Podcast
Questions and Answers
A 40-year-old man with a history of recurrent painful attacks affecting the right big toe, was diagnosed with gout and started on allopurinol. He is also a known case of psoriasis for several years. He presented to the clinic with recurrent joint pain affecting the right big toe, left ankle, and bilateral knees. He is using allopurinol regularly as prescribed but has no improvement in his joint pain. Examinations revealed he has active arthritis at the left ankle and knee joints bilaterally (see lab results). Which of the following is the most likely cause for his joint pain?
A 40-year-old man with a history of recurrent painful attacks affecting the right big toe, was diagnosed with gout and started on allopurinol. He is also a known case of psoriasis for several years. He presented to the clinic with recurrent joint pain affecting the right big toe, left ankle, and bilateral knees. He is using allopurinol regularly as prescribed but has no improvement in his joint pain. Examinations revealed he has active arthritis at the left ankle and knee joints bilaterally (see lab results). Which of the following is the most likely cause for his joint pain?
- Psoriatic arthritis. (correct)
- Active gout arthritis.
- Active pseudogout arthritis.
- Osteoarthritis.
A 28-year-old woman with systemic lupus erythematosus for 2 years on hydroxychloroquine 200 mg/day, prednisone 5 mg/day, and azathioprine 100 mg/day presented to the Emergency Room with sudden onset of lower limb weakness and urinary incontinence. Examination revealed she has paraplegia and hyperreflexia (see lab results). Which of the following is the most appropriate test to be done immediately?
A 28-year-old woman with systemic lupus erythematosus for 2 years on hydroxychloroquine 200 mg/day, prednisone 5 mg/day, and azathioprine 100 mg/day presented to the Emergency Room with sudden onset of lower limb weakness and urinary incontinence. Examination revealed she has paraplegia and hyperreflexia (see lab results). Which of the following is the most appropriate test to be done immediately?
- Lumbar puncture, MRI, MRA, and MRV of the brain
- Lumbar puncture, CT brain
- Lumbar puncture, MRI spinal cord (correct)
- Lumbar puncture, MRI brain
A 50-year-old man is complaining of pain affecting the wrist joints bilaterally, second and third proximal interphalangeal joints, and right knee joint for the last 4 months. His examination revealed active arthritis at both wrists and second and third proximal interphalangeal joints (see lab results). Which of the following is the most appropriate treatment?
A 50-year-old man is complaining of pain affecting the wrist joints bilaterally, second and third proximal interphalangeal joints, and right knee joint for the last 4 months. His examination revealed active arthritis at both wrists and second and third proximal interphalangeal joints (see lab results). Which of the following is the most appropriate treatment?
- Methotrexate
- Methotrexate, hydroxychloroquine, and prednisone (correct)
- Methotrexate and sulfasalazine
- Methotrexate and hydroxychloroquine
A 30-year-old woman with systemic lupus erythematosus is evaluated for right hip pain that started 3 weeks ago and occurs at night and with walking. Her current medications are azathioprine, hydroxychloroquine, prednisolone, and lisinopril for the last 5 years. Her examination was normal except for pain on internal rotation of the right hip. Laboratory tests including pelvic and left hip radiographs were normal. Which of the following is the most likely cause of hip pain?
A 30-year-old woman with systemic lupus erythematosus is evaluated for right hip pain that started 3 weeks ago and occurs at night and with walking. Her current medications are azathioprine, hydroxychloroquine, prednisolone, and lisinopril for the last 5 years. Her examination was normal except for pain on internal rotation of the right hip. Laboratory tests including pelvic and left hip radiographs were normal. Which of the following is the most likely cause of hip pain?
A 60-year-old man complaining of right knee pain for several years that has increased over the last few months. He also has noticed frequent knee clicks. A diagnosis of osteoarthritis is suspected. Which of the following is the most appropriate to confirm the diagnosis?
A 60-year-old man complaining of right knee pain for several years that has increased over the last few months. He also has noticed frequent knee clicks. A diagnosis of osteoarthritis is suspected. Which of the following is the most appropriate to confirm the diagnosis?
