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A 7-year-old boy is brought to you by his parents with a complaint of ear pain that is worse when pressed on. He has no fever, voming, diarrhea or any other symptoms. He just arrived from summer camp where he did a lot of swimming and water skiing. His tympanic membrane appears normal, and otoscopy is shown as below:
What would be the best therapy for this child?
A 7-year old boy is brought to you by his parents with a complaint of ear pain. He has no fever, voming, diarrhea or any other symptoms. He just arrived from summer camp where he did a lot of swimming and horseback riding. Physical examination is significant for tender pinna with movement, swollen and red external ear canal.
What is the most likely diagnosis?
A 4-year-old child is rushed to the emergency department from the nearby rural area. The child was playing in the farm when they were spraying for insects.She started drooling in the waiting room and her examination is only significant for tachycardia.
What is the next step in the care of this patient?
A 4-year-old child is rushed to the emergency department from the nearby rural area. The child was playing in the farm when they were spraying for insects. She suddenly developed abdominal cramps, coughing and drooling. She also soiled and wet herself on the way to the hospital.
How is the diagnosis confirmed?
A 4-year-old child is rushed to the emergency department from the nearby rural area. The child was playing in the farm when they were spraying for insects. She then suddenly developed abdominal cramps, coughing and drooling. She also soiled and wet herself on the way to the hospital.
What is the most likely diagnosis?
A 5-year-old child with a history of acute lymphoblastic leukemia currently in remission and completed his chemotherapy three months ago, is brought to the clinic for a well-child visit. Which catch-up or routine immunizations are contraindicated for this child?
An 11-year-old girl with a history of repeated sinopulmonary infection tests for total serum classic hemolytic complement test which indicates the presence of complement deficiency.
Which of the following vaccinations are contraindicated in this patient?
An 8-month-old boy with a history of recurrent severe infections with multiple hospitalizations is found to have severe T-cell disorder.
Which of the following vaccinations are contraindicated?
A 6-month-old girl, a product of normal pregnancy and delivery, is brought to the physician for routine immunization. She is being exclusively breastfed with no issues. The mother reports that she has had a loose stool since yesterday, but has no vomiting or fever. Physical examination is within normal limits.
Which of the following are contraindications of rota vaccine?
A 6-month-old girl, a product of normal pregnancy and delivery, is brought to the physician for routine immunization.. She is being exclusively breastfed with no issues. The mother reports that she has had loose stools since yesterday, but has no vomiting or fever. Physical examination is within normal limits.
Which of the following statements is true?
A 3-year-old boy, a product of a normal pregnancy and delivery, is brought to the emergency department after having a seizure attack. His mother reports that they had moved to Canada from an old refugee camp three months ago. He has become irritable and restless and has abdominal pain, intermittent vomiting and constipation. Lab work is
What is the most likely diagnosis?
A 15-year-old adolescent is brought to a clinic with swelling around an insect bite after returning from a visit in brazil. He also has swelling around his eyes associated with fever, anorexia, headache, and muscle pain. Physical examination showed mild hepatosplenomegaly.
What would be the most appropriate treatment?
A 50-year-old woman born and raised in brazil, presents with dyspnea on minimal exertion for months with recent worsening associated with orthopnea and paroxysmal nocturnal dyspnea. In the recent past she underwent barium study which showed megaesophagus after having been assessed for dysphagia. Serology testing for T. cruzi comes back positive.
Which of the following statements is false about infection with T. cruzi?
A 48-year-old man who recently immigrated from latin America, presents with dyspnea following minimal activity for 2 months with recent worsening associated with orthopnea and paroxysmal nocturnal dyspnea.. Physical examination shows irregular heartbeat, jugular venous distension, displaced apical impulse and hepatomegaly. In the recent past he underwent barium study which showed megaesophagus after presenting with dysphagia.
Which of the following laboratory testing is warranted in this patient?
A 48-year-old man who recently immigrated from latin America, presents with dyspnea following minimal activity for 2 months with recent worsening associated with orthopnea and paroxysmal nocturnal dyspnea.. Physical examination shows irregular heartbeat, jugular venous distension, displaced apical impulse and hepatomegaly. In the recent past he underwent barium study which showed megaesophagus after presenting with dysphagia.
