Yehuda Wolf, MPA, PA-C

Retinal Detachment Sample question: A 67-year-old man presents to the emergency department complaining of vision changes for the last few hours. He describes a painless decrease in the vision in his left eye. This was preceded by an increase in floaters in his vision. Fundoscopic exam reveals a floating, gray “cloud.” What is the most read more…

Pterygium Patient with a history of excessive sunlight exposure Complaining of something in the eye PE will show triangular-shaped growth on the medial side Sample question: A 62-year-old man presents with complaints of right eye irritation for the past three days. He is a landscaper and he is often outside. Physical examination reveals a fleshy, triangular growth from the read more…

Pyloric Stenosis Sample question: A 3-week-old boy presents with two days of non-bilious projectile vomiting. Examination reveals a mass in the infant’s right upper quadrant. On a barium upper GI series report, the radiologist states a “string sign” is present. Which of the following is this infant at greatest risk of developing?

Wolff-Parkinson-White (WPW) Syndrome Sample question: A 23-year-old previously healthy man presents to your clinic with complaints of chest discomfort, heart palpitations and decreased exercise tolerance. Physical exam findings include a pulse of 110 bpm and an otherwise normal cardiac exam. Which of the following findings on ECG confirm the diagnosis of Wolff-Parkinson-White syndrome?

Sample question: A 2-year-old boy is brought by his parents to the clinic because of opacity and hyperpigmentation of both eyes. His skin is noted to be dry and scaly, especially on the arms, legs, shoulders, and buttocks. He also gets sick frequently. Physical examination reveals an afebrile and weak-looking child. There is a note read more…

Polycystic Ovarian Syndrome (PCOS) Sample question: A 26-year-old obese woman with a 2-year history of increased acne, abnormal hair growth, and menstrual abnormalities presents to her obstetrician for an infertility workup. A pelvic ultrasound reveals enlarged cystic ovaries. She desires to become pregnant. Which of the following is the first-line treatment?

Ulcerative Colitis Patient will be 15–30 years old Complaining of bloody diarrhea, crampy abdominal pain, and tenesmus Colonoscopy will show continuous mucosal inflammation always involving the rectum Treatment is sulfasalazine, surgery is curative Complications: Toxic megacolon, ↑ colon cancer risk Sample question: A 32-year-old man presents to clinic with worsening colicky stomach pains, and bloody, mucous streaked diarrhea. He reports he has no fever, nausea or vomiting. read more…

Rocky Mountain spotted fever (RMSF) Patient with a history of recently being in the woods hiking or camping Complaining of abrupt onset of severe headache, photophobia, vomiting, diarrhea, and myalgia PE will show maculopapular eruption on the palms and soles Most commonly caused by Rickettsia rickettsia Treatment is ALWAYS doxycycline, even in children Sample question: A 19-year-old woman presents with four days of read more…

Anticholinergic Toxidrome PE will show hyperthermia, tachycardia, mydriasis, and dry skin Treatment is supportive care alone or in combination with antidotal therapy with physostigmine Comments: Classes of medications with anticholinergic properties include antihistamines, tricyclic antidepressants, and sleep aids Mnemonic: “Mad as a hatter” (AMS), “blind as a bat” (mydraisis), “red as a beet” (flushed skin), “hot as a hare”(anhydrosis), and “dry as read more…

de Quervain Tenosynovitis Sample question: A 20-year-old man who is employed in construction presents with pain to his thumb and wrist for 4 months. He states that the pain worsens while he is working. Examination reveals pain along the radial surface of the wrist with forced ulnar abduction. What management is indicated?

Kawasaki Disease Patient is a child With a history of high fever for 5 days Conjunctivitis, rash, adenopathy, strawberry tongue, hand/feet edema, fever Treatment is IVIG + aspirin Comments: #1 cause of pediatric acquired heart disease, risk for coronary artery aneurysm Mnemonic: CRASH and burn: Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand/feet edema, Fever Sample question: A 4-year-old girl is brought to read more…

Wernicke Encephalopathy Patient will be a chronic alcoholic Complaining of ataxia and confusion PE will show nystagmus Most commonly caused by thiamine (B1) deficiency Treatment is aggressive thiamine repletion Comments: replace thiamine BEFORE glucose Sample question: A 53-year-old woman with chronic alcohol use presents with confusion and blurred vision. Her vital signs are normal. Physical examination reveals a wide-based gait, inability to abduct her read more…

Achalasia Patient will complain of dysphagia to solids and liquids PE will show absent peristalsis in lower esophagus Barium swallow shows “bird beak” appearance Diagnosis is made by esophageal manometry increased LES pressure Sample question: A 60-year-old man comes to the clinic complaining of difficulty swallowing, heartburn, chest pain, and mild weight loss. He has difficulty swallowing solids and liquids and read more…

Tetralogy of Fallot Sample question: A 1-year-old girl presents to the emergency room after her mother noticed that she became blue while crying. The patient subsequently squatted on the ground and the mother noticed a resolution in the cyanosis. On physical exam, the patient is now calm and vital signs are normal. A loud systolic ejection murmur read more…

Chlamydia Cervicitis

Cushing’s Syndrome Patient will be complaining of amenorrhea, central obesity, depressive symptoms, and easy bruising PE will show purple striae, “moon face” (facial adiposity), “buffalo hump” (increased adipose tissue in the neck and upper back), and hypertension Diagnosis is made by 24-hr urine cortisol and testing ACTH levels Most commonly caused by hypercortisolism from ACTH-secreting pituitary tumor Comments: If cause is pituitary tumor, then read more…

Hypercalcemia Patient will be complaining of bone pain (Bones), kidney stones (Stones), abdominal pain (Groans), lethargy, psychosis (Psychiatric overtones) Labs will show ↓ QT interval Most commonly caused by: Malignancy (most common inpatient cause) Primary hyperparathyroidism (most common outpatient cause) Treatment is IV fluids Sample question: A 67-year-old woman who was recently diagnosed with breast cancer presents read more…

Pertussis (Whooping Cough) Patient with a history of nasal congestion, cough, and low-grade fever “Rapid fire,” repetitive coughing followed by an inspiratory “whoop” and post-tussive emesis Most commonly caused by Bordetella pertussis Treatment is a macrolide – azithromycin Sample question:  A 2-year-old boy who is new to your practice is brought to the clinic because of coughing. For the past two weeks, he has had rhinorrhea read more…