A 52-year-old man with rheumatoid arthritis for 12 years. His current treatment consists of methotrexate 15 mg weekly and adalimumab 40 mg/2 weeks. He presented to the clinic complaining of fever and shortness of breath for 1 week. His chest examination revealed coarse crackles over the lower part of the right lung (see lab results). Which of the following is the most appropriate action to be taken on this visit?
A 52-year-old man with rheumatoid arthritis for 12 years. His current treatment consists of methotrexate 15 mg weekly and adalimumab 40 mg/2 weeks. He presented to the clinic complaining of fever and shortness of breath for 1 week. His chest examination revealed coarse crackles over the lower part of the right lung (see lab results). Which of the following is the most appropriate action to be taken on this visit?
A 30-year-old man presented to the Emergency Department with an acute monoarthritis where joint aspiration was performed. Based on the presence of crystals in the synovial fluid, he was diagnosed with gout. Which of the following is the most likely type of the crystals seen?
A 30-year-old man presented to the Emergency Department with an acute monoarthritis where joint aspiration was performed. Based on the presence of crystals in the synovial fluid, he was diagnosed with gout. Which of the following is the most likely type of the crystals seen?
A 30-year-old woman with a diagnosis of systemic lupus erythematosus who was maintained on mycophenolate mofetil 1 gm/day, hydroxychloroquine 200 mg/day, and prednisone 5 mg/day for the last 1 year. She has had inactive disease for more than 6 months. She is planning to get pregnant (see lab results). Which of the following is the most appropriate action at this time?
A 30-year-old woman with a diagnosis of systemic lupus erythematosus who was maintained on mycophenolate mofetil 1 gm/day, hydroxychloroquine 200 mg/day, and prednisone 5 mg/day for the last 1 year. She has had inactive disease for more than 6 months. She is planning to get pregnant (see lab results). Which of the following is the most appropriate action at this time?
A 61-year-old woman is evaluated for a left pulmonary nodule that was discovered incidentally 2 months ago. She is currently asymptomatic and has not had shortness of breath, fever, chills, weight loss, or night sweats. Medical history is otherwise unremarkable, and she takes no medications. She never smoked. Examination revealed no cervical or supraclavicular lymphadenopathy, and the lungs are clear to auscultation (see report). CT scan chest: Showed an 8 mm left lung nodule. Which of the following is the most appropriate next step in management?
A 61-year-old woman is evaluated for a left pulmonary nodule that was discovered incidentally 2 months ago. She is currently asymptomatic and has not had shortness of breath, fever, chills, weight loss, or night sweats. Medical history is otherwise unremarkable, and she takes no medications. She never smoked. Examination revealed no cervical or supraclavicular lymphadenopathy, and the lungs are clear to auscultation (see report). CT scan chest: Showed an 8 mm left lung nodule. Which of the following is the most appropriate next step in management?
A 63-year-old woman presented with exertional dyspnea for 8 months. She was diagnosed with COPD 3 years ago and has had 4 exacerbations in the last year. She completed pulmonary rehabilitation and quit smoking 2 years ago. Medications include long-acting B2 agonist, inhaled glucocorticoid, roflumilast, and albuterol as needed. Examination revealed no jugular venous distention; decreased breath sounds, a loud pulmonary component of S1 (see lab results and reports). Chest radiograph: Normal. Echocardiogram: Ejection fraction of 60%, no valvular or wall motion abnormalities, and estimated mean pulmonary artery pressure is 55 mmHg. Which of the following is the most appropriate treatment?
A 63-year-old woman presented with exertional dyspnea for 8 months. She was diagnosed with COPD 3 years ago and has had 4 exacerbations in the last year. She completed pulmonary rehabilitation and quit smoking 2 years ago. Medications include long-acting B2 agonist, inhaled glucocorticoid, roflumilast, and albuterol as needed. Examination revealed no jugular venous distention; decreased breath sounds, a loud pulmonary component of S1 (see lab results and reports). Chest radiograph: Normal. Echocardiogram: Ejection fraction of 60%, no valvular or wall motion abnormalities, and estimated mean pulmonary artery pressure is 55 mmHg. Which of the following is the most appropriate treatment?
