FA CS - MiniCases Flashcards
1
Q
47 yo M presents with impotence that started three months ago. He has hypertension and was started on atenolol four months ago. He also has diabetes and is on insulin.
A
Drug-related ED ED caused by hypertension ED caused by diabetes mellitus Psychogenic ED Peyronie's disease
W/U: Genital exam Rectal exam Glucose CBC
2
Q
19 yo M c/o receiving messages from his television set. He reports that he did not have many friends in high school. In college, he started to suspect his roommate of bugging the phone. In the same time frame, he stopped going to classes because he felt that his professors were saying horrible things about him that no one else noticed. He rarely showered or left his room and has recently been hearing a voice from his television set telling him to 'guard against the evil empire.'
A
Schizophrenia Schizoid or schizotypal personality disorder Schizophreniform disorder Psychotic disorder due to a general medical condition Substance-induced psychosis Depression with psychotic features
W/U: Mental status exam Urine toxicology TSH CBC Electrolytes
3
Q
40 yo F presents with occasional double
vision and droopy eyelids at night with
normalization by morning.
A
Myasthenia gravis Horner's syndrome Multiple sclerosis Intracranial tumor compressing CN III, IV, or VI Amyotrophic lateral sclerosis
W/U: Tensilon test ACh receptor antibodies (in serum) CXR CT—chest MRI—brain EMG
4
Q
25 yo F presents with two weeks of a
nonproductive cough. Three weeks ago
she had a sore throat and a runny nose.
A
Atypical pneumonia
Reactive airway disease
URI-associated ('postinfectious')
Postnasal drip
GERD
W/U: CBC Induced sputum Gram stain and culture CXR IgM detection for Mycoplasma pneumoniae Urine Legionella antigen
5
Q
65 yo M presents with right foot pain. He has been training for a marathon.
A
Stress fracture
Plantar fasciitis
Foot sprain or strain
W/U:
XR—foot
Bone scan—foot
MRI—foot
6
Q
28 yo F c/o seeing bugs crawling on her bed over the past two days and reports hearing loud voices when she is alone in her room. She has never experienced symptoms such as these in the past. She recently ingested an unknown substance.
A
Substance-induced psychosis Brief psychotic disorder Schizophreniform disorder Schizophrenia Psychotic disorder due to a general medical condition
W/U: Urine toxicology Mental status exam TSH CBC Electrolytes, BUN/Cr, AST/ ALT
7
Q
18 yo M boxer presents with severe LUQ
abdominal pain that radiates to the left
scapula. He had infectious
mononucleosis three weeks ago.
A
Splenic rupture Kidney stone Rib fracture Pneumonia Perforated peptic ulcer Splenic infarct
W/U: Rectal exam CBC, electrolytes CXR CT—abdomen U/S—abdomen
8
Q
30 yo F presents with alternating constipation and diarrhea and abdominal pain that is relieved by defecation. She has no nausea, vomiting, weight loss, or blood in her stool.
A
Irritable bowel syndrome Infl ammatory bowel disease Celiac disease Chronic pancreatitis GI parasitic infection (ascariasis, giardiasis) Lactose intolerance
W/U: Rectal exam, stool for occult blood CBC Electrolytes Stool for ova and parasitology AXR CT—abdomen/pelvis
9
Q
30 yo F presents with a thick, white,
cottage cheese-like, odorless Vaginal discharge and vaginal itching.
A
Vaginitis—candidal
Bacterial vaginosis
Vaginitis—trichomonal
W/U:
Pelvic exam
KOH prep ('whiff test')
Wet mount
Cervical cultures
pH of vaginal fl uid
10
Q
46 yo F presents with fever and sore
throat.
A
Pharyngitis (bacterial or viral) Mycoplasma pneumonia Acute HIV infection Infectious mononucleosis
W/U: Throat swab for culture and rapid streptococcal antigen Monospot test CBC HIV antibody and viral load
11
Q
20 yo African-American F presents with acute onset of severe chest pain. She has a history of sickle cell disease and multiple previous hospitalizations for pain and anemia management.
A
Sickle cell disease—pulmonary infarction Pneumonia Pulmonary embolism MI Pneumothorax Aortic dissection
W/U: CBC, reticulocyte count, LDH, peripheral smear ABG CXR CPK-MB, troponin ECG CT—chest with IV contrast
12
Q
44 yo F presents with a weight gain of > 11 kg over the past two months. She quit smoking three months ago and is on amitriptyline for depression. She also reports cold intolerance and constipation.
A
Smoking cessation Drug side effect Hypothyroidism Cushing's syndrome Polycystic ovary syndrome Diabetes mellitus Atypical depression
W/U: CBC, electrolytes, glucose TSH 24-hour urine free cortisol Dexamethasone suppression test
13
Q
28 yo F who is eight weeks pregnant
presents with lower abdominal pain and vaginal bleeding.
A
Spontaneous abortion
Ectopic pregnancy
Molar pregnancy
W/U: Pelvic exam Urine hCG U/S—pelvis CBC, PT/PTT Quantitative serum hCG
14
Q
34 yo F presents with retrosternal stabbing chest pain that improves when she leans forward and worsens with deep inspiration. She had a URI one week ago.
A
Pericarditis Aortic dissection MI Costochondritis GERD Esophageal rupture
W/U: ECG CPK-MB, troponin CXR Echocardiography CBC Upper endoscopy
15
Q
65 yo F presents with inability to use
her left leg and bear weight on it after tripping on a carpet. Onset of menopause was 20 years ago, and she did not receive HRT or calcium supplements. Her left leg is externally rotated, shortened, and
adducted, and there is tenderness in her left groin.
A
Hip fracture
Hip dislocation
Pelvic fracture
W/U: XR—hip/pelvis CT or MRI—hip CBC Serum calcium and vitamin D Bone density scan (DEXA)
16
Q
56 yo obese F presents with right knee stiffness and pain that increases with movement. Her symptoms have gradually worsened over the past 10 years. She noticed swelling and deformity of the
joint and is having diffi culty walking.
A
Osteoarthritis
Pseudogout
Gout
Meniscal or ligament damage
W/U: XR—knee CBC ESR Knee arthrocentesis and synovial fl uid analysis (cell count, Gram stain, culture, crystals) MRI—knee
17
Q
56 yo F presents with shortness of breath
as well as with a productive cough that
has occurred over the past two years for
at least three months each year. She is a
heavy smoker.
A
COPD—chronic bronchitis
Bronchiectasis
Lung cancer
Tuberculosis
W/U: CBC Sputum Gram stain and culture CXR PFTs CT—chest PPD
18
Q
12 yo F presents with a two-month
history of fi ghting in school, truancy, and breaking curfew. Her parents recently divorced, and she just started school in a new district. Before her parents divorced,
she was an average student with no
behavioral problems.
A
Adjustment disorder Substance intoxication/abuse/ dependence Manic episode Oppositional defi ant disorder Conduct disorder
W/U:
Physical exam
Mental status exam
Urine toxicology
19
Q
44 yo M presents with fatigue, insomnia, and nightmares about a murder that he witnessed in a mall one year ago. Since then, he has avoided that mall and has not gone out at night.
A
Post-traumatic stress disorder (PTSD) Depression Generalized anxiety disorder Psychotic or delusional disorder Hypothyroidism
W/U: CBC TSH Calcium Urine toxicology
20
Q
35 yo F presents with intermittent
episodes of vertigo, tinnitus, nausea, and
hearing loss over the past week.
A
Ménière's disease Vestibular neuronitis Labyrinthitis Benign positional vertigo Acoustic neuroma
W/U: CBC VDRL/RPR (syphilis is a cause of Ménière's disease) MRI—brain
21
Q
45 yo G5P5 F presents with postcoital bleeding. She is a cigarette smoker and takes OCPs.
A
Cervical cancer Cervical polyp Cervicitis Trauma (e.g., cervical laceration)
W/U:
Pelvic exam
Pap smear
Colposcopy and biopsy
22
Q
29 yo F presents with amenorrhea for the
past six months. She has a history of
occasional palpitations and dizziness. She
lost her fi ancé in a car accident.
A
Anxiety-induced amenorrhea
W/U: CBC TSH FT4 ACTH Urine cortisol level Progesterone challenge test FSH/LH/estradiol levels
23
Q
40 yo F presents with fatigue, weight
gain, sleepiness, cold intolerance,
constipation, and dry skin.
A
Hypothyroidism
Depression
Diabetes
Anemia
W/U:
TSH, FT3, FT4
CBC
Glucose, HbA1c
24
Q
25 yo M presents with hemiparesis (after
a tonic-clonic seizure) that resolves over
a few hours.
