Medical Cases for Students

A patient 18 years old came to your office with a generalized rash

2012-01-25T21:31:00.004+01:00

A patient 18 years old came to your office with a generalized rash. He has 24h having those lesions and didn't sleep well because of the pruritis in all his body. Physical examination consist in a severe rash with 2 cm lesions in form of rings in all his body. About 2 weeks ago he went to the dentist and the dentist told to him for some papular lesions in his gingivas. At the moment his gingivas were inflamed.

Which of the following is the most likely diagnosis?

a. Erythema multiforme
b. Syphilises
c. Lupus erythematosus
d. Simple Urticaria
e. Psoriasis

[SOLVED] A 2-year-old boy is being followed for congenital cytomegalovirus

2012-01-19T17:31:00.005+01:00

A 2-year-old boy is being followed for congenital cytomegalovirus infection. He is deaf and developmentally delayed. The child’s mother informs you that she has just become pregnant and is concerned that the new baby will be infected.

Which of the following is true?

a. The mother's antibodies of CMV are passed to the fetus
b. The mother’s infection cannot become reactivated
c. The new baby will become clinically ill in approximately 80%
d. Termination of pregnancy is advised

[SOLVED] A married 40 years old presents to your office for a routine exam.

2012-01-16T11:43:00.003+01:00

A married 40 years old presents to your office for a routine exam. This patient has been married for 20 years and is very happy being a good mom. She is healthy and denies any medical problems except migraine headaches that are sometimes exacerbated by her menses. She reports that all her pregnancies were uncomplicated. She drink a little alcohol and smoke occasionally. Her menses are regular and with no problems.When questioned about her family history, she states that she thinks her grandmother was diagnosed with ovarian cancer when she was in her 50s. She denies a family history of other cancers or medical diseases. After placement of the speculum, you note a clear cyst approximately 2.5 cm in size on the anterior lateral wall of the vagina on the right side. The cyst is nontender and does not cause the patient any dyspareunia or discomfort.

What is the most likely diagnosis of this mass?

a. Bartholin’s duct cyst
b. Gartner’s duct cyst
c. Lipoma
e. Inclusion cyst

[SOLVED] A healthy 7 year old girl came to your office by her father because

2012-01-13T10:05:00.004+01:00

A healthy 7 year old girl came to your office by her father because she has some acne, breast development, and pubic hair.

The most likely etiology for her condition is...

a. An ovarian tumor
b. A gonadotropin-producing tumor
c. A lesion of the central nervous system
d. “Normal” puberty

[SOLVED] An 80 year old man with chronic lymphocytic leukemia

2012-01-09T20:36:00.005+01:00

An 80 year old man with chronic lymphocytic leukemia develops pain and burning over the right side of his face. In a few days, he develops a papular rash in the distribution of the first division of the trigeminal nerve. Within 1 month the rash has largely resolved, but the man have actually the shooting pain on his face. Imipramine 100 mg helps reduce the pain.

What do you think is the possible diagnosis?

a. Cluster headache
b. Trigeminal neuralgia
c. Hemiplegic migraine
d. Atypical facial pain
e. Postherpetic neuralgia
f. Lupus erythematosus

[SOLVED] A patient 80-year-old female has had several episodes of syncope

2012-01-07T20:01:00.003+01:00

A patient 80-year-old female has had several episodes of syncope, all of which have occurred while she was returning to her room after breakfast. She complains of headache and she feels cold and weak. She takes nitroglycerin in the morning for a history of chest pain, but denies recent chest pain or shortness of breath.

The most likely method of diagnosis is

a. Cardiac catheterization
b. Blood pressure monitoring
c. Holter ECG
d. CT scan

[SOLVED] An athletic male 20 year old is healthy and suddenly he develops

2012-01-04T23:14:00.004+01:00

An athletic male 20 year old is healthy and suddenly he develops fever and pain in the right foot and leg. On physical exam, the foot and leg are red with a well defined indurated margin that appears to be rapidly advancing. There is inguinal lymphadenopathy.

The most likely organism to cause this infection is...

a. Staphylococcus epidermidis
b. Tinea pedis
c. Streptococcus pyogenes
d. Mixed anaerobic infection
e. Herpes simplex

[SOLVED] An 20 year old male came to the hospital for urethral discharge

2011-12-28T19:07:00.003+01:00

An 20 year old male came to the hospital for urethral discharge. He is treated with ceftriaxone, but the discharge has not resolved and the culture has returned as no growth.

