Clinical Year

Ectopic Pregnancy Patient will be a woman With a history of prior ectopic, PID, tubal surgery, IUD Complaining of vaginal bleeding, abdominal pain, amenorrhea PE will show adnexal tenderness or unexplained hypotension Labs will show positive pregnancy test and lower than expected serum beta-hCG levels Diagnosis is made by ultrasound Most commonly located in a fallopian tube Treatment is MTX or surgery Sample question: A 44-year-old woman with 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…

Pyloric Stenosis Patient will be 2–6 weeks old Non-bilious projectile vomiting after feeding and early satiety PE will show RUQ olive-like mass (hypertrophied pylorus) Labs will show hypochloremic hypokalemic metabolic alkalosis Diagnosis is made by ultrasound or UGI series (string sign) Treatment is surgical Sample question: A 3-week-old boy presents with two days of non-bilious projectile vomiting. Examination reveals a mass in the infant’s right upper quadrant. 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…

Kawasaki Disease Patient is a child With a history of high fever for 5 days Conjunctivitis, rash, adenopathy, strawberry tongue, hand/feet edema, fever Treatment is IVIG + aspirin Comments: #1 cause of pediatric acquired heart disease, risk for coronary artery aneurysm Mnemonic: CRASH and burn: Conjunctivitis, Rash, Adenopathy, Strawberry tongue, Hand/feet edema, Fever Sample question: A 4-year-old girl is brought to 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…