Fenderson Final Clinical Vignettes

Question 1

A 12 year old boy presents for a pre sumer camp physical examination. Routine Urinalysis discloses 3+ glucosuria. On questioning the child admits to thirst and frequent urination accompanied by weight loss over the past few months. A finger stick glucose test in the office shows elevated blood glucose level of 280.

Answer 1

Polydipsia and polyuria DM 1

Question 2

A 23 year old woman fails to resume her menstrual cycle after pregnancy. Laboratory findings revela decreased levels of circulating hormones including MSH TSH ACTH and FSH

Answer 2

Pituitary Failure SheHan’s Syndrome

Question 3

A 30 year old woman complains of headache visual disturbances deepending of her voice and generalized weakness. She reports Amenorrhea for the past year and states that she recently required a larger shoe size.

Answer 3

Acromegaly caused by pituitary adenoma

Question 4

A 40 year old man reported having sudden attacks of dizziness blurred vision and excruciating headaches. During these attacks his blood pressure was 180/120.

Answer 4

Pheochromacytoma

Question 5

A 45 year old woman presented with complaints of sweating a lot feeling hot and being constantly tired. She had a fast pulse rate and reported feeeling constantly hungry. On examination she was found to have bulgin eyes and enlarged thyroid.

Answer 5

Graves disease

Question 6

A 50 year old man became extremely obese with fat accumulating most markedly on his upper trunk. He had a red rounded face and almost translucent skin that was prone to bruising

Answer 6

Cushings disease

Question 7

A 48 year old woman presents with renal stones bone pain moans groans

Answer 7

hyperparathyroid and a tumor is adenoma

Question 8

A 1 month old is brought to the emergency room with severe unremitting water diarrhea (systemic dehydration(. Her blood pressure is 80 and HR is 120

Answer 8

Neonatal necrotizing entercolitis

Question 9

A 10 year old boy sustains cerbral contuions after falling from the upper rafters of a garage. The parents of the child ask you for general information regarding functional anatomy of the brain.

Answer 9

Parietal lobe (somatosensory)

Question 10

A 12 year old boy is rushed to the emergency room in a coma. MRI shows a subdural hematoma over the left hemisphere. What is the most likely source of intracranial bleedin gin this patient?

Answer 10

Tearing of the subdural bridge vein caused by trauma

Question 11

A 17 year old woman presents to her gynecologist with a 5 day history of vaginal bleeding. A home pregnancy test had been positive 1 week previously. This morning the patient passed tissue with the apperacnce of small grapes. An ultrasound shows a dilated endometrial cavity but no evidence of a fetus. Endometrial evacuation of the uterus by suction curettage reveals grapelike clusters with individual units measureing up to 5 mm in diameter.

Answer 11

choriocarcinoma (hydatidiform mole)

Question 12

A 22 year old woman presents with a painless nodule in the lower outer aspect of her right breast she ahs had for 2 months. The nodule in the lower outer aspect of her right breast that she has had for over 2 months. the nodule appears to be freely movable sharply demarcated from the surroudning parenchyma and firm. A mammogram demonstrates a circumscribed and homogenous density. The encapsulated tumor is removed and the surgiucal specimen is shown in the image what is the appropriate pathologic diagnosis?

Answer 12

Fibroadenoma

Question 13

A 24 year old woman delivers a healthy baby and begins breastfeeding her neonate. The patient presents 2 weeks later with a fever of 38. Physical examincation shows no abnormal vaginal discharge or evidence of pelvic pain bnut does reveal redness on the lower side of the left breast. The patient stops nursing the infant temporarily, but the symptoms persist and the entire breast beocomes swollen and painful.

Answer 13

Acute mastitis

Question 14

A 25 year old woman is referred to the gynecologist for treatment of infertility. The patient is obese and has a pronounced facial hair (hirtuism). She states that she has always had irregular menstrual periods. On gynecologic examination both ovaries are found to be symetrically enlarged.

Answer 14

PCOS – Polycystic Ovary Cysts

Question 15

A 26 year old woman presents for a routine physical exam and a cervical pap smear is taken. Exfoliated cervidcal cells from the exocervix are examined by light microscopy.

Answer 15

Stratified squamous cell epithelium – Normal cervix

Question 16

A 3 day old neonate presents with a fever 38.7 and convulsing. The baby is started on broad spectrum antibiotics and antiviral medications but sliops into a coma and expires. At autopsy the brain shows a purulent exudate in the subarachnoid space at the base of the brain.

