Random
A 30-year-old woman comes to the clinic due to recurrent headaches for the past 2 years. The pain is unilateral, pulsating, and associated with nausea, photophobia, and phonophobia. She reports that the headaches typically last 4–6 hours and improve with sleep or ibuprofen. Her menstrual cycle often triggers the headaches. She denies vision changes, fever, neck stiffness, weakness, or sensory changes. There is no history of trauma, and she has no neurologic deficits on exam. Vital signs are normal. Fundoscopic exam is normal.
Which of the following is the next best step in management?
A) MRI of the brain
B) CT of the head without contrast
C) Start sumatriptan therapy
D) Lumbar puncture
E) Referral for neurology evaluation
C) Start sumatriptan therapy
Anxiety?
12
8
Drugs that decrease mortality in CHF
ACE/ARB
B blocker
MRA
SGLT-2 inh
A study is conducted to evaluate the effect of a new anticoagulant on the risk of stroke in patients with atrial fibrillation. Patients are randomly assigned to receive either the new drug or standard warfarin therapy and are followed for 3 years.
The results show a hazard ratio (HR) of 0.85 (95% CI: 0.62–1.10) for the primary outcome of ischemic stroke when comparing the new drug to warfarin.
Which of the following best describes the correct interpretation of this result?
A) The new drug significantly reduces the risk of stroke
B) The new drug is significantly inferior to warfarin
C) The result is not statistically significant
D) The study has demonstrated equivalence between the two drugs
E) The result suggests an increased risk of stroke with the new drug
C) the result is not statistically significant
Preceding sore throat + course rash on chest + glossitis
Scarlet fever
Cervical Cancer Screening Guidelines
Pap smear alone: 21-30yr, Every 2-3yr
Pap smear + HPV: 30 - 65, Every 5yrLifestyle interventions for HTN in order of effectiveness
Wt loss (BMI > 25)
DASH
Exercise
Low sodium
Drugs that decrease mortality in MI
ACE/ARB
B blocker
ASA
Statin
A 35-year-old African American woman comes to the clinic with gradually worsening fatigue, cough, and joint pain for the past two months. She also reports painful bumps on her lower legs that started last week. She denies fever, weight loss, or recent travel. Past medical history is unremarkable. She does not take any medications.
Vital signs are normal.
On exam:
She has tender, erythematous nodules on both shins
Mild bilateral swelling and tenderness of the ankles
Lungs are clear to auscultation
No lymphadenopathy
A chest X-ray reveals bilateral hilar fullness. Laboratory studies show:
Serum calcium: 11.2 mg/dL
25-hydroxyvitamin D: normal
PPD skin test: 0 mm induration
Which of the following is the most likely diagnosis?
A) Tuberculosis
B) Sarcoidosis
C) Systemic lupus erythematosus
D) Histoplasmosis
E) Rheumatoid arthritis
B) Sarcoidosis
Kid just left summer camp + many hypopigmented lesions on face and trunk
Pityriasis versicolor (tinea versicolor)
Colon Cancer Screening
Normal Person: 45yr - 75yr
FOBT - Annually
Sigmoidoscopy - every 5yr
Colonoscopy - every 10yr
IBD: 8yr after ddx, every 1-2yr
FH of colon cancer (1 deg relative <60yr): 40yr or 10yr prior to age of dx in relative, every 3-5yr
Conn's syndrome
Primary hyperaldo 2/2 adrenal adenoma
Increased PAC/PRA
If unilat: surgery
If BL: MRA
A 2-week-old girl is brought to the pediatrician for evaluation of poor feeding and persistent irritability. She was born at term to a 26-year-old woman who received no prenatal care and recently immigrated to the United States. The infant's birth weight was at the 5th percentile. On examination, she is irritable and has a continuous murmur best heard at the left upper sternal border. Her lenses appear hazy bilaterally. A faint purpuric rash is noted on the lower extremities. On fundoscopy, there is evidence of chorioretinitis. A head ultrasound shows periventricular calcifications.
Which of the following is the most likely underlying diagnosis?
