Yehuda Wolf, MPA, PA-C

Acanthosis Nigricans Patient will be obese or diabetic PE will show thickened, velvety, darkly pigmented plaques on the neck or axillae Comments: Screen for diabetes in those not yet diagnosed Sample question: A 19-year-old woman presents to her primary care provider’s office for a rash on the back of her neck that has grown and gotten darker over read more…

Subdural Hematoma Patient will be elderly or alcoholic With a history of a fall or traumatic head injury Complaining of headache, mental status changes, seizures, or focal deficits Diagnosis is made by non-contrast CT, crescent-shaped hematoma Most commonly caused by rupture of the bridging veins Treatment is neurosurgical consultation Sample question: A 68-year-old man presents to the ED after a fall down 12 stairs. read more…

Ankylosing Spondylitis Patient will be a male Complaining of low back pain that’s worse in the morning and improves with exercise X-ray will show multiple vertebral fusions (bamboo spine) Labs will show increased ESR Most commonly caused by presence of HLA-B27 Treatment is NSAIDs, physical therapy Comments: diseases associated with HLA-B27 PAIR: Psoriatic arthritis, Ankylosing spondylitis, Inflammatory bowel disease, Reactive arthritis Sample question: A 51-year-old man presents with low back read more…

von Willebrand Disease Patient with a history of a parent with similar symptoms Mucosal hemorrhage or bleeding that is difficult to control Labs will show decreased factor VIII, prolonged bleeding time Treatment is desmopressin (DDAVP) Comments: Most common inherited bleeding disorder, autosomal dominant Sample question: A 9-year-old child is being evaluated for frequent epistaxis and easy bruising tendencies. Bleeding time is prolonged, PT, PTT, read more…

Hypothyroidism Patient will be complaining of generalized weakness, fatigue, facial swelling, constipation, cold intolerance, and weight gain PE will show periorbital edema, dry skin, and coarse brittle hair Labs will show high TSH and low free T4, antithyroid peroxidase, and antithyroglobulin autoantibodies Most commonly caused by Hashimoto’s thyroiditis Treatment is levothyroxine Comments: Takes about 6 weeks to see treatment effects. Monitor TSH Hashimoto’s: Risk factor for non-Hodgkin lymphoma Sample Question: A 55-year-old woman presents to your office with complaints of fatigue, read more…

Hyphema Patient with a history of blunt or penetrating trauma Complaining of blurry vision PE will show unequal pupils, injected conjunctiva/sclera and blood in anterior chamber Treatment is eye protection and rest with the head of the bed at 30-45 degrees all the times A 13-year-old boy is brought to the urgent care clinic by his mother. He read more…

Meniere Disease Patient will be complaining of episodic low-frequency hearing loss, tinnitus with aural (ear) fullness, and vertigo lasting one to eight hours Diagnosis is made clinically Most commonly caused by too much inner ear endolymph and increased pressure within the inner ear Treatment is low salt diet, diuretics (HCTZ + triamterene) Example: A patient complains of read more…

Osgood-Schlatter Disease Patient will be an athlete 10–15 years old Complaining of knee pain while running PE will show tenderness over the tibial tubercle Treatment is ice, NSAIDs, quadriceps stretching Example: A 12-year-old boy presents to his pediatrician’s office for right knee pain that started three months ago after starting basketball practices. On physical exam, the read more…

Patient will be complaining of proximal muscle weakness, ptosis, and diplopia that is worse at the end of the day PE will show ice test improves sx Diagnosis is made by edrophonium (tensilon) test, EMG Most commonly caused by autoimmune destruction of acetylcholine receptors Treatment is acetylcholinesterase inhibitors, such as pyridostigmine Comments: associated with thymoma Example: A 28-year-old read more…

Multiple Myeloma Patient will be elderly Complaining of back pain PE will show CRAB: hyperCalcemia, Renal insufficiency, Anemia, lytic Bone lesions/Back pain Labs will show monoclonal antibody spike X-ray will show lytic lesions Peripheral blood smear: Rouleaux formations Serum protein electrophoresis: M spike Protein electrophoresis urine analysis: Bence-Jones proteins Most commonly caused by single clone plasma cell read more…

Molluscum Contagiosum Patient will be a school-age child Presenting with “warts” PE will show multiple waxy, dome-shaped papules with umbilicated appearance Most commonly caused by poxvirus Treatment is self-limiting

Complex Regional Pain Syndrome Patient will have a history of previous extremity injury or fracture Complaining of light touch causing extreme pain and allodynia (pain felt from a nonpainful stimulus, such as clothes or bed sheets on the skin) Treatment is NSAIDs, gabapentin, sympathectomy

Bacterial Tracheitis Patient will be 3–5 years old High fever, barky cough, stridor Treat as airway emergency! Comments: Patient will look like croup but toxic appearing Sample Question: A 3-year-old boy presents in severe respiratory distress. His mother informs you that he has been ill for the last five days, initially with a low-grade fever and “barky cough.”  read more…

Absence Seizures Patient will be a 5–10 years old Sudden mental status alteration without motor activity or a blank stare EEG during an event would show symmetric 3 Hz spike and wave activity Treatment is ethosuximide Comments: There will be no aura or postictal state