A
Todd's paralysis TIA Stroke Complicated migraine Malingering
W/U: CBC, electrolytes EEG MRI—brain Doppler U/S—carotid
25
```
84 yo F brought by her son c/o
forgetfulness (e.g., forgets phone
numbers, loses her way back home) along
with diffi culty performing some of her
daily activities (e.g., bathing, dressing,
managing money, using the phone). The
problem has gradually progressed over
the past few years.
```
```
Alzheimer's disease
Vascular dementia
Depression
Hypothyroidism
Chronic subdural hematoma
Normal pressure hydrocephalus
Intracranial neoplasm
B12 defi ciency
Neurosyphilis
```
```
W/U:
CBC
VDRL/RPR
Serum B12
TSH
MRI—brain (preferred)
CT—head
LP—CSF analysis (rare)
```
26
35 yo M policeman c/o feeling tired and
sleepy during the day. He changed to the
night shift last week.
Sleep deprivation
Sleep apnea
Depression
Anemia
W/U:
CBC
Nocturnal pulse oximetry
Polysomnography
27
```
55 yo F presents with gradual altered
mental status and headache. Two weeks
ago she slipped, hit her head on the
ground, and lost consciousness for two
minutes.
```
Subdural hematoma
SIADH (causing hyponatremia)
Creutzfeldt-Jakob disease
Intracranial neoplasm
```
W/U:
Electrolytes
CT—head
MRI—brain
LP
```
28
45 yo diabetic F presents with dysuria,
urinary frequency, fever, chills, and
nausea over the past three days. There is
left CVA tenderness on exam.
Acute pyelonephritis
Nephrolithiasis
Renal cell carcinoma
Lower UTI (cystitis, urethritis)
```
W/U:
UA
Urine culture and sensitivity
CBC, BUN/Cr
U/S—renal
CT—abdomen
```
29
17 yo M presents with low back pain that radiates to the left leg and began after he fell on his knee during gym class. He also describes areas of loss of sensation in his left foot. The pain and sensory loss do not
match any known distribution. He insists on requesting a week off from school because of his injury.
```
Malingering
Lumbar muscle strain
Disk herniation
Knee or leg fracture
Ankylosing spondylitis
```
W/U:
XR—L-spine/knee
MRI—L-spine
30
37 yo F presents with dyspareunia,
| inability to conceive, and dysmenorrhea.
```
Endometriosis
Cervicitis
Vaginismus
Vulvodynia
PID
Depression
Domestic violence
```
```
W/U:
Pelvic exam
Wet mount, KOH prep, cervical
cultures
U/S—pelvis
Laparoscopy
```
31
28 yo F presents with pain in the
metacarpophalangeal joints of both
hands. Her left knee is also painful and red. She has morning joint stiffness that lasts for an hour. Her mother had rheumatoid arthritis.
```
Rheumatoid arthritis
SLE
Disseminated gonorrhea
Arthritis associated with
infl ammatory bowel disease
Osteoarthritis
```
```
W/U:
ANA, anti-dsDNA, ESR, RF,
CBC
XR—hands, left knee
Cervical culture
Arthrocentesis and synovial
fl uid analysis
```
32
65 yo M presents with postural dizziness
and unsteadiness. He has hypertension
and was started on hydrochlorothiazide
two days ago.
```
Drug-induced orthostatic
hypotension
Vestibular neuronitis
Labyrinthitis
Benign positional vertigo
Brain stem or cerebellar tumor
Acute renal failure
```
```
W/U:
Orthostatic vital signs
CBC
Electrolytes
BUN/Cr
MRI—brain
```
33
25 yo M presents with RUQ pain, fever,
anorexia, nausea, and vomiting. He has
dark urine and clay-colored stool.
```
Acute hepatitis
Acute cholecystitis
Ascending cholangitis
Choledocholithiasis
Pancreatitis
Acute glomerulonephritis
```
```
W/U:
Rectal exam
CBC, amylase, lipase
AST/ALT/bilirubin/alkaline
phosphatase
UA
Viral hepatitis serologies
U/S—abdomen
```
34
```
20 yo F presents with nausea, vomiting
(especially in the morning), fatigue, and
polyuria. Her last menstrual period was
six weeks ago, and her breasts are full
and tender. She is sexually active with
her boyfriend, and they use condoms for
contraception.
```
```
Pregnancy
Gastritis
Hypercalcemia
Diabetes mellitus
UTI
Depression
```
```
W/U:
Urine hCG
Pelvic exam
U/S—pelvis
CBC, electrolytes, calcium,
glucose
UA, urine culture
Baseline Pap smear, cervical
cultures, rubella antibody,
HIV antibody, hepatitis B
surface antigen, and VDRL/
RPR
```
35
32 yo F presents with sudden onset of left lower abdominal pain that radiates to the scapula and back and is associated with vaginal bleeding. Her last menstrual period was fi ve weeks ago. She has a
history of PID and unprotected
intercourse.
Ectopic pregnancy
Ruptured ovarian cyst
Ovarian torsion
PID
```
W/U:
Pelvic exam
Urine hCG
Cervical cultures
U/S—pelvis
Quantitative serum hCG
```
36
15 yo M presents with a one-year history of failing grades, school absenteeism, and legal problems, including shoplifting. His parents report that he spends most of
his time alone in his room, adding that when he does go out, it is with a new set of friends.
Substance abuse
Conduct disorder
Oppositional defi ant disorder
Adjustment disorder
W/U:
Urine toxicology
Mental status exam
37
28 yo F presents with pain in the
interphalangeal joints of her hands
together with hair loss and a butterfly
rash on her face.
```
Systemic lupus erythematosus
(SLE)
Rheumatoid arthritis
Psoriatic arthritis
Parvovirus B19 infection
```
```
W/U:
ANA, anti-dsDNA, ESR, C3,
C4, rheumatoid factor (RF),
CBC
XR—hands
UA
```
38
12-month-old M presents with fever
| for the last two days accompanied by a maculopapular rash on his face and body. He has not yet received the MMR vaccine.
```
Measles (or other viral
exanthem)
Rubella
Roseola
Fifth disease
Varicella
Scarlet fever
Meningitis
```
```
W/U:
Physical exam
CBC
Viral antibodies/titers
Throat swab for culture
LP
```
39
28 yo F presents with a thin, grayish white, foul-smelling vaginal discharge.
```
Bacterial vaginosis
Vaginitis—candidal
Vaginitis—trichomonal
Cervicitis (chlamydia,
gonorrhea)
```
```
W/U:
Pelvic exam
Wet mount
Cervical cultures
KOH prep ('whiff test')
pH of vaginal fl uid
```
40
26 yo M presents with sore throat, fever,
rash, and weight loss. He has a history of
IV drug abuse and sharing needles.
```
HIV, acute retroviral
syndrome
Infectious
mononucleosis
Hepatitis
Viral pharyngitis
Streptococcal tonsillitis/
scarlet fever
Secondary syphilis
```
```
W/U:
CBC
Peripheral smear
HIV antibody and viral load
CD4 count
Monospot test
Throat culture
VDRL/RPR
AST/ALT/bilirubin/alkaline
phosphatas
```
41
```
30 yo F presents with weakness, loss of
sensation, and tingling in her left leg
that started this morning. She is also
experiencing right eye pain, decreased
vision, and double vision. She reports
feeling 'electric shocks' down her spine
upon fl exing her head.
```
```
Multiple sclerosis
Stroke
Conversion disorder
Malingering
CNS tumor
Neurosyphilis
Syringomyelia
CNS vasculitis
```
```
W/U:
CBC, ESR
VDRL/RPR
MRI—brain
LP—CSF analysis
Retinal evoked potentials
```
42
44 yo F c/o dizziness on moving her
head to the left. She feels that the room
is spinning around her head. Tilt test
results in nystagmus and nausea.
Benign positional vertigo
Vestibular neuronitis
Labyrinthitis
Ménière's disease
W/U:
MRI—brain
Audiogram
43
35 yo M presents with shortness of breath and cough. He has had unprotected sex with multiple sexual partners and was recently exposed to a patient with active tuberculosis.
```
Tuberculosis
Pneumonia (including
Pneumocystis jiroveci)
Bronchitis
CHF (cardiomyopathy)
Asthma
Acute HIV infection
```
```
W/U:
CBC
PPD
Sputum Gram stain, acid-fast
stain, silver stain, and culture
CXR
HIV antibody
```
44
55 yo M presents with sudden onset of
severe chest pain that radiates to the
back. He has a history of uncontrolled
hypertension.
