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👨‍👩‍👧‍👦 Clinical Case Challenge 🏢 Brand: UWorld 📚 Source: UWorld ABFM Qbank 📝 A 65-year-old woman comes to the physician with a pruritic rash. This is the second year the rash has appeared, both times during the onset of winter. She has intensely pruritic…

👨‍👩‍👧‍👦 Clinical Case Challenge
🏢 Brand: UWorld
📚 Source: UWorld ABFM Qbank

📝 A 57-year-old woman, gravida 3 para 3, comes to the office due to increasing vaginal pressure. The patient has a normal, soft bowel movement daily but sometimes has to put her fingers in her vagina and apply pressure to defecate. The patient had 3 vaginal births, 2 of which were forceps assisted. BMI is 32 kg/m2. Physical examination shows protrusion of the distal rectovaginal wall into the vagina. The anal sphincter is intact with normal tone. Which of the following is the best next step in management of this patient?

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[poll]
👨‍👩‍👧‍👦 Clinical Case Challenge 🏢 Brand: UWorld 📚 Source: UWorld ABFM Qbank 📝 A 57-year-old woman, gravida 3 para 3, comes to the office due to increasing vaginal pressure. The patient has a normal, soft bowel movement daily but sometimes has to put her fingers…

👨‍👩‍👧‍👦 Clinical Case Challenge
🏢 Brand: UWorld
📚 Source: UWorld ABFM Qbank

📝 A 65-year-old woman comes to the physician with a pruritic rash. This is the second year the rash has appeared, both times during the onset of winter. She has intensely pruritic areas on her lower extremities along the shins and above the right lateral malleolus. The patient sometimes experiences pruritus on her lower back and the extensor surfaces of the forearms. One area usually predominates. There is no visible rash initially, but the involved areas can become rough and scaly after a few weeks of frequent scratching. Her only other medical problem is perennial rhinitis. Her medications include cetirizine, calcium plus vitamin D supplements, and a multivitamin. Skin examination findings are shown in the photograph. Which of the following is the best next step in management of this patient?

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👨‍👩‍👧‍👦 Clinical Case Challenge 🏢 Brand: UWorld 📚 Source: UWorld ABFM Qbank 📝 A 62-year-old man comes to the clinic due to shoulder pain that began after a fall 3 weeks ago. The pain is felt over the patient's lateral shoulder and often keeps him awake. It…

👨‍👩‍👧‍👦 Clinical Case Challenge
🏢 Brand: UWorld
📚 Source: UWorld ABFM Qbank

📝 A 32-year-old man comes to the office for treatment of work-related anxiety. He recently accepted a job promotion that requires giving monthly presentations at conferences. At the last conference, he "almost died of embarrassment" when his skin turned bright red, his voice quavered, and he spilled water due to his hand shaking. The patient has no medical history. His psychiatric history is significant for marijuana abuse and major depressive disorder in his 20s, which was treated successfully with psychotherapy. He uses alcohol occasionally but does not use illicit drugs. Physical examination is unremarkable. Which of the following is the most appropriate pharmacotherapy?

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[poll]
👨‍👩‍👧‍👦 Clinical Case Challenge 🏢 Brand: UWorld 📚 Source: UWorld ABFM Qbank 📝 A 32-year-old man comes to the office for treatment of work-related anxiety. He recently accepted a job promotion that requires giving monthly presentations at conferences. At the…

👨‍👩‍👧‍👦 Clinical Case Challenge
🏢 Brand: UWorld
📚 Source: UWorld ABFM Qbank

📝 A 42-year-old man comes to the physician with a non-pruritic skin rash for the last 2 weeks. He also has malaise and a sore throat. Two months ago he saw his primary care doctor for HIV testing, which was negative. The patient smokes marijuana on weekends. He travels frequently to the Midwestern and Northeastern United States for business. His temperature is 37.2 C (99 F), blood pressure is 130/80 mm Hg, pulse is 78/min, and respirations are 16/min. Examination shows a maculopapular rash involving the entire body, including the palms and soles. Generalized lymphadenopathy is also present. Which of the following is the most likely cause of this patient's current symptoms?

