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, An 18-year-old patient comes to the office for evaluation of a rash. At first there was
only one large patch, but then more lesions erupted suddenly on the back and torso; the
lesions itch. On physical examination, you note that the pattern of eruption is like a
Christmas tree and that there are a variety of erythematous papules and macules on the
cleavage lines of the back. Based on this description, what is the most likely diagnosis?
- ANSWER Pityriasis rosea
A 19-year-old construction worker presents for evaluation of a rash. He notes that it
started on his back with a multitude of spots and is also on his arms, chest, and neck. It
itches a lot. He does sweat more than before because being outdoors is part of his job.
On physical examination, you note dark tan patches with a reddish cast that has sharp
borders and fine scales, scattered more prominently around the upper back, chest,
neck, and upper arms as well as under the arms. Based on this description, what is your
most likely diagnosis? - ANSWER Tinea versicolor
You are examining a child with severe cerebral palsy. When you suddenly move his foot
dorsally, a sustained "beating" of the foot against your hand ensues. What does this
represent? - ANSWER Clonus
A patient presents with a daily headache which has worsened over the past several
months. On funduscopic examination, you notice that the disk edge is indistinct and the
veins do not pulsate. Which is most likely? - ANSWER Increased intracranial pressure
A patient complains of epistaxis. Which other cause should be considered? - ANSWER
Hematemesis
A patient complains of shortness of breath for the past few days. On examination, you
note late inspiratory crackles in the lower third of the chest that were not present a week
ago. What is the most likely explanation for these? - ANSWER Heart failure
You are excited about a positive test finding you have just noticed on physical
examination of your patient. You go on to do more examination, laboratory work, and
diagnostic tests, only to find that there is no sign of the disease you thought would
correlate with the finding. This same experience happens several times. What should
you conclude? - ANSWER Continue using the test, perhaps doing less laboratory work
and diagnostics.
A 50-year-old woman presents with a new complaint of headache. The patient states,
"this is worst headache of my life". Her concurrent conditions includes hypertension. Her
history includes habitual ER visits for various complaints and panic attacks. Her most