RLQ pain with intercourse, Nausea without vomiting, LMP 33 days ago; breast tenderness, closed cervix, slight cervical motion tenderness; right adnexa tender; bhCG 1800; 3cm multi cystic mass in R ovary; apparent intrauterine sac without identifiable embryonic pole:
intrauterine pregnancy with corpus luteum cyst
C-section if the baby is in what position:
most common symptom of perimenopausal:
abnormally slow labor progress:
gush of flood, workup:
nitrazfine test and fern test to confirm ROM
2 ova fertilized by 2 sperm;
diaphragm is hormonal or non hormonal contraception
lichen simplex chronicus secondary to
education for postpartum includes: lochia (vaginal bleed) up to 8 weeks; breastfeeding: colostrum for 5 days; nothing vaginally until next office visit; uterus will return to size over 6 weeks. Not:
no peripheral lung marking with presence by pleural line—pneumo
TOF: make sure adequate O2
46 y/o F, overweight abdominal pain, nausea, would see a
RUQ lithiasis of gallbladder on US
healthy weight loss from
decreased calories and exercise
28 y/o healthy, order blood work for
narrow maxilla, long thin face + limbs and fingers; arm span > height, pectus carinatum; perform this physical exam:
chest tightness, SOB, especially with exertion; retrosternal pain 6/10, 10 min radiates to neck, jaw, shoulders, systolic crescendo-decrescendo murmur in R second intercostal space and radiates to carotids bilaterally
polyps on colonoscopy:
repeat colonoscopy in 5 years
normal saline (flattened T, U waves) K 2.5
most common inherited disorder
polycystic kidney disease:
swelling, protein in urine, decreased albumin, hyperlipidema:
sudden decreased vision, pain in R eye, lacrimation, dilated pupil with circumcorneal injection; clouding of cornea:
red, swollen eyelids:
itchy eyes, nose bilaterally; rhinorrhea, sneezing with exposures—determined to be vasomotor rhinitis:
exposures are cold weather
persistent dizziness 3-4h, N/V; resolved spontaneously; tinnitus. Weber lateralizes to R side; AC=BC. nystagmus seen:
avid swimmer. pain, drainage in left ear. pain with manipulation. canal is narrowed and erythematous with white debris:
acute blurred vision and severe pain in left eye. halos, n/v, shallow anterior chamber, hazy cornea. fixed, moderately dilated pupil, ciliary injection:
fever, ST, enlarged glands in neck for 3 days. no cough, rhinorrhea. malaise, body aches, HA. Temp of 101.5, pulse is 102, swollen tonsils with exudates, enlarged cervical nodes bilaterally and tender:
group A strep
nasal stuffiness, HA, fatigue, facial pain, chronic PND 2-3 times for the past year. acute sinusitis. symptoms for 3m, given abx. nasal mucosa is inflamed, mucopurulent secretion in nasal cavity. right maxillary sinus is tender:
get CT of sinuses
decreased vision in right eye, mild opacification, cataract, the patient would see:
visual halos around objects
swollen, inflamed left tonsil displaces uvula. temp of 102, pain with swallowing and opening mouth. cervical lymph node enlargement:
normal veins are smaller/larger than normal arteries
1hr hx severe right eye pain with blurred vision, halos. pupil is 7mm right and 3mm left. right is nonreactive to light. cornea is steamy:
acute angle closure glaucoma
3wk old baby: persistent tearing on the right eye. eyelashes crusted. increased tear meniscus, macerated eyelid skin, slight conjunctival hyperemia. material expressed from puncta with palpation:
lacrimal sac massage, reevaluate at 12m.
