Pulmonary
a 34 year old woman has episodic dyspnea and cough. Spirometry shows an obstructive pattern that improves significantly after albuterol. what does this finding demonstrate?
reversible airflow obstruction consistent with asthma.
MORE INFO:improvement in FEV after bronchodilator = reversible obstruction.
A 63-year-old man has a resting tremor, bradykinesia, and rigidity.
What neurotransmitter is deficient?
ANSWER: DOPAMINE
A 22-year-old woman has fever, sore throat, and tender anterior cervical lymph nodes. She has no cough.
What is the most likely diagnosis?
ANSWER: Group A streptococcal pharyngitis.
A 72-year-old man has several rough, gritty, erythematous papules on the dorsal surfaces of both hands. He has spent decades working outdoors.
Which diagnosis best describes these lesions?
A. Basal cell carcinoma
B. Actinic keratoses
C. Seborrheic keratoses
D. Squamous cell carcinomas
E. Melanoma
ANSWER: B. Actinic keratoses
Chronic UV exposure + rough/gritty scaly papules = actinic keratoses
REMEMBER: They are premalignant, not SCC itself.
A 5-year-old has fever, cough, rhinorrhea, and bilateral conjunctival injection. He has no respiratory distress and is drinking normally.
What is the most likely cause?
A. Streptococcus pneumoniae
B. Adenovirus
C. Mycoplasma pneumoniae
D. Influenza virus
E. Group A Streptococcus
answeR: B. Adenovirus
more info: Pharyngoconjunctival fever → adenovirus.
---Conjunctivitis makes strep pharyngitis less likely. ---
63 year old smoker has chronic cough and dyspnea. spirometry shows: FEV1 / FVC = 0.58
after bronchodilator therapy, there is minimal improvement . What is likely the diagnosis?
answer: COPD.
MOER INFO: persistent obstructive physiology with limited reversibility
A 45-year-old woman has episodes of unilateral pulsating headache associated with nausea and photophobia. Mom has history of brain tumor.
What is the most likely diagnosis?
ANSWER: Migraine.
A 31-year-old man develops profuse watery diarrhea after returning from a trip abroad. He has no fever or blood in the stool.
What is the most likely pathogen?
ANSWER: Enterotoxigenic E. coli.
KEY: Traveler's diarrhea → ETEC.
A 69-year-old man has two lesions on his face:
Which lesion has greater metastatic potential?
answer: Lesion B, squamous cell carcinoma
more info: BCC is locally invasive but rarely metastasizes.
SCC has greater metastatic potential, particularly when lesions are large, recurrent, rapidly growing, or located on high-risk sites such as the ear or lip.
A 9-month-old infant has episodes of crying and drawing the legs toward the abdomen. Between episodes, the infant appears comfortable. Later, the parents notice a stool containing blood and mucus.
What is the most likely diagnosis?
A. Meckel diverticulum
B. Intussusception
C. Hirschsprung disease
D. Pyloric stenosis
E. Malrotation with volvulus
Bonus:What's the preferred diagnostic/therapeutic procedure in a stable child?
Answer: B. intussusception
more info: intermittent colicky abdominal pain + bloody mucoid stool.
Bonus answer: air contrast enema.
45 year old woman has progressive exertional dyspnea. Echocardiography shows elevated pulmonary artery pressure. She has no left-sided heart disease or lung disease.
**Which medication class is most appropriate for confirmed pulmonary arterial hypertension?
ANSWER: A pulmonary vasodilator such as a PDE-5 inhibitor or endothelin receptor antagonist, depending on risk/clinical context.
MORE INFO: Think pulmonary arterial hypertension, not pulmonary hypertension secondary to left-heart disease.
A 71-year-old man has repeated brief episodes of right-arm weakness lasting 10 minutes. Neurologic examination is normal between episodes.
What is the most appropriate next step in management?
ANSWER: Urgent evaluation for TIA, including vascular and cardiac evaluation, followed by secondary stroke prevention.
MORE INFO: Recurrent transient focal neurologic deficits = TIA until proven otherwise.
A patient develops profuse diarrhea several days after completing clindamycin. Stool testing is positive for toxigenic C. difficile.
What is the appropriate treatment for an initial nonfulminant episode?
ANSWER: Oral fidaxomicin is preferred; oral vancomycin is an alternative.
A 58-year-old woman has a 1.2-cm irregularly pigmented lesion on her upper back with asymmetry and multiple colors. Melanoma is suspected.
The lesion is easily accessible and can be completely removed. What is the preferred diagnostic procedure?
A. Shave biopsy
B. Punch biopsy of the darkest area
C. Excisional biopsy with narrow margins
D. Cryotherapy
E. Incisional biopsy of the edge
ANSWER: C. Excisional biopsy with narrow margins
more info: When melanoma is suspected and complete removal is feasible → excisional biopsy.
The goal is to determine Breslow thickness, which influences prognosis and management.
