A 34-year-old woman presents with complaints of difficulty swallowing and recurrent vomiting for the past 6 months. She even noticed food particles in her vomit a few hours after eating her meals. She has lost about 3.0 kg (6.6 lb) over the past 4 months. Her history is significant for a trip to Argentina last year. Her past medical history is insignificant. BMI is 24 kg/m². There is no abdominal tenderness, distension, or evidence of jaundice. Which of the following is the most appropriate next step in the management of this patient?

A 41-year-old construction worker presents to the office with a complaint of progressively worsening breathlessness for the last 2 months. He has a 30-pack-year smoking history and drinks alcohol on the weekends. He works mainly with insulation and drywall placement. His temperature is 37.0°C (98.6°F), blood pressure is 144/78 mm Hg, pulse is 72/min, and respirations are 10/min. On further questioning about his employment, the patient admits that he does not regularly use a mask or other protective devices at work. Which of the following malignancies is this patient most likely at risk for?

A 36-year-old man presents to a physician with the complaint of a dry cough for the last 2 months. He denies any nasal discharge, sneezing, nose congestion, blood in sputum, breathlessness, fever, or weight loss. He started smoking 2 years ago. Auscultation of the lungs reveals localized rhonchi over the left infrascapular region. His chest radiograph reveals a single, round-shaped nodule with scalloped margins in the lower zone of the left lung. The nodule is surrounded by normally aerated lung tissue, and it is approximately 9 mm (0.35 in) in diameter. The physician explains to the patient that he requires further diagnostic evaluation, as the nodule could be malignant. Regarding the radiograph, which of the following features of the nodule is associated with the increased possibility of a malignant lesion?

A 10-year-old boy is brought to the pediatrician by his mother for evaluation. Last night, he was playing with his younger brother and a hot cup of coffee fell on his left shoulder. Although his skin became red and swollen, he acted as if nothing had happened and did not complain of pain or discomfort. The skin over his left shoulder is erythematous and swollen. Sensory examination reveals impaired pain and temperature sensation in a cape-like distribution across both shoulders and arms, and the neck. The light touch, vibration, and position senses are preserved. The motor examination is within normal limits, and he has no signs of a cerebellar lesion. His gait is normal. Which of the following disorders is most likely associated with this patient’s condition?

A 65-year-old Asian American man presents to his primary care physician because of abdominal distension, right upper quadrant (RUQ) abdominal pain, decreased appetite, and weight loss for several weeks. He denies smoking or excessive alcohol intake. The physical examination reveals a cachectic man with jaundice, palmar erythema, ascites, and a palpable mass in the RUQ. Abdominal ultrasound shows a 3-cm hypoechoic mass in the right lobe of the liver. The alpha fetoprotein (AFP) is 500 μg/L. Which of the following is a risk factor for this patient’s condition?

A 20-year-old woman comes to the clinic for her first follow-up visit after being diagnosed with bipolar 1 (BP1) disorder a month ago. At that time, she was acutely manic and was brought to the emergency department by her concerned boyfriend. She was started on lithium and was discharged after her symptoms improved. A week later, after the patient had forgotten to take her medication for a few days, she again began to manifest manic symptoms, which required bringing her to the emergency department for the second time. Since then, she has been compliant with her medications and currently has no significant complaints. The patient is of reproductive age and sexually active. Which of the following recommendations would be most helpful in minimizing the risk to the fetus if this patient were to become pregnant?

A 41-year-old construction worker presents to the office with a complaint of progressively worsening breathlessness for the last 2 months. He has a 30-pack-year smoking history and drinks alcohol on the weekends. He works mainly with insulation and drywall placement. His temperature is 37.0°C (98.6°F), blood pressure is 144/78 mm Hg, pulse is 72/min, and respirations are 10/min. On further questioning about his employment, the patient admits that he does not regularly use a mask or other protective devices at work. Which of the following malignancies is this patient most likely at risk for?