A 6-year-old girl is admitted to the hospital due to a week of fever.  The patient has a history of fulminant viral myocarditis for which she received a cardiac transplant 8 months ago.  Viral studies prior to transplantation were negative for Epstein-Barr virus (EBV) and cytomegalovirus (CMV).  She is taking maintenance immunosuppression medications.  Temperature is 38.1 C (100.6 F), blood pressure is 102/74 mm Hg, pulse is 76/min, and respirations are 22/min.  Heart examination reveals normal S1 and S2 with no S3 or S4 and no murmurs.  Pulses are 2+ in all extremities.  The lungs are clear to auscultation.  There are several enlarged anterior cervical lymph nodes bilaterally.  Laboratory results are as follows:Complete blood count    Hemoglobin 10 g/dL    Platelets 180,000/mm3    Leukocytes 1,900/mm3Blood, plasma, and serum    Lactate dehydrogenase, serum 412 U/L    Serum EBV PCR 90,500 copies/mL    Serum CMV PCR negativeEchocardiogram shows normal heart structure and function.  A CT scan of the chest reveals scattered bilateral atelectasis and several highly enlarged mediastinal lymph nodes.  Which of the following is the most likely cause of this patient's symptoms?

A 58-year-old man comes to the emergency department due to sudden onset of severe right leg pain several hours ago; the leg has since become numb.  He has never had similar symptoms and has no history of trauma, fever, or chills.  The patient recently had an acute anterior wall myocardial infarction that resulted in cardiogenic shock; he is undergoing cardiac rehabilitation.  Temperature is 36.7 C (98.1 F), blood pressure is 120/70 mm Hg, pulse is 90/min and regular, and respirations are 16/min.  Cardiopulmonary examination is unremarkable.  Compared with the left leg, the right leg appears pale and is cool to the touch.  In the right lower extremity, the popliteal pulse is normal, but more distal pulses are not palpable.  Pulses in the other extremities are normal.  Neurologic examination shows loss of sensation over the dorsum of the right foot and mild weakness with dorsiflexion.  Which of the following is the most likely cause of this patient's symptoms?

A 75-year-old man is brought to the emergency department from home after being found unresponsive by his son.  His medical history is significant for coronary artery disease with coronary stenting 2 years ago, diabetes mellitus, hypertension, and stroke.  He was hospitalized 2 months ago with pneumonia and upper gastrointestinal bleeding, during which time he received intravenous antibiotics and a transfusion of 4 units of packed red blood cells.  In the emergency department today, temperature is 39.1 C (102.4 F), blood pressure is 70/40 mm Hg, pulse is 120/min, respiratory rate is 32/min, and oxygen saturation is 79% on room air.  Laboratory results are notable for leukocytosis but are otherwise unremarkable.  Chest x-ray reveals a new right upper lobe infiltrate.  He is treated with normal saline, antibiotics, vasopressors, and mechanical ventilation.  The next day, laboratory analyses reveal the following:Hemoglobin 9.5 mg/dLLeukocytes 15,000/mm3Platelet 120,000/mm3Sodium 137 mEq/LPotassium 4.1 mEq/LChloride 100 mEq/LBicarbonate 19 mEq/LBlood urea nitrogen 51 mg/dLCreatinine 2.1 mg/dLBilirubin, total 1.2 mg/dLAspartate aminotransferase 3,720 units/LAlanine aminotransferase 3,250 units/LAlkaline phosphatase 162 mEq/LWhich of the following most likely accounts for the abnormal liver function panel? A.Acute viral hepatitis B.Alcoholic liver disease C.Granulomatous liver disease D.Ischemic hepatic injury E.Acalculous cholecystitis F.Iron overload G.Autoimmune hepatitis

A 64-year-old woman is brought to the emergency department due to fever, chills, flank pain, and lethargy for the past 2 days.  Temperature is 38.9 C (102 F), blood pressure is 100/60 mm Hg, and pulse is 120/min.  The patient has right costovertebral angle tenderness.  Leukocytes are 16,000/mm3 and urinalysis shows pyuria, many bacteria, and positive nitrites.  ECG shows sinus tachycardia.  A central venous catheter placement is planned for intravenous therapy and hemodynamic monitoring.  After the patient's chest is appropriately prepared and draped, a needle is inserted just lateral to the angle of the left clavicle and a triple lumen catheter is placed into the left subclavian vein.  Each lumen is flushed with sterile saline after obtaining blood return.  The catheter is sutured in place to the skin and a sterile dressing is applied.  Which of the following is the best next step in management of this patient?

A 32-year-old man comes to the physician complaining of fever, shortness of breath, and a productive cough that has developed slowly over the past week. He has no other medical history and does not take any medications. His temperature is 38.5°C, blood pressure is 122/78 mmHg, heart rate is 68 beats per minute, respiratory rate is 18 breaths per minute, and oxygen saturation is 98% on room air. There are decreased breath sounds and dullness to percussion over the right lung base. The rest of the physical examination, including cardiac auscultation, is normal. A chest x-ray confirms consolidation of the right lower lobe. What is the most appropriate course of action for this patient?

The Epstein-Barr virus causes the condition known as Blank______.Multiple choice question.Chagas diseaseacute endocarditisLyme diseaseinfectious mononucleosis