Which of the following viruses has the respiratory tract as the main portal of entry into the human body?
A 50-year-old female with a history of intrauterine device (IUD) use for 10 years presents with pelvic pain, fever, and weight loss. Imaging reveals a pelvic mass with fistulous tracts. Biopsy shows filamentous gram-positive bacteria. What is the most likely diagnosis?
A 45-year-old man presents with a slowly growing, painless mass on the left side of his jaw for the past three months. He reports occasional yellowish discharge from small openings in the lesion. He had a tooth extraction six months ago. Examination reveals a firm, indurated submandibular mass with multiple draining sinus tracts. A pus sample reveals Gram-positive filamentous branching rods with sulfur granules. What is the most appropriate initial treatment?
A 50-year-old woman with a history of intrauterine device (IUD) use for 10 years presents with pelvic pain, fever, and weight loss over 4 months. Imaging reveals a mass in the right pelvis with invasion into adjacent structures. Surgical exploration shows multiple abscesses with purulent discharge containing yellow granules. Actinomycosis is suspected. Question: What is the most significant risk factor for this patient’s pelvic actinomycosis?
A 35-year-old man presents with a 2-month history of a painful, non-healing lump on his lower jaw. He reports occasional drainage of yellow pus from the site. He had a dental extraction 3 months ago. Physical examination reveals a firm mass with sinus tracts on the mandible, and imaging shows bone erosion. A biopsy demonstrates “sulfur granules.” What is the most likely causative organism of this patient’s actinomycosis?
A 4-year-old girl is brought to the pediatric clinic by her mother due to recurrent episodes of fever, abdominal pain, and painful urination over the past 6 months. The mother reports that the child has had three urinary tract infections (UTIs) confirmed by urine cultures. The most recent episode occurred two weeks ago, with a high fever (102°F), flank pain, and dysuria. The child was treated with antibiotics, and her symptoms resolved temporarily. Past Medical History: Birth history: Full-term, normal delivery No significant past medical history other than recurrent UTIs No known allergies Family History: Mother had a history of recurrent UTIs during childhood and was treated for vesicoureteral reflux (VUR). Physical Examination: Temperature: 37.8°C Heart rate: 90 bpm Blood pressure: 105/65 mmHg Abdomen: Mild tenderness in the suprapubic region and right flank External genitalia: Normal, no erythema or discharge Costovertebral angle tenderness (right side): Present Diagnostic Workup: Urinalysis: Positive for leukocytes, nitrites, and moderate protein Urine culture: Positive for Escherichia coli Serum creatinine: Normal Blood urea nitrogen (BUN): Normal Renal ultrasound: Shows mild right hydronephrosis, but no visible structural abnormalities Voiding cystourethrogram (VCUG): Demonstrates grade III vesicoureteral reflux (retrograde flow of contrast from the bladder to the right ureter and renal pelvis) DMSA renal scan: Shows areas of scarring in the right kidney consistent with previous infections. Question: What is the first-line treatment for managing vesicoureteral reflux in this patient?
A 35-year-old man with a history of heroin use disorder presents to the clinic seeking help for his addiction. He reports strong cravings when he sees places where he previously used heroin. He also describes reduced pleasure from activities he once enjoyed, such as eating and socializing. Neuroimaging studies in individuals with chronic substance abuse often show which of the following neurobiological changes?
A 22-year-old college student reports frequent cocaine use over the past year. He describes an intense “high” but also experiences strong cravings when he sees cocaine paraphernalia or people he used to use drugs with. Which of the following brain regions plays the most significant role in linking environmental cues to drug-seeking behavior?
A 28-year-old man with opioid use disorder presents to the emergency department with withdrawal symptoms. He reports that he no longer feels pleasure from daily activities and struggles with intense cravings. The long-term dysregulation of the dopamine reward system in addiction is best explained by which of the following?
