A 34 year-old male comes to your office with fever, chills, headache, fatigue, myalgias, arthralgia, anorexia, nausea, sweats,and depression. He returned from a hunting trip after spending two weeks in St.Paul, Minnesota. He reports that he is not sure but he might have had some tick bites during this trip. His past medication history is significant for splenectomy after a motor vehicle accident four years ago. Physical examination is significant for tenderness in the right upper quadrant. Laboratory tests showed anemia, thrombocytopenia, elevated transaminases and intraerythrocytic parasites on Giemsa-stained blood smears and later confirmed by a PCR assay which showed the DNA of the organism. You suspect babesiosis in this patient. Of the following, which is the characteristic diagnostic feature of babesiosis?

A 34 year-old male comes to your office with fever, chills, headache, fatigue, myalgias, arthralgia, anorexia, nausea, sweats,and depression. He returned from a hunting trip after spending two weeks in St.Paul, Minnesota. He reports that he is not sure but he might have had some tick bites during this trip. His past medication history is significant for splenectomy after a motor vehicle accident four years ago. Physical examination is significant for tenderness in the right upper quadrant. Laboratory tests showed anemia, thrombocytopenia, elevated transaminases and  intraerythrocytic ring-shaped parasites in tetrads on Giemsa-stained blood smears and later confirmed by a PCR assay which showed the DNA of the organism.  You suspect babesiosis in this patient.  Regarding the transmission of this disease, which of the following is true? 

A 34 year-old male comes to your office with fever, chills, headache, fatigue, myalgias, arthralgia, anorexia, nausea, sweats,and depression. He returned from a hunting trip after spending two weeks in another state. He reports that he is not sure but he might have had some tick bites during this trip. His past medication history is significant for splenectomy after a motor vehicle accident four years ago. Physical examination is significant for tenderness in the right upper quadrant. Laboratory tests showed anemia, thrombocytopenia, elevated transaminases and  intraerythrocytic ring-shaped parasites in tetrads on Giemsa-stained blood smears and later confirmed by a PCR assay which showed the DNA of the organism.  You suspect Babesiosis in this patient. It is is found in which of the following areas of the United States?

A 22-year-old medical student comes to the urgent care clinic and reports a sudden onset of high fever, chills, severe headache, pain around the eyeballs and behind the eyes, muscle pain, bone pain, nausea and vomiting. She attends a medical school in the Caribbean Islands and is now visiting her family in the United States. On further questioning, she reports that her apartment building is surrounded by many mud pits infested with Aedes mosquitoes and she had many mosquito bites over the last few weeks. One of her classmates got ‘breakbone fever’ last week. On examination, she has a faint, generalized macular rash that looks like ‘islands of white in a sea of red’. Laboratory tests demonstrated thrombocytopenia, monocytosis, elevated albumin, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase. A PCR test confirmed the diagnosis. When she was told that she was infected with a virus that belongs to the flaviviridae family, she rightly worried about the possibility of a hemorrhagic fever. What is the mainstay of care for this patient?

A 32-year-old woman presents to the emergency department with a four-day history of high-grade fever, severe headache, retro-orbital pain, and muscle aches. She also reports significant fatigue, nausea, and decreased appetite. On the second day of her illness, she developed a skin rash that started on her trunk and later spread to her extremities. She mentions a recent trip to a tropical region. On examination, the patient appeared lethargic and febrile with a temperature of 39.5°C. Her blood pressure was 100/70 mmHg, with a pulse of 100 beats per minute. The rash was erythematous and maculopapular, sparing the palms and soles. Petechiae were noted on her arms, and a positive tourniquet test suggested increased capillary fragility. Laboratory investigations revealed leukopenia with a white blood cell count of 3,000/μL, thrombocytopenia with a platelet count of 90,000/μL, and mildly elevated liver enzymes. Based on her recent travel history, you suspect dengue in this patient. Of the following, which is the most common symptom of dengue?

