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A 28-year-old woman with a history of ulcerative colitis and pulmonary embolism presented with a 3-day history of dry cough and pleuritic chest pain. A chest radiograph was obtained. What is the name of this imaging finding? | Hampton’s hump | {
"A": "Fleischner sign",
"B": "Hampton’s hump",
"C": "Palla sign",
"D": "Spine sign",
"E": "Westermark sign"
} | B |
A 50-year-old woman with a history of Crohn’s disease presented with 10 days of tongue and inner cheek pain. Laboratory studies showed an absolute eosinophil count of 870 per cubic millimeter (reference range, 50 to 500). What is the most likely diagnosis? | Pyostomatitis vegetans | {
"A": "Herpes simplex gingivostomatitis",
"B": "Herpetic geometric glossitis",
"C": "Lichen planus",
"D": "Oral candidiasis",
"E": "Pyostomatitis vegetans"
} | E |
Which one of the following is the least likely cause of this patient’s symptoms of retrobulbar swelling and diplopia? | Dermatomyositis | {
"A": "Dermatomyositis",
"B": "Cancer",
"C": "Oral contraceptive use",
"D": "Facial trauma",
"E": "Sinusitis"
} | A |
A 26-year-old man from Somalia presented with a 5-month history of dry cough, night sweats, and unintentional weight loss of 18 kg. During this period, epigastric pain and postprandial vomiting had also developed. His BMI was 11. On examination, he was cachectic with abdominal distention and diffuse tenderness to palpation. On the basis of chest imaging and sputum studies, a diagnosis of pulmonary tuberculosis was made, and intravenous antituberculous treatment was initiated. However, he continued to have postprandial vomiting. Contrast-enhanced CT of the abdomen was obtained. What is the cause of his abdominal symptoms? | Superior mesenteric artery syndrome | {
"A": "Chronic mesenteric ischemia",
"B": "Gastric tuberculosis",
"C": "Gastrointestinal lymphoma",
"D": "Intussusception",
"E": "Superior mesenteric artery syndrome"
} | E |
A 50-year-old woman presented with an 18-month history of asymptomatic skin lesions on her forehead and the dorsum of her hands. What is the diagnosis? | Actinic granuloma | {
"A": "Necrobiosis lipoidica",
"B": "Actinic keratosis",
"C": "Tinea capitis",
"D": "Actinic granuloma",
"E": "Cutaneous sarcoidosis"
} | D |
A 53-year-old landscaper presented to the dermatology clinic with a 4-month history of red, raised, itchy skin lesions on his left lower back and buttock. Physical examination showed numerous verrucous nodules and plaques with overlying crusting and surrounding erythema on the left lower back and buttock. Grocott-Gomori methenamine silver staining showed broad-based budding organisms. Chest imaging showed no abnormalities. Which of the following is the best treatment? | Itraconazole | {
"A": "Clarithromycin and amikacin",
"B": "Itraconazole",
"C": "Penicillin",
"D": "Rifampicin, isoniazid, pyrazinamide, and ethambutol",
"E": "Trimethoprim-sulfamethoxazole"
} | B |
A 96-year-old woman presented to the emergency department with a 1-day history of pleuritic chest pain 4 days after a single-chamber transvenous pacemaker had been implanted. A chest radiograph and computed tomographic scan of the chest showed the tip of the right ventricular lead in the left pleural space. What rhythm does the electrocardiogram show? | Complete heart block | {
"A": "Atrial fibrillation",
"B": "Complete heart block",
"C": "Second degree heart block",
"D": "Ventricular-paced rhythm",
"E": "Wandering atrial pacemaker"
} | B |
A 54-year-old man presented to the emergency department with confusion and vomiting. He also reported an unintentional 10 kg weight loss and progressive darkening of his skin over the past 6 months. Laboratory studies showed a serum glucose of 40 mg per deciliter (reference range, 70 to 110 mg per deciliter), sodium of 108 mmol per liter (reference range, 136 to 145), and a potassium of 6.4 mmol per liter (reference range, 3.5 to 5.1). What is the diagnosis? | Primary adrenal insufficiency (Addison’s disease) | {
"A": "Primary adrenal insufficiency (Addison’s disease)",
"B": "Acanthosis nigricans",
"C": "Cushing’s disease",
"D": "Smoker’s melanosis",
"E": "Solar lentigines"
} | A |
What is the most likely cause of this physical exam finding in a 65-year-old woman undergoing treatment for breast cancer? | Chemotherapy | {
"A": "Vitamin E deficiency",
"B": "Chemotherapy",
"C": "Scleroderma",
"D": "Chronic inflammatory demyelinating polyneuropathy",
"E": "Mercury toxicity"
} | B |
Deficiency of what micronutrient is likely to account for this rash following Roux-en-Y gastric bypass? | Zinc | {
"A": "Copper",
"B": "Thiamine",
"C": "Vitamin B6",
"D": "Vitamin C",
"E": "Zinc"
} | E |
A 73-year-old woman presented to the emergency department with a painful umbilical nodule that had been enlarging over the past 4 months. Physical examination revealed a painful and firm erythematous umbilical nodule measuring 2 cm in its largest diameter. What is the likely diagnosis? | Sister Mary Joseph's nodule | {
"A": "Keloid",
"B": "Umbilical hernia",
"C": "Pyoderma gangrenosum",
"D": "Pyogenic granuloma",
"E": "Sister Mary Joseph's nodule"
} | E |
A 34-year-old man with a history of intravenous drug use and hepatitis C infection presented to the ophthalmology clinic with a 1-week history of pain and decreased vision in his right eye. The visual acuity was 20/400 in the right eye and 20/20 in the left eye. Slit-lamp examination of the right eye showed conjunctival injection and inflammation in the anterior chamber. Indirect ophthalmoscopy showed vitreous haze with yellow-white lesions on the retina and optic nerve. Following workup, surgery was performed and a white mass measuring 4 mm by 3 mm by 1 mm was seen adherent to the optic nerve. What is the most likely diagnosis/etiology? | Fungal endophthalmitis | {
"A": "Retinoblastoma",
"B": "Amelanotic uveal melanoma",
"C": "Astrocytic hamartoma",
"D": "Fungal endophthalmitis",
"E": "Malignant optic nerve prolapse"
} | D |
An 8-year-old boy receiving treatment for relapsing B-cell leukemia presented with subcutaneous nodules associated with a 1-week history of fever which persisted despite treatment with broad-spectrum intravenous antibiotics and antifungals. Physical examination revealed nodules ranging from 5 to 18 mm in diameter on the chest, back, arms, and legs. What is the diagnosis? | Fusariosis | {
"A": "Erythema nodosum",
"B": "Fusariosis",
"C": "Dermatofibroma",