painful, pruritic left ear after returning from beach. erythematous canal without clear visualization of the TM, debris, discharge, pain with manipulation:
not able to hear in right ear. whisper test decreased on right, weber materializes to right. BC>AC:
conductive hearing loss, possible cerumen impaction
mouth, jaw pain. swelling on right side with eating and subsides within 2 hrs. palpable mass near TMJ:
calculus formation in stenson’s duct
ST, think it’s strep. dry cough, 102F, feels miserable. PE: 101.2F, TM dull bilaterally. pharynx is red with whitish exudates. cervical lymph nodes palpable bilaterally in cervical chains. tonsils large and inflamed. rapid strep is positive, tx:
10days of penicillin
clear nasal drainage and nighttime cough. clear rhinorrhea, dark circles under eyes, transverse nasal crease:
10 y/o asmatic, sore throat. tongue: creamy white curd-like patches that cover other oral mucosal surfaces. epiglottis, tonsils not inflamed, red. takes inhaled steroids:
5 y/o in acute respirator distress. ST, fever, dyspnea. neck extended, chin protrudes as if something is blocking throat. drooling. 38.7C, RR 130/m?? bright red epiglottis, extremely swollen and obstructing pharynx:
bacteria of dental caries:
6 y/o grinds teeth, tell the parent:
common and will stop by age 12 without intervention
decreased appetite, fever, ST, not feeling well. rash on hands, 3y/o, febrile, ill, flushed face. vesicular lesions on palms, soles of feet, ulcers on mucosa:
hand foot mouth
early childhood caries causes damage to permanent teeth. failure to thrive, oral infections, difficulty in school. not:
low grade fever, HA, nasal congestion, green nasal discharge, tenderness to palpation over right maxillary sinus: URI, tx:
give nasal saline lavage and acetaminophen prn
ha, stuffy nose, green nasal discharge, low grade fever, body aches, facial pain, dry cough. temperature 99.9, nasal mucosa boggy, tenderness over maxillary:
conductive hearing loss
cause of sensorinerual hearing loss:
inflamed eyelids, normal vessels, normal pupil, unaffected vision
red eye blepharitis:
homogenous bright red patch between conjunctiva and sclera; normal pupil, unaffected vision
2.5h painless, progressive vision loss in right eye. htn controlled with beta blockers. cardiac dysrhythmia treated with amiodarone. blood pressure 180/110. right eye: can see light but can’t see anything else. pale retina with red spot
central retinal artery occlusion
stuffy, runny nose with watery discharge. itchy, tearing eyes in spring. frontal head ache, decreased appetite. nasal membranes swollen, reddish-blue conjunctival injection visible bilaterally one eyes. IgE 1520 IU/mL, eosinophiles:
red lump on left eyelid. red pustule, hyperemia, swelling, oozing:
left ear pain, hx of travel to the beach. pain with retraction of the pinna. left ear canal is inflamed, white discharge. TM not visualized:
cortisporin otic suspension topically to the ear
2 week old: pain & white reflux in right eye: retinoblastoma
poked in eye. pain, tearing, blurred vision. pupils equal and reactive, EOMI; sclera mildly injected, visual acuity 20/30 OS, OD; no foreign body seen:
stain cornea with fluorescein
poked in right eye; pain, photophobia, increased tearing, redness, no foreign object seen. dark red fluid level in lower half of iris.
immediate referral to ophthalmologist
23m old: irritable, cough, congestion, rhinorrhea, 101.8F, pulls left ear. 1 week ago had URI: cough, rhinorrhea, congestion. rhonchi in both lung fields. bilateral TMs are red, bulging, middle ear infusion:
amox 10 days
child (ear infections) is back for 4th time this year:
give abx and recommend placement for tympanostomy tubes
ST, fever of 39C, dull, midepigastric pain. 1 episode of non-bilous emesis. frontal HA, allergic to penicillin. tonsils enlarged, beefy red with purulent exudate. petechiae on soft palate. white coat on tongue. cervical adenopathy. sandpaper rash. group A strep +:
azithromycin 12mg/kg/day for 5 days
acute red eyes, watery discharge, aversion to bright lights. gritty foreign body. conjunctiva injected and mildly swollen. palpable conjunctiva with cobblestoning. bilateral conjunctival redness with watery discharge:
21m old cranky, refused food. pulling right ear, fever. coughing, runny nose, diarrhea, flushed, temp 103.1F. red pharynx with mucous. right TM erythematous and bulges, light reflex is displaced:
tinnitus, loud noises often, music. uncomfortable in crowds, deteriorating grades. Weber to the middle of the forehead. AC>BC. 30db hearing threshold at 4000Hz:
noise induced hearing loss
ST, fever, drooling, change in voice, difficulty swallowing. temp 102.4, hot potato voice, fluctuant left tonsil displaced medially, erythema and edema of soft palate. uvula deviated to the right; cervical adenopathy:
IV abx and ENT surgical consultation
4y/o with 6 episodes of tonsillitis; fever, difficulty swallowing, throat pain, tender enlarged cervical nodes. tonsils moderately swollen and inflamed with exudate on 3 occasions. 4/6 episodes were strep. intermittent snoring, apnea. more aggressive in preschool:
dizzy, spinning, sudden onset, worse with position changes, nausea, vomiting once. no tinnitus:
location of most nosebleeds:
chronic rhinitis, congestion, decreased sense of smell. yellow, boggy nasal mucosal masses bilaterally in nares. tissue is pale without erythema. clear discharge. posterior oropharynx inflamed without exudate. dry, nonproductive cough:
MVA, trauma to chest:
carotid pulses +3 bilaterally without bruits. soft S1. blowing diastolic murmur at sternal border. murmur increased with handshake. fingernails blanche with pressure:
3 year old, erythematous vesicle with thick yellowish/gold crust around lips:
acute spreading inflammation of dermis and subcutaneous tissue often caused by bacteria:
11 year old itching skin rash on back. appeared 1 week ago, growing. ½ dollar size, annular with sharp margins and lightly scaly. center is starting to clear. KOH shows hyphae.
severe plant contact dermatitis, tx:
40 year old with 3 day history of right sided CP. increasing intensity, burning, like a band across mid chest and mid back on the right side. light rash in the area. fatigue and malaise. on R chest, small vesicles with surrounding erythema in mid region. skin is tender in dermatomal fashion along affected area.
