What process cloes this Systenatic descirsitization.

Wonan rvith anrietv about a

gr,necologic er:rnr is toid to relax cxemplift?
and tci inaginc going through
the steps of the cratn.
What clo vou cloT Assess nfiether telling the paticnt
65-t'ear-old tnau is diagnosed
lvith incurttb le trtetastatic
lvill negativcly affcct his health. If
not, tell him.
pancr eatic aclcnocarcillonla. I {is
fanliv atsks 1'6s, the doctor, not
to tcli the patient.
What defense Der-rial.
Nilan adrnittcd for chest pain is
meclicated for ve ntricular nechanism is he using?
tachi'carclia. 'l'he nert clar'' he
jun-rps out of becl :rnd cloes 50
push-ups to shotv the trurses he
has trot l-rad a heart attack.
What do you sa!'? Notl-ring! T'he tonc of the
You fincl vourself attractecl to
intcrvieu' nttst be vcr-v professional;
vour 26-"'eat-old paticnt'
it is not acceptable to h:rve ant'sort
of rol'rantic relationship u'ith
patients. If 1'ou feel votir actiot-ts
tlal' bc lttisinterpretecl, invite a
cliarperone into the roonl.

Large group ofpeoPlc rs What Tpe of stuch'is Cohort str-rclr'.

follorvcd over l0 1'ears. Everv 2 this?

1'ears, it is detcrnrincd ri'ho
clevelops hcart disease arnd lvhcr
clocs not.
()ir-l can grooil herself, can hoP Hou,old is sire? Four ,vears old.
0n onc foot, and has atr
itnaginarv frie ncl.
What is the cliagnosis? N or-r t ritl bercittt'tl tct t l.
NIatr has flashbacks about his
girlfriend's de:rth 2 tnotrths
ago foliou,ing a hit-ancl-nrrl
acciclelt. Hc often cries ancl
u,ishes for thc clcath of thc
culprit.
What do vott do? L)iscuss the risks arrcl benefits of
36-year-old \llonltlrl u'ith a strong
not having a ltlitttlmogran. Each
Lrnril,v historv of breast callcer
patient rlust give Liet ou'tl
refiiscs tr n-talrlttograttlr llccatlse
irfonr-red couscnt to each proceclure;
shc l'reard it hurts.
if the patient refttses, 1'ou must allicle
b-v her r'r,ishes.
4-year-old girl complains of a Hon ln'as she irrlecled? Serual abuse.
br-rrning feeling in her genitalia;
otherwise, she behaves and sleeps
normally. A smear of the
discharge shows N. gononhoeae.
7Z-year-old man insists on Wl'rat do you do? Although you want to encourage
stopping treatment for his the patient to take his rnedication,
heart condition because it
the patient has the fir-ral say in his
n'iakes him feel "funny." own treatment regirnen. You
should ir-rvestigate the "funny"
feelir-rg zrnd determine if there are
drugs available that don't elicit this .$*
ii;
particular side effect. |**
During a particular stage of sle ep, What stage of sleep is REM sleep.
:,,ii
,iill
nan has variable blood pressure l^
ne tn( rl:}
:}il
and EEG together with penile ,X'
tumescence.
A certain screening test I'ras a What is the sensitivity of Sensitivity is 98%. i1\
2% false-negative rate. rKi
the test? ,f'!
:1:{
The prevalence of influenza Whal carr be assurrred The disease duration is 2 times
in population A is 2 times about the disease course longer in population A.
the prevalence of influenza in ir-r population A versus
population B. Tl're incidence is population B?
the same in populations A
and B.
%, r Full-term neonate of an uneventful What is the diagnosis? PKU.
tt-&
delivery becomes mentally
w
M. retarded and hyperactive and
&*
has a musty odor.

