A 26 year old man with lesions on his body...

A 26-year-old man is seen for an upper respiratory infection. After removing his shirt, you notice the lesions shown in the picture below. He reports that his father has similar lesions.

The differential diagnosis should include
A) Hypothyroidism
B) Addison’s disease
C) Multiple sclerosis
D) Neurofibromatosis
E) Gardner’s syndrome

Answer:

A 60 year old woman with a h/o Rheumatic heart disease and recently being treated for heart failure...

This ECG was recorded from a 60-year-old woman with rheumatic heart disease. She had been in heart failure, but this had been treated and she was no longer breathless.

What does the ECG show and what question might you ask her?

The ECG shows:
• Atrial fibrillation with a ventricular rate of 60-65/min
• Normal axis
• Normal QRS complexes
• Prominent U wave in lead V2
• Downward-sloping ST segments, best seen in leads V5-V6

Clinical interpretation
The downward-sloping ST segments (the 'reverse tick') indicate that digoxin has been given. The
ventricular rate seems well-controlled. The prominent U waves in lead V2 could indicate hypokalaemia.

An 18-year-old woman presents to your office complaining of tender nodules that have developed on the lower extremities.

An 18-year-old woman presents to your office complaining of tender nodules that have developed on the lower extremities.

She has no other symptoms. She continues with her oral contraceptives but has not started any new medications. She denies any fevers and has no history of recent trauma.

The likely diagnosis is
A) Erythema multiforme
B) Erythema nodosum
C) Lyme disease
D) Pyoderma gangrenosum
E) Rheumatoid arthritis

Answer:

Stress (Exercise Tolerance) Testing - Learning Flash card

A sexually active 24-year-old woman presents to your office complaining of vaginal discharge.

A sexually active 24-year-old woman presents to your office complaining of vaginal discharge. Findings from a wet prep are pictured here.

The most likely diagnosis is
A) Yeast vaginitis
B) Gardnerella infection
C) Trichomonas infection
D) Gonorrhea
E) Chlamydia

Answer is

A 12-year-old boy presents with a crusted honey-brown lesion that affects his face

A 12-year-old boy presents with a crusted honey-brown lesion that affects his face. The rash began as red macules 3 days earlier. The best treatment is

A) Intramuscular ceftriaxone
B) Topical hydrocortisone cream
C) Oral ciprofloxacin
D) Topical mupirocin ointment
E) Oral acyclovir

Answer:

A 25 Year old Pregnant woman presents with Palpitations...

This ECG was recorded from a 25-year-old pregnant woman who complained of an irregular heart beat. Auscultation revealed a soft systolic murmur but her heart was otherwise normal.

What does the ECG show and what would you do?

The ECG shows:
• Sinus rhythm
• Ventricular extrasystoles
• Normal axis
• Normal QRS complexes and T waves

A 29-year-old man presents to his doctor with a rash ...

A 29-year-old man presents to his doctor with a rash (shown in picture below). The rash does not itch and has been present over the last week. A large, red area developed first, followed by a more generalized rash that is now present.
Physical examination shows that the rash appears in a Christmas-tree pattern on his chest and back.

The most likely diagnosis is
A) Pityriasis rosea
B) Tinea versicolor
C) Herpes zoster
D) Varicella
E) Lyme disease

The answer is

A Skin lesion that developed Over A 4 week period....

The pictured skin lesion developed over a 4-week period. The most likely diagnosis is
A) Melanoma
B) Basal cell carcinoma
C) Keratoacanthoma
D) Dermatofibroma
E) Molluscum contagiosum

Answer:

A 19 Year Old Woman With Fever And Sore Throat

A 19-yr-old woman presents with a severe sore throat, fever and malaise. She has marked cervical lymphadenopathy, gross splenomegaly and scattered petechiae on the soft palate, with enlarged tonsils covered by a confluent white exudate.

Her White cell count is mildly elevated, her serum ALT and AST concentrations are twice normal and her ALP is slightly elevated.
Which one of the following investigations is most likely to help guide your management?
A. FNA of a LN
B. HBsAg
C. CMV IgM
D. Heterophilic antibodies
E. HIV test

Answer:

A 55-year-old woman complains of generalized fatigue, weakness and a rash.....

A 55-year-old woman complains of generalized fatigue, weakness, inability to climb stairs, arthralgias, and dysphagia.
Physical examination reveals definite proximal muscle weakness, a periorbital heliotrope rash, and skin findings associated with the hands (shown here).

