contaminated food andor water in many counties Grcuting Tawen) Although paves with heptts infections prevent ih fre and aeration of ter ensynes in vl thet may even exceed 10/00 ral) Repel suey Present and occasionally myperoirubinema lang favre, which ts peter oes not have. Frequent hand wasting is a propacuc measue ft Some wal seats, uch a necous mononucleosis IN, which ‘aure by he patna irs though te patent: atry of fever nd male would make BY fection 3 posable “erential agnosis, he aks typical etues such as Sore tet, mphocyes nd splenomegalya a ge 8 oats Oma s wl fs-yur-otmun ones te psn bec -mar nyo atone sh haat yon a has mpetension and coronary artery disease He does ot sme odin alot. Curren medication ine rmetoproncopdogeresaasan and enalapril He appear thn Hs temperatures 27.2 (887). pulse 8mm {na blod pesres 138/92 mm Hi. Pulmonary examination shows Ieper eres sne rant nacaicu ar Hs hemoglobin concertaon 1229, leukocyte court 11,200 mm, and ayowocye Sedimentation fae {meh Urano. Ansa of as chert shown. Which of thal ent Ml beeen on ter ‘ahuaon ofthe pati BO Za (© acetate stan (© Pestie ea ation (©) Away dtaton and ron wal cening ‘el Exposure to asbestos [o ‘epostioning the paben causes the mass 0 mone le 5) Mati ye foo an skeletal seinigraty @ a @Pulmonary asperuillosis eetOmns al <> ‘46-year-old man comes roth psican because of 2 1-montn story o eas aay ylosn ea Sputum wth celal steaks of od in fore mon He has mpetesion and coronary artery disease He does fot smoke o dk lot. Current mediation inde rmetoproncopdoge resaasain and enalapril He appear thn Hs temperatures 27.2 (897). ple min na ood pressure Is 136/92 mm Ho. Pulmonary examin shows Hs hemoglobin concertaon 122 9/,leukoyte court 1,200 mm, ad aytwocyesedmenczon 1a 235 mh Lai fe normal axa of ie cert shown, Which oe flng emo kalo Be zc outer alan ofthe patient “The inal enures productive cough hemoptysis, fehgue, and weight os) he hstoryof tuberculous nd the Finding ‘ofan nracavtary mass on chest xray are sugestne of evo ulnar speriioss 2a ‘es: fst baci sputum characters of pulmonary tabeclon Pulmonary taberculon as antes wth productive ‘ough, hemoodss nd weg os, BU the patient sacha fever and ihe suet. Adena tough he pate asa Instr a tunetoss and a elapse posse, he aeay ecaved Weaument for § months and tat sno elder ert ‘pont unry antigen could sugges! stesso ginal. Faents wth hatoplasmose ual hase «Wat of "uevel endemic reas speoaly the Msisspp and Oho mer vals or are mmunocompomsed fe AU stopsmoss abo manfss wid cough, but fever, cis and myalgias would aso be expecta. X12 1 ary Bu pial ‘how conealiation(rpecil nace daze) nd wal-fined mauler th conta aoeston,Lginelons eo EOm Dt at ‘pont unry antigen could sugges! stesso ginal. Faents wth hatoplasmose ual hase «Wat of "uevel endemic reas speoaly the Msisspp and Oho mer vals or are mmunocompomsed fe AU stopsmoss abo manfss wid cough, but fever, cis and myalgias would aso be expecta. X12 1 ary Bu pial hom conealiation (pein scte daze) nd wal-dfine nal th cota aeeston. Legit eo ‘iagnosed va postive nay angen Ts condition aso cases cough but wold mans wih ore ci yng of [peeumeris an pony arten. Chest x-ray ypc shows fase, interstate. ‘Aray ation ana bronchial wal thickening are suggest of bronchiectasis, which also mantest th produce cough, emopesis ng crackles, weg 55, anda prevous story of bres. Hower, bronchecass usualy causes OYSpea Godwnecrng on lng autculaton Adconaly,bonehecais would manfert wh l-deined pulmonary vatulture 2d Increased anchovasculr marking, which