```
Aortic dissection
MI
Pericarditis
Esophageal rupture
Esophageal spasm
GERD
Pancreatitis
Fat embolism
```
```
W/U:
ECG, CPK-MB, troponin
CXR
CBC, amylase, lipase
Transesophageal
echocardiography (TEE),
MRI/MRA—aorta
Aortic angiography
Upper endoscopy
```
45
```
60 yo M presents with nocturia, urgency,
weak stream, and terminal dribbling. He
denies any weight loss, fatigue, or bone
pain. He has had two episodes of urinary
retention that required catheterization.
```
```
Benign prostatic hyperplasia
(BPH)
Prostate cancer
UTI
Bladder stones
```
```
W/U:
Rectal exam
UA
CBC, BUN/Cr, PSA
U/S—prostate (transrectal)
```
46
```
60 yo M presents with dull epigastric
pain that radiates to the back, together
with weight loss, dark urine, and
clay-colored stool. He is a heavy drinker
and smoker.
```
```
Pancreatic cancer
Acute viral hepatitis
Chronic pancreatitis
Cholecystitis/choledocholithiasis
Abdominal aortic aneurysm
Peptic ulcer disease
```
```
W/U:
Rectal exam
CBC, electrolytes
Amylase and lipase
AST/ALT/bilirubin/alkaline
phosphatase
U/S—abdomen
CT—abdomen
```
47
55 yo M presents with pain in the
elbow when he plays tennis. His grip is impaired as a result of the pain. There is tenderness over the lateral epicondyle as well as pain on resisted wrist dorsiflexion
(Cozen's test) with the elbow in
extension.
```
Tennis elbow (lateral
epicondylitis)
Stress fracture
W/U:
XR—arm
Bone scan
MRI—elbow
```
48
60 yo F c/o left arm pain that started
| while she was swimming and was relieved by rest.
Angina/MI
Tendonitis
Osteoarthritis
Shoulder dislocation
```
W/U:
CPK-MB, troponin, ECG
CBC
ESR
XR—shoulder
CXR
Echocardiography
Stress test
```
49
55 yo M c/o falling after feeling dizzy
and unsteady. He experienced transient
LOC. He has hypertension and is on
numerous antihypertensive drugs.
```
Drug-induced orthostatic
hypotension (causing
syncope)
Cardiac arrhythmia
Syncope (vasovagal, other
causes)
Stroke
MI
Pulmonary embolism
```
```
W/U:
Orthostatic vital signs
CBC
Electrolytes
CT—head
ECG
V/Q scan
CT—chest with IV contrast
```
50
35 yo M presents with burning epigastric
pain that starts 2-3 hours after meals.
The pain is relieved by food and
antacids.
```
Peptic ulcer disease
Gastritis
GERD
Cholecystitis
Chronic pancreatitis
Mesenteric ischemia
```
```
W/U:
Rectal exam
Amylase, lipase, lactate
AST/ALT/bilirubin/alkaline
phosphatase
Endoscopy (including H. pylori
testing)
Upper GI series
```
51
```
21 yo F presents with acute onset of
severe RLQ pain, nausea, and vomiting.
She has no fever, urinary symptoms, or
vaginal bleeding and has never taken
OCPs. Her last menstrual period was
regular, and she has no history of STDs.
```
```
Ovarian torsion
Appendicitis
Nephrolithiasis
Ectopic pregnancy
Ruptured ovarian cyst
PID
Bowel infarction or perforation
```
```
W/U:
Pelvic exam
Rectal exam
Urine hCG
UA
CBC
Doppler U/S—pelvis
CT—abdomen
Laparoscopy
```
52
55 yo obese M presents with several
months of poor sleep and daytime
fatigue. His wife reports that he snores
loudly.
```
Obstructive sleep apnea
Daytime fatigue in primary
hypersomnia
Insomnia with circadian rhythm
sleep disorder
Insomnia related to major
depressive disorder
```
```
W/U:
CBC
TSH
Polysomnography
ECG
```
53
61 yo obese F presents with profuse
vaginal bleeding over the past month. Her last menstrual period was 10 years ago. She has a history of hypertension and diabetes mellitus. She is nulliparous.
```
Endometrial cancer
Cervical cancer
Atrophic endometrium
Endometrial hyperplasia
Endometrial polyps
Atrophic vaginitis
```
```
W/U:
Pelvic exam
Pap smear
Endometrial biopsy
U/S—pelvis
Endometrial curettage
Colposcopy
Hysteroscopy
```
54
```
68 yo M presents with a two-month
history of crying spells, excessive sleep,
poor hygiene, and a 7-kg weight loss, all
following his wife's death. He cannot
enjoy time with his grandchildren
and reluctantly admits to thinking he
has seen his dead wife in line at the
supermarket or standing in the kitchen
making dinner.
```
```
Normal bereavement
Adjustment disorder with
depressed mood
Major depressive disorder with
psychotic features
Schizoaffective disorder
Depressive disorder not
otherwise specifi ed (NOS)
```
```
W/U:
Physical exam
Mental status exam
TSH
CBC
Urine toxicology
```
55
```
67 yo M presents with alternating
diarrhea and constipation, decreased
stool caliber, and blood in the stool for
the past eight months. He also reports
unintentional weight loss. He is on a
low-fi ber diet and has a family history
of colon cancer.
```
```
Colorectal cancer
Irritable bowel syndrome
Diverticulosis
GI parasitic infection (ascariasis,
giardiasis)
Infl ammatory bowel disease
Angiodysplasia
```
```
W/U:
Rectal exam
CBC
AST/ALT/bilirubin/alkaline
phosphatase
Colonoscopy
Barium enema
CT—abdomen/pelvis
```
56
65 yo M presents with painless
hematuria. He is a heavy smoker and
works as a painter.
```
Bladder cancer
Renal cell carcinoma
Nephrolithiasis
Acute glomerulonephritis
Prostate cancer
Coagulation disorder (i.e., factor
VIII antibodies)
Polycystic kidney disease
Genitourinary exam
```
```
W/U:
UA, urine cytology
BUN/Cr, PSA, CBC, PT/PTT
Cystoscopy
U/S—renal/bladder
CT—abdomen/pelvis
IVP
```
57
```
48 yo F presents with dysphagia for both
solid and liquid foods that has slowly
progressed in severity over the past year.
It is associated with regurgitation of
undigested food, especially at night.
```
```
Achalasia
Plummer-Vinson syndrome
Esophageal cancer
Esophagitis
Systemic sclerosis
Mitral valve stenosis
Esophageal stricture
Zenker's diverticulum
```
```
W/U:
CXR
Endoscopy
Barium swallow
Esophageal manometry
```
58
```
37 yo M presents with severe epigastric
pain, nausea, vomiting, and mild fever.
He appears toxic. He has a history of
intermittent epigastric pain that is
relieved by food and antacids. He also
smokes heavily and takes aspirin on a
regular basis.
```
```
Peptic ulcer perforation
Acute pancreatitis
Hepatitis
Cholecystitis
Choledocholithiasis
Mesenteric ischemia
```
```
W/U:
Rectal exam
CBC, electrolytes, amylase,
lipase, lactate
AST/ALT/bilirubin/alkaline
phosphatase
AXR
Upright CXR
Endoscopy (including H. pylori
testing)
```
59
65 yo M presents after falling and losing
consciousness for a few seconds. He
had no warning prior to passing out but
recently had palpitations. His past history
includes coronary artery bypass grafting
(CABG).
```
Cardiac arrhythmia (causing
syncope)
Severe aortic stenosis
Syncope (other causes)
Seizure
Pulmonary embolism
```
```
W/U:
ECG
Holter monitoring
CBC, electrolytes
Glucose
Echocardiography
CT—head
```
60
30 yo F presents with frontal headache,
fever, and nasal discharge. There is pain
on palpation of the frontal and maxillary
sinuses. She has a history of sinusitis.
```
Sinusitis
Migraine
Tension headache
Meningitis
Intracranial neoplasm
```
CBC
XR—sinus
CT—sinus
LP
61
25 yo M presents with high fever, severe
headache, confusion, photophobia, and
nuchal rigidity. Kernig's and Brudzinski's
signs are positive.
```
Meningitis
Migraine
Subarachnoid hemorrhage
Sinusitis/encephalitis
Intracranial or epidural abscess
```
```
W/U:
CBC
CT—head
MRI—brain
LP—CSF analysis (cell count,
protein, glucose, Gram stain,
PCR for antigens, culture)
```
62
```
20 yo M presents with severe RLQ
abdominal pain, nausea, and vomiting.
His discomfort started yesterday as a
vague pain around the umbilicus. As the
pain worsened, it became sharp and
migrated to the RLQ. McBurney's and
psoas signs are positive.
