A 6-year-old female becomes ill. She has a high fever and joint pain. Her joints become red, swollen, and warm. Her knee joint is involved initially, but then her ankle joint becomes involved. Her mother takes her to her pediatrician. On physical examination, she is found to have a heart murmur. She is also found to have firm, painless nodules on her elbows. Her doctor orders several laboratory tests and an EKG. Her laboratory results are as follows: TEST RESULTS REFERENCE RANGE Hematocrit 39 35-45 (age 6-12) Hemoglobin 13.9 gm/dL 11.5-15.5 gm/dL (age 6-12) Mean corpuscular volume 83 cu μ 77-95 cu μ (age 6-12) WBC 16.9 x 103/mm3 5.5-15.5 x 103/mm3 (age 4-7) RBC 4.1 x 106/μl 3.7-5.2 x 106/μl (age 2-14) ESR 41 mm/hr

A 4-year-old girl presents with a 2-day history of muscle weakness. Her parents state she has stopped walking, and she tells them her legs feel “loose.” Two weeks ago, she had mild flu-like symptoms, including fever, sore throat, headache, and fatigue. Her family is seeking asylum from West Africa. Her vitals are blood pressure 110/78 mm Hg, heart rate 64 bpm, respiratory rate 15 breaths/min, and temperature 98 °F (36.7 °C). The physical examination demonstrates asymmetric proximal muscle weakness in the lower extremities and the absence of reflexes. Polymerase chain reaction confirms the suspected diagnosis. A vaccine would have prevented this child’s condition. Which of the following is a component of this vaccine?

A 12-month-old boy presents with a rash that followed a 2-day fever of 102°F. His mother states that she saw a pink, raised rash on the child’s trunk as the fever went away. “The rash looks like pink or red spots that turn white when I touch them.” On physical exam, the child is currently afebrile, and there is a diffuse, maculopapular rash on the chest, abdomen, and thighs. The rash spares the face, palms, and soles. The child has no symptoms of upper respiratory infection, and the physical examination is otherwise normal. Which of the following conditions is the most likely diagnosis for this patient?

Systemic Inflammatory Response Syndrome (SIRS) defines a clinical response to a nonspecific insult of either infectious or noninfectious origin and may be caused by ischemia, inflammation, trauma, infection, or several insults combined.

A 26-year-old student with no significant PMH arrives at student health services for persistent diarrhea. She states that for the past 2 months, she has had foul-smelling diarrhea and abdominal cramping. She also reports increased bloating, flatulence, and an unintentional 4 lb weight loss. Prior to 2 months ago, she had never felt these symptoms before. She denies other extra-gastrointestinal symptoms. The patient is an avid hiker and says her symptoms have caused her to miss recent camping trips. The patient has tried to add more fiber to her diet without relief. She feels her symptoms worsen with milk or cheese. The patient currently takes no prescription or OTC medications. She drinks alcohol socially and denies smoking tobacco or using any illicit drugs. She is sexually active with her boyfriend of 2 years. Her last multi-day backpacking trek was about 3 months ago in Vermont. Her temperature is 98.6°F (37°C), blood pressure is 110/70 mmHg, pulse is 76/min, and respirations are 15/min. Physical examination is unremarkable. A stool sample is negative for fecal occult blood. Which of the following is an associated adverse effect of the most appropriate treatment for this patient’s symptoms?

A 3-year-old girl presents with a 1-day history of irritability and weakness in her legs. Neurologic exam reveals an ascending symmetrical paralysis with cranial neuropathy. A lumbar puncture is performed and cerebrospinal fluid is found to have a normal glucose level,

The causative organism for Lyme disease is _____________________.

The patient is a 30-year-old male who presents to the Emergency Department with a recent travel history to Africa where he spent 6 months as a Peace Corps Volunteer in Uganda. His chief complaint is fevers, headache, myalgias, and shaking chills. T 39.6°C (103.3°F). The patient was admitted for observation and further work-up. The patient had documented episodes of fever and chills approximately 3 times a day. Based on this information, which of the following laboratory tests would confirm your diagnostic suspicion?

Clinical manifestations of botulism typically include a descending symmetric flaccid paralysis.

A woman presents to your office after a 6-month sabbatical during which she worked in caves in the eastern part of South America. The patient reports fever, chills, productive cough, and joint stiffness that started 1 month before her return. Physical exam reveals 3 ulcerated lesions on her inner cheek. Which of the following is the most appropriate treatment for this patient?