,QUESTION 1
Martin, age 13, just started taking amoxicillin for otitis media. His mother reports he woke up this
morning with a non-pruritic rash on his trunk. What is your first action?
Answer: Stop the amoxicillin.
Rationale: A rash following the administration of amoxicillin in a pediatric patient may indicate a drug
allergy or a reaction associated with viral infections (like Mononucleosis). The immediate priority is to
cease the potential allergen.
QUESTION 2
A 10-year-old male presents with itchy, red eyes for 1 day and watery drainage. He has no fever. On
exam, he has bilateral inflamed preauricular lymph nodes. His sibling recently started daycare. What is
the most likely diagnosis?
Answer: Viral conjunctivitis.
Rationale: The presence of watery (serous) drainage and preauricular lymphadenopathy is classic for
viral etiology, often highly contagious in daycare/school settings.
QUESTION 3 A patient presents with a white, depigmented patch of skin that is not pruritic and shows
no signs of erythema or infection. What is the most likely diagnosis?
Answer: Vitiligo.
Rationale: Vitiligo is characterized by the autoimmune destruction of melanocytes, resulting in smooth,
non-inflammatory, depigmented macules or patches.
QUESTION 4
A 22-year-old college student presents with multiple 1- to 2-mm erythematous pustules on her buttocks
after a spring break trip involving daily hot tub use. What is the most likely pathogen?
Answer: Pseudomonas aeruginosa.
Rationale: This is the classic presentation of "Hot Tub Folliculitis," caused by Pseudomonas thriving in
contaminated, poorly chlorinated wooden hot tubs.
QUESTION 5
A 25-year-old musician finds it difficult to understand fellow band members in a noisy club environment
at the end of a night of performing. These symptoms are most characteristic of:
Answer: Sensorineural loss.
Rationale: Difficulty understanding speech in the presence of background noise (the "cocktail party
effect") is a hallmark of sensorineural hearing loss, often exacerbated by chronic noise exposure.
QUESTION 6
, A 25-year-old male presents with "bleeding in my eye" for 1 day. He denies pain, visual changes, or
trauma but mentions drinking alcohol and vomiting the night before. Exam shows a dark red area in the
sclera taking up less than 50% of the eye. What is the best treatment?
Answer: Reassurance that the lesion will resolve without treatment in 2 to 4 weeks.
Rationale: This is a subconjunctival hemorrhage, likely caused by increased intrathoracic pressure during
vomiting (Valsalva). It is benign and self-limiting.
QUESTION 7
A 27-year-old female presents with a perioral rash. She previously noticed burning around her lips that
went away, followed by a group of vesicles on erythematous bases. She is afebrile. What test would
confirm the diagnosis?
Answer: Tzanck smear.
Rationale: A Tzanck smear is used to identify multinucleated giant cells characteristic of Herpes Simplex
Virus (HSV).
QUESTION 8
A 3-year-old patient in daycare presents with 3 small, superficial, honey-colored vesicles on the right
side of the mouth. The child is afebrile and energetic. What is the appropriate treatment? Answer:
Topical mupirocin (Bactroban).
Rationale: Honey-colored crusts are pathognomonic for non-bullous impetigo, typically treated with
topical antibiotics if the area is localized.
QUESTION 9
A patient presents with a "stuck-on," waxy, pigmented lesion on their back. It appears well-
circumscribed and "greasy." What is the most likely diagnosis?
Answer: Seborrheic keratosis.
QUESTION 10
A 65-year-old patient complains of a sudden onset of "flashing lights" and "floaters" in their vision,
followed by a sensation of a "curtain" being pulled over their eye. What is the most likely diagnosis?
Answer: Retinal detachment.
QUESTION 11
On physical exam of an infant, you notice a white reflex (leukocoria) instead of the normal red reflex in
the left eye. What is the most urgent differential diagnosis?
Answer: Retinoblastoma.
QUESTION 12
A patient presents with a painful, red, swollen lump on the eyelid margin. It is tender to the touch. What
is the likely diagnosis?