&&,& i Stressed executive comes What is the mechanism? NADH l prevents

W home from work, consumes 7 gluconeogenesis by shunting
or 8 martinis in rapid succession pyruvate and oxaloacetate to
6&
before dinner, and becomes lactate and malate.
hypoglycemic.
,, 2-year-old girl has ,t't t it't What is the diagnosis? Kwashiorkor.
abdominal girth, failure to thrive,
and skin and hair depigmentation.
, Alcoholic develops a rash, What is the vitamin Vitamin B3 (pellagra).
diarrhea, and altered mental deficiency?
status.
* 51-year-old man has black spots Whal is the diagnosis? Alkaptonuria.
in his sclera and has noted that
his urine turns black upon
standing.
,r' Z5-yea:o\d man complains What is the disease, Familial hypercholesterolemia;
of severe chest pain and has and where is the defect? LDL receptor.
xanthomas of his Achilles
tendons.
* Woman complains of intense What is the diagnosis? McArdle's disease.
muscle cramps and darkened
urine after exercise.
2 parents with albinrsm What genetic mechanism Locus heterogenei!,.
' could explain why the
have a son who is normal.
son is not affected?
40-year-old man has chronic Whaf vilamins are likely A, D, E, and K.
pancreatitis with pancreatic deficient?
insufficiency.
Child exhibits weakness and What is the disease, Duchenne's muscular dystrophy;
enlarged calves. and how it is inherited? Xlinked recessive.
 What organisns are Anaerobes.
,, Alcoholic vomits gastric
contents and develoPs foul- most likely?
srnellilg sptttum'
What is the likelY Lyn-re disease; bite from kodes tick'
male presents wiih
', Midclle-age
acttte-onset monoarticttlar ioint disease, and how did he

pain and bilaieral Bell's PalsY' get it?

Wl'rat is the diagnosis? Pyelonephritis.
',,UA of patient shows WBC
CAStS.
What is the infectiotts Sporothrix schenckii.
with "rose
':, Patieirt presents
garcletter's" scenario (tl'rorn prick bug?
witl'r ulcers along lYrnPl'ratic
drainage).
What is the likelY Helicobacter PYIori.
,,, 25-year-old medical studer-rt has
a burning feeling in his gut after otganisrn?
rtteals. Biopsy oF gastric rlltrcosl
shows gram-r'regative rods'
W'rat is the likelY Blastontyces.
r 3Z-year-old n-rale l-ras
"cauiiflower" skin lesions' Tissue organism?
biopsy shows broad-based
budding yeasts.
Wi-rai is tl're diagnosis? Mastitis caused bY S. auretLs
,., Breast-feeding woman suddenly
develops redness and swelling of
her rigl'rt breast. On examinatiou,
it is for.rnd to be a fluctttant nass'
WJrat cell is ir-rfecteci? B cell (EBV;infectious
,,,,' 20-year-old college student
nononucleosis).
presents with lYniPiradenoPathY,
ieuer, a,,d I-repatospler-romegaly'
His serum agglutilates sheep RBCs'
What is the organisn'r? S. aureus (produces Preforned
,', I hslrls after eatiugcustard at
enterotoxin).
a picnic, a whole fan-rilY began to
vomit. After l0 hours' theY
were better.
What organisr-r-r is Clostridiurn bohLlinum; inhibited
,,, Infart becomes flaccid after
il-rplicatecl, and what is release of ACh.
eating honeY.
the nechanisrn of
action?
He l-rad exposure to HPV.
Man presents with squanolls
cell carcinorna of the Penis. wl'rat virus?
What organisrn is S. epidermidis
Patient deveiops endocarditis
3 rveeks after receiving a suspected?
proslhetic lteart valve.
* 55-year-old man who is a What is the diagnosis? Legionella pneumonia
smoker and a heavy drinker
presents with a new cough
and flulike symptoms. Gram
slain shows no organisms;
silver stain of sputum shows
grarn-negative rods.
w After taking clindamycin, What is the mechanism C Io stri dium diffic ile ove rgrowth.
patient develops loxic of diarrhea?
megacolon and diarrhea.
* Z5-year-o\d man presents with What is the diagnosis, and Septic arthritis; N. gonorrhoeae.
3 days of fever, chills, and a what is the causative
painftrl, swollen knee. agent?
,s l9-year-old female college What is the causative Candida albicans.
student presents with vaginal agent?
itching and a thick, curdy
discharge.
a 30-year-old woman returns What is the causative Giardia lamblia.
from a camping trip and agent?
complains of watery diarrhea
and cramps.
 IgNit
What tvPes of
Paticnt u'ith NI)'coPlasnra
imu-rr.rttoglobulirls are
pnetnt-tcniae erh ibits
re:rcting?
cr1'oagglutinins drtrttlg reco\Ienr
pirase.
\\that irtrrntttlc cerll is 1'ccll (DiGeorge)
Young child presents n'iti'r tct:rnr'
cleficient?
ancl c-rnclidi asis. I lrpoc:tlcetriia
atrd inrttlunosllPllrcssloll are
loturcl.
What etrzr,'nlc is cleficietrt NADPFI oriclase (chrotrtc
Yrung chilcl has rccurt-ent ltirlg granr-tiotlatorts discasc )'
in neutroPhils?
i rtfcctiorls :rncl gratrttlotl:rtous
le sions.
C]6-CE.
u'itb cttne ut What comPlernerlt
Patie rt pt e scrlts re
proteirrs auc clcfi ciert?
Nais.seria irrfections' anti-Snrith'
'fhc prescnce of u'hich Anti-clsDNA erncl
Woittari complains of a r-nalar
antibodies are sPccific for
rash :urcl arthritis'
SLIr?
\\ lr..rf dircrr:t' t:s ir Cl aft-r'et sus-lrost cliscase'
Pl-ot
P:rtient ptese nts rvith clelnratitis'
afte r bone occurri ng?
e ntcritis, anci hcpatitis