A 24 year-old Colombian male who was detained in the local immigration processing center was brought to your office by ICE officers for the evaluation of syphilis tests done as part of his immigration application. The RPR test and later FTA-ABS test came positive for syphilis. Through a translator, the patient explained that recently he got a fever, sore throat, wart-like lesions around his genitalia and rough, reddish brown spots on the bottom of his feet and on the palms of his hands. He also informed that many years ago, he received penicillin treatment for syphilis with no adverse complications. You diagnosed him with syphilis and started treatment with benzathine penicillin G. He was taken back to the detention center. Four hours later, the officers brought him back to your office because starting about two hours ago, the patient complained of fever as high as 107.6 F, chills, sweating, headache, nausea and vomiting, and muscle pains. His vital signs recorded were Temp = 102 F, BP = 110/80 mm Hg, RR = 24/minute, Pulse = 96/minute. Physical examination was unremarkable except for an anxious and distressful patient. Skin did not show any urticaria and wheels. Stat laboratory values showed elevated neutrophils but normal eosinophils. With rest, oral fluids, and acetaminophen, four hours later, the patient reported ‘I feel a lot better than when I came in’. His vital signs were Temp = 98.2 F, BP = 110/80 mmHg, RR = 18/minute; Pulse = 69/minute. Which of the following laboratory tests the clinician should rely on in establishing the diagnosis in this patient?

A 68 year-old female came to your office complaining of dry eyes, dry mouth, painful oral sores, nausea, vomiting, wheezing and vaginal dryness and irritation. She is especially sensitive to hot or spicy foods. Her urine looks dark brown colored and her stools look pale and clay-colored. She also developed a rash which is itchy and irritating. She used some hydrocortisone cream but it is not seeming to help her much.  It is hard to open mouth and extend her elbows. Her past medical history is remarkable for aplastic anemia for which she received a matched, related allogeneic stem cell transplant from her brother approximately 10 months prior to this presentation.  During the physical examination you noticed that her sclera looks yellow. There are several fluid-filled cysts on the inner surface of her mouth. You noticed grayish white lines on the palate. In the auscultation of her lungs, you noticed bilateral wheezing. She has abdominal tenderness in the right upper quadrant. As you were examining the range of motion, the patient put her palms together and had difficulty extending her elbows and fingers. There are deep pigmentation changes over her shoulders and back. She has a rash on her trunk which is made up of small, discolored dots covered with scaly patches. Her nails looked hard and brittle with some dystrophy. You noticed the loss of hair on her head. To investigate her condition further, you ordered some routine labs which are significant for the following values:  Total serum bilirubin is 7.9 mg/dl  Alanine aminotransferase (ALT) …….175 U/L       Aspartate aminotransferase (AST)……..145 U/L  and alkaline phosphatase of 440 U/L   Antinuclear antibodies….Positive  Rheumatoid factor………Positive  What is the most likely diagnosis in this patient? 

A 72 year-old male came to your urgent care clinic complaining of maculopapular skin rash, nausea, anorexia,jaundice, watery diarrhea, abdominal pain for the last one week. His medical history is significant for receiving an allogeneic hematopoietic cell transplantation four weeks ago for multiple myeloma. In the physical examination, you noticed blistery maculopapular rash all over his body, sparing the scalp. Laboratory results are remarkable for hyperbilirubinemia. You suspect graft-versus-host disorder in this patient. Which is the most common organ affected in patients with graft-versus-host disease? 

A 72 year-old male came to your urgent care clinic complaining of maculopapular skin rash, nausea, anorexia,jaundice, watery diarrhea, abdominal pain for the last one week. His medical history is significant for receiving an allogeneic hematopoietic cell transplantation four weeks ago for multiple myeloma. In the physical examination, you noticed blistery maculopapular rash all over his body, sparing the scalp. Laboratory results are remarkable for hyperbilirubinemia. What is the most likely diagnosis in this patient? 

A 72 year-old female came to your office complaining of fever, fatigue, lower abdominal pain, and decreased urine output. Her past medical history is significant for dialysis dependent end-stage renal disease for 12 years and a renal transplantation 9 months ago. Your physical examination is significant for pain on the right lower abdomen. In consultation with her nephrologist, you ordered some laboratory studies and a renal transplant biopsy.  Laboratory tests came positive for circulating donor-specific antibodies. In biopsy, histological examination showed microvascular inflammation, intimal arteritis, acute thrombotic microangiopathy, acute tubular injury, linear C4d staining in peritubular capillaries, and de novo glomerulonephritis. This patient received treatment and her condition improved well with plasmapheresis. She asked for your advice regarding vaccinations. Of the following, which is the best advice to give her?