DERM
Pt comes to the clinic for Ringworm on his scalp. What is the first line topical treatment for this patient’s diagnosis, and the name?
None, topical treatments are ineffective, try Griseofulvin Oral
A 34-year-old male presents to the clinic complaining of the sudden onset of a sensation that the room is constantly spinning. Beginning this morning, he reports that the spinning feeling is accompanied by nausea and vomiting. Notably, he also mentions that he is having difficulty hearing out of his right ear and has a high-pitched ringing (tinnitus) in that same ear. On physical exam, you observe horizontal nystagmus. He mentions that he was recovering from a bad cold about one week ago. What is the patient’s most likely differential diagnosis, and what is the treatment plan?
Labyrinthitis, they are experiencing a post viral inflammation with hearing loss associated. There is no mention of it being episodic and thus the continuous vertigo points to labyrinthitis. Treatment plan is supportive care, steroids, antiemetics, and vestibular suppressants (meclizine)
A 30-year-old patient with a history of asthma presents with a dry cough, dyspnea, and classically presenting purplish, hardened skin lesions on the patient’s nose, cheeks and ears. A CXR is taken:
What is the 1st line treatment for this patient?
Oral corticosteroids (Prednisone)
An EF of less than 35 indicates what level of HF and places patients at greater risk of what rhythm complication?
HFrEF, V-Tach, need cardioverter/defibrillator
Pt comes in for a follow up appointment for a chief complaint of a painful and burning sensation on one side of the body in a dermatomal pattern. No rash is apparent, but the patient was recently treated for Herpes Zoster. What was the patient’s most likely treatment, and what is the patient’s current, most likely diagnosis?
Valacyclovir/acyclovir antiviral, and postherpetic neuralgia
A 68-year-old patient with a history of hypertension presents with a sudden, painless, monocular loss of vision. The provider determined the patient had a central retinal artery occlusion after fundoscopy. Given the diagnosis, what was the finding of the fundoscopic exam, and describe it?
Fundoscopic exam reveals a "cherry-red spot" at the fovea and a pale, edematous retina.
A 65-year-old male presents with a productive cough and fever. His vitals show a respiratory rate of 24 breaths/min and a blood pressure of 138/86 mmHg. He is alert and oriented to person, place, and time. Labs reveal a BUN of 18 mg/dL. What is his CURB-65 score, and what is the recommended disposition?
0000-1, have a CURB-65 score of 1 for now. Outpatient treatment.
A 58-year-old male with a PMH of Type 2 Diabetes Mellitus and a previous Myocardial Infarction presents for a follow-up. He is currently taking Atorvastatin 80mg daily. Despite excellent medication adherence and lifestyle modifications, his latest lipid panel shows an LDL-C of 92 mg/dL. Given his history, what is his LDL goal, and what is the next appropriate step for pharmacological management to reach his LDL goal?
A PCSK9-inhibitor like Evolocumab/Praulent given the fact that his LDL goal is 55mg/dL (still has 37%)
Needs to make progress greater than 25%, and is actually Group 1 High ASCVD risk, thus his lipid levels trump his T2DM grouping.
What mineralocorticoid receptor agonist also has an off-label use for treatment of skin conditions?
Spironolactone
An 8-year-old male is brought to the emergency department for worsening ear pain, fever, and lethargy. He was diagnosed with Acute Otitis Media five days ago and started on Amoxicillin, but his mother says he has not improved. On physical exam, the patient is febrile at 102.4F. You observe significant post-auricular erythema and swelling, and the pinna is displaced laterally and inferiorly. There is exquisite tenderness to palpation over the bony prominence behind the ear. Otoscopy reveals a bulging, opacified tympanic membrane. What is the next steps for the patient?
IV antibiotics can include beta-lactamase inhibitors such as unasyn and zosyn.
must get 1.5 to be correct
A 62-year-old male presents with a chronic cough and progressive shortness of breath over the last several years. He spent 35 years working in the underground mines of Southwest Virginia. He denies any history of smoking.On physical exam, you note fine inspiratory crackles at the lung bases. Pulmonary function testing reveals a normal FEV1/FVC ratio with a TLC is decreased. What could you expect the CXR results to indicate? Describe the most classic abnormalities found.