illrtrro\\r tr ansPl antati on'

r90
 (1ow
score Low Gleason score
What is the Gleason "grade") and irigh stage'
rlto''r:, rreopllttic
l)rostrrtc biop:r ,
irncl stage of the Prostate
rtirted
,.,r,,iti"tttl"t r of rt cll-tlitfercr cancer?
'*irtta, rritlr cviderrce of ttttttor and
rrodet' C arcliac rhabclon-rYornas
li".r..r to rcgiorrrtl lr rrrplr zrre
What tYPe of cancers astrocYtomas
(in tttberous
nental with
Bou Pr.'"'-'ts-rvith
angiofibron:rs'
;;;;"il" associateci
sc lerosis)'
i.inr.1"tiot t, faci:ri 1'ris disease? fusion Protein
ltt ttl tt'izttrcs mo.st abl (toform the
Whait oncogene bcr-abl)'
Paiier-it u'itl-r markecl
ieukocytosts
ii;i; ;;;e translocated

^"q
t'":i"' "
cells irr tire PertPnet
:it*i ,1:'lTl, t;;ii" .rYeloid stem ceils?
71,
;;;il ; i'^i" iv"'P1-'"de'oPatu'v
Osteosarcona (Rb
tttmor
1; ancl sPletroilegalY' Her tiririglrtcr has
trrr T
nrutation)'
ge'e
;.,;;;"tt"t
. M"'r.",,,1:l::::ii:i],".",..,x.i:[',:' ;tJ;i"'i.'" other tvPe of
i; \
',:.
has a white PtlPll' cancer?
."tti"t"a to be inheritecl
are inost Types 16 and 18'
i:, retir-robiastonrit' What HPV $Pes
shor'vs with
;r Wonrau's PaP st-uear often associaiecl
rgcs'
'J tlr :lllrtsl ic cltrtr cervical carcinoma? fiom
of T nucleic acicl turnover
l What is ihe side effect dui,-tg."t"r cells leacls to
of joirrt patt-t
Mirtr cotnplains his cancer treatment? ti."tnia ( tunror lysis
for AML' i'y1r.?,,
i"if"*t"* tftemotherapv syndrome)'

is tl-re Br-microglobulin'
Fron-r what Protein
clrrotric
Llclerli \\ tllllall orr a anrYloid deiived?
it"lt"at^fttts treartnrent has
sPaces thart
i,;;;;';ii'"r ioi.i
tft*'t an-rvloid ciePosits'
 t-

rrl:trilti
.

::frlt

Dopar-utne.
What neurotransmitter
ZS-year-old cher-nist Presents
is depleted?
witlr MPI'P crPosttre' of
Rasir on stln-exPoseci regions
What are ihe clinical
Woruan taking tetracYcline tl're boclY.
nanifestations?
exl'ribits PhotosensitivrtY' Gluc ose-6-PhosPI'rate
who Wl'rai is the er-izYne
Afric:rn-Ar-nerican rnan clel'rychogenase'
a cleficie ncY?
goes to Africa develo-Ps
i-ret-nolytic anemia after
taking
malaria ProPhl'laris' lnsecticicle poisoning; inl-ribition
What caused this, and
Farrner presents witl'r dyspnea' of ac etYlcl-rol iuestet ase'
what is the mechanism
salivation, miosis, diarthea'
bltrrrl visiorl' of action?
cr.atrrpirrg. arrd Bethanechol'
What clo You treat tt
27--vear-o1c1 wolllan u'ith a hisiory ..1 .
has \\'ltnr
of psycl'riatric iilness norv
ra,,:,,1i

