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Medical Case Flashcards
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1
Question
What is the most appropriate next step in management for a suspicious pigmented lesion with recent growth?
Answer
Full-thickness biopsy to assess depth of melanoma.
2
Question
What causes severe chills, headache, and hypotension after penicillin in a patient with a suspected spirochetal infection?
Answer
Jarisch-Herxheimer reaction.
3
Question
What is the emergency management for postoperative hypocalcemia after thyroidectomy?
Answer
Intravenous calcium gluconate.
4
Question
What is the most likely cause of constipation in an older man taking verapamil with a recent history of bowel changes?
Answer
Verapamil-induced constipation.
5
Question
What is the next step to evaluate a woman with new-onset confusion, fever, and temporal lobe hyperattenuation on MRI?
Answer
Start acyclovir for herpes simplex encephalitis.
6
Question
What spirometry finding suggests chronic obstructive pulmonary disease in a smoker with chronic cough?
Answer
FEV1/FVC ratio less than 0.7.
7
Question
What is the most appropriate next step in a trauma patient with flank injury and no hematuria?
Answer
No further testing needed.
8
Question
What deficiency is most likely in a woman with microcytic anemia and blood smear showing hypochromia?
Answer
Iron deficiency.
9
Question
What vascular syndrome explains a patient's syncope, arm arm ischemia, and absent pulses due to subclavian artery stenosis?
Answer
Subclavian steal syndrome.
10
Question
What is the next step in management for a hypertensive woman with proteinuria and systolic ejection murmur?
Answer
Start lisinopril.
11
Question
What is the most likely cause of recurrent dysuria and tender prostate with negative urine culture?
Answer
Chlamydia trachomatis infection.
12
Question
What is the cause of left hand weakness with hypothenar atrophy and sensory loss over pinky in a diabetic patient?
Answer
Ulnar nerve compression.
13
Question
What abnormality explains a woman’s light-headedness when standing, with an irregular pulse and enlarged nodular thyroid?
Answer
Atrial fibrillation with possible sick sinus syndrome.
14
Question
What explains decreased urine output with rising serum creatinine and coarse granular casts after hypotension?
Answer
Acute tubular necrosis.
15
Question
What is the most likely cause of decreased urine output in a patient with hypotension and coarse granular casts?
Answer
Acute tubular necrosis (ATN)
16
Question
Which laboratory finding indicates the worst prognosis in a patient with acute pancreatitis according to Ranson's criteria?
Answer
Serum calcium concentration below 8 mg/dL (hypocalcemia)
17
Question
What condition explains a patient's recurrent asthma with positive Aspergillus fumigatus culture and fixed infiltrate?
Answer
Allergic bronchopulmonary aspergillosis (ABPA)
18
Question
What is the primary mechanism of lung injury in a young woman with progressive dyspnea, low FEV₁, and a family history of early emphysema?
Answer
Defective chloride secretion from respiratory epithelium (cystic fibrosis)
19
Question
In a patient with metastatic breast cancer and high serum calcium, what is the most likely cause of hypercalcemia?
Answer
Recurrence of breast cancer with bone metastases
20
Question
What is the most appropriate initial management step for a patient with hematemesis and signs of hypovolemic shock?
Answer
Intravenous administration of 0.9% saline (fluid resuscitation)
21
Question
Which laboratory finding in a dehydrated diabetic patient indicates prerenal azotemia?
Answer
Low urine sodium (e.g., 8 mEq/L) and elevated BUN and creatinine
22
Question
What is the most appropriate next step in evaluation for a woman with progressive back pain, anemia, elevated calcium, and lytic skull lesions?
Answer
Serum protein electrophoresis with immunofixation (to diagnose multiple myeloma)
23
Question
Which of the following best describes Ranson's criterion for predicting severe acute pancreatitis?
Answer
Presence of hypocalcemia (<8 mg/dL) at 48 hours as a predictor of mortality
24
Question
What is the most common cause of acute kidney injury in a hypotensive patient not responding to fluids?
Answer
Acute tubular necrosis
25
Question
What is the most appropriate next step to confirm diagnosis of multiple myeloma?
Answer
Serum and urine protein electrophoresis with immunofixation
26
Question
What does the patient's elevated calcium and lytic skull lesion suggest?
Answer
Multiple myeloma
27
Question
What laboratory findings support multiple myeloma in this patient?
Answer
Anemia, elevated serum calcium, renal failure
28
Question
What is the typical triad in multiple myeloma?
Answer
Bone pain, anemia, renal failure
29
Question
Why is bone scan less useful in suspected multiple myeloma?
Answer
Lytic lesions are better seen on skeletal survey or MRI
30
Question
Which component of the patient's presentation indicates renal failure?
Answer
Elevated serum creatinine and urea nitrogen