Assess and diagnose the patient presenting with generalized fatigue, pallor, and abnormal blood findings.

The patient complains of a 2-month history of generalized fatigue. He mentions no specific triggers but notes that the fatigue has been progressively worsening. He denies any recent infections, significant weight loss, or night sweats.

Presence of multiple pinpoint, red, nonblanching spots on extremities

No significant past medical history. No known blood disorders or cancer history in the family.

Retired teacher, lives with his wife. Non-smoker and drinks alcohol socially.

Denies fever, significant weight loss, night sweats, or recent infections. Mentions occasional mild shortness of breath during exertion.

Multiple pinpoint, red, nonblanching spots (petechiae) noted on the extremities.

Presence of immature cells with large, prominent nucleoli and pink, elongated, needle-shaped cytoplasmic inclusions.


Assess and manage a young man brought in by his wife for bizarre and agitated behavior, suspecting a possible psychiatric disorder.

The patient has been demonstrating bizarre and agitated behavior for the past 6 weeks. He believes that he is being spied on by the NSA which is also controlling his mind. His wife adds that he has been increasingly withdrawn and intermittently depressed over the last 3 months. He was terminated from his job 4 weeks ago after he ceased attending work. Since his unemployment, he has been focused on creating a device to prevent people from controlling his mind.

Delusions of persecution
Social withdrawal
Depressed mood at times
Disorganized speech
Psychomotor agitation

No significant medical or psychiatric history reported.

Previously employed. No history of substance abuse reported. Married.

No significant findings. Denies any drug use, recent travel, or physical health issues.


Evaluate and diagnose the patient presenting with sudden-onset lower abdominal pain, with consideration of the patient's recent history and physical examination findings.

The patient reports the sudden onset of abdominal pain while playing football two hours ago. He has a past medical history significant only for asthma. Additionally, his social history is notable for unprotected sex with four partners in the past month.

No history of similar episodes
Pain started while playing football

Only significant for asthma, well-controlled on medication.

Unprotected sex with multiple partners. No use of tobacco, alcohol, or illicit drugs reported.

Denies fever, vomiting, diarrhea, dysuria, hematuria, or back pain.

Abdomen appears normal, without distension or discoloration.

Scrotum appears normal, without swelling or discoloration.

Right testicle is elevated with a horizontal lie, pain on elevation (negative Prehn's sign). Cremastric reflex is absent on the right side.

Decreased blood flow to the right testicle, suggestive of testicular torsion.


Assess and diagnose the pediatric patient presenting with a low-grade fever, itchy rash, and generalized joint pain following antibiotic treatment.

The patient was brought to the emergency department because of a 2-day history of low-grade fever, itchy rash, and generalized joint pain. The rash initially started in the antecubital and popliteal fossae before spreading to the trunk and distal extremities. One week ago, she was diagnosed with acute sinusitis and started on amoxicillin. She has no history of adverse drug reactions, and her immunizations are up to date.

Rash in the antecubital and popliteal fossae

Rash spread to trunk and distal extremities

Diagnosed with acute sinusitis one week ago, no known history of adverse drug reactions, immunizations up to date.

Multiple erythematous, annular plaques of variable sizes over the entire body

One lesion in the right popliteal fossa has an area of central clearing

Generalized joint pain, no swelling or redness observed


Evaluate and diagnose the pediatric patient presenting with a limp and localized pain, without fever or acute distress.

Mother has noticed a change in the child’s play patterns, specifically favoring his left leg while walking or running. The child complains of pain in his left knee, but denies any recent trauma or injury. He has no fever or other systemic symptoms. Nutrition and developmental milestones are appropriate for age.

Limping favoring left leg
No fever
No systemic symptoms

No significant past medical or surgical history.

The patient is in the second grade, lives with parents and one younger sibling. No exposure to tobacco or known toxins.

Denies recent illness, rash, weight loss, change in appetite or urinary symptoms.

No visible deformity, swelling, or bruising of the knee or hip

Tenderness on palpation of the left hip, not knee

Full range of motion in the knee; pain elicited with passive motion of the hip

Negative for anterior drawer test and McMurray's, suggesting no knee joint instability or meniscal tear

Flattening and fragmentation of the left femoral head consistent with Legg-Calvé-Perthes disease


Assess and diagnose the patient presenting with chronic cough and recurrent bouts of bronchitis.

The patient has been experiencing an aggressive cough producing copious amounts of thick, foamy, yellow-green sputum for about 11 years, with exacerbations similar to the current presentation today. Reports that the cough is worse in the morning and has had multiple evaluations in the past due to recurrent bouts of bronchitis requiring antibiotics treatment. The patient is a non-smoker.

Aggressive cough with thick, yellow-green sputum

Cough worse in the morning
History of recurrent bronchitis

No other significant past medical history aside from the recurrent bronchitis.

Non-smoker, no history of alcohol or drug abuse.

Denies any fever, weight loss, night sweats, or shortness of breath.

No cyanosis or use of accessory muscles for breathing.

Crackles and wheezing over the right middle lobe.

Irregular opacities in the right middle lobe and diffuse airway thickening.

Heavy growth of non-specific bacteria, no TB or fungal growth.


Assess and diagnose the newborn presenting with a generalized rash.

The newborn was born at term with no complications. The mother had no prenatal care and has a history of gonorrhea treated 4 years ago. The newborn presents with a generalized rash that has been present for 1 day.

Generalized erythematous maculopapular rash and pustules

Rash with an erythematous base
Rash over the trunk and extremities
Sparing of the palms and soles

Born at term, no prenatal care for the mother, mother's history of gonorrhea treated 4 years ago.

No other abnormalities noted in the systems review; the rest of the examination shows no abnormalities.

Erythematous maculopapular rash and pustules with an erythematous base observed over the trunk and extremities. Palms and soles are spared.


Assess and diagnose the patient presenting with weakness and fatigue.

The patient reports feeling extremely fatigued and weak, especially towards the end of the day, to the point of difficulty in self-care. She mentions experiencing these symptoms currently. The patient has been traveling, hiking, and camping recently and notes having had multiple illnesses in the recent past.

No significant past medical history provided.

Enjoys outdoor activities such as hiking and camping. No mention of smoking, alcohol, or drug use.

Denies fever, weight loss, headache, or any respiratory, gastrointestinal, or urinary symptoms.

Indicates the presence of autoantibodies to acetylcholine receptors, which is associated with myasthenia gravis.

Decreased response with repetitive nerve stimulation, suggestive of a neuromuscular junction disorder.