::::l:,::] rtrinarY retentioi-t clue to a

neuroiePtic' Ketoconazole'
patient What ar-rtifr'ngai drug
Recent kich'rey transplar-rt
.,:lii
,,,
for would result in
it wl-ro is on cYclosPorine
.,::.:
retltLi rcs at t cyclosPorine toxicitY?
t ttt tttt tosrlpllr.cssion
it
,tl;.,

antifungal agent for car-rdicliasis' LF'fs.

rt" Wl-rat routine workuP
Pltier r t is ort cr rbar t rlzclrir
should alwaYs be done?
RifarnPin arugments estrogen
is on wry?
,, 23-year-oid wotlatr wiro mctabolisn-r in tl're liver'
,ifr-Pi" for TB ProPhYlaxis and rert<lcrirtg it less eFfei tivc'
gets
on birtir control (estrogen)
pre g11a1lt.

220
 ComPression of the
IVC'
What is the diagnosis?
in 3rd trimester
c- ';";*al woman
Pregnant
blood Pressure when
;;;;t* and sitting' Wherr suPine'
go/t()'
;il p?","t'" droPs to
What is ihe diagnosis? Coarctation of the aorta'
high- blood
35-year-old man has
and low
or"rr.rt" in his arms
pr"rr.rt" in his legs' cliagnosis? ASD'
What is the
, !-y""r-old boY Presents with a
wide'
,nr,oli" murmur and
fixed sPlit S2' likely Hlpertrophic cardiomyopathy'
What is the most
-* During a game' a Young and !,pe of cardiac disease?
;;il*fi pi"v"' collaPses
dies immediatelY' infarct? Fat emboli'
What caused the
,, Patient has a stroke after
it.trrl,'tgmultiPle long bone
stemmtng
fiactures in trauma
it;;" motor vehicle accident' What is the diagnosis? Temporal arteritis'
with a
*' ElderlY woman Presents
Labs
f't"ra""f't" and jaw Pain'
show elevated trSR' likely Aortic stenosis'
with a What is the most
*- 80-Year-old man Presents cause?
;;a* crescendo-decrescendo
murmur' Niacin.
for What drug is it?
* Man starts a medication
#s
q* hvPerlipidernia' He therr
and
*# a'.i"f"Pt a rash' Pruritus'
w
GI uPset. Losartan, an angiotensin
IIa.
rl*
and What is a good does not I
;B
Patient develoPs a cough and recePtor antagonist'
#wk reDlacement drug, as caPtoPril does'
must discontinue caPtoPril' why doesn't it have the bradykinin
ffi
effi
&re same side effects?
Quinidine'
ringing Wl'rat drug is it?
c Patient Presents with
i" tf'," ears' dizziness' headaches'
and GI distress' cXR finding?
what is the
* Patient with a historY
of }n,::T,';;t
with
hyPertension Prese.nts
sudden sharP, tearing Patn
radiating to the back' cause? Mitral
What is the likelY
n, On auscultation' a PansYstolic . insufficiencY'
at the aPex with
radiation
*.tr-.,'
to the axilla is noted'

242
 What are tl're exPected Low TSH ancl high tl'rYroid
Won-ran presents with diffuse
goiter and hvPerthYroidisrl.' valttes of '|SH and hormones.
thyroid hormones?
Wlral is thc diegnosir? Hypotl-ryroidisn'r.
48-year-old woillall presents with
progressive lethargv ar-rcl extreme
sensitivity to colcl temperatr-tres'
Wi'rat is the cliagnosis? Pituitary tumor.
Patier-rt rvitl'r elevaied serum
cortisol ievels undergoes a

derarnethasone sLlPPresslon
test. I nlg of clexan'retilasone
cloes rot J cortisol levels, but
8 n-rg does.
of Whi,rt is the diagnosisz Carcinoid synclrorre
5O-y,ear-old rrran comPlains
diarrhea. On PhYsical exaln'
his face is pletl'roric and a heart
ntlmtllr is detected.
What endocrine Albright's editart'
1'rer
Wonan of sl'rort stature Presents
disorder comes to rnilrcl? osteoclystrophy, or
rvith sl-rortenecl4th and 5t1'r
p s e u cl ohyp oP a rathYroi di s rr-r'
metacarpals.
What is the dizrgnosis? Surreptitious insulin rnjection'
Nondi:rbetic Patient Presents
rvitl'r hypoglvcemia but low
levels of C-PePtide'
What is the most likelY Nornarl. Residuai pituitary tissue
, Patient's MRI sl-rows filling of
clinical prescntation? is functiotal and can comPcnsate
sella turcica with cerebrospinal
(ernpty sella syndrome).
fluid.
What is tl-re l-rost likelY Prolactinoma.
Patient cornPiaius of clouble
vision, gynecolrastia, and cliagnosis?