Herpes zoster infection
molluscum contagiouscum common in children (very contagious) in adults, considered:
30 year old with itchy pimples on wrist for 2 weeks. violaceous papules with network of grey lines on surface of medial aspect of R wrist:
hypopigmented macules with enhanced appearance after sun exposure in lighter skinned patients:
8 year old with papular rash. lesions are vesicular and crusted. 3 stages are visible:
urticaria treated with antihistamines, H2 blockers, systemic steroids. Not
HSV 2 is transmitted
tinea capitus tx:
48 year old long term inflamed papules about face and thickened appearance of nose (rhinophyma), flares with alcohol:
do not drain subungual hematoma if suspected
fracture of digit
antibiotics (not for rubella, varicella, 5th dz)
topical steroids, topical vitamin D, oral steroids (Not ABX) for
delivery vehicles for hairy areas:
gels and lotions
symptom in eczema:
tinea unguium (onychomycosis) tx
actinic keratosis, rosacea, melanoma (not keloids) common factor is
oral antifungals: assess what (on physical exam)
Breslow depth and Clark level
a common area that harbors bacteria that causes impetigo
15 year old with constant itching, burning on arms and thighs for 2 weeks. acetaminophen without relief. multiple 2cm wheals with a few small papules on thighs and forearms. red and slightly raised.
pityriasis rosea starts with lesion called
65 year old with skin lesions in dermatomal distribution on trunk. preceded by pain (shingles): tx
oral steroids, antivirals, pain meds
45 year old professional surfer with a lesion on his face with a waxy appearance with pearly, rolled borders:
basal cell carcinoma
52 year old coming in for a mole check; lesion on R forearm. present several months, getting bigger. poor sunscreen use, at least 3 blistering sunburns: Diameter of what is bad
>6mm is bad
location of leukoplakia:
majority of skin CA deaths from:
biopsies used for
eczema and asthma and allergic rhinitis
24 year old with flu like sx including malaise, anorexia, chills, fever, petechial lesions on wrists and ankles, spread inward to trunk. went camping:
Rocky Mountain spotted fever
Lyme dz, Rocky Mt Spotted Fever: give
5 year old with macular, erythematous rash on cheeks that resembles sunburn:
5th dz (slap cheek)
32 year old with a rash for 4 days. recently on abx. target lesions on arms, soles of feet:
44 year old with 3 week history of generalized rash. minimal pruritus. no fever. single lesion grew in size; rash progressed elsewhere. scaly, reddish pink plaques concentrated on the trunk in a Christmas tree pattern with a single lesion (PR): least likely to affect
palms and soles
45 year old identical twins. 1 looks younger. loss in tone, elasticity, keratoses, telangiectasias, pigmented and depigmented lesions on face, neck, hands, occupation:
2 year old scratches head. patch of hair loss on top. patchy hair loss in right parietal area and another area of “black dot” alopecia about 4 cm lateral to it. area of hair loss—grayish ring-shaped lesion. KOH prep—branching hypae and spores: tinea capitus, give
23 year old with severe itching and burning pain in earlobes. hx of new studs. allergic contact dermatitis:
33 year old with redness, itching, burning on back of hands. clearing weeds—3 leaves. several tiny blisters with linear distribution:
poison ivy dermatitis
3 year old with a 6 day history of sx including itchy red “wound” on R knee. worsened. a few intact vesicles and ruptured vesicles covered with honey colored crust on R knee. Staph Areus:
45 year old with overgrowth on forehead over 2 weeks. has grown in size. bleeds. hx of tanning beds. SCC risk:
2 year old with atopic dermatitis. long term care:
frequent lubrication with emollient cream and BID hydrocortisone 1’1 cream
16 year old F with severe cystic facial acne. Isotretinoin (Accutane): ALWAYS
rule out pregnancy
47 year old with “CA” on back: single lesion 3mm, brown/black, “stuck on” appearance:
28 year old with itchy, scaly rash on elbows for 1 week. knees are also affected. lesions are whitish on erythematous base, irregular but well demarcated (psoriasis), tx:
topical fluorinated glucocorticoids
20 year old who needs increased acne therapy. progressed to severe:
add oral isotretinoin
55 year old with lesions on top of head. 6 months ago more are appearing. multiple lesions <1cm. yellow-brown, dry, scaly, rough, coarse-like texture and tender.