"D": "Leukemia cutis",
"E": "Disseminated Bacillus Calmette Guerin (BCG) disease"
} | B |
A 4-week-old boy was brought to the emergency department after having drainage from both eyes for 2 days and redness and swelling under his left eye for 1 day. The perinatal history was uncomplicated, and he was breast-feeding well. Physical examination revealed a temperature of 38.2°C, purulent drainage from both eyes, and a 1-cm erythematous, fluctuant mass inferior to the medial canthus of the left eye. What is the most likely diagnosis? | Acute dacrocystitis | {
"A": "Trichiasis",
"B": "Gonococcal conjunctivitis",
"C": "Chlamydial conjunctivitis",
"D": "Simple nasolacrimal duct obstruction",
"E": "Acute dacrocystitis"
} | E |
Which one of the following biochemical measures would be most likely to be elevated in this patient? | Alkaline phosphatase | {
"A": "Alkaline phosphatase",
"B": "Calcium",
"C": "Ferritin",
"D": "Phosphorus",
"E": "25-hydroxy-vitamin D"
} | A |
A 44-year-old man with diabetes and end-stage kidney disease presented with a 2-week history of pain and blurry vision in his left eye, fevers, and back pain. An ophthalmologic examination was notable for conjunctival injection and corneal clouding in the left eye. Visual acuity was 20/60 in the right eye and was reduced to minimal light perception in the left eye. Slit-lamp examination revealed a hazy, edematous cornea and a small hypopyon in the left eye. Cultures of vitreous fluid and blood grew methicillin-sensitive Staphylococcus aureus. Which of the following is the best next step in management in addition to systemic antimicrobial treatment? | Intravitreal antimicrobial injections | {
"A": "Intravitreal antimicrobial injections",
"B": "Intravitreal steroid injection",
"C": "Removal of intraocular lens",
"D": "Topical antimicrobial drops",
"E": "Topicals steroid drops"
} | A |
What is the most likely cause of these plaques that developed after the patient's home heating system failed? | Cold agglutinins | {
"A": "Cold agglutinins",
"B": "Methemoglobinemia",
"C": "Multiple myeloma",
"D": "Scleroderma",
"E": "Von Willebrand disease"
} | A |
This 46-year-old woman developed pruritus and similar papular lesions over her axillae, groin, and buttocks. What is the most likely diagnosis? | Scabies | {
"A": "Pilonidal sinus",
"B": "Psoriasis",
"C": "Impetigo",
"D": "Dermatomyositis",
"E": "Scabies"
} | E |
An 80-year-old man presented to the emergency department with abdominal bloating and constipation. He had lost 5 kg during the previous 8 months. Examination of the abdomen was notable for a mass that extended from the epigastrium to the pelvis and was nontender and dull on percussion. What is the diagnosis? | Urachal mucinous cystic tumor | {
"A": "Abdominal aortic aneurysm",
"B": "Castleman disease",
"C": "Urachal mucinous cystic tumor",
"D": "Cysticercosis",
"E": "Wilm’s tumor"
} | C |
A 30-year-old pregnant woman at 34 weeks of gestation presented to the emergency department with a 5-day history of an itchy rash that began on her abdomen and then spread to her thorax and extremities. Physician examination revealed papules on her abdomen and bullous blisters on her arm. What is the diagnosis? | Pemphigoid gestationis | {
"A": "Dermatitis herpetiformis",
"B": "Pemphigoid gestationis",
"C": "Bullous pemphigoid",
"D": "Erythema multiforme",
"E": "Pruritic urticarial papules and plaques of pregnancy (PUPPP)"
} | B |
A 44-year-old male construction worker presented to the dermatology clinic with nonpruritic skin lesions over his face, chest, back, arms, and legs. Six months earlier, he had fever, cough, and vomiting for 1 week. Skin biopsy showed pseudoepitheliomatous hyperplasia, intraepidermal neutrophilic abscesses, and round yeast forms with broad-based budding. What is the likely diagnosis? | Disseminated cutaneous blastomycosis | {
"A": "Basal cell carcinoma",
"B": "Giant keratoacanthoma",
"C": "Pyoderma gangrenosum",
"D": "Disseminated cutaneous blastomycosis",
"E": "Cutaneous leishmaniasis"
} | D |
A 38-year-old man presented with a 9-month history of a mildly itchy rash in his groin. The rash had been previously diagnosed as tinea cruris, but it had not improved with topical antifungal treatment. On physical examination, well-circumscribed, reddish-brown plaques were visualized in the inguinal folds when the patient elevated his genitals (left image). No scaling or satellite lesions were present. A potassium hydroxide preparation of skin scrapings was negative. Under a Wood’s lamp, the rash showed coral-red fluorescence (right image). What is the most likely causative organism? | Corynebacterium minutissimum | {
"A": "Candida albicans",
"B": "Corynebacterium minutissimum",
"C": "Malassezia furfur",
"D": "Pseudomonas aeruginosa",
"E": "Trichophyton mentagrophytes"
} | B |
Which of these medications, used to treat this patient's glioblastoma multiforme, is most likely to have contributed to this complication? | Dexamethasone | {
"A": "Acetazolamide",
"B": "Dexamethasone",
"C": "Levetiracetam",
"D": "Temozolomide",
"E": "Topotecan"
} | B |
A 48-year-old man presented to the dermatology clinic with a 2-month history of an itchy rash that began in the genital region and then progressed to his torso, hands, and legs. He also noted a 13-kg weight loss over the past few months. On examination, he had erythematous patches and plaques at various stages of healing. What is the diagnosis? | Necrolytic migratory erythema | {
"A": "Herpes simplex virus",
"B": "Acrodermatitis enteropathica",
"C": "Paraneoplastic pemphigus",
"D": "Discoid lupus",
"E": "Necrolytic migratory erythema"
} | E |
A 30-year-old man presented with a 15-month history of intermittent discomfort in the right upper quadrant of the abdomen. He lived in a rural area of Morocco and had occasional contact with dogs. The physical examination revealed hepatomegaly with a palpable hepatic mass. Laboratory tests showed a normal white-cell count and a normal absolute eosinophil count. Ultrasonography and computed tomography of the abdomen revealed a large cyst in the right lobe of the liver. What is the diagnosis? | Cystic echinococcosis | {
"A": "Primary hepatic carcinoma",
"B": "Autoimmune hepatitis",
"C": "Primary biliary cholangitis",
"D": "Amebiasis",
"E": "Cystic echinococcosis"
} | E |
What is the most likely underlying diagnosis in this 82-year-old patient with diabetes mellitus who had undergone a total hip replacement 10 years previously? | Colon cancer | {
