History Taking and Performing Physical Examination
EENT: "A patient presents with progressive hearing loss and tinnitus in one ear, along with facial numbness. A thorough neurological examination suggests compression of cranial nerves V and VIII. This condition should be suspected."
Answer: What is acoustic neuroma (vestibular schwannoma)?
Why: Acoustic neuroma is a benign tumor that affects cranial nerves, leading to unilateral hearing loss, tinnitus, and facial numbness.
Cardiology: "A patient with acute chest pain, normal initial ECG, and risk factors for coronary artery disease has a negative high-sensitivity troponin at presentation. What is the recommended timeline for repeat high-sensitivity troponin testing to accurately diagnose or rule out myocardial infarction?"
Answer: What is 3 hours after the initial test?
Why: High-sensitivity troponin should be repeated at 3 hours after the initial test to detect any rise that would indicate myocardial injury. This approach allows for the identification of myocardial infarction that may not be apparent with an initial negative test.
Cardiology: "A patient reports exertional chest pain that is relieved by rest. An ECG shows ST-segment depressions during a treadmill test."
Answer: What is stable angina?
Why: Stable angina is characterized by predictable chest pain relieved by rest and confirmed by stress test findings of ST depressions.
Endocrine: "A patient diagnosed with primary hyperthyroidism is treated to reduce hormone synthesis. What medication is typically used?"
Answer: What is methimazole?
Why: Methimazole inhibits thyroid hormone synthesis and is a first-line treatment for hyperthyroidism.
Endocrine: This hormone replacement therapy is the standard treatment for primary hypothyroidism, and its dose is adjusted based on TSH levels, with monitoring recommended every 6-8 weeks after initiating or changing the dose.
Answer:
What is levothyroxine?
Cardiology: "What is the preferred intervention for a patient experiencing an ST-elevation myocardial infarction (STEMI) within 90 minutes of arrival?"
Answer: What is percutaneous coronary intervention (PCI)?
Why: PCI is the gold standard for reperfusion in STEMI, restoring blood flow promptly
Cardiology: "What specific ACE inhibitor is commonly prescribed as a first-line treatment for heart failure with reduced ejection fraction (HFrEF)?"
Answer: What is enalapril?
Why: enalapril reduces mortality by decreasing afterload and preventing cardiac remodeling.
Endocrine "The pathophysiology of Graves' disease involves autoantibodies stimulating this receptor."
Answer: What is the TSH receptor?
Why: Autoantibodies mimic TSH, leading to excessive thyroid hormone production.
Dermatology: "A patient reports pruritic, erythematous papules and vesicles on the wrists and ankles, often in a linear pattern after hiking. This diagnosis should be considered."
Answer: What is allergic contact dermatitis (poison ivy)?
Why: Poison ivy causes linear erythematous and vesicular lesions due to the oil urushiol, which triggers a type IV hypersensitivity reaction.
GI: "A patient presents with unexplained iron deficiency anemia and a positive fecal occult blood test. If a colonoscopy reveals no significant findings, what is the next recommended diagnostic procedure to assess the upper GI tract?"
Answer: What is an esophagogastroduodenoscopy (EGD)?
Why: An EGD allows direct visualization of the esophagus, stomach, and duodenum, which can help identify upper GI sources of bleeding, such as ulcers or malignancies, that may contribute to iron deficiency anemia.
Endocrine: "A young woman presents with sudden weight gain, facial rounding, purple striae, and hypertension. Further testing reveals elevated 24-hour urinary free cortisol and an adrenal mass on imaging."
Answer: What is Cushing disease due to an adrenal adenoma?
Why: Elevated cortisol levels and an adrenal mass suggest an adrenal adenoma causing Cushing disease.
Heme/Onc: "A 6-year-old child presents with fatigue, bone pain, and pallor. Blood tests reveal anemia, thrombocytopenia, and an elevated white blood cell count with blast cells. What is the most likely diagnosis, and what initial test confirms it?"
Answer: What is acute lymphoblastic leukemia (ALL) and a bone marrow aspiration/biopsy?
Why: Acute lymphoblastic leukemia (ALL) is the most common childhood leukemia, presenting with symptoms such as fatigue, bone pain, and cytopenias. A bone marrow aspiration/biopsy confirms the diagnosis by demonstrating increased lymphoblasts and allows for immunophenotyping to differentiate ALL from other leukemia types.
