Author Topic: Medical Board Vignettes  (Read 4200 times)

Lorenzo

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Medical Board Vignettes
« on: March 10, 2011, 02:34:26 AM »
Soccer player who was kicked in the leg suffered a damaged medial meniscus.

What else is likely to have been damaged?

A: Anterior cruciate ligament ("unhappy triad")

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Re: Medical Board Vignettes
« Reply #1 on: March 10, 2011, 02:35:47 AM »
X-RAY show bilateral hilar lymphadenopathy. What is diagnosis?

A: Sarcoidosis

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Re: Medical Board Vignettes
« Reply #2 on: March 10, 2011, 02:37:12 AM »
25 year old woman presents with a low grade fever, a rash across her nose that gets worse when she is out in the sun, and widespread edema.

You are concerned about what disease?

A: SLE (systemic lups erythermatosus)

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Re: Medical Board Vignettes
« Reply #3 on: March 10, 2011, 02:38:35 AM »
A 60 year old asian man  presents with acute knee pain and swelling. X-RAY shows joint space without erosion.

What is the diagnosis and what would you find on aspiration?

A: Pseudogout; rhomboid calcium pyrophosphate crystals in aspirate.



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Lorenzo

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Re: Medical Board Vignettes
« Reply #4 on: March 10, 2011, 02:39:34 AM »
A 60 year old asian man  presents with acute knee pain and swelling. X-RAY shows joint space without erosion.

What is the diagnosis and what would you find on aspiration?

A: Pseudogout; rhomboid calcium pyrophosphate crystals in aspirate.



Treatment?

A: Long-term NSAID treatment, colchicine, allopurinol.

A2: Advise patient to stay away from high cholesterol intake

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Re: Medical Board Vignettes
« Reply #5 on: March 10, 2011, 02:42:33 AM »
Man presents with 1 wild, flailing arm. Where is the lesion?

A: Contralateral subthalamic nucleus (Hemiballismus)



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Re: Medical Board Vignettes
« Reply #6 on: March 10, 2011, 02:43:28 AM »
Patient's tongue protrudes toward the left side, and patient exhibits a right-sided spastic paralysis.

Where is the lesion?

A: Left medulla, CN XII

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Re: Medical Board Vignettes
« Reply #7 on: March 10, 2011, 02:44:30 AM »
43 year old man experiences dizziness and tinnitus. CT shows an enlarged internal acoustic meatus.

What is diagnosis?

A: Schwannoma

Treatment: Surgical removal

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Re: Medical Board Vignettes
« Reply #8 on: March 10, 2011, 02:45:22 AM »
25 year old woman presents with sudden monocular vision loss and slightly slurred speech. She has a history of weakness and parethesias that have resolved.

What is the diagnosis?

A: Multiple Sclerosis

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Re: Medical Board Vignettes
« Reply #9 on: March 10, 2011, 02:47:47 AM »
25 year old woman presents with sudden monocular vision loss and slightly slurred speech. She has a history of weakness and parethesias that have resolved.

What is the diagnosis?

A: Multiple Sclerosis

Treatment: Steroids, Interferon

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Re: Medical Board Vignettes
« Reply #10 on: March 10, 2011, 02:53:13 AM »
10 year old child "spaces out" in class. During spells, the child has a slight quivering of the lips.

Diagnosis?

A: Absence Seizures

Treatment: Ethosuximide

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Re: Medical Board Vignettes
« Reply #11 on: March 10, 2011, 02:57:04 AM »
65 year old man presents with paranoia, obsessive compulsion, delusion of neighbours following him, presents with introverted lifestyle.

What is diagnosis?

A: Cluster A personality disorder with possible schizoid tendency

Treatment: Neuroleptics (Thioridazine, fluphenazine, chlorpromazine ) + adjutant psychoanalytic psychotherapy




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Re: Medical Board Vignettes
« Reply #12 on: March 10, 2011, 03:03:42 AM »
** very popular board question


Military Veteran becomes paralyzed upon hearing airplane engines.

What is the diagnosis?

