A sexually active 20-year-old woman has had fever, chills, malaise, and pain of the vulva for 2 days. Examination shows a vulvar pustule that has ulcerated and formed multiple satellite lesions. Nodes are palpated in the inguinal and femoral areas. A smear of fluid from the lesions establishes the diagnosis. What is the most likely causal organism?
A 7-year-old girl is brought to the physician because of a 2-day history of fever, headache, sore throat, and swollen glands. She does not have a runny nose, congestion, or cough. She has no allergies to medications. Her temperature is 38.6C (101.4 F), blood pressure is 100/60 mm Hg, pulse is 120/min, and respirations are 16/min. Examination shows a swollen, erythematous oropharynx with tonsillar exudates. The anterior cervical lymph nodes are enlarged and tender. No other abnormalities are noted. Which of the following is the most likely causal organism?
Two days after admission to the hospital because of a 3-day history of slurred speech, double vision, and dysphagia, a 24-year-old woman becomes quadriplegic and requires intubation and mechanical ventilation. Her medical history is unremarkable. One week ago, she attended a family picnic; several of her family members have had abdominal cramps and diarrhea since the picnic. Her temperature is 37C (98.6 F), blood pressure is 120/80 mm Hg, and pulse is 120/min. Examination shows dry mucous membranes, large nonreactive pupils, ophthalmoplegia, and profound facial weakness. There is areflexia, quadriplegia, and no movement of the palate and tongue. Sensation is normal. Babinski’s sign is absent. Which of the following is the most appropriate pharmacotherapy?
A 2-year-old boy is brought to the physician because of fever and listlessness for 12 hours. He has had recurrent episodes of pneumonia and otitis media over the past year. Two maternal uncles died of pneumonia in early childhood. One year ago, he was at the 50th percentile for height and weight; he is currently at the 25th percentile for height and 10th percentile for weight. He appears ill. His temperature is 39 C (102.2 F), blood pressure is 60/40 mm Hg, pulse is 160/min, and respirations are 36/min. Examination shows cool and mottled extremities. A blood culture grows Streptococcus pneumoniae. Serum IgE, IgG, and IgM levels are markedly decreased. Which of the following diagnostic tests is most likely to be abnormal?
A 37-year-old woman comes to the physician because of a 1-day history of throbbing facial pain. She describes the pain as 7 out of 10 in intensity. Over the past 9 days, she has had nasal congestion, purulent nasal discharge, sore throat, and a nonproductive cough. She does not smoke. Her husband and children have had no recent illness. Her temperature is 38.5 C (101.3 F). Examination shows congested nasal mucosa and purulent discharge on the left. There is tenderness to palpation over the left cheek and no transillumination over the left maxillary sinus. The tympanic membranes are normal, and there is no erythema of the throat. Examination shows no cervical adenopathy. The lungs are clear to auscultation. What is the most likely causal organism?
A 3-year-old boy is brought to the physician because of a 7-day history of fever and a painful, swollen lymph node in his groin. This is his sixth episode of lymph node swelling; the previous episodes resolved after drainage and prolonged antibiotic therapy. He also had pneumonia at the age of 12 months that required chest tube placement for drainage. A maternal uncle died during childhood of recurrent infections. The patient is at the 5th percentile for height and weight. His temperature is 38.5 C (101.3 F). Examination shows a warm, tender, erythematous lymph node in the right inguinal area. There are several healed incisions over the inguinal area and neck from old drainage sites. Laboratory studies show: Hematocrit 35%, Leukocyte count 17,000/mm3, Segmented neutrophils 65%, Bands 10%, Lymphocytes 25%, Platelet count 350,000/mm3. A Gram’s stain of the lymph node aspirate shows numerous segmented neutrophils filled with bacteria; cultures grow Staphylococcus aureus. Which of the following is the most likely mechanism for these findings?
A 32-year-old man, who is receiving intensive chemotherapy for Hodgkin’s disease, has a temperature of 39°C (102.2°F). His respirations are 40/min and widespread crackles are heard in all lung fields. An x-ray film of the chest shows a diffuse alveolar and interstitial pattern. What is the most likely causal organism?
A previously healthy 52-year-old woman comes to the physician because she has had a large pimple on her right hand for 2 weeks that has failed to heal. She resides in southeastern USA where she owns a nursery and garden shop. Examination shows a painless red papule on the hand with several non tender subcutaneous nodular lesions above it. What is the most likely diagnosis?
A 32-year-old woman comes to the physician because of vaginal discharge for 2 weeks. She has been sexually active with one female partner for 5 years. She has not been treated with antibiotics over the past 2 years. Her last Pap smear was 6 years ago when she was sexually active with a male partner. She has not used illicit drugs or alcohol. Examination shows a grayish vaginal discharge with a pH greater than 4.5. A wet mount preparation of the vaginal discharge is most likely to show which of the following?
A previously healthy 37-year-old man comes to the physician because of fever, generalized muscle aches, and an ulcer on his neck. The ulcer began 10 days ago as a painless, itchy papule that enlarged over a 2-day period. Small, fluid-filled blisters formed on top of the papule. The blisters broke down, forming a painless ulcer covered by a black scab. He is employed as a postal worker, and his hobby is gardening. He also takes care of several cats at home. What is the most likely diagnosis?