A 26-year-old man presents to his primary care physician with fatigue, headache, and a sore throat for the past week. There is also nausea and diarrhea, but no weight loss, productive cough, or difficulty breathing. He has no known past medical history, does not take any medications, and has no recent sick contacts. He is sexually active and uses condoms inconsistently; he drinks alcohol heavily on the weekends and has had previous IV drug use. On examination, his temperature is 39°C and the rest of his vital signs are normal. He has nontender cervical and axillary lymphadenopathy, tonsillar exudates, and mild splenomegaly. There are also several painful, well-demarcated ulcers within his mouth and a mild maculopapular rash over his chest and arms. A rapid Strep test and a monospot (heterophile antibody) test are negative; further screening for chlamydia, gonorrhea, syphilis, and HIV antibody is negative. What is the likely diagnosis?Ask StudybuddyGroup of answer choicesUpper respiratory infectionSecondary syphilisHodgkin lymphomaAcute retroviral syndromeInfectious mononucleosis

A 19-year-old athlete comes to the office with a week of fever, malaise, headache, and cough that disrupts her sleep.  She was unable to do her gymnastics training this past week due to fatigue and exertional dyspnea.  The patient has no chronic medical problems and takes no medications.  Temperature is 37.2 C (99 F), blood pressure is 110/60 mm Hg, pulse is 84/min, and respirations are 18/min.  The neck is supple, and there is no pharyngeal erythema or cervical lymphadenopathy.  Cardiopulmonary examination reveals normal S1 and S2 and scattered wheezes.  Neurologic examination shows preserved muscle strength in all extremities and 2+ deep tendon reflexes.  Laboratory results are as follows:Complete blood countHemoglobin 12.2 g/dLReticulocytes 2.2%Platelets 240,000/mm3Leukocytes 8,000/mm3Chest x-ray shows diffuse reticulonodular opacities.  Which of the following is likely to be the most effective treatment for this patient? A.Amoxicillin B.Azithromycin C.Ceftriaxone D.Clindamycin E.Trimethoprim-sulfamethoxazoleProceed To Next Item

27-year-old woman comes to an outpatient urgent care facility because of 3 days of joint pain. She reports significant pain in her wrists, ankles, and knees. She also has had a low-grade fever, fatigue, and a new skin rash. The patient does not have a headache, throat pain, abdominal pain, dysuria, vaginal discharge, or vision changes. She has otherwise been healthy and she takes no medications. She recently began a new sexual relationship with a male partner. The patient has an intrauterine device and does not use condoms. One month ago, she traveled to Connecticut for a camping trip with her parents. She drinks alcoholic beverages socially; she does not smoke or use illicit drugs. Temperature is 38.3°C (101°F), pulse is 96/min, and blood pressure is 127/80 mm Hg. Examination shows a clear oropharynx and no cervical or axillary lymphadenopathy. The abdomen is nontender and there is no hepatosplenomegaly. Upper extremity examination discloses pain along the tendon sheaths during passive and active movement of the hands. Lower extremity examination shows a total of six well-demarcated pustular lesions. Which of the following is the most likely diagnosis?A. BlastomycosisB. Gonococcal infectionC. Lyme diseaseD. Reactive arthritisE. Secondary syphilisProceed to Next ItemShow Explanation

A 35-year-old white man presents to the primary care physician with complaints of fever, weight loss, and a skin rash. The fevers are intermittent and began approximately two months ago. The rash appeared six-week ago. He also complains of abdominal pain and nausea for the past month with a weight loss of 3 kg (6.6 lbs). His medical history is significant for HIV, diagnosed two years ago, and he has not been compliant with his antiretroviral therapy. He denies any sick contacts, but he did recently buy a cat from a shelter three months ago. He lives in Florida and has no recent travel. He is febrile with a temperature is 38.3ºC (101.4ºF) but in no distress. On examination, there are numerous exophytic, raised purple patches on his skin that bleed when instrumented. There are similar lesions on the oral mucosa, tongue and genitals. There is hepatomegaly on abdominal examination. A complete blood count reveals normocytic anemia and mild thrombocytopenia. Alkaline phosphatase is markedly elevated, and transaminases are at the upper limit of normal. His CD4+ count is 140/mm3. CT scan of the abdomen reveals hypodense ring like lesions in the liver that enhance with contrast. Which of the following is the most likely diagnosis?A. AngiosarcomaB. Bacillary angiomatosisC. CryptococcosisD. HistoplasmosisE. MalariaProceed to Next ItemShow Explanation

A 49-year-old man presents to the Emergency Department complaining of fever and a productive cough for several weeks. He also endorses night sweats and perceived weight loss. The patient is homeless and is a known alcoholic. On examination, the patient's temperature is 38.3°C, blood pressure is 144/90 mmHg, heart rate is 94 beats per minute, and respiratory rate is 20 breaths per minute. He appears weak and disheveled with poor dentition. There are bronchial and amphoric breath sounds at the right lung base. His laboratory values are significant for a hemoglobin of 11.8 g/dL and a leukocyte count of 13,500/mm3. Blood and sputum cultures are collected and sent to the laboratory.What should be done next in the management of this patient?

A 68-year-old male with a history of lung cancer undergoes follow-up labs after recent cycle of chemotherapy. He has mild difficulty with concentration over the past week but is otherwise able to complete all of his daily tasks. He reports no nausea, vomiting, or positional lightheadedness. He has no other significant past medical history. He takes no medications. Vital signs are as follows: Temperature 99.8°F, RR 18, BP 135/88 mm Hg, pulse 76. On examination, he is alert and oriented. Cardiac examination reveals regular rate and rhythm, no murmurs, JVP not elevated. Lung and abdominal examinations are normal. There is no lower extremity edema. Skin turgor is normal. Neurologic examination reveals 5/5 strength in all extremities, no focal deficits, and normal gait. Laboratory tests reveal the following: serum Na+ 121 mEq/L, K+ 4.3 mEq/L, BUN 7.0 mg/dL, Cr 0.4 mg/dL, glucose 106 mg/dL. TSH 2.0 mU/L. Serum osmolality 250 mOsm/kg, urine Na 45 mEq/L, urine osmolality 450 mOsm/kg. What is the most appropriate management of this patient?