EKG
Clinical Images
Radiology
High Value Care
Misc.
100
Identify this rhythm!
1st Degree Heart Block (Prolonged PR interval- 0.4 sec)
100
A 54-year-old woman with atrial fibrillation is hospitalized with a painful skin lesion involving the breasts, as shown. What is the diagnosis?
Protein C Deficiency
Warfarin therapy was initiated for this patient
100
Endoscopic view of the esophagus in a 36-year-old male with dysphagia. Dx?
Eosinophilic Esophagitis
(whitish papules are also visible representing eosinophilic abscesses)
100
At what age is an upper GI endoscopy routinely considered to exclude malignancy in patients with dyspepsia?
60 years and older
100
What is first-line treatment for post-traumatic stress disorder?
Cognitive behavioral therapy
200
Identify the rhythm
Multifocal Atrial Tachycardia
200
Dx
Retinal detachment
200
A radiograph of the knee is shown.
Osteoarthritis
200
In patients with cystic fibrosis, what is the recommended age for routine colorectal cancer screening?
40 years (And then rescreening every 5 years)
200
What are the three FDA approved medications for the treatment of opioid use disorder.
300
A 36-year-old man is evaluated in the emergency department for an irregular heart rhythm. He is otherwise asymptomatic.
This ECG demonstrates Mobitz type 1 second-degree (Wenckebach) atrioventricular block, which is characterized electrocardiographically by a PR interval that progressively prolongs until, eventually, the beat is dropped. In the tracing shown, the PR interval widens over the first six beats and no ventricular complex follows the seventh atrial beat.
300
A 60-year-old male presented with fever, fatigue, shortness of breath, and cough. The p smear is given below. What is the most probable Dx?
Acute Myelogenous Leukemia
(Very large, immature myeloblasts with many nucleoli. Linear reddish "Auer rod" composed of crystallized granules is visible in some cells. These findings are typical for acute myelogenous leukemia (AML) most prevalent in young adults)
300
A 62-year old woman is evaluated for an 8-month history of progressive dyspnea, dry cough, and clubbing. She continues to smoke cigarettes.
Chest CT scan is shown.
This patient's chest CT scan suggests idiopathic pulmonary fibrosis. There are fibrotic cystic changes to the lungs, commonly called "honeycombing" because of their appearance, as shown (arrow). Honeycombing is a pathologic finding and not specific for a single disease, but it is commonly associated with advanced interstitial lung diseases, such as idiopathic pulmonary fibrosis. The presence of honeycombing is associated with a poor prognosis.
300
What is the preferred initial imaging test of choice in patients with suspected osteomyelitis?
Plain X-ray
300
Which of the following is the most likely diagnosis? 
Psoriatic arthritis.
400
Atrial Flutter with 2:1 pattern conduction
(Typical atrial flutter (negative flutter waves in lead II) with 2:1 AV conduction.
Ventricular rate= 135/min
Atrial rate = 270/min (every other flutter wave is partly hidden in the QRS)
400
Identify the lesion
Pyogenic Granuloma
400
The most likely diagnosis is progressive multifocal leukoencephalopathy (PML), which is caused by reactivation of the polyomavirus JC (JCV).
PML-associated demyelination is confined to the subcortical white matter and the cortex. On MRI, PML presents as a discrete unilateral or bilateral foci of demyelination-appearing hyperintense lesions without mass effect. Diagnosis requires polymerase chain reaction testing for the presence of JCV and occasionally brain biopsy. In contrast, cerebral toxoplasmosis and primary central nervous system lymphoma cause discrete mass lesions whereas neurosyphilis is associated with non-specific changes on MRI.
400
Interpret: HBsAg+, Anti-HBc IgG+, HBeAg+
1. Acute Hep B
2. Chronic Hep B
3. Carrier
4. Cleared
5. Vaccinated
Acute - HBsAg+, Anti-HBc IgM+, HBeAg+
Chronic - HBsAg+, Anti-HBc IgG+, HBeAg+
Carrier - HBsAg+, Anti-HBc IgG+
Cleared - Anti-HBs Ab+, Anti-HBc IgG+
Vaccinated - Anti-HBs Ab+
400
33 y/o M with PMH of HIV presents with one day of fever, productive cough, and a left-lower-lobe infiltrate on chest radiograph. His CD4 count is 440 cells/mm3. What is the most-likely cause of his pneumonia?
Streptococcus pneumoniae
(pneumocystis jiroveci isn't more common until CD4 is less than 200 cells/mm3)
500
EKG of a 30-year-old male from Thailand who presented after experiencing multiple episodes of syncope. What is the diagnosis? 
Brugada Syndrome (Brugada Pattern on EKG+ Arrhythmogenic Syncopal Episodes)
(Incomplete RBBB pattern and elevation of the ST segments that gradually descends to an inverted T wave in leads V1 and V2 - characteristic of the classic variety of Brugada syndrome)
500
A 65-year-old white male presented with the following painless scrotal lesions.
Angiokeratomas
500
Dx?
Pulmonary Embolism
500
Patients age 19-65 with all of the following underlying conditions should receive pneumococcal vaccine except?
A- Alcohol Use Disorder
B- Diabetes Mellitus
C- Essential Hypertension
D- Sickle Cell Disease
C- Essential Hypertension
(Patients age 19-65 with the following clinical conditions should receive pneumococcal vaccine
- Chronic heart disease
- Chronic lung disease
- Chronic liver disease
- Diabetes Mellitus
- Sickle cell disease or other hemoglobinopathies
- Current cigarette smoking
- Alcohol use disorder)
500
Thyroid scan findings are shown.
Which of the following is the most likely diagnosis?
The most likely diagnosis is a multinodular goiter.