A 58-year-old woman presented to the medical clinic complaining of daily wheezing and breathlessness during allergy season. These episodes of wheezing have limited her activities several times a week. She has a long history of seasonal allergies in the form of itchy eyes and runny nose. No other medical history. Medications include loratadine as needed, and antihistamine eye drops. Examination revealed watery eyes with conjunctival irritation, expiratory wheezing, and normal cardiac examination (see reports). Chest radiograph: Unremarkable. Spirometry: FEV1 of 74% of predicted, which improved by 18% with a bronchodilator. Which of the following is the most appropriate treatment?
A 58-year-old woman presented to the medical clinic complaining of daily wheezing and breathlessness during allergy season. These episodes of wheezing have limited her activities several times a week. She has a long history of seasonal allergies in the form of itchy eyes and runny nose. No other medical history. Medications include loratadine as needed, and antihistamine eye drops. Examination revealed watery eyes with conjunctival irritation, expiratory wheezing, and normal cardiac examination (see reports). Chest radiograph: Unremarkable. Spirometry: FEV1 of 74% of predicted, which improved by 18% with a bronchodilator. Which of the following is the most appropriate treatment?
A 71-year-old man is evaluated after a recent hospitalization 10 days ago for pneumonia and was discharged with a 10-day course of appropriate antibiotics. For the past 5 days, he has had a low-grade fever and increased shortness of breath. Pulmonary examination reveals decreased fremitus, dullness to percussion, and decreased breath sounds over the lower third of the right hemithorax (see lab results and report). Chest radiograph: Moderate right-sided pleural effusion. Which of the following is the most appropriate management?
A 71-year-old man is evaluated after a recent hospitalization 10 days ago for pneumonia and was discharged with a 10-day course of appropriate antibiotics. For the past 5 days, he has had a low-grade fever and increased shortness of breath. Pulmonary examination reveals decreased fremitus, dullness to percussion, and decreased breath sounds over the lower third of the right hemithorax (see lab results and report). Chest radiograph: Moderate right-sided pleural effusion. Which of the following is the most appropriate management?
A 20-year-old man is evaluated for a 6-month history of chest and throat tightness, acute episodes of stridor, and a prolonged wheeze that occur during his college basketball practice. He has a history of moderate persistent asthma, which is controlled. He takes a short-acting B2 agonist inhaler as needed, but this does not relieve his symptoms. In addition to a low-dose inhaled glucocorticoid and a long-acting inhaled B2 agonist, he otherwise feels well. Medical history is otherwise unremarkable. Examination reveals normal vital signs and unremarkable systemic examination (see reports). Chest radiograph: Normal. Spirometry: No evidence of obstruction. Which of the following is the most appropriate next step in management?
A 20-year-old man is evaluated for a 6-month history of chest and throat tightness, acute episodes of stridor, and a prolonged wheeze that occur during his college basketball practice. He has a history of moderate persistent asthma, which is controlled. He takes a short-acting B2 agonist inhaler as needed, but this does not relieve his symptoms. In addition to a low-dose inhaled glucocorticoid and a long-acting inhaled B2 agonist, he otherwise feels well. Medical history is otherwise unremarkable. Examination reveals normal vital signs and unremarkable systemic examination (see reports). Chest radiograph: Normal. Spirometry: No evidence of obstruction. Which of the following is the most appropriate next step in management?
A 33-year-old man presented with shortness of breath, fatigue, and nighttime cough. He has been working in a car repair shop for the past 1 year and notes that his symptoms began about 8 months ago. He believes his symptoms are associated with his workdays. He is being evaluated after several days off from work and currently has no symptoms or medical concerns. He has an unremarkable medical history and takes no medications. He has never smoked. Physical examination is unremarkable. A chest radiograph and spirometry results are normal. Which of the following is the most appropriate next step in management?
A 33-year-old man presented with shortness of breath, fatigue, and nighttime cough. He has been working in a car repair shop for the past 1 year and notes that his symptoms began about 8 months ago. He believes his symptoms are associated with his workdays. He is being evaluated after several days off from work and currently has no symptoms or medical concerns. He has an unremarkable medical history and takes no medications. He has never smoked. Physical examination is unremarkable. A chest radiograph and spirometry results are normal. Which of the following is the most appropriate next step in management?