The most likely diagnosis is

A) Lupus erythematosus
B) Sarcoidosis
C) Sjögren’s disease
D) Dermatomyositis
E) Polymyalgia rheumatica

Answer:

A 19-yr-old woman Presents with Fever, Rash and Cough.....

A 19-yr-old woman presents with fever, rash and cough, and is pyrexial, tachycardic and tachypnoeic. She has a florid erythematous rash on her face, trunk and arms, with scattered whitish papular lesions on the buccal mucosa.

What is the most likely Dx?
A. Meningococcaemia
B. Rubella
C. Parvovirus B19
D. Secondary syphilis
E. Measles

Answer: E. Measles

Discussion: Adult measles is unusual except in non-immunised persons. The description of this Pt’s rash is classical: the rash is maculopapular, starts on the face and migrates caudally; Koplik’s spots are present in the mouth.

In contrast, meningococcaemia is a petechial/purpuric macular rash with no buccal lesions, and there is no typical migratory pattern.

A 27 year Old Woman presents With Sudden Excessive Hair Loss

A 27-year-old woman , a mother of 2 children and who is now 6 months postpartum complains of excessive hair loss.
The most likely diagnosis is
A) Alopecia areata
B) Telogen effluvium
C) Trichotillomania
D) Tinea capitis
E) Hypothyroidism

The answer is

A 35 Year Old Patient With Progressive Hearing Loss

A 35-year-old presents with unilateral hearing loss that has been gradual but progressive over the last 6 months. Otoscopy reveals a Cholesteatoma.

Appropriate treatment of the above condition consists of
A) Prolonged antibiotics for up to 4 weeks
B) Decongestant and antihistamine administration
C) Corticosteroid treatment for 2 weeks
D) Hearing aid amplification
E) Tympanomastoidectomy

Answer:

A 19 Year Old Male With Cough, headache and Malaise...

A 19-yr -old army cadet is admitted to hospital with cough, headaches and malaise. He has a temperature of 38°C. His blood count and renal and liver function are normal. Cold agglutinins
are positive. A CXR shows bibasal shadowing.

What is the most likely Dx?

A. Legionella pneumonia
B. Viral pneumonia
C. Q fever
D. Klebsiella pneumonia
E. Mycoplasma pneumonia

Answer:

Management Of Pressure Ulcers

A 85-year-old debilitated nursing home resident was found to have pressure ulcers. He has no evidence of bacteremia or osteomyelitis. Which of the following is an acceptable treatment?
A) Application of povidone-iodine gauze two times per day
B) Application of hydrogen peroxide 3 times per day
C) Systemic antibiotics for 7 to 10 days
D) Keeping the area clean and dry until granulation tissue forms
E) Surgical debridement

The answer is

A 38-year-old man presents with rapid hair loss that has occurred over the last few weeks.

A 38-year-old man presents with rapid hair loss that has occurred over the last few weeks. He reports that his father had a similar condition.
The picture is shown below:

The most likely diagnosis is
A) Alopecia areata
B) Androgenic alopecia
C) Tinea capitis
D) Trichotillomania
E) Secondary syphilis

The answer is

A Patient With Black Discoloration of The Tongue

You are examining a a patient and discover the findings seen on the picture above. Which of the following conditions is this associated with?
A) Prolonged antibiotic use
B) Sjogren’s syndrome
C) Addison’s disease
D) Chronic gastroesophageal reflux
E) Malignant melanoma

The answer is

A Young Woman Presents With Painful Ulcers On Her Lower Lip

An 18-year-old sexually active woman presents with a two small ulcers located on the lower lip which are painful. She is a smoker and has noticed that the ulcers have been recurrent and correlate with the onset of menses. The most likely diagnosis is
A) Kawasaki disease
B) Aphthous stomatitis
C) Squamous cell carcinoma of the lip
D) Syphilis
E) Koplik’s spot

The answer is

Seborrheic Keratoses- Management

                                             Seborrheic keratoses seen in an Elderly man 

An 82-year-old nursing home resident is seen on monthly rounds. The floor nurse points out the skin lesions shown here. The patient is asymptomatic. Appropriate management includes
A) Punch biopsy
B) Topical 5-fluorouracil cream
C) Cryotherapy
D) Hydrocortisone cream
E) Observation

Answer: The answer is E. (Observation)

Discussion: Seborrheic keratoses are common skin lesions that affect the elderly. They tend to run in families. The average diameter is 1 cm, but they can grow to 3 cm in diameter. The lesions are brown or black, oval in shape, raised, and have a “stuck on” appearance.