A) Cytomegalovirus infection
B) Toxoplasmosis
C) Congenital rubella
D) Herpes simplex virus
E) Syphilis
C) Congenital rubella
A new rapid test is developed to detect influenza A infection in symptomatic patients during flu season. The test is found to have a sensitivity of 90% and a specificity of 95%.
In a small rural clinic, 5 patients test positive, and 1 patient tests negative. Later, PCR testing reveals that only 2 of the 5 positive patients truly had influenza, and the 1 negative test was also a true negative.
Which of the following is the most likely explanation for the discrepancy between the high test sensitivity/specificity and the poor performance in this clinic?
A) Selection bias
B) Spectrum bias
C) Confounding
D) Low disease prevalence
E) Poor interobserver reliability
D) Low disease prevalence
Farmer + rough yellow/brown scale on face
Actinic keratosis
Cryoablation/ topical 5-FU
Lipid screening
Lipid panel for everyone 35yr+
Every 5yr
HTN
Reducing mortality in COPD
Smoking cessation + Home O2
A 42-year-old woman with no significant past medical history presents for evaluation of a breast lump. Mammography reveals a suspicious mass. A new blood test has been developed to detect early-stage breast cancer. The test has a sensitivity of 95% and a specificity of 90%. The prevalence of breast cancer in asymptomatic women in this age group is 1%, but the estimated pretest probability in this symptomatic patient is 20%.
What is the approximate positive predictive value (PPV) of the test for this patient?
A) 5%
B) 15%
C) 35%
D) 70%
E) 90%
D) 70%
We’ll assume 1000 patients with a 20% pretest probability (because she’s symptomatic — not screening). That means:
Step 1: Set up the base rates
200 have cancer, 800 do not
Step 2: Apply the test characteristics:
Sensitivity 95%: → 95% of the 200 true positives = 190 true positives
Specificity 90%: → 90% of 800 true negatives = 720 true negatives
That means 10% false positives = 80 false positives
Step 3: Calculate PPV:
PPV = TP / (TP + FP) = 190 / (190 + 80) = 190 / 270 ≈ 70%
24yr old woman + tender red nodules on both shins
dx?
Next step?
Erythema Nodosum
CXR to rule out sarcoid/TB
No causeOcp/pregnancy
Drugs (sulfonamides, penicillin)
Ongoing infection (strep, TB, yersinia)
Sarcoidosis
Uc/crohn's
Malignancy
start at 18yr, every 2yr
Major risk factor for CAD
Smoking
A 48-year-old woman comes to the clinic due to progressive difficulty climbing stairs and raising her arms over the past 3 months. She also notes increasing fatigue and trouble swallowing solid foods but denies weight loss, rash, or sensory changes. She has no joint pain. Medical history includes hypertension and hyperlipidemia, for which she takes lisinopril and atorvastatin. Vitals are normal. Neurologic exam reveals symmetric proximal muscle weakness in both upper and lower extremities. Reflexes and sensation are intact.
Labs:
CK: 4,200 U/L (↑)
ESR: 45 mm/hr (↑)
TSH: Normal
ANA: Positive
Anti-Jo-1 antibodies: Positive
Which of the following is the most likely diagnosis?
A) Statin-induced myopathy
B) Dermatomyositis
C) Polymyositis
D) Myasthenia gravis
E) Hypothyroid myopathy
C) Polymyositis
A 70-year-old man is evaluated for progressive hearing loss and mild left leg pain. He denies recent trauma or fever. He has no significant past medical history and takes no medications. He walks independently and has not had any fractures. Physical exam reveals a bowed left tibia with no overlying erythema or swelling. There is decreased hearing in the left ear, but no tenderness or discharge.
Laboratory studies:
Calcium: 9.2 mg/dL
Phosphate: 3.6 mg/dL
Alkaline phosphatase: 420 U/L (elevated)
PTH: Normal
25-OH Vitamin D: Normal
Plain radiographs of the left leg show cortical thickening and mixed lytic/sclerotic lesions.
Which of the following is the most likely diagnosis?
A) Osteomalacia
B) Osteoporosis
C) Paget disease of bone
D) Multiple myeloma
E) Osteogenesis imperfecta
C) Paget disease of bone
Flat, oval, salmon-colored macule -> multiple salmon-colored scaling lesions with a trailing scale
Pityriasis rosea