headacl-res.
o
What is the most likelY I acirenocorticai defi ciencY
Patient presents witi'r
cliagnosis? (Acldison's disease)'
hvpotension and bronzed skin'

274
 7

,r,
Wlraf kirrd of lrtttrla is Blincl esophagus rvith lower
Baby vonits milk wl-ren fed ancl segluent of esophagus attachecl
present?
l-ras zr gasiiic an bubble'
to the trachea

Wh:rt is the diagnosrs? Crohn's cliscase.

After a stressful life event,
3O-year-old man has diarri'rea
and blood Per rectun;
intestinal bioPsv shows
transmural infl anmatiou'
Whai treatment sl'rould Penicillan-rine for Wilson's
Young Inan Presents with nental disease.
he receirte?
cleterioration ancl tremors' FIe
has browtt Pignrerrtafiort itt a

ring around the periphery of l-ris

cornea ar-rcl altered LFTs'

What is the tnost Gilbert's sYndrorne'
20-year-olcl illan presellts witl-r
idiopathic hyperbilin rbinemia'
collllllon cause?
Wi'rat is the rrost likelY Adenoc:rrcinonra'
5 S-vear-old mar with chronic
wiih esoPhageal histologic sulrtr'Pe?
CdnO presents
cancer. ronle'
What is thc nosi )ikelY Irritable bor'vcl svnd
, Woman preseuts with alternatir-rg
diagnosis?
bouts of Painful diarrhea and
constipatiorr' ColorroscoPY is
nornal.

. Child has been anelrllc
birth.
:, Patient presents r'vith fatigue, and
blood tests show a macrocvttc,
ncglloblastit' attct I tt;t'
r Sqgr,ph
:, p"1iart, preseuts with ane r-nia,
hypercalcenria, and bone Pain
on palpation; bone marrow
biopsy shows a slicle Packecl
witl-r cells thai have a large,
rouncl, off-center nucleus'
,', AIDS patient has iust beeir
diagnosed with c:rncer'
SplenectomY lvould Spl'rerocytosis
slnce
result in t hematocrit
in wl-rat disease?
What is tl-re danger of Corrects atlentia, but neural
giving folate aione? darnage progresses if the
patielt is Btr cleficient'
What is the diagnosis, Multiple myeloma (Plasma ccli
rrcopltsnt t: Bence Jorrcs proteirr
?olgchrur
and wl-rat maY be found
(lg light chains).
Cv.lhoqhr
or-r urinail'sis?
Wf iat neoPlasrls are B-cell lymphoma' KaPosi's
associated with AIDS? SATCOIT}A.

Whicl-r chemotheraPeutic Dororr-rbicin (cardiotoxic)'

Paiient with a ne\'v calcer
'.
dizrgnosis and a kuou'n 1-ristory
agent should be avoidecl !.*
of CHF is being evaluated
in this patient? csf:
for cl'rer-notheraPY. Ff.^
Wrat is the latest targeteci Imatinib (Gleevec) is used to tL: r-
,,, Chroilosome analYsis re'n'eals treat CML; inl'ribitor of hcr-abl tntt
tl-ieraPl' for this disease'
the presence of tl-re Philaclelphia tyrosine kinase.
and horv does it rvork?
chtomosom e, t(9;77) '

What abnormal lab t bleecling time,'f PT' T PTT,

,: After a nornal sPontzrneous
J platelet count (DIC)'
valttes are notecl? ancl
vaginal deliverY, a Patient
bleeds Profi-rselY from her
vagina ancl l:rter from her
gtll]ls.
What clrug can imProve H1'clroryurea (T HbF)
, l0-year-old chiid Presents
tl're cl-rild's sYmPtoms?
with a chronic i-ronhealing
ulcer on l'ris lower leg'
irnagir-rg shows a stlall,
calcified sPleen'
,F

,',,,tt,,,,,',., 'lt.:].:ll.l:t.:ll'll,1,.'::ll.ii:.tll:i::.l.
't,t.',,:,'l.

