2023 Flashcards
Patient came with hypopigmented patches with fine scales asking about causative organism (Tinea Versicolor)
Malassezia
Soft palate ulcer and posterior throat with fever and rash in the hands and digits (Most likely hand,foot, and mouth disease)
antipyretics (supportive)
Question explained the presenting history of the patient and the following picture was attached. Determine the diagnosis.
molluscum contagiosum
Case presented with hyper pigmentation on the face as pic , what is the condition
melasma
His of red pigmented lesion on the axilla , that turned brown ,wood light exam showed coral red- fluorescence what is the appropriate ttx ? (case of erythrasma)
Infection may be treated with topical and/or oral agents. First-line therapy is topical erythromycin or clindamycin, or fusidic acid cream or miconazole cream
pt came middle age complain of lesion grow in hand over few months progressively and cause bothersome sensation, not painful at Dorsum of wrist penlight test show transillumination +ve, what is the diagnosis ?
Ganglion Cyst
Patient presents with a mass in wrist, sometimes painful
Most commonly caused by repetitive activity causing tear or degeneration in joint capsule or tendon synovial sheath
Treatment is observation or needle aspiration
Most common soft tissue tumors of the hand
pt came middle age complain of lesion grow in hand over few months progressively and cause bothersome sensation, not painful at Dorsum of wrist penlight test show transillumination +ve , what is the management ?
Patient came concerned about white colored pigmentation on the nail what is the name of the condition
leukonychia
Pediatric patient , came with hx of fever , coryza and rash , examination as showed (showed kiplok spots , exact picture) , What is the diagnosis?
measles
Pt complaining of hypopigmented lesion of the back (pitryiasis versicolor ) asking about the organism :
Pityriasis versicolor is caused by mycelial growth of fungi of the genus Malassezia furfur
A 6-year-old girl presents to your clinic with a fever and rash as seen in the image above. Her mother states she has also had a headache, runny nose, and diarrhea over the past few days. Which of the following is the most likely diagnosis?
Erythema Infectiosum (Fifth Disease)
Most common in children aged 4–10 years
History of URI symptoms 3–4 days prior to rash
PE may show erythematous macular slapped-cheek rash
Adults present with arthralgia w/wo rash (not on cheeks)
Most commonly caused by parvovirus B19
Aplastic crisis in sickle cell patients
A 6-year-old girl presents to your clinic with a fever and rash as seen in the image above. Her mother states she has also had a headache, runny nose, and diarrhea over the past few days. What is the management ?
The diagnosis is clinical and treatment is symptomatic. There is no vaccination that can prevent parvovirus B19 infection.
anti
A 5-year-old boy is brought in to urgent care by his father for a bug bite on his hand. He recently went camping and remembers being bit by mosquitos. The majority of lesions have resolved, but a bite on his hand has now become yellow. He otherwise feels well with no fevers, rash, nausea, or vomiting. On exam, you note a single 0.5 cm honey-colored crusting lesion. Which of the following is the most appropriate treatment?
A 13-year-old boy presents to the clinic with a one-week history of a pruritic rash on his feet. Physical examination reveals a vesicular eruption with underlying erythema over the medial aspect of his feet bilaterally. Potassium hydroxide preparation shows segmented hyphae on a background of squamous cells. Which of the following is the most likely diagnosis?
Tinea pedis
a case about pediatric glaucoma , asking what to tell the parents ?
