OBGYN
Multiple breast masses in a 25 y/o female that gets more painful with menstrual cycle.
What are the four seronegative spondyloarthropathies?
Reactive arthritis, IBD associated arthritis, Psoriatic arthritis, ankylosing spondylitis
25-year-old male with schizophrenia is started on haloperidol. Within hours, he develops painful neck muscle contractions, oculogyric crisis, and difficulty speaking. What is the best immediate treatment?
IV or IM benztropine or diphenhydramine (anticholinergics).
Scenario: Recent chest trauma with paradoxical movement of chest with breathing
Flail Chest (3+ continuous ribs in 2+ places)
Newborn with abdominal viscera to the right of umbilicus.
Gastroschisis
Mechanism behind infertility in a patient with PCOS
Anovulation
A 55-year-old male with a history of recurrent urinary tract infections and diabetes mellitus presents with flank pain, fever, and dysuria. Urinalysis shows hematuria and alkaline urine. A CT scan reveals a staghorn-shaped kidney stone filling the renal pelvis. A urine culture grows a gram-negative rod that is urease-positive.
What is the most likely microbe causing the infection, and what type of crystal is associated with the kidney stone?
Proteus mirabilis, a urease-positive, gram-negative rod that frequently causes urinary tract infections and is associated with the formation of struvite stones.
What are the four MATURE defense mechanisms?
Sublimation, Altruism, Suppression, Humor
Fall of outstretched hand with pain in the anatomical snuffbox with normal xray? What is it? How to treat?
Scaphoid fracture; nondisplaced = thumb spica cast + serial xray
displaced = surgical intervention
A 1 week old infant is brought in due to a fine, red, bumpy rash that developed on his chest and back. The parents report that the baby has been fussy but afebrile. Examination reveals numerous small, erythematous papules concentrated in the skin folds and covered areas.
Milia rubra (due to blockage of eccrine sweat ducts in the setting of increased heat) tx: prevent overheating
Breast cancer screening guidelines with BRCA1 and 2 mutations
Age 25-30 perform annual breast MRI
>30 + mammogram
Acute pericarditis EKG findings
Diffuse ST elevations/PR depressions
A 42-year-old female with bipolar disorder on long-term therapy presents with worsening fatigue, memory impairment, weight gain, and constipation. Additionally, she reports increased polyuria and polydipsia. What medication is she on? What are the two most likely medication-induced side effects in this patient?
Lithium; Lithium-induced hypothyroidism and nephrogenic diabetes insipidus (NDI).
A 30-year-old male is involved in a motor vehicle collision and presents to the trauma center with hypotension, tachycardia, and pelvic instability. On exam, there is bruising over the lower abdomen, pain on palpation of the pelvis, and distended abdomen. He is unresponsive to fluid resuscitation, and his hemoglobin is noted to drop. A pelvic x-ray reveals an anteroposterior compression fracture of the pelvis, but no clear bowel or bladder injury.
Despite aggressive resuscitation, the patient remains hypotensive. After ruling out major vascular injury and performing a focused abdominal ultrasound (FAST), CT scan reveals a large retroperitoneal hematoma. What is the most appropriate next step in management?
Pelvic binders (for stabilization and to control bleeding)
A four year old boy presents with days of high fever, red eyes without discharge, and irritability. His parents note dry, cracked lips and a diffuse rash on his trunk, along with swollen hands and feet. Exam reveals cervical lymphadenopathy and bilateral conjunctival injection. What is the dx and one associated lab finding that could present in this patient?
Kawasaki disease; Normochromic anemia, leukocytosis, thrombocytosis, elevated ESR, elevated CRP
Which Quad screen results for Downs syndrome are high?
B-HCG, Inhibin
Triad for Plummer-Vinson Syndrome
Impulsive, intense relationships, radial nerve damage dx?
Type of therapy?
Borderline Personality Disorder (BPD)
Dialectical Behavior Therapy (DBT) (specialized cognitive-behavioral therapy focusing on emotional regulation and distress tolerance).
A 45-year-old woman presents with chronic epigastric pain, early satiety, and unexplained weight loss. Laboratory tests show mild anemia, and a CT scan reveals a 3 cm mass at the junction of the body and tail of the pancreas. Fine needle aspiration confirms the diagnosis of pancreatic cancer. Which of the following is the most important prognostic factor in determining resectability of pancreatic cancer?
Vascular involvement
What are two manifestations of Wiskott-Aldrich syndrome?
Purpura (thrombocytopenia) and Eczema
A 35-year-old woman presents to the clinic with a 3-month history of progressively worsening pelvic pain, dysmenorrhea, and dyspareunia. She also complains of heavy menstrual bleeding, with episodes of passing clots. She has a history of infertility for 2 years and has not been able to conceive despite regular unprotected intercourse. She denies any gastrointestinal or urinary symptoms. Her medical history is unremarkable, and she takes no medications. On pelvic examination, the uterus is enlarged and tender to palpation. A transvaginal ultrasound shows a bulky uterus with small, multiple cystic areas, and a heterogeneous appearance. There is also free fluid in the pelvic cavity. Laparoscopy is performed and reveals the presence of “gunpowder” lesions on the ovaries and uterosacral ligaments. What is the most likely diagnosis?
Endometriosis
What is the characterized murmur for mitral valve prolapse? How does valsalva and standing affect the intensity of this murmur
High pitched midsystolic click at the apex; louder
A 15-year-old boy is brought to the clinic by his father, who is concerned about recent changes in his behavior. Over the past few months, the teen has become withdrawn and irritable, frequently locking his bedroom door and leaving the house at odd hours. His teachers report a decline in academic performance, and he has been caught laughing inappropriately during class even when nothing seemed funny. At home, he has been found staring off into space, appearing dazed and uncoordinated, and once fell suddenly while standing. Physical exam reveals tremor, dizziness, and erythematous irritation around his mouth and nostrils.
What substance is most likely responsible for his symptoms?
What is the potential long term complication?
Vitamin deficiency associated with long term use?
Inhalant use (likely volatile hydrocarbons such as toluene, glue, or spray paint).
Irreversible CNS damage and polyneuropathy.
B12 deficiency
A 25-year-old man comes to the physician because of a 1-week history of fever and severe pain above his buttocks. He has been unable to sit for extended periods of time. He has ulcerative colitis and type 2 diabetes mellitus. He is a third-year student in law school. His medications are mesalamine and metformin. He is 175 cm (5 ft 9 in) tall and weighs 109 kg (240 lb); BMI is 35 kg/m2. Temperature is 37°C (98.6°F), pulse is 76/min, respirations are 16/min, and blood pressure is 130/80 mm Hg. Examination shows a 2-cm erythematous, fluctuant mass just lateral to midline overlying the sacrum between the gluteal folds. Mucopurulent drainage is noted from a 2-mm opening overlying the mass. The mass and surrounding tissue are tender to palpation. Which of the following is the most likely diagnosis?
Pilonidal disease
A mother brings her infant for a routine wellness visit and reports that he enjoys playing peek-a-boo, responds to his name, and can transfer small objects between his hands. He is also able to crawl and pull to stand. Based on typical development progression, how old is the child? What new gross motor milestone wouold he be expected achieve by his next visit?
9 months, walk alone at 12 months