"A": "Colon cancer",
"B": "Hypogammaglobulinemia",
"C": "Hypophosphatasia",
"D": "Osteosarcoma",
"E": "Tuberculosis"
} | A |
A 3-year-old boy was brought to the endocrinology department with an 18-month history of bowing of the left leg that had resulted in regression of his ability to walk. On physical examination, there was lateral bowing of the left femur and anterior bowing of the left tibia, as well as testicular enlargement. Café au lait spots were also noted on the lower back, cheek, and neck. Radiographs of the wrist, femur, and tibia on the left side showed fibrous dysplasia (arrows) and rickets. What is the most likely diagnosis in this case? | McCune–Albright syndrome | {
"A": "Carney complex",
"B": "Fanconi anemia",
"C": "McCune–Albright syndrome",
"D": "Neurofibromatosis type 1 (NF1)",
"E": "Osteofibrous dysplasia"
} | C |
A 68-year-old woman presented to clinic with a 40-year history of worsening hyperkeratotic non-painful, non-pruritic papules and plaques on her hands and feet. Her mother, son, and granddaughter had similar lesions. What is the diagnosis? | Punctate palmoplantar keratoderma | {
"A": "Erythema multiforme",
"B": "Punctate palmoplantar keratoderma",
"C": "Incontinentia pigmenti",
"D": "Tuberous sclerosis",
"E": "Syphilis"
} | B |
A 35-year-old man presented with sharp neck pain and a sensation of having a foreign body in his throat over the past year. What is the most likely diagnosis? | Eagle’s syndrome | {
"A": "Cervical spondyloarthropathy",
"B": "Oropharyngeal fish bone foreign body",
"C": "Temporomandibular joint dysfunction",
"D": "Ernest syndrome",
"E": "Eagle’s syndrome"
} | E |
A 36-year-old woman presented with uncontrolled hypertension after an emergency cesarean section and was found to have bilateral renal artery stenosis and this imaging finding. What is the most likely diagnosis? | Takayasu’s arteritis | {
"A": "Takayasu’s arteritis",
"B": "Aortic dissection",
"C": "Classical polyarteritis nodosa",
"D": "Abdominal aortic aneurysm",
"E": "Microscopic polyangiitis"
} | A |
This patient presented with a 1-day history of fever, acute painful symmetric polyarthritis, abdominal pain, and hematemesis. What is the diagnosis? | Henoch-Schönlein purpura | {
"A": "Bacterial endocarditis",
"B": "Henoch-Schönlein purpura",
"C": "Purpura fulminans",
"D": "Rheumatic fever",
"E": "Rocky Mountain spotted fever"
} | B |
A 38-year-old woman with a history of three cesarean sections was admitted to the hospital in labor at 36 weeks of gestation. Following an emergency cesarean section, histopathological examination identified invasion of chorionic villi into but not through the myometrium. What is the diagnosis? | Placenta increta | {
"A": "Placenta accreta",
"B": "Placenta increta",
"C": "Placenta percreta",
"D": "Decidua",
"E": "Choriocarcinoma"
} | B |
A 36-year-old man presented with 1 month of fever and pain in his shoulders and knees after having a sore throat. He subsequently developed this evanescent nonpruritic macular rash (marked with a skin marking pen). What is the diagnosis? | Erythema marginatum | {
"A": "Erythema infectiosum",
"B": "Erythema multiforme",
"C": "Erythema migrans",
"D": "Erythema nodosum",
"E": "Erythema marginatum"
} | E |
A 26-year-old woman presented with recurrent hemoptysis coinciding with her menstrual cycles. Noncontrast computed tomography (CT) imaging of the lungs showed a cavitary nodule with ground-glass appearance in the right lower lobe. What is the most likely diagnosis? | Thoracic endometriosis | {
"A": "Accessory breast tissue",
"B": "Catamenial pneumothorax",
"C": "Ectopic pregnancy",
"D": "Progestogen hypersensitivity",
"E": "Thoracic endometriosis"
} | E |
A previously healthy 10-year-old boy was brought to the pediatric emergency department with a 4-day history of progressively worsening bruising around the eyelids. Four weeks prior, he developed a dry cough, which had intensified over the previous week. The patient was up to date on routine vaccinations and had no history of trauma or bleeding disorders. On physical examination, ecchymosis was noted on the eyelids, along with subconjunctival hemorrhages in both eyes. A complete ophthalmologic examination was otherwise normal. Which of the following is the most likely etiology of the patient’s symptoms and findings? | Pertussis | {
"A": "Acute lymphoblastic leukemia",
"B": "Influenza",
"C": "Inhaled foreign body",
"D": "Leptospirosis",
"E": "Pertussis"
} | E |
An 11-year-old boy was brought to the emergency department with epistaxis and severe nasal pain. What is the likely diagnosis? | Button magnets in the nasal cavity | {
"A": "Nasal polyps",
"B": "Nasal septum fracture",
"C": "Pills in the nasal cavity",
"D": "Coins in the nasal cavity",
"E": "Button magnets in the nasal cavity"
} | E |
A 67-year-old man with a substantial cardiac history and renal disease presented to the emergency department with neck swelling, dysphagia, and hoarseness. Computed tomographic scans of his neck showed these findings. What is the diagnosis? | Iodide-associated sialadenitis | {
"A": "Acute bacterial sialadenitis",
"B": "Mumps",
"C": "Iodide-associated sialadenitis",
"D": "Sialolithiasis",
"E": "Mikulicz syndrome"
} | C |
A 44-year-old man presented to the emergency department with a 3-day history of vision loss and pain in the left eye. The symptoms had started after he had passed out for 3 hours in a position that put pressure on his left eye; before losing consciousness, he had taken insomnia medications and consumed alcohol. An anterior segment examination showed hemorrhagic chemosis and a fixed, mid-dilated pupil (left). The intraocular pressure in the left eye was normal. Funduscopy showed diffuse retinal whitening, a finding consistent with infarction, and optical coherence tomography revealed full-thickness retinal edema. Magnetic resonance imaging of the orbit showed engorgement of the extraocular muscles and orbital tissue (right). A diagnosis of ischemic retinopathy and choroidopathy owing to prolonged orbital compression was made. Which of the following is LEAST likely to be found on physical examination in this patient? | Vertical nystagmus | {
"A": "Absence of light perception in the left eye",
"B": "A relative afferent pupillary defect",
"C": "Complete ophthalmoplegia of the left eye",
"D": "Proptosis",
"E": "Vertical nystagmus"
} | E |