```
```
Acute appendicitis
Gastroenteritis
Diverticulitis
Crohn's disease
Nephrolithiasis
Volvulus or other intestinal
obstruction/perforation
```
```
W/U:
Rectal exam
CBC, electrolytes
AXR
CT—abdomen
U/S—abdomen
```
63
```
55 yo F c/o dizziness that started this
morning. She is nauseated and has
vomited once in the past day. She had a
URI two days ago and has experienced
no hearing loss.
```
```
Vestibular neuronitis
Labyrinthitis
Ménière's disease
Benign positional vertigo
Vertigo associated with cervical
spine disease/injury
Vertebrobasilar insufficiency
```
```
W/U:
CBC
Electrolytes
Electronystagmography
MRI/MRA—brain
```
64
```
50 yo F presents with recurrent episodes
of bilateral squeezing headaches that
occur 3-4 times a week, typically
toward the end of her work day. She is
experiencing signifi cant stress in her life.
```
```
Tension headache
Migraine
Depression
Caffeine or analgesic
withdrawal
Hypertension
Cluster headache
Pseudotumor cerebri
Intracranial neoplasm
```
```
CBC
Electrolytes
ESR
CT—head
LP
```
65
21 yo F presents with several episodes of
throbbing left temporal pain that lasts
for 2-3 hours. Prior to its onset, she sees
fl ashes of light in her right visual fi eld
and feels weakness and numbness on the
right side of her body for a few minutes.
Headaches are often associated with
nausea and vomiting. She has a family
history of migraine.
```
Migraine (complicated)
Tension headache
Cluster headache
Pseudotumor cerebri
Trigeminal neuralgia
CNS vasculitis
Partial seizure
Intracranial neoplasm
```
```
CBC
ESR
CT—head
MRI—brain
LP
```
66
38 yo M presents with dysphagia and pain
on swallowing solids more than liquids.
Exam reveals oral thrush.
```
Esophagitis (CMV, HSV, pillinduced)
Systemic sclerosis
GERD
Esophageal stricture
Zenker's diverticulum
```
```
W/U:
CBC
Endoscopy
Barium swallow
HIV antibody
CD4 count
```
67
30 yo F presents with watery diarrhea
and abdominal cramping and bloating.
Her symptoms are aggravated by milk
ingestion and are relieved by fasting.
```
Lactose intolerance
Gastroenteritis
Infl ammatory bowel disease
Irritable bowel syndrome
Hyperthyroidism
```
```
W/U:
Rectal exam
Stool exam
Hydrogen breath test
TSH
```
68
20-day-old M presents with fever,
| decreased breast-feeding, and lethargy. He was born at 36 weeks as a result of premature rupture of membranes.
Neonatal sepsis
Meningitis
Pneumonia
UTI
```
W/U:
Physical exam
CBC, electrolytes
UA
Urine culture
Blood culture
CXR
LP—CSF analysis
```
69
48 yo F presents with amenorrhea for the
past six months accompanied by hot
fl ashes, night sweats, emotional lability,
and dyspareunia.
Menopause
Pregnancy
Pituitary tumor
Thyroid disease
```
W/U:
Pelvic exam
Urine hCG
LH/FSH, TSH, prolactin,
testosterone, DHEAS
CBC
MRI—brain
```
70
45 yo F presents with low back pain that radiates to the lateral aspect of her left foot. Straight leg raising is positive. Thepatient is unable to tiptoe.
Disk herniation
Lumbar muscle strain
Tumor in the vertebral canal
W/U:
XR—L-spine
MRI—L-spine
71
23 yo obese F presents with amenorrhea
for six months, facial hair, and infertility
for the past three years.
```
Polycystic ovary syndrome
Thyroid disease
Hyperprolactinemia
Pregnancy
Ovarian or adrenal malignancy
Premature ovarian failure
```
```
W/U:
Pelvic exam
Urine hCG
U/S—pelvis
LH/FSH, TSH, prolactin
Testosterone, DHEAS
```
72
55 yo M presents with fl ank pain and
blood in his urine without dysuria. He
has experienced weight loss and fever
over the past two months.
```
Renal cell carcinoma
Bladder cancer
Nephrolithiasis
Acute glomerulonephritis
Pyelonephritis
Prostate cancer
Genitourinary, rectal exam
```
```
W/U:
UA, urine cytology, BUN/Cr,
PSA, CBC, PT/PTT
U/S—renal
CT—abdomen/pelvis
IVP
```
73
18 yo obese F presents with a pulsatile
headache, vomiting, and blurred vision
for the past 2-3 weeks. She is taking
OCPs.
```
Pseudotumor cerebri
Tension headache
Migraine
Cluster headache
Meningitis
Intracranial venous thrombosis
Intracranial neoplasm
```
```
W/U:
Urine hCG
CBC
CT—head
LP—opening pressure and CSF
analysis
```
74
33 yo M presents with watery diarrhea,
diffuse abdominal pain, and weight loss
over the past three weeks. He has not
responded to antibiotics.
```
Crohn's disease
Gastroenteritis
Ulcerative colitis
Celiac disease
Pseudomembranous colitis
Hyperthyroidism
Small bowel lymphoma
Carcinoid
```
```
W/U:
Rectal exam
Stool exam and culture
CBC, electrolytes
TSH
CT—abdomen
Colonoscopy
Small bowel series
Urinary 5-HIAA
```
75
28 yo M presents with constipation (very
hard stool) for the last three weeks. Since
his mother died two months ago, he and
his father have eaten only junk food.
```
Low-fi ber diet
Irritable bowel syndrome
Substance abuse (e.g., heroin)
Depression
Hypothyroidism
```
```
W/U:
Rectal exam
TSH
Electrolytes
Urine toxicology
```
76
55 yo M presents with tingling and
numbness in the hands and feet (gloveand-
stocking distribution) over the past
two months. He has a history of diabetes
mellitus, hypertension, and alcoholism.
There is decreased soft touch, vibratory,
and position sense in the feet.
```
Diabetic peripheral
neuropathy
Alcoholic peripheral neuropathy
B12 defi ciency
Hypocalcemia
Hyperventilation
Paraproteinemia/myeloma
```
```
W/U:
HbA1c
ESR
Calcium
Serum B12
Serum and urine protein
electrophoresis
```
77
25 yo M presents with watery diarrhea
and abdominal cramps. He was recently
in Mexico.
```
Traveler's diarrhea
Giardiasis
Amebiasis
Food poisoning
Hepatitis A
```
```
W/U:
Rectal exam
Stool leukocytes, culture,
Giardia antigen, Entamoeba
histolytica antigen
Electrolytes
AST/ALT/bilirubin/alkaline
phosphatase
Viral hepatitis serology
```
78
35 yo M presents with sudden severe
headache, vomiting, confusion, left
hemiplegia, and nuchal rigidity.
```
DDX:
1 - Subarachnoid hemorrhage
2 - Migraine
3 - Meningitis/encephalitis
4 - Intracranial hemorrhage
5 - Intracranial neoplasm, vertebral a. dissection, intracranial venous thrombosis, acute htn
```
W/U:
1 - CBC, PT/PTT, CT head w/o contrast, MRI/MRA brain
3 - LP
79
45 yo M presents with pain in the lower back and legs during prolonged standing and walking. The pain is relieved by sitting and leaning forward (e.g., pushing a grocery cart).
Lumbar spinal stenosis
Lumbar muscle strain
Tumor in the vertebral canal
Peripheral vascular disease
```
W/U:
XR—L-spine
MRI—L-spine
(preferred)
CT—L-spine
Ankle-brachial index
```
80
```
68 yo M presents with slurred speech,
right facial drooping and numbness, and
right hand weakness. Babinski's sign is
present on the right. He has a history
of hypertension, diabetes mellitus, and
heavy smoking.
```
```
Stroke
TIA
Seizure
Intracranial neoplasm
Subdural or epidural hematoma
```
```
W/U:
CBC, electrolytes
PT/PTT
CT—head
MRI—brain (preferred)
Doppler U/S—carotid
Echocardiography
```
81
35 yo F presents with amenorrhea,
galactorrhea, visual fi eld defects, and
headaches for the past six months.
```
Amenorrhea secondary to
prolactinoma
Pregnancy
Thyroid disease
Premature ovarian failure
Pituitary tumor
```
```
W/U:
Pelvic and breast exam
Urine hCG
Prolactin
LH/FSH, TSH
MRI—brain
```
82
```
50 yo obese F presents with fatigue
and daytime sleepiness. She snores
heavily and naps 3-4 times per day
but never feels refreshed. She also has
hypertension.