What else is likelv to Antcrior crucialte liganent

Soccer pl:tver $'ho was kickecl in
have been damaged? (renember the "ur-rhapp,v triad")
thc leg suffercd a cianagccl
nedial rneniscr-ts.
slocates her siroulcler What nerve is uost Axillary nerve (C5, Cb).
G1'rnnast ch

ante riorly. likel,v to havc bcen

clarnagccl?
Wl-rat is the diagnosis? Sarcoidosis.
X-ray shor'vs bilatcral hilar
l,vir-rpl-i :r cl c no p athY.
Yolt arc colcerned SLE
2 5-year-olcl womall prcseuts rvitl't
a lorv-grade fever, a rash across about u,l'rat clisease?
her nose that gets ',1'orse rvhen
stre is ottt in thc stin, and
ividespread edema.
Wl-rat is ti-rc cliagnosis, l'seuclogottt; r I'ronboid calciun
85-vear-old lre1n Presents rvith
and what u'ottlcl pvr opl'rosphalte civstals'
acrttc knec p:-rir arlcl srvelling. )'or-t

X-ray sholr's joir-rt space u'ithout find on aspiratiol?

crosion.
A deficit in u,hat Dorsiflerion ancl eversion of thc
Patient describes J Prick
nltscltlar action can foot (cornnon Peroneal nerve).
sensatiou on the lateral asPect
of her leg ancl foot. also be erpected?
What is the diaglosis? C:rrpal tunnel svtrclronle,
Elderlv wornar] Presents lvith
nerliar r Iterve ('olllPrcssiott.
arthritis, pain, nulrbness, and
r
t,

3"

t:,
tingling over the lateLal cligits
:i
of l-rcr right liartcl. Ou ex:rrt, she
a has wersting of ttre t}'relrar
erninence.
Whart spinal nerve T'ibial (L4-S3)
2O-vear-old clancer rePorts J
plantar flexion and J sensatiotr is inrtolr'ecl?
over the back of her tl-righ, calf,
ar-rd lateral half of hcr foot'
Which nerve ancl lr4rett Uh-rar ncrvc clue to broken medial
Teen falls r'r'hile rollerblading
jr-rrv? conch'le .
and hurts his clborv' He can't ir-r

feel the nedial part of his palirr

Which ncrve ancl r'l4lich Tlre rrtlirl tterve artd dt'eP
Fielcl 1-rockey player prescnts to
artery are nrost likclY brachial artcr,v, lvhich run
tl're ER afteL falling on het atrlt
clarnagecl? together.
during practice. X-r:rY shou's
miclshaft break of thc httnlerr-ts.

342
 Patient presents rvith J Pain Whzit is the lesion? Syringornyelia.
and telrpcrature se nsation ovet
tl-re iateral aspects of both amrs.

Penlight in patient's right eYe What is the defect? Atrophy of the left optic trerve.
produces bilateral pupillary
constriction. Wl-ren lttoved to
the lcft ele, there is paracloxical
clilatatior-r.
Womau involvecl iu ar motot Wl'rat structure is Right CN XI (rr-rrts througli tl're
jugular foramen with CN IX
vehiclc accident cannot turtl clarlraged?
her head to the left ancl has ancl X), innervating thc
,,, rigl-rt shoulcler clroop. sternocleidomastoid and
': trapezius muscles.
i
,a:,::::.:.

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rlr:"1 Man presents witir I wilcl, Whcre is the lesionT Contralatcral subtl-ralanic ttttclerts
:l
(he nriballisrnus).
a .i.,.r':
flailing am.
, ,l:..r,
Right parictal lobe.
Patient r.l,ith cortical lesion cloes Where is tire lesion?
i ,,,.,.

:::. ::t t'.' rlot know that he has a disease.

. 1..:4, Patient's tongue protrudes Where is the lesior-r? L,eft rneclulla, CN XII.
',,
jr
::..'..:...
.,,i:,:,, torvard thc left sidc, and
patient exhibits a right-sided
spastic paralysis.
Patient cannot blink his right What is the diagnosis, Bell's palsy; CN VII.
eye or scal his lips. and which Irerve is
affectecl?