20 year old pruritic rashes on arms. recurrent for forever. asthmatic. erythematous maculopapular lesions with hyper pigmentation and lichenification in antecubital fossae bilaterally:
21 year old with recurrent painful nodules in axillae. red inflammatory nodules tender to palpation. areas break down and drain a foul-smelling purulent material:
18 month old infant with a 1 day history of fever of 101F rectally. back 2 days later with small red spots that became bumps and are now blisters. itchy. on thorax. vesicles reside on erythematous base:
22 year old with painful blisters at a R angle to the mouth. tingling and burning 3-4 days before. temperature of 99.5F. multiple vesicles seen at mouth but have not spread: give
35 year old with a changing mole on the neck. irregular, nodular, superficial with variegated appearance. malignant. for an accurate long term prognosis: assess the
83 year old bedridden patient with lesion below the surface of tissue. lesion is a crater. loss of epidermis and dermis. inflammation accompanies the lesion:
66 year old with a rash over 3 weeks. getting worse. blisters in the mouth itch. red with blisters about a week ago. also on abdomen. uricarial, inflammatory papules and plaques with blister formation. abdomen—inflammatory plaques surmounted by tense blisters:
poorly differentiated, diffuse redness with warmth
38 year old with a skin rash. history of psoriasis. salmon-pink papular lesions on flexor surfaces of wrists. linear pattern. around 3 days old. scratched and lesions appeared:
55 year old with lower back 2mm well-circumscribed non-raised black lesion:
6 year old who is scratching his scalp. tiny, white, wingless insect and tiny eggs attached to hair shafts. also on eyelashes:
65 year old with a lesion on his upper back. flat, slightly raised, blue-gray pigmented lesion. 1x2 cm with irregular borders:
50 year old with facial rash. 10 year history of reddening of the face that comes and goes. erythema, telangiectasia, red papules, tiny pustules on bilateral cheeks:
17 year old son with a rash on his face, getting worse over 3 years. multiple comedones and papulo-pustules covering his cheeks, forehead, chin. mild acne, tx:
60 year old with itchy lesions on left ankle for 6 months. left leg is erythematous with scaly patches and ulcer over medial malleolus. bilateral varicose veins:
40 year old with itchy lesions on the face for 2 days. new after shave. erythematous, sharply demarcated, weeping lesions on cheeks and chin:
25 year old with itchy lesion on the back of neck for 1 year. increased itching when studying. scaly, well-circumscribed lichenified plaque on posterior nuchal region
Lichen simplex chronicus
20 year old with 2 month history of itchiness of scalp. greasy yellowish scales on scalp and eyebrows.
10 year old with rash on scalp present for 1 week. scratching scalp, hair has fallen out. no improvement with OTC. erythematous, circular, scaly patches. areas without hair are brittle and broken off. KOH showed hypae:
12 year old with itchy, redness between toes. anti fungal before. interdigital spaces are macerated and erythematous, tx:
continue anti fungal and give health education
19 year old with a new rash for 2 days. sore throat treated with penicillin. target like lesions on palms bilaterally and symmetric.
24 year old with a new rash. mild itching. scattered, multiple lesions. sharply marginated with central clearing that an annular configuration that appears on arms, neck, trunk. etiologic cause:
27 year old with painful itching blisters on genitalia. 2 days ago, sick, OTC aspirin, increased temperature to 37.5C. enlarged lymph nodes in inguinal area. vesicles on labia and perineum. some ruptured and some crusted over. no vaginal discharge: give
73 year old with toenails that are thick, hard to cut, discolored, dystrophic. KOH showed a fungal infection:
eczematous dermatitis are:
23 year old with skin lesions, history of allergic rhinitis and asthma:
41 year old with itchy rash on R foot for 1 day. allergy to nickel from boot. irregular papular reaction over medial malleolus of right ankle distally to level of mid foot. some excoriation. prescribe topical corticosteroid flucinonide 0.05% strength: do not apply to
genitalia or face
63 year old farmer. 4mm papule on forehead, pearly white with rolled borders. small tenangiectasias in the lesion. small scale in the center:
basal cell carcinoma
66 year old ulcerative lesion on plantar surface of the right foot in pressure point area:
hairless, pale, shiny skin:
venous insufficiency caused by:
venus reflux dz
conservative therapies for venous insufficiency (exercise, elevation, compression hose, unna boot):treats the sx but
not root cause
regular part of wound care
COPD with pedal and sacral edema, JVD, EKG showed narrow P waves:
fever, malaise, ST, erythematous pharynx with tonsillar exudate. posterior cervical nodes 2+ and tender, strep negative:
23 year old with URI, CP, worse lying down, better sitting up and leaning forward, EKG showed ST elevation:
pericardial friction rub
Varicella transported through
Most common STD is
A sporeforming anaerobic bacilli is
Number of MMR vaccines are given
Aplastic anemia presents with
hypocellularity of bone marrow
Smudge cells are pathognomonic for
An elderly patient lost 30lbs over 6 months. She attributes it to a loss of appetite and cooking for one since her husband’s death. Her blood smear shows hypochromic, normocytic anemia, low serum iron, low total iron binding capacity (TIBC), and high ferritin. She has
anemia secondary to chronic disease.
