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Questions and Answers
What is the most likely diagnosis for a 58 year-old male presenting with weakness of grip, hyperactivity of DTRs, extensor plantar reflexes, and dysarthria?
What is the most likely diagnosis for a 58 year-old male presenting with weakness of grip, hyperactivity of DTRs, extensor plantar reflexes, and dysarthria?
Which of the following is NOT a risk factor for the development of osteoporosis?
Which of the following is NOT a risk factor for the development of osteoporosis?
Which of the following diagnostic modalities will identify the source of a pale, cool extremity with severe pain and 'burning' sensation in approximately 95% of cases?
Which of the following diagnostic modalities will identify the source of a pale, cool extremity with severe pain and 'burning' sensation in approximately 95% of cases?
What is the most likely diagnosis for a patient experiencing rectal pain described as 'severe tightness' that interrupts sleep?
What is the most likely diagnosis for a patient experiencing rectal pain described as 'severe tightness' that interrupts sleep?
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Which condition is best described for a 38 year-old chronic smoker with recurrent wheezing and a chronic cough producing mucus?
Which condition is best described for a 38 year-old chronic smoker with recurrent wheezing and a chronic cough producing mucus?
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What is the most likely agent causing central scotomata and loss of green-red color perception in a patient treated for Tuberculosis?
What is the most likely agent causing central scotomata and loss of green-red color perception in a patient treated for Tuberculosis?
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What kind of fracture is most likely for a child with a fracture line through the metaphysis of the proximal middle phalanx ending at the epiphyseal plate?
What kind of fracture is most likely for a child with a fracture line through the metaphysis of the proximal middle phalanx ending at the epiphyseal plate?
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Which test would be most compatible with a suspected diagnosis of pericarditis in a patient with chest pain worsened by swallowing?
Which test would be most compatible with a suspected diagnosis of pericarditis in a patient with chest pain worsened by swallowing?
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What is the most important diagnostic study for a 2-month-old febrile male with a petechial rash?
What is the most important diagnostic study for a 2-month-old febrile male with a petechial rash?
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What condition is most likely being treated if a sister requests refills of dexamethasone and homatropine ophthalmic drops?
What condition is most likely being treated if a sister requests refills of dexamethasone and homatropine ophthalmic drops?
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What is the best initial test to establish the diagnosis for a small pulsating mass at the level of the umbilicus?
What is the best initial test to establish the diagnosis for a small pulsating mass at the level of the umbilicus?
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What is the most likely diagnosis for a patient complaining of right lower extremity swelling after cardiac catheterization with a bruit heard over the right groin?
What is the most likely diagnosis for a patient complaining of right lower extremity swelling after cardiac catheterization with a bruit heard over the right groin?
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What is the treatment of choice for a patient with chronic venous insufficiency presenting with nonpitting edema and dermatitis?
What is the treatment of choice for a patient with chronic venous insufficiency presenting with nonpitting edema and dermatitis?
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What is the most likely diagnosis for a 78-year-old woman who develops severe diffuse abdominal pain four days after MI?
What is the most likely diagnosis for a 78-year-old woman who develops severe diffuse abdominal pain four days after MI?
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From which of the following is a cyanotic and cold right lower extremity likely to originate in a patient with atrial fibrillation?
From which of the following is a cyanotic and cold right lower extremity likely to originate in a patient with atrial fibrillation?
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Which is the most common site at which an arterial embolus lodges?
Which is the most common site at which an arterial embolus lodges?
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Stenosis of which vessel is associated with the highest patency rates following angioplasty or stenting?
Stenosis of which vessel is associated with the highest patency rates following angioplasty or stenting?
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What further impairs wound healing after a midline abdominal incision and bowel resection performed on a retired surgeon?
What further impairs wound healing after a midline abdominal incision and bowel resection performed on a retired surgeon?
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For a 60-year-old male with an inguinal hernia of recent onset, which statement is TRUE?
For a 60-year-old male with an inguinal hernia of recent onset, which statement is TRUE?
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What is the likely diagnosis for a 70-year-old male cigarette smoker with a right inguinal mass that reduces when resting?
What is the likely diagnosis for a 70-year-old male cigarette smoker with a right inguinal mass that reduces when resting?
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What is correct regarding a strangulated inguinal hernia?
What is correct regarding a strangulated inguinal hernia?
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What is the most likely diagnosis for a 25-year-old man with recurrent fistula in ano, weight loss, and diarrhea with blood in the stool?
What is the most likely diagnosis for a 25-year-old man with recurrent fistula in ano, weight loss, and diarrhea with blood in the stool?
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In a patient with known ulcerative colitis, which of the following indicates a need for total proctocolectomy?
