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Question 1 of 6
1. Question
A 10-year-old boy is brought to the office due to abrupt onset fever and sore throat that began a day ago. He has had similar illnesses in the past, which were treated with oral antibiotics. The patient has no other medical conditions and has received all recommended vaccinations. Temperature is 38.3 C (101 F). Physical examination shows erythema of the posterior pharyngeal wall and enlarged tonsils, which are covered by white exudate. There are no enlarged cervical lymph nodes. Throat swab specimen is obtained. Which of the following would be most helpful in determining the need for antibiotic treatment in this patient?
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Question 2 of 6
2. Question
A 57-year-old man comes to the office due to 2 months of progressive cough and weight loss. He has a history of diabetes mellitus type 2 and chronic kidney disease. He does not smoke cigarettes. The patient traveled to Denmark 4 months ago for a 2-week vacation. He has 2 cats and a bird. He works in the maintenance department of a large hotel and services the hot tub and swimming pools. Temperature is 38 C (100.4 F), blood pressure is 140/100 mm Hg, pulse is 88/min, and respirations are 16/min. The patient is 190 cm (6 foot 3 inches) tall. BMI is 22 kg/m2. Examination shows cervical lymphadenopathy. Chest imaging is shown in the exhibit. Hemoglobin A1c is 8.5% and serum creatinine is 3.8 mg/dL. Which of the following risk factors most likely contributed to this patient’s current condition?
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Question 3 of 6
3. Question
A 2-month-old girl is brought to the office due to restricted movements of her upper and lower extremities with swelling of the wrist and knee joints for a week. She was born at 38 weeks gestation via an uncomplicated vaginal delivery and had an unremarkable neonatal course with no history of birth trauma or excessive bleeding. The mother had inconsistent prenatal care. The patient is exclusively breastfed. Examination shows swelling with no warmth or erythema of the bilateral wrist and knee joints. Spontaneous limb movements are decreased; the patient cries on passive movement of the joints. Mild pallor, generalized lymphadenopathy, and hepatosplenomegaly are present. X-rays of the wrist and knee joints reveal metaphyseal erosions with periosteal reaction. Which of the following is the most likely cause of this patient’s illness?
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Question 4 of 6
4. Question
A 25-year-old man comes to the office due to 4 days of persistent diarrhea. He has a history of HIV and is compliant with antiretroviral therapy. The diarrhea was initially watery but has become bloody over the past day. A stool culture grows Shigella flexneri, which is resistant to both azithromycin and fluoroquinolones. A recent study tracking resistance patterns in Shigella species reveals rapid spread of resistance genes between different bacterial populations due to the transfer of nonchromosomal DNA between adjacent bacteria via a small hair-like appendage. Which of the following best describes the process by which the bacteria responsible for this patient’s infection likely developed resistance?
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Question 5 of 6
5. Question
A 2-hour-old girl develops tachypnea and grunting in the newborn nursery. The patient was born via cesarean delivery to a 26-year-old mother, gravida 2 para 2. Respiratory rate is 82/min. The other vital signs are within normal limits. Physical examination shows grunting and subcostal retractions but clear lungs. Blood culture reveals gram-positive rods after 11 hours of incubation. Which of the following pathogens is the most likely cause of this patient’s condition?
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Question 6 of 6
6. Question
A 12-year-old girl is brought to an urgent care clinic due to nausea, vomiting, and crampy abdominal pain 3 hours after a summer cookout in a park, where she consumed potato salad, coleslaw, and a hamburger. Two other children who attended the event also had similar symptoms. She has no chronic medical conditions and previously felt well. On examination, the patient is afebrile, and the abdomen is soft and nontender. Her symptoms quickly resolve with supportive care. Which of the following strategies would have been most effective in preventing this patient’s illness?
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