HIV + mom gives birth. At 2 months old, her baby is found to be HIV+. Is this true? Any more testing to be done?
Newborn is HIV+
5 year old boy presents with increased lethargy for the past 2 months. On PE, he has a Temp of 37.3C and ecchymoses. Hgb and Hct are decreased. MCV is normal. PLT is normal. WBC is increased. A bone marrow biopsy is done and shows 100% cellularity with replacement by primitive cells with large nuclei and indistinct nucleoli with scanty cytoplasm. Cells mark + CALLA CD 10 antigen. He has
62 year old male with increasing Dyspnea On Exertion and abdominal discomfort for 4 months. On exam, nontender cervical adenopathy. liver span is 10cm with a smooth and palpable liver edge. Spleen is palpable. WBC increased; segs decreased; bands decreased; and lymph increased. Direct Coombs test +. He has
Parts of Clostridium tetani:
neurotoxin + exogenous infection.
12 year old boy with bulls eye rash. The tick carried
borrelia burgdorfer bacteria.
17 year old female complaining of vaginal discharge. Mucopurulent discharge is present. No cervical motion tenderness or adnexal tenderness. Chlamydia is positive. Give
Azithromycin 1g x1.
A 20 year old white male presents with 2 week history of fever. A friend had strep throat but he doesn’t have ST, HA, or stiff neck. Went hot-tubbing recently.
Fever of Unknown Origin.
21 year old female nursing student with low grade fever, ST, malaise, and fatigue. Swollen lymph nodes and LUQ discomfort is present. 50% atypical lymphocytes. Heterophile antibody test +. Has
Epstein-Barr virus. (mono)
22 year old female immigrant has entamoeba histolytic present in her stool. Give
23 year old female presents with a partner who is HIV+ but her ELISA was negative. Work up?
Repeat the ELISA in 6 months.
23 year old presents with painful sores on penis. Fever, tender, enlarged inguinal lymph nodes. Numerous vesicular sores on red tissue. Has
24 year old IV drug user presents with a 4 week history of fever, dry cough, dyspnea, and rapid breathing. Diffuse, interstitial pattern on Xray. Has
28 year old male presents with a rash on his nose. It is painful, red, and itchy with blisters. It is linear with small vesicles and a crust. Examine for
involvement of cornea.
3 month old female is lethargic and weak. She won’t eat. Hypotonia of extremities and flaccid neck. Poor gag and suck reflex. Decreased respirations. Had eaten honey.
32 year old female reports being tired and run down. She has difficulty swallowing and reports changes in her tongue and mouth. She is pale with angular stomatitis and atrophic glossitis.
Iron deficiency anemia.
36 year old female traveled to Indonesia. She complains of profuse, watery diarrhea, cramps, nausea, and overwhelming thirst. She is dehydrated, diaphoretic, and has orthostatic hypotension and hypokalemia. Oxidase positive curved gram negative rod on TCBS agar.
40 year old male reports being easily fatigued and feels weak with recent weight loss. Philadelphia chromosome is present.
44 year old female presents for an exam. She has pale mucous membranes, increased uterine size, and menorrhagia for the past 2 years. Her RBCs are microcytic and hypochromic. Decreased serum iron, increased TIBC, and decreased ferritin.
Anemia secondary to iron deficiency.
5 year old hispanic male with ALL complains of fever and rash. He has been exposed to varicella. Blood tests are negative but he has small vesicles and red macules on his face and chest. Give
52 year old alcoholic male complains of being easily distraught, tired, and constantly weak. He has GI complaints and diarrhea. He eats a poor diet and is malnourished. Decreased Hct, Hg, and increased MCV. Hypersegmented granulocytes. Bone marrow biopsy reveals hypercellularity with numerous megaloblasts.
Anemia secondary to folic acid deficiency.
62 year old male with AML: tell him survival is based on the
duration of his first remission.