A 49-year-old woman is evaluated for a 4-month history of dry cough, which began 4 months ago when she noted a paroxysmal onset of persistent coughing spells that make it difficult to carry on a conversation. She was initially diagnosed with allergic rhinitis and was started on a glucocorticoid nasal inhaler with no improvement. Medical history is otherwise unremarkable except for a history of dust allergies. Examination revealed normal vital signs, slight nasal congestion, and dry cough are noted during the examination. Cardiovascular, pulmonary, and abdominal examination findings are unremarkable (see reports). Chest radiograph: Normal. Spirometry: Slightly reduced FEV/FVC ratio of 70% which increased after bronchodilator challenge by 20%. Which of the following is the most appropriate diagnostic test to perform next?
A 49-year-old woman is evaluated for a 4-month history of dry cough, which began 4 months ago when she noted a paroxysmal onset of persistent coughing spells that make it difficult to carry on a conversation. She was initially diagnosed with allergic rhinitis and was started on a glucocorticoid nasal inhaler with no improvement. Medical history is otherwise unremarkable except for a history of dust allergies. Examination revealed normal vital signs, slight nasal congestion, and dry cough are noted during the examination. Cardiovascular, pulmonary, and abdominal examination findings are unremarkable (see reports). Chest radiograph: Normal. Spirometry: Slightly reduced FEV/FVC ratio of 70% which increased after bronchodilator challenge by 20%. Which of the following is the most appropriate diagnostic test to perform next?
A 57-year-old man is evaluated for chronic cough, occasional wheezing, and exertional dyspnea while walking. Medical history includes an episode of bronchitis, for which he underwent outpatient treatment 8 months ago. He has a 20-pack-year smoking history. Examination revealed normal vital signs, mildly decreased breath sounds throughout both lungs, and scattered expiratory wheezes bilaterally. Spirometry shows an FEV1 of 75% of predicted and a post-bronchodilator FEV/FVC ratio of 68%. His modified Medical Research Council (mMRC) symptom score is 2. In addiction to smoking cessation, which of the following is the most appropriate long-term management plan?
A 57-year-old man is evaluated for chronic cough, occasional wheezing, and exertional dyspnea while walking. Medical history includes an episode of bronchitis, for which he underwent outpatient treatment 8 months ago. He has a 20-pack-year smoking history. Examination revealed normal vital signs, mildly decreased breath sounds throughout both lungs, and scattered expiratory wheezes bilaterally. Spirometry shows an FEV1 of 75% of predicted and a post-bronchodilator FEV/FVC ratio of 68%. His modified Medical Research Council (mMRC) symptom score is 2. In addiction to smoking cessation, which of the following is the most appropriate long-term management plan?
A 42-year-old woman presented to the clinic for follow-up of a 7-month history of chronic, nonproductive cough. She was recently diagnosed with cough-variant asthma after a methacholine challenge test. She was started on inhaled fluticasone and as-needed albuterol 2 months ago. Her cough initially improved; however, her symptoms have not fully resolved and are worsened at times, most notably when she lies down. She also noted that mild hoarseness occasionally accompanies her cough, especially when she wakes up in the morning. Examination revealed a dry cough with frequent throat clearing. The chest was clear with no wheezing. Which of the following is the most appropriate management?
A 42-year-old woman presented to the clinic for follow-up of a 7-month history of chronic, nonproductive cough. She was recently diagnosed with cough-variant asthma after a methacholine challenge test. She was started on inhaled fluticasone and as-needed albuterol 2 months ago. Her cough initially improved; however, her symptoms have not fully resolved and are worsened at times, most notably when she lies down. She also noted that mild hoarseness occasionally accompanies her cough, especially when she wakes up in the morning. Examination revealed a dry cough with frequent throat clearing. The chest was clear with no wheezing. Which of the following is the most appropriate management?
A 17-year-old man presented to the Emergency Department with severe asthma exacerbation that began 12 hours ago. He is on an albuterol inhaler and a long-acting glucocorticoid at home without improvement. He was hospitalized and intubated 2 years ago. Examination revealed respiratory distress with diffuse expiratory wheezes. After 1 hour of systemic glucocorticoid and B2 agonist nebulizer, he still appeared in respiratory distress (see lab results and report). Chest X-ray: Hyperinflated lungs. Which of the following is the most appropriate next step in management?
