Q7. You decide to examine the heart. The murmur and sounds during auscultation are shown below. The S1 is accentuated. What is your initial diagnosis of this murmur based on the patient history?
a. Aortic regurgitation
b. Aortic stenosis
c. Mitral regurgitation
d. Mitral stenosis
e. Tricuspid stenosis
Q6. During the exam of the patient with suspected rheumatic fever, you note his right knee which he says is tender. Exam reveals a warm, swollen and tender knee. What is false about this condition in these patients?
Q3. Based on the history and exam, you suspect that this patient may have developed rheumatic fever. What organism will you culture from his throat?
Q2. When the patient undresses, you note the following rash on his back. The patient denies any pain or itching sensation. Considering his history, you instantly make a diagnosis of?
Q1. A 35-yo Asian male presents with 5-month history of progressive dyspnea, cough and right knee pain. For the past week, he has been severely dyspneic and has no exercise endurance. He was born in Cambodia and denies use of alcohol, tobacco or illicit drugs. He did not see a doctor because of lack of insurance and he has been self medicating himself with over the counter meds to no avail. He is afebrile and hemodynamically stable. As you start to examine him, you note his elbow. The lesions appear to firm, painless and located below the skin in the dermis-see below. At this point, what is your preliminary diagnosis?
a. Gout
b. Lyme disease
c. Rheumatoid arthritis
d. Sarcoidosis
e. Rheumatic fever
f. Lupus
Q5. The patient’s barium study is shown. What key feature is indicative of achalasia on this study?
Q4. Following the CXR in a patient with suspected achalasia, what is the next step in her management?
