A 56-year-old man comes to the physician because of throat pain and increasing difficulty swallowing food for the past 5 months. He has also had episodic left ear pain for the past 3 months. He has hypertension. His only medication is amlodipine. His father died of laryngeal cancer at the age of 55 years. He has smoked one pack of cigarettes daily for 36 years. He drinks 2–3 beers daily. Vital signs are within normal limits. Examination shows left cervical lymphadenopathy. Oropharyngeal examination shows a 3-cm ulcerating left tonsillar mass. Examination of both auditory canals is unremarkable. Which of the following is the most appropriate initial step in management?

A 7-year-old boy is brought to the physician because of a 4-day history of fever, headache, earache, and sore throat that is worse when swallowing. He has not had a runny nose or cough. He had a similar problem 1 year ago for which he was prescribed amoxicillin, but after developing a skin rash, facial swelling, and dyspnea he was switched to a different medication. His immunizations are up-to-date. His temperature is 38.9°C, pulse is 136/min, and respirations are 28/min. Examination of the oral cavity reveals a coated tongue, red uvula, and enlarged right tonsil covered by a whitish membrane. The deep cervical lymph nodes are enlarged and tender. A throat swab is taken for culture. Which of the following is the most appropriate next step in management?

A 69-year-old man comes to the physician with a 2-year history of progressive hearing loss. His hearing is worse in crowded rooms, and he has noticed that he has more difficulty understanding women than men. He has no history of serious illness and does not take any medications. A Rinne test shows air conduction is greater than bone conduction bilaterally. This condition is most likely associated with damage closest to which of the following structures?

A 52-year-old obese man is brought to the emergency department 30 minutes after he was involved in a high-speed motor vehicle collision. He was the unrestrained driver. On arrival, he is lethargic. His pulse is 112/min, respirations are 10/min and irregular, and blood pressure is 94/60 mm Hg. Pulse oximetry on room air shows an oxygen saturation of 91%. The pupils are equal and react sluggishly to light. He withdraws his extremities to pain. There are multiple bruises over his face, chest, and abdomen. Breath sounds are decreased over the left lung base. Two large bore peripheral venous catheters are inserted and 0.9% saline infusion is begun. Rapid sequence intubation is initiated and endotracheal intubation is attempted without success. Bag and mask ventilation is continued. Pulse oximetry shows an oxygen saturation of 84%. The patient has no advance directive and family members have not arrived. Which of the following is the most appropriate next step in the management of this patient?

A 26-year-old woman comes to the physician because of a progressive swelling in her mouth that she first noticed 5 years ago. Initially, the swelling was asymptomatic but has now caused some difficulty while chewing food for the past month. She has no pain. She has bronchial asthma. She appears healthy. Her temperature is 37°C (98.6°F), pulse is 70/min, and blood pressure is 110/70 mm Hg. Examination shows a 1.5-cm smooth, unilobular, bony hard, nontender mass in the midline of the hard palate. There is no cervical or submandibular lymphadenopathy. The remainder of the examination shows no abnormalities. Which of the following is the most likely diagnosis?

A 45-year-old woman comes to the physician for a 3-week history of intermittent episodes of dizziness. The episodes last for hours at a time and are characterized by the sensation that the room is spinning. The patient also reports that she has started using her cell phone with her left ear because she hears better on that side. She has experienced intermittent ringing and fullness in her right ear. There is horizontal nystagmus to the right. Motor strength is 5/5 in all extremities, and sensory examination shows no abnormalities. Finger-to-nose and heel-to-shin testing are normal bilaterally. Weber test shows lateralization to the left ear. The Rinne test is positive bilaterally. Which of the following is the most likely cause of this patient's symptoms?

A 19-year-old woman comes to the physician because of worsening pain with swallowing for 3 days and a dry sensation in the mouth over the past week. She has a history of asthma controlled with inhaled fluticasone and albuterol. Physical examination shows white plaques on the dorsal surface of the tongue and buccal mucosa that bleed when scraped off. Which of the following is the most appropriate pharmacotherapy?

A 23-year-old man comes to the physician because of a whistling sound during respiration for the past 3 weeks. He reports that the whistling is becoming louder, and is especially loud when he exercises. He says the noise is frustrating for him. Two months ago, the patient underwent outpatient treatment for an uncomplicated nasal fracture after being hit in the nose by a high-velocity stray baseball. Since the accident, the patient has been taking aspirin for pain. He has a history of asymptomatic nasal polyps. His temperature is 37°C (98.6°F), pulse is 70/min, respirations are 12/min, and blood pressure is 110/70 mm Hg. Physical examination shows no abnormalities. Which of the following would have prevented the whistling during respiration?

A 30-year-old man comes to the physician because of recurrent episodes of right-sided jaw pain over the past 3 months. The patient describes the pain as dull. He says it worsens throughout the day and with chewing, and that it can also be felt in his right ear. He also reports hearing a cracking sound while eating. Over the past 2 months, he has had several episodes of severe headache that improves slightly with ibuprofen intake. Vital signs are within normal limits. Physical examination shows limited jaw opening. Palpation of the face shows facial muscle spasms. Which of the following is the most likely underlying cause of this patient's symptoms?