```
Obstructive sleep apnea
Hypothyroidism
Chronic fatigue syndrome
Narcolepsy
```
W/U:
CBC
TSH
Nocturnal pulse oximetry
Polysomnography
ECG
```
83
30 yo F secretary presents with wrist pain and a sensation of numbness and burning in her palm and the fi rst, second, and third fingers of her right hand. The pain
worsens at night and is relieved by loose shaking of the hand. There is sensory loss in the same fi ngers. Exam reveals a positive Tinel's sign.
```
Carpal tunnel syndrome
Median nerve compression in
forearm or arm
Radiculopathy of nerve roots C6
and C7 in cervical spine
```
W/U:
Nerve conduction study
EMG
84
55 yo M presents with retrosternal
squeezing pain that lasts for two minutes
and occurs with exercise. It is relieved by
rest and is not related to food intake.
Angina
Esophageal spasm
Esophagitis
```
W/U:
ECG
CPK-MB, troponin
CXR
CBC, electrolytes
Exercise stress test
Upper endoscopy/pH monitor
Cardiac catheterization
```
85
9 yo M presents with a two-year history of angry outbursts both in school and at home. His mother complains that he runs around 'as if driven by a motor.' His teacher reports that he cannot sit still in
class, regularly interrupts his classmates, and has trouble making friends.
```
Attention-defi cit hyperactivity
disorder (ADHD)
Oppositional defi ant disorder
Manic episode
Conduct disorder
```
W/U:
Physical exam
Mental status exam
86
28 yo F c/o multiple facial and bodily
injuries. She claims that she fell on the stairs. She was hospitalized for some physical injuries seven months ago. She presents with her husband.
```
Domestic violence
Osteogenesis imperfecta
Substance abuse
Consensual violent sexual
behavior
```
```
W/U:
XR—skeletal survey
CT—maxillofacial
Urine toxicology
CBC
```
87
26 yo F presents with sore throat, fever,
severe fatigue, and loss of appetite for
the past week. She also reports epigastric
and LUQ discomfort. She has cervical
lymphadenopathy and a rash. Her
boyfriend recently experienced similar
symptoms.
```
Infectious
mononucleosis
Hepatitis
Viral or bacterial
pharyngitis
Acute HIV infection
Secondary syphilis
```
```
W/U:
CBC, peripheral smear
Monospot test
Throat culture
AST/ALT/bilirubin/alkaline
phosphatase
HIV antibody and viral load
Anti-EBV antibodies
VDRL/RPR
```
88
```
41 yo obese F presents with RUQ
abdominal pain that radiates to the right
scapula and is associated with nausea,
vomiting, and a fever of 101.5°F. The
pain started after she had eaten fatty
food. She has had similar but less intense
episodes that lasted a few hours. Exam
reveals positive Murphy's sign.
```
```
Acute cholecystitis
Hepatitis
Choledocholithiasis
Ascending cholangitis
Peptic ulcer disease
Fitz-Hugh-Curtis syndrome
```
```
W/U:
Rectal exam
CBC
AST/ALT/bilirubin/alkaline
phosphatase
U/S—abdomen
HIDA scan
```
89
65 yo F presents with severe, intermittent
right temporal headache, fever, blurred
vision in her right eye, and pain in her
jaw when chewing.
```
Temporal arteritis (giant cell
arteritis)
Migraine
Cluster headache
Tension headache
Meningitis
Carotid artery dissection
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm
```
```
CBC
ESR
CRP
Temporal artery biopsy
Doppler U/S—carotid
MRI—brain
```
90
58 yo M presents with pleuritic chest
pain, fever, chills, and cough with
purulent yellow sputum. He is a heavy
smoker with COPD.
```
Pneumonia
Bronchitis
Lung abscess
Lung cancer
Tuberculosis
Pericarditis
```
```
W/U:
CBC
Sputum Gram stain and culture
CXR
CT—chest
ECG
PPD
```
91
5 yo M presents with a six-month
history of temper tantrums that last
5-10 minutes and immediately follow a disappointment or a discipline. He has no trouble sleeping, has had no change
in appetite, and does not display thesebehaviors when he is at day care.
Age-appropriate behavior
ADHD
Oppositional defiant disorder
W/U:
Physical exam
Mental status exam
92
```
55 yo M presents with increased dyspnea
and sputum production over the past
three days. He has COPD and stopped
using his inhalers last week. He also
stopped smoking two days ago.
```
```
COPD exacerbation
(bronchitis)
Lung cancer
Pneumonia
URI
CHF
```
```
W/U:
CBC
CXR
PFTs
Sputum Gram stain and culture
CT—chest
```
93
65 yo M presents with pain in the heel of the right foot that is most notable with his first few steps and then improves as he continues walking. He has no known
trauma.
Plantar fasciitis
Heel fracture
Splinter/foreign body
W/U:
XR—heel
Bone scan
94
40 yo F c/o feeling tired, hopeless,
and worthless and of having suicidal
thoughts. She recently discovered that
her husband is homosexual.
Depression
Adjustment disorder
Hypothyroidism
Anemia
```
W/U:
CBC
TSH
HIV/STD testing (given
husband's possible risk
factors)
```
95
30 yo M presents with night sweats,
cough, and swollen glands of one
month's duration.
```
Tuberculosis
Acute HIV infection
Lymphoma
Leukemia
Hyperthyroidism
```
```
W/U:
PPD
CBC
CXR
Sputum Gram stain, acid-fast
stain, and culture
HIV antibody
TSH, FT4
```
96
27 yo F presents with painful wrists and elbows, a swollen and hot knee joint that is painful on fl exion, a rash on her limbs, and vaginal discharge. She is sexually active with multiple partners and occasionally uses condoms.
```
Disseminated gonorrhea
Rheumatoid arthritis
SLE
Psoriatic arthritis
Reiter's arthritis
```
```
W/U:
Knee arthrocentesis and
synovial fluid analysis (cell
count, Gram stain, culture)
ANA, anti-dsDNA, ESR, RF,
CBC
Blood, cervical cultures
XR—knee
```
97
45 yo M presents with right knee pain with swelling and redness.
```
Septic arthritis
Gout
Pseudogout
Lyme arthritis
Trauma
Reiter's arthritis
```
```
W/U:
CBC
Knee arthrocentesis and
synovial fl uid analysis (see
above)
Blood, urethral cultures
XR—knee
Uric acid
Lyme antibody
```
98
34 yo F presents with stabbing chest pain
that worsens with deep inspiration and is
relieved by aspirin. She had a URI one
week ago. Chest wall tenderness is noted.
```
Costochondritis
Pneumonia
MI
Pulmonary embolism
Pericarditis
Muscle strain
```
```
W/U:
ECG
CPK-MB, troponin
CXR
CBC
```
99
```
40 yo F presents with amenorrhea,
morning nausea and vomiting, fatigue,
and polyuria. Her last menstrual period
was six weeks ago, and her breasts are full
and tender. She uses the rhythm method
for contraception.
```
```
Pregnancy
Anovulatory cycle
Hyperprolactinemia
UTI
Thyroid disease
```
```
W/U:
Pelvic exam
Urine hCG
U/S—pelvis
CBC, electrolytes
UA, urine culture
Prolactin, TSH
Baseline Pap smear, cervical
cultures, rubella antibody,
HIV antibody, hepatitis B
surface antigen, and VDRL/
RPR
```
100
60 yo F presents with pain in both legs that is induced by walking and is relieved by rest. She had cardiac bypass surgery six months ago and continues to smoke heavily.
```
Peripheral vascular disease
(intermittent claudication)
Leriche's syndrome (aortoiliac
occlusive disease)
Lumbar spinal stenosis
(pseudoclaudication)
Osteoarthritis
```
```
W/U:
Ankle-brachial index
Doppler U/S—lower extremity
Angiography
MRI—lumbar spine
```
101
67 yo M presents with blood in his stool,
weight loss, and constipation. He has a
family history of colon cancer.
```
Colorectal cancer
Anal fi ssure
Hemorrhoids
Diverticulosis
Ischemic bowel disease
Angiodysplasia
Upper GI bleeding
Inflammatory bowel disease
```
```
W/U:
Rectal exam
CBC, PT/PTT
AST/ALT/bilirubin/alkaline
phosphatase
CEA
Colonoscopy
CT—abdomen/pelvis
Barium enema
```
102
```
45 yo F presents with coffee-ground
emesis for the last three days. Her stool is
dark and tarry. She has a history of
intermittent epigastric pain that is
relieved by food and antacids.
```
Bleeding peptic ulcer
Gastritis
Gastric cancer
Esophageal varices
```
W/U:
Rectal exam
CBC, electrolytes
AST/ALT/bilirubin/alkaline
phosphatase
Endoscopy (including H. pylori
testing if ulcer is confi rmed)
```
103
58 yo M presents with bright red blood
per rectum and chronic constipation. He
consumes a low-fi ber diet.