Womatr presents u,ith headache, \Vhirt is tlre diagrrosi:l Prolactinorla.

visual disturbauce, galactorrhe:r,
ancl anenorthea.
4?-vear-old tnatt erperiet tces What is the diagnosis? Schrvannona.
clizziness and tinr-ritus. C'I'
shou,s an enlarged intertlal
acottstic ureatus.
a:,:::"a:.a: 2 5-1'ear-old \\rolran presents What is the cliagnosis? Nlultiple sclerosis.
with sudden tnouocular visiotr
loss and slightly slurred speech.
Sl're l-ras a I'ristory of u'eakness
and paresthesias that have resolvecl.
l0-year-old child "spaces out" in Wl-rat is the cliagnosis? Absence seizures
class (e.g., stops talking
miclsentence and then continues
as if notl-ring had harppenecl).
During spells, ttre cl-rild has a
slight quivering of the liPs.
 ,r;.1,t:..i.lli,,lt.l.

Z3-year-old worlan crashes her Which bone ancl vessel Viddle rucrrirrgeal artetl lrttl
' ierrrporll botte. resullittg itt al
motorcyclc. She initially feels rvere injured during the
I-
fine, but ininlites later she loses craslt r cpidr-rral hematoma.
consciousness. At the ER, a CT
shows an intracranial hernorrhage
that does not cross sttture lir-res.

' 38-)'ear-old tnan with a history of What is thc car-ise of the S ubarachnr-rid Lrernorrhage
Marfan's slrndrone and man's head pain? resulting fiorn a rupturecl berry
hvpertension prcsents rvith a aneLlr\"snr.
seve re I'readache. A spinal tap
reveals blood in tlie CSF.
,,, 78-,vcar-olcl marr rvith Wl-rat structlrres were Britlgirrg reirrs. rcsttltirrg in
iii:l:il

Alzl-reimer's clisease fails ancl darraged by the fallT subdural hernatoma.

presents 3 days later u'ith
sevcre I'reaclache and
vorniting.
 oniy thc best
Pcrsor-r dernands What is the persor-rality Narcissistic personality clisorder.
and nost famotts doctor ln towll. disordcrT
Nurse has episodes of Wl'rat is the diagnosisT Factitious disorder; surreptitious
l'rlpoglycerni a; blood ariah,'5i5 insulin.
reveals no elevtrtion in
C-pcptide.
5 5-,vcaL-old businessman What migl'rt bc tl're Fertr of stttlder deatlrdrrrirrg
conpiair-is of lack of successfill cause of his prolrlem? rntercoLlrse.
sexual contacts with wonen ancl
lack of abilit),to reach a full
ercction. Two years ago he hacl
a heart attack.
I5-year-oid girl of normal height What is the cliagnosis? Bulinria.
and weigl-rt for her age has
enlargecl parotid glands but no
other complaints.'fhe rnotl-rer
confides that she found laratives
in the daughter's closet.
Marr on scveral neclicatiotts, What is the cause of TCAs (anticholinergic effects)
including antidepressants and his symptoms?
antil-rypcrtensives, has nydriasis
ai-rd becon-ics constipated.

Won:l't on MAO inhibitor What did she ingest? Tyramine (wine or cheese).
has hypertensive crisis after
ar meal.
3-,vear-oid cl-rild prescnts with What is tl're rnost likcly Child abr-rse. Report it!
retinal cietacl-rrnent. cliagnosis, ancl 'nl,hat rnttst
you do?
Horneless n-ian atdnrittecl for Wl-rat is the rr-rost likely Dcliriurn tremens 2' to alcohol
pneumonia complaitts of bugs cliagnosis? ll,ithchau,ai.
crawling or-r his skir-r
(fon-nication).
Vietnam veteran becomes What is the most likely PTSD.
paralyzed upon hearing diagnosis?
airplane engines.
Urtcottsciotts Iec'r rltger is What is the rnost likelr, Opioid overdose.
rushecl to thc ER. Ile has diagnosis?
pinpoint pttpils zrnd is
seizing.
tt.:::]::t:t:::t::: iir.r:i:t;lr.l:rt :: {!liil!:ql
3-year-olcl boy presents with facial What is tl-re appropriate Steroids for minirrrrl change
ed.'rrta. m:tlitise. arrrl proteiltttria. treatmcnt? cliseasc.

