A 46-year-old woman presents to your medical office complaining of ‘feeling tired’. The patient states that she has been having some trouble eating because her ‘tongue hurts’, but she has no other complaints. On examination, the patient has pale conjunctiva and skin and also appears tired. She has a smooth, red tongue that is tender to touch with a tongue depressor. The patient’s hands and feet feel cold. Fluoroscopic evaluation of the swallowing mechanism and esophagus is normal. Which of the following diagnoses is most likely?
AHerpes simplex virus-1 infection
BOral candidiasis infection
CKawasaki disease
DPernicious anemia
EPlummer-Vinson syndrome
A 4-year-old boy is brought to the emergency department by his mother with a rash on his trunk, malaise, and fever with spikes up to 38.5°C (101.3°F) for the past 2 weeks. The patient's mother says she tried giving him Tylenol with little improvement. Past medical history includes a spontaneous vaginal delivery at full term. The patient's vaccines are up-to-date and he has met all developmental milestones. On physical examination, his lips are cracking, and he has painful cervical lymphadenopathy. The rash is morbilliform and involves his trunk, palms, and the soles of his feet. There is fine desquamation of the skin of the perianal region. Which of the following anatomical structures is most important to screen for possible complications in this patient?
AMitral valve
BKidneys
CGallbladder
DCoronary artery
EPylorus
A 5-year-old boy is brought to the emergency department for evaluation of a progressive rash that started 2 days ago. The rash began on the face and progressed to the trunk and extremities. Over the past week, he has had a runny nose, a cough, and red, crusty eyes. He immigrated with his family from Turkey 3 months ago. His father and his older brother have Behcet disease. Immunization records are unavailable. The patient appears irritable and cries during the examination. His temperature is 40.0°C (104°F). Examination shows general lymphadenopathy and dry mucous membranes. Skin turgor is decreased. There is a blanching, partially confluent erythematous maculopapular exanthema. Examination of the oral cavity shows small white spots with erythematous halos on the buccal mucosa. His hemoglobin concentration is 11.5 g/dL, leukocyte count is 6,000/mm3, and platelet count is 215,000/mm3. Serology confirms the diagnosis. Which of the following is the most appropriate next step in management?
AOral acyclovir
BOral penicillin V
CReassurance and follow-up in 3 days
DVitamin A supplementation
EIntravenous immunoglobulin (IVIG)
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