What is the most likely diagnosis?
A 40-year-old man with alcohol dependence is brought to the emergency department from a nearby shelter with a history of confusion and ataxia. He is noted to be disoriented and have horizontal nystagmus in the triage.
Which of the following statements is true of thiamine deficiency?
A 40-year-old man with alcohol dependence comes to a walk-in clinic from a nearby shelter with a complaint of shortness of breath. He also has orthopnea and paroxysmal nocturnal dyspnea. Physical examination reveals tachycardia, wide pulse pressure and pedal edema.
Which vitamin deficiency could explain his symptoms?
A 4-day-old newborn, a product of an uncomplicated homebirth with the help of a midwife, is brought with nasal bleeding and ecchymosis. He has been exclusively breastfed since birth, and has not received any medications .
Which of the following statements is true about possible test results?
A 4-day-old newborn, a product of an uncomplicated labour and homebirth with a midwife, is brought to the emergency department with rectal bleeding. He has been exclusively breastfeeding, and has not received any medications.
What is the most likely cause of this infant’s symptoms?
A-7-year old girl who is a recent refugee is brought to a clinic with a history of bone and muscle pain. She also has a history of easy bruising of her legs. Physical examination shows swollen, friable gingivitis and scattered petechiae. T
he radiograph of her lower extremities is as shown below:
Which of the following statements is true?
A-7-year old girl who is a recent refugee is brought to an ambulatory care center with a history of vague myalgias. She also has a history of easy bruising and poor wound healing. Physical examination shows swollen, friable gingivitis and scattered petechiae.
What is the most likely diagnosis?
A 4-year old boy is brought to the clinic by his father who moved to Canada from a refugee camp. Review of systems is significant for decreased vision in the dark.His past history is remarkable for recurrent diarrheal disease. On physical examination you find a bitot spot on the left eye, and generalized dry skin.
What is the most likely diagnosis?
A 3-year-old boy is brought to the clinic by her mother, who recently immigrated from Ecuador, with a complaint of bowing of legs. His immunization is uptodate. Physical examination shows protruding forehead, scattered furrows and loss of papillae on her tongue, and enlarged medial malleolus.
Which of the following is true about this patient?
A 70-year-old man with hypertension brought to his primary care provider by his son with a complaint of disorganized thinking and forgetfulness of 2 weeks duration. He has been inattentive when he is being spoken to and appears apathetic. He recently lost his wife of 40 years to breast cancer. His blood work and imaging studies were all normal.
What is the diagnosis?
A 65-year-old woman with hypertension and diabetes presents with dizziness which occurs when she gets up from bed. She denies falls, or loss of consciousness.
Which of the following is the most appropriate next step in the care of this patient?
A 30-year-old homeless woman living in a shelter presents to a walk-in clinic with a history of chronic cough, fever, and night sweats. She reports that a woman she shares a room with has similar symptoms.Her mantoux test is noted to have >10mm of induration.
Which of the following statements is true?
A 65-year-old man presents to the clinic with his daughter who reported that he has become forgetful. He also lost his way back home twice in the past month. He was noticed to have trouble remembering the names of familiar objects. What is the most likely diagnosis?
A 30-year-old homeless woman living in a shelter presents to a walk-in clinic with a history of chronic cough, fever, and night sweats. She reports that a woman she shares a room with has similar symptoms. She denies smoking cigarettes, and admitted to drinking alcohol on a daily basis.
Which of the following statements is true?
A 40-year-old homeless man presents to the emergency department with a complaint of fever and persistent productive cough of 4 weeks duration. He also says that he is really bothered by the drenching night sweats these past 2 weeks.He states that he doesn’t smoke, but uses marijauna a few times per week. His chart indicates that he was treated for pneumonia 3 weeks ago.His physical examination is unremarkable other than a T° of 37.9? and rales on auscultation of the right lower lung field.
What is the most likely diagnosis?