ar ot preset on this pater’ Xray ‘Ahouoh asbestosis manfess wh cough, 5 usualy onoroduct. Adena this patent des ot have dysenea oF ‘inuceodateal tates on cz aay wc are equating io abectoas, would ao not expan te pens “This tng isi fr aspargiloms, ane of th forms af chronic pulmonary aspergillosis (Ps), Previous pulmonary Putholgiesespecallyeavtary dacases rec a tuberelos) are ak factor for PA, and thease rarely affects Immunocompetent hosts witout prior pulmonary disease. The fungus eolonizes tes re-onstngcntes and forms sold ‘ung bal whichis not tached t he sttounding sue can thateore be moved by feaostioning he paveRL Bo ‘Clusters of aram-oostne coe sbutun are dina seen in lana abces. This ate has some fans of luna abscessOm ns al < 13°10 > “Ths tna syle fr aseraloma, one ofthe forms of envi pulmonary asperiosis (CA), Previous pumonary puhologiesespecllycatary diseases Such a tuberculosis are rk cos for CPA, ad he ease arta {eemccorpates tne deat pcr pulmonary deen Thu fang oer ova pre-teens sed rms aod ‘ung bal whichis not tached tthe surrounding sue. can thteor be moved by vepostoning the patent nae ‘Clusters of aram-postve coc m sputum area finding Seen ung abscess. This patent has some finns of lung abscess {ee poauctve cough, Memos, wet ss, reduced breath sounds), Bu paLeMs wh ng aascss ae aCe il th Wis pave eds. " ” areas ofinceaned bone turove om skeletal satrap woul be naive of metastases for primary malgnaey Bony metastases are common m pets wit vance sol on cancers. Ts pater oes have sme features consent tng cancer such as prosucve ouch hemoptysis, weight ss, radological eudene of amass ata ey of eros (ech eit er fr lung canean Aree nots rnc! andthe lason ie loeatd nthe pepe of he ans, {enocercnama and largencl ung cancer wou be the most ikl pes. Adenocarcinoma would commeniy be substantial Salles than the lesion on tha a-ray- Actonny, none ofthe lang ances ret oor na preventing cay an they would not be sounded by a crescent ofa ‘ponte ANCA test a fining character of garalomstose wth payangiti. Ti condn can manifest wth produce cough hemoptysis and weight oss, 5 Senin ths pavent Honeer, SON of cases of granulomatosis with Pohangits involve ENT lesions eg. chore thi sunt, and oa ees) and about SO are notable frre Irvclvermert,wRich tis stent ack r would als nt expan this eben aangOns al < 2-0 > “nis question spat o «sequnce ot quests. Answering tis qustion wil unlock he follow-up ausstons. Hower, you won't be > ‘.e4-yer-oldmn comes othe yan fecal cleaner oa ceded igh agli He z {ols wall. His fathar died of colon cancer at the age of 34 yaars. He has smoked two packs of cigarettes daily for 44 yaars. a tetas aot seen apyscan na ya Ferenc rn abies pola? wes oo Me apes ey 8 tempertire 37-10 GREP, pve 85m and lon peste 11672 mm. xaminton so il eth gs Sounds beteraly Carlc examination shows no murmur, ub, o gallop. Theres reéuible nga ria onthe oe ‘igh. Labocoystuaes show o anormal. Atay of he ces stows a cm cea octed ss ‘Chest shows regular megs and spicules, Which of he allowing isthe most appropiate next sep menagemen? 