A 19-year-old university student presents to the student clinic with painful joints. He states that over the past week his right wrist has become increasingly stiff. This morning he noticed pain and stiffness in his left ankle and left knee. The patient has celiac disease and takes a daily multivitamin. He says he is sexually active with multiple male and female partners. He smokes marijuana but denies intravenous drug abuse. He recently traveled to Uganda to volunteer at a clinic that specialized in treating patients with human immunodeficiency virus (HIV). He also went on an extended hiking trip last week in New Hampshire. Physical exam reveals swelling of the right wrist and a warm, swollen, erythematous left knee. The left Achilles tendon is tender to palpation. There are also multiple vesicopustular lesions on the dorsum of the right hand. No penile discharge is appreciated. Arthrocentesis of the left knee is performed. Synovial fluid results are shown below: Synovial fluid: Appearance: Cloudy Leukocyte count: 40,000/mm^3 with neutrophil predominance Gram stain is negative. A synovial fluid culture is pending. Which of the following is the patient’s most likely diagnosis?
ALyme disease
BDisseminated gonococcal infection
CDermatitis herpetiformis
DReactive arthritis
ESeptic arthritis
A 32-year-old man comes to the physician for a follow-up examination 1 week after being admitted to the hospital for oral candidiasis and esophagitis. His CD4+ T lymphocyte count is 180 cells/μL. An HIV antibody test is positive. Genotypic resistance assay shows the virus to be susceptible to all antiretroviral therapy regimens and therapy with dolutegravir, tenofovir, and emtricitabine is initiated. Which of the following sets of laboratory findings would be most likely on follow-up evaluation 3 months later? $$$ CD4 +/CD8 ratio %%% HIV RNA %%% HIV antibody test $$$
A↓ ↓ negative
B↑ ↑ negative
C↓ ↑ negative
D↑ ↓ positive
E↓ ↑ positive
A 17-year-old boy comes to the physician because of body aches and sore throat for 1 week. He has no history of serious illness and takes no medications. He lives with his parents; they recently adopted a cat from an animal shelter. He is sexually active with one female partner, and they use condoms consistently. His temperature is 38.7°C (101.7°F), pulse is 99/min, and blood pressure is 110/72 mm Hg. Examination shows bilateral posterior cervical lymphadenopathy. The pharynx is red and swollen. Laboratory studies show: Hemoglobin 15 g/dL Leukocyte count 11,500/mm3 Segmented neutrophils 48% Band forms 2% Basophils 0.5% Eosinophils 1% Lymphocytes 45% Monocytes 3.5% When the patient's serum is added to a sample of horse erythrocytes, the cells aggregate together. Which of the following is the most likely causal pathogen?
ACytomegalovirus
BInfluenza virus
CToxoplasma gondii
DEpstein-Barr virus
EHuman immunodeficiency virus
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