Ophthalmology
This is a pathologic eversion of the eyelid, usually the lower, away from the globe.
Irritable bowel syndrome is diagnosed in a 25-year-old woman. The symptoms that bother her most are feeling bloated and production of gas. Elimination from the diet of these types of foods will most likely alleviate her symptoms.
A 62-year old woman complains of a sudden painless loss of vision in the left eye that lasted about 20 minutes and then resolved spontaneously. She says the loss of vision was like "pulling a cover over her eye." Name this historical feature.
A 30-year-old woman with a history of diabetes mellitus presents with a 3-week history of hand numbness that often awakens her from sleep. The symptoms resolve after she shakes her hands for a few minutes. On physical examination, there is no sensory or motor deficit of her hands but there is a positive Tinel’s sign. This is the most likely diagnosis.
A 51-year old welder presents to your office complaining that during work yesterday afternoon he thinks a piece of metal flew into his eye. You do not see any foreign bodies, but you do notice this physical exam finding which makes you suspicious for a history of having metal in his eye.
A 43-year-old woman is seen in the emergency department with right upper abdominal pain that began two hours ago after she ate dinner. She is nauseated, and has vomited one time. With the exception of vomiting, she states that she has had similar episodes intermittently over the past two weeks. Physical examination shows moderate tenderness over the epigastrium and right upper quadrant. This is the most appropriate first imaging test to order.
A 45-year old male presents to the clinic complaining of terrible headaches that he has been having each afternoon. He described the pain as excruciating and concentrated behind his right eye. While speaking with him, he is pacing around the room holding the right side of his face. When you examine the right eye you notice that it has significant injection as well as extra tears when compared with the left. This is the best first-line treatment for the condition seen here.
A 57-year-old woman comes to the office because of shortness of breath and fatigue for one day. Upon awakening this morning, she felt sweaty, and slightly nauseated. An electrocardiogram shows ST elevation in leads II, III, and aVF. The patient is most likely suffering from this type of MI.
A 25-year-old man is seen in the office because of persistent pain of the left wrist for the past three days since accidentally falling onto his outstretched hand. Physical examination of the wrist shows mild to moderate swelling, moderate tenderness over the dorsal radial aspect specifically over the anatomic snuffbox, and intact skin. Range of motion is decreased because of pain. Neurovascular examination shows no abnormalities. Name the bone that is most likely fractured.
A 5-year old male is brought into the clinic by his mother because his eyes have been red since yesterday afternoon. She admits that his eyes have been very watery, but denies discharge. On physical exam his vision is 20/20 OU, both eyes have significant red injection, and he has mildly tender preauricular lymphadenopathy. This is the most likely diagnosis.
A 59-year-old man is brought to the emergency department by ambulance because of severe back pain that started immediately after lifting a bag of horse feed three hours ago. Since the injury, he states that his legs are progressively feeling heavier and weaker. He has also been unable to void urine. Physical examination shows 4/5 muscle strength in both legs, and decreased sensation along the lateral foot and perineal region. MRI of the back shows a large central herniation of the nucleus pulposus at the level of L5-S1. This is the most likely diagnosis.
This is the first-line antibiotic for endocarditis prophylaxis for patients with a prosthetic cardiac valve (used prior to invasive dental procedures.)
What are supraspinatus, infraspinatus, subscapularis, and teres minor?
This is the test of choice for a patient with a suspected blowout fracture.
A 27-year-old man is brought to the office by his brother for evaluation following a three month long solo sailing voyage. During the first week of his trip, he lost most of his pre-packaged food, and for the remainder of the voyage, he relied upon food acquired from the ocean. In addition to weight loss, he also has bone pain, easy bruising, loosening of his teeth, and poor wound healing. The patient has a deficiency of this vitamin.
What is Vitamin C? He has scurvy.
A 33-year-old woman who is otherwise healthy comes to the emergency department because of abrupt onest of right-sided facial weakness since arising from bed this morning. She has also had some pain behind her right ear, and has noticed a change in her ability to taste food. Physical examination shows flattening of the right forehead, and nasolabial fold. She is unable to raise her right eyebrow, close her right eye tightly, or smile on the affected side. The remainder of the examination shows no abnormalities. This is the most appropriate medication to give the above patient.
A 32-year-old man is being evaluated in the office for moderately severe claudication of the upper limbs. Thromboangiitis obliterans is suspected. This is the most common risk factor associated with this disorder.
A 7-year-old girl is brought to the emergency department by her mother because she has had pain and swelling of her right elbow for two hours since jumping from a swing. Physical examination of the elbow shows mild diffuse swelling, and moderate tenderness over the distal humerus. The remainder of the examination, including neurovascular examination, shows no abnormalities. Supracondylar fracture of the humerus is suspected. This X-ray finding would confirm the presence of an elbow fracture.
A 47-year old woman complains of severe pain and blurred vision in the left eye. She also reports seeing halos around lights and has photophobia. She has had nausea and vomiting for the past two hours. Her eye is red, the cornea appears hazy, and the pupil is nonreactive to light. This is the most likely diagnosis.
A 44-year-old man is brought to the emergency department by ambulance because of diffuse abdominal pain for the past day. Medical history is significant for ascites due to alcohol-related cirrhosis. Temperature is 37.8°C (100°F), pulse rate is 92/min, respirations are 24/min, and blood pressure is 118/68 mmHg. Physical examination shows a protuberant abdomen with mild diffuse tenderness. Shifting dullness to percussion is present. This procedure is considered to be both diagnostic and therapeutic for patient's with this diagnosis.
A 29-year-old woman comes to the office seeking evaluation for multiple symptoms that have come and gone over the past six months. Initially, she had paresthesias in her left hand that lasted one week, but then disappeared. About two months later, she developed burning pain and weakness in her right leg that lasted about three days then resolved. She has also felt fatigued and depressed during this time, and has had difficulty keeping up her work schedule as a librarian. One day ago, she developed intermittent double-vision along with some blurry vision and pain in her right eye, and became very concerned. Physical examination of the left upper limb shows decreased proprioception and vibration. Extraocular movements show decreased lateral gaze of the right eye. Reflexes are 3+ and symmetric bilaterally. This is the most appropriate diagnostic test to order.
A 22-year-old man is brought to the student health center by his baseball coach because of severe right arm pain after being accidently struck in that arm by a baseball bat. Physical examination shows ecchymosis, exquisite tenderness, and crepitance over the middle-third of the right upper arm. The skin is intact. There is decreased sensation over the first dorsal web space of the right hand, and decreased ability to extend the thumb and wrist. X-ray study shows a comminuted fracture of the middle-third of the humerus. This is the most likely nerve injured in this patient.