An 83-year-old woman presented to the emergency department with a 1-day history of right-sided tongue swelling. Sensory examination of the tongue was normal. What is the diagnosis? | Thromboembolism | {
"A": "Thromboembolism",
"B": "Sjogren's disease",
"C": "Hematoma",
"D": "Anti-neutrophil cytoplasm antibodies (ANCA) vasculitis",
"E": "Hereditary angioedema"
} | A |
A newborn boy was admitted to the neonatal intensive care unit for management of a congenital abnormality, which had first been identified on an antenatal ultrasound image at 20 weeks’ gestation. A physical examination was notable for the presence of a red, fluid-filled sac, measuring 7.7 cm by 7.1 cm by 5.3 cm, that protruded through a lumbosacral defect. Subsequent magnetic resonance imaging of the spine confirmed the finding. What is the most likely diagnosis? | Meningocele | {
"A": "Dandy-Walker syndrome",
"B": "Hemangioma",
"C": "Meningocele",
"D": "Presacral neurenteric cyst",
"E": "Spina bifida occulta"
} | C |
A 64-year-old man with metastatic lung adenocarcinoma who had recently started high-dose steroids for malignant spinal cord compression developed an itchy rash and diarrhea. He had a 3-year history of intermittent peripheral eosinophilia of unknown cause. What is the most likely diagnosis? | Larva currens from Strongyloides | {
"A": "Cutaneous larva migrans",
"B": "Cutaneous schistosomiasis",
"C": "Larva currens from Strongyloides",
"D": "Lichen striatus",
"E": "Scabies"
} | C |
A 68-year-old woman presented to the otorhinolaryngology clinic with a 5-year history of swelling in the neck and the recent development of discomfort when she swallowed. What is the most likely diagnosis? | Thyroglossal duct cyst | {
"A": "Pharyngeal abscess",
"B": "Thyroglossal duct cyst",
"C": "Reactive viral lymphadenopathy",
"D": "Hodgkin's lymphoma",
"E": "Hemangiomas"
} | B |
A previously healthy 42-year-old woman presented to the dental clinic with a 6-month history of swelling and pain on the right side of her chin (left). She reported no history of chin trauma, tooth pain, or fevers, but did recall injuring her right lateral incisor 10 years prior. Palpation of the lesion caused pain and serosanguinous fluid drainage. Intra-oral examination showed discoloration of the right lateral mandibular incisor (right). What is the most likely diagnosis? | Odontogenic cutaneous fistula | {
"A": "Odontogenic cutaneous fistula",
"B": "Osteosarcoma",
"C": "Pilar cyst",
"D": "Sebaceous cyst",
"E": "Squamous cell carcinoma"
} | A |
A 66-year-old man with a history of hypertension, diabetes mellitus, and ischemic stroke was transferred to a tertiary hospital after a cardiac arrest. For 6 months before presentation, he had recurrent exertional angina but had not sought evaluation. On the morning of the cardiac arrest, he had woken up with chest pain, lost consciousness, and regained consciousness after brief cardiopulmonary resuscitation by his family. On transfer to the tertiary hospital, findings from a physical examination and a transthoracic echocardiogram were normal. Coronary angiography revealed 50% stenosis in the middle left anterior descending (LAD) coronary artery during diastole (upper left) with complete occlusion during systole (upper right) and sluggish distal flow. Which of the following is NOT a recommended therapy for this condition? | Nitroglycerin | {
"A": "Beta blockers",
"B": "Calcium channel blockers",
"C": "Coronary artery bypass grafting",
"D": "Ivabradine",
"E": "Nitroglycerin"
} | E |
What is the most likely cerebrospinal fluid (CSF) finding from the lumbar puncture seen here in a patient with lower-extremity weakness? | Elevated protein | {
"A": "Bilirubin elevation",
"B": "Pseudomonas aeruginosa",
"C": "Lymphocytosis",
"D": "Bleeding diathesis",
"E": "Elevated protein"
} | E |
Which of the following choices is the least likely diagnosis for the sudden painless vision loss in this patient? | Narrow angle glaucoma | {
"A": "Vitreous hemorrhage",
"B": "Retinal artery occlusion",
"C": "Retinal vein occlusion",
"D": "Occipital stroke",
"E": "Narrow angle glaucoma"
} | E |
A 6-year-old girl presented with short stature, impaired hearing, and vision loss at 2 years of age. A radiograph of her wrists show the following features. What is the diagnosis? | Osteopetrosis | {
"A": "Lead poisoning",
"B": "Osteopetrosis",
"C": "Fibrous dysplasia",
"D": "Hypoparathyroidism",
"E": "Hypervitaminosis D"
} | B |
This patient presented with transient, painless visual obscuration in the left eye. What is the diagnosis? | Cholesterol emboli | {
"A": "Papilledema",
"B": "Hypertensive retinopathy",
"C": "Cholesterol emboli",
"D": "Temporal arteritis",
"E": "Diabetic retinopathy"
} | C |
These lesions appeared spontaneously in a patient with untreated multiple myeloma. Coagulation studies were normal and platelet count was 80,000 per cubic millimeter. What is the diagnosis? | Amyloid purpura | {
"A": "Orbital fracture",
"B": "Disseminated intravascular coagulation",
"C": "Tuberous sclerosis",
"D": "Amyloid purpura",
"E": "Horner's syndrome"
} | D |
An otherwise healthy 10-year-old girl presented to the primary care clinic with a 10-day history of multiple itchy papules on the soles of her feet and on her toes. The lesions had black dots in the center and were painful. Two weeks earlier, the family had traveled to rural Brazil. During that time, the patient had played in a pigsty without wearing shoes. Sand fleas were removed from multiple lesions. What is the most likely diagnosis? | Tungiasis | {
"A": "Coxsackievirus infection",
"B": "Furuncular myiasis",
"C": "Foreign body granulomas",
"D": "Tungiasis",
"E": "Scabies infestation"
} | D |
This 6-year-old boy presented with fever and rash that did not improve despite treatment with cephalexin. What diagnosis is suggested? | Staphylococcal scalded skin | {
"A": "Bullous pemphigoid",
"B": "Staphylococcal scalded skin",
"C": "Stevens-Johnson syndrome",
"D": "Herpes simplex infection",
"E": "Kawasaki disease"
} | B |
A 77-year-old woman presented to a clinic with a 2-year history of slowly progressive, painful swelling of her fingertips. Physical examination of the hands showed thickening of the skin on her right hand as well as soft-tissue swelling of the tips of the fingers of both hands. A plain radiograph of the hands is shown. What is the most likely diagnosis? | Calcinosis | {
"A": "Tophaceous gout",
"B": "Calcinosis",