2a > Fost emission vomography 1@ oll chest ray n3 months 9/0 oO} 4oats Om Ds al < n> “nis question spat o «sequnce ot quests. Answering tis qustion wil unlock he follow-up ausstons. Hower, you won't be bite change te anewar a soon at you have iewed the fllow-up asin. 4 ran comes othe psc ora mee cemance pro axed ag gun ema reac EE tik poses poses eats eral ena haar oe eee eee eee eee ‘eon bla Caruc roninatin sows pommers nye. Tee eee tahoe {ght bers stats sow no torn hay oe che shows Sch oe icin hii a claw ia x pcepnadoek ae aca 4a “A ubeculn skin est maybe performed to rule out ater tuberculss Whi dispar recent retuned fem ati ora, feria perc ern fl eer cer nlc: eeemrmereresonrec {buss elconelsm) Eventhough 2 tuberculous granuloma car eopear 35 pulmonary nodule Sela SlRary node om nest Sera isnot ype for ubeross Fonton emesiontmoatahy EN ithe nxt appropiate stp for pairs wh sh pulmonary nodule = 5 mo in 26 lh an tcermedtate proba of malignancy t's also commonly conducted fo paint wth high vik 25 pat of staging ‘edo to bapa a FET sans postive, wansboncl bop should be canducted for th contra locate tan Soma cases, srlcal exsson may be considered te FETs nagathe th nxt BET ta smal determined of & “case-by-case scene, and may nude CT suvellance of even eps SL .Ome al < m0 > BB tang cancer ‘AToNOW-up Cx snot cna fra Slay pulmonary nodule eguingte-eauson the est maging melt ot ‘Serial CT scar monitoring appropiate in patie peseming with ete: oli pulmonary neue» 8 mm andlow Fraligrancy robe ase nodule betneen > ana dm meth any malignancy proba itme periods vary acon Size ora sobs nodule © 4 mm whan irtermediar o hgh malnancy probably. This alent resets with a pulmonary edule» Sen that has a emeiae proba of magna. ‘CT-guided vanstorai biopsy spr na patent wth «peripheral oi pulmonary nade = wm wth a igh probly of ralgnaney ecose ths patent poset wth a entra lated see pumenary ole thet would be ict to aces ranthraclly method I ot sutbl for obtaming 2 Ussue sample, Adena, ths stent only as an Irarmediat robanity of malgearcy, meaning anare tervenuon would mst ale aeducieafist before Hops lh alow mtgnency risk n patents th peeing conden ssecate wth pumenaty nodes eg, Srcalcss, latent Ijcobactenum tuberin), further etluton may io ot be neeed. Th pabent has esunpes ndle and mule nak facors for malnancy, whch waren frter evaluator.o a Om Ds al <-> | “Tis question spat oa Sequence of questons and as unlocked by answering 2 pewous question. ostron emssontomogrephy 1s conducted and inicates 2 malignant nodule Bronchoscopy wth vansbonchal ops 1s Detormed snd a specimen spl of te nedue sn Tor fozen scion aahst Te sue sample most hy wo ae 2a Large clung carcoma, a non-small clung cance, peripatal tumor nas catatezed by te metastases and ‘te pout progress Os Hscloy, linge ellcarcioms cht! by poy dferntsed, paomerhe ga alls alnough large cell catcnoma Is sSocated wth smoking, ts 35 conmon than oer asSoclted pes of cance ad Ns tet s nodule cena loeted aay. Bronchial cares tumor spell characterized by hlar or pana opacies eters can develop card syndrome ‘rajacisized by dare, Tushing,dyspea, ang wheeang These symptoms te absentia is paler Adan he has 2 povtve emoking hetory and carcino! bronchial crchowe fe sual nor vacated wh roto Lung adenocarcinoma s mare cone in woe an typical affects te paigheral pts of he ing. Kray ao lead 82 hyperophic ostearenroathy clioing of fingers ara tos, painful swelng noms andiong bones). On hs004, enocarorama ssn aba genta tumor with rwan-progueng als, BUN a pater Wh a postve Song Mon, rothartpe of tumor mre ialOmns al ‘ung adenocarcinomas more comiron in women an typical affects the ptpheral arts ofthe lungs may also led to hypertrophic osteaurthropaty lating of fingers ar os, pl sweling nowt an lng bones). On hogy. _adenocaronama is sen 5a lenular tumor wh rucn-producmg cal, BU napster Wa poste smoking Mson, {roter type tumor i moe kay ‘Squamous cll ing canons (SCC) the mos ay agnosia hi patent ae he oe common