In a patient with known ulcerative colitis, which of the following indicates a need for total proctocolectomy?
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Colectomy should be advised in patients with ulcerative colitis who have symptoms that persist for more than which of the following?
Colectomy should be advised in patients with ulcerative colitis who have symptoms that persist for more than which of the following?
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What is the most likely cause of increased abdominal pain, vomiting, and fever in a patient with a long history of bloody diarrhea?
What is the most likely cause of increased abdominal pain, vomiting, and fever in a patient with a long history of bloody diarrhea?
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The most likely diagnosis for a large amount of seroanguinous drainage from the abdominal wound that occurs 5 to 7 days post-op is:
The most likely diagnosis for a large amount of seroanguinous drainage from the abdominal wound that occurs 5 to 7 days post-op is:
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Which cardiac disease is most likely to cause exertional dyspnea and angina in a 49-year-old man?
Which cardiac disease is most likely to cause exertional dyspnea and angina in a 49-year-old man?
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The hypertensive emergency that is most easily reversible with pharmaceutical management is:
The hypertensive emergency that is most easily reversible with pharmaceutical management is:
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Which statement regarding posterior wall infarction is correct?
Which statement regarding posterior wall infarction is correct?
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Regarding treatment of heart failure in patients with diastolic rather than systolic dysfunction:
Regarding treatment of heart failure in patients with diastolic rather than systolic dysfunction:
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Which statement regarding the use of continuous positive airway pressure therapy in pulmonary edema is correct?
Which statement regarding the use of continuous positive airway pressure therapy in pulmonary edema is correct?
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The most specific diagnostic test that can be obtained for an emergency department patient to make the initial diagnosis of aortic dissection is:
The most specific diagnostic test that can be obtained for an emergency department patient to make the initial diagnosis of aortic dissection is:
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Which of the following is the most common ECG abnormality associated with mitral valve prolapse?
Which of the following is the most common ECG abnormality associated with mitral valve prolapse?
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The next most appropriate management step for a 46-year-old woman with abdominal pain and elevated liver enzymes is:
The next most appropriate management step for a 46-year-old woman with abdominal pain and elevated liver enzymes is:
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Which of the following statements regarding ingested foreign bodies is correct?
Which of the following statements regarding ingested foreign bodies is correct?
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What is the appropriate next management step for a patient with Boerhaave syndrome?
What is the appropriate next management step for a patient with Boerhaave syndrome?
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The most appropriate management for a 53-year-old man with cirrhosis who presents with abdominal pain and elevated WBCs is:
The most appropriate management for a 53-year-old man with cirrhosis who presents with abdominal pain and elevated WBCs is:
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After assessing a 54-year-old man with a history of 'alcoholic liver disease' presenting with hematemesis, what is most likely to provide definitive treatment?
After assessing a 54-year-old man with a history of 'alcoholic liver disease' presenting with hematemesis, what is most likely to provide definitive treatment?
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What is the Glasgow Coma Scale score for a patient who is moaning, will not open his eyes to pain but withdraws to pain?
What is the Glasgow Coma Scale score for a patient who is moaning, will not open his eyes to pain but withdraws to pain?
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What would be the best diagnostic test to definitively diagnose the etiology of the patient's abdominal pain after trauma?
What would be the best diagnostic test to definitively diagnose the etiology of the patient's abdominal pain after trauma?
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Which patient could be safely managed in a community emergency department, avoiding transfer to a burn unit?
Which patient could be safely managed in a community emergency department, avoiding transfer to a burn unit?
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Which statement is correct regarding the treatment of a patient with lacerations to the hand?
Which statement is correct regarding the treatment of a patient with lacerations to the hand?
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What is the most appropriate emergency department management for uncomplicated diverticulitis in a middle-aged patient?
What is the most appropriate emergency department management for uncomplicated diverticulitis in a middle-aged patient?
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What is the next appropriate intervention for a 27-year-old woman with rapid narrow-complex regular tachycardia?
What is the next appropriate intervention for a 27-year-old woman with rapid narrow-complex regular tachycardia?
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What is the next best step in management for a patient with blunt force trauma to the chest who developed severe shortness of breath?
What is the next best step in management for a patient with blunt force trauma to the chest who developed severe shortness of breath?
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Which of the following is most likely true about a 26-year-old female with multiple bruises and anxiety?
Which of the following is most likely true about a 26-year-old female with multiple bruises and anxiety?
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What is the most likely diagnosis for a young male with erratic atrial activity showing irregular ventricular response after heavy alcohol consumption?
What is the most likely diagnosis for a young male with erratic atrial activity showing irregular ventricular response after heavy alcohol consumption?