"C": "Metastatic chondrosarcoma",
"D": "Vitamin D toxicity",
"E": "Myositis ossificans"
} | B |
A 24-year-old woman with a 10-year history of intermittent episodes of redness and photophobia in both eyes presented to the ophthalmology clinic. On examination, the visual acuity was 20/30 in the right eye and 20/25 in the left eye. Slit-lamp examination revealed conjunctival hyperemia and peripheral corneal opacification, with inflammation and crystalline deposits on the corneal stroma consistent with interstitial keratitis. Six months later, the patient reported having vertigo, tinnitus, and hearing loss. What is the diagnosis? | Cogan’s syndrome | {
"A": "Syphilis",
"B": "Systemic lupus erythematosus",
"C": "High lead exposure",
"D": "Cogan’s syndrome",
"E": "Lymphoma"
} | D |
A 43-year-old woman presented to the dermatology clinic with an 8-year history of yellow-brown spots on her shins. The lesions had been asymptomatic, and she had not sought care for them until they had grown in size. She had no history of diabetes mellitus, hypertension, or thyroid disease. On physical examination, atrophic yellow-brown plaques with telangiectasias and irregular violaceous borders were observed on both shins. A skin biopsy of the right shin was performed. Histopathological analysis showed several layers of necrobiosis within the dermis, perivascular inflammatory-cell infiltrates, collagen degeneration, and findings consistent with granulomatous dermatitis. Which of the following is the most likely diagnosis? | Necrobiosis lipoidica | {
"A": "Cutaneous sarcoidosis",
"B": "Granuloma annulare",
"C": "Necrobiosis lipoidica",
"D": "Pigmented purpuric dermatosis",
"E": "Stasis purpuric dermatosis"
} | C |
A 3-day-old male infant presented to the hospital with vomiting and inability to pass stools. Physical exam revealed a distended abdomen without bowel sounds. Exploratory laparotomy was done. What is the diagnosis? | Hirschsprung’s disease | {
"A": "Bowel obstruction",
"B": "Hirschsprung’s disease",
"C": "Toxic megacolon",
"D": "Meckel’s diverticulum",
"E": "Meconium ileus"
} | B |
A 65-year-old man with type 2 diabetes was admitted to the hospital with hyperosmolar hyperglycemia state. Two weeks before admission, the patient’s insulin dose had been increased owing to inadequate glycemic control. The physical exam was notable for confusion and sarcopenia. There were also rubbery, subcutaneous masses on either side of the umbilicus where the patient had been repeatedly administering insulin injections. Which of the following should be done to prevent this finding? | Rotating insulin injection sites | {
"A": "Cool site before injecting",
"B": "Discontinue the use of irritating cleansing solutions at injection sites",
"C": "Massage the injection site after injecting",
"D": "Rotating insulin injection sites",
"E": "Use smaller needles"
} | D |
A 27-year-old man with a history of obesity presented to the dermatology clinic with an asymptomatic rash on his back, arms, and hands that had developed 1 week earlier. On physical examination, scattered pink-yellow papules were present on the upper back, extensor surfaces of the upper arms, and dorsa of the hands. A fasting blood sample was grossly lipemic. Which of the following is the most likely diagnosis? | Eruptive xanthomas | {
"A": "Eruptive xanthomas",
"B": "Generalized eruptive histiocytoma",
"C": "Granuloma annulare",
"D": "Molluscum contagiosum",
"E": "Sebaceous hyperplasia"
} | A |
A 62-year-old man presented to the emergency department with a 2-week history of generalized weakness and a diffuse rash. On examination he had a temperature of 38.1°C (100.6°F). Physical examination showed a maculopapular, hyperpigmented, and scaly eruption on his palms, soles, and trunk. Which one of the following is the diagnosis? | Secondary syphilis | {
"A": "Erythema multiforme",
"B": "Rocky Mountain spotted fever",
"C": "Secondary syphilis",
"D": "Pityriasis rosea",
"E": "Infectious mononucleosis"
} | C |
A 17-year-old boy from rural Mexico presented to the hospital with a 3-week history of decreased visual acuity and pain in the right eye. What is the diagnosis? | Intraocular parasite infection | {
"A": "Intraocular parasite infection",
"B": "Bacterial uveitis",
"C": "Viral keratitis",
"D": "Angle closure glaucoma",
"E": "Optic neuritis"
} | A |
A 40-year-old man presented with a 2-day history of a burning rash on both hands. Physical examination was notable for a confluent region of erythema extending from the dorsal aspect of the thumbs to the medial aspect of the second finger. Scattered patches of erythema were observed on the knuckles and other fingers, and a small blister was noted on the base of the left thumb. What is the most likely diagnosis? | Phytophotodermatitis | {
"A": "Atopic dermatitis",
"B": "Hand, foot, and mouth disease",
"C": "Irritant contact dermatitis",
"D": "Phytophotodermatitis",
"E": "Porphyria cutanea tarda"
} | D |
A 71-year-old man presented to the nephrology department for the evaluation of chronic kidney disease. He had erythematous papules on his face and these lesions on his toenails. What is the diagnosis? | Periungual fibroma | {
"A": "Squamous-cell carcinoma",
"B": "Verrucae vulgaris",
"C": "Cutaneous horn",
"D": "Pyogenic granuloma",
"E": "Periungual fibroma"
} | E |
This 6-day-old infant's mother had developed intensely pruritic lesions at 33 weeks of gestation. What is the diagnosis? | Herpes gestationis | {
"A": "Congenital syphilis",
"B": "Epidermolysis bullosa acquisita",
"C": "Neonatal gonorrhea",
"D": "Herpes gestationis",
"E": "Pruritic plaques of pregnancy"
} | D |
An 82-year-old man presented to the emergency department with a 3-year history of progressive generalized weakness. Four months before presentation, a left adrenal mass had been identified incidentally on computed tomography (CT) that had been performed to evaluate an episode of chest pain. During the month preceding presentation, he had lost 8 kg of weight and had become unable to sit up in bed. Physical examination was unremarkable. Laboratory studies were notable for a white-cell count of 2700 per cubic millimeter (reference range, 3700 to 10,500), a normal adrenal axis, and negative testing for HIV. Owing to concern for cancer, positron-emission tomography–CT of the whole body was performed and showed an adrenal mass on each side with fluorodeoxyglucose (FDG) uptake (left image shows a coronal view), a 17-cm-long spleen without FDG uptake (asterisk in left image), and no other abnormal findings. Subsequent biopsy of the left adrenal mass showed necrotizing granulomatous inflammation with intracellular fungal organisms (middle, arrows; hematoxylin and eosin staining) that stained positive with Grocott’s methenamine
