Q6. A 27 yo female presents with an eruption of red irregular plaques and nodules on her leg of 10 days duration. She had a previous episode a year ago which the dermatologist said was due to shaving her legs. You at once make a diagnosis of?
Q5. In general, tinea corporis and the causative organism are usually confined to what layer of skin?
A
B
C
D
E
Q4. If you suspect this is tinea corporis, what is the most likely organism?
Q3. The KOH wet mount is shown. If this test showed a ‘spaghetti and meatball’ appearance, what organism would you think of?
Q1. A 19 yo presents with several lesions on his hand and trunk after returning from a summer job at a camp for underprivileged and poor children. The individual interacted closely with the children including supervising swimming classes and many outdoor activities. Exam reveals several distinctive circular lesions with well demarcated raised edges that are red and scaly. The lesions appeared 2 weeks ago and are extremely itchy. Your initial diagnosis is?
Q4. You have decided to treat the patient with the drug with the mode of action shown below. What blood work will you order prior to administration of this agent?
Q3. After a few days the patient’s lesion changes and is shown below. What does the term loxoscelism mean to you?
Q2. You show an image of the creature to the patient and he recalls seeing such an insect at the camp site. This is the?
Q1. A 32 yo presents with a 2 day history of a very painful lesion on his arm. He reports that he had gone camping and while sleeping on the floor felt an insect bite. He immediately developed pruritus and mild pain. The next day, the site had developed into a large blister with redness and significant pain. Over the past 24 hours, the blister has ruptured and developed into a red painful area. Now he has developed a fever, diaphoresis and nausea. The exam reveals a 3 x 3 cm necrotic ulcer that is painful to touch. The surrounding area is inflamed. You suspect a bite from?
Q3. You select the medication with the mode of action shown below to treat the symptomatic child with the congenital heart disorder in the previous slide. How does this drug relieve the cyanosis?
Q2. Which medication can you use to relieve severe cyanotic episodes in these children?
Q1. A 2 year old with a congenital heart disorder presents with failure to thrive. While waiting for the child to undress, you note that the child has developed profound cyanosis of his lips and nail bed. The mother quickly places him in the position shown below. How does this position help the patient?
A 67 yo is admitted with an anterior wall MI. Two hours after admission he develops the rhythm shown below. Because of hemodynamic instability, he undergoes successful defibrillation and is back in normal sinus rhythm. What will you tell the patient regarding his prognosis?
Q5. What does the arrow in the figure of the carotid tracing denote?
Q4. What does this extra sound represent in this patient?
Q3. From the previous question, the patient’s murmur at site A is drawn. What is the extra heart sound?
Q2. In the previous patient, you hear a murmur along site A which radiates to site B. As you move your stethoscope to site B, you hear a musical murmur. This phenomenon is known as?
Q1. A 49 yo patient with a family history of sudden death among males, presents for a work evaluation. He denies any complaints and does not smoke or drink alcohol. On physical examination a midsystolic ejection murmur is heard along the left sternal border and at the apex you hear a presystolic gallop. An image of his carotid pulse tracing is shown in the image. What is the most likely diagnosis?
Q2. On physical examination of a 55 yo patient, you note the following heart sound. Which of the following is unlikely to be the cause of this finding?
Q1. During your cardiology rotation, you are learning the basics of auscultation. On examination, what is false about the sound depicted by the arrow?
Q3. Because of the severe itching in the patient with cutaneous larva migrans, you decide to treat him with the drug that has the mode of action shown below. The drug is?
Q2. If you were to biopsy the skin in a patient with cutaneous larva migrans, you will find the organism confined to which layer of the skin?
Q1. After wading barefoot at a beach in South America, a 39 yo presents 2 weeks later with a prickling sensation and an intense itch in his foot. Exam of his foot is shown. The most likely organism he has acquired is?
A. Ancylostoma braziliense
B. Scabies
C. Tinea pedis
D. Enterobius vermicularis
E. Ascariasis lumbricoides
F. Taenia soleum
A concerned mother brings her 3 month old infant with a rash on his back that has been present since birth. Evidence shows that these lesions are frequently associated with?
b. Neurocutaneous genetic disorders
c. Inborn errors of metabolism
d. Skin cancer
e. Spina bifida
Q2. From the angio, which of the following vessels will become the dorsalis pedis artery?
Q1. While reviewing the angiogram of a 68 year old male, you are told that a distal leg bypass is needed on the posterior tibial artery. From the image below, which letter reflects the posterior tibial artery?
Q1. A 16 year old male with a history of hay fever presents to the emergency department complaining of palpitations and dizziness. He has always been healthy and had no prior cardiac issues. The ECG rhythm strip is shown below. What is the likely cause?
Q3. What treatment would you recommend for the patient with Klippel Trenanauy syndrome?
Q2. If you suspect that the patient has Klippel Trenaunay syndrome, what else will the physical exam reveal?