```
Diverticulosis
Anal fi ssure
Hemorrhoids
Angiodysplasia
Colorectal cancer
```
```
W/U:
Rectal exam
CBC, PT/PTT
Electrolytes
Colonoscopy
CT—abdomen/pelvis
```
104
72 yo M presents with memory loss, gait
disturbance, and urinary incontinence for
the past six months.
```
Normal pressure
hydrocephalus
Alzheimer's disease
Vascular dementia
Chronic subdural hematoma
Intracranial neoplasm
Depression
B12 defi ciency
Neurosyphilis
Hypothyroidism
```
```
W/U:
CT—head
LP—opening pressure and CSF
analysis
Serum B12
VDRL/RPR
TSH
```
105
```
60 yo M presents with sudden onset
of substernal heavy chest pain that has
lasted for 30 minutes and radiates to
the left arm. The pain is accompanied
by dyspnea, diaphoresis, and nausea.
He has a history of hypertension,
hyperlipidemia, and smoking.
```
```
Myocardial infarction (MI)
GERD
Angina
Costochondritis
Aortic dissection
Pericarditis
Pulmonary embolism
Pneumothorax
```
```
W/U:
ECG
CPK-MB, troponin
CXR
CBC, electrolytes
Echocardiography
Cardiac catheterization
```
106
```
33 yo M presents with watery diarrhea,
vomiting, and diffuse abdominal pain
that began yesterday. He also reports
feeling hot. Several of his coworkers are
also ill.
```
```
Infectious diarrhea
(gastroenteritis)—bacterial,
viral, parasitic, protozoal
Food poisoning
Infl ammatory bowel disease
```
```
W/U:
Rectal exam, stool for occult
blood
Stool leukocytes and culture
CBC
Electrolytes
CT—abdomen/pelvis
```
107
20 yo M presents with fatigue, thirst,
| increased appetite, and polyuria.
Diabetes mellitus
Atypical depression
Primary polydipsia
Diabetes insipidus
```
W/U:
Glucose tolerance test, HbA1c
UA
CBC, electrolytes, glucose
BUN/Cr
```
108
68 yo M presents with LLQ abdominal
pain, fever, and chills for the past three
days. He also reports recent onset of
alternating diarrhea and constipation. He
consumes a low-fi ber, high-fat diet.
```
Diverticulitis
Crohn's disease
Ulcerative colitis
Gastroenteritis
Abscess
```
```
W/U:
Rectal exam
CBC, electrolytes
CXR
AXR
CT—abdomen
```
109
42 yo F presents with a 7-kg weight loss
over the past two months. She has a fi ne
tremor, and her pulse is 112.
```
Hyperthyroidism
Cancer
HIV infection
Dieting/diet drugs
Anorexia nervosa
Malabsorption
```
```
W/U:
TSH, FT4
CBC, electrolytes
HIV antibody
Urine toxicology
```
110
40 yo F presents with watery diarrhea
and abdominal cramps. Last week she
was on antibiotics for a UTI.
```
Pseudomembranous
(Clostridium diffi cile) colitis
Gastroenteritis
Cryptosporidiosis
Food poisoning
Inflammatory bowel disease
```
```
W/U:
Rectal exam
Stool leukocytes, culture, occult
blood
C. diffi cile toxin in stool
Electrolytes
```
111
43 yo obese F presents with RUQ
abdominal pain, fever, and jaundice. She
was diagnosed with asymptomatic
gallstones one year ago.
```
Ascending cholangitis
Acute cholecystitis
Hepatitis
Choledocholithiasis
Sclerosing cholangitis
Fitz-Hugh-Curtis syndrome
```
```
W/U:
Rectal exam
CBC
AST/ALT/bilirubin/alkaline
phosphatase
Viral hepatitis serologies
U/S—abdomen
MRCP
ERCP
```
112
54 yo F c/o painful intercourse. Her last menstrual period was nine months ago. She has hot fl ashes.
```
Atrophic vaginitis
Endometriosis
Cervicitis
Depression
Domestic abuse
```
```
W/U:
Pelvic exam
Wet mount, KOH prep, cervical
cultures
U/S—pelvis
```
113
35 yo M presents with painless
hematuria. He has a family history of
kidney problems.
```
Polycystic kidney disease
Nephrolithiasis
Acute glomerulonephritis (e.g.,
IgA nephropathy)
UTI
Coagulation disorder
Bladder cancer
```
```
W/U:
Genitourinary exam
UA
BUN/Cr, PSA, CBC, PT/PTT
U/S—renal
CT—abdomen/pelvis
IVP
```
114
57 yo M c/o daily pain in the right cheek
over the past month. The pain is electric
and stabbing in character and occurs
while he is shaving. Each episode lasts
2-4 minutes.
```
Trigeminal neuralgia
Tension headache
Migraine
Cluster headache
TMJ dysfunction
Intracranial neoplasm
```
W/U:
CBC
ESR
MRI—brain
115
30 yo F presents with multiple facial and physical injuries. She was attacked and raped by two men.
Rape
```
W/U:
Pelvic exam
Urine hCG
Wet mount, KOH prep, cervical
cultures
XR—skeletal survey
CBC
HIV antibody
Viral hepatitis serologies
```
116
35 yo F presents with a malodorous,
profuse, frothy, greenish vaginal
discharge with intense vaginal itching and discomfort.
```
Vaginitis—trichomonal
Vaginitis—candidal
Bacterial vaginosis
Cervicitis (chlamydia,
gonorrhea)
```
```
W/U:
Pelvic exam
Wet mount
Cervical cultures
pH of the vaginal fl uid
KOH prep ('whiff test')
```
117
```
24 yo F presents with bilateral lower
abdominal pain that started with the fi rst
day of her menstrual period. The pain is
associated with fever and a thick,
greenish-yellow vaginal discharge. She
has had unprotected sex with multiple
sexual partners.
```
```
PID
Endometriosis
Dysmenorrhea
Vaginitis
Cystitis
Spontaneous abortion
Pyelonephritis
```
```
W/U:
Pelvic exam
Rectal exam
Urine hCG
Cervical cultures
CBC/ESR
UA, urine culture
U/S—pelvis
```
118
18 yo M presents with pain in the
interphalangeal joints of both hands. He also has scaly, salmon-pink lesions on the extensor surface of his elbows and knees.
Psoriatic arthritis
Rheumatoid arthritis
SLE
```
W/U:
RF, ANA, ESR
CBC
XR—hands
XR—pelvis/sacroiliac joints
Uric acid
```
119
30 yo F presents with wrist pain and
a black eye after tripping, falling,
and hitting her head on the edge of a
table. She looks anxious and gives an inconsistent story.
Domestic violence
Factitious disorder
Substance abuse
W/U:
XR—wrist
CT—head
Urine toxicology
120
33 yo F presents with rectal bleeding and
diarrhea for the past week. She has had
lower abdominal pain and tenesmus for
several months.
```
Ulcerative colitis
Crohn's disease
Proctitis
Anal fi ssure
Hemorrhoids
Diverticulosis
Dysentery
```
```
W/U:
Rectal exam
CBC, PT/PTT
AXR
Colonoscopy
CT—abdomen/pelvis
Barium enema
```
121
65 yo M presents with worsening cough
over the past six months together with
hemoptysis, dyspnea, weakness, and
weight loss. He is a heavy smoker.
```
Lung cancer
Tuberculosis
Lung abscess
COPD
Vasculitis (i.e., Wegener's)
Interstitial lung disease
CHF
```
```
W/U:
CBC
Sputum Gram stain, culture,
and cytology
CXR
CT—chest
PPD
Bronchoscopy
```
122
```
42 yo F presents with a four-week history
of excessive fatigue, insomnia, and
anhedonia. She states that she thinks
constantly about death. She has suffered
fi ve similar episodes in the past, the fi rst
in her 20s, and has made two previous
suicide attempts. She further admits to
increased alcohol use in the past month.
```
Major depressive disorder
Substance-induced mood
disorder
Dysthymic disorder
```
W/U:
Physical exam
Mental status exam
Blood alcohol level
TSH
CBC
Urine toxicology
```
123
45 yo F presents with right calf pain. Her calf is tender, warm, red, and swollen compared to the left side. She was started on OCPs two months ago for dysfunctional uterine bleeding.
```
DVT
Baker's cyst rupture
Myositis
Cellulitis
Superfi cial venous thrombosis
```
```
W/U:
Doppler U/S—right leg
CBC
CPK
D-dimer
PT, aPTT, fi brinogen
XR—right leg
```
124
```
55 yo M presents with a rapidly
progressive change in mental status,
inability to concentrate, and memory
impairment for the past two months. His
symptoms are associated with myoclonus
and ataxia.