silver (right). The organism causing this disease is predominantly found in what geographic regions? | Central and mideastern United States & Central America | {
"A": "Central and mideastern United States & Central America",
"B": "Central and South America",
"C": "Southeast Asia, southern China, & eastern India",
"D": "Southwestern United States",
"E": "Ubiquitously in soil throughout the globe"
} | A |
A 70-year-old woman with depression and irritable bowel syndrome presented to the emergency department with a 3-day history of altered mental status, shortness of breath, nausea, and vomiting. She had recently been self-medicating worsening irritable bowel symptoms. Physical examination was notable for a respiratory rate of 22 breaths per minute, confusion, and mild, diffuse abdominal pain. Laboratory testing showed primary anion-gap metabolic acidosis and primary respiratory alkalosis. Toxicity of which of the following is the most likely cause of her acute symptoms and the findings seen in this non-contrast abdominal radiograph? | Bismuth Salicylate | {
"A": "Bismuth Salicylate",
"B": "Calcium Carbonate",
"C": "Ferrous Sulfate",
"D": "Magnesium hydroxide",
"E": "Simethicone"
} | A |
A 62-year-old man with chronic obstructive pulmonary disease presented to the emergency department with a 2-day history of dyspnea. He required intubation and ventilation when he was found to be in hypercapnic respiratory failure. Five days after admission to the ICU, his urine became green. Which of the following medications caused this? | Propofol | {
"A": "Omeprazole",
"B": "Morphine sulfate",
"C": "Ipratropium bromide",
"D": "Propofol",
"E": "Midazolam"
} | D |
Which of the following is the least likely differential diagnosis associated with this image finding? | Pulmonary hypertension | {
"A": "Pulmonary hypertension",
"B": "Neoplasm",
"C": "Vasculitis",
"D": "Septic emboli",
"E": "Infection"
} | A |
A 4-month-old boy who was exclusively breast-fed presented to the clinic with a 6-week history of a worsening rash. Physical examination revealed extensive erosive plaques throughout the body. What is the diagnosis? | Zinc deficiency | {
"A": "Atopic dermatitis",
"B": "Epidermolysis bullosa",
"C": "Stevens-Johnson Syndrome",
"D": "Zinc deficiency",
"E": "Erythema infectiosum"
} | D |
These lesions became more evident after the skin was illuminated with Wood's light. What diagnosis is suggested? | Vitiligo | {
"A": "Pityriasis rosea",
"B": "Melanoma",
"C": "Tuberous sclerosis",
"D": "Psoriasis",
"E": "Vitiligo"
} | E |
A 3-year-old boy was brought to the endocrinology department with an 18-month history of bowing of the left leg that had resulted in regression of his ability to walk. On physical examination, there was lateral bowing of the left femur and anterior bowing of the left tibia, as well as testicular enlargement. Café au lait spots were also noted on the lower back, cheek, and neck. Radiographs of the wrist, femur, and tibia on the left side showed fibrous dysplasia (arrows) and rickets. What is the most likely diagnosis in this case? | McCune–Albright syndrome | {
"A": "Carney complex",
"B": "Fanconi anemia",
"C": "McCune–Albright syndrome",
"D": "Neurofibromatosis type 1 (NF1)",
"E": "Osteofibrous dysplasia"
} | C |
A 80-year-old man undergoing treatment for multiple myeloma presented with fevers and confusion. Magnetic resonance imaging (MRI) of the head showed ring-enhancing lesions. Gram stain of cerebrospinal fluid (CSF) showed gram-positive bacilli. What is the most likely diagnosis? | Nocardiosis | {
"A": "Clostridium septicum",
"B": "Listeriosis",
"C": "Nocardiosis",
"D": "Peptostreptococcus species",
"E": "Propionibacterium acnes"
} | C |
A 46-year-old woman receiving atezolizumab for bladder cancer presented to the ophthalmology clinic with a 7-day history of pain, photophobia, and blurring of vision in both eyes. Slit-lamp examination showed conjunctival redness, pseudomembrane formation, and corneal epithelial damage. What is the diagnosis? | Autoimmune keratitis | {
"A": "Autoimmune keratitis",
"B": "Herpes simplex virus",
"C": "Pseudomonas keratitis",
"D": "Acanthamoeba keratitis",
"E": "Bladder cancer metastases"
} | A |
A previously healthy 2-year-old boy was brought to clinic with a 1-week history of itchy, red spots. Three days before the onset of the rash, the child had had an upper respiratory infection for which he had been given ibuprofen. On physical examination, tense vesicles and edematous pink plaques with central erosions and crust were seen on the patient’s legs, arms, and back. Dense clustering of skin lesions was observed in the axillae and inguinal folds. No mucosal involvement was noted. Histopathological analysis of a skin-biopsy sample obtained from the right lower back showed a subepidermal blister with robust neutrophilic infiltration. Direct immunofluorescence revealed a linear band of IgA along the dermoepidermal junction. What is the most likely diagnosis? | Linear IgA bullous dermatosis of childhood | {
"A": "Acute febrile neutrophilic dermatosis",
"B": "Dermatitis herpetiformis",
"C": "Erythema multiforme",
"D": "Henoch-Schonlein purpura",
"E": "Linear IgA bullous dermatosis of childhood"
} | E |
What is the most likely diagnosis for these two painless periumbilical masses in a 76-year-old man with type 2 diabetes mellitus? | Insulin-induced lipohypertrophy | {
"A": "Abscess",
"B": "Dermatofibrosarcoma protuberans",
"C": "Hematoma",
"D": "Insulin-induced lipohypertrophy",
"E": "Nodular fasciitis"
} | D |
A 7-year-old boy presented to the pediatric otolaryngology clinic with a 3-year history of multiple firm, painless, slow-growing nodules on his tongue. He had a history of mild developmental delay, and a physical examination showed a high arched palate and marfanoid habitus. What is the most likely underlying diagnosis? | Multiple endocrine neoplasia type 2B | {
"A": "Gaucher’s disease",
"B": "Multiple endocrine neoplasia type 2B",
"C": "Tuberous sclerosis",
"D": "Familial hypercholesterolemia",
"E": "Marfan’s syndrome"
} | B |