A 4-year-old boy has fever and refuses to walk. He has severe pain with passive movement of the right hip. ESR and CRP are elevated.Ultrasound shows a hip effusion. What is the next best step?
A. NSAIDs and observation
B. Oral antibiotics
C. MRI of the hip
D. Joint aspiration
E. Physical therapy
answeR: D. Joint aspiration.
more info:This is concerning for septic arthritis. Once there's a suspicious joint effusion with systemic/inflammatory findings, obtain synovial fluid for diagnosis and culture and initiate appropriate treatment.
remember: transient synovitis can occur after a viral infection, but the fever + severe pain + inflammatory markers make septic arthritis much more concerning.
A 29-year-old man develops sudden dyspnea several minutes after a central venous catheter is removed.
He is hypotensive and has absent breath sounds on one side.
What is the immediate intervention?
ANSWER: Immediate needle/finger decompression followed by chest tube placement.
MORE INFO: Don't wait for imaging in a tension pneumothorax with hemodynamic compromise.
A 38-year-old woman develops ascending weakness several days after a diarrheal illness. Reflexes are absent.
What is the most likely diagnosis?
Bonus: what dangerous complications must be monitored for?
ANSWER: Guillain-Barré syndrome.
BONUS ANSWER: Respiratory failure.
A 19-year-old college student develops fever, hypotension, petechial rash, and meningismus.
What organism should be suspected?
ANSWER: Neisseria meningitidis.
MORE: Meningitis + petechial/purpuric rash + rapid deterioration.
A 61-year-old man has a slowly enlarging lesion on his cheek. It is a well-demarcated, waxy, brown papule with a “stuck-on” appearance.
He is concerned because it resembles a skin cancer.
What is the most likely diagnosis?
A. Melanoma
B. Seborrheic keratosis
C. Basal cell carcinoma
D. Squamous cell carcinoma
E. Actinic keratosis
ANSWER: B. Seborrheic keratosis
more info: “Stuck-on,” waxy, sharply demarcated → seborrheic keratosis.
remember: “Brown” doesn't automatically mean melanoma.
A 6-year-old boy has recurrent episodes of sinusitis and pneumonia. He has had multiple infections with encapsulated bacteria.Immunoglobulin levels are markedly decreased. Which additional finding is most likely?
A. Absent T cells
B. Absent B cells
C. Decreased neutrophil oxidative burst
D. Low complement levels
E. Increased IgE
answeR: Absent B cells
More info:X-linked agammaglobulinemia (Bruton) → failure of B-cell maturation → very low immunoglobulins.
remember: Don't confuse this with CVID, which typically presents later and has B cells present.
A 66-year-old man with pneumonia develops worsening hypoxemia despite supplemental oxygen. Chest imaging shows bilateral diffuse opacities. Echocardiography shows normal cardiac function.
What is the underlying mechanism of his hypoxemia?
ANSWER: Intrapulmonary shunting due to alveolar filling/collapse.
MORE INFO: ARDS → severe V/Q mismatch and shunt physiology that responds poorly to supplemental oxygen.
A 58-year-old man develops diplopia and ptosis that worsen throughout the day. Strength improves after rest. Pupils are normal.
What is the most likely diagnosis?
ANSWER: Myasthenia gravis.
KEY: Fatigable weakness + ocular symptoms + normal pupils.
REMEMBER: Lambert-Eaton also improves with activity, but typically causes proximal weakness + autonomic symptoms + reduced reflexes, often associated with small-cell lung cancer.
A 42-year-old man with HIV has a CD4 count of 70 cells/mm³. He develops progressive shortness of breath and nonproductive cough. CT shows diffuse bilateral ground-glass opacities.
What is the most likely diagnosis?
Bonus: What additional medication should be given if PaO₂ is significantly decreased?
ANSWER: Pneumocystis jirovecii pneumonia.
Bonus answer: Corticosteroids.
A 66-year-old woman has a slowly enlarging dark lesion on her lower leg. It is asymmetric with irregular borders and multiple shades of brown.
Biopsy confirms melanoma with a Breslow thickness of 1.8 mm and no evidence of distant metastases.
Which factor is most important when determining prognosis?
A. Patient's age
B. Degree of pigmentation
C. Breslow thickness
D. Anatomic location alone
E. Duration of the lesion
ANSWER: C. Breslow thickness
more info:For localized melanoma, tumor thickness is a major prognostic factor.
A 2-year-old child has recurrent respiratory infections and chronic diarrhea. Growth has fallen from the 50th to the 5th percentile.
Labs show:
Which diagnosis is most likely?
A. X-linked agammaglobulinemia
B. Severe combined immunodeficiency
C. Common variable immunodeficiency
D. Chronic granulomatous disease
E. DiGeorge syndrome
answeR: C. Common variable immunodeficiency
more info: Low immunoglobulins + B cells present → think CVID.
remember: Bruton = absent B cells.