A: PTSD (post traumatic stress disorder)



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Re: Medical Board Vignettes
« Reply #13 on: March 12, 2011, 01:08:08 AM »
child has been anemic since birth.

splenectomy would result in increased hematocrit in what disease?

A: spherocytosis

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Re: Medical Board Vignettes
« Reply #14 on: March 12, 2011, 01:08:52 AM »
patient presents with fatigue and blood tests show a macrocytic , megaloblastic anemia.

what is the danger of giving folate alone?

A: corrects anemia, but neural damage progresses if the patient is B12 deficient.

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Re: Medical Board Vignettes
« Reply #15 on: March 12, 2011, 01:10:21 AM »
Patient presents with anemia, hypercalcemia, and bone pain on palpation; bone marrow biopsy shows a slide packed with cells that have a large, round, off-center nucleus.

what is the diagnosis and what may be found on urinalysis?

A: multiple myeloma (plasma cell neoplasm); Bence Jones protein (Ig Light Chains)

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Re: Medical Board Vignettes
« Reply #16 on: March 12, 2011, 01:11:15 AM »
AIDS patient has just been diagnosed with cancer.

What neoplasms are associated with AIDS?

A: B-cell lymphoma, kaposi's sarcoma

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Re: Medical Board Vignettes
« Reply #17 on: March 12, 2011, 03:13:40 AM »
A 16 year old gymnast presents to the emergency department after landing awkwardly on her ankle. She is diagnosed with a sprained ankle. Which of the following ligaments is most commonly injured in an ankle sprain?



A: Anterior talofibular ligament

Reason: The lateral ligaments are most commonly injured , and the most common of these ligaments is the Anterior Talofibular Ligament.

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Re: Medical Board Vignettes
« Reply #18 on: March 12, 2011, 03:23:40 AM »
An 8 year old boy is brought to his pediatrician by his parents with complaints of swelling
and pain over his right femur for the past 2-3 weeks. The child and parents deny any history
of trauma to the region. The patient reports that the pain is often worse at night, and his
mother states that he has been having low grade fevers of 37.8 degs C. On physical exam,
there is no erythema of the region, but a firm immobile tender mass is palpable. Fine needle
aspiration cytology of the region reveals anaplastic small blue cells. Genetic evaluation of this
patient is most likely to reveal which of the following?


A: t (11; 22) chromosomal translocation


Reasoning: the patient's presentation and histology is most consistent with Ewing's Sarcoma and is associated with t(11;22) translocations.

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Deepwater

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Re: Medical Board Vignettes
« Reply #19 on: March 18, 2011, 03:13:11 PM »
thanks for these, doc... nice ireview

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Lorenzo

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Re: Medical Board Vignettes
« Reply #20 on: March 18, 2011, 03:14:33 PM »
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Lorenzo

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Re: Medical Board Vignettes
« Reply #21 on: March 18, 2011, 03:16:50 PM »
do you remember the pneumonic for BRACHIAL PLEXUS damage?


DR. MACU


------

Damage to Radial Nerve = Drop Wrist

Damage to Median Nerve = Ape Hand

Damage to Ulnar Nerve = Claw Hand

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Deepwater

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Re: Medical Board Vignettes
« Reply #22 on: March 18, 2011, 03:19:02 PM »
put some more. nalingaw ko. hehehe

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Re: Medical Board Vignettes
« Reply #23 on: March 18, 2011, 03:20:31 PM »
haha. nalingaw ka sa anatomy ? oy, you are indeed a geek eh? ;)

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Re: Medical Board Vignettes
« Reply #24 on: March 18, 2011, 03:25:39 PM »
buing... nice man ireview nga naay mkarelate gud... lahi sad ako remembering tool sa brachial plexus... Radial.n---wRist drop (R=R),  Ulnar n.--Claw hand (itakilid ang u= c) median n.---ape hand or waiters tip (balihon ang M=W)

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Re: Medical Board Vignettes
« Reply #25 on: March 18, 2011, 03:26:55 PM »
Warning: This is sexual, but highly useful and well remembered by many, many male medics. bwahahaha


THE 12 CRANIAL NERVES


Mnemonic : Oh Oh Oh To Touch And Feel Virgin Girl's Vagina Ah Heaven!