A 39-year-old man with human immunodeficiency virus infection that was being treated with antiretroviral therapy presented to the dermatology clinic with a 1-year history of recurrent, painful penile ulcers. Approximately once per month, erosions would appear ulcerate, heal spontaneously and then recur. Laboratory testing showed a CD4 cell count of 494 per cubic millimeter (reference range, 414 to 1123) and an HIV viral load of 450 copies per milliliter (reference range, <20). Biopsies of the lesions revealed epidermal necrosis, pseudoepitheliomatous epidermal hyperplasia, and a dense infiltrate of inflammatory cells in the dermis and subcutaneous tissue. Next-generation sequencing (NGS) of the tissue was performed. What is the most likely diagnosis? | Herpes vegetans | {
"A": "Chancroid",
"B": "Condyloma acuminata",
"C": "Condyloma lata",
"D": "Herpes vegetans",
"E": "Pemphigus vegetans"
} | D |
A 55-year-old man underwent colonoscopy after complaining of crampy lower abdominal pain. Mobile 1-cm worms were noted in cecum. What is the most likely diagnosis? | Enterobius vermicularis | {
"A": "Trichuris trichiura",
"B": "Enterobius vermicularis",
"C": "Ancylostoma duodenale",
"D": "Ascaris lumbricoides",
"E": "Necator americanus"
} | B |
Which of the following is the least likely differential diagnosis associated with this image finding? | Lead exposure | {
"A": "Lead exposure",
"B": "Polyvinyl chloride exposure",
"C": "Hyperparathyroidism",
"D": "Systemic sclerosis",
"E": "Diabetes"
} | A |
What is the most likely diagnosis in a woman with a chronic depigmenting rash with periods of remission and these findings? | Tinea versicolor | {
"A": "Tinea versicolor",
"B": "Psoriasis",
"C": "Seborrheic dermatitis",
"D": "Vitiligo",
"E": "Pityriasis rosea"
} | A |
A 31-year-old man presented to the emergency department with confusion. He was found to be anemic with a hemoglobin level of 6.7 g per deciliter. Additional laboratory tests revealed an elevated indirect bilirubin level, an elevated lactate dehydrogenase level, and undetectable haptoglobin. A peripheral-blood smear was performed. With what underlying disease process is this form of anemia most closely associated? | Decompensated cirrhosis | {
"A": "Decompensated cirrhosis",
"B": "Myelodysplastic syndrome",
"C": "Iron deficiency",
"D": "End-stage renal disease",
"E": "Vitamin B12 deficiency"
} | A |
A 19-year-old man with a history of mild acne vulgaris presented with a 10-day history of rapidly worsening acne, along with fever, muscle aches, and knee pain. His temperature was 38.5°C. On physical examination, diffuse papulonodular and pustular lesions with areas of overlying crusting were noted across the forehead, nose, cheeks, and chin. There were similar lesions on the neck, shoulders, chest, back, and thighs. Laboratory studies were notable for neutrophilic leukocytosis and an elevated erythrocyte sedimentation rate and C-reactive protein level. A culture of a skin swab grew only Cutibacterium acnes. Histopathological examination of a skin-biopsy specimen taken from behind the left ear showed suppurative folliculitis with adjacent dermal edema. What is the most likely diagnosis? | Acne fulminans | {
"A": "Acne fulminans",
"B": "Acute febrile neutrophilic dermatosis",
"C": "Hidradenitis suppurativa",
"D": "Pustular psoriasis",
"E": "Rosacea fulminans"
} | A |
A previously healthy 18-month-old girl was brought to the emergency department with sudden-onset abdominal distention that had been preceded by 3 days of diarrhea and 1 day of vomiting. On physical examination, the patient appeared lethargic and dehydrated. The abdomen was markedly distended with decreased bowel sounds, but there was no tenderness or guarding. An abdominal radiograph, obtained with the patient in the supine position, showed three circular radiopaque objects in the intestines, along with dilated loops of bowel. What is the most appropriate next step in this case? | Emergency exploratory laparotomy | {
"A": "Colonoscopy retrieval",
"B": "Emergency exploratory laparotomy",
"C": "Laxatives",
"D": "Observation and monitoring",
"E": "Serial imaging"
} | B |
A 51-year-old male with diabetes presented with 2 weeks of general malaise and fever. What is the diagnosis? | Emphysematous pyelonephritis | {
"A": "Small bowel obstruction",
"B": "Emphysematous pyelonephritis",
"C": "Paralytic ileus",
"D": "Renocolic fistula",
"E": "Splenic abscess"
} | B |
A 71-year-old man was hospitalized with altered mental status progressing over the preceding 3 weeks. The patient had a recent diagnosis of adenocarcinoma of the colon with known metastatic lesions in the lung and bones. A gadolinium-enhanced magnetic resonance image of the brain was performed and is shown. What is the most likely diagnosis? | Metastatic adenocarcinoma | {
"A": "Group D streptococcus abscesses",
"B": "Neurocysticercosis",
"C": "Metastatic adenocarcinoma",
"D": "Tuberculosis",
"E": "Primary central nervous system lymphoma"
} | C |
A 68-year-old woman living in Japan presented to the clinic with a 5-day history of fevers, myalgias, and petechial rash spreading on her arms, trunk, palms, and soles. On exam, there was also an eschar on the right medial ankle. Laboratory studies showed thrombocytopenia, elevated inflammatory markers, and elevated liver transaminases. Which of the following is the most appropriate treatment? | Tetracycline | {
"A": "Antihistamine",
"B": "Glucocorticoid",
"C": "Observation",
"D": "Tetracycline",
"E": "Valacyclovir"
} | D |
A 48-year-old man presented to the dermatology clinic with a 6-month history of painful hand ulcerations and shortness of breath. He has no muscle weakness or arthritis. What is the diagnosis? | Anti-MDA5 dermatomyositis | {
"A": "CREST syndrome",
"B": "Anti-MDA5 dermatomyositis",
"C": "Pyoderma gangrenosum",
"D": "Cutaneous polyarteritis nodosa",
"E": "Behcet’s disease"
} | B |
A 64-year-old man with a history of bladder cancer treated with radical cystectomy and orthotopic neobladder construction with intestinal segments presented to the emergency department with left flank pain and urinary retention. CT of the abdomen and pelvis showed a very large stone in the neobladder. What is the predominant composition of this patient’s stone? | Calcium phosphate | {
"A": "Struvite",
"B": "Uric acid",
"C": "Calcium oxalate",
"D": "Calcium phosphate",
"E": "Cystine"
} | D |