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What is the best initial treatment for a 13-year-old girl with acute, heavy vaginal bleeding?
What is the best initial treatment for a 13-year-old girl with acute, heavy vaginal bleeding?
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What would be most helpful to differentiate androgen insensitivity syndrome from mullerian agenesis?
What would be most helpful to differentiate androgen insensitivity syndrome from mullerian agenesis?
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Which vitamin is most commonly deficient in vegetarian diets?
Which vitamin is most commonly deficient in vegetarian diets?
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Which birth control method has the highest failure rate?
Which birth control method has the highest failure rate?
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What is the most appropriate next step for managing a 39-year-old female with vaginal bleeding and a negative pregnancy test?
What is the most appropriate next step for managing a 39-year-old female with vaginal bleeding and a negative pregnancy test?
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What is the most appropriate next step in managing a 64-year-old female with light vaginal bleeding and no abdominal pain?
What is the most appropriate next step in managing a 64-year-old female with light vaginal bleeding and no abdominal pain?
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What type of placentation is the most common in monozygotic twins?
What type of placentation is the most common in monozygotic twins?
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Patients with the gene for hereditary non-polyposis colorectal cancer have an increased risk for which gynecologic cancer?
Patients with the gene for hereditary non-polyposis colorectal cancer have an increased risk for which gynecologic cancer?
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What risk factor confers the highest risk for an ectopic pregnancy?
What risk factor confers the highest risk for an ectopic pregnancy?
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What is the appropriate treatment for vulvar pruritis revealed by colposcopy?
What is the appropriate treatment for vulvar pruritis revealed by colposcopy?
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Study Notes
Neurological Disorders
- A 58-year-old male with bilateral grip weakness and hyperactive deep tendon reflexes likely suffers from ALS (Amyotrophic Lateral Sclerosis).
- Multiple sclerosis (MS) may present with dysarthria but would typically have sensory impairment and bladder dysfunction, differentiating it from ALS.
Osteoporosis Risk Factors
- Risk factors for osteoporosis include low testosterone, low physical activity, smoking, and chronic corticosteroid use.
- Inadequate dietary protein is not a risk factor; low dietary calcium is the concern for osteoporosis.
Pain and Diagnostic Procedures
- Severe extremity pain, pale and cool limb with absent pulsation suggests arterial occlusion; an aortic angiogram is the gold standard for diagnosis.
- Proctalgia fugax is indicated for recurring rectal pain that interrupts sleep without other symptoms like bleeding.
- Chronic bronchitis is presented by a chronic smoker with cough and wheezing, often exacerbated by respiratory infections.
Tuberculosis Treatment Side Effects
- Ethambutol causes eye symptoms including scotomata and altered color perception in tuberculosis treatment.
Pediatric Conditions
- In a child with abdominal pain and fever where the appendix appears normal, consider mesenteric adenitis or similar diagnoses.
Beta-Blockers and Airways
- Metoprolol is the most cardioselective beta-blocker and could theoretically be used in patients with reactive airway disease despite general contraindications.
Abdominal Aortic Aneurysm (AAA) Management
- Acceptable indications for surgery in AAA include a 5.5 cm asymptomatic aneurysm and presence of an associated iliac aneurysm.
- Ultrasound is the preferred initial diagnostic test for abdominal aortic aneurysms due to its non-invasive nature.
Venous Issues and Treatments
- Chronic venous insufficiency treatment of choice is pressure-gradient stockings, not surgical options unless indicated.
Embolism Sources
- The heart accounts for approximately 90% of lower extremity emboli; common sites for emboli to lodge include the common femoral artery.
Hernias
- Direct inguinal hernias typically occur in adults and are less prone to strangulation due to wider necks, differing from indirect hernias.
Inflammatory Bowel Disease
- Crohn's colitis is characterized by recurrent anus fistulas, diarrhea with blood, and weight loss, differing from ulcerative colitis which affects the rectum.
Surgical Complications
- Wound dehiscence can occur 5 to 7 days post-op and is characterized by serosanguinous drainage, indicating an issue with surgical closure.
Cardiac Conditions
- Aortic stenosis is characterized by exertional dyspnea, angina, and syncope, especially in younger patients engaged in physical activities.### Tricuspid Incompetence
- Tricuspid incompetence involves the improper closure of the tricuspid valve, leading to backward flow of blood into the right atrium during ventricular contraction.
- Symptoms include fatigue, peripheral edema, ascites, and jugular venous distension.
Hypertensive Emergency
- The most easily reversible hypertensive emergency is encephalopathy.
