VISUAL LEARNING/RADIOLOGY
MISCL
High Value Care
CARDS/EKG
CLINICAL IMAGES
100
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.
100
A 28-year-old woman is evaluated for fever, generalized lymphadenopathy, and the rash shown. What is the diagnosis? 
Secondary syphilis
Generalized mucocutaneous rash; involvement of the palms and soles is characteristic. The rash takes various morphologic forms, except for vesicular. Generalized lymphadenopathy and constitutional symptoms also occur.
100
What is the preferred initial imaging test of choice in patients with suspected osteomyelitis?
Plain X-ray
100
Diagnose
Polymorphic VT
100
Diagnose the skin condition. 
BCC: Pearly nodule with arborizing telangiectasias (bottom left of nodule) and ulceration characteristic of nodular basal cell carcinoma.
Most common type of skin cancer. Metastasis rarely occurs; however, without treatment, it can cause significant local tissue destruction. The most common causative factor is UV light exposure.
Prevention with sun protection, including routine use of sunscreen with sun protection factor greater than 35, protective clothing (wide-brimmed hats, long sleeves), and avoidance of midday sun (10:00 AM to 2:00 PM), is highly recommended.
Tx: Surgery, MOHS, electrodessication and curettage; cryosurgery; topical chemotherapy; radiation therapy; and, for metastatic or inoperable lesions, oral hedgehog pathway inhibitors (vismodegib, sonidegib).
200
Clinical diagnosis?
Pulmonary Embolism ("Hampton's Hump")
Hampton AO, Castleman B (1940). "Correlation of postmortem chest teleroentgenograms with autopsy findings". Am J Roentgenol Radium Ther. 34: 305–326.
200
Drug to treat hyperthyroidism in the first trimester of pregnancy?
- Propylthiouracil (PTU), rather than methimazole, is the drug of choice during the first trimester. Although rare, methimazole has been associated with fetal development of aplasia cutis (absence of a portion of skin on the scalp in a localized or widespread area) and choanal atresia (blockage of the posterior nasal passage due to failed recanalization of the nasal fossae during fetal development) when used in the first trimester.
200
Name the medication that Increases smoking cessation rates about 3.5 times more than control and almost 2 times more than bupropion; more effective than nicotine replacement monotherapy.
Varenicline
200
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)
200
Identify the findings in a HIV patient. 
Kaposi sarcoma, presenting as firm purple nodules on the face and purple palatal nodules, is seen in a patient with AIDS.
300
A 62-year-old woman with end-stage kidney disease is evaluated for the painful skin lesion shown. what is the diagnosis?
Calciphylaxis (calcific uremic arteriopathy). The tissue can become necrotic, painful, and a potential source for secondary infection that may lead to sepsis and death. Treatment is usually supportive with pain control. Aggressive control of calcium, phosphorus, and intact parathyroid hormone is recommended.
300
Identify the lesion
Pyogenic Granuloma
300
First line treatment for insomnia?
The goals of treatment of insomnia are to improve overall sleep and quality of life. Effective treatment programs are multimodal in their approach and include cognitive behavioral therapy for insomnia (CBT-I), sleep hygiene techniques, environmental changes, and, in poorly controlled cases, pharmacologic therapy.
300
Hypertrophic cardiomyopathy-
- Voltage criteria for left ventricular hypertrophy (LVH) — S wave in V1 + R wave in V5 > 35mm (note there are many different ways of measuring voltage criteria for LVH)
- Deep, narrow Q waves in lateral leads I, aVL, V5-6
300
A 65-year-old white male presented with the following painless scrotal lesions.
Angiokeratomas
400
24 y/o F, abdominal bruit, 165/99 BP, thinking?
Renal artery, fibromuscular dysplasia
400
- True or False? Topical antibiotics should not be used as monotherapy for acne.
True
Topical antibiotics are helpful in inflammatory acne as they target P. acnes and exhibit anti-inflammatory effects. Because of increased antibiotic resistance, topical antibiotics should not be used as monotherapy. It is recommended that topical antibiotics be combined with topical benzoyl peroxide in treatment for mild, moderate, or severe acne. Topical benzoyl peroxide has bactericidal properties and is not known to promote the development of resistant bacteria.
400
What is the recommended follow up for asymptomatic hepatic cysts?
Asymptomatic hepatic cysts are benign and require no follow-up.
400
Guidelines for ICD in HFrEF.
For ischemic and nonischemic cardiomyopathy in patients with an EF ≤35% and NYHA functional class II-III or with an EF ≤30% and NYHA functional class I to improve survival.
400
Likely Diagnosis?
ash leaf spot/tuberous sclerosis
500
Identify the finding on CT scan of the chest 
Bullous lung disease
Emphysema
500
How often should you obtain routine surveillance echocardiography for patient with chronic/stable heart failure?
- Current guidelines recommend against routine surveillance echocardiography in patients with chronic heart failure in the absence of a change in clinical status or planned intervention.
500
Expected hemoglobin electrophoresis findings for a patient with Beta Thalassemia Major
no HbA, HbF >95%, remainder HbA2
500
Name the medication that is recommended if EF ≤35% who are in sinus rhythm with a heart rate ≥70/min despite maximal β-blocker therapy.
Ivabradine
500
What is the diagnosis? Is there increased risk of malignancy with this condition compared to general population?
Becker's Naevus
There are no current reports of Becker naevi undergoing malignant changes.