Clinical Year

von Willebrand Disease Sample question: A 9-year-old child is being evaluated for frequent epistaxis and easy bruising tendencies. Bleeding time is prolonged, PT, PTT, and INR are within normal limits. What is the most likely diagnosis?

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 A 13-year-old boy is brought to the urgent care clinic by his mother. He was struck in the eye with a baseball while playing with classmates during recess. He complains of blurred vision and excruciating eye pain. Examination of the eye reveals decreased visual acuity, miosis, photophobia, and grossly visible blood in the anterior chamber.

Meniere Disease Example: A patient complains of a 6-month history of tinnitus and vertigo that occurs with nausea, vomiting and a sensation of “ears full of water.” These symptoms occur intermittently in attacks at a frequency of once or twice a week. He denies head trauma, headache, photophobia or focal neurologic deficits. Otoscopic examination reveals no read more…

Osgood-Schlatter Disease 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 boy is tender to palpation over the anterior tibial tubercle. There is no erythema or warmth to the area. A lateral radiograph of the knee reveals elevation of read more…

Example: A 28-year-old woman presents with complaints of double vision and fatigue. These symptoms are generally better in the morning and progress throughout the day. She works long hours and says toward the end of her shift she is extremely fatigued and has difficulty completing her tasks. Which of the following is the most likely etiology?

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

Bacterial Tracheitis 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.”  He was seen at an urgent care facility four days ago and given a “breathing treatment” and discharged on steroids. He has become 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

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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…

Today’s teaching image and Rapid Review covers cardiac tamponade. Pericardial Tamponade Patient will be complaining of dyspnea and chest pain PE will show muffled heart sounds, JVD and hypotension (Beck’s triad), pulsus paradoxus  ECG will show low voltage QRS, electrical alterans Echocardiography will show diastolic collapse of RV Treatment is pericardiocentesis For more teaching images, try read more…

Today’s teaching image and Rapid Review covers tinea versicolor. Tinea Versicolor Malassezia furfur Patches with altered pigmentation Torso Affected skin does not tan Selenium shampoo For more teaching images, try a free trial of our board review qbanks.

Today’s teaching image and Rapid Review covers basilar skull fracture. Basilar Skull Fracture Petrous portion of temporal bone fracture most common Battle’s sign, raccoon eyes, hemotympanum, CSF otorrhea/rhinorrhea CN VII, VIII entrapment CT For more teaching images, try a free trial of our board review qbanks.