Internal Medicine

Scabies Patient will be complaining of severe pruritus that is worse at night PE will show small papules, vesicles and burrows in the webbed spaces of the fingers and toes Diagnosis is made by microscopic visualization Most commonly caused by Sarcoptes scabiei hominis Treatment is permethrin 5% Sample question: A 15-year-old boy presents with an itchy rash on his hands and wrists. read more…

Ectopic Pregnancy Sample question: A 44-year-old woman with a history of hypertension presents to her primary care provider’s office with complaints of nausea and vomiting. Her last menstrual cycle was six weeks ago. Two years ago she had a bilateral tubal ligation performed. On physical exam, her abdomen is nontender and her uterus is not read more…

Polycythemia Vera Patient will be complaining of headache, dizziness, pruritus after showering PE will show hypertension, splenomegaly Labs will show increased RBC mass, overproduction of all cell lines, increased Hgb Most commonly caused by mutation of the Janus kinase 2 gene (JAK2) Treatment is phlebotomy, hydroxyurea, aspirin Sample question: A 60-year-old man presents to your office complaining of generalized pruritus following warm showers. He also read more…

Retinal Detachment Patient will be complaining of painless loss of vision, floaters, flashing lights, curtain lowering sensation PE will show retina appears hazy gray with white folds Treatment is stat ophthalmology consult 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 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…

Wolff-Parkinson-White (WPW) Syndrome ECG will show short PR interval, delta wave, wide QRS Most commonly caused by an accessory pathway (bundle of Kent) connects atria to ventricles, bypassing AV node Definitive treatment is radiofrequency ablation 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 read more…

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) Patient will be an obese female Complaining of amenorrhea, obesity, hirsutism PE will show bilateral ovarian enlargement, acanthosis nigricans Labs will show high LH:FSH, androgen excess Most commonly caused by insulin resistance Treatment is combination OCPs, lifestyle changes, metformin 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 read more…

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 Patient will be complaining of radial wrist pain PE will show pain on ulnar wrist deviation with thumb in fist (Finkelstein’s test) Treatment is thumb spica splint, NSAIDs 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 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…

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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…