```
```
Creutzfeldt-Jakob disease
Vascular dementia
Lewy body dementia
Wernicke's encephalopathy
Normal pressure hydrocephalus
Chronic subdural hematoma
Intracranial neoplasm
Depression
Delirium
B12 defi ciency
Neurosyphilis
```
```
W/U:
CBC, electrolytes, calcium
Serum B12
VDRL/RPR
MRI—brain (preferred)
CT—head
EEG
LP—CSF analysis
Brain biopsy
```
125
```
56 yo M presents with severe
midepigastric abdominal pain that
radiates to the back and improves when
he leans forward. He also reports
anorexia, nausea, and vomiting. He is an
alcoholic and has spent the past three
days binge drinking.
```
```
Acute pancreatitis
Peptic ulcer disease
Cholecystitis/choledocholithiasis
Gastritis
Abdominal aortic aneurysm
Mesenteric ischemia
Alcoholic hepatitis
Mallory-Weiss tear
```
```
W/U:
Rectal exam
CBC, electrolytes, BUN/Cr,
amylase, lipase, AST/ALT/
bilirubin/alkaline phosphatase
U/S—abdomen
CT—abdomen
Upper endoscopy
ECG
```
126
25 yo F presents with a three-week history
of diffi culty falling asleep. She sleeps
seven hours per night without nightmares
or snoring. She recently began college
and is having trouble with her boyfriend.
She drinks 3-4 cups of coffee a day.
```
Stress-induced insomnia
Caffeine-induced insomnia
Insomnia with circadian rhythm
sleep disorder
Insomnia related to major
depressive disorder
```
```
W/U:
Polysomnography
Mental status exam
Urine toxicology
CBC
TSH
```
127
```
70 yo F presents with acute onset of
shortness of breath at rest and pleuritic
chest pain. She also presents with
tachycardia, hypotension, tachypnea,
and mild fever. She is recovering from
hip replacement surgery.
```
```
Pulmonary embolism
Pneumonia
Costochondritis
MI
CHF
Aortic dissection
```
```
W/U:
ECG
CXR
ABG
CPK-MB, troponin
CBC, electrolytes
CT—chest with IV contrast
Doppler U/S—legs
D-dimer
```
128
4 yo M presents with diarrhea, vomiting, lethargy, weakness, and fever. The child attends a day care center where several children have had similar symptoms.
```
Gastroenteritis (viral, bacterial,
parasitic)
Food poisoning
UTI
URI
Volvulus
Intussusception
```
```
W/U:
Physical exam
Stool exam and culture
CBC
Electrolytes
UA, urine culture
AXR
```
129
18 yo M presents with a burning
sensation during urination and urethral
discharge. He recently had unprotected
sex with a new partner.
Urethritis
Cystitis
Prostatitis
```
W/U:
Genital ± rectal exam
UA
Urine culture
Gram stain and culture of
urethral discharge
Chlamydia and gonorrhea PCR
```
130
55 yo F c/o dizziness that started this
morning and of 'not hearing well.' She
feels nauseated and has vomited once in
the past day. She had a URI two days ago.
```
Labyrinthitis
Vestibular neuronitis
Ménière's disease
Acoustic neuroma
Vertebrobasilar insuffi ciency
```
W/U:
Audiogram
Electronystagmography
MRI/MRA—brain
131
33 yo F presents with ascending loss of
strength in her lower legs over the past
two weeks. She had a recent URI.
```
Guillain-Barré syndrome
Multiple sclerosis
Polymyositis
Myasthenia gravis
Peripheral neuropathy
Tumor in the vertebral canal
```
```
W/U:
CBC, electrolytes
CPK
LP—CSF analysis
MRI—spine
EMG/nerve conduction study
Tensilon test
Serum B12
```
132
40 yo F presents with epigastric pain and
coffee-ground emesis. She has a history
of rheumatoid arthritis that has been
treated with aspirin. She is an alcoholic.
```
Gastritis
Bleeding peptic ulcer
Gastric cancer
Esophageal varices
Mallory-Weiss tear
```
```
W/U:
Rectal exam
CBC, electrolytes
AST/ALT/bilirubin/alkaline
phosphatase
Barium swallow
Endoscopy
```
133
```
40 yo M presents with crampy
abdominal pain, vomiting, abdominal
distention, and inability to pass fl atus or
stool. He has a history of multiple
abdominal surgeries.
```
```
Intestinal obstruction
Small bowel or colon cancer
Volvulus of the bowel
Gastroenteritis
Food poisoning
Ileus
Hernia
```
```
W/U:
Rectal exam
CBC, electrolytes
AXR
CT—abdomen/pelvis
CXR
```
134
```
70 yo F presents with acute onset of
severe, crampy abdominal pain. She
recently vomited and had a massive dark
bowel movement. She has a history of
CHF and atrial fi brillation, for which
she has received digitalis. Her pain is out
of proportion to the exam.
```
```
Mesenteric ischemia/infarction
Diverticulitis
Peptic ulcer disease
Gastroenteritis
Acute pancreatitis
Cholecystitis/choledocholithiasis
MI
```
```
W/U:
Rectal exam
CBC, amylase, lipase, lactate
ECG, CPK-MB, troponin
AXR
CT—abdomen
Mesenteric angiography
Barium enema
```
135
70 yo diabetic M presents with episodes of
| palpitations and diaphoresis. He is on insulin.
```
Hypoglycemia
Cardiac arrhythmias
Angina
Hyperthyroidism
Hyperventilation
episodes
Panic attacks
Pheochromocytoma
Carcinoid
```
```
W/U:
Glucose
CBC, electrolytes
TSH
BUN/Cr
ECG
Holter monitor
```
136
17 yo F presents with prolonged,
| excessive menstrual bleeding occurring irregularly over the past six months.
```
Dysfunctional uterine bleeding
Coagulation disorders (e.g., von
Willebrand's disease,
hemophilia)
Cervical cancer
Molar pregnancy
Hypothyroidism
Diabetes mellitus
```
```
W/U:
Pelvic exam
Urine hCG
Cervical cultures, Pap smear
CBC, ESR, glucose
PT/PTT
Prolactin, LH/FSH
TSH
U/S—pelvis
```
137
```
71 yo M presents with nocturia, urgency,
weak stream, terminal dribbling,
hematuria, and lower back pain over the
past four months. He has also
experienced weight loss and fatigue.
```
```
Prostate cancer
BPH
Renal cell carcinoma
UTI
Bladder stones
```
```
W/U:
Rectal exam
UA
CBC, BUN/Cr, PSA
U/S—prostate (transrectal)
CT—pelvis
IVP
```
138
```
81 yo M presents with progressive
confusion over the past several
years together with forgetfulness
and clumsiness. He has a history of
hypertension, diabetes mellitus, and two
strokes with residual left hemiparesis. His
mental status has clearly worsened after
each stroke (stepwise decline in cognitive
function).
```
```
Vascular ('multi-infarct')
dementia
Alzheimer's disease
Normal pressure hydrocephalus
Chronic subdural hematoma
Intracranial tumor
Depression
B12 defi ciency
Neurosyphilis
Hypothyroidism
```
```
W/U:
CBC
VDRL/RPR
Serum B12
TSH
MRI—brain
CT—head
LP—CSF analysis (rare)
```
139
```
26 yo M presents after falling and losing
consciousness at work. He had rhythmic
movements of the limbs, bit his tongue,
and lost control of his bladder. He was
subsequently confused (as witnessed by
his colleagues).
```
```
Seizure, grand mal (now called
complex tonic-clonic seizure)
Convulsive syncope
Substance abuse/overdose
Malingering
Hypoglycemia
```
```
W/U:
CBC, electrolytes, glucose
Urine toxicology
EEG
MRI—brain
CT—head
LP—CSF analysis
ECG
```
140
```
75 yo M presents with dysphagia that
started with solids and progressed to
liquids. He is an alcoholic and a heavy
smoker. He has had an unintentional
weight loss of 7 kg over the past four
months.
```
```
Esophageal cancer
Achalasia
Esophagitis
Systemic sclerosis
Esophageal stricture
Amyotrophic lateral sclerosis
```
```
W/U:
CBC
CXR
Endoscopy with biopsy
Barium swallow
CT—chest
```
141
3 yo M presents with a two-day history of fever and pulling on his right ear. He is otherwise healthy, and his immunizations are up to date. His older sister recently had a cold. The child attends a day care center.
Acute otitis media
URI
Meningitis
UTI
```
W/U:
Physical exam (including
pneumatic otoscopy)
CBC
UA
```
142
```
26 yo F presents with a 3-kg weight loss
over the past two months, accompanied
by early-morning awakening, excessive
guilt, and psychomotor retardation.