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[poll]
👨‍👩‍👧‍👦 Clinical Case Challenge 🏢 Brand: UWorld 📚 Source: UWorld ABFM Qbank 📝 A 42-year-old man comes to the physician with a non-pruritic skin rash for the last 2 weeks. He also has malaise and a sore throat. Two months ago he saw his primary care doctor…

[poll]
👨‍👩‍👧‍👦 Clinical Case Challenge 🏢 Brand: UWorld 📚 Source: UWorld ABFM Qbank 📝 A 55-year-old man comes to the physician with a 3-month history of gnawing upper abdominal pain. His appetite is decreased and he has had a 10 kg (22 lb) weight loss. He takes ibuprofen…

👨‍👩‍👧‍👦 Clinical Case Challenge
🏢 Brand: UWorld
📚 Source: UWorld ABFM Qbank

📝 A 55-year-old man comes to the physician with a 3-month history of gnawing upper abdominal pain. His appetite is decreased and he has had a 10 kg (22 lb) weight loss. He takes ibuprofen and methotrexate for rheumatoid arthritis and lisinopril for hypertension. He consumes 5-6 alcoholic beverages daily. CT scan findings are shown below. Which of the following is the most likely cause of this patient's symptoms?

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👨‍👩‍👧‍👦 Clinical Case Challenge
🏢 Brand: UWorld
📚 Source: UWorld ABFM Qbank

📝 A 62-year-old man comes to the office for follow-up of diabetes mellitus type 2. He admits missing his appointments and medications and not following a strict diet. The patient does not smoke but has chewed tobacco for many years. He drinks 6-10 beers each weekend. His body mass index is 27.5 kg/m2. On oral examination, a white patch is seen on the buccal mucosa. The lesion appears to have a granular texture, is not indurated, and is not removed by scraping with a tongue depressor. There is no regional lymphadenopathy. His hemoglobin A1c is 8.5%. Which of the following is the most likely diagnosis?

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[poll]
👨‍👩‍👧‍👦 Clinical Case Challenge 🏢 Brand: UWorld 📚 Source: UWorld ABFM Qbank 📝 A 62-year-old man comes to the office for follow-up of diabetes mellitus type 2. He admits missing his appointments and medications and not following a strict diet. The patient…

[poll]
👨‍👩‍👧‍👦 Clinical Case Challenge 🏢 Brand: UWorld 📚 Source: UWorld ABFM Qbank 📝 A 2-year-old boy is brought to the pediatric clinic after his family was notified that a playmate at day care was diagnosed with pertussis. The parents were instructed to make an…

👨‍👩‍👧‍👦 Clinical Case Challenge
🏢 Brand: UWorld
📚 Source: UWorld ABFM Qbank

📝 A 2-year-old boy is brought to the pediatric clinic after his family was notified that a playmate at day care was diagnosed with pertussis. The parents were instructed to make an appointment with the boy's physician regarding any need for further evaluation or treatment. The boy and his parents are all asymptomatic, with no cough or rhinorrhea. Their immunizations are up-to-date. The child is otherwise healthy and has no drug allergies. Which of the following is the best next step in management of this patient?

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👨‍👩‍👧‍👦 Clinical Case Challenge 🏢 Brand: UWorld 📚 Source: UWorld ABFM Qbank 📝 A 6-year-old boy is brought to the emergency department with left arm pain that started after he fell off the monkey bars earlier today. Swelling immediately developed in the left…

👨‍👩‍👧‍👦 Clinical Case Challenge
🏢 Brand: UWorld
📚 Source: UWorld ABFM Qbank

📝 A 6-year-old boy is brought to the emergency department with left arm pain that started after he fell off the monkey bars earlier today. Swelling immediately developed in the left elbow, and the patient has been reluctant to use the arm. Physical examination shows swelling of the left elbow, with tenderness to palpation of the distal humerus. The patient can move his fingers but resists passive motion of the extremity. He has a 2+ radial pulse and no tenderness to palpation of the distal radius or ulna. The remainder of the neurovascular examination is normal. X-ray is shown in the exhibit. Which of the following is the best next step in management of this patient's injury?

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