62 year old male with increased left rib pain, tingling, numbness of lips and extremities. Hypercalcemia. X rays show a rib fracture and diffuse osteoporosis. Serum protein electrophoresis revealed monoclonal protein spike in gamma region.
70 year old male here for a follow up with his cardiologist. He has pale mucous membranes. Hypochromic microcytic RBCs. Low serum iron, low TIBC, high ferritin.
Anemia of chronic disease.
70 year old male complains of weakness in his arms and legs and disorientation You suspect pernicious anemia. He takes B12 capsules. You give him B12 shots and it relieves his symptoms. What does he have? Reduced synthesis of
78 year old male with ESRD on hemodialysis. Blood smear shows moderate normocytic normochromic anemia. Give
IgM antibody response is [what number] with the flu infection.
Patient reports tongue having a thick white coating, otherwise red and irritated. She can scrape it off.
8 year old boy with fever and URI and blue-gray spots in his mouth and a rash on his face. The rash has reddened papules and macules that is moving downwards.
Fever, lymphadenopathy, HA. Toxoplasmosis found in
1 year old boy is physically underdeveloped, weak, and unresponsive. He is a recent immigrant from southern Italy. His parents also mildly anemic. RBCs decreased, Hg decreased, Hct decreased. Peripheral smear positive for basophilic stippling, hypochromia and presence of codocytes.
Bence Jones proteins:
Epstein Barr Virus
Clostridium botulinum produces
The most life threatening part of clostridium is the production of
Helminthic infection: use what test for eggs
cellophane tape test
15 year old female with ST, low grade fever for 4 days, and gray-white patch on pharynx. Gram + beaded bacilli. Long, slender bacilli with green body and deep blue prominent granules.
55 year old comes to the ER with complaints of fatigue, night sweats, and a low grade fever for 1 week. Spleen is palpable. CBC shows a WBC 105,000 with left shift. Increased platelets. BCR/ABL gene is present.
Going to the DR. Take
chloroquine weekly starting 1 week before travel.
22 year old Italian male orders meat with fava beans. He experiences fatigue, HA, abdominal pain, nausea, fluttering chest, and SOB. Bite cells are present.
5 year old with fever, hemorrhages and repeat bacterial infections. WBC 50,000.
45 year old male complaining of a change in appearance of skin. It is thickened and reddened. A biopsy shows neoplastic T lymphocytes.
63 year old male with bleeding gums, illness, low grade fever, fatigue, and bone and joint pain. He is pale with mild petechia, gingival hyperplasia, and a palpable spleen. CBC reveals pancytopenia and blasts with auer rods.
Rickettsia rickettsi: give
doxy, even in kids
Multiple myleoma, CMP results show:
Interstitial plasma cell pneumonia in AIDS patient:
vector for malaria
Kaposi sarcoma associated with:
Hematologic CA workup:
bone marrow biopsy/aspirate
65 year old male with lymphoma. PMH includes chronic renal insufficiency. He reports vomiting, restlessness, muscle weakness, tingling, dry mucous membranes. BP 90/40; HR 110; increased WBC, BUN, creatinine, and decreased Ca. Crucial to give
negri bodies (intracytoplasmic) in brain tissue
19 year old male cut himself with a nail. Give
Tdap vaccine and antibiotics
Oncologic emergency associated with childhood leukemia:
Tumor lysis syndrome
Remission rate of children with ALL
SCLC: very responsive to chemo. (In the center.) FALSE:
in periphery, amenable to resection, good long term survival, not spread hematogenously
Nulliparous woman with increased risk of breast cancer: more
high risk breast lobule cell types
Hypercalcemic, an adult oncologic emergency. Presents with abdominal cramping, bone pain, kidney stones, and confusion. (Bones, stones, abdominal groans) Not
70 year old black male with high grade fever, nausea, infection, and severe back pain. He fell 2 years ago and has had the back pain since. Decreased RBC. Paraprotein. Bone marrow biopsy shows 50% infiltrate by plasma cells.
CA patient with hypercalcemia: give
IV normal saline
Hemophilia C is NOT
most common bleeding disorder.
Von Willebrand’s dz
55 year old female with a prior DVT is now on Coumadin. Target INR is
48 year old male smoker with a DVT and PE. He will be on coumadin for
lab test to monitor the intrinsic pathway of the coagulation cascade.
Clotting factor X is ____ dependent.
used to treat Von Willebrand’s dz.
Graft v. host disease is a complication of
bone marrow transplant.
Acid fast bacilli
62 year old male smoker with lung CA in the bronchus with hilar and mediastinal lymph node abnormalities. It has early hematogenous spread, is rarely amenable to surgery, and aggressive.
Small cell lung CA
Patient presents with burning lesions on his penis and tender inguinal adenopathy. Give
Valcyclovir 1000mg PO BID x7-10 days.