- it is associated with CYP1B1 gene
- most cases discovered within the first year of life
- Sign and symptoms Corneal enlargement High IOP
(NEEDS BETTER RECALL ) hx of sudden floater in the eye with pic attached , what is the likely case
vitreous hemorrhage
26 year old female patient came with eye symptoms , loss of color , loss of the superior vision of one eye, painful eye Investigation: all normal except high ESR
With fundoscopic picture attached: (A) is normal
Optic neuritis
Pediatric Pt come with unilateral red eye, photophobia. Hx of leaf trauma 5 days ago., Diagnosis?
fungal corneal ulceration
contact lens user , came with ? red eye , itchiness, tearing, fluorescein test -ve (?and sensation of foreign body) for 2 weeks
Giant papillary conjunctivitis
giant papillary conjunctivitis (GPC). GPC is a noninfectious inflammatory disorder that represents a reaction to lid movement over a foreign substance, such as contact lenses. It is characterized by foreign-body sensation on the upper tarsus, associated with formation of “giant” (>1 mm) papillae.
cobblestone appearance
Elderly patients came with painless vision loss , they didn’t mention any chronic diseases, on examination: systolic murmur , and something else I didn’t remember. What is most likely the patient to have ?
-retinal artery occlusion
case of corneal abrasion Child complaining of red eye and photophobia ( fluorescent stain +ve ) What is the appropriate management
1- foreign body removal
2- analgesia
3- Abx if dirty injury arithromycin
Patient came with a headache, left red eye, blurred vision, right eye vision 20/20, left eye 20/100, dilated pupil with injected conjunctiva, diagnosis? ( Exact pic )
acute angle closure glaucoma
Treat fast: “time is optic nerve” * Avoid topical B blockers in COPD/asthma * Avoid acetazolamide in sickle cell disease or if sulfa allergy
Case about children and adults is hearing loss. It can affect one or both ears at the same time. It may seem like you’re wearing earplugs, muffling the noises around you
Glue ear, or otitis media with effusion, happens when fluid collects in your child’s middle ear. The main symptom of glue ear is temporary hearing loss. Glue ear often occurs after ear infections, but it can also occur when a blockage affects your child’s Eustachian tube. Glue ear frequently goes away on its own, but some cases may require surgery
Patient with history of fall down on the head , with hx of clear fluid coming from the nose , x-ray attached showing nasal bone fracture
x-ray attached (similar pic) what is the diagnosis
Ethmoid bone Fx
Case of patient come with hoarseness and difficulty swallowing , history of heavy smoker
Ex:non tender mass on neck
Laryngeal cancer
Pt with sinusitis for 3 weeks and? high grade fever
Augmentin
Patient diabetic came in with ear pain & itching , what’s the proper management
could be fungal OE - Itraconazole & paracetamol
could be MOE -Ciprofloxacin-hydrocortisone
patient with recent history of upper respiratory tract infection , presented complaining of ? 1 week history of ear pain and dizziness , ? and nausea Ask about the treatment ?
Vestibular neuritis: Treatment: based on the underlying cause
Therapy is primarily supportive
can’t remember the scenario well, pic of audiogram (same like this) asking about diagnosis Old patient complained of unilateral hearing loss, vertigo, ear fullness (no tinnitus mentioned or facial nerve symptoms) + nystagmus
Labyrinthitis:
Clinical features
Severe vertigo, nausea, and vomiting
Hearing loss, tinnitus
Nystagmus
case of perforated ear , ttx?
Management is mainly supportive; consult ENT if there is hearing loss or vertigo.
Instruct patients to keep the ear canal dry.
Consider topical antibiotics if there is evidence of infection (e.g., otorrhea) or remaining foreign bodies
Middle aged male pt came with hx of lower back pain no radiation no alarming signs , restricted lumber ROM Next step ( 3 weeks duration)
“Red flag” symptoms include saddle anesthesia, loss of bowel or bladder function, significant motor deficits, a history of trauma and concern for fracture, a history of spinal procedures in the last 12 months, fever, a history of intravenous drug use, a history of metastatic cancer, or unexplained weight loss.
if none is present (Ibuprofen and muscle stretch exercises, promote activey)
patient was alarmed by the appearance of the Swelling with mild “ pain or tenderness not sure which one “ of medial part of the clavicle for 1 month
Reassurance - this is a ganglion cyst
A 42-year-old female came with right hand pain and stiffness in the right hand including multiple PIP and DIP joints, with one Heberden’s nodule. Which of the following is the most likely diagnosis?
