Adult-Gerontology Primary Care

Sample question: Which muscle is most commonly involved with rotator cuff injuries?

Megaloblastic Anemia Sample question: A middle-aged patient in the ED has a hemoglobin of 8.1 g/dL with an MCV of 112 fL. Which of the following is a common cause of this disease process?

Today’s teaching image is about alkaptonuria, or black urine disease. For more teaching images, try a free trial of our board review qbanks.

Sample question: In children under 8 years of age, which of the following is the most common fracture involving the elbow?

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…

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 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…

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?