Least likely cause of FUO:
FUO: temperature >101F on several occasions; diagnosis is not established after 1 week of inpatient investigation; lasts 21 days or longer. Not:
fever presenting without any localizing symptoms over time.
important in FUO: detailed history; complete PE; and frequent reassessments; least important is
pattern of fevers.
FUO: transaminases elevated
Sepsis: caused by
Poor prognostic indicator in sepsis: (Not: urinary source, female, or 35 years old)
63 year old black male with DM and HTN complaining of feeling woozy and unwell. Temperature 40C, HR 22, RR 26, BP 84/56, and SpO2 91%. Recently hospitalized. Suspect sepsis secondary to hospital acquired pneumonia. First tx:
Maintain his airway.
53 year old female reports a fever and poor condition of teeth leading to a tooth infection, which has spread to her face and neck. She is febrile. An erythematous, edematous, hot, and tender area is on her lower right cheek and upper right lateral neck is present. She can swallow. No stridor. Poor dentition. Posterior pharynx isn’t affected. Give
32 year old female patient presents with a warm, painful, red, and swollen area of her forearm with multiple bullae. Culture it and expect it to come back positive for
32 year old febrile female patient presents with a warm, painful, red, swollen 12cm area on her forearm with multiple bullae. Give
sulfa trimethoprim (SMX-TMP) double strength.
7 year old boy with a bat bite. He has local pain but no other symptoms. There is tenderness at the bite mark with 2 punctae of right thenar eminence with minimal erythema and no exudates. Give a
rabies immunization immediately.
17 yo F heart beating ‘funny’ and intense seems down and emotional and significant wt loss, exophthalmous, fine tremor, pulse 100
42 yo F with fatigue, coldness, constipation and elevated TSH
-skin dry and rough
papillary thyroid cancer-best treatment
22 yo F with weight loss with good appetite, diarrhea, heat intolerance, menstrual irregularity, R lobe os thyroid is enlarges. She has hyperthyroid
-palpitations and tremors
most common type of thyroid cancer
32 yo white F with hyperthyroid order which test?
-TSH and free T4
Chart: TSH elevated, total T4 decreased, free T4 decreased, free T3 elevated
which is most accurate test to dx thyroid cancer
-FNA (fine needle aspiration)
55yo F with depression, fatigue, apathy, weight gain, amenorrhea, dull facial expression, periorbital swelling and coarse dry skin. No thyromegaly. She is anemic. Decreased Hct. Decreased hemoglobin. Increased MCV.
31 y/o M c constipation, fatigue, and weight gain of 20lbs over last 6months. Weigh 220 and 6ft. Low T4, High TSH (193). Prescribe
patient is hypothyroidism. Serem TSH decreased. After TRH stimulation decreased. T4 elevated
hyperthyroidism alleviate symptoms with
4-6 weeks after Rx
Iodine 131 treatment: do ____ first
55 yo M with weight loss, good appetite, polydipsia, polyuria. FH DM. increasingly tired and lethargic, overweight and random blood sugar 312.
-check Chem 7
72 yo with altered level of consciousness, decreased mental status, no trauma. Glucose 678. Serum osmolality 305. K decreased.
-treat with normal saline first
superous patient progressive lethary confusion, polyuria, polydipsia, dehydrated, no Kussmal respirations. Glucose 1200, pH 7.5, osmolality 320, no ketones in UA.
21 yo F with DM
which of following hypoglycemic agents cause more hypoglycemia
20) 50 y/o man c 2 year hx of DM. On Glipizide 5mg/day. Weight has gone up albs and HgA1C increased. Change
glipizide to metformin.
early DM nephropathy
symptom of hypoglycemia in elderly patient
cardiovascular complication in type II DM (CEO bank man)
-prevented with tight control of BP
43 yo F with fasting serum glucose 130 (high) and A1C 6% (normal)
-she is in good glycemic control
Which is more prevalent in Type II vs Type I DM
Hispanic 45 yo with DM, sleep apnea
-feeling of malaise due to DM
72 yo with Type II DM recent URI excessive diuresis, decreased oral intake, increasingly stuperous and lethargic
microaneurysms, cotton wool spots, and neovascularizations on fundascopic
62 yo M with 25 yr hx DM, worsening edema, currently on glipizide 20 mg BID, glucose 287, A1C 8.6%
-start on metformin
18 yo DM F with altered level of consciousness, deep breathing, and fruity odor-use
HgA1C should be between
10 yo Hispanic boy, mom wants to prevent DM
-favorite sport and pediatric dietician
52 yo DM F, lantis 50 units at night but post parandeal sugars are elevated and A1C is 7.8%
-add rapid meal time insulin
(Chart) 56 yo M DM and hypertensive wants to make sure no kidney problems
Target LDL in DM
glycosilated hemoglobin for 2-3 months
38 yo M has pheo (golfer): CP, HA, palpitations, flushed, diaphoretic, BP 195/110. @ ED felt better BP 150/90. Has had episodes for 2 months and HA that come like waves.