Osteoarthritis
MRI Achilles tendon rupture , with Positive Thompson test MRI pic attached
Conservative treatment is usually the treatment of choice for elderly, inactive individuals, or those who are high-risk surgical candidates (multiple or severe comorbidities).
Early surgical repair is considered for active, healthy patients, or those with a complete Achilles tendon rupture.
Pediatric patient was brought to your care , not flexing his arm , history of being pulled by the hand while being in the stair x-ray showing
radial head subluxation (pulled elbow )
2 months old boy with hx of unstable HIP joint click sound with passive movment of one hip (DDH) > investigation
(HIP US)
Screening with imaging is recommended up to 6 months of age only if one or more of the following risk factors are present
Breech presentation at birth
Positive family history of DDH
Clinical features of DDH
Case of ankle sprain , with swelling in the malleolus , on exam , there is tendered on the ANTERIOR SIDE of the malleolus
what is your management :
57 Female has forefoot pain, burning sensation, Increase by wearing thigh High heel Tenderness on 3th and 4th metatarsal
Morton neuroma
Post total hip replacement 2 weeks ago , complain of foot drop and high step foot what is the diagnosis?
Sciatic nerve injury
Patient with Mid clavicular shaft none-displaced fracture, management
Sling
Female pt postpartum 3 months ago came with symptoms of loss of interest and sad mood, decreased concentration
postpartum depression
Case of anorexia nervosa, while nurse was taking the vital signs she said I would prefer to die rather than trying food disorders program, when physician asked her about suicide she refused to answer the questions, what would be the Next step?
develop safety plan with the patient
A pediatric patient was brought by his family , they stated that he is Always carrying sanitizer and growing fear of germs. Avoid public bathrooms, what would be the first treatment?
exposure with response prevention (ERP)
Patient with delusion about his company steeling his thoughts for 6 month (no mania symptoms) no hallucination , has been enjoying sometime going out with his friends ; no depressive symptoms what is the diagnosis
delusional disorder
Bipolar case of hypomania and then mania, what is the most appropriate treatment (not mentioned of initial or first line treatment)
-lithium
Patient came to the clinic in tears and felt depressed and hopeless . He was fired from his job 2 months ago . Still thinks about his job . enjoys hobbies and sitting with family and friends, what is the diagnosis ?
adjustment disorder
(NEEDS BETTER RECALL )PTSD , Mid 20s male, with poor sleep He witnessed his brother’s death in a car accident 2 months ago. What is the initial treatment:
First-line: psychotherapy with or without adjunctive pharmacotherapy [7]
Trauma-focused cognitive-behavioral therapy
Exposure therapy (e.g., showing war veterans images of war, returning to the scene of an accident)
Cognitive processing therapy
patient k/c of schizophrenia, with recent increase haloperidol dose from 2.5 to 10 mg come with tachycardia 120 -, confusion , stiffness
what to measure to confirm your diagnosis?
CK
Neuroleptic malignant syndrome (NMS), a potentially fatal syndrome characterized by hyperpyrexia, muscle rigidity, altered mental status, and autonomic instability, reported with antipsychotic agents, including haloperidol. [ref]
Immediately discontinue therapy and initiate supportive and symptomatic therapy if NMS occurs.
Pt on Fluoxetine , Came complaining of erectile D what is your management
Change or add bupropion or mirtazapine
anorexia nervosa case about a female visited the clinic and you diagnosed her with anorexia nervosa , treatment?