Infectious disease:
Patients with a history of splenectomy are at increased risk for infections with encapsulated organisms. To prevent pneumonia, meningitis, and infections caused by the organism most likely to cause epiglottitis, these three vaccines are recommended on an accelerated or more frequent schedule.
Answer: What are the pneumococcal, meningococcal, and Haemophilus influenzae type b (Hib) vaccines?
GI:
This diagnostic imaging study, often performed in patients with suspected biliary obstruction, allows for both visualization of the biliary tree and the option for therapeutic intervention such as stone removal or stent placement.
Answer:
What is Endoscopic Retrograde Cholangiopancreatography (ERCP)?
Endocrine: "What medication is used to treat hyperprolactinemia by inhibiting prolactin secretion?"
Answer: What is cabergoline or bromocriptine?
Why: Dopamine agonists reduce prolactin levels effectively.
Cardiology "The Frank-Starling law states that increased preload leads to this change in stroke volume."
Answer: What is an increase in stroke volume?
Why: The heart pumps more effectively with greater initial fiber stretch.
Endocrine: "A patient presents with a history of polyuria, polydipsia, and recent unintentional weight loss. On examination, fruity breath odor and Kussmaul respirations are noted. This emergency condition is likely."
Answer: What is diabetic ketoacidosis (DKA)?
Why: DKA presents with hyperglycemia, ketonemia, and metabolic acidosis, accompanied by specific clinical signs like Kussmaul breathing and fruity breath.
Endocrine: "A patient with fatigue, muscle weakness, and salt cravings has low sodium and high potassium levels. This diagnostic test confirms the condition."
Answer: What is an ACTH stimulation test?
Why: The ACTH stimulation test evaluates adrenal function and confirms adrenal insufficiency (Addison’s disease) by showing low cortisol response.
Heme/Onc: "A patient presents with painless cervical lymphadenopathy, weight loss, and night sweats. A lymph node biopsy shows Reed-Sternberg cells."
Answer: What is Hodgkin's lymphoma?
Why: The presence of Reed-Sternberg cells on biopsy is pathognomonic for Hodgkin's lymphoma.
Cardiology: "A patient with atrial fibrillation and a CHADS2-VASc score of 2 requires this treatment for stroke prevention."
Answer: What is an oral anticoagulant (e.g., apixaban, warfarin)?
Why: Patients with a CHADS2-VASc score of 2 or higher benefit from anticoagulation to reduce the risk of stroke.
Dermatology: "Patients with a history of melanoma should be educated to use this specific method when performing regular self-examinations to monitor for suspicious skin changes."
Answer: What is the ABCDE method (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolving)?
Why: The ABCDE method helps patients identify potential signs of melanoma during self-examinations by focusing on changes in moles or lesions that may indicate malignancy. Educating patients on this method can aid in early detection of new or recurring melanoma.
Pulmonary: "A patient with a large pleural effusion causing respiratory distress should undergo this image-guided procedure to ensure safe fluid drainage."
Answer: What is ultrasound-guided thoracentesis?
Why: Ultrasound guidance improves the safety and accuracy of thoracentesis.
Heme/Onc: "What medication is used for rapid anticoagulation in patients with deep vein thrombosis or pulmonary embolism?"
Answer: What is low-molecular-weight heparin?
Why: LMWH provides immediate anticoagulation and is safer than unfractionated heparin.
Pulmonary: "Surfactant, produced by type II alveolar cells, reduces this in the lungs to prevent collapse."
Answer: What is surface tension?
Why: Surfactant lowers surface tension, maintaining alveolar stability.
Heme/Onc: "A patient with a recent history of viral illness presents with petechiae, easy bruising, and mucosal bleeding. Examination shows a low platelet count without splenomegaly."
Answer: What is immune thrombocytopenic purpura (ITP)?
Why: ITP involves isolated thrombocytopenia after a viral infection, causing mucocutaneous bleeding without organomegaly.
Heme/Onc: "A patient presents with fatigue, pallor, and a high mean corpuscular volume (MCV). A peripheral blood smear reveals hypersegmented neutrophils. This test confirms the suspected diagnosis."
Answer: What is serum vitamin B12 level?