Answer 16

E. Coli. Meningitis

Question 17

A 30 year old woman presents to the emergency room complaining that she has the worst headache of her life. Her temperature is 37 blood pressure 135/85 and pulse 90. The patient shows no evidence of muscle weakness or ataxia. Imaging studies reveal subarachnoid heorrhage and an angiogram shows a congenital saccular (berry) aneurysm.

Answer 17

Ruptured berry anuerysm

Question 18

A 30 year old woman suffers traumatic injury to her breast while playing soccer. Physical exam reveals a 3cm area of ecchymosis on the left breast two weeks later the patient palpates a firm lump beneath the area where the bruise had been located.

Answer 18

Fat necrosis

Question 19

A 35 year old nulliparous woman complains that her breast are swqollen nodular upon palpation. A mommogram discloses foci of calcification in both breasts. A breast biopsy reveals cystic duct dilation and ductal epithelial hyperplasia without atypic. What is the most likely diagnosis?

Answer 19

Fibrocystic change

Question 20

A 35 year old woman complains of urinary incontinence and blurred vision for 2 months. a funduscopic examination shows no abnormalities. Two months later the patient develops double vision and numbness in the fingers of her left hand. MRI shows scattered plaques in the patients brain and spinal cord. Over the next several months some of these plaques diminish in size while others appear in new locations

Answer 20

Multiple sclerosis – Plaques on the brain

Question 21

A 36 year old woman presents with infertility she complains of having had dull pelvic pain for 9 months which is accentuated during menstruation. Physical exam and endocrinoligc studies are normal. Laparoscopy reveals multiple small hemorrhagic lesions over the surface of both ovaries and fallopian tubes and abundant pelvic scarring.

Answer 21

Endometriosis

Question 22

A 44 year old woman presents with a 5 year history of dysmenorrhea. Physical examination and endocrine studies are normal. A hysterectomy is performed. Histologic examination of the uterine wall reveals areas of etenisve adenomyosis

Answer 22

Uteirn Fibroid Leiomyoma benign tumor of smooth muscle origin

Question 23

A 45 year obese woman with a history of diabetes mellitus and poorly controlled hypertension complains of increased mestual blood flow of 3 months duration. An endometrial biopsy reveals adenocarcinoma

Answer 23

Uterine cancer most likely caused by estrogen therapy or high levels of estrogen

Question 24

A 45 yera old woman discovers a solitary mass in her right breast on self examination which is confirmed on physical examination. Mammography rdemonstrates focal calcification with a linear configuration in the region of the breast mass. A breast biopsy reveals large pleomorphic epithelial cells confined to dilated ducts with central zones of necrosis.

Answer 24

DCIS

Question 25

A 45 yera old woman suffered massive head trauma in snowboarding accident. The oatient persists in a vegetative coma for several months and then expires. A section of the temporal lobe shows proliferation of cells with a star shaped appearance.

Answer 25

Astrocytes

Question 26

A 5 year old boy is brought to the emergency room with fever vomitting and convulsions. The patient is febrile 39.5. Physical exam reveals cervical rigidity and pain in the neck and knee. Examination of cerbrospinal fluid reveals neutrophils

Answer 26

Bacterial menengitis

Question 27

A 50 year old nulliparous woman complains that her menstrual blood flow is more abundant than usual. During the last two menstrual cycles she noticed spotting throughout the entire cycle. The patient is obese and her blood pressure is 160/100. An ultrasound examination reveals a thickened endometrial strripe with polypoid mass in the uterine fungus. Tha patient undergoes a hysterectomy. The uterus is opened to reveal a partially necrotic mass. Mucoscopic examination of the tumor reveals moderately differentiated adenocarcinoma

Answer 27

Endometrial adenocarcinoma

Question 28

A 50 year old woman presents with a 1 month history of intermittent vaginal bleeding. A pap smear is normal. Pelvic examination reveals a left adnexal mass. A uterine curettage shows complex endometrial hyperplasia without atypic. A CT scan of the abdomen reveals a 5 cm mass replacing the left ovary. The patient undergoes hysterectom and bilateral salpingo oophorectomy.

Answer 28

Serous cystic adenocarcinoma

Question 29

A 54 old woman dies 48 hours after suffering severe head injuries in an automibile accident. Just before her death her left pupil became fixed and dilated. (Occulomotor nerve palsy)

Answer 29

Cerebral contusion d/t epidural hematoma.