Qs about child , mother was considered that he is not responding to commands , patient was heard repeating phrases were said in the clinic , also was avoiding eye contact
what is your diagnosis
autism
Pt with multiple complain despite normal physical exam and investigation, ( somatization ) Asking about management
schedule regular visit with the same doctor
pic of CT scan (scenario about headache and morning vomiting and ataxia)
what is your diagnosis
Hydrocephalus
Patient brought to the ER with a history of gasping, pulse and blood pressure can’t be obtained, with VT showing on ECG (ECG similar pic ), what’s your immediate action?
depends on the hemodynamic stability of the patient .
in this given seniro the patient is unstable so Immediate defibrillator , if no plus start CPR
Hypertensive pt came with active epistaxis , despite anterior packing the pt still bleeding What is the management ?
posterior packing
patient presented with hx of constipation of 6 months , stool became thin , DRE : no masses ; positive occult blood test , what is the cause?
rectal cancer
patient known case of ulcerative colitis have been complaining ?abd pain , ?constipation x-ray attached , what is the diagnosis :
toxic mega colon
pt man 27 years have came with dysuria and mild tenderness of testis, not mention sexual intercourse what is the most likely organism :
E. coli
(NEEDS BETTER RECALL)patient came with ? previous hx of URTI 2 weeks ago with history of ?(headache , hematuria , flank pain ,nausea and vomiting
labs showing : normal plt number , ?creatinine and urea normal , frank hematuria what is the cause
IgA Vasculitis
Henoch-Schönlein purpura
(not exact pic )Husband brings his wife due to an episode of tonic-clinic seizure for the first time, he was previously healthy. CT of brain mass what to do?
Toxoplasmosis ag
Patient for HBV investigation:
Hepatitis serology: HBsAg negative , HBeAg negative , HBeAb negative , HBcIgM positive, HBsAb negative HBV DNA positive What is the diagnosis:
Acute infection, window
50 year old male patient/c of DM came to ER with history of confusion, vomiting
labs showed blood sugar level of 49 (>800) , PH normal , bicarbonate , normal all other labs were normal except for mild hyponatremia what is your diagnosis
high osmolarity
60 year old male patient . known case of atrial fibrillation
with history of ? transient right sided weakness that was resolved spontaneously investigation showed :Right carotid showed 60% stenosis,%,
left 40% stenosis Next step to prevent recurrence?
Apixaban
medical treatment needs to be adjusted prior to intervention , patient has a-fib with high Chads2-vasc score , need anticoagulant
Female Pregnant ,9 week gestation age , with nausea and vomiting no abdominal pain ,no diarrhea mildly dehydrated
What test to order
urine ketone body
-Malar rash with sun exposure sparing nasolabial fold , Morning stiffness , Labs show + blood in urine What is most likely to be positive:
ANA
adult patient came with hx of frontal bossing, Bowing of tibia ; high ALP , high Ca, normal vit D ( cotton wool on x ray )
paget’s disease
A 54-year-old man with long-standing diabetes develops redness, pain, and swelling of his left lower extremity. Examination shows a 15 cm by 7 cm area of nonfluctuant, nonelevated erythema and swelling over the anterior aspect of the left lower extremity. He also has scaling and erythema between his toes consistent with a fungal infection. Vital signs are within normal limits. Which of the following is the most likely diagnosis?
Cellulitis
A 54-year-old man with long-standing diabetes develops redness, pain, and swelling of his left lower extremity. Examination shows a 15 cm by 7 cm area of nonfluctuant, nonelevated erythema and swelling over the anterior aspect of the left lower extremity. He also has scaling and erythema between his toes consistent with a fungal infection. Vital signs are within normal limits. What ABX to use?
dicloxacillin
Child with sore throat, dysphasia and splenomegaly. rapid streptococcal antigen test -ve
:Asking for treatment?
supportive treatment
Question about nerve palsy
abducens nerve palsy (6th)
patient with difficulty swallowing for the last 1 week and presented with sob + pic of pneumonia (fever , sputum) x-ray attached shows:
aspiration pneumonia
middle age female hx of fatigue and lower limb edema non
pitting and rash bilateral , vitals tachycardic and low BMI, what is
next to do
pic attached , what to measure :
TSH
A rare dermatological feature of Graves disease that manifests as nonpitting edema and skin thickening, typically in the pretibial areas.
case scenario of male in 40-50 (I think),can’t
remember the complaint but 2 of his brothers had
kidney problems in their 30 , CT attached (similar to
this). Asking about his diagnosis
Poly cystic kidney
she is at risk of having another febrile seizure
Q about which indicates a bad prognosis of pneumonia?