O = Ocular
O = Optic
O = Oculomotor
T = Trochlear
T = Trigeminal
A = Abducens
F = Facial
V = Vestibulococchlear
G = Glossopharyngeal
A = Accessory
H = Hypoglossal


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Re: Medical Board Vignettes
« Reply #26 on: March 18, 2011, 03:27:28 PM »
buing... nice man ireview nga naay mkarelate gud... lahi sad ako remembering tool sa brachial plexus... Radial.n---wRist drop (R=R),  Ulnar n.--Claw hand (itakilid ang u= c) median n.---ape hand or waiters tip (balihon ang M=W)

hehehe. cute. salamat, Doctora. :)

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Re: Medical Board Vignettes
« Reply #27 on: March 18, 2011, 03:29:44 PM »
Warning: This is sexual, but highly useful and well remembered by many, many male medics. bwahahaha


THE 12 CRANIAL NERVES

the ever famous.


Mnemonic : Oh Oh Oh To Touch And Feel Virgin Girl's Vagina Ah Heaven!



O = Ocular
O = Optic
O = Oculomotor
T = Trochlear
T = Trigeminal
A = Abducens
F = Facial
V = Vestibulococchlear
G = Glossopharyngeal
A = Accessory
H = Hypoglossal


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Lorenzo

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Re: Medical Board Vignettes
« Reply #28 on: March 18, 2011, 03:29:49 PM »
buing... nice man ireview nga naay mkarelate gud... lahi sad ako remembering tool sa brachial plexus... Radial.n---wRist drop (R=R),  Ulnar n.--Claw hand (itakilid ang u= c) median n.---ape hand or waiters tip (balihon ang M=W)

dra, what do we call waiter's tip ?

;)

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Re: Medical Board Vignettes
« Reply #29 on: March 18, 2011, 03:31:21 PM »
hahaha @ 'the ever famous'.

i remember during my 1st Medical Anatomy Exam.

We had to locate all the 12 nerves and then name them.

I started to name the nerves (but i said the mnemonic first!). My proctor's eyes got wide after hearing me. Bwahahahaha!

good times. good times.

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Re: Medical Board Vignettes
« Reply #30 on: March 18, 2011, 03:43:28 PM »
dra, what do we call waiter's tip ?

;)

they have the same nerve involvement sa ape hand. so as with claw hand, also known as pope hand

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Re: Medical Board Vignettes
« Reply #31 on: March 18, 2011, 03:45:51 PM »
I'd like to add something that i saw today (and was saddened by):


21 year old african american female comes in to the ER after failing to meet her dialysis appointment. Patient's history indicates that she has CHF (chronic heart failure), CRF (chronic renal failure) , both of which are secondary to her untreated hypertension. The patient came in because she was suffering from asthma. What drug would she be given if she suffered an acute asthma attack?


A: Albuterol



OT: I was really saddened today to see such a young person who has yet to live life already dying. Only 21 years old and already CHF and CRF.   :-\

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Re: Medical Board Vignettes
« Reply #32 on: March 18, 2011, 03:46:38 PM »
they have the same nerve involvement sa ape hand. so as with claw hand, also known as pope hand

very good! high yield ra ba ni sa USMLE. very high yield.

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Re: Medical Board Vignettes
« Reply #33 on: March 18, 2011, 03:51:01 PM »
I'd like to add something that i saw today (and was saddened by):


21 year old african american female comes in to the ER after failing to meet her dialysis appointment. Patient's history indicates that she has CHF (chronic heart failure), CRF (chronic renal failure) , both of which are secondary to her untreated hypertension. The patient came in because she was suffering from asthma. What drug would she be given if she suffered an acute asthma attack?