A 37-year-old primigravid woman presented at 30 weeks’ gestation with a 4-month history of pruritic pustules on her torso, arms, and legs. On examination, there were papules, nodules, and follicular pustules with surrounding erythema, with no lesions on the palms and soles. A skin biopsy showed subepidermal pustules and perifollicular neutrophilic infiltration. Gram’s stain, periodic acid–Schiff stain, and Grocott methenamine silver stain were all negative. What is the most likely diagnosis? | Atopic eruption of pregnancy | {
"A": "Atopic eruption of pregnancy",
"B": "Disseminated herpes zoster",
"C": "Pemphigoid gestationis",
"D": "Polymorphic eruption of pregnancy",
"E": "Secondary syphilis"
} | A |
A 37-year-old woman with idiopathic T-cell deficiency underwent computed tomography of the abdomen. What diagnosis is most likely to account for the findings? | Histoplasmosis | {
"A": "Histoplasmosis",
"B": "Miliary tuberculosis",
"C": "Amyloidosis",
"D": "Lymphoma",
"E": "Portal hypertension"
} | A |
This man presented 1 day after being treated with penicillin for a toothache. What is the diagnosis? | Ludwig's angina | {
"A": "Acute parotitis",
"B": "Angioneurotic edema",
"C": "Ludwig's angina",
"D": "Penicillin allergy",
"E": "Peritonsillar abscess"
} | C |
A 6-month-old girl was referred to the hospital for evaluation and treatment of a perirectal mass which had first been noted at 2 weeks of age. Physical examination showed frontal bossing but no rash, hepatosplenomegaly, lymphadenopathy, or limitation of limb movement. A lateral radiograph of the right tibia showed severe periostitis. What is the diagnosis? | Congenital syphilis | {
"A": "Infantile hemangioma",
"B": "Imperforate hymen",
"C": "Perianal hamartomatous polyps",
"D": "Congenital syphilis",
"E": "Perianal rhabdomyosarcoma"
} | D |
A 23-year-old woman presented with a 1-month history of headache, syncope, weight gain. Physical examination revealed hypertrophic appearance of the thigh and calf muscles, and imaging of her thighs is shown. What is the diagnosis? | Cysticercosis | {
"A": "Septic emboli",
"B": "Echinococcus granulosus",
"C": "Myxoid sarcoma",
"D": "Cysticercosis",
"E": "Toxoplasma gondii"
} | D |
A 37-year-old man presented with a 4-year history of excessive sweating, headaches, and joint pain. His wife had also noticed increasing skin folds on his scalp. What is the most likely diagnosis? | Acromegaly | {
"A": "Acromegaly",
"B": "Amyloidosis",
"C": "Systemic sclerosis",
"D": "Hypogonadism",
"E": "Sarcoidosis"
} | A |
This patient presented with cough. What diagnosis accounts for the combination of findings on the bone scan? | Metastatic lung cancer | {
"A": "Adverse effect of chronic glucocorticoids",
"B": "Mastocytosis",
"C": "Metastatic lung cancer",
"D": "Osteomalacia with fracture",
"E": "Paget's disease"
} | C |
This 75-year-old man presented with cough and hoarseness. What is the most likely cause of his appearance? | Superior vena cava syndrome | {
"A": "Superior vena cava syndrome",
"B": "Mitral stenosis",
"C": "Chronic obstructive airways disease",
"D": "Angioedema",
"E": "Systemic lupus erythematosus"
} | A |
A 50-year-old man with a history of large-cell neuroendocrince carcinoma of the lung presented with a 5-day history of shortness of breath, chest pain, and a cough. Physical examination noted diminished breath sounds in the right lower lobe and cough after fluid intake. What is the diagnosis? | Bronchoesophageal fistula | {
"A": "Bronchoesophageal fistula",
"B": "Aspiration pneumonia",
"C": "Pharyngeal pseudodiverticulum",
"D": "Zenker’s diverticulum",
"E": "Gastroesophageal reflux disease"
} | A |
A 90-year-old man with atrial fibrillation and dementia presented to the hospital with sudden onset of dyspnea that had begun 1 hour earlier. Before admission, he had not been taking anticoagulation therapy on the basis of discussions of his preferences with his primary care physician. Physical examination was notable for tachypnea and tachycardia. On chest radiography, the pulmonary vasculature was not visible in the right lung fields. In addition, the right descending pulmonary artery was enlarged. What diagnosis is suggested by these chest radiograph appearances? | Pulmonary embolism | {
"A": "Ascending Aortic Aneurysm",
"B": "Atrial septal defect",
"C": "Bullous emphysema",
"D": "Pulmonary embolism",
"E": "Pulmonary arterial hypertension"
} | D |
A 62-year-old man presented to the emergency department with a 1-day history of fever and 3-day history of chest pain. He had a history of coronary artery disease and splenectomy. On examination, he had three dog-bite wounds on his left hand. Laboratory studies revealed a white-cell count of 16,700 per cubic millimeter (reference range, 3900 to 10,200) and a platelet count of 3100 per cubic millimeter (reference range, 15,000 to 37,000). Review of a peripheral-blood smear was as shown. What is the etiology of his illness? | Capnocytophaga canimorsus | {
"A": "Pasteurella multocida",
"B": "Capnocytophaga canimorsus",
"C": "Pasteurella canis",
"D": "Babesia microti",
"E": "Bacillus anthracis"
} | B |
A 30-year-old man presented with a rash on his face, hands, and feet. He had a history of HIV with a CD4+ T-cell count of 374 per cubic millimeter. Physical examination showed circinate lesions on the palms, soles, and face and patchy alopecia. What is the likely diagnosis? | Syphilis | {
"A": "Disseminated granuloma annulare",
"B": "Erythema annulare centrifugum",
"C": "Syphilis",
"D": "Tinea corporis",
"E": "Tuberculoid leprosy"
} | C |
An 80-year-old man presented with this lesion on the bottom of his left foot, which had been growing for the past 2 years. It had become ulcerated and bled intermittently. What is the diagnosis? | Amelanotic melanoma | {
"A": "Microvenular hemangioma",
"B": "Benign lymphangioendothelioma",
"C": "Amelanotic melanoma",
"D": "Pyogenic granuloma",
"E": "Bacillary angiomatosis"
} | C |
A 37-year-old man presented to the neurosurgery clinic with blurry vision, headache, and difficulty looking upward. On exam, he had diplopia, upward gaze palsy, and vertical misalignment of the eyes. His pupils only minimally constricted to light but constricted to near objects. What is the name of this pupillary exam finding? | Light-near dissociation | {
"A": "Adie’s pupil",
"B": "Anisocoria",
"C": "Argyll Robertson pupil",
"D": "Light-near dissociation",
"E": "Relative afferent pupillary defect (e.g., Marcus Gunn pupil)"
} | D |
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