A 55-year-old woman with hypertension, CKD and anemia of chronic disease presents with knee pain.
Which of the following statements is true about medications for pain control in this patient?
A 4-year-old girl is brought to the clinic with a sore throat following a runny nose, cough and sneezing the past few days. She has had trouble swallowing and vomited once earlier in the day. Physical examination is only significant for erythematous pharynx.
What is the next step in the care of this child?
A 2-year girl is brought to the clinic with a history of ear pain of 2 days duration. She has no fever or discharge from ears. Other than a little fussiness her review of systems is unremarkable. Physical examination shows a temperature reading of 37.7℃ and erythematous left tympanic membrane. His past history is unremarkable with uptodate immunization.
What is the most appropriate treatment for this child?
A 7-year-old girl is brought by her mother to the emergency department with a history of “repeated seizures”. Her past medical history is significant for admissions to ED every 2 months for the past 6 months with similar complaints with no documentation of witnessed seizure in the hospital. Physical examination and exhaustive laboratory workup as well as EEG and imaging studies are within normal limits.
Which of the following statements is true about this condition?
A 69-year-old woman presents to her primary care provider with a history of constipation and painful defecation. She denies rectal bleeding, abdominal pain or distension and any recent weight changes. Her colorectal screening is uptodate along with her other periodic preventive care.
Which of the following is NOT the best long term treatment for this patient?
A 68-year-old man with benign prostatic hyperplasia and seasonal allergy presents with nasal congestion and sneezing for 3 days.
Which of the following therapy is most appropriate for this patient?
A 70-year-old man with atrial fibrillation on warfarin and metoprolol is recently diagnosed with osteoarthritis of the left knee.
Which of the following is appropriate therapy for this patient?
A 68-year-old woman with no underlying condition is diagnosed with iron deficiency anemia with her Hgn level at 90. Which of the following would be appropriate treatment for this patient?
A 67-year-old man with COPD and type 2 diabetes mellitus comes to the clinic for a routine check-up. Which of the following medications he is currently on should be re-evaluated?
A 70-year woman with congestive heart failure, atrial fibrillation hypertension, and insomnia presents for a followup visit. She is currently taking metoprolol, Furosemide, lasix, spironolactone, enalapril,warfarin and amitriptyline.
Which of these medications require review and adjustment?
A 40-year-old first nation man presents to the clinic for an annual examination. Which of the following is Not true about health issues in the indigious communities?
A 10-year-old child is brought by his parents for a health check after the family recently immigrated from Asia. What mandatory medical examinations had he received on entry to Canada?
A 25-year-old woman presents with bruises on her face, back and thighs. She states that she fell off the stairs the day before and wants to check if she has broken any bones. On further questioning, she becomes tearful and admits that her husband hit her, and that this is not the first time.
What would I like to do?
A 25-year-old primigravida presents with bruises on her face, back and thighs. She states that she fell off the stairs the day before and wants to check if the baby is ok. On further questioning, she tearfully admits that her husband hit her.
Which of the following statements are true about intimate partner violence?
A 44-year-old man with a history of substance use disorder presents with sweats, diarrhea, abdominal and leg cramps. A physical examination shows mydriasis, lacrimation, rhinorrhea, and a temperature of 37.7°C. His mental status reveals an irritable man with dysphoric mood.
What is the most likely diagnosis?
A 40-year-old man with a history of substance use disorder is brought to the emergency department from a nearby shelter with nausea, and vomiting. His Vitals indicate that he is tachycardic with high blood pressure.On mental status examination, he is agitated. His thought content is paranoid; he states that “feels fantastic” and has a euphoric effect.
What is the most likely diagnosis?
A 19-year-old man is brought to the emergency department by her friends from a party. She becomes belligerent towards the nurses in the room. Her friends report that she might have ingested “angel dust” at the party about 30 minutes ago.
What are ways of treating this patient?
A 19-year-old woman is brought to the emergency department by her friends from a party. She is
unable to verbalize any history but displays aggressive behavior in triage. Her friends report that she might have snorted “angel dust” at the party.