Small, rounded opacities, primarily in the upper lobes, with fibrosis.
See CXR
A 68-year-old male with a 30-pack-year smoking history presents with a 6-month history of cramping pain in his right calf that occurs after walking approximately 200 yards. The pain is consistently relieved within 5 minutes of standing still. On physical exam, the right lower extremity is cool to the touch with a diminished popliteal and dorsalis pedis pulse. You calculate his Ankle-Brachial Index (ABI). His right brachial systolic pressure is 150 mmHg, and the highest systolic pressure in his right ankle is 105 mmHg. What would the patient’s ABI be around?
150/105 = 0.7, Mild to moderate PAD, below 0.9.
What would an ABI greater than 1.3 could indicate?
A 54-year-old female presents to the urgent care with a sudden onset of fever, chills, and a painful rash on her left cheek. On physical examination, you observe a bright red, indurated, and edematous plaque with sharply demarcated borders that are distinctly raised from the surrounding skin. The area is warm and tender to the touch. She mentions that the redness appeared very rapidly over the last 24 hours. What is the most common causing pathogen of the most likely diagnosis of this?
Erysipelas: more red, superficial cellulitis that is caused by group A strep (same as cellulitis)
A 65 y/o male presents with a BMI of 41.05kg/m^2. What might be the patient's Mallampati score and what does it indicate?
Likely 3-4, and indicates r/o OSA and intubation difficulty
A 45-year-old male with recent immigration history presents to the clinic complaining of a persistent, productive cough for the past four weeks. He reports associated night sweats, a 15-lb unintentional weight loss, and occasional hemoptysis.On physical exam, he appears chronically ill and thin. He is febrile. Chest X-ray reveals: (view image)
What is an appropriate confirmatory test and the treatment of choice?
Sputum smear (ID acid-fast bacilli) vs culture (ID the specific pathogen) 2 months of pyrazinamide, rifapentine, isoniazide, and moxifloxacin and then 2 months of pyrazinamide, isoniazide, and moxifloxacin
2PRIM+2RIM
A 52-year-old male recently underwent a successful surgical aortic valve replacement with a mechanical bileaflet prosthesis. He has no other significant comorbidities and his recovery has been unremarkable. You are seeing him for his first post-operative follow-up to finalize his long-term anticoagulation plan. What is it?
Warfarin/Coumadin
What is his target INR range?
A mother brings in her 2 year-old child stating that the child has had a 3-day history of a nonproductive cough, thick copious rhinorrhea, conjunctivitis, and a fever to 103 degrees. Physical examination reveals a well-hydrated child, with numerous 1-2 mm white papules on both buccal mucosa, normal heart and breath sounds. What is the treatment for this patient?
Supportive care, patient has rubeola or Measles, and has koplik spots
On physical exam, you note a firm, erythematous, and exquisitely tender mass in the right submandibular region. When you massage the area, you observe purulent discharge expressing from under the tongue. The patient also has a low-grade fever and a dry mouth. What is the most likely diagnosis and the etiology?
Sialadenitis, bacterial infection of the salivary gland (wharton’s duct), and staph aureus is the MC. Use PO or IV abx, augmentin for nonsevere situations.
Pt in the ED comes in for chest pain, productive cough, and fever. He is diagnosed with CAP and admitted into the ICU. There is high local prevalence of pseudomonas in CAP cases. What is an example regimen for appropriate coverage of the most common offending pathogens?
Cover for pseudomonas (x2)usually with a betalactam/nonbetalactam, atypicals, and gram+positives like MRSA in a hospital setting. Most important is to have double coverage of pseudomonas.
Cefepime+Fluoroquinolone/Gentamicin
A 22-year-old male presents to the Emergency Department complaining of a "racing heart" and lightheadedness that began suddenly while he was at the gym. He has no chest pain or shortness of breath. His blood pressure is 115/75 mmHg, and his oxygen saturation is 98% on room air.
An EKG is performed: showing a wide-complex, irregularly irregular tachycardia with a rate of 180 bpm. You note varying QRS morphologies and occasional delta waves during slower segments of the rhythm. What is the most appropriate next step for the patient?
Procainamide (given the patient is stable) else would prep patient for OR synchronized cardioversion
What class Vaughn-William class is this drug?