lung ance Sekar. SCC pil aes he cert! parts of he ang and may present with hypercaeriaas eso the pracicton of Puatyrd hamone-relted poten PTH On Matlogy, SS nani epithe tumor tha an have terelar bridges and era pers, Bo ‘SCLC play fers the canal pat fhe lungs avery aggresive tumor wth ary metastases. On histology SCLC haraceried by Smal dark ble wor cll with ypechvomatic mel and scarce yoplasm.aiough SCLC stengly Colorectal cancer may meassiz hematogenous tthe ver, lungs, bone, and bam and can spread imphatiay to mesenteric gara-aortc and eve mph nodes. Pants pial preset wth consuutana symptoms, rn dency {ara anddarhes Qn ight-td CRC, or changes to bowel hab, oed-tesed ol, ad eck shana pt ietesied CRO) though the patent in the vignte has postive family story of olan cana, he does Net ave ay of he ‘apical syptons whch res thc ogre of corel emer ens. Aino thong singe cee pot umonary mersass ply ss00ate wth mItpe odes om acest x-ray.ge 8 Ons al < 20> ‘14-year-old is bough othe ys ater she acdemaly cu her sght forearm ear that morning he ‘Sementary ana mei school abroad andi ot sre she ese alo he hikdood saccnaton, Sh appa bea Her temperatures 37° (8.6. pulse 80min, and lod pressures 102/68 mmHg. Examination shows a clean 2-er laceration on her ng fear with surrounding edema There no erthems or alscharge. The wound Is \mgeed wih ater and washed wih soup ich ofthe following isthe ost appropiate ek tp n manager Za (@) Adina DTaP ty (@) mvaverous mevonicazoie ‘Ani aap only © (©) AdrnsterTéap and 6 (©) Adria TC ony (F) No farther tes are mcesanyOMRs al < 20> a oe. 4 yt toughen er shady char i fren ei mong he Es Stray a ml scot avon Ncrempuetre'n47€(68) peer an Sond prerre 10/68 rane sows Sen ah @ [sews on hr ia team ih sauna abn Tween nhs orev. Tne wou ras wh a ‘tera wee i So ie ler the Nos prereset? . ea cnt 2 = DTaP ste vacine preparation of coc fo eps mmunizaton shed aswel aso postexpasutepophous a ‘chlrenberwsen th ages of@ necks and 7 yas. na 14-year-old patent wh a lan, minor wound and an unknown w Immunization history, active immunieatio vege However, iferen preparation suited or ave nmurzaion holder adres requtessece OTe? sat nceated or postespute prophets inch olde tha 7 yeas of age & Meeonigazl is efecveapsnt nseobie bacteria icuina Closer tar whieh cases eta Inravencus cot Imevorgazle use ng with wean munogobuln To eat ace tetanus iteaton, Mevonazle des Ne ay & ropans. required, fhe wound was nether clean or miner, Tdap should otherwise be comoimed th TI. See table “Tetanus propyl ater inv) Bl TeamsOm Ds al < 20> metronidazole use alona wth fears mmunoglobun TG) 0 ea acute fetus infin, Meorcezle dos ot play & {olen postexposue srpmyans. Ina Myeurol pave with aan, minor wound and an unknown immunization Nstoy, cve immunization wih Taps requ. wound ws eer clean or miner, Tap should atherise be combined th Te tale "Tetanss ‘ropa tr mun’) By tetas ‘A combination oF Tc an Tau s used Tor postenposure propa indus Wi an urisown immunization Sor who thre wows tat are ether en a mor Tot eae fo ea wound se cm wth spat. “Tics wed for posteaponure propia combination wth sie immunization in ini wth an unkroun ‘immunization Miston whe have wounds that renter cen for mor. TGs ret nested fr clean wounds, or shoul be ‘minstre ane, ony passive mmunizae) nay pale olde ban 6 weeks of age. ‘etanu hat 2 high moray ate (1) even wth ear, apgtestve entment. Therefore, reverion of tetanus ia postexposur pophivans is lnays required na paver with ary wound and zn urkrown mmunzation WS patent woul be requred