discharge with 24 hour urine catecholamine and f/u with PCP
53 yo F with near syncope episode, fatigues, weak, nausea, weight loss, vomiting, abdominal pain, orthostatic hypotension, suntan
44 yo F with near syncope, fatigue, n/v, weight loss, weakness, BP 95/55, orthostatic + tilt, dry mucous membrames, and increased pigmentation, distant heart sounds, tachy, diffuse abdominal tenderness s guarding, tan
44 yo F with HA, increased fatigue, weight gain, stretch marks, increased BP, neck is thick and full (buffalo hump), purple striae, and bruising
32 yo F (associate editor) fat, with pimples, hair on face (hiritism), purple stripes on tummy-which test?
-urinary free cortisol
-restriction of free H2O
DM symptoms but has acromegaly bc he needs larger wedding ring
thyroidectomy, + chvostek sign
-decreased serum calcium (hypocalcemia)
most common pituitary adenoma (prolactinoma)
-get serum prolactin level
14 yo F short stature, growth failure, Tanner stage I, wrinkles on face, apathetic
-tumor on anterior pituitary
vasopressin challenge for
DI, deficient hormone:
pituitary gland imaging:
T score 0.8
-bone density is normal
T score -2.0 and -0.5
-osteopenia and needs treatment
76 yo F with Fx – broke hip, demineralization
primary prevention in rickets
-inform public benefits of breast feeding and vit D supplements
25 yo M with cramping, abdominal pain, fever, diarrhea, R abdominal pain, RLQ tenderness, bowel sounds present, + hemoccult, transverse and descending not present with ulcerations
35 yo F African American, red irritated eyes, SOB, CXR perihilar adenopathy, increased ACE (Sarcoidosis)
acute exacerbation of asthma
infection of kidney in pelvis
giantism is coarse facial features, heavier browridge, large hands and feet
giantism is NOT small jawline
acromegaly dx with
pituitary adenomas management goals include relief of visual impairment, multiple recurrences raise suspician for ca, transsphenoidal surgery is 1st line therapy for macro adenomas NOT
macroadenomas are more common (false)
32 yo impaired vision, vertigo, and asks for Rx of Viagra
33 yo F HA, diplopia, macroadenoma underwent surgery, HA again, another tumor, also ptosis, difficulty hearing
-consider work up with imaging for possible pituitary cancer
increased hyperpigmentation in Cushings
increased ACTH and decreased cortisol
HA, diaphroesis, palpitations, severe HTN
6 year old girl staring off into space; the teacher can’t get her attention. She seems to talk to herself but no sound is coming from her mouth. After these “episodes” the girl is fine.
Petit Mal (absence seizure)
Symptom of lesion of the trigeminal nerve
trouble clenching teeth
deteriorates first in Alzheimer’s dz
Motion sickness, mitral valve prolapse, hyperlipidemia, and adrenal dysfunction are associated with migranes. _____ is NOT
60 y/o F with right-sided facial pain. Severe, electrical stabbing for 15-30 seconds. Touching her face brings on the pain.
44 y/o M whose jaw is weak, has ptosis, and difficulty swallowing. Positive Tensilon test. (Myasthenia gravis). Look for a
Dizziness, nausea, vomiting, no PMH, no injury. When patient moves his head, lies down, or rolls in his bed.
Spinal epidural abscess—workup
Temporal lobe damage causes
memory loss/auditory deficits
Male with difficulty tolerating medicine, ADLs. Surgery can be done for
Pediatrics: most ______ for concussion
Tremors are absent at rest and worsen with activity, especially as the target is neared.
Injection for migraines, then chest pain. was given:
Daily HA, also has watery eyes, stuffy nostrils.
Weakness of grip bilaterally. Hyperactive DTRs. Sensation is intact. No urinary symptoms—
Give tPA within
3 year old girl who is irritable and weak in her legs for 1 day. Ascending symmetrical paralysis. LP has normal glucose but increased protein. Recent recovery from mild diarrhea. (Guillian-Barre); bacterial cause is
Left eye does not move outward. Lesion is located:
Left 6th nerve lesion
a sudden interruption of blood flow to the brain.
18 year old F with a history of HA above the right eye. Throbbing with N/V. Alleviated with a nap. Last a few hours. Happens 2x a month.
32 year old F with difficulty brushing hair. Ptosis relieved with rest in the AM.