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21 Cards in this Set
- Front
- Back
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Ms. Martinez, 74-years-old, is brought to your family practice by her husband. He is concerned because his wife, who used to take pride in keeping the house in good shape, has stopped cleaning and caring for her appearance. She recently went shopping and left the stove on. She frequently misplaces her car keys and checkbook. Ms. Martinez reports trouble concentrating and does not have much energy. She has a poor appetite and no longer enjoys knitting. Her mini-mental status exam is 28/30. Physical Exam: General Appearance: well-nourished, appears stated age, HEENT[LW1] : pupils equally round and reactive to light, moist mucus membranes, Chest: normal S1 and S2, no murmurs, Lungs: clear to auscultation bilaterally, Abdomen: soft, non-tender, non-distended, Extremities: no cyanosis, no clubbing. Neurologic: no focal deficits Psychiatric: flat affect. Labs: TSH: 2, WBC: 6.0, HgbA1c: 4.5. Which of the following is the most likely diagnosis? |
Depression |
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Ms. Brady, a 78-year-old female prevents to your office after six months for follow-up. Her interval history is significant for a TIA three months ago. Today her MMSE is 19. You note that six months ago her MMSE was 22 and nine months ago it was 26. Physical exam shows T=98.8, BP=167/95, HR=76, RR=14. Chest: regular, rate and rhythm, no murmurs, Lungs: clear to auscultation, Neuro: weakness in the right upper extremity, Abdomen: soft, non-tender. She takes atorvastatin and aspirin. Lab studies show Hgb A1c: 5, TSH: 3, B12: 500 pg/mL. Which of the following is the most important recommendation to prevent further disability in this patient? |
Start hydrochlorothiazide (BP control) |
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A 68-year-old male becomes confused and agitated on post-operative day three after open cholecystectomy. He does not recall his surgery or where he is and wants to leave the hospital. Physical exam shows T=99.9, BP=143/89, HR=90, RR=13, O2 sat: 98% on room air. He appears agitated and uncomfortable. He has a Foley catheter. His physical exam is unremarkable. Labs: WBC-11,000, Urinalysis: 2+ nitrites and 2+ leukocyte esterase, 10 WBC/hpf. Glucose finger stick: 80, EKG: normal sinus rhythm at 88 beats per minute. Which of the following is the best initial step in the management of this patient? |
Remove catheter |
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Ms. Michaels is an 80-year-old female with a past medical history of shingles. She comes to your office accompanied by her daughter Jennifer who reports that her mother is forgetting things. Jennifer explains that her mother will ask the same question several times throughout the day although it was answered. Ms. Michaels also gets confused easily and is more passive than usual. Her memory problem was noticed two years ago after she forgot to pay her bills on multiple occasions. Jennifer now pays her mothers’ bills and cleans and cooks for her. Ms. Michaels’ vital signs are T=99.2, BP= 118/70, HR=80, RR=12. Her physical exam is significant for bilateral osteoarthritis hand deformities. CT head shows mild atrophy of the hippocampus. Her MMSE is 20. The patient’s diagnosis is most likely associated with what brain tissue abnormality |
Plaque formation |
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A 34-year-old male comes to the clinic complaining of abdominal pain. He says the pain has been bothering him for the past two weeks. He reports episodes of diarrhea and constipation, with more episodes of constipation. He states he has noticed an increase in flatulence. He denies any nausea or vomiting. He has noticed mucus in his stools, but no blood. He states that he cannot recall if anything aggravates the pain, but admits to being under more stress than usual, due to his mother-in-law moving in with him and his wife. Vital signs show a blood pressure of 124/76, pulse of 74, respirations of 16, a temperature of 97.9, and oxygen saturation of 98% on room air. Physical exam is unremarkable. Next step and likely diagnosis |
Performing a CBC, TSH, complete metabolic panel, and stool studies. Likely IBS though. |
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A 22-year-old female comes to the clinic complaining of frequent urination. She states she has noticed some increased frequency for the past week. She denies itching or pain in the vaginal area, but reports a burning sensation during urination that began a week ago. When asked if she has noticed blood in her urine, she admits to not paying attention to its color. She states that she has some abdominal pain in her pelvic area. She admits to being inconsistent with her birth control pills, and states she is sexually active. She does not recall the date of her last menstrual period. Urine hCG test is negative. Physical exam reveals suprapubic tenderness. She exhibits no costovertebral angle tenderness. Vital signs show a blood pressure of 126/78, temperature of 98.2, respirations of 18, heart rate of 82, and oxygen saturation of 97%. The most likely diagnosis is: |
Uncomplicated urinary tract infection |
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A 23-year-old female patient comes to your office complaining of bothersome symptoms the week before her period each month. She reports that she has significant breast tenderness, is very irritable, and eats significantly more than she does at any other time during the month. Her coworkers notice the difference in her mood and it is beginning to affect her interactions with them. The symptoms resolve after her period. She has no other medical problems or significant past medical history. Physical exam is normal. What is this patient’s most likely diagnosis? |
Premenstrual syndrome |
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A 23-year-old female patient comes to your office complaining of bothersome symptoms the week before her period each month. She reports that she has significant breast tenderness, is very irritable, and eats significantly more than she does at any other time during the month. Her coworkers notice the difference in her mood and it is beginning to affect her interactions with them. The symptoms resolve after her period. She has no other medical problems or significant past medical history. Physical exam is normal. What is the most effective treatment for this patient’s condition? |
Continuous SSRI treatment |
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A 55-year-old male with a past medical history that includes hypertension, Chronic Obstructive Pulmonary Disease (COPD), and hyperlipidemia presents to clinic as a new patient for a general physical exam. History reveals that he has been smoking a pack of cigarettes daily since age 20. He drinks two beers daily. He is intermittently noncompliant with his medications. Review of the state immunization database reveals that the only immunization he has received as an adult was a tetanus diphtheria shot administered 12 years ago. Which of the following vaccine combinations would be most appropriate for this patient?