The most likely agent which causes this infection is...

a. Candida albicans
b. Gonococcus
c. Chlamydia trachomatis
d. Herpes simplex
e. Trichomonas vaginalis

[SOLVED] A patient 55 years old with type 2 diabetes mellitus has an elevated

2011-12-26T16:53:00.005+01:00

A patient 55 years old with type 2 diabetes mellitus has an elevated blood sugar. He came to the hospital with acidosis and a headache around the paranasal sinuses. He saw black material falling from his nares.

Which of these agent causes this?

a. Zygomycosis
b. S. epidermidis
c. Rotavirus
d. Rhinovirus

[SOLVED] A 70 year old patient with type 2 diabetes mellitus presents

2011-12-25T20:54:00.005+01:00

A 70 year old patient with type 2 diabetes mellitus presents with pain in the left ear with purulent drainage. On physical exam, the patient is afebrile. The pinna of the left ear is tender, and the external auditory canal is swollen and edematous. The peripheral white blood cell count is normal.

Which is the organism most likely organism that causes that?

a. Pseudomonas aeruginosa
b. Staphylococcus aureus
c. Haemophilus influenzae
d. Moraxella catarrhalis

[SOLVED] A patient 55 year old had an acute shortness of breath shortly after a 12-hour

2011-12-20T16:44:00.004+01:00

A patient 55 year old had an acute shortness of breath shortly after a 12-hour automobile ride. The patient consults his internist, and findings on physical examination are normal, except for tachypnea and tachycardia. An electrocardiogram reveals sinus tachycardia.

Which of the following is correct?

a. Pulmonary angiogram
b. Ventilation-perfusion scan
c. D-dimer assay
d. Venous ultrasound

[SOLVED] A female 30 years old pregnant shows a laboratory urinalysis in your office

2011-12-18T17:16:00.005+01:00

A female 30 years old pregnant shows a laboratory urinalysis in your office with 2+ leukocyte esterase, trace blood, no protein, no glucose, and 2+ nitrites. You send the urine to the laboratory for culture and sensitivity but want to start empiric treatment for the patient’s symptoms.

Which medication is the most appropriate?

a. Ciprofloxacin
b. Cephalexin
c. Trimethoprim-sulfamethoxazole
d. Tetracycline
e. Gentamicin

[SOLVED] A patient 53 year old suffer of chronic obstructive lung disease for about 10 years

2011-12-16T12:09:00.004+01:00

A patient 53 year old suffer of chronic obstructive lung disease for about 10 years. He recently develops an episode of aching in the distal extremities in both wrists.There is a 10-lb weight loss. The skin over the wrists is warm and erythematous. Plain film is shows periosteal thickening.

What should you do?

a. Start ciprofloxacin
b. Chest x-ray
c. Aspirate both wrists
d. Begin gold therapy

[SOLVED] A 50-year-old continues to have an elevated blood pressure of 160/95

2011-12-14T17:59:00.003+01:00

A 50-year-old continues to have an elevated blood pressure of 160/95 even after a third agent is added to his antihypertensive regimen. Physical exam is normal, electrolytes are normal, and the patient is taking no over-the-counter medications.

Which is the next step for this patient ?

a. Check pill count
b. Evaluate for Cushing syndrome
c. Check chest x-ray for coarctation of the aorta
d. Renal angiogram
e. Adrenal CT scan

[SOLVED] A man 65 year old presents with painless hematuria

2011-12-12T13:55:00.003+01:00

A man 65 year old presents with painless hematuria.He has smoke for about 40 year. He denies fever and dysuria. A urinalysis shows 100 red blood cells per high power field. No white cells are present. Three months previously, the patient had an abdominal ultrasound: both kidneys were normal.

The most useful diagnostic test at this time is...

a. Urine culture
b. PSA
c. Renal biopsy
d. Cystoscopy

[SOLVED] A female 40 year old presents with sore throat.

2011-12-09T19:51:00.004+01:00

A female 40 year old presents with sore throat. She is on no medication,dont use alchool and has no history of renal disease.Physical exam is normal. The labratory data shows Hgb of 9.3 g/dL, MCV is normal, white blood cell count is 2,100/μL, and platelet count is 33,000/μL.

The best examination to diagnosis is...

a. Erythropoietin level
b. Level of B12 in blood
c. Bone marrow biopsy
d. CT of liver spleen

[SOLVED] A 70 year old female had an acute myocardial infarction

2011-12-08T13:33:00.003+01:00

A 70 year old female had an acute myocardial infarction and congestive heart failure, then has an episode of ventricular tachycardia. She takes multiple medications and soon develops confusion.