Which of the following are possible findings in this patient?
A 19-year-old man is brought to the emergency department after becoming aggressive toward his friends at a party. He is agitated and hostile toward the team in the triage area. His friends claim that he has no medical condition prior to this event. Physical examination could not be completed due to his lack of cooperation, but he is noted to have slurred speech, and vertical nystagmus.
What is the most likely diagnosis?
A 12-year-old boy is brought to the emergency department by his mother with multiple bruises over his thighs and torso. Skeletal surveys reveal fractures of a rib and left femur. Upon further questioning, a history of child abuse is ilicited.
Which of the following statements is true?
A 68-year-old woman is brought in by her daughter for her diabetes follow-up. You notice that the daughter constantly interrupts the patient and dismisses her concerns. When you ask her to step out of the room so you can examine her, she says that her mother is “losing it” and that she needs to be in the room to speak for her.
Which of the following statements is true?
A 37-year-old factory worker presents with a history of low back pain and weakness of his legs bilaterally. He says that his symptoms followed lifting boxes at his workplace and requests a sick note explaining how he won’t be able to work for a while due to his condition. Physical examination shows significant lumbar pain with no muscle spasm. Power could not be assessed due to lack of effort.Straight leg raise test is negative, and all reflexes are normal.
What is the most likely diagnosis?
A 25-year old woman presents to the clinic 6 months after she was sexually assaulted. She feels depressed, irritable, anxious and she has been having nightmares and flashbacks of the event. She avoids places and activities that remind her of what happened, and reports that her work performance has declined as a result.
What is the most likely diagnosis?
A 30-year-old woman with no underlying medical condition presents to the emergency department with diaphoresis, palpitation and dizziness. Spot blood glucose shows serum glucose level of 2 mmol/L. Her past medical history shows a similar event 3 months ago. She takes care of her widowed father with diabetes who now lives with her.
A 42-year-old woman has a decade-long history of numerous physical symptoms such as dysuria, headaches, chest pain, joint pain nausea, and double vision. .She has undergone multiple investigations and hospitalizations over the years with no specific diagnosis.She mentions that these have affected her personal and work life tremendously. During the examination, she is anxious. Complete physical exam is within normal limits.
What is the best way to treat this patient?
A 42-year-old woman has a decade-long history of numerous physical symptoms such as dysuria, headaches, chest pain, joint pain nausea, and double vision. She mentions that these have affected her personal and work life tremendously.She has undergone multiple investigations and hospitalizations over the years with no specific diagnosis. She is extremely anxious with normal physical findings on examination.
What is the most likely diagnosis?
A 45-year-old woman presents with sudden-onset left hemiparesis and left hemisensory loss following a collapse with a reported loss of consciousness for 30 minutes. Physical examination shows left hemiparesis and loss of left fine touch sense, intact temperature sensation and reflexes. CT of the brain comes back normal.
Which of the following is true about the treatment for this patient?
A 26-year-old woman is brought by her sister who says that she has been having fits everyday for the past 3 weeks. Her sister describes the episodes as uncontrollable shaking of arms and legs which lasts about 15 minutes without loss of consciousness or loss of bowel or bladder function.The patient has never been injured from falling down during the episodes and has recollection of the events afterwards. Physical examination and neurologic workup is unremarkable.
Which of the following is the most likely diagnosis?
A 39-year-old man complains
Of abdominal pain and worries that he might have colon cancer. He has had numerous appointments with his doctor where repeated fecal immunochemical testing and colonoscopy indicated negative results. He has no family history of colon cancer or concerning social history other than being on probation for missing too many days at work due to doctor’s appointments. Physical examination is unremarkable.
What are the most effective ways to care for this patient?
A 52-year-old woman complains
of numerous vague symptoms and believes that she might have serious illness. She scheduled numerous appointments with the physician in the past year and had multiple tests run.She reports she was relieved after negative results then. She recently lost her job due to multiple absences for doctor’s appointments and tests. She doesn’t smoke or drink and denies using any form or recreational drugs.
What is the most likely diagnosis?