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Tdap, influenza, pnumococcal |
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A 55-year-old male comes to the clinic for a visit. He has read about the dangers of being overweight and inquires about which category he fits into. He is 5’ 10’’ (1.78 m) and weighs 220 lbs (100 kg), BMI = 31.6. Which of the following categories most accurately describes the patient based on his BMI? |
Obese (>30) |
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A 55-year-old white male with a family history of melanoma presents to the clinic for evaluation of a skin lesion on his back which appeared three months ago. His wife first alerted him to it, hasn’t noticed it change and he has not noticed any symptoms associated with it. Physical examination reveals a 7 mm uniformly black macule that is symmetrically round with sharply demarcated borders on his upper back near the right shoulder. Which of the following characteristics would most justify it being biopsied today? |
Diameter |
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A 60-year-old Hispanic female presents to the office complaining of increased frequency of urination and fatigue for the past several months. She denies fevers, dysuria, back pain, diarrhea and abdominal pain. She has noted some weight loss without working on diet or exercise. Her past medical history is significant for hyperlipidemia and hypertension, for which she takes simvastatin and lisinopril. She is a non-smoker and consumes 1-2 glasses of wine per week. Her vitals are BP 130/70, HR 70/min. Her BMI is 30 kg/m2. Physical examination reveals increased pigmentation in her axilla bilaterally. Her labs are as follows: random blood glucose of 205 mg/dL Creatinine 0.8 mg/dL, TSH 2.1 U/L. What test is needed to diagnose diabetes mellitus? |
Random fasting glucose is sufficient |
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Diabetic patient attempting only exercise and diet A1c is found to be 8.9%. What is the best medicine to start at this time? |
metformin |
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What percent of people with severe diabetes requiring insulin have retinopathy 5 years after diagnosis? |
40% of people with severe diabetes requiring insulin have retinopathy five years after diagnosis |
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A 65-year-old male with known type 2 diabetes mellitus presents to the emergency department with altered mental status. The patient experienced no known head trauma. His vitals are BP 90/74, HR 102, RR 16, Temperature 38.1 C. His mucous membranes appear very dry and he is started on IV fluids. Neurological exam reveals no focal deficits. His plasma glucose is found to be 700 mg/dL. Urinalysis reveals no ketone bodies. What is the most likely diagnosis? |
Hyperosmolar hyperglycemic state (HHS) |
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A 61-year-old female has recently been diagnosed with type 2 diabetes. Her fasting glucose was 240 mg/dL and her A1c was 8.9%. Her BP has been 150/92 and 154/96 at two separate office visits. Her home BP measurements have been in a similar range. Her creatinine is 0.9 and she has no known heart disease. You diagnose her with hypertension and consider adding which medications? |
lisinopril |
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A 65-year-old female presents to your office for a routine visit. She is found to have a blood pressure of 146/96. You repeat the blood pressure in her other arm and get 148/92. Her pulse is 70 and regular. Her last BP reading was one year ago and was 120/76. She has no other medical problems. Her BMI is 28. She states that she likes to walk 30 minutes every other day with her husband and has been doing that for years now. At this time, the most appropriate diagnosis is |
elevated blood pressure |
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A 68-year-old male was diagnosed with benign essential hypertension a few months ago and has been working on diet and lifestyle modifications. He has a BMI of 28, mild knee arthritis but no other medical diagnoses. He has been a patient of yours for several years, and returns today as planned. Today his blood pressure is 156/94. The remainder of his cardiovascular exam is within normal limits. After counseling the patient, he agrees to start an antihypertensive medication. His creatinine is 0.9, urinalysis is normal, and electrolytes are within normal limits. which of the following is the most appropriate medication to begin in this patient? |
thiazide diuretics, ACE inhibitors, angiotensin II receptor blockers, or calcium channel blockers |
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A 54-year-old male with a history of chronic gout and GERD presents to your office for his health maintenance exam. Vitals today are BP 156/92, pulse 65, respirations 10, afebrile, BMI 29. He smokes 10 cigarettes per day, does not regularly exercise, and drinks one to two beers daily, four or five times a week. He has no current concerns, review of systems is negative, and his physical exam is unremarkable. You recommend lifestyle changes. Which of the following changes is least likely to improve his blood pressure? |
reducing alcohol intake |
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A 26-year-old professional football player comes to the clinic with the complaint of hair loss. On examination, the scalp is scaly, erythematous, and certain regions are purulent. There are several circular spots where the hair follicles are no longer present. KOH of skin shows hyphae. What is the most appropriate treatment for this patient? |
Oral griseofulvin |
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A 64-year-old African American man with a history of frontotemporal dementia is brought to the doctor for multiple dark spots found on the palms of his hands. The lesions are asymmetric and some have more than one color. Based on the information provided, which is the most likely finding on the biopsy? |
Acral lentiginous melanoma |