Why: Macrocytic anemia with hypersegmented neutrophils is indicative of B12 deficiency, confirmed by serum levels.
GI: "A patient with a long-standing history of heartburn presents with dysphagia and unintentional weight loss. Endoscopy shows a narrowing at the distal esophagus with columnar epithelium."
Answer: What is Barrett's esophagus with possible progression to esophageal adenocarcinoma?
Why: Barrett's esophagus is a complication of GERD that can lead to dysplasia or adenocarcinoma, confirmed by endoscopy.
Psychiatry: "A patient diagnosed with major depressive disorder has failed to respond to two different SSRIs. What medication class is typically considered next?"
Answer: What are serotonin-norepinephrine reuptake inhibitors (SNRIs)?
Why: SNRIs like venlafaxine are used after SSRI failure due to their dual action on serotonin and norepinephrine.
Cardiology: "To prevent cardiovascular disease, patients should maintain this target LDL cholesterol level."
Answer: What is below 100 mg/dL for high-risk individuals?
Why: Lower LDL levels reduce the risk of coronary artery disease.
Endocrine: "A patient with a pheochromocytoma must be treated with this class of drugs preoperatively to prevent hypertensive crisis."
Answer: What are alpha-blockers?
Why: Alpha-blockers manage catecholamine-induced hypertension before surgery.
Pulmonary: "What class of drugs is the mainstay for managing chronic COPD symptoms?"
Answer: What are long-acting bronchodilators (LABAs or LAMAs)?
Why: Long-acting bronchodilators improve airway patency and reduce exacerbations.
Heme/Onc: "Patients taking warfarin need to be mindful of their dietary intake of this vitamin, as fluctuations can impact the drug’s effectiveness and INR levels. What dietary advice should be given to patients on warfarin regarding this vitamin?"
Answer: What is to maintain a consistent intake of vitamin K-rich foods?
Why: Warfarin works by inhibiting the vitamin K-dependent synthesis of certain clotting factors. Sudden changes in dietary intake of vitamin K (found in green leafy vegetables like spinach and kale) can affect the effectiveness of warfarin and cause fluctuations in INR levels. Patients should be advised to maintain a consistent amount of vitamin K in their diet to avoid altering their anticoagulation status.
Pulmonary: "A young adult presents with recurrent episodes of wheezing, coughing, and shortness of breath, which worsen at night and during exercise. Family history includes atopy."
Answer: What is asthma?
Why: Asthma is a chronic inflammatory airway condition that often presents with episodic symptoms, and a family history of atopy supports the diagnosis.
Pulmonary: "A patient presents with chronic cough, weight loss, night sweats, and a positive tuberculin skin test. What imaging study should be used to further evaluate this condition?"
Answer: What is a chest X-ray?
Why: A chest X-ray can reveal granulomas and other findings suggestive of tuberculosis.
Pulmonary: This chronic condition is diagnosed based on a post-bronchodilator FEV1/FVC ratio less than 0.70, along with a history of exposure to risk factors such as smoking or environmental pollutants and clinical symptoms of chronic cough, sputum production, or dyspnea.
Answer:
What is Chronic Obstructive Pulmonary Disease (COPD)?
Pulmonary: "A patient with a severe COPD exacerbation requires noninvasive ventilation to reduce hypercapnia. What intervention is most appropriate?"
Answer: What is bilevel positive airway pressure (BiPAP)?
Why: BiPAP helps to improve ventilation and reduce carbon dioxide levels during COPD exacerbations.
GI: "Patients with a family history of colorectal cancer should begin colonoscopy screening at this age."
Answer: What is age 40 or 10 years before the youngest case in the family?
Why: Early screening can catch precancerous polyps before they develop into cancer.
Psychiatry: "Severe catatonia unresponsive to benzodiazepines may require this intervention for rapid relief."
Answer: What is electroconvulsive therapy (ECT)?
Why: ECT is effective for severe catatonia, especially when other treatments fail.
GI: "What medication is used to treat severe hepatic encephalopathy by reducing ammonia levels?"
Answer: What is lactulose?
Why: Lactulose acidifies the colon, converting ammonia to ammonium, which is excreted.
GI: "The primary site for nutrient absorption in the GI tract is this section of the small intestine."
Answer: What is the jejunum?
Why: The jejunum has specialized structures for efficient nutrient absorption.