Question

• On physical exam of a pregnant patient, what is a normal finding with cardiac auscultation?

• A 58 yo female presents with a white spot on her tongue. She has a 42 pack year smoking history. On exam,, she has an 8 mm white, thickened, keratinized lesion on the ventral tongue. The lesion cannot be removed by rubbing the mucosal surface. What is the most likely diagnosis of the white lesion and what test would you perform to confirm the diagnosis?

• A 26 yo male presents with a 2 wk history of back pain after lifting a heavy object. The pain is in the low mid back and aggravated with movement. Radicular symptoms are noted in the left buttock down the left leg to the dorsal aspect of the foot.   On exam, inability to stand on his toes and positive straight leg raise test. What is the most likely diagnosis and what diagnostic test would be best to confirm your diagnosis?

• A 60 yo male nonsmoker with a history of CAD presents with worsening dyspnea on exertion for 3 weeks. He admits to orthopnea and lower extremity edema, but denies chest pain, palpitations, and syncope. His echocardiogram reveals an ejection fraction of 30%. What is your diagnosis and on cardiac auscultation what should be a common finding with this diagnosis?

• A 44 yo female hairdresser presents with a 2 month history of pain and numbness of her left hand that awakens her from sleep. On exam, you reveal electric tingling sensations with percussion over the volar surface of the wrist and paresthesias within 15 seconds of passively flexing the wrist. What is the most likely diagnosis and what is the initial noninvasive treatment of choice to maintain a neutral position of the wrist?

• A 34 yo male presents with fever of 102 F, chills, and perineal pain for the past 2 days. He has difficulty voiding, dysuria, urgency, and nocturia. What is your diagnosis and what physical findings would most likely accompany this diagnosis?

• A 48 yo G3P3003 African American female presents complaining of severe secondary dysmenorrhea and menorrhagia over the last 6 months. On exam, her uterus feels enlarged and irregular. What is the most likely diagnosis?

• A 60yo female with 30 pack year smoking history presents complaining of new onset of shortness of breath. On exam, dullness is noted on percussion with diminished breath sounds over the left base. Chest X-ray shows a new left pleural effusion. What would be the next step in the management of this patient – be specific in what diagnostic test(s) you would order?

Answer 1

1. On physical examination of pregnent women normal cardiac auscultation there is Expanded (increased) second heart sound split with inspiration is regular in pregnancy because of the expanded blood stream over the aortic and pulmonic valves.

2.diagnosis is leukoplakia

Leukoplakia is described as a white plaque that can't be evacuated by cleaning the mucosal surface. Tobacco use is unequivocally connected with an expanded occurrence of leukoplakia and oral malignancy. An incisional biopsy of the sore is required for histologic assessment of the tissue.

3.daignosis is circle herniation

MRI is the demonstrative (diagnostic) investigation of decision in a patient with suspected circle herniation

4.diagnosis is heart failure

an S3 on physical examination is consistent with heart failure . third heart sound will be heared on physical examination

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