ugh
A 45-year-old woman presents to the dental clinic for a routine check-up. She denies pain or discomfort. On oral examination, you note a midline, bony, hard protuberance on the hard palate. The surface is covered by normal mucosa, and there is no erythema, ulceration, or tenderness. She reports that she has noticed it for many years and that it has not changed in size.
Torus palatinus
A 40-year-old man comes to the clinic complaining of hearing loss in his right ear for several months. On examination, you perform the Weber test by placing a tuning fork on the center of his forehead. The patient reports that the sound is louder in his right ear.
Conductive hearing loss in the right ear
chronic inflammation of the eyelid due to seborrheic dermatitis or staphylococcla infection resulting in redness and crusting. complains of mild burning
difference in pupillary diameter
constriction of pupils
dilation of pupils
anisicoria
mydriasis
miosis
Enlargement of the supraclavicular node suggests
metastisis from a thoracic or an abdominal malignancy
A 32-year-old woman presents with white patches on her tongue and inner cheeks that she has noticed for the past week. She complains of mild soreness and a burning sensation, especially when eating spicy foods. She has a history of recent antibiotic use for a urinary tract infection and uses inhaled corticosteroids for asthma. On examination, the white patches scrape off easily, leaving a slightly erythematous base.
A 55-year-old woman reports gradual hearing loss in her left ear. You perform the Rinne test by placing a vibrating tuning fork on her mastoid process, then near the external auditory canal. She reports that she hears the sound louder on the mastoid than in front of her ear.
Conductive hearing loss in the left ear
Pupil is large and fixed to light and near effort. Ptosis of the upper eyelid and lateral deviation of the ey downward and outwards always present
Oculomotor nerve (CNIII) paralysis
which CN and what muscle?
rotates the top of the eye toward the nose around the long axis and also downward
superior oblique (CN4)
Diffuse thyroid enlargement that includes symptoms such as heat intolerance, palpitations, weight loss
graves disease
A 28-year-old man presents to the clinic with a 2-day history of sore throat, mild fatigue, and low-grade fever. He denies cough and nasal congestion. On examination:
Temperature: 101.8°F
Tonsils are erythematous with exudates
Tender anterior cervical lymphadenopathy is present
No rash is observed
Based on the Centor criteria, how many points does this patient score, and what is the most appropriate next step in management?
4- test for GAS
A 50-year-old woman presents for a routine hearing check. She denies ear pain, discharge, or vertigo. On otoscopic examination, you notice chalky white plaques on the tympanic membrane. Her hearing is mildly decreased on the affected side. She has a history of multiple recurrent otitis media during childhood.
Tympanosclerosis
A 45-year-old man presents with drooping of his left eyelid and a smaller left pupil that has been noticed for the past week. He also reports decreased sweating on the left side of his face. He denies pain or trauma. On examination, the left pupil constricts more slowly in bright light and dilates more slowly in the dark compared to the right. There is mild ptosis of the left upper eyelid.
A 27-year-old man presents to the clinic with sudden onset of left eye pain after getting sand in his eye while jogging on the beach. He describes a foreign body sensation and excessive tearing. He reports sensitivity to light but denies vision loss. On examination, you note ciliary injection and a small, superficial corneal defect with fluorescein staining. There is epithelial defect in cornea.
Corneal abrasion
an enlarged thyroid gland with two or more nodules suggests
a metabolic process rather than a neoplastic process
A 19-year-old college student presents with a sore throat for 2 days, mild fatigue, and low-grade fever. He reports cough, runny nose, and hoarseness. On examination:
Temperature: 100.2°F
Pharyngeal erythema without exudates
Cervical lymph nodes are mildly tender
No tonsillar exudates
No rash
A 6-year-old boy presents with mild hearing difficulties and a sensation of fullness in his right ear for the past two weeks. He has no fever, ear pain, or recent upper respiratory infection. On otoscopic examination, the tympanic membrane appears retracted with an amber-colored fluid level behind it, and the light reflex is diminished.
Serous effusion
A 58-year-old man with a 15-year history of type 2 diabetes presents for a routine eye exam. He has no visual complaints. On fundoscopic examination, you note multiple small, round red dots scattered throughout the retina and a few areas of fragile new blood vessel growth along the retinal surface. There are also some flame-shaped hemorrhages and cotton-wool spots.
Microaneurysms and neovascularization associated with diabetic retinopathy
A patient presents with sharp eye pain, photophobia, and foreign body sensation. Vision may be normal or decreased. On examination, dilated conjunctival and episcleral vessels are noted, along with a corneal infiltrate. Which of the following is the most likely diagnosis?
Infectious Keratitis
hyper or hypothyroidism: weight loss despite increased appetite, increased systolic and decreased diastolic blood pressure, also seen with graves disease
hyperthyroidism
A 4-year-old boy is brought to the clinic with fever, cough, runny nose, and red eyes for the past 3 days. His mother reports that he refuses to eat and complains of a sore throat. On examination:
Temperature: 102.5°F
Conjunctivitis and cough are present
Small, white spots on the buccal mucosa opposite the lower molars
A maculopapular rash is starting to appear on the face, spreading downward
Mild petechiae are noted on the soft palate
Koplik spots
A 7-year-old boy presents with ear pain for the past 2 days. His mother reports that the pain is worse when he touches or pulls his ear, and he has had a low-grade fever. He also complains of mild hearing difficulty. On examination:
Right ear: Tenderness when the pinna and tragus are manipulated, ear canal erythema, and mild swelling with some debris. Tympanic membrane is difficult to visualize.
Left ear: Tympanic membrane is erythematous and bulging with visible purulent fluid behind it. No tenderness when touching the auricle.
Left ear: acute otitis media with purulent effusion
A 65-year-old man with a 20-year history of poorly controlled type 2 diabetes and hypertension presents for a routine eye exam. He reports no vision changes. On fundoscopic examination, you note the following:
Small, yellow, well-circumscribed deposits in the macula
Cotton-wool–like fluffy white patches along the retinal nerve fiber layer
Yellow, waxy deposits with sharp borders scattered around the posterior pole
Retinal findings and their typical causes:
Hard exudates – diabetic retinopathy and vascular dysplasias
Soft exudates – hypertensive/diabetic retinopathy, HIV
Drusen – age-related macular degeneration
A 34-year-old woman presents with moderate, aching pain in her right eye for the past 24 hours. She reports photophobia, tearing and vision is slightly decreased. On examination, her right eye shows clear or slightly clouded cornea, a small, irregular pupil and pattern of redness being ciliary injection. Urgent or Emergent referral?
Acute Iritis - Urgent
hyper or hypothyroidism: modest weight gain, fatigue, swelling of face, hands, constipation, decreased systolic and increased diastolic BP
hypothyroidism