Martin, age 13, just started taking amoxicillin for otitis media. His mother reports he woke up this
morning with a non-pruritic rash on his trunk. What is your first action?
Answer: Stop the amoxicillin.
Rationale: A rash following the administration of amoxicillin in a pediatric patient may indicate a drug
allergy or a reaction associated with viral infections (like Mononucleosis). The immediate priority is to
cease the potential allergen.
QUESTION 2
A 10-year-old male presents with itchy, red eyes for 1 day and watery drainage. He has no fever. On
exam, he has bilateral inflamed preauricular lymph nodes. His sibling recently started daycare. What is
the most likely diagnosis?
Answer: Viral conjunctivitis.
Rationale: The presence of watery (serous) drainage and preauricular lymphadenopathy is classic for
viral etiology, often highly contagious in daycare/school settings.
QUESTION 3 A patient presents with a white, depigmented patch of skin that is not pruritic and shows
no signs of erythema or infection. What is the most likely diagnosis?
Answer: Vitiligo.
Rationale: Vitiligo is characterized by the autoimmune destruction of melanocytes, resulting in smooth,
non-inflammatory, depigmented macules or patches.
QUESTION 4
A 22-year-old college student presents with multiple 1- to 2-mm erythematous pustules on her buttocks
after a spring break trip involving daily hot tub use. What is the most likely pathogen?
Answer: Pseudomonas aeruginosa.
Rationale: This is the classic presentation of "Hot Tub Folliculitis," caused by Pseudomonas thriving in
contaminated, poorly chlorinated wooden hot tubs.
QUESTION 5
A 25-year-old musician finds it difficult to understand fellow band members in a noisy club environment
at the end of a night of performing. These symptoms are most characteristic of:
Answer: Sensorineural loss.
Rationale: Difficulty understanding speech in the presence of background noise (the "cocktail party
effect") is a hallmark of sensorineural hearing loss, often exacerbated by chronic noise exposure.
QUESTION 6
, A 25-year-old male presents with "bleeding in my eye" for 1 day. He denies pain, visual changes, or
trauma but mentions drinking alcohol and vomiting the night before. Exam shows a dark red area in the
sclera taking up less than 50% of the eye. What is the best treatment?
Answer: Reassurance that the lesion will resolve without treatment in 2 to 4 weeks.
Rationale: This is a subconjunctival hemorrhage, likely caused by increased intrathoracic pressure during
vomiting (Valsalva). It is benign and self-limiting.
QUESTION 7
A 27-year-old female presents with a perioral rash. She previously noticed burning around her lips that
went away, followed by a group of vesicles on erythematous bases. She is afebrile. What test would
confirm the diagnosis?
Answer: Tzanck smear.
Rationale: A Tzanck smear is used to identify multinucleated giant cells characteristic of Herpes Simplex
Virus (HSV).
QUESTION 8
A 3-year-old patient in daycare presents with 3 small, superficial, honey-colored vesicles on the right
side of the mouth. The child is afebrile and energetic. What is the appropriate treatment? Answer:
Topical mupirocin (Bactroban).
Rationale: Honey-colored crusts are pathognomonic for non-bullous impetigo, typically treated with
topical antibiotics if the area is localized.
QUESTION 9
A patient presents with a "stuck-on," waxy, pigmented lesion on their back. It appears well-
circumscribed and "greasy." What is the most likely diagnosis?
Answer: Seborrheic keratosis.
QUESTION 10
A 65-year-old patient complains of a sudden onset of "flashing lights" and "floaters" in their vision,
followed by a sensation of a "curtain" being pulled over their eye. What is the most likely diagnosis?
Answer: Retinal detachment.
QUESTION 11
On physical exam of an infant, you notice a white reflex (leukocoria) instead of the normal red reflex in
the left eye. What is the most urgent differential diagnosis?
Answer: Retinoblastoma.
QUESTION 12
A patient presents with a painful, red, swollen lump on the eyelid margin. It is tender to the touch. What
is the likely diagnosis?