Q1. A 28 year old female is seen in the vascular clinic with a right leg that appears at least twice the size of the left leg. The patient states that right the leg has been discolored and large for many years. Examination reveals a large port wine stain on the anterior thigh. It appears that the right leg is slightly longer than the left leg. What is your initial diagnosis?
Q2. Four weeks after surgery on the lesion in the previous slide, the patient is seen in the clinic. It appears that the nerve marked with the arrow was injured. His chief complaint will be?
Q1. A 50-year-old man presents with the lesion shown on his hand. Except for some mild discomfort he has no symptoms. In general, where are the majority of these lesions located on the hand?
A 55-yo male presents to the ER with two bouts of severe retching and vomiting followed by hematemesis. In both instances he vomited after drinking home made wine. He denies any use of drug or regular alcohol. Except for some mild abdominal he has stable vital signs. While blood work is pending, he undergoes an endoscopy shown below. There is no active bleeding and fibrin was seen overlying the mucosa. In the majority of these patients, what blood vessel is involved in the pathology?
A 55 yo male presents to the ED with complaints of left leg pain. He developed a laceration in the ankle area after he was kicked 3 days ago. He cleaned it with water but the wound has become red and fluctuant. His past medical history reveals arthritis, hypertension and gout. His only prescription medication is clonidine; the arthritis and gout are controlled with Ibuprofen. You start on him on an antibiotic and he presents four days later complaining of a metallic taste. The drug’s mode of action is shown in the image. Prolonged use of this drug is also associated with?
Q1. A patient is sedated for colonoscopy. The drug used affects the neurotransmitter (See circle with ?????) shown in the slide below. If this patient was to overdose, what antidote will you use?
Q1. A patient has had insomnia for many months and would prefer to take a supplement instead of a medication. You decide to treat him with a substance released from the gland shown in the image (see ????). This substance is generally contraindicated in patients with?
A 28 year immigrant presents with several asymptomatic lesions on his skull which are hard and bony. The lesions are fixed, non tender and have been present for at least a year. He is not able to provide much of a history because of the language barrier. What test would you order in him?
A 3 yo is involved in an MVA which resulted in multiple injuries and required intubation at the scene. His vitals are labile and he is rushed to the hospital. Because of poor IV access, the resident starts an intraosseous line as shown below. The child is resuscitated and stabilized. CT scan reveals fracture of the pelvis, and 4 ribs on the left chest. After application of an external fixator the child is taken to the ICU. Late in the night the nurse notes no pulses in the right leg which is now tense and ecchymotic. Which of the following muscles is not involved in his pathology?
If this is the right side, the structure marked ‘E’ will drain into the?
A child underwent a study to determine the oxygen levels in the heart chambers - see below. In the majority of people with this type of congenital heart defect, the major hemodynamic effect is?
Q2. SB is a 16 yo female who presents to the ED with a 18-hour history of vague abdominal pain. The pain was sudden in onset and colicky in nature. She did take some Tylenol but the pain did not abate. Her past medical history is unremarkable. On exam, her pain has localized to the area ‘C.’ If the patient in the previous slide has appendicitis, then the laboratory work may reveal?
Q1. SB is a 16 yo female who presents to the ED with a 18-hour history of vague abdominal pain. The pain was sudden in onset and colicky in nature. She did take some Tylenol but the pain did not abate. Her past medical history is unremarkable. On exam, her pain has localized to the area ‘C.’ What is the next step in her management?
A. WBC > 20
B. Elevated ESR
C. Raised levels of urinary 5 HIAA
D. Hematuria
E. Elevated levels of amylase
F. Neutropenia
A 28-yo male with AIDS presents with a 2 week vision problems. He denies any injury but claims that the vision is blurred in the periphery and he is seeing numerous particles floating in the visual field. During the eye exam, scrapings from the right eye are obtained and stained. The pathologist has circled two areas of concern. You at once make a diagnosis of?
Q2. If you are told that the patient has Heinz bodies on the RBC smear, what pathophysiology would come to mind?
Q1. A newborn is being investigated for anemia. His blood smear is stained with a supravital stain (New Methylene Blue)- see below. What do you see?
Q2. What does the term ‘heterophile antibody’ mean to you?
Q1. A 14-year-old boy with a low-grade fever, sore throat, headache and a cough of 3 days duration is seen in the ER. Without doing the physical exam, blood work is ordered. The physician sends blood work for measurement of heterophile antibodies because he suspects?
A patient with hepatitis C presents with intense pruritus of many months. Exam of his arm is shown. What skin condition does the patient most likely have?
Q3. Besides hypokalemia, which common arrhythmia is associated with the wave shown below?
Q1. You have a patient with an electrolyte disorder on the floor. An ECG is obtained and the cardiologist states that there are ‘U’ waves present. In general, where do you normally see these waves on the ECG?