- Other emergencies include acute coronary syndrome, aortic dissection, eclampsia/preeclampsia, and intracranial hemorrhage.
Posterior Wall Infarction
- Linked with ST-segment depression in V1 on ECG.
- It is characterized by inverted T waves and large S waves in V1; affects about 5% of acute myocardial infarctions (MIs).
Heart Failure Management
- In diastolic heart failure, β-blocking agents may enhance cardiac output.
- Diuretics are not as effective compared to therapies for systolic dysfunction; both types may present challenges in cardiac contractility.
Continuous Positive Airway Pressure Therapy
- CPAP in pulmonary edema reduces the work of breathing.
- It is effective in decreasing left ventricular preload and increasing thoracic pressure but does lower intrathoracic pressure.
Aortic Dissection Diagnosis
- The most specific and rapid test is a helical CT chest scan.
- Other possible diagnostic methods include 12-lead ECG, aortic angiography, portable chest x-ray, and transesophageal echocardiography.
Mitral Valve Prolapse
- The most common ECG abnormality associated with mitral valve prolapse is paroxysmal supraventricular tachycardia.
- It can also lead to QT prolongation and ST-segment changes.
Management of Abdominal Pain
- For suspected gallbladder pathology, RUQ ultrasonography is the most appropriate initial diagnostic step for a woman with abdominal pain and elevated liver enzymes.
Management of Ingested Foreign Bodies
- Objects longer than 5 cm and wider than 2 cm should be removed before passing through the stomach to prevent complications.
Boerhaave Syndrome
- Initial management includes administering broad-spectrum antibiotics following perforation of the esophagus due to severe vomiting.
Spontaneous Bacterial Peritonitis
- In a patient with cirrhosis and abdominal pain, starting cefotaxime and admitting the patient is the most appropriate management.
Treatment for Hematemesis
- Definitive treatment for a patient with hematemesis from liver disease is emergent endoscopy with sclerotherapy.
Glasgow Coma Scale
- A 23-year-old man with a score of 7 on the Glasgow Coma Scale demonstrates a medically altered state following trauma.
Abdominal Pain Evaluation
- An abdominal CT scan is the preferred diagnostic test for a stable patient with suspected abdominal injury after trauma.
Burn Management
- A 75-year-old man with a 5% BSA superficial partial-thickness burn can often be managed in a community emergency department, avoiding transfer to specialized burn units.
Wound Care Post-Fistfight
- Delayed primary closure or healing by secondary intention is appropriate for lacerations following a fistfight.
Diverticulitis Management
- The most appropriate management for uncomplicated diverticulitis in a suitable patient involves prescribing oral antibiotics.
Tachycardia Intervention
- In cases of persistent rapid narrow-complex tachycardia, the next step following initial treatment is administering adenosine 12 mg IV.
Chest Trauma Management
- In cases of blunt chest trauma leading to respiratory distress, immediate needle decompression is critical.
Intimate Partner Violence
- Pregnancy increases the risk of abuse in situations of domestic violence.
Alcohol-Induced Cardiac Problems
- Atrial fibrillation can occur in intoxicated individuals, characterized by erratic atrial activity and associated symptoms.
Heavy Vaginal Bleeding in Adolescents
- IV estrogen is the best initial treatment for severe vaginal bleeding in a young female with heavy menstrual issues.
Endocrine Disorders
- A distinguishing factor for androgen insensitivity syndrome is elevated serum testosterone compared to mullerian agenesis.
Nutritional Deficiencies
- Vegetarian diets often lead to vitamin B12 deficiency, necessitating supplementation during preconception counseling.
Birth Control Efficacy
- The lowest efficacy in preventing pregnancy is seen with oral contraceptive pills (OCPs), while surgical methods like sterilization have the highest effectiveness.
Management of Vaginal Bleeding
- In cases of prolonged vaginal bleeding in a middle-aged female, a referral to a gynecologist for endometrial biopsy is warranted.
Placental Types in Twins
- The most common placentation type in monozygotic twins is monochorionic/diamniotic.
Cancer Risks in Hereditary Syndromes
- Patients with hereditary non-polyposis colorectal cancer have a heightened risk for endometrial cancer.
Ectopic Pregnancy Risk Factors
- A history of previous ectopic pregnancy is a significant risk factor for future ectopic pregnancies.
Laser Treatment for Vulvar Issues
- Laser vaporization is a potential treatment option for multifocal conditions like vulvar pruritis.
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Description
Test your knowledge with these PANCE practice questions. This quiz focuses on neurological symptoms and diagnoses, featuring a case study on a patient presenting with grip weakness and hyperactive reflexes. Challenge yourself to identify the correct diagnosis based on the given information.