A 17-year-old man presented to the Emergency Department with severe asthma exacerbation that began 12 hours ago. He is on an albuterol inhaler and a long-acting glucocorticoid at home without improvement. He was hospitalized and intubated 2 years ago. Examination revealed respiratory distress with diffuse expiratory wheezes. After 1 hour of systemic glucocorticoid and B2 agonist nebulizer, he still appeared in respiratory distress (see lab results and report). Chest X-ray: Hyperinflated lungs. Which of the following is the most appropriate next step in management?
A 63-year-old man was evaluated in the Emergency Room for 1 week of progressive shortness of breath and found to have right pleural effusion on chest X-ray. Aspiration yielded a clear transudative fluid. Which of the following is the most likely cause?
A 63-year-old man was evaluated in the Emergency Room for 1 week of progressive shortness of breath and found to have right pleural effusion on chest X-ray. Aspiration yielded a clear transudative fluid. Which of the following is the most likely cause?
A 24-year-old woman is reviewed in the Asthma Clinic. She currently uses a salbutamol inhaler 100 mcg prn combined with a beclometasone dipropionate inhaler 400 mcg bd. Despite this, she is having frequent exacerbations of her asthma that required frequent courses of prednisolone and hospitalization three times in the last 6 months. What is the most appropriate next step in management?
A 24-year-old woman is reviewed in the Asthma Clinic. She currently uses a salbutamol inhaler 100 mcg prn combined with a beclometasone dipropionate inhaler 400 mcg bd. Despite this, she is having frequent exacerbations of her asthma that required frequent courses of prednisolone and hospitalization three times in the last 6 months. What is the most appropriate next step in management?
A 63-year-old woman is in the COPD clinic for frequent exacerbations, despite being maintained on a salbutamol inhaler as required and a tiotropium inhaler regularly. She was diagnosed with COPD three years ago and and recently quit smoking. Her latest FEV1 was 39% of predicted. Which of the following is the most appropriate step in her management?
A 63-year-old woman is in the COPD clinic for frequent exacerbations, despite being maintained on a salbutamol inhaler as required and a tiotropium inhaler regularly. She was diagnosed with COPD three years ago and and recently quit smoking. Her latest FEV1 was 39% of predicted. Which of the following is the most appropriate step in her management?
Flashcards
Gout
Gout
A type of arthritis characterized by sudden, severe pain, redness, and tenderness in joints, often the big toe.
Psoriatic arthritis
Psoriatic arthritis
A type of arthritis that affects some people who have psoriasis, causing joint pain and swelling.
Systemic lupus erythematosus (SLE)
Systemic lupus erythematosus (SLE)
An autoimmune disease where the body's immune system attacks its own tissues, affecting multiple systems.
Avascular necrosis
Avascular necrosis
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Osteoarthritis
Osteoarthritis
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Rheumatoid arthritis
Rheumatoid arthritis
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CT scan
CT scan
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Lumbar puncture
Lumbar puncture
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Pulmonary embolism
Pulmonary embolism
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COPD
COPD
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Asthma
Asthma
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Bronchitis
Bronchitis
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Renal failure
Renal failure
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Echocardiogram
Echocardiogram
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Anemia
Anemia
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Cirrhosis
Cirrhosis
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Thrombosis
Thrombosis
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Sepsis
Sepsis
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Cardiac enzymes
Cardiac enzymes
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Infection control
Infection control
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Bronchoscopy
Bronchoscopy
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Intervention for variceal bleeding
Intervention for variceal bleeding
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HIV and pneumonia association
HIV and pneumonia association
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Hyperthyroidism
Hyperthyroidism
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Hypothyroidism
Hypothyroidism
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Respiratory distress syndrome (ARDS)
Respiratory distress syndrome (ARDS)
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Glomerulonephritis
Glomerulonephritis
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Cognitive impairment
Cognitive impairment
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Acute kidney injury (AKI)
Acute kidney injury (AKI)
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Study Notes
Medical Case Studies - Summaries
- These notes summarize medical case studies from a variety of scenarios, including patient symptoms, diagnoses, and treatment plans.
- Focus is on key medical facts, diagnoses, and treatments. No personal information is included.
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Description
Concise summaries of diverse medical case studies. Focuses on patient symptoms, diagnoses, and treatment plans. Emphasis on key medical facts and analytical insights.
