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A 32-year old women complains of amenorrhea since delivery of a baby 15 months previously, despite the fact that she did not breast feed her baby. The delivery was complicated by excessive hemorrhage that required transfusion of 2.5 liters of blood. She has also been fatigued and has gained an additional 10 pounds since the baby was born. Laboratory data show the following: Serum LH < 1 IU/L (normal, 4-24 IU/L) Serum estradiol 5 pg/mL (normal, 20 - 100 pg/mL) Serum TSH 0.1 mU/L (normal, 0.5 - 5 mU/L) Serum GH 3 ng/mL (normal, < 5 ng/mL) Serum ACTH 28 pg/mL (normal, 10 - 50 pg/mL) Serum prolactin 2 ng/mL (normal, <20 ng/mL) Injection of 500 mg of TRH failed to produce the expected rise in both serum TSH and prolactin. Which of the following diagnoses most likely explains the findings in this patient?

A 7- year-old girl develops behavioral changes, and her performance in school begins to deteriorate. Several months later she develops a seizure disorder, ataxia, and focal neurologic symptoms. She is eventually quadriparetic, spastic, and unresponsive. Death occurs within a year. This patient may have had which of the following viral diseases at 1 year of age?

A 40-year-old, moderately obese man presents with a persistent productive cough. The cough has been present for several weeks, but recently the man noted that his sputum has assumed a greenish color. Further questioning elicits a history of productive cough, usually in the winter months, over the past several years. He has smoked two packs of cigarettes per day since he was 16 years old. On examination, the man is febrile (100° F), and coarse rhonchi and wheezes can be appreciated bilaterally. Which of the following is the most likely diagnosis?

A 7-year-old patient presents with a mass in the anterior midline of the neck, slightly above the larynx. The mass is mobile and elevates upon protrusion of the tongue. This mass is most likely a cyst that developed from which of the following embryonic structures?

An elderly man comes to medical attention because of anemia and multiple infections. Physical examination is remarkable for hepatosplenomegaly. An automated blood count demonstrates pancytopenia. Review of the peripheral smear by a hematologist demonstrates rare, distinctive, neoplastic white cells covered by fine, hairlike projections. Which of the following characteristics would likely be associated with these cells?

A patient develops a swollen and tender lymph node in his popliteal fossa. An infected skin lesion in which of the following sites would most likely induce lymphadenopathy in this region?

A 50-year-old physician is recovering from aseptic meningitis that began two weeks ago. He appears to have lost considerable cognitive function, and he says he will not go on living if his cognitive ability remains compromised. To demonstrate to him that recovery is occurring, serial evaluations with which of the following psychological assessments is indicated?

A 37-year-old woman is abducted, beaten, and repeatedly raped. For five months after the attack she is nervous, tearful, easily fatigued, and has difficulty concentrating. She also notes difficulty sleeping and lack of appetite, and is hyperreactive to unexpected or loud stimuli. By six months she has returned to her characteristic pre-attack behavioral patterns. Which of the following is the most likely diagnosis?

A 67-year-old black man with a history of glucose-6-phosphate dehydrogenase (G-6-PD) deficiency presents with fever, irritative voiding symptoms, and perineal pain. Rectal examination is remarkable for a boggy, exquisitely tender prostate. A urine Gram's stain is positive for gram-negative rods. The risk for development of hemolytic anemia is highest if he receives high-dose, 21-day therapy with

A patient, who appears to be female, is found to be 46,XY. The patient's vagina is very shallow, ending in a blind pouch, and there are palpable masses in the labia. The diagnosis of testicular feminization syndrome is made. Which of the following was most likely present during the early fetal life of this individual?