Womar-r presents with UTI What type of kiclne,v Amrnonittrr magnesitttti

positive for ProtetLs tnLlgaris.
Patierrt clescribes a ?-year
history of acetarninophen use.
X-ray fih-r-r shows massively
enlarged kidr.reys bilaterally.
Patient taking enalaprii
complains of constant coughing.
stone is sl're at risk for?
Wl-rat is sl-re at risk for?
What is tl-re diagnosis?
What is an appropriate
alternative drug?
phosphaie (struvite).
Renrl papi llary ttec'rosis.
Adult polycystic kidney disease
lesxllzp-2ngiotensin II
receptor blocker.

Paticnt wiil'r CHF needs What is an appropriate Etiracrl,nic acid.

diurctic therapy but has aiternative drug?
a sulfa allergy.
Patient is diaglosed witi-r What artery keeps it IMA.
a horseshoe kiclncy. low ir-r the abdornen?
Patier-rt presents witl-t What is the diagnosis, Corn's syndromc
hypertensiol, hypokalemia, ancl how clo you treat it? ( l' h,vperaldosteronism).
'l-reat with
r-r-retabol ic alkaiosis, ar-rcl low
plasma renin. spironolactone.
 * Z4-year-old man develops
testicular cancer.
Woman with a previous cesarean
section has a scar in her lower
uterus close to tl're opening of
the os.
Obese woman presents with
hirsutism and t levels of serum
testosterone.
Pregnant woman at l6 weeks
of gestation presents with an
atypically large abdon'ren.
55-year-old postmenopausal
woman is on tamoxifen therapy.
Metastatic spread first Para-aortic lymph nodes (recall
occurs to what site? de scent of testes during
development).
What is sl're at t risk Placenta previa.
IOrr
What is the diagnosis? Polycystic ovarian syndrome-'
What is the diagnosis? High hCG; hydatidiform mole.
What is she at t risk E,ndometrial carcinonra.
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ur rrrSl

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Patient exhibits an exteuclecl What is the clisease Obstmctive lung clisc:rse.

erpiratorv phase. proccss?

Tall, thin nale teenager has What is ihe cliagnosis? Spontaneotts puertmothoratr.
al>rupt-onset cl1'spnea ancl lcft-
sidetl c lresl lxtirt. fl rerc is
1ri perresor rlt rt ltcrt tt:siot r ot I

thc affectecl side, :rnd breath

sor-rnds are dinrinished.

Young man is concernecl about \Vlr icl r of l rt'r' 1>rr,tcir rt Durcin (K:ltagener's)
.ll
his u'ife's inabilitv to concett'c 1S delecil\'er
and her recttrrent URIs. Sire
has dertrocar-dia.
'f1-re
follou'ing lung volrttttes ate What is his'l LC? 7.0 L
obtainccl from an elclerh'smokcr:
F'RC L,IRV 1.i I,, IC 2.0 L,
VC35L.
'.0
Preterm infant has clifficultv What is the diagnosis, Neonatal respirator-v clistress

breathing. An x-rerv reveals t erncl r'r,h:lt cottld h:rr''c svnclronre ; achrinistr-atiott of

lur-ig clensitics. prever-rted this rnatern:rl steroicls betbr-e birth to
cor-rclition? t snrfactant procluctiott.

25-vear-old couatose lttitlt otl What is the likelv Aspiration of infcctive material
ventilatory support foll orving ctioiogy'? leachng to lung abscess.
an autorrobile acciclent deveiops
fever and clies. Ar-rtopsl' reveals
a pus-filled cavih'in his right
lung.
5 2-1's2.-r14 \r'orr-ran ttr-rclergoing What is tirc irost likeh' Anenria clttc to chronic blood loss

rxerlopause is chronicallv tir ecl. cliagnosis, auci w'hat J or-ug.tt content; oxvgett
changes trave occutr-ecl irt sattrrirtion rtnchatrtgcd
her oxvgcn cotrte nt :rrtd
setttt r:rtioir ?

Patient is sho.,r'n to irave hvpori:t Wl-r:rt is the cause of the Prtl tttrtt rlrv ert rltoli:rrr.

clespite a normal chcst r-r:rv. hvporia, and lvhat cliscase N,Iai be nristerken for an N,tll.

process does it ntittticz

Patier-rt is shou,p to have hl,poxia What is the most likeh' C]HF'
ancl has an abnorual chest r-ra\' cause of the hlporia?
shorving an eniargecl hcart.
;
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