She does not identify a trigger for the
depressive episode but reports several
weeks of increased energy, sexual
promiscuity, irresponsible spending,
and racing thoughts approximately six
months before her presentation.
```
```
Bipolar I disorder
Bipolar II disorder
Cyclothymic disorder
Major depressive disorder
Schizoaffective disorder
```
W/U:
Physical exam
Mental status exam
Urine toxicology
143
55 yo M presents with crampy bilateral thigh and calf pain, fatigue, and dark urine. He is on simvastatin and clofibrate for hyperlipidemia.
```
Rhabdomyolysis due to
simvastatin or clofi brate
Polymyositis
Inclusion body myositis
Thyroid disease
```
```
W/U:
CBC
CPK
Aldolase
UA
Urine myoglobin
TSH
```
144
```
34 yo F nurse presents with worsening
cough of six weeks' duration together
with weight loss, fatigue, night sweats,
and fever. She has a history of contact
with tuberculosis patients at work.
```
```
Tuberculosis
Pneumonia
Lung abscess
Vasculitis
Lymphoma
Metastatic cancer
HIV/AIDS
Sarcoidosis
```
```
W/U:
CBC
PPD
Sputum Gram stain, acid-fast
stain, and culture
CXR
CT—chest
Bronchoscopy
HIV antibody
```
145
30 yo M presents with shortness of
breath, cough, and wheezing that worsen
in cold air. He has had several such
episodes over the past four months.
```
Asthma
GERD
Bronchitis
Pneumonitis
Foreign body
```
```
W/U:
CBC
CXR
Peak fl ow measurement
PFTs
Methacholine challenge test
```
146
70 yo insulin-dependent diabetic M
presents with episodes of confusion,
dizziness, palpitation, diaphoresis, and
weakness.
```
Hypoglycemia
Transient ischemic attack
Arrhythmia
Delirium
Angina
```
```
W/U:
Glucose
CBC, electrolytes
Echocardiography
ECG
MRI—brain
Doppler U/S—carotid
```
147
18 yo F presents with amenorrhea for the
past four months. She has lost 95 pounds
and has a history of vigorous exercise and
cold intolerance.
Anorexia nervosa
```
W/U:
CBC
TSH
FT4
ACTH
FSH
LH
```
148
```
30 yo F presents with periumbilical pain
for six months. The pain never awakens
her from sleep. It is relieved by
defecation and worsens when she is
upset. She has alternating constipation
and diarrhea but no nausea, vomiting,
weight loss, or anorexia.
```
```
Irritable bowel syndrome
Crohn's disease
Celiac disease
Chronic pancreatitis
GI parasitic infection
(amebiasis, giardiasis)
Endometriosis
```
```
W/U:
Rectal exam, stool for occult
blood
Pelvic exam
Urine hCG
CBC
Electrolytes
CT—abdomen/pelvis
Stool for ova and parasitology,
Entamoeba histolytica
antigen
```
149
```
26 yo M presents with severe right
temporal headaches associated with
ipsilateral rhinorrhea, eye tearing, and
redness. Episodes have occurred at the
same time every night for the past week
and last for 45 minutes.
```
```
Cluster headache
Migraine
Tension headache
Sinusitis
Pseudotumor cerebri
Trigeminal neuralgia
Intracranial neoplasm
```
```
CBC
ESR
CT—head
MRI—brain
LP
```
150
```
33 yo F c/o three weeks of fatigue and
trouble sleeping. She states that she falls
asleep easily but wakes up at 3 A.M. and
cannot return to sleep. She also reports
an unintentional weight loss of 3.5 kg
along with an inability to enjoy the
things she once liked to do.
```
```
Insomnia related to major
depressive disorder
Primary hypersomnia
Insomnia with circadian rhythm
sleep disorder
```
```
W/U:
Mental status exam
TSH
CBC
Polysomnography
```
151
45 yo F presents with dysphagia for two
weeks together with fatigue and a craving
for ice and clay.
```
Plummer-Vinson syndrome
Esophageal cancer
Esophagitis
Achalasia
Systemic sclerosis
Mitral valve stenosis
```
```
W/U:
CBC
Serum iron, ferritin, TIBC
Barium swallow
Endoscopy
```
152
48 yo F presents with a one-week history
of auditory hallucinations, stating, 'I am
worthless' and 'I should kill myself.' She
also reports a two-week history of weight
loss, early-morning awakening, decreased
motivation, and overwhelming feelings
of guilt.
```
Schizoaffective disorder
Mood disorder with psychotic
features
Schizophrenia
Schizophreniform disorder
Psychotic disorder due to a
general medical condition
```
```
W/U:
Mental status exam
Beck Depression Inventory
TSH
CBC
Electrolytes
```
153
```
68 yo M presents following a 20-minute
episode of slurred speech, right facial
drooping and numbness, and right hand
weakness. His symptoms had totally
resolved by the time he got to the ER.
He has a history of hypertension, diabetes
mellitus, and heavy smoking.
```
```
Transient ischemic attack
(TIA)
Hypoglycemia
Seizure
Stroke
Facial nerve palsy
```
```
W/U:
CBC
Glucose
Electrolytes
ECG
CT—head
MRI—brain
Doppler U/S—carotid
Echocardiography
EEG
```
154
```
35 yo F presents with amenorrhea, cold
intolerance, coarse hair, weight loss, and
fatigue. She has a history of abruptio
placentae followed by hypovolemic shock
and failure of lactation two years ago.
```
```
Sheehan's syndrome
Premature ovarian failure
Pituitary tumor
Thyroid disease
Asherman's syndrome
```
```
W/U:
Pelvic exam
Urine hCG
CBC
LH/FSH, prolactin
TSH, FT4
ACTH
MRI—brain
Hysteroscopy
```
155
50 yo M presents with a cough that
is exacerbated by lying down at night
and improved by propping up on three pillows. He also reports exertional dyspnea.
```
CHF
Cardiac valvular disease
GERD
Pulmonary fi brosis
COPD
Postnasal drip
```
```
W/U:
CBC
CXR
ECG
Echocardiography
PFTs
BNP
```
156
```
45 yo M presents with sudden onset
of colicky right-sided fl ank pain that
radiates to the testicles, accompanied by
nausea, vomiting, hematuria, and CVA
tenderness.
```
Nephrolithiasis
Renal cell carcinoma
Pyelonephritis
GI etiology (e.g., appendicitis)
```
W/U:
Rectal exam
UA
Urine culture and sensitivity
BUN/Cr
CT—abdomen
U/S—renal
IVP
```
157
55 yo M presents with fatigue, weight
loss, and constipation. He has a family
history of colon cancer.
```
Colon cancer
Hypothyroidism
Renal failure
Hypercalcemia
Depression
```
```
W/U:
Rectal exam, stool for occult
blood
CBC, electrolytes, calcium,
BUN/Cr, AST/ALT, TSH
Colonoscopy
Barium enema
```
158
50 yo M presents with right shoulder pain after falling onto his outstretched hand while skiing. He noticed deformity of his shoulder and had to hold his right arm.
Shoulder dislocation
Fracture of the humerus
Rotator cuff injury
W/U:
XR—shoulder
XR—arm
MRI—shoulder
159
45 yo F presents with low back pain that started after she cleaned her house. The pain does not radiate, and there is no sensory deficit or weakness in her legs. Paraspinal muscle tenderness and spasm
are also noted.
Lumbar muscle strain
Disk herniation
Abdominal aortic aneurysm
Vertebral compression fracture
W/U:
XR—L-spine
160
55 yo F c/o dizziness for the past day.
She feels faint and has severe diarrhea
that started two days ago. She takes
furosemide for her hypertension.
```
Orthostatic hypotension due
to dehydration (diarrhea,
diuretic use)
Vestibular neuronitis
Labyrinthitis
Benign positional vertigo
Vertebrobasilar insuffi ciency
```
```
W/U:
Orthostatic vital signs
CBC
Electrolytes
Stool exam (occult blood, fecal
leukocytes
```
161
45 yo F presents with a retrosternal
burning sensation that occurs after
heavy meals and when lying down. Her
symptoms are relieved by antacids.
```
GERD
Esophagitis
Peptic ulcer disease
Esophageal spasm
MI
Angina
```
```
W/U:
ECG
Barium swallow
Upper endoscopy
Esophageal pH monitoring
```
162
40 yo M presents with pain in the right groin after a motor vehicle accident. His right leg is fl exed at the hip, adducted, and internally rotated.
Hip dislocation—traumatic
Hip fracture
```
W/U:
XR—hip
CT or MRI—hip
CBC
PT/PTT
Blood type and cross-match
Urine toxicologyand blood
alcohol level
```
