Internal Medicine

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Chlamydia Cervicitis Diagnosis is made by nucleic acid amplification testing (NAAT) Most commonly caused by Chlamydia trachomatis Treatment is azithromycin Comments: Most commonly reported sexually transmitted disease in the United States Empirically treat for concomitant gonorrhea The United States Preventive Services Task Force recommends routine screening for sexually active women < 24 years of age, and in women > read more…

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…

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…

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

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

Many of our savvy customers realize intuitively that there is a treasure trove of performance data accumulating in the background with each new question answered by each of our users (40,933,037 total questions answered, as of today).

Causes: adhesions (pelvic surgery) > tumor > hernia (inguinal) Proximal: bilious vomiting  Distal: feculent vomiting High pitched bowel sounds X-ray: dilated bowel, air-fluid levels, “stack of coins” or “string of pearls” sign Modality of choice: CT NGT, surgery

Appendicitis Patient will be complaining of fever, pain that began periumbilical then moved to RLQ, nausea and anorexia PE will show Psoas sign (RLQ pain on extension of right hip), Obturator sign (RLQ pain on internal rotation of flexed right hip), Rovsing sign (right lower quadrant pain when the left lower quadrant is palpated) Diagnosis is made by ultrasound, CT Most commonly caused read more…