RR the scenario was 32
Respiratory rate 32
A 40-year-old woman has double vision, fatigue, weakness, and spastic paraparesis. Physical examination reveals optic atrophy, nystagmus, dysarthria, and cerebellar deficits in the limbs. Flexion of the neck produces electric shock-like sensations that run down the back. Which of the following is the most appropriate diagnostic study for this patient’s condition?
MRI of the brain
A 40-year-old woman has double vision, fatigue, weakness, and spastic paraparesis. Physical examination reveals optic atrophy, nystagmus, dysarthria, and cerebellar deficits in the limbs. Flexion of the neck produces electric shock-like sensations that run down the back. MRI ATTACHED, WHAT IS THE DIAGNOSIS ?
Multiple Sclerosis - MRI shows periventricular lesions
A 26-year-old woman reports a history of amenorrhea for the past year. She has also had an increased amount of milky discharge from her nipples over the past several months and has lost all interest in sex for the past 6 months. She reports no drug or medication use other than occasional over-the-counter analgesics for frequent headaches. A physical examination confirms the presence of an easily expressed milky niple discharge, as well as vaginal dryness. A pregnancy test is negative. Which one of the following tests would be most appropriate at this point?
Serum prolactin level
- A pregnancy test is an appropriate first step in the evaluation of a woman with amenorrhea and galactorrhea who is not taking medications. If the test is negative, hyperprolactinemia should be suspected. Prolactin levels can be elevated because of medications, a pituitary adenoma, hypothyroidism, or a mass lesion compromising normal hypothalamic inhibition. Elevated prolactin levels inhibit the secretion and effect of gonadotropins.
Case about pneumonia calculate the CURB 65 ?
A 10-day-old male infant is brought to the ED by his mother for difficulty feeding. Whenever he breastfeeds, he becomes extremely agitated, and his skin color turns bluish-gray. The infant was born at 39 weeks gestation, and the mother did not receive prenatal care other than a doctor’s visit during the first trimester to confirm and date her pregnancy. Labor lasted for 24 hours and resulted in a vaginal delivery at home. Cardiac examination of the infant reveals a palpable right ventricular impulse. A harsh, systolic, decrescendo-crescendo murmur is auscultated at the left mid to upper sternal border. Peripheral pulses are normal, and there is no hepatomegaly. Which of the following is the most likely diagnosis?
Tetralogy of Fallot
exposure to varicella to sibling one of them infected what to do for The 1 year old ?
3 months child came with undescended testes, right can be felt high but can not be brought to
scrotum, and the left testis was seen in the abdomen
mostly 90% it will descend by the age of 1 year
Pregnant 27 weeks with strong contractions 3 minutes apart, Dilated 3 cm , effacement 70%,
positive GBS culture , asking for most appropriate next step:
- IM Betamethasone
Female with 2 years amenorrhea and mentioned MRI show suprasellar
something High FSH High LH, Prolactin :normal , Ask about diagnosis:
premature ovarian failure
case of vaginal discharge , off white , ph alkalosis , clue cells, not pruritic
what is the cause
bacterial vaginosis
Pregnant lady 27 week b/p: 150/ Previously: 110/70, normal labs , and urine analysis
gestational HTN
25-year-old woman who is currently breastfeeding her 1-week-old newborn presents to the clinic with breast pain. She also reports general malaise, fevers, and chills. Physical exam reveals a firm, erythematous, tender, and swollen area on her left breast. Her blood pressure is 123/84 mm Hg, heart rate is 93/min, and oral temperature is 38.3°C (101°F). Which of the following antibiotics is appropriate for the treatment of this patient?
oral Abx : Dicloxacillin
pt came with back pain progressive with red flags, she did MRI showed Metastasis, you ordered
another investigation to confirm.asking about pt how to receive the bad news
What’s your idea about what you have?