Which is the most likely cause of this confusion?

a. Captopril
b. Digoxin
c. Furosemide
d. Lidocaine
e. Nitroglycerin

[SOLVED] A patient female 77 year old has had hypertension for about 20 years.

2011-12-06T22:42:00.004+01:00

A patient female 77 year old has had hypertension for about 20 years. Recently she had a mild left hemiparesis and the atrial fibrillation on ECG which persist during the hospital stay.

Which is the best treatment (for the time she is in hospital) includes antihypertensive plus …?

a. Observation
b. Aspirin
c. Pacemaker
d. Heparin
e. Warfarin

[SOLVED] A 32-year-old female with HIV, on indinavir and stavudine,

2011-11-26T22:26:00.004+01:00

A 32-year-old female with HIV, on indinavir and stavudine, presents with severe edema and a level of creatinine in serum is 2.2 mg/dL. He has had bone pain for about 6 years and takes large amounts of acetaminophen with codeine, aspirin, and ibuprofen. He is on prophylactic trimethoprim sulfamethoxazole.
Blood pressure is 160/110; urinalysis shows 3+ protein, 5 to 8 RBC, 1 WBC; 24-h urine protein is 6.1 g.

What is the most likely cause of his renal disease?

a. The toxicity of Indinavir
b. Focal sclerosis
c. Trimethoprim sulfamethoxazole
d. Analgesic nephropathy

[SOLVED] A child 4 years old came to the emergency room because of an episode of vomiting

2011-11-22T17:38:00.006+01:00

A child 4 years old came to the emergency room because of an episode of vomiting and headache, problems of the motor skills, cranial nerve dysfunction and problems of breathing.

This syndromes are most related to which of the following disorders?

a. Hydrocephalus
b. Anencephaly
c. Syringomyelia
d. Congenital aneurysm

[SOLVED] A female 65 year old refused the vaccine of influenza

2011-11-16T19:07:00.006+01:00

A female 65 year old refused the vaccine of influenza. She normally had influenza and she died 10 days after having the flu with pneumonia.

Which is the most common cause of these situation?

a. Haemophilus influenzae
b. Pneumococcus
c. Staphylococcus aureus
d. Klebsiella
e. Escherichia coli
f. Streptococcus group A

[SOLVED] A patient 70 year old male had a CT of the head because of the headache

2011-11-11T23:33:00.004+01:00

A patient 70 year old male had a CT of the head because of the headache in one part of the head. There was a mass in the left side of the brain and it is seen that the bone next to the mass was more thick that the other part of the skull.

Which is the most likely diagnosis?

a. Schwannoma
b. Astrocytoma
c. Meningioma
d. Tumor of pituitary gland

[SOLVED] A patient 57 year old male had a surgical intervention to make Billroth II

2011-11-10T23:09:00.007+01:00

A patient 57 year old male had a surgical intervention to make Billroth II because he had a peptic ulcer for about 10 years. But recently he had abdominal pain and his diagnosis was a recurrent ulcer. Now what can we do to distinguish that this is secondary to the intervention or to a gastrinoma.

What will be the best test to differentiate this situation?

a. The level of gastrin
b. The level of the acid production in 24 hours
c. The level of calcium in serum
d. The level of secretin in serum

[SOLVED] A 43-year-old black female has abdominal pain, a loss of weight

2011-09-27T20:06:00.003+02:00

A 43-year-old black female has abdominal pain, a loss of weight, weaknessand joints pain. She used acai berry cleanse tabs to get a better nutrition for two weeks. The patient has a palpable liver. Glucose level is 178mg/dL.

Which of the following can be the diagnosis?

a. Diabetes Mellitus
b. Chronic Pancreatitis
c. Addison’s disease
d. Hemochromatosis

[SOLVED] A patient male 55 year old had a sudden crash on the road

2011-09-26T23:36:00.004+02:00

A patient male 55 year old had a sudden crash on the road. He took the first aid from one of the passengers and went immidiatelly to the hospital. There, he learn that he had a heart attack . Four hours after the accident his blood pressure was 80/55 mm Hg and the pulse 52/min. Electrocardiogram shows sinusal rhythm

Which is the most appropriate?

a. Atenolol
b. Enalapril
b. Dobutamine
c. Atropine
d. Hydrochlorothiazide