A: Albuterol



OT: I was really saddened today to see such a young person who has yet to live life already dying. Only 21 years old and already CHF and CRF.   :-\


for the first 5 minutes, this patient did not talk to me. i came to her bed to take her H&P pero she would not talk. luoy kaayo. i told her that her failure to take her anti-hypertension pills and chf pills are hurting her. she is so young. she looked at me today after i said to her, "you are still very young, so very young.  you can still enjoy your life , but you have to protect your life..."

ingon sija nako, "i dont want to die...i just dont want to die.."

luoy kaayo. its kind of hard sometimes when dealing with cases like this. after finishing her history, i let the nurse continue the dialysis.

 luoy kaayo.    :-\

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Re: Medical Board Vignettes
« Reply #34 on: March 18, 2011, 03:53:59 PM »
I'd like to add something that i saw today (and was saddened by):


21 year old african american female comes in to the ER after failing to meet her dialysis appointment. Patient's history indicates that she has CHF (chronic heart failure), CRF (chronic renal failure) , both of which are secondary to her untreated hypertension. The patient came in because she was suffering from asthma. What drug would she be given if she suffered an acute asthma attack?


A: Albuterol



OT: I was really saddened today to see such a young person who has yet to live life already dying. Only 21 years old and already CHF and CRF.   :-\

this is really unfortunate. how did she get CHF? tambok ni sya? african americans have the highest risk of cardiovascular problem and hardest to treat depending on their inherited genes. ambot lng sad pero so far mao ako nabantayan. have to update myself more with US statistics.

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Re: Medical Board Vignettes
« Reply #35 on: March 18, 2011, 03:56:49 PM »
sure mo asthma to basin nagcongestive heart failure sya. wla pajud dialysis, basin ni.inom daghan fluids mao na nagdyspnea. mao pud na ka-paet kay non-compliant mga patients also because mahal sad tambal.

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Re: Medical Board Vignettes
« Reply #36 on: March 18, 2011, 03:59:30 PM »
this is really unfortunate. how did she get CHF? tambok ni sya? african americans have the highest risk of cardiovascular problem and hardest to treat depending on their inherited genes. ambot lng sad pero so far mao ako nabantayan. have to update myself more with US statistics.

not morbidly obese, her weight was normal for her age and height. long term untreated hypertension. non-compliant history of not taking her medication led to chf, with chf, ning manifest ijang CRF.

Edematous kaajo.

~~~

Very sensitive kaayo ning african american population, because they react differently to chf / hypertension medication.

normally i would prescribe my patients (hypertensive patients) : Ace inhibs (Lisinipril, Captopril), ARBS (losartan).

however, for African americans, they do not do well with Aceinhibs. They do really well with : CCBs, and Diuretics (Hydrocholorthiazide).

Note: importante jud i monitor ilang uric acid levels when they're on HCT; kai mag hyperuricemic cases; gouty attack.




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Re: Medical Board Vignettes
« Reply #37 on: March 18, 2011, 04:00:32 PM »
lisod kaayo asthmatic pajud. ang pagkahypertensive ani cguro wlay check-up check-up. taas cguro cholesterol sad ani bataa.

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Re: Medical Board Vignettes
« Reply #38 on: March 18, 2011, 04:01:20 PM »
sure mo asthma to basin nagcongestive heart failure sya. wla pajud dialysis, basin ni.inom daghan fluids mao na nagdyspnea. mao pud na ka-paet kay non-compliant mga patients also because mahal sad tambal.

oo asthma kai gi tagaan ug albut, na wa ijang symptom. asthmatic man pood to sija sa ijang history.

pero yes, you are right, dra, one has to be cautious in seeing all possibilities. thanks.

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Lorenzo

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Re: Medical Board Vignettes
« Reply #39 on: March 18, 2011, 04:03:23 PM »
lisod kaayo asthmatic pajud. ang pagkahypertensive ani cguro wlay check-up check-up. taas cguro cholesterol sad ani bataa.

oo. ang problema kai non-compliant kaajo. preventable man jud ni ijang crf . unta ning take to sija sa ijang CHF medication sa una. sus ijang lab values...hyperprotenemia ...beyond high levels.

gi admit nako, gi order jud nako